REGURGITATION AND FOOD ALLERGY IN INFANTS AND YOUNG CHILDREN.

}  Regurgitation is sudden, effortless expulsion through the mouth of a small quantity (5 to 10 ml) of gastric fluid mixed with food usually as a result of ineffectiveness of anti-reflux barrier.

}  Regurgitation could be simple regurgitation (most common) or pathological (Gastroesophageal reflux - GER) regurgitation.

                                                    

Simple Regurgitation

}  Simple regurgitation is different from GER because;

◦       A few ml in quantity is regurgitated

◦        Postprandial (after meals). It occurs usually after feeding or eating.

◦        Occurs during burping. May occur during laying the child on the shoulder

◦        Never occurs during sleep. Unlike pathologicl reggurgitation, simple regurgitation does not occur while the baby or child is asleep 

◦        Isolated, no concomitant symptoms.

◦        Transient.

}  Causes of Regurgitation

◦       Inappropriate relaxation of lower oesophageal sphincter: Usually feeding, when the child is not sitting properly after feeding or eating, regurgitation may occur, because the oesophageal sphincter (a door like structure that opens up for food to move down from osesophagus to the stomach, and prevents its return), its not fully matured (as a matter of fact, most of the organs of the baby is still developing at this stage). As a result, when a child lies down or tun head upside down immediately after feeding, this 'door like sturcture' may open into oaesophagus, leading to regurgitation. .

◦       Gastric emptying: The rate at which the food leaves the stomach is important. Usually food stays aboyut two hours in an average adult, this is shorter in children, for example gastric emptying time of milk is about 48 minutes. However, when fed on foods other than milk, and there is delay in the food transition from stomach to the next channels, regurgitation may occur.

}  Factors promoting Regurgitation

◦       Large meal: This may increase the gastrc emptying time, by slowing down the rate.

◦        Caloric (energy content) of the meal:  Too much calorie in a meal could also contribute to slowing down of the rate of emptying.

◦       Compression of abdomen by diaper:  Whenever this happens, the oesophageal sphincter may be pushed open and results into return of the food.

}  Management of Regurgitation.

◦       Reassure the parents: If its simple regurgitation, mothers should be assure of no complications, however when it is Pathological, health care professional should be contacted for appropriate solution.

◦       Minimize role of precipitating factors: Prevent compression of the abdomen by diaper or other things, and the baby /child lieing down immediately after feeding or eating.

◦       Dietary measures: Monitor the caloric intake of the food, and serve small meal at a time. Food quide pyramid as well as food composition table should be used as a guide.

Food Allergy

}  Food allergy corresponds to reproducible symptoms occurring after ingestion of a specific food and associated with an abnormal immunologic response (IgE or Non IgE dependent). In other words, certain reactions due to consumption or feeding foods containing allergens (substance that promote immune response), because they are foreign/alien to the body. Food allergy is very common in infant and young children.

◦       Food allergens include; Cow’s milk protein, Soy’s protein, Egg, Fish, Peanut, and Other foods (wheat, pepper, citrus, banana etc).

                                      

}  Food allergy is different from Food intolerance - a clinical gastro-intestinal reaction to certain food in which there is no immunologic mechanism. For example Lactose intolerance

}  Factors promoting allergy include;

◦       family history of allergy

◦       increased intestinal permeability

◦       immune system immaturity (IgA deficit )

◦       early exposure to allergens, early weaning

}  In Newborn, the chances of allergic risk is greatly influenced when;

◦       neither parent is allergic  8-15%

◦       one parent is allergic      20-40%

◦       a sibling is allergic             25-30%

◦       both parents are allergic 40-60%

◦       both parents are allergic 60-80% with the same symptoms

}  Generally, food allergy is characterized by;

◦       Cutaneous manifestation

◦       GIT symptoms

◦       Respiratory symptoms

◦       Anaphylatic shock

}  Management

◦       Breast milk

◦       Hypoallergenic formulas

 

 

                                        DIARRHEA

Diarrhea is the passage of watery stools, usually at least three times in a 24 hour period. It is still one of the most prevalent and important public health problems in the developing nations of the world. The incidence of diarrhea is common among infants and young children in these countries remaining the 2^nd largest killer disease in under-five children after neonatal causes. 

watery stool

When the diarrhea episode (the duration/period of passage of the watery stool) is < 14days it is called Acute diarrhea and when > 14 days it is Chronic diarrhea.

                Acute diarrhea means the symptoms associated with the diarrhea appear suddenly , worsen rapidly and disappear.
                Chronic diarrhea means the symptoms develop gradually, and worsens over an extended period of time.

Generally, diarrhea can be caused by different microorganisms. These organisms thrive in a poorly sanitize and unhygienic environment typical of developing countries. When these pathogenic organisms or their toxins are found in food, food borne diarrhea disease may occur.

In infant, one of the following among others may cause diarrhea. Detail explanation would be shared later.

·         Cow’s milk and Soy-protein

·         Inherited transport defect

·         Immune deficiency status

·         Mid-gut malrotation

·         Glucose-galactose malabsorption

Consequences of Diarrhea.

These include;

·         Loss of fluids

·         Loss of nutrients

·         Dehydration

·         Malabsorption

·         Malnutrition.

Basic Management of Diarrhea (extensive discussion subsequently)

Rehydration: Because water and electrolytes are lost in all types of diarrhea, replacement of these by rehydration is always the first priority treatment. This is possible using suitable available fluids (or ORS+Zinc) at home immediately once diarrhea starts

Refeeding: Starts an age –appropriate unrestricted diet as soon as dehydration is corrected. For some individuals (infants), a lactose free solution can be given for quick recovery from malnutrition and severe dehydration.

Note: anti diarrhea agents in children should not be encouraged.

Tips for home management

1.       Give extra fluid

2.       Continue feeding

3.       Give Zinc supplement for 10-14 days.

4.       Recognize the signs that suggest the child need medical help.

Reference

World Health Organization

Nestle Nutrition Institute Africa.

What we eat defines us. cont'd

 

Dietary diversification siply put is eating varieties of food groups/classes in a single diet or spread across meals for the day. This is because no single food roup provides all the nutrients required by man for optimal growth and development. Consumption of a monotonous diet (single food group) overtime may lead to nutritional deficiency condition(s). Such conditions include Kwashiorkor, Marasmus, Marasmic Kwashiorkor etc and these are common among children in developng countries especially suh-saharan Africa and India.

Note that the body cells (building blocks of all body components) require nutrients only for effective performance of their duties, however nutrients are provided majorly through dietary sources (food groups).

Although, food/dietary diversification plays an important role in achieving the nutrients' requirements of the body, there are recommended intakes of all food groups to prevent over consumption of some. This is because not all nutrients are required in the same volume/quantity, a reason why they are categorized (to be discussed in the next article). As a result of these, health/nutrition organizations published a universal acceptable recommended intake of the food groups.

An important guide to achieve dietary diversification is the Food Guide Pyramid- a pyramid shaped guide of healthy foods divided into sections to show the recommended intake for each food group.



Following this pattern above has proven  to be nutritionally healthy. Grains based foods are obviously required more than the other groups because of man's energy requirements, while fat and fat based products are to be consumed sparingly as indicated by the pointed end of the pyramid. In the developed countries the term serving sizes are used to measure the quantity of food eaten or to be eaten from these food groups, these help them in adhering to the recommended intake. On the otherhand, this has not yet been embraced in the developing countries like Nigeria, because culturally we don't measure what we eat.  As a result we under or over consume certain nutrients. Food guide pyramid is essential and a necessary tool towards maintaining consumption of healthy diets.

 

What we eat defines us

Food is essential primarily to man because it contains all the nutrients (important bits and micro bits that make up the body, bring about body growth, replace loss cells of the body and also rejuvenate the cells) that we need in order for us to function correctly. Also, it also important in fighting pathogens, microorganism causing diseases, in other words unwanted soldiers/intruders in the body. These facts clearly answer why, where and when we eat food.

Because there is clear distinction between man and other animals (mammals, reptiles, aquatic etc). Simply put, man eats while animals feed.  Man eats because he has the distinctive characteristic/ability and wisdom to choose what to eat among the unlimited varieties of foods and recipes available, and the preparation of different delicacies.

Animals on the other hand feed using their instinct, as a result feed on what is available. They lack varieties and only make do with what is available whether raw, dirty, sandy, sour or leftover etc.

 

Unfortunately the varieties (dietary diversity) of foods available to man, is rarely patronized. Recent surveys provide data of monotonous  nature of food consumed by man across the world. This forms the basis of geometric rise in the rate of nutrition related diseases.

to be continued...