Early cow's milk introduction is associated with failed personal-social milestones after 1 year of age

Food consumption, nutritional intakes and the role of milk formulas in nutrient adequacy among young children from birth to 2 years living in urban Algeria

OBJECTIVE

Undernutrition, stunted growth and obesity remain a concern in Algeria. Currently, limited data are available on nutrient intakes among children. Our study aimed to describe food and nutrient intakes and the role of milk formulas among Algerian children.

DESIGN

Dietary intakes were collected using a 4-d interview-based survey for children aged 0-24 months, living in urban areas in Algeria in 2019.

SETTING

Food consumptions were described. For children aged 6-24 months, nutrient intakes and adequacy were estimated. Modelling was used to estimate the nutritional impact of substituting cow's milk for age-appropriate infant formulas (IF).

PARTICIPANTS

Totally, 446 children aged 0-24 months.

RESULTS

Before 6 months, 91·6 % of infants were breastfed. Breastmilk was also the main milk consumed between 6 and 12 months, whereas cow's milk predominated after 12 months. In children aged 6-24 months, nutrient adequacy prevalence was above 75 % for the majority of nutrients. However, less than 30 % of the children had adequate intakes for total fats, Fe and vitamin D. Simulated substitution of cow's milk for IF led to improved adequacy for proteins, Fe, and vitamins D and E.

CONCLUSIONS

Our study showed that breast-feeding rates were high until 6 months, then declined with age. Consumed foods allowed Algerian children aged 6-24 months to meet most of their nutritional needs, but inadequate intakes were reported for some key nutrients. Our modelling suggested that milk formulas may help to improve nutrient adequacy among non-breastfed infants. Other dietary changes could also be further investigated to enable children to meet all nutritional recommendations.

Pediatricians' responses to printed clinical reminders: does highlighting prompts improve responsiveness?

OBJECTIVE

Physicians typically respond to roughly half of the clinical decision support prompts they receive. This study was designed to test the hypothesis that selectively highlighting prompts in yellow would improve physicians' responsiveness.

METHODS

We conducted a randomized controlled trial using the Child Health Improvement Through Computer Automation clinical decision support system in 4 urban primary care pediatric clinics. Half of a set of electronic prompts of interest was highlighted in yellow when presented to physicians in 2 clinics. The other half of the prompts was highlighted when presented to physicians in the other 2 clinics. Analyses compared physician responsiveness to the 2 randomized sets of prompts: highlighted versus not highlighted. Additionally, several prompts deemed high priority were highlighted during the entire study period in all clinics. Physician response rates to the high-priority highlighted prompts were compared to response rates for those prompts from the year before the study period, when they were not highlighted.

RESULTS

Physicians did not respond to prompts that were highlighted at higher rates than prompts that were not highlighted (62% and 61%, respectively; odds ratio 1.056, P = .259, NS). Similarly, physicians were no more likely to respond to high-priority prompts that were highlighted compared to the year before, when the prompts were not highlighted (59% and 59%, respectively, χ(2) = 0.067, P = .796, NS).

CONCLUSIONS

Highlighting reminder prompts did not increase physicians' responsiveness. We provide possible explanations why highlighting did not improve responsiveness and offer alternative strategies to increasing physician responsiveness to prompts.