Follow-up study of children with growth deficiency

Oral protein calorie supplementation for children with chronic disease

BACKGROUND

Poor growth and nutritional status are common in children with chronic diseases. Oral protein calorie supplements are used to improve nutritional status in these children. These expensive products may be associated with some adverse effects, e.g. the development of inappropriate eating behaviour patterns. This is a new update of a Cochrane review last updated in 2009.

OBJECTIVES

To examine evidence that in children with chronic disease, oral protein calorie supplements alter daily nutrient intake, nutritional indices, survival and quality of life and are associated with adverse effects, e.g. diarrhoea, vomiting, reduced appetite, glucose intolerance, bloating and eating behaviour problems.

SEARCH METHODS

Trials of oral protein calorie supplements in children with chronic diseases were identified through comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. Companies marketing these products were also contacted.Most recent search of the Group's Trials Register: 24 February 2015.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials comparing oral protein calorie supplements for at least one month to increase calorie intake with existing conventional therapy (including advice on improving nutritional intake from food or no specific intervention) in children with chronic disease.

DATA COLLECTION AND ANALYSIS

We independently assessed the outcomes: indices of nutrition and growth; anthropometric measures of body composition; calorie and nutrient intake (total from oral protein calorie supplements and food); eating behaviour; compliance; quality of life; specific adverse effects; disease severity scores; and mortality; we also assessed the risk of bias in the included trials.

MAIN RESULTS

Four studies (187 children) met the inclusion criteria. Three studies were carried out in children with cystic fibrosis and one study included children with paediatric malignant disease. Overall there was a low risk of bias for blinding and incomplete outcome data.Two studies had a high risk of bias for allocation concealment. Few statistical differences were found in the outcomes we assessed between treatment and control groups, except change in total energy intake at six and 12 months, mean difference 304.86 kcal per day (95% confidence interval 5.62 to 604.10) and mean difference 265.70 kcal per day (95% confidence interval 42.94 to 485.46), respectively. However, these were based on the analysis of just 58 children in only one study. Only two chronic diseases were included in these analyses, cystic fibrosis and paediatric malignant disease. No other studies were identified which assessed the effectiveness of oral protein calorie supplements in children with other chronic diseases.

AUTHORS' CONCLUSIONS

Oral protein calorie supplements are widely used to improve the nutritional status of children with a number of chronic diseases. We identified a small number of studies assessing these products in children with cystic fibrosis and paediatric malignant disease, but were unable to draw any conclusions based on the limited data extracted. We recommend a series of large, randomised controlled trials be undertaken investigating the use of these products in children with different chronic diseases. Until further data are available, we suggest these products are used with caution.

Low-income mothers' perceptions of health in their children with growth delay

ISSUES AND PURPOSE

Parental characteristics are the strongest predictor of poor health for children. This study examined how low-income mothers of children with growth delay define health for their children, and the behaviors they use to monitor their children's health.

DESIGN AND METHODS

Naturalistic design using Kleinman's Explanatory Model approach and interviews with 22 mothers.

RESULTS

Mothers consider nutritious food as a primary contributor to their children's health and consider healthy children to be chubby. Other indicators of health include children's energy levels, provision of nutritious food, and physical and mental activity balanced with rest.

PRACTICE IMPLICATIONS

A mother's explanatory model of health for her child can guide health promotion targeted to the mother's beliefs.

Oral protein calorie supplementation for children with chronic disease

BACKGROUND

Growth failure and poor nutritional status are common features in children with chronic diseases due to reduced appetite, malabsorption and increased nutritional requirements associated with some diseases. The provision of oral protein calorie supplements is one of a number of interventions used to improve nutritional status in these children. The use of these products, which are expensive, may be associated with a number of adverse effects, for example, they may effect development of normal eating behaviour patterns or lead to unpleasant symptoms such as vomiting and diarrhoea.

OBJECTIVES

To examine the evidence that in children with chronic disease, oral protein calorie supplements alter daily nutrient intake, nutritional indices, survival and quality of life and are associated with adverse effects, for example diarrhoea, vomiting, reduced appetite, glucose intolerance, bloating and eating behaviour problems.

SEARCH STRATEGY

All publications describing RCTs of the use of oral protein calorie supplements in children with chronic diseases were identified through comprehensive electronic database searches, handsearching relevant journals and handsearching abstract books of conference proceedings. The companies which market oral protein calorie supplements were also contacted.

SELECTION CRITERIA

All randomised or quasi-randomised controlled trials comparing use of oral protein calorie supplements for at least one month to increase calorie intake with existing conventional therapy, which may include nutritional advice on how to improve nutritional intake from food or no specific intervention, in children with chronic disease.

DATA COLLECTION AND ANALYSIS

The following outcomes were assessed: indices of nutrition and growth, anthropometric measures of body composition, calorie and nutrient intake (total, from oral protein calorie supplements and from food), eating behaviour, compliance, quality of life, specific adverse effects and disease severity scores, and mortality.

MAIN RESULTS

Three trials have been identified as being suitable for inclusion in the review and we are awaiting further data from one of these trials. All of these trials were carried out in children with cystic fibrosis. Few statistical differences could be found between the treatment and control groups apart from change in total fat intake at three months (weighted mean difference 69.20 [95% CI 11.05, 127.35]). However, this was based on the results of only one, small study. No trials have been identified which assess the effectiveness of oral protein calorie supplements in children with other chronic diseases.

REVIEWER'S CONCLUSIONS

Oral protein calorie supplements are widely used to improve the nutritional status of children with a number of chronic diseases. We have only been able to identify a small number of trials assessing these products in children with cystic fibrosis and have been unable to draw any conclusions based on the limited data extracted from these. We therefore recommend that a series of large, randomised controlled trials are undertaken investigating the use of these products in children with different chronic diseases. Until further data are available, we would suggest that these products are only used with caution.

Reversing growth deficiency in children: the effect of a community-based intervention

INTRODUCTION

The effect of a community health nursing intervention on children with growth deficiency (also called nonorganic failure to thrive or growth failure) was examined in a pretest and post-test experimental study. This study evaluated the impact of the intervention on growth quotients, children's diets, parent-child interaction, home environment, and mothers' perceived stress.

METHODS

The sample consisted of 39 children (ages 3 months to 3 years) with growth deficiency in weight or height for age, weight for height, or a decrease in growth across two percentiles. The children were enrolled in Special Supplemental Feeding Program for Women, Infants and Children (WIC) clinics in county health departments and were randomly assigned to experimental or control groups. After preliminary data were collected for the entire sample, a community-based intervention was administered to the experimental group during home visits. The intervention included education about nutrition and about parenting and community skills.

RESULTS

Data collected after the intervention by a research assistant blind to group assignment indicated positive changes (P < or = .05) in the experimental group's growth quotients, home environments, and their mothers' perceived stress.

DISCUSSION

This study supports the community health nursing practice of teaching nutrition and child care during home visits to families of children with growth deficiency.

New directions for the study of overweight

In this issue, three authors contribute to our knowledge of triggers or cues to weight-related behavior. Two of these authors focus on the effect of emotion on eating behavior. Popkess-Vawter, Wendel, Schmoll, and O'Connell (1998, in this issue) explicate reversal theory as a way to account for feelings and stress that trigger weight cyclers to overeat. Timmerman (1998, in this issue), in a study of nonpurge binge eaters, reports the relationship between caloric intake patterns and binge eating. Both researchers have added to our knowledge about triggers to eating behavior. Finally, Brink and Ferguson (1998), in their study of male and female successful dieters, add to the limited knowledge concerning triggers to weight loss. They describe reasons for deciding to lose weight among a population of successful underweight, normal weight, and obese dieters. Three authors contribute to the new weight research thrust of prevention. Two of the authors report the results of intervention studies. Reifsnider (1998, in this issue), in the only article on children, presents a follow-up study of a family-focused, community-based nursing intervention for growth-deficient, low-income Euro-American and Mexican American preschool children. Her work is an example of the context- and lifestyle-sensitive prevention-focused studies needed in weight research. Ciliska (1998, in this issue) reports findings from a randomized trial of a psycho-educational intervention with obese healthy women aimed at increasing self-esteem and decreasing restrained eating patterns. Her work follows some new thinking in the area of weight control that recognizes the dangers of chronic dieting and proposes a focus on self-acceptance, better nutrition, regular physical activity, and the prevention of further weight gain triggered by chronic dieting (Brownell & Cohen, 1995). Walker (1998, in this issue), the third author, in a multiethnic study of new mothers, explores the concept of weight-related distress and associations of anthropometric and psychosocial variables with feelings about weight. Her work adds to our understanding about critical periods and risks for weight gain. Allan (1998, in this issue), in a study of African American, Euro-American, and Mexican American women, reports women's explanatory models of overweight and the congruence of these models with professional models and recommendations for treatment for overweight. Her research contributes needed understandings of how high-risk populations view overweight, how participants' lifestyles and situations influence their ideas about weight, and how these perspectives influence efforts to control weight. Nursing needs to continue to refine and rethink what constitutes research on weight. This special issue offers some examples of scholars attempting to trailblaze new directions in nursing weight research. One thrust has been the significant attention on weight as a focus of investigation and not just as one of several health behaviors. A second and equally compelling area of inquiry has been the explicit attention directed to studying people of color, especially women, within the social context of their lives. Because ethnicity, social status, and gender are inextricably intertwined with health, one challenge is to try to understand weight issues through an ethnic, gender, and social status lens. Researchers who embrace this paradigm refuse to look at weight as a homogeneous condition but focus their attention instead on specific subgroups in the population without making middle-class Euro-Americans the norm. The number of researchers who are examining connections between ethnicity and social status and weight is growing. The complexity of weight-health promotion requires that we not only boldly examine weight in relationship to the individual in context but also explicate the macroenvironmental influences on weight. More needs to be done to translate findings from this body of research into better models