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Résumé: Les aliments industriels destinés aux nourrissons (4–12 mois) et enfants en bas âge (1–3ans) (en dehors des laits infantiles et des céréales), dénommés aussi aliments pour bébés, se distinguent des aliments industriels non spécifiques conçus pour les adultes et des aliments courants par des critères stricts de composition et de sécurité sanitaire définis par la réglementation française et européenne. Évaluée en France à 89 666 tonnes en 2011 l’offre commerciale pour ces denrées vise à répondre à tous les besoins alimentaires des jeunes enfants : produits laitiers, denrées salées et sucrées, adaptés à l’âge (composition, texture, portions). Les aliments pour bébés ne représentent qu’une part modérée des apports alimentaires des 4–36 mois. Exprimés en pourcentage de l’apport énergétique total, ils constituent en moyenne 7 % de la consommation à 4–5 mois, 28 % à 6–7 mois, 27 % à 8–11 mois, 17 % à 12–17 mois, 11 % à 18–24 mois. Vingt-quatre pour cent des parents n’en donnent jamais à leur enfant, 13 % 1 à 3j/semaine et 63 % 4 à 7j/semaine. Même chez les gros consommateurs, les aliments pour bébés ont peu d’effets sur la qualité nutritionnelle du régime. Cependant, leur emploi retarde et diminue l’utilisation des aliments industriels non spécifiques, ce qui peut contribuer à réduire les risques nutritionnels et toxicologiques liés à la consommation de ces denrées chez les jeunes enfants. Si ces produits sont bien adaptés aux nourrissons et enfants en bas âge, ils doivent rester des aliments de sevrage et de complément à l’alimentation familiale ű faite maison Ƈ. [ABSTRACT FROM AUTHOR]

Résumé La remédiation cognitive (RC) est une nouvelle approche thérapeutique dont le postulat repose sur l’hypothèse de la plasticité cérébrale permettant ainsi à des sujets présentant des défaillances cognitives spécifiques d’améliorer leurs fonctions exécutives ainsi que leur qualité de vie. Des programmes ont été appliqués et validés chez des adultes présentant un trouble schizophrénique et sont à l’origine du développement de programmes dédiés aux enfants présentant divers troubles psychiatriques pour lesquels des dysfonctionnements exécutifs ont été repérés. C’est le cas des enfants présentant un trouble du spectre autistique, un trouble déficit de l’attention/hyperactivité (TDA/H) ou encore une anorexie mentale. Le centre hospitalier Sainte-Anne qui a créé un centre de référence de remédiation et de réhabilitation psychosociale (C3RP) a développé, en parallèle de prises en charge destinées aux adultes, des programmes destinés aux enfants présentant des troubles du développement. Inspirés de programmes validés, français et anglo-saxons, la méthode associe des tâches papier-crayon et des jeux de société pour optimiser les fonctions d’attention, de mémorisation, de planification et de flexibilité mentale chez des enfants présentant un TDA/H ou des troubles des apprentissages. Ce programme, mené en parallèle de programmes classiques de prise en charge, témoigne dans une étude de faisabilité de sa bonne acceptation par l’enfant et sa famille ainsi que d’un impact positif sur les fonctions exécutives même si ce résultat demande à être répliqué. Summary The hypothesis of cerebral plasticity in psychiatric disorders has encouraged clinicians to develop cognitive remediation therapy (CRT), a new therapeutic approach based on attention, memory, planning, and mental flexibility tasks. The first cognitive remediation programs were developed and validated for adults with schizophrenia and were shown to have a positive impact on executive functions as well as on quality of life. In children and adolescents, researchers emphasized the existence of executive dysfunction in neurodevelopmental disorders such as autistic spectrum disorder, attention deficit disorder, and eating disorders. For these disorders, neuropsychological studies suggest that memory, planning, attention and mental flexibility are impaired. Despite the paucity of studies on cognitive remediation (CR) in children, preliminary results have suggested, as in adults with schizophrenia, good compliance and optimization of executive functioning. Consequently, programs dedicated to young subjects were developed in English-speaking countries, and the Department of Child and Adolescent Psychiatry of Sainte Anne Hospital (Paris) developed a new CR program for children with attention deficit disorder, academic problems, or eating disorders. These programs complete the field of CRT proposed by Sainte Anne Hospital's Remediation and Psychosocial Rehabilitation Reference Center, initially designed for adults with schizophrenia. Our team used and adapted validated tools such as Delahunty and Wykes's CRT program (translated and validated in French by Amado and Franck) and Lindvall and Lask's CRT Resource Pack. One program was developed for an adolescent with anorexia nervosa and applied to the subject and her family, but the purpose of this paper is to present a CR approach for children with attention deficit disorder or academic disorder, a 6-month program based on paper-pencil tasks and board and card games. The team was trained in different kinds of cognitive remediation, and the program was applied by a clinical nurse with the supervision of a child and adolescent psychiatrist and the department's neuropsychologists. Paper-pencil tasks were adapted from the CRT program for adults; the card and board games used were geometric figures, illusions, Rush Hour ® , Set ® , Jungle Speed ® , Color Addict ® , etc. These games are available in stores and the program can be applied at home, which helps families set aside their preoccupations with their child's academic performance. Diagnostic and neuropsychological evaluations were done before the beginning of the therapy and repeated at the end of the 6-month program. This program does not ignore the metapsychological impact of the therapy, and work on self-esteem is also done. The presence of the therapist is necessary, which seems better than a computer program, which cannot encourage the young subject in the same personalized and empathetic way. We therefore conducted the first clinical feasibility trial of cognitive remediation in young subjects and present a clinical case of a 6-year-old boy with attention deficit disorder and academic disorder. The results of neuropsychological evaluations before and after therapy suggest improvement in executive functions and better self-esteem. Satisfaction for the boy and his family was high. Even if these results need to be replicated, cognitive remediation appears to be a new therapeutic tool, complementary to classical approaches used in childhood psychiatric disorders. The Department of Child and Adolescent Psychiatry will submit this program to a research program conducted by the National Health Department to study the impact of this approach in a controlled study. [ABSTRACT FROM AUTHOR]

Résumé Chez l’enfant à risque de crises d’épilepsie prolongées, le traitement exige une administration rapide de benzodiazépines par un accompagnant ou un proche formé à l’administration du médicament. Chez les enfants considérés à risque de convulsions prolongées, la possibilité d’une évolution vers un état de mal augmente à partir de la 5 e minute. Le traitement de ces crises au moment où elles surviennent permet souvent d’éviter une telle évolution et peut contribuer à éviter des interventions d’ambulances et des hospitalisations inutiles, tout en facilitant l’intégration scolaire de l’enfant. L’étude PERFECT™ a été mise en place en 2011 afin d’établir un état des lieux des pratiques réelles d’administration des médicaments de secours en cas de crise d’épilepsie prolongée à travers l’Europe, en dehors du milieu hospitalier et plus particulièrement dans les écoles. Les conclusions initiales de cette étude en France sont qu’il existe un défaut de recommandations claires pour la prise en charge des enfants souffrant de crises prolongées d’épilepsie en dehors du milieu hospitalier. Les principaux obstacles à une prise en charge appropriée sont un manque d’informations et de connaissance, une formation inadéquate des accompagnants qui encadrent l’enfant, en particulier des enseignants, sur les crises prolongées et leur prise en charge et un manque de recommandations et de cadres juridiques clairs et cohérents pour orienter les pratiques. Pour qu’une prise en charge médicamenteuse des crises épileptiques prolongées soit systématique, une action concertée devra être mise en place entre les secteurs de la santé et de l’enseignement pour combler ces lacunes. Toutes les parties concernées devront également reconnaître qu’il s’agit là d’une étape cruciale pour favoriser l’intégration sociale de la catégorie vulnérable des enfants atteints d’épilepsie. Summary Context and objectives Guidelines recommend that any epileptic seizure that lasts more than 5 min (prolonged seizures) be treated immediately with benzodiazepines in order to prevent progression to status epilepticus. However, there is very little published information on how such seizures are managed outside of the hospital setting, for example in schools or at home. This paper presents the initial results, specific to France, of the Practices in Emergency and Rescue medication For Epilepsy managed with Community-administered Therapy (PERFECT™) Initiative, which was set up in 2011 to gain a better understanding of how prolonged convulsive seizures are managed and rescue medication is administered in out-of-hospital settings across Europe. Methods The PERFECT Initiative was conducted in six countries (France, Germany, Italy, Spain, Sweden, the United Kingdom) and consists of three phases. This paper reports on the first two phases of this study and focuses on findings for France. Phase I of the PERFECT initiative consisted of a review of existing clinical guidelines, guidance to schools, and relevant policy and legal frameworks in France, from both published and web-based sources. Phase II consisted in a telephone survey of 20 pediatricians, pediatric neurologists, and neurologists who treat children with prolonged convulsive seizures in France in order to obtain their views on how prolonged seizures are managed outside of hospitals. Phase III is ongoing and consists of a survey of children with prolonged seizures and their caregivers. Results Existing clinical guidelines pertain mainly to the hospital setting and contain very little informations on how prolonged seizures should be managed outside the hospital. Guidance to schools is unclear as to whether teachers are allowed to administer rescue medication to children and legal frameworks are full of contradictions. As a result, whether or not children who experience prolonged seizures receive their rescue medication during school hours depends mostly on the resources and training available in each school. Healthcare professionals stated that lack of information on prolonged seizures and their management, as well as a lack of up-to-date guidance specific to schools were considerable obstacles to a systematic approach to managing prolonged seizures outside of the hospital. Discussion In France and elsewhere, there has been growing recognition of substantial gaps in the provision of care to children with epilepsy in recent years. However, the issues that arise for children who require rescue medication for prolonged seizures outside of hospitals are conspicuously absent from policy documents or clinical guidelines. This lack of information, combined with insufficient training in schools on epilepsy, and inadequate guidelines create a situation in which schools are likely to call an ambulance every time a child has a prolonged seizure, therefore risking delays in treatment, and putting the child at risk of status epilepticus and clinical sequelae, not to mention stigmatization at school. Conclusion There is a need for more explicit guidance covering educational and healthcare settings, clearer information to parents and schools, and more systematic training to be made available to caregivers in order to ensure that all children at risk of prolonged seizures receive their prescribed rescue medication as quickly as possible, regardless of where their seizure occurs. [ABSTRACT FROM AUTHOR]

Problems in mathematics are a frequent major complaint in neuropediatric departments, for which there are two explanatory theoretical models: the hypothesis of a genetic and modular origin (with a number sense deficit) and a multidetermined origin. The purpose of this paper is to review the mathematical difficulties described in Turner syndrome and Fragile X syndrome, because a specific mathematical disorder is usually reported in these populations, supporting the existence of a number sense. Analysis of the literature reveals highly variable cognitive phenotypes in these populations, especially regarding mathematical abilities. Performance heterogeneity might be related to different factors such as the abilities needed to perform the task, the variability of definitions, the different tests used in the studies and the heterogeneity of the syndromes themselves. A number sense deficit is usually described in these syndromes, but variable cognitive impairments are also observed. The idea of a modular functioning is then debated and we argue for the necessity of a global cognitive evaluation approach. [ABSTRACT FROM AUTHOR]

Résumé Avec l’avènement de la procréation médicalement assistée (PMA) et le recul de l’âge maternel à la 1 re grossesse, l’incidence des grossesses gémellaires a fortement augmenté depuis une quarantaine d’années. Les risques obstétricaux et néonatals liés à ces grossesses particulières déterminent les modalités de suivi à long terme de ces enfants par le pédiatre. Durant la période périnatale, les jumeaux sont en effet soumis à un risque accru d’anoxie périnatale, de prématurité, de malformations congénitales, de mort fœtale in utero, de retard de croissance intra-utérin (RCIU) et de complications cardiovasculaires – notamment lors des grossesses monochoriales. De ce fait, les jumeaux sont plus à risque, en comparaison des singletons, de décès périnatal et de troubles neurodéveloppementaux nécessitant un suivi à long terme, incluant une évaluation du retentissement familial et psychosocial. Cette revue propose une mise au point des aspects épidémiologiques, des enjeux obstétricaux et génétiques et des risques fœtaux et néonatals des grossesses gémellaires, ainsi qu’une synthèse des connaissances sur le devenir de ces enfants et l’impact psychosocial de la gémellité. Summary The incidence of twin pregnancies has increased steadily for the last 40 years due to assisted reproductive technology and increased maternal childbearing age. Multiple pregnancies, especially monochorionic twin pregnancies, carry a high risk for the mother and the fetuses and require close follow-up. Twins are exposed to a higher risk of perinatal anoxia, in utero fetal demise, preterm birth, congenital malformations, fetal growth restriction, and vascular complications. Compared to singletons, twins are at higher risk of perinatal mortality and impaired neurodevelopmental outcome, justifying a thorough follow-up by pediatricians, including assessment and management of familial and psychosocial impact. This paper discusses the epidemiological, obstetrical, and genetic issues raised by twin pregnancies and reviews the data on the perinatal and neurological long-term outcomes of twins, as well as the psychosocial impact of multiple births on twins and their families. [ABSTRACT FROM AUTHOR]

Résumé Être confronté à une maladie grave à l’adolescence sans bénéficier du soutien de ses parents est une épreuve extrême. Nous évoquons dans cette étude la situation d’adolescents confrontés à des carences affectives profondes qui préexistaient à la maladie et qui sont renforcées par l’absence d’étayage parental durant le temps des traitements. Après avoir analysé les mécanismes psychopathologiques en jeu dans de telles situations – chez les parents, chez l’adolescent comme chez les soignants – nous montrons que l’absence d’implication auprès de leur enfant peut parfois représenter, chez certains parents qui sont dans l’impossibilité de répondre à ses besoins affectifs, une façon paradoxale de prendre soin de lui. Summary Facing a serious somatic disease during adolescence without any parental support is a very difficult life event. In this paper, we discuss the situation of teenagers facing deep emotional deprivation that existed prior to the illness and is reinforced by the lack of parental support during treatment. After analyzing the psychopathological mechanisms involved in such situations – in parents, teenagers, and healthcare teams – we hypothesize that the absence of involvement of parents can sometimes represent, for those who are not able to meet their child's emotional needs, a paradoxical way to take care of him. [ABSTRACT FROM AUTHOR]

Résumé Si le deuil d’un proche aimé est toujours une grande épreuve à traverser, qu’en est-il du deuil périnatal ? Ce deuil, qui éprouve tant les parents aujourd’hui, a commencé à être reconnu comme un deuil à part entière depuis les années 1970. Mais il mérite d’être analysé dans toute sa complexité, afin de proposer des pistes d’action et de réflexion aux soignants qui ont à prendre en charge des nouveau-nés en fin de vie, en lien avec leurs parents. La plus grande difficulté est bien celle des traces et des souvenirs de la très courte vie de ce tout-petit, éléments qui doivent pouvoir être préservés pour aider les parents à dépasser le choc du décès de celui qui devait leur survivre. Des recommandations ont été faites pour faire de ces temps particuliers, coincés entre naissance et mort, des moments intenses de vie et d’accompagnement à vivre en plein, avec le soutien des soignants. Car sans traces et sans reconnaissance, les parents ne peuvent rien faire de cette expérience bouleversante, et potentiellement traumatisante, qui est de mettre au monde leur bébé déjà décédé ou juste pour le voir mourir peu de temps après. La médecine palliative, dans son approche de la fin de vie, peut être source d’inspiration pour les soignants mais aussi pour les parents, en validant l’importance des gestes, des mots et de l’attention dans l’accompagnement de ces tout-petits. Summary The loss of a close friend or relative is always an ordeal. When this loved one is a baby, born or even unborn, a number of specific aspects have been reported by parents and researchers. The specificities of perinatal mourning have been progressively recognized since the 1970s, with increasing literature on this topic. Its complexity should be acknowledged by healthcare professionals who cope with perinatal loss, to allow them to offer adapted familial support. This paper is written by a mother, a founding member of a French nonprofit organization supporting parents in case of a prenatal or postnatal life-limiting disorder (Association SPAMA, soins palliatifs et accompagnement en maternité) with an internet support forum and a neonatologist involved in research with parents after the loss of their baby. It attempts to describe how parents experience this situation and how palliative care provides a source of inspiration to families and helps them give meaning to these situations. [ABSTRACT FROM AUTHOR]

Résumé Les troubles organiques à expression psychiatrique sont divers et davantage mis en évidence aujourd’hui du fait des recherches de plus en plus avancées. Certains restent néanmoins mal connus, dépourvus de consensus, posant des questions cliniques, diagnostiques, thérapeutiques et concernant, du fait de leur présentation, différents intervenants tels que pédiatres et pédopsychiatres. Ces troubles justifient la mise en place par les praticiens d’une collaboration efficace dont les enjeux sont multiples (diagnostique, thérapeutique, pronostique) et dont la complexité clinique ne doit pas faire disparaître le sujet derrière sa symptomatologie. Autour de trois cas d’encéphalite dysimmunitaire, nous proposons une réflexion autour de la prise en charge de ces pathologies et de la collaboration nécessaire entre somaticiens et pédopsychiatres. Il semble essentiel dans ces cas où la frontière entre psychique et organique est difficile à établir qu’une évaluation conjointe puisse s’établir, l’une ne devant pas se substituer à l’autre, dans l’optique d’une prise en charge optimale. Il s’agit de dépasser le clivage initial posé par une clinique singulière en apportant un éclairage sur la place du pédopsychiatre et de son expertise clinique l’orientant, ou non, vers une cause psychiatrique. Cela n’exclut pas la nécessité d’une prise en charge du symptôme, au-delà du lieu de soins, de la place du sujet et de son vécu. L’accompagnement est nécessaire du fait des possibles conséquences fonctionnelles mais également psychiques, souvent d’ordre traumatique. Plus largement, il s’agit d’articuler la présence de chacun quand le symptôme psychiatrique vient traduire une affection organique et d’accompagner au mieux le sujet dans son corps en souffrance. Summary Organic mental disorders are different and further revealed by increasingly advanced research. They are nevertheless misunderstood, without consensus, and raise clinical, diagnostic, and therapeutic questions. These disorders require effective collaboration between practitioners such as pediatricians and child psychiatrists. The subject should not disappear behind the complexity related to the clinical expression of these symptoms. Based on three cases of autoimmune encephalitis, we offer a reflection on the management and assessment of these diseases by a multidisciplinary team with the intention of providing optimal management. The aim of this paper is to override an initial divide posed by a particular clinical presentation. We would like to shed light on the place and legitimacy of child psychiatrists and their clinical expertise. This does not exclude the need for care of the symptoms, considering each subject and her experience. Follow-up is necessary because of the possible, often traumatic, functional and psychological consequences. Finally, the presence of each professional should be specified when the psychiatric symptoms appear to be the result of an organic disease in order to better support the subject in his suffering body. [ABSTRACT FROM AUTHOR]

Résumé La diffusion du séquençage haut débit (ou NGS pour Next Generation Sequencing) représente un tel changement d’échelle par rapport aux méthodes classiques que les indications et l’organisation du diagnostic moléculaire s’en trouvent modifiées. Dans tous les champs de la médecine et en particulier en pédiatrie, cette nouvelle méthode offre une meilleure efficacité et une plus grande rapidité du diagnostic génétique, améliorant ainsi significativement la prise en charge des enfants et de leur famille. En parallèle, une réflexion sur les enjeux éthiques est menée pour encadrer au mieux les pratiques et éviter les dérives liées aux potentialités de cette technique. Dans cette revue, nous présentons le principe, les stratégies existantes ainsi que les difficultés et les enjeux du séquençage haut débit pour le diagnostic moléculaire dans les maladies génétiques. Summary The advent of next generation sequencing (NGS) technologies is so scale-changing that it modifies molecular diagnostics indications and induces laboratories to rethink their diagnostic strategies, until now based on the Sanger sequencing routine. Several high-throughput approaches are available from the sequencing of a gene panel, to an exome, or even a genome. In all cases, a tremendous amount of data is generated, which has to be filtered, interpreted and analyzed using powerful bioinformatics tools. In parallel, ethical considerations are raised to avoid the potential drifts of these powerful approaches. In all medical fields, and particularly in pediatrics, this new strategy offers better efficacy and faster mutation identification, allowing better support and care for patients and their families and even improving genetic counseling. In the present paper, we discuss the different NGS-based approaches and strategies as well as the issues involved in these new technologies applied to molecular diagnosis of rare diseases. Altogether, rare diseases affect more than 3 million people in France and are responsible for about one-third of childhood deaths. [ABSTRACT FROM AUTHOR]

Résumé Les équipes de réanimation pour adultes sont rarement confrontées à la prise en charge de patients mineurs. Les objectifs de notre travail étaient d’évaluer la qualité de la formation pédiatrique des unités de réanimation pour adultes, la charge de travail représentée par l’activité de réanimation pédiatrique et d’identifier les difficultés rencontrées lors de l’approche de patients mineurs. Une enquête prospective a été conduite en Basse Normandie entre le 4 avril et le 1 er septembre 2012 auprès des professionnels médicaux et paramédicaux, exerçant dans un des 9 services de réanimation pour adultes. Un questionnaire évaluant leur expérience pédiatrique, leur activité pédiatrique quotidienne et les difficultés rencontrées leur a été adressé. Cent neuf réponses (26 médecins séniors, 18 internes, 38 infirmières et 27 aides-soignantes) ont été reçues. Les trois-quarts (76 %) ont signalé ne jamais avoir exercé dans une unité de pédiatrie. Quarante-deux pour cent pensaient que la limite d’âge de la pédiatrie était officiellement de 15 ans et 3 mois, mais plus de 50 % souhaitaient voir cette limite à 16 ans ou au-delà. Quatre-vingt-treize participants (85 %) estimaient avoir une activité pédiatrique dans leur pratique courante mais celle-ci restait rare. Des difficultés ont été rapportées par 73 soignants (67 %). Il y a peu d’évaluations récentes de la qualité de la formation des réanimateurs pour adultes dans le domaine de la pédiatrie et peu de données concernant le ressenti que ces équipes ont de la charge de travail et des difficultés que représente l’activité pédiatrique dans leur pratique quotidienne. Summary In routine practice, intensive care physicians rarely have to manage children under 18 years of age, particularly those under 15. This study's objectives were to assess the quality of training in pediatrics of adult intensive care teams, to document the workload generated by care of pediatric patients, and to identify the difficulties encountered in managing minors as patients. A survey was administered in Lower Normandy from 4 April 2012 to 1 September 2012. Physicians, residents, nurses, and nurses’ aides practicing in one of the nine intensive care units of Lower Normandy were asked to complete an electronic or paper format questionnaire. This questionnaire assessed their level of pediatric training, the workload management of pediatric patients entailed, and the challenges posed by these patients. One hundred and nine questionnaires were returned (by 26 attending physicians, 18 residents, 38 nurses, and 27 nurses’ aides). Eighty-three of the respondents (76%) had no experience in a pediatric unit of any kind. Forty-two percent thought that the pediatric age range lies between 3 months and 15 years of age. However, more than 50% of respondents would like the upper limit to be 16 years or even older. Ninety-three respondents (85%) estimated having some exposure to pediatric patients in their routine practice, but this activity remained quite low. Seventy-three (67%) reported difficulties with the management of these young patients. This survey provides current information regarding the level of training of adult intensive care unit professionals and their concerns about managing patients under 18 years of age, both in terms of workload and specific challenges. [ABSTRACT FROM AUTHOR]

Résumé Introduction La maltraitance des enfants constitue une problématique complexe qui nécessite une approche pluridisciplinaire encore non systématique en France. Le centre d’accueil en urgence des victimes d’agression (CAUVA) du centre hospitalier universitaire (CHU) de Bordeaux a pu rassembler dès création différents acteurs médicaux, paramédicaux et sociaux. Il a ainsi été établi une procédure d’évaluation psychosociale standardisée, qui est systématiquement diligentée en cas de suspicion de maltraitance sur mineurs. Méthode Nous avons étudié les 74 dossiers non judiciarisés de sujets mineurs (45 filles) ayant bénéficié d’une évaluation pour suspicion de violences entre le 1 er juillet 2014 et le 30 juin 2015. Résultats Ils étaient âgés en moyenne de 7 ans, nous avaient été adressés par des partenaires internes ( n = 15) ou externes au CHU ( n = 37), 22 s’étant présentés spontanément et alléguaient principalement (75 %) des faits de violences sexuelles. Trente-cinq ont pu rentrer au domicile, 17 fait l’objet d’un dépôt de plainte, 19 d’un signalement au Procureur de la République et 3 d’une information préoccupante au Conseil départemental. Conclusion En l’absence de consensus national sur la méthodologie d’évaluation des cas de suspicion de violences sur mineur, nous proposons une évaluation psychosociale comportant un regard collégial qui permet non seulement de faciliter le travail des professionnels mais également le dépistage et la judiciarisation des cas de maltraitance. Summary Introduction Maltreatment is a complex issue and therefore, requires a multidisciplinary approach, which has been commonly used in North America since the 1980s but remains unsystematic in France. Since 1999, the Centre d’Accueil en Urgence des Victimes d’Agression (emergency unit for victims of assault) of the Bordeaux University Hospital has brought together various medical, paramedical, and social actors on this issue. A standardized psychosocial assessment procedure has been introduced and is detailed in this paper, and was consistently conducted in all cases of suspicion of abuse on a minor. Method The authors studied 74 cases of minors having undergone a psychosocial assessment following suspicions of maltreatment between 1 July 2014 and 30 June 2015 that were not referred to the courts. Results Forty-five girls and 29 boys, mean age 7 years, claiming mainly (75 %) to have been subjected to sexual violence, were addressed to us by internal partners ( n = 15) and external partners ( n = 37) and 22 who came to our unit by self-referral. Following our assessment, 35 returned to their home and 36 went to court following a police complaint ( n = 17) and a report filed to the public prosecutor of the Republic ( n = 19). Three of these cases were subjected to a report on matters of concern sent to the departmental council. Conclusion Given the absence of a national consensus on the methodology used for assessing suspicions of maltreatment on minors, our psychosocial assessment can facilitate the task with its peer review as well as the detection and judicialization of the maltreatment. The authors also highlight the recent modification of article 226-14 of the Penal Code, which aims at protecting professionals reporting matters to legal authorities from any legal proceeding, except if it is established that the individual did not act in good faith. [ABSTRACT FROM AUTHOR]

In this paper written by the Groupe francophone d’he´patologie, gastroente´rologie et nutrition pe´diatriques, recommandations are given on the indications of drugs in infant and child infectious acute diarrhea, based upon the current scientific knowledge on their effectiveness and tolerance. This paper complements an article on nutritional treatment of acute diarrhea written by the Comite´ de nutrition de la Socie´te´ franc¸aise de pe´diatrie, and published in the same issue of the Archives de Pe´diatrie. [ABSTRACT FROM AUTHOR]

Résumé Dans le cadre du « Programme nutrition, prévention santé », une intervention a été mise en place dans des collèges et lycées d’Aquitaine en 2007–2008. Cette étude contrôlée interventionnelle avait pour objectif d’améliorer le comportement alimentaire des adolescents en dehors des repas, en associant des actions d’amélioration de l’offre alimentaire (supprimer/limiter les produits gras et sucrés vendus au foyer des élèves et favoriser la vente de fruits et pain) et d’éducation à la santé permettant de les sensibiliser à l’équilibre alimentaire et d’orienter leur choix vers les produits recommandés. L’objectif de cette étude était d’évaluer l’impact de l’intervention sur le comportement alimentaire des adolescents et sur l’offre proposée au foyer des élèves des collèges et lycées impliqués. Une enquête a été menée avant et après la mise en place de l’intervention dans 7 établissements « intervention » et 8 établissements « contrôles » (seuls les « interventions » ayant bénéficié des actions). Dans ces établissements, 1602 adolescents ont répondu à l’enquête avant et 1050 après la mise en place de l’intervention (échantillons indépendants du fait de l’anonymat des réponses). L’impact de l’intervention sur le comportement alimentaire des élèves a été modélisé à l’aide de régressions logistiques ajustées sur les variables de confusion potentielles (sexe, âge, niveau scolaire, statut de demi-pension). Dans l’analyse multivariée, l’intervention a été associée à une prise quotidienne plus fréquente du petit-déjeuner (OR = 2,63 IC95 % [1,89 ; 3,66]), de féculents (OR = 1,77 IC95 % [1,30 ; 2,42]) et de pain au petit-déjeuner, en en-cas et au goûter (OR = 1,43 IC95 % [1,07 ; 1,90]). L’intervention a également conduit à une consommation moins fréquente d’un en-cas au moment de la récréation (OR = 0,66 IC95 % [0,48 ; 0,90]) et à une amélioration de l’offre en produits recommandés proposée au foyer des élèves (OR = 1,34 IC95 % [1,01 ; 1,78]). Ces résultats montrent que le projet « Amélioration de l’offre alimentaire au foyer des élèves associée à des actions d’accompagnement pédagogique » conduit à l’apparition d’aliments plus recommandés au foyer des élèves et à une amélioration du comportement alimentaire de ceux-ci. Ces résultats encouragent les partenaires du programme aquitain à poursuivre ces actions dans tous les établissements volontaires. Summary Within the Nutrition, Prevention, and Health Program for children and teenagers in Aquitaine, an experimental intervention was implemented in 2007–2008 in the middle and high schools in Aquitaine (southwest France). This intervention aimed to improve the eating habits of adolescents, combining actions to improve the food supply sold during recreational times (remove/limit fat and sugar products sold and promote the sale of fruits and bread) and health education actions to make adolescents aware of the concept of nutritional balance and steer their choice towards recommended products. The aim of this paper was to evaluate the impact of the intervention on the eating behavior of adolescents and the food supply sold during recreational times in middle and high schools in Aquitaine. A survey was conducted before and after the implementation of the intervention in seven middle and high schools that have implemented actions (intervention group) and eight middle and high schools that have not implemented actions (control group). In these schools, 1602 adolescents answered the survey before and 1050 after the intervention (samples were independent because of the anonymity of responses). The impact of the intervention on the dietary behavior of teenagers was modeled using logistic regression adjusted on potential confounding variables (sex, age, and educational status). In multivariate analyses, the intervention was associated with more frequent daily intake of breakfast (OR = 2.63; 95% CI [1.89; 3.66]) and lower intake of morning snacks (OR = 0.66; 95% CI [0.48; 0.90]), higher consumption of starchy foods (OR = 1.77; 95% CI [1.30; 2.42]), bread at breakfast, morning snacks, and a light afternoon meal (OR = 1.43; 95% CI [1.07; 1.90]), and the food supply sold at recreational times (OR = 1.34 95% CI [1.01; 1.78]). These results show that the “Improving food supply in middle and high schools associated with educational support actions” project led to the sales of recommended foods during recreational times and improved students’ eating behavior. These results encourage partners to pursue these actions in all volunteer middle and high schools. [ABSTRACT FROM AUTHOR]

Résumé Introduction Les enfants et adolescents atteints de cancer sont pris en charge en France par des équipes pluri-professionnelles au sein de centres spécialisés d’onco-hématologie pédiatrique, labellisés par l’Institut national du cancer, qui travaillent en réseau avec des centres de pédiatrie de proximité. Le diplôme inter-universitaire d’oncologie pédiatrique (DIUOP) propose une formation à l’onco-hématologie maligne pédiatrique comprenant un enseignement théorique, un stage dans un service validant et un projet de recherche soutenu devant un jury. Méthode Nous avons adressé un questionnaire aux diplômés pour connaître leur situation professionnelle actuelle et avons recherché sur PubMed tous les articles publiés. Résultats De 2000 à 2011, le DIUOP a formé 290 médecins spécialistes : 242 pédiatres, 21 chirurgiens et 19 radiothérapeutes, 8 ayant une autre spécialité telle que l’imagerie, l’hématologie ou l’anatomo-pathologie. Quatre-vingt-douze étaient titulaires d’un diplôme obtenu à l’étranger : en Europe (50 %), en Afrique et au Proche-Orient (42 %) et en Amérique du Sud (8 %). Cent quatre-vingt-dix-sept des 266 diplômés (74 %) ont répondu au questionnaire. Quatre-vingt-dix pour cent prenaient en charge des enfants et adolescents atteints de cancer. Pour ceux exerçant en France, ils travaillaient principalement dans les établissements impliqués dans l’organisation des soins définie par la circulaire DHOS (Direction de l’hospitalisation et de l’organisation des soins) de 2004. Soixante-neuf articles, soit un mémoire sur 4, avaient été publiés dans une revue avec un facteur d’impact médian de 3,5 (0–22,6) dont 85 % en langue anglaise. Conclusion Le DIUOP est la seule formation européenne en langue française offrant une formation professionnalisante, multidisciplinaire, de qualité et complète aux spécialistes impliqués dans la prise en charge des cancers de l’enfant et de l’adolescent. Summary Introduction According to the European Society of Pediatric Oncology (SIOPE) standard of care guidelines, high-quality care of children and adolescents with cancer needs to be delivered by well-trained multidisciplinary teams in specialist centers working with designated shared-care local centers in a so-called hub-and-spoke model. The Diplôme Inter-Universitaire d’Oncologie Pédiatrique (DIUOP) is the only European training program in pediatric oncology in French for all physicians involved in care of patients with pediatric malignancies. In agreement with the SIOPE syllabus, the DIUOP is composed of training courses (120 h), on-site practical training in a specialist center, and a research project to be defended before an examining board. Method All graduates received a questionnaire to describe their current professional position. A comprehensive PubMed analysis retrieved all papers published form DIUOP research projects. Results From 2000 to 2011, 290 physicians were trained: 242 pediatricians, 21 surgeons, and 19 radiation therapists. Eight had another specialty including imaging, hematology, and pathology. Ninety-two were initially trained outside of France: 50% in Europe (mainly in Italy, Belgium, and Switzerland), 42% in Africa and the Middle East, and 8% in South America. Of the 266 graduates, 74% answered the questionnaire, and 90% of them take care of children and adolescents with cancer. Sixty-nine articles, i.e., one out of four research projects, were published in 34 journals with a median impact factor of 3.5 (0–22.6), 85% in English. Conclusion DIUOP is the only French-speaking European education program providing a high-quality, professionalizing, and comprehensive multidisciplinary training program for French and international specialists taking care of children and adolescents with cancer. [ABSTRACT FROM AUTHOR]

Résumé Introduction La présente recherche a été menée à la demande d’une association de parents (Vaincre les maladies lysosomales [VML]) dont les enfants polyhandicapés sont atteints de maladies génétiques rares. Plusieurs parents évoquaient alors des épisodes de « dépression » chez leurs enfants conduisant parfois à la prescription d’antidépresseurs. Comme la question de la souffrance psychique chez les enfants polyhandicapés a été peu étudiée, l’objectif de cette étude était de constituer un premier état des lieux. Matériel et méthodes Au moyen d’entretiens semi-directifs, nous avons interrogé les savoirs et savoir-faire de quatre familles et quatre professionnels qui accompagnaient treize enfants polyhandicapés atteints de maladies lysosomales. Résultats Plusieurs facteurs (principalement : épilepsie, douleur, solitude et pertes des compétences), signes (passifs et actifs) et modes de souffrance (angoisse, peur, déprime, frustration, colère) ont été identifiés ainsi que plusieurs types de réponses (réconfort, traitements médicamenteux, socialisation). Discussion Le protocole de recherche a présenté deux limites : d’une part, l’intrication complexe entre la souffrance psychique et d’autres troubles somatiques tels que la douleur et, d’autre part, le recours aux seules interprétations de l’entourage pour accéder au vécu subjectif des enfants. Conclusion Bien que le faible effectif de familles rencontrées ne permette pas de généraliser les résultats obtenus, ces derniers conduisent néanmoins à saisir plus finement comment les proches repèrent et donnent sens à la souffrance psychique des enfants polyhandicapés ; ils invitent également à développer des méthodologies permettant à l’enfant d’exprimer ce qu’il vit et ressent. Summary Introduction In this paper, we present the results of research conducted on the psychological distress of lysosomal-disease-affected children. Lysosomal diseases are rare genetic diseases most often leading to severe disabilities, both psychological and physiological. As frequently reported by their relatives, affected children experience nervous breakdowns, which are sometimes treated with antidepressant prescriptions. However, mental impairment as well physical disabilities can prevent children from making their pain noticed and identified by their relatives. This raises a new research question: when disabilities are severe, how should the psychological distress of affected children be identified? Method and population Recent studies on the care of children with multiple disabilities (San Salavadour 2000; Scelles 2003; Camelio 2006; Pautrel, 2009) have used the children's family and caregivers to access their feelings, considered to be translators of children's feelings because they understand their nonverbal language (Camelio, 2006). Using this methodology, four parents from the French not-for-profit association called “VML” ( Vaincre les maladies lysosomales ) and four professionals were involved in semi-structured interviews. The goal of these interviews was to identify signs of possible psychological suffering, the context in which those signs were expressed, the meaning and the value attributed to it by the family and caregivers, and the reaction as well as an evaluation of that reaction. Thirteen children were involved, 12 of whom were described as having shown signs of psychological distress. Six lysosomal diseases were represented. Results Two types of signs were reported: active signs (e.g., agitation, screaming, crying) and passive signs (e.g., no communication, withdrawal, lack of facial expression). Most of the time, passive signs were interpreted by the family and caregivers as evidence of deep psychological distress. The meanings of both types of sign were the following: fear, anxiety, distress, sadness, depression, stress, anger, and frustration. The family and caregivers responded by socializing with the child, providing him with comfort, assisting him in meeting his basic needs, administering medication, etc. Loneliness, disease-progression-related loss of abilities, physical pain, and epilepsy were the main factors of psychological distress. Three children were prescribed an antidepressant, two with an anticonvulsive effect. Discussion The results of this research depend on the difficulty making a distinction between physical and psychological pain and the interpretation of the child's relatives remains an imperfect translation of what the child feels. Further research to overcome these shortcomings is currently under consideration. Moreover, quantitative analysis is needed to make this research more robust. [ABSTRACT FROM AUTHOR]

Résumé La médecine « personnalisée », ou médecine des 4P pour « personnalisée », « prédictive », « préventive » et « participative », est en plein essor pour la mucoviscidose avec le développement de thérapies ciblant certaines mutations de CFTR . Les différents enjeux de la médecine personnalisée appliquée à la mucoviscidose sont discutés dans cette mise au point. Summary Personalized medicine, or P4 medicine for “Personalized”, “Predictive”, “Preventive” and “Participatory”, is currently booming for cystic fibrosis, with the development of therapies targeting specific CFTR mutations. The various challenges of personalized medicine applied to cystic fibrosis issues are discussed in this paper. [ABSTRACT FROM AUTHOR]

Résumé Tout retard de croissance staturo-pondérale conduit généralement le médecin référent à adresser l’enfant à une équipe hospitalière. Souvent, à l’issue d’un bilan complémentaire, un diagnostic est posé et un traitement instauré. Mais certaines situations aboutissent à une errance et à un retard diagnostiques qui pourraient parfois être évités dès le début de la prise en charge par un examen des urines à la bandelette (BU). Nous présentons un cas clinique illustrant l’importance de cet examen de débrouillage simple. La BU oriente rapidement vers une cause rénale (glycosurie, protéinurie), en particulier une tubulopathie proximale dont la cause la plus fréquente est la cystinose. Un syndrome polyuro-polydipsique y est le plus souvent associé et doit être soigneusement recherché à l’interrogatoire. La particularité de la cystinose est d’avoir un traitement dont l’âge d’instauration conditionne le pronostic et le délai de survenue de l’insuffisance rénale terminale. La BU devrait faire partie du bilan systématique d’un retard de croissance staturo-pondérale. Summary Observation of stunted growth in children usually leads the general practitioner to refer the patient to endocrinologists or gastroenterologists. In most cases, after a complementary check-up, the diagnosis is made and treatment is initiated. However, certain cases remain undiagnosed, particularly renal etiologies, such as proximal tubulopathy. The urine strip test at the initial check-up would be an easy and inexpensive test to avoid delayed diagnosis. The aim of the present paper is to increase general physicians’ and pediatricians’ awareness of the significance of questioning the parents and using the urine strip test for any child presenting stunted growth. We report a patient case of a 20-month-old child admitted to the emergency department for severe dehydration. He had displayed stunted growth since the age of 5 months and showed a negative etiologic check-up at 9 months of age. Clinical examination at admission confirmed stunted growth with loss of 2 standard deviations and signs of dehydration with persistent diuresis. Skin paleness, ash-blond hair, and signs of rickets were also observed and the urine strip test showed positive pads for glycosuria and proteinuria. Polyuria and polydipsia were also revealed following parents’ questioning, suggesting proximal tubulopathy (Fanconi syndrome). Association of stunted growth, rickets, polyuria and polydipsia, glycosuria (without ketonuria and normal glycemia), and proteinuria suggest nephropathic cystinosis. Ophthalmic examination showed cystine deposits in the cornea. The semiotic diagnosis of nephropathic cystinosis was confirmed by leukocyte cystine concentrations and genetic investigations. This case report clearly illustrates the significance of the urine strip test to easily and quickly concentrate the diagnosis of stunted growth on a renal etiology (glycosuria, proteinuria), especially on proximal tubulopathy for which the most frequent cause is nephropathic cystinosis. Specificity of nephropathic cystinosis treatment is that the age of treatment initiation is crucial and determinant for the prognosis of the disease and the onset of final stage renal failure. Therefore, the urine strip test should be included in the systematic check-up of stunted growth to identify any renal etiology. [ABSTRACT FROM AUTHOR]

Résumé Introduction Bien que les spécialistes aient longtemps pensé que les problèmes de jeu d’argent ne concernaient que les adultes, les travaux récents tendent à montrer que les adolescents sont également touchés. Objectif L’objectif de ce travail est de montrer les spécificités du jeu pathologique chez l’adolescent. L’article présentera les caractéristiques cliniques, la prévalence, la psychopathologie, la prévention et le traitement de ce trouble. Matériels et méthodes Une revue de littérature a alors été effectuée. Nous avons sélectionné 12 articles scientifiques de langue anglaise publiés entre 1997 et 2014 en consultant la base de données Medline. Les mots utilisés seuls ou en association sont les suivants : pathological gambling , dependence , addiction et adolescents . Résultats Les travaux récents estiment qu’entre 4 et 8 % des adolescents souffriraient d’un problème de jeu d’argent, et que la prévalence du jeu pathologique est 2 à 4 fois plus élevée chez les adolescents que chez les adultes. Le parcours de l’adolescent joueur pathologique débute précocement autour de 10–12 ans, avec un passage rapide du statut de joueur occasionnel à celui de joueur problématique puis joueur dépendant. Les complications apparaissent rapidement et les comorbidités sont fréquentes. Il n’existe pas de traitement pharmacologique curatif validé par les autorités de santé. Conclusion Le jeu pathologique chez les adolescents a connu un essor important depuis quelques années et doit être rapidement pris en charge. D’autres études devront être menées, afin de répondre avec plus de précisions à cette problématique chez les adolescents. Background Although experts have long thought that the problems of gambling involved only adults, recent studies tend to show that teenagers are also affected. Objective The objective of this paper is to show the characteristics of pathological gambling in adolescents. This review focuses on the clinical features, prevalence, psychopathology, prevention and treatment of this disorder. Methods A review of the medical literature was conducted, using PubMed, using the following keywords alone or combined: pathological gambling, dependence, addiction and adolescents. We selected 12 English articles from 1997 to 2014. Results Recent work estimate that between 4 and 8% of adolescents suffer from problem gambling, and the prevalence of pathological gambling is 2–4 times higher in adolescents than in adults. The term adolescent pathological gambler starts early around the age of 10–12 years, with a quick change of status from casual to that of problem gambler and player. Complications appear quickly and comorbidities are common. There is no curative pharmacological treatment approved by health authorities. Conclusion Pathological gambling among adolescents has grown significantly in recent years and should be promptly taken care of. Further studies must be performed to improve our understanding of this problem among adolescents. [ABSTRACT FROM AUTHOR]

Résumé Les enfants nés avant terme sont à risque de développer des difficultés cognitives, scolaires et comportementales. Ces difficultés peuvent en partie s’expliquer par un déficit dans le développement des fonctions exécutives (FE). Ce terme désigne un ensemble de processus cognitifs de haut niveau permettant un comportement flexible et adapté au contexte. Ces FE regroupent des capacités liées à l’anticipation, la planification, l’organisation, la mémoire de travail, l’apprentissage de règles, l’attention sélective. Elles sont principalement associées au fonctionnement des lobes frontaux du cerveau, mais les structures sous-corticales sont aussi impliquées. Elles sont importantes pour le développement cognitif, le comportement social et les apprentissages. Cette mise au point examine le fonctionnement exécutif chez les enfants nés avant terme. Bien que des travaux de recherche à plus long terme soient nécessaires, il est actuellement démontré que les enfants prématurés présentent un risque accru de troubles dans tous les domaines exécutifs. Il est donc important de procéder à un dépistage plus fin des dysfonctionnements cognitifs qui aille au-delà d’une mesure globale par le quotient intellectuel (QI). L’investigation de certains domaines spécifiques tels que les FE et le développement des compétences sociales nous paraît indispensable pour adapter au mieux la prise en charge des enfants prématurés. Summary The rate of children born prematurely has increased considerably in the last few decades, and their developmental outcome remains of great concern. The literature on the impact of prematurity has reported a wide range of cognitive and behavioral problems that may be related to deficits in executive function (EF) skills. EF refers to a series of high-level processes (selective attention, inhibition, set shifting, working memory, planning, goal setting) that develop throughout childhood and adolescence and play an important role in cognitive and social development as well as in school achievement. EF skills have been linked to the prefrontal cortex, as well as to other neural networks and brain regions including the basal ganglia and cerebellum. This paper focuses on studies related to the development of EF and social behavior in children born preterm. The preschool period is a critical time to perform neuropsychological assessment in addition to IQ testing, and to detect the child's specific needs in order to adapt effective intervention to enhance the development of executive processes in these high-risk children. [ABSTRACT FROM AUTHOR]

Résumé Le calendrier vaccinal 2013 répondant à un objectif de simplification à efficacité comparable, a diminué le nombre d’injections recommandées et a en particulier supprimé l’injection effectuée à l’âge de trois mois en population générale. En dehors de la prévention des infections invasives à pneumocoque pour laquelle il est recommandé de maintenir trois doses en primovaccination, la vaccination du prématuré n’est pas abordée dans ce nouveau calendrier. Les grands prématurés peuvent-ils bénéficier de ce nouveau calendrier ou doit-on maintenir chez eux trois injections ? L’objectif de ce travail est de préciser ce point à travers les données disponibles dans la littérature. Les enfants nés prématurément et surtout les « grands prématurés » nés avant 33 SA sont des enfants à haut risque de contracter des infections dont certaines peuvent être prévenues par la vaccination. Pour les valences coqueluche, pneumocoque, Hib, hépatite B quels que soient les critères d’immunogénicité retenus, elle est nettement moins bonne chez les grands prématurés que chez les nouveau-nés à terme. Bien qu’il n’y ait pas de preuve clinique, ceci fait craindre que le passage à deux doses ne permette pas d’une part, de protéger suffisamment à court terme et, d’autre part, laisse craindre une moins bonne réponse immunitaire après le rappel à 11 mois. Compte tenu de ces données, le GPIP prend position pour le maintien d’une primo-vaccination à 3 doses à 2,3 et 4 mois pour les prématurés de moins de 33 semaines. The French 2013 immunization schedule having a goal of simplification with comparable efficacy, has decreased the number of injections and removed the injection performed at three months of age in the general population. Apart from the prevention of invasive pneumococcal infections for which it is recommended to maintain three dose primary immunization, vaccination of premature is not addressed in this new calendar. Can the extremely preterm infants (< 33 weeks of gestational age) benefit from this new schedule or should we keep them in three injections schedule? The objective of this paper is to clarify this point through the data available in the literature. Children born prematurely and especially the “extremely premature” born before 33 weeks are at high risk of infections, some of them are preventable by immunization. Although there is no clinical evidence, for pertussis, pneumococcus, Haemophilus influenzae b, hepatitis B, whatever the immunogenicity criteria, immunogenicity is significantly lower in preterm than in term newborn after 3 doses primary schedule. This lower immunogenicity raises concerns about the transition to two doses, about the ability to give short term protection and booster responses. Given these data, GPIP takes the position for maintaining a primary 3-dose vaccination at 2.3 and 4 months for premature infants less than 33 weeks. [ABSTRACT FROM AUTHOR]

Summary: Allogeneic bone marrow transplantation has dramatically changed over the years since its beginnings. The diseases treated with transplantation (malignant hemopathies, severe benign hemopathies such as congenital or acquired congenital medullary aplasia, hemoglobinopathies, as well as severe immune system deficiencies and certain overload diseases), stem cell sources (bone marrow, peripheral stem cells, placental blood), donor types (intrafamilial, nonrelated, totally or partially compatible), conditioning regimen (immunosuppressors, graft manipulation), and supportive care increasingly vary. Allogeneic stem cell transplantation and more widely cellular therapies now need to be discussed. In this paper, we propose an overview of these therapies in 2012 for pediatric patients. [ABSTRACT FROM AUTHOR]

Summary: Research has shown a high rate of autism spectrum disorders among very low birth weight children over the past decade. This paper proposes a literature review on this topic. Two generations of research have followed one another. The first retrospective studies found a high rate of ASD among premature babies. The second generation of prospective studies underlined and relativized this risk. Prospective research using screening tools (M-CHAT) have found around 20 % ASD, whereas 2 studies assessing the actual diagnosis found 5 % and 8 % ASD, 10 to 12 times more than in the general population. A number of hypotheses have been put forward to explain these high rates of ASD: sensory impairment associated with prematurity, white matter abnormalities, and cerebellar impairment. The authors propose complex models that take into account neurological deficits and the effects of perinatal events on interactive dynamics between infants and their caregivers. These models aim to allow suitable prevention and care for premature children with autism, a heavy additional handicap. [Copyright &y& Elsevier]

Summary: The question of the risk of cancer associated with postnatal diagnostic medical exposure involving ionizing radiation in childhood is particularly relevant at the moment given the growing use of diagnostic examinations, especially computed tomography scans, in children. Compared to adults, pediatric patients are more sensitive to radiation and have more years of life expectancy and therefore more years at risk of cancer occurrence as compared to adults. This paper provides a description of diagnostic x-ray exposure in children in France and summarizes epidemiologic studies on subsequent risk of cancer. Overall, this review, based on 12 case-control studies and 6 cohort studies, shows no significant association between exposure to medical diagnostic radiation exposure and childhood cancer risk. The methodological limitations of these studies are discussed. As the expected cancer risks are low, epidemiological studies require very large sample sizes and long periods of follow-up in addition to a good dosimetry assessment to enable quantitative risk estimation. New cohort studies of young patients who underwent CT scans are currently underway within the European EPI-CT project. In the meantime, continued efforts to reduce doses and the number of radiological examinations in children are needed, including adhering to the “as long as reasonably achievable” (Alara) principle. [ABSTRACT FROM AUTHOR]

Summary: Since its first description as a phosphaturic agent in the early 2000s, fibroblast growth factor 23 (FGF23) has rapidly become the third key player of phosphate/calcium metabolism after PTH and vitamin D. FGF23 is a protein synthesized by osteocytes that acts mainly as a phosphaturic factor and a suppressor of 1α hydroxylase activity in the kidney. It inhibits the expression of type IIa and IIc sodium-phosphate cotransporters on the apical membrane of proximal tubular cells, thus leading to inhibition of phosphate reabsorption. Moreover, it also inhibits 1α hydroxylase activity. These two renal pathways account together for the hypophosphatemic effect of FGF23, but FGF23 has also been recently described as an inhibiting factor for PTH synthesis. Its exact role in bone remains to be defined. A transmembrane protein, Klotho, is an essential cofactor for FGF23 biological activity, but it can also act by itself for calcium and PTH regulation. This paper gives an overview of these recent data of phosphate/calcium physiology, as well as a description of clinical conditions associated with FGF23 deregulation (genetic diseases and chronic kidney disease). As a conclusion, future therapeutic consequences of the FGF23/Klotho axis are discussed. [Copyright &y& Elsevier]

Summary: This article updates the respiratory physiotherapy technique used in France, and the rationale for its use. This paper reports the results of a recent randomized clinical trial that did not show any efficiency of respiratory physiotherapy (using increased expiratory acceleration) in infants hospitalized for a first episode of bronchiolitis. Further trials are necessary for evaluating this technique in infants who are not hospitalized. [Copyright &y& Elsevier]

Summary: Cerebral palsy is the commonest cause of motor impairment in childhood. Parents of children with this particular neurodevelopmental disorder face many problems encountered by disabled children''s parents. The aim of the present paper is to report the current knowledge on this parental impact, highlighting consensus and disagreement. A literature search was conducted using the key words “Cerebral palsy” and “Parents/Father/Mother” and “Adapt/Adjust/Cost/Economic/Impact/Well-being” in the Medline and PsycInfo databases searching for articles published between 1989 and 2009. Seven parental impact dimensions were distinguished: time spent, occupational restrictions, social relationships, family relationships, psychological well-being, physical health, and financial burden. Of 40 selected references, the studies were mostly cross-sectional, although longitudinal surveys highlighted the causal relationship between factors. Despite various methodologies, this review confirms that parents of CP children have greater risk of experiencing a sense of burden than parents of typically normally developing children. Time spent caring for the child appears to be an important factor that depends on the child''s autonomy. The 7 impact dimensions seem to be related to each other and to child''s and caregiver''s characteristics. The severity of motor impairment is not unanimously viewed as a worsening factor: however, the child''s behavioral problems influence the impact experienced by the parents. The level of intellectual impairment also has a negative influence on family relationships and on the parent''s psychological well-being. The child''s developmental stage seems to be related to the level of parental impact, but there is no agreement on the dimensions involved. We also observed that the mother and father do not experience this situation in the same way, probably because of the role played by each one in the family. The current literature lacks data on caregiver characteristics, identifying families at risk of burden, and the environmental context that would allow for a less negative impact on parents. In addition, the tools measuring the impact lack standardization. No questionnaire covering all 7 dimensions exists, but useful validated questionnaires for different dimensions were identified. We consider that the caregiver''s occupation and physical health needs further research. The current knowledge is insufficient for proposing an overall model taking all the dimensions into account. Research is needed before a complete model of the CP child''s impact on parents can be tested in view of providing guidelines to professionals for identifying families with a risk of maladaptation and suggesting solutions to decrease the negative impact. [Copyright &y& Elsevier]

Abstract: The market value for energy drinks is continually growing and the annual worldwide energy drink consumption is increasing. However, issues related to energy drink ingredients and the potential for adverse health consequences remain to be elucidated. This aim of the present paper is to review the current knowledge on putative adverse effects of energy drinks, especially in youths. There are many energy drink brands in the worldwide market, even if only few brands are available in France. Although the energy drink content varies, these beverages often contain taurine, caffeine, vitamins B and carbohydrates. These drinks vary widely in both caffeine content (80 to 141mg per can) and caffeine concentration. Except caffeine, the effects of energy drink ingredients on physical and cognitive performances remain controversial. Researchers identified moderate positive effects of energy drinks on performances, whereas others found contrary results. The adverse effects of energy drink can be related to either the toxicity of ingredients or specific situations in which energy drinks are used such as ingestion in combination with alcohol. Although the issue of taurine-induced toxic encephalopathy has been addressed, it is likely that the risk of taurine toxicity after energy drink consumption remains low. However, whether the prolonged use of energy drinks providing more than 3g taurine daily remains to be examined in the future. The consumption of energy drinks may increase the risk for caffeine overdose and toxicity in children and teenagers. The practice of consuming great amounts of energy drink with alcohol is considered by many teenagers and students a primary locus to socialize and to meet people. This pattern of energy drink consumption explains the enhanced risk of both caffeine and alcohol toxicity in youths. Twenty five to 40% of young people report consumption of energy drink with alcohol while partying. Consumption of energy drinks with alcohol during heavy episodic drinking is at risk of serious injury, sexual assault, drunk driving, and death. However, even after adjusting for alcohol consumption, students who consume alcohol mixed with energy drinks had dramatically higher rates of serious alcohol-related consequences. It has been reported that the subjective perceptions of some symptoms of alcohol intoxication are less intense after the combined ingestion of the alcohol plus energy drink; however, these effects are not detected in objective measures of motor coordination and visual reaction time. [Copyright &y& Elsevier]

Summary: Background: This paper aims at showing the immediate and long-term consequences affecting newborns whose mothers did not reduce or stop their consumption of alcohol when they were pregnant; these women were chosen among women who also used psychoactive substances. Methods: A retrospective cohort was constituted of babies who were found to have been exposed in utero to one or more legal or illegal psychoactive substance(s) and who were born or hospitalized between 1999 and 2008 in a hospital near Paris. Among the cohort of 170 babies, 56 had mothers who had not modified their alcohol consumption when they were pregnant, 30 had mothers who had reduced their alcohol consumption, and 84 had mothers who declared having been abstinent. Results: The babies born to mothers who did not modify their alcohol consumption when pregnant were more likely to be premature (30%) and hospitalized in the neonatology hospital unit (60.7%). They needed specific care for durations significantly longer than the babies exposed in utero to other psychoactive substances (P <0.005). They were more often diagnosed with fetal alcohol spectrum disorders (18%) and placed in a foster family (18%). Conclusion: Given the negative consequences on the babies born to mothers who do not modify their alcohol consumption when pregnant, these mothers should be identified and provided with better care. The successful strategies for early therapeutic interventions used in other countries should be studied as examples. This would make it possible to reduce the enormous financial, material and human costs that are a direct consequence of alcohol consumption during pregnancy. [ABSTRACT FROM AUTHOR]

Summary: This paper engages into a global assessment of statistics and their potential uses, ranging from 19th century accounts of “suicidal acts” by the central services of criminal justice in France, to European comparative data on suicide in the years 2000. The most recent facts and figures about teenagers’ suicides in France are taken into account, thanks to the Inserm records on deaths by suicide and to public polls on suicidal attempts. [ABSTRACT FROM AUTHOR]

Summary: Secondary causes of thrombocytopenia as immunologic thrombopenia purpura, or ITP, are far more common than inherited causes, which even as a group, are rare. Nevertheless, diagnosis is important and progress made in uncovering the molecular basis of these disorders has contributed greatly to our knowledge of these diseases. Inherited thrombocytopenias are a heterogeneous group of disorders. Different criteria have been suggested to classify the forms, such as the inheritance mechanism and the platelet volume as well as the associated platelet dysfunctions or clinical abnormality. This paper describes the clinical and biological data, and current knowledge of the molecular findings of inherited thrombocytopenia, allowing a diagnostic approach to these diseases. [ABSTRACT FROM AUTHOR]

Summary: Dystonia is not uncommon in childhood, but is clinically very heterogeneous. Therefore, introduction and follow-up of the treatment of dystonia in children are often a challenge for the physicians. Progresses in functional neurosurgery have open new fields in the treatment of dystonia in children, but it should be managed by a multidisciplinary team. This paper reviews the various therapeutic options available for childhood-onset dystonia, with a specific attention to dosage and side effects of the drugs regarding pediatric population according to the data of the literature. The rational strategy for therapeutic management of the various types of childhood dystonia is discussed. [Copyright &y& Elsevier]

Summary: The efficacy of pain management is subordinated to the efficacy of pain assessment. Children are particularly difficult-to-assess patients. In this area, child psychology can contribute to the development of tools and to improving pain assessment. This paper highlights the relevance of studies on dialog in pain assessment situations and the importance of the specificity of both the patient and his pain. Assessing pain and listening to the patient''s complaint means meeting the child in his own world. Nonetheless, it is necessary to use and develop assessment tools that are scientifically validated. [Copyright &y& Elsevier]

Abstract: Although treatment of gastroesophageal reflux is commonly prescribed in pediatrics, an examination of the scientific literature seems worthy. First, this paper develops the treatment options of gastroesophageal reflux and analyses the different studies aimed at demonstrating their efficacy. Evidence-based data are scant either for dietetic and postural advice or drugs prescriptions. Evidence does exist for thickened feeding, some prokinetics and proton pump inhibitors only. Secondly, a treatment strategy based on these data is proposed according to the different situations in current practice. An appraisal of the therapeutic approach of this frequent and mild child''s disease appears necessary. [Copyright &y& Elsevier]

Summary: Aims: Provide a descriptive analysis of children admitted to a tertiary care pediatric emergency department (PED) for a nasal foreign body (NFB) and describe the current knowledge and management of such accidents. Material and methods: A retrospective study was conducted from January 2003 to May 2008, including all patients aged less than 15 years admitted for a NFB. The data collected were age, sex, geographic origin, time and day of admission, duration in PED, duration of NFB insertion, nostril location, symptoms and clinical signs, prehospital extraction attempts, facial x-ray, extraction mode, referral to an ENT specialist, progression, and complications. For statistical analysis, the data were entered in Microsoft Excel spreadsheets. The data were analyzed with StatView 5.1 (SAS Institute®) and EpiInfo 6.04fr (VF, ENSP Epiconcept®). In the descriptive analysis, the data are presented as mean values with standard deviation, median with extreme values or with 95% confidence intervals where appropriate, unless otherwise indicated. To compare qualitative variables, a χ2 test (Mantel-Haenszel) was used and the two-tailed Fisher exact test if the expected value was 5 or less. Statistical significance was set at p <0.05. Results: A total of 388 patients were included (393 NFB). The annual mean number of cases was 68. The annual distribution showed a higher number in January, March, April, and October following Christmas, Easter and Halloween celebrations, totaling 40% of all NFB admissions. The sex-ratio was 0.95. Children aged less than 4 years accounted for 71% of the studied population. The mean age was 3.5±1.6 years (range, 1.4–13 years). The majority of accidents occurred at home (95%). The length of time spent in the PED was 78±57 min. The NFB duration of insertion was unknown in one-quarter of cases, present for less than 4 h in 65% of cases. No symptoms were described in most cases (88%). When symptoms were described, bleeding, pain or nasal discomfort, and foul nasal odor were the principal symptoms. The right nostril was the predominant location (60%). This difference tended to disappear in the group of children aged less than 4 years. Five children had bilateral NFB. Nonorganic compounds accounted for 80% of the NFB: plastic beads or balls (39%), plastic or toy parts (20%), stones or pebbles (11%), and paper (6%). The extraction was instrumental in 82% of cases, and 26% of patients were referred to an ENT specialist when PED attempts were unsuccessful. One child needed hospitalization for extraction under general anesthesia of two beads located deep in the same nostril. No complication occurred. Five children had repeated accidents within an average delay of 6 months. Conclusion: Often benign, this frequent accident can be serious in case of batteries or neodymium magnet insertion: the extraction becomes an emergency because of risks of nasal mucosa necrosis and/or nasal septum perforation. In other cases, positive pressure techniques (the parent''s kiss or its variants) could be tried first in the emergency department or at home at the time of a call to emergency services before a medical visit. [Copyright &y& Elsevier]

Summary: This paper is about the computer use by teenagers, often estimated abusive by their family circle. In most cases, it is a “simple abundant use” more than a true addiction or a passion. The author describes the psychosocial mechanisms of such behaviours and the characteristics of each one. Finally, he describes how the adults, teachers and nursing staff can face up their responsibilities to contribute towards a safe use of multimedia in young people. [Copyright &y& Elsevier]

Summary: Williams–Beuren syndrome (WBS) (OMIM# 194050) is a rare, most often sporadic, genetic disease caused by a chromosomal microdeletion at locus 7q11.23 involving 28 genes. Among these, the elastin gene codes for the essential component of the arterial extracellular matrix. Developmental disorders usually associate an atypical face, cardiovascular malformations (most often supravalvular aortic stenosis and/or pulmonary artery stenosis) and a unique neuropsychological profile. This profile is defined by moderate mental retardation, relatively well-preserved language skills, visuospatial deficits and hypersociability. Other less known or rarer features, such as neonatal hypercalcemia, nutrition problems in infancy, ophthalmological anomalies, hypothyroidism, growth retardation, joint disturbances, dental anomalies and hypertension arising in adolescence or adulthood, should be treated. The aim of this paper is to summarize the major points of WBS regarding: (i) the different genes involved in the deletion and their function, especially the elastin gene and recent reports of rare forms of partial WBS or of an opposite syndrome stemming from a microduplication of the 7q11.23 locus, (ii) the clinical features in children and adults with a focus on cardiovascular injury, and (iii) the specific neuropsychological profile of people with WBS through its characteristics, the brain structures involved, and learning. [Copyright &y& Elsevier]

Summary: In France, an annual seasonal influenza vaccination has been recommended since 2000 for patients suffering from chronic respiratory diseases, including asthma. Each year, a free influenza vaccination voucher is sent by the French Public Health Insurance authorities to patients with chronic respiratory disease, including severe asthma. In November 2006, this measure was extended to all asthmatic patients, irrespective of asthma severity. The present paper examines the 2006–2007 influenza vaccination coverage rate in 433 asthmatic children aged six to 17 years (mean age: 9.5 years; male: 61%) who consulted a pediatric pulmonologist between March and September 2007 in eight hospitals throughout France. The influenza vaccination coverage rate was 15.7% for the 2006–2007 season (13.9% for the 2005–2006 season and 10.9% for the 2004–2005 season). General practitioners vaccinated 72.1% of the children. Lack of information (42%) was the most frequently reported reason for non-vaccination. Free vouchers (received by 39.6% of the children) significantly increased the vaccination coverage rate (31% versus 5.9%; p <0.001). In France, in 2006–2007, the influenza vaccination coverage rate in asthmatic children was far below the national public health objective to achieve for the year 2008 (at least 75%). Concerted action is needed to improve the influenza vaccination coverage rate in asthmatic children. [Copyright &y& Elsevier]

Summary: Central venous catheterizations are often used in pediatric intensive care units or for long-term intravenous treatment. It consists in positioning the catheter extremity in the venous cava–right atrium junction. Adapted material and techniques are necessary for young children because of particularities in anatomy and the size of the different venous trunks. The aim of this paper is to present the different material and techniques and to show the indications, complications and follow-up in central venous catheterization for young children. [Copyright &y& Elsevier]

Summary: Umbilical venous and peripherally inserted venous central catheters are widely used to perfuse low-weight preterm and term newborns in intensive care units. This catheter must be inserted carefully and monitored rigorously to prevent complications. This paper develops today''s knowledge on the use and complications in the newborn population. [Copyright &y& Elsevier]

Summary: Between 1981 and 1996, several interventional studies proved the efficacy of periconceptional folic acid supplementation in the prevention of neural tube closure defects (NTCD), first in women at risk (with a previous case of NTCD) and also in women of the general population in age to become pregnant. The poor observance of this supplementation led several countries (USA, Canada, Chile…) to decide mandatory folic acid fortification of cereals, which permitted a 30% (USA) to 46% (Canada) reduction in the incidence of NTCD. Moreover, this benefit was accompanied by a diminished incidence of several other malformations and of stroke and coronary accidents in elderly people. However, several papers drew attention to an increased risk of colorectal and breast cancer in relation with high blood folate levels and the use of folic acid supplements. A controlled interventional study showed a higher rate of recurrence of colic adenomas and a higher percentage of advanced adenomas in subjects receiving 1mg/day of folic acid. A recent study demonstrated an abrupt reversal of the downward trend in colorectal cancer 1 year after the beginning of cereal folic acid fortification in the USA and Canada. Two studies also reported impaired cognitive functions in elder persons with defective vitamin B12 status. Taken in aggregate, these studies question the wisdom of a nationwide, mandatory, folic acid fortification of cereals. As of today, despite their limited preventive efficacy, a safe approach is to keep our current French recommendations and to increase the awareness of all caregivers, so as to improve the observance of these recommendations. [Copyright &y& Elsevier]

Abstract: Two recent laws have significantly reformed the French Public Health Code: the law of March 4th 2002, related to the patient''s rights and the quality of the health care system and the law of April 22nd 2005, related to the patient''s rights and the end of life. These changes have prompted health care professionals involved in perinatal and neonatal medicine to update their considerations on the ethical aspects of the end of life in neonatal medicine. Therefore, the authors examined the clauses of the law related to the patient''s rights and to the end of life, confronting them with the distinctive features of neonatal medicine. In this paper, the medical practices, which are either prohibited or authorized in the course of end of life are considered: prohibition of euthanasia, authorization for alleviating pain at the risk of shortening life, authorization for restricting, withholding or withdrawing treatments. Next, the justifications provided by the legislation to authorize these practices are analysed: prohibition of unreasonable obstinacy and respect for individual wishes. Then, the conditions required by the law to determine and to implement these acts are discussed: consultation with the healthcare staff and justified advice from a consulting physician, consideration of parental opinion, registration of the decision and its justifications into the patient''s medical file, protection of the dying patient''s dignity and preservation of his life quality by providing palliative care. Lastly, we report the terms of the ethical dilemma which may occur in the area of neonatal medicine in spite of genuine and persevering efforts in order to conciliate legal requirement and ethical responsibility. [Copyright &y& Elsevier]

Abstract: The administration act, as each step of the drugs circuit, can lead to an adverse drug event potentially harmful for the patient. The aim of this study was to highlight the adverse drug events outcoming at the administration stage and to suggest improvement elements. Errors were identified in a retrospective manner. We compared the written prescriptions (“Prescription forms”) with the administration registration (“Administration forms”). The differences observed between these two paper media were classified according to the errors types defined by the American Society of Hospital Pharmacists and by the American Society of Consultant Pharmacists. This study settled in the pediatric intensive care unit of a teaching hospital. We checked 1035 administrations lines: 180 errors (17,4%) were detected, including 63 omissions, 44 infusion rate errors, 42 administrations without prescription, 20 administration time errors, 7 dose errors, 2 drug form errors, 2 errors of other types, but no route of administration error. This method choice is debatable because without direct observation we could only compare what was noted to be administrated and not what was really administrated. We did not try to identify neither the causes nor the consequences of these errors on the patients. Following this study, several improvements have been set up: a new “Prescription form” (expecting the computerized prescription order entry) and reconstitution and dilution protocols for the most prescribed drugs. [Copyright &y& Elsevier]

Abstract: Keeping babies skin dry in the diaper environment, reducing leaking while increasing absorbency and preventing skin pH increase lead to provide better skin tolerance disposable diapers. During 80''s, basic cellulose diapers were replaced by the introduction of absorbent gelling materials (AGM) and since 90''s by microbreatheable diapers. These advances in diaper technology have contributed to the reduction of diaper dermatitis. [Copyright &y& Elsevier]

Abstract: This paper starts with a review of the metabolism of n–6 (ω6) and n–3 (ω3) fatty acids, the resulting eicosanoids (prostaglandins, leucotrienes, and thromboxanes), and the physiological functions they are involved in, with special emphasis on effects during pregnancy (such as possible benefits on fetal growth, prevention of hypertension of pregnancy, and prevention of premature labor). Attention is then turned to the key role for long-chain polyunsaturated fatty acids (LCPUFAs), most notably docosahexaenoic acid (DHA), in central nervous system and retinal cell membrane structure and in cerebral and retinal development. Massive maternofetal transfer of LCPUFAs occurs during the third trimester of pregnancy, so that maintaining an adequate intake of DHA during pregnancy is crucial. Preterm babies must receive sufficient amounts of DHA, either via breast milk or via formula supplemented with LCPUFAs, both of which prevent DHA levels from declining in blood and cerebral phospholipids. These two methods of achieving an adequate DHA intake ensure normal maturation of visual acuity and cognitive function, as shown by randomized controlled trials. Formula supplemented with fish oils rich in n–3 LCPUFAs but lacking a proportionate supply of arachidonic acid (ArA, 20: 4n–6) negatively affects somatic growth, confirming the need for an adequate ArA supply. Eicosapentaenoic acid (EPA) can also exert negative effects. Therefore, the best source of supplemental LCPUFAs may be oil from single-cell algae and microscopic fungi, which contains adequate amounts of DHA and ArA. In full term neonates, strong arguments support LCPUFA supplementation, despite continuing controversy generated by conflicting results from interventional studies. These discrepancies in study results may be ascribable to differences in study design, patient age, intervention duration, assessment tool sensitivity, and LCPUFA sources. In 1996, an amendment to the European Directive on infant formulas and follow-on formulas was developed to authorize LCPUFA supplementation and to specify appropriate ranges. As a result, formulas supplemented with DHA and ArA were introduced on the market. Pregnant and nursing women should be advised to maintain an adequate dietary intake of DHA in order to meet their increased needs and those of the fetus or infant. [Copyright &y& Elsevier]

Abstract: The occurrence of back pain in children and adolescents varies from 30 to 51% in the literature. Bone tumors can be responsible for back pain. This paper presents the more common spinal bone tumors in children and adolescents, and specifies their etiology, their natural history, and their treatment as well. [Copyright &y& Elsevier]

Abstract: Recurrent respiratory tract infections are a common reason for visits to primary care practitioners or hospital physicians. They are placed at the junction of several medical specialities: paediatrics, ENT, pneumology, allergology, immunology, infectiology. The great diversity of the laboratory tests requested and on the other hand the proposed treatments, are the consequences of the diversity of the patients encountered and the paucity of the evidence based-medicine studies in this setting. The dilemma is how to identify the child for which recurrent respiratory tract infections are the witness of underlying condition, without performing repeated medical examinations, laboratory tests and treatments for normal children for which immunologic development occurs normally. The essential tools are the history analysis, physical examination and few laboratory tests. The other questions are how to include, for these patients, influenza and pneumococcal vaccines in the immunization program and how to assess the benefit/risk ratio and the cost of surgical treatments. This paper presents the thought of an expert group trying to define the situations where biological tests or treatments are useful. [Copyright &y& Elsevier]

The study of the cognitive abilities of hearing-impaired children is important for both practical (e.g. to determine appropriate teaching strategies) and theoretical reasons (e.g. to examine the role of language in thought processes). The aim of this paper is to examine the cognitive function of hearing-impaired children from a review of the literature. If most studies show that deaf children are similar to normal children in virtually all aspects of cognitive function, many studies also emphasize pronounced differences in their academic achievement. Besides the degree of hearing loss and the age at onset of deafness, environmental factors (such as parental support and educational methods) seem to play an important role in the cognitive development and academic success of these children. This underlines the importance of the measures adopted for the deaf children as they may have a positive or negative impact on their development. [Copyright &y& Elsevier]

This paper presents practical guidelines for nutrition and feeding of infants and toddlers including vitamin D, vitamin K and floride supplementations and preventive measures at risk for food allergy based on family history. [Copyright &y& Elsevier]

This paper written by the Comite´ de nutrition de la Socie´te´ franc¸aise de pe´diatrie is specially devoted to the nutritional treatment of infant and child acute diarrhea, ie oral rehydration with salts solution and feeding. It complements an article on drug therapy of child acute diarrhea written by the Groupe francophone d’he´patologie, gastroente´rologie et nutrition pe´diatriques, and published in this same issue of the Archives de pe´diatrie. [ABSTRACT FROM AUTHOR]

Scho¨nlein-Henoch purpura is a systemic vasculitis involving primarily the skin, musculoskeletal system, gastro-intestinal tract, and kidneys. The purpose of this paper was to report the first described pediatric case, to our knowledge, of adrenal hemorrhage occurring in Scho¨nlein-Henoch purpura.Case report. – Our patient was a 12 year-old girl who presented a right adrenal hematoma diagnosed following an episode of acute right flank pain, ten days prior to the appearance of the clinical symptoms of Scho¨nlein-Henoch purpura.Conclusion. – We think that Scho¨nlein-Henoch purpura should be included in the diagnosis of adrenal hematomas. [ABSTRACT FROM AUTHOR]