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Extensive studies have shown that breast milk is the best source of nutrition for infants, especially during the first six months, because it fulfills almost all of their nutritional needs. Among the many functional building blocks in breast milk, human milk oligosaccharides (HMOs) have been receiving more attention recently. Furthermore, it is the third most common group of compounds in human milk, and studies have demonstrated the health benefits it provides for infants, including improved nutritional status. HMOs were previously known as the 'bifidus factor' due to their 'bifidogenic' or prebiotic effects, which enabled the nourishment of the gastrointestinal microbiota. Healthy gastrointestinal microbiota are intestinal health substrates that increase nutrient absorption and reduce the incidence of diarrhea. In addition, HMOs, directly and indirectly, protect infants against infections and strengthen their immune system, leading to a positive energy balance and promoting normal growth. Non-modifiable factors, such as genetics, and modifiable factors (e.g., maternal health, diet, nutritional status, environment) can influence the HMO profile. This review provides an overview of the current understanding of how HMOs can contribute to the prevention and treatment of nutritional issues during exclusive breastfeeding.

BACKGROUND: Dadiah, traditional yogurt from Indonesia, which is known as a source of probiotics, also contains micronutrients. AIM: This descriptive study aimed to determine whether additional ingredients and processes during the manufacture of Dadiah pudding maintain the iron, zinc, calcium, and total lactic acid bacteria (LAB) contents. METHODS: Dadiah pudding was made using Dadiah originated from Bukittinggi, West Sumatra. Micronutrient levels were analyzed according to Indonesian National Standard 01-2896-1998. The total LAB were counted by inoculating samples on Man, Rogosa, and Sharpe agar with serial dilution, and morphological identification was carried out using gram stain. RESULTS: In 100 g of original Dadiah, mango and chocolate Dadiah pudding contained 347.98, 276.61, and 279.29 mg of calcium; 4.87, 3.75, and 6.31 mg of zinc; 6.53, 6.60, and 9.39 mg of iron; and 6.4 × 10⁹, 6.1 × 10⁹, and 2.4 × 10⁹ CFU/ml LAB, respectively. CONCLUSION: This study found that modifying the original Dadiah into Dadiah pudding has been proved to affect the concentration of calcium, zinc, and iron and to maintain total LAB. We suggest that consuming Dadiah pudding may be a good choice as a food supplementation for pregnant women to optimize the golden period outcomes.

Background Aerophagia is a functional gastrointestinal disorder characterized by repeated air swallowing leading to chronic abdominal distension. Symptoms can be long lasting, lead to frustration, and distress. This study describes prevalence, related factors, and symptomatology of aerophagia, together with its relationship with emotional stress. Materials and methods Cross-sectional study. Adolescents aged 10 to 17 years from selected state schools by convenient sampling from Jakarta, Indonesia, were recruited. Rome III self-administered questionnaire was used to compile data on gastrointestinal symptoms. Data on sociodemographic characteristics, intestinal and extraintestinal symptoms, and stressful life events were collected using a separate questionnaire. Results A total of 1796 questionnaires were included in the analysis [males 732 (40.8%), mean age 13.58 (SD 0.992) years]. There were 81 (4.5%) subjects diagnosed with aerophagia. When the criterion of belching was removed from the diagnosis of aerophagia, the prevalence drops to only 2 (0.1%). Subjects Bivariate analysis showed that sociodemographic factors have no correlation with aerophagia. In subjects with aerophagia, among the intestinal-related and extraintestinal symptoms, only loss of appetite was significantly more common in the aerophagia population (33.3%) when compared with controls (22.8%). Death of a close family member [adjusted odds ratio (OR), 2.78; 95% confidence interval (CI), 1.46-5.31; P=0.002], divorce or separation of parents (adjusted OR, 2.54; 95% CI, 1.38-4.66; P=0.003), and divorce followed by separate individual remarriage of parents (adjusted OR, 2.01; 95% CI, 1.01-3.98; P=0.046) were found to be significantly associated with aerophagia by multivariate analysis. Conclusions The prevalence of aerophagia was found in 4.5% of Indonesian school-aged children according to Rome III criteria, but the prevalence was found only 0.1% if the belching is removed from the criteria. Besides the main symptoms, only loss of appetite was significantly more common in aerophagia among intestinal-related and extraintestinal symptoms. Family-related stress showed a significant correlation with aerophagia.

BACKGROUND: There is a lack of local data about recurrent acute respiratory infections in children with congenital heart disease (CHD). This study aims to investigate the incidence and recurrence of acute respiratory infection (ARI) in left-to-right shunt CHD. METHODS: This prospective cohort study investigated children with left-to-right shunt CHD, aged three months to five years, at Dr. Cipto Mangunkusumo Hospital between September 2012 and April 2013. Age and sex-matched participants without CHD were recruited as reference. The occurrence of ARI was observed for six months. Acyanotic CHD patients from 2015 to 2019 were also evaluated to determine the proportion of ARI among this population. RESULTS: A total of 100 subjects were enrolled in the study, 50 in the CHD group and 50 in the non-CHD group, six of whom were later excluded. The monthly incidence of ARI in the CHD group ranged between 40-60% ( p =0.027). Subjects with CHD had a cumulative increased risk of 10% for acquiring ARI (RR=1.1; 95% CI=1.02-1.2, p =0.027). The proportion of subjects with a high recurrence of ARI was also higher in the CHD compared to the non-CHD group (67% vs. 30 %, p

Infants react sensible to dietary changes because the gut physiology and functionality is not fully mature. The first few months of life is the 'window of opportunity' for optimal physical growth and development, cognitivedevelopment, and emotional and social development. Exclusive breastfeeding is recommended for the first 6 months of life. Breast milk is important for the maturation of the infant’s digestive system. Potentially protectivefactors are present in higher amounts in feces from breast-fed infant than from formula-fed infants. The amount of intestinal bifidobacteria in breastfed infants is higher than in formula-fed babies. Mother's milk protects againstinfection because it contains different factors with immologic properties. The differences in protein fractions between human and cow milk are impressive. The human milk oligosaccharides are the third most important nutritional component are fermented in the colon, making the environment in the colon suitable for the growth of bifidobacteria and lactobacillus.

The first report of soy being administered to an infant is over 100 years old (1). Since the 1960s the composition of soy formula has been better adapted to the nutritional needs of infants and since 2000 infant formula based on soy fulfills European Directives and legislation for infant feeding.Soy infant formula contains a soy protein isolate (95% protein), and methionine, carnitine, taurine, iron, calcium phosphor and zinc are added. Heating destroys the anti-protease activity of soy for over 90 %. In 2016, soy infant formula was still 12% of the USA market and 25 % of infants were fed soy infant formula during their first years of life (2).

Aim This paper discusses the risk factors and management of paediatric irritable bowel syndrome (IBS), with a focus on the role of the gastrointestinal microbiome. Methods English articles of interest published in PubMed and Google Scholar were searched using subject heading and keywords of interest. Results Only few randomised controlled trials on the management of IBS in children have been published. The vast majority of these intervention trials target to change the composition of the gastrointestinal microbiome. Most studies are underpowered. Major heterogeneities in study designs such as differences in inclusion criteria, including patients with different pain-related functional gastrointestinal disorders and differences in primary outcomes, make it impossible to formulate recommendations. Overall, few adverse events are reported what could indicate safety or point to suboptimal conduction of clinical trials and safety reporting. However, it can also not be excluded that some interventions such as the administration of selected probiotic products may result in benefit. Conclusion There is insufficient evidence to recommend any therapeutic intervention in paediatric IBS, including manipulation of the gastrointestinal tract microbiome, despite the evidence that dysbiosis seems an associated pathophysiologic factor. More designed prospective trials are needed since IBS is not a rare condition during childhood.

Objectives Soy-based formula has evolved in usage and processing technology since its introduction in 1909, and has been used as substitute formula for infants or children with cow milk allergy since 1929. At present, personal opinions, religious background, availability, palatability, and cost are part of the reasons soy-based formula is chosen. Technology in processing soy-based formula has evolved from using soy flour to soy protein isolate, which provides advantages. However, concerns remain regarding the impact of its use on the growth and development of children. Methods An expert meeting, attended by 12 experts, was initiated in Jakarta, Indonesia, to obtain an evidence-based consensus on the role of soy protein isolate formula, as well as its nutritional value to support growth and development. Results Ensuring that plant-based formula (i.e., soy protein isolate formula) is fortified with key nutrients, such as calcium, iron, and dietary fiber is important. Conclusions Consensus was achieved, concluding that soy protein isolate formula is safe, affordable, and an alternative option for cow's milk–based formula for term infants.

The World Health Organization recommends that infants should be exclusively breastfed for the first 6 months of life to provide optimal nutrition in this critical period of life. After this, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to 2 years of age or beyond. For nonbreastfed infants, infant formula is an available option to provide the nutrition needed. Infant formula is usually prepared from industrially modified cow's milk and processed to adjust for the nutritional needs of infants. However, cow's milk is one of the most common causes of food allergy, affecting 2%-5% of all formula-fed infants during their first year of life. One strategy to prevent cow's milk allergy in nonbreastfed infants is the use of partially hydrolyzed formula (pHF) in high-risk infants, which are infants born in families with atopic disease. However, based on an epidemiological study, approximately half of the infants who develop allergy are not part of the at-risk group. This is because the non-at-risk group is significantly larger than the at-risk group and the non-at-risk infants have approximately 15% risk of developing allergies. This study aimed to evaluate the effects of partially hydrolyzed whey formula (pHF-W) in nonbreastfed infants and determine whether pHF-W can prevent atopic disease in high-risk infants and can be used as routine starter formula regardless of the allergy risk status.

Background: Functional gastrointestinal disease (FGID) has a worldwide prevalence of 10–45%, and is one of the most common causes of recurrent abdominal pain in children. FGID is characterized with abdominal discomfort and changes in bowel movement. Alteration in gut microbiota is associated with FGID, but data are limited, and there are no data from Indonesia. Methods: A case–control study was conducted in 22 FGID children and 28 healthy subjects aged 13–18 years at the junior high school and senior high school in Central Jakarta. FGID was diagnosed using Rome IV criteria. Age, sex, and level of education were recorded. Stool samples were collected and investigated for Bifidobacterium spp. and Enterobacteriaceae. Results: Most of the FGID subjects were females (17/22), with a median age of 16 years. The median values of Bifidobacterium spp. were 138.95 (range: 0.2–22,735.8) CFU/gram for the FGID subjects and 232.5 (range: 1.9–38,985.6) CFU/gram in healthy subjects, which showed no statistically significant difference (P = .49). The median values of Enterobacteriaceae were 58.9 (range: 2.5–9577.8) CFU/gram in FGID subjects and 85 (range: 12.1–3139.4) CFU/gram in healthy subjects, which showed no statistically significant difference (P = .94). Our findings indicate that the gut microbiome of adolescents with FGIDs is characterized by a huge variability in levels of Bifidobacterium spp. and Enterobacteriaceae. Conclusion: Because of the wide range detected in the number of Bifidobacterium spp. and Enterobacteriaceae in FGID and healthy subjects, no statistically significant difference was observed. More studies in larger groups of selected patients may be needed. Keywords: Functional gastrointestinal disease, Adolescents, Microbiome

Purpose The aim of this study was to identify the minimally meaningful dosage of inulin leading to a prebiotic effect in Indonesian infants. Methods In a randomized controlled double-blinded, parallel, 3-arm intervention study, 164 healthy formula-fed infants aged 3 to 5 months first obtained formula-A (without inulin) during a 4-week adaptation period. Subsequently, 142 subjects were subjected to a 4-week feeding period by administering either formula-A (no inulin), formula-B (0.2 g/100 mL inulin) or formula-C (0.4 g/100 mL inulin). The primary outcome parameter was %-bifidobacteria in faecal samples determined using quantitative polymerase chain reaction analyses. Secondary outcome parameters were faecal %-lactobacilli, pH and stool frequency, and consistency. Growth and tolerance/adverse effects were recorded as safety parameters. Results Typical %-bifidobacteria and %-lactobacilli at the end of the adaptation period in the study population were 14% and 2%, respectively. For faecal pH, significant differences between formula groups A vs. C and A vs. B were found at the end of the intervention period. Testing for differences in faecal %-bifidobacteria and %-lactobacilli between groups was hampered by non-normal data set distributions; no statistically significant differences were obtained. Comparisons within groups revealed that only in formula group C, all the three relevant parameters exhibited a significant effect with an increase in faecal %-bifidobacteria and %-lactobacilli and a decrease in pH. Conclusion A consistent prebiotic effect along with a decrease in pH and increase in %-bifidobacteria and %-lactobacilli was found only in the group administered 0.4 g inulin/100 mL.

Lactose is the most important source in mammalian milk. In normal children, Lactose is hydrolyzed by lactase, and directly absorbed into bloodstream by an active transport mechanism. The term of lactose malabsorption is reserved to patients in whom impaired intestinal lactose hydrolysis and uptake has been proven by an appropriate test. The severity of lactose malabsorption and the extent of symptoms vary widely and are the results of several factors such as the amount of ingested lactose, gastric emptying time, intestinal transit time, and colonic flora. The diagnosis of lactose malabsorption is based on clinical findings and the results of appropriate tests. The breath hydrogen test has obvious advantages for pediatric population because it is painless, non-invasive, sensitive and specific. In the absence of bacterial colonization in the small intestine, the elevation of the concentration of hydrogen in the expired air implies the arrival of lactose in the colon. The increasing respiratory excretion of hydrogen is indicative of a deficit of lactase in enterocyte brush border. This test can also be used to show the existence of bacterial growth. Dietary fiber, some drugs, preparation for colonoscopy, colonic pH, and diarrhea can influence the result of breath hydrogen test.

Background Exclusive breastfeeding by healthy mothers to their healthy, term babies who underwent vaginal birth, should be readily accomplished. However, exclusive breastfeeding by Indonesian mothers has declined. Objective To assess the monthly success rate prevalences for exclusive breastfeeding for the first 6 months of life, as well as factors that affect exclusive breastfeeding. Methods A prospective cohort study was conducted in 243 healthy mothers with healthy term babies who underwent normal births at Cipto Mangunkusumo Hospital (CMH), Jakarta, Indonesia. Guided interviews were conducted monthly for six months. Bivariate and multivariate analyses were performed on the factors potentially affecting breastfeeding with equal subject numbers. Results Exclusive breastfeeding prevalences were 64.8% (first month), 53.7% (second month), 43% (third month), 30.7% (fourth month), 23.5% (fifth month), and 22.3% (sixth month). Multivariate analysis revealed that the mother’s confidence in breast milk production, as well as husband or family support, affected the success of exclusive breastfeeding for each month. Maternal not working/studying outside the home affected the success of exclusive breastfeeding in the third (RR 3.38; 95%CI 1.21 to 9.43) and fourth months (RR 6.56; 95%CI 1.39 to 30.99). Conclusion Exclusive breastfeeding prevalences in Cipto Mangunkusumo Hospital decrease in a monthly fashion up to the sixth month. Several factors affecte the success rate for each month in the six month period, including maternal confidence in breast milk production and family support.

Background: Various pathogenic bacteria are reported as the cause of infectious colitis in children. Infectious colitis does not have a specific sign, therefore an accurate examination is required. The implementation of fecal cultures accompanied with drug resistance tests often have constraints, beside the relatively expensive costs, longer times are needed, and not all health care facilities have required instruments. On the other hand, this condition requires an immediate antibiotic therapy, so that the infection should not be continued. In daily practice, it is not uncommon to find diarrhea with the amount of fecal leukocyte 10/hpf with pathogenic bacteria on the examination of the fecal culture.Method: Cross-sectional study was conducted to observe the pattern of bacterial distribution in children’s fecal who have acute diarrhea and the correlation between the existence of pathogenic bacteria and the number of leukocytes in the fecal, as well as antibiotic resistance patterns. The population of this study is children with age of 6 months old - 18 years old who were suffering from acute diarrhea with the amount of fecal leucocyte ≥ 5/hpf, who recruited from polyclinic or patient admitted at Cipto Mangunkusumo Hospital and Fatmawati General Hospital, Jakarta.Results: Based on examinations of fecal cultures and PCR, Salmonella sp and C. dificille were found subsequently in 2 children (33.3%), Enterophatogenic E. Coli(EPEC) and Shigella were found subsequently in 1 child (16.7%). Based on the ROC curve, it was found that there was no intersection of maximum and minimal leukocyte value with the midline, whereas the best sensitivity and specificity value was found at the cut-off point of 8.5, hence the cut-off point of leukocytes was determined at 8 and 8. The sensitivity value was 83.3% and the specificity value was 45.1%.Conclusion: The antibiotic sensitivity test showed that one child infected by EPEC was sensitive to ciprofloxacin. Two children infected by Salmonella, were still sensitive to chloramphenicol, cotrimoxazole, cefixime, and ceftriaxone. Two children infected by C. Difficile were sensitive to ceftriaxone, and 1 child infected by Shigella was sensitive to cefixime, ceftriaxone and ciprofloksazine.

Purpose Impaired intestinal mucosal integrity may affect the gastrointestinal function, especially in relation to nutrition, absorption, and barrier function. The purpose of this study was to measure the prevalence of impaired intestinal mucosal integrity in presumed healthy children aged 1-3 years and assess the effects of zinc, glutamine, fiber, and prebiotic supplementation in them. Methods A cross-sectional study was conducted in 200 children aged 1-3 years in Pasar Minggu, South Jakarta, Indonesia. A randomized double-blind parallel group method clinical trial was then performed to assess the effects of zinc, glutamine, fiber, and prebiotic supplementation. Results Elevated calprotectin was found in 91/200 subjects (45.5%) at the onset of the study. After 10 months, 144 subjects completed the study: 72 subjects received the trial formula, whereas the other 72 received the standard formula. A transitory decrease in fecal calprotectin (FC) was observed after 6 months in the subgroup with normal FC levels, who were fed the test formula (p=0.012). Conclusion The prevalence of impaired intestinal mucosal integrity in this group of Indonesian children aged 1-3 years was high. Supplementation with zinc, glutamine, fiber, and prebiotics during 6 months reduced FC only in those who had low levels at baseline but not in those with impaired integrity.

Background The prevalence of lactose malabsorption varies widely throughout the world. Only people of Caucasian genetic background continue to produce high amount of lactase throughout adulthood. Previous studies in Indonesia revealed that the prevalence of lactose malabsorption was 21-58% in children aged 3-11 years. Objective To determine the prevalence of lactose malabsorption in the older age group and whether a change in milk drinking habit can affect it. Methods A cross sectional descriptive study was conducted on 98 children aged between 12 and 14 years (junior high school) in Jakarta. Lactose malabsorption was evaluated with Lactometer Breath Hydrogen Test (Hoek Loes, Amsterdam). Milk drinking habit was recorded, and drinking at least 1 glass of milk everyday since 6 months or more before the study was considered as regular milk drinking. Results This study showed 73% of the children had lactose malabsorption. Regular milk drinking habit was found in 32 (33%) children and lactose malabsorption occurred in 26. From 66 children who were irregular milk drinkers, lactose malabsorption was found in 46 (70%). Lactose intolerance was about the same in both groups. Conclusion There was an increasing prevalence of lactose malabsorption in older children. Milk drinking habit is a major concern to review the practical implications of lactose malabsorption.

Human breast milk contains numerous biomolecules. Human milk oligosaccharides (HMOs) are the third most abundant component of breast milk, after lactose and lipids. Amongst the synthetized HMOs, 2′-fucosyllactose (2′-FL) and lacto-N-neotetraose (LNnT) are widely studied and are considered safe for infant nutrition. Several studies have reported the health benefits of HMOs, which include modulation of the intestinal microbiota, anti-adhesive effect against pathogens, modulation of the intestinal epithelial cell response, and development of the immune system. The amount and diversity of HMOs are determined by the genetic background of the mothers (HMO secretors or non-secretors). The non-secretor mothers secrete lower HMOs than secretor mothers. The breastfed infants of secretor mothers gain more health benefit than those of non-secretor mothers. In conclusion, supplementation of infant formula with 2′-FL and LNnT is a promising innovation for infant nutrition.

BackgroundFunctional abdominal pain disorders (FAPD) have been widely reported as a major group of gastrointestinal disorders across the world. This study describes the prevalence, related factors, symptomatology and its relationship to emotional stress in Indonesian adolescents.MethodsThis is a cross-sectional study. Adolescents aged 10 to 17 years from nine randomly selected state schools from five districts of Jakarta, Indonesia, were invited to participate. A translated and validated Rome-III self-administered-questionnaire was used to collect data on gastrointestinal symptoms. Data on sociodemographic characteristics, intestinal as well as extra-intestinal symptoms, and exposure to stressful life events were also collected using a separate validated questionnaire.ResultsA total of 1813 questionnaires were included in the analysis [males 739 (40.8%) mean age of 13.54 years + 0.89]. Of them, 209 children (11.5%) fulfilled Rome III criteria of FAPD. Functional abdominal pain (FAP) was reported as the most prevalent subtype (5.8%), followed by functional dyspepsia (3.3%), irritable bowel syndrome (2%) and abdominal migraine (0.4%). The prevalence was higher in girls (p p p = P = 0.001), and father’s alcoholism (adjusted OR 1.94, 95% CI 1.22–3.1,P = 0.005).ConclusionsFAPD are common paediatric entities among Indonesian adolescents with a prevalence of 11.5%. FAPD were noted to be higher in girls and adolescents exposed to family-related stressful life events.

Background We aimed to study the epidemiology and risk factors, including exposure to emotional stress, for constipation in Indonesian children and adolescents of 10–17 year age group. Methods A cross-sectional survey using a validated, self-administered questionnaire was conducted in randomly selected children and adolescents in nine state junior high schools from five districts of Jakarta. All of them were from urban areas. Constipation was defined as a diagnosis by using the Rome III criteria. Results Of 1796 children included in the analysis, 328 (18.3%; 95% CI 016–0.2) had constipation. Females and those residing in North Jakarta showed risks associated with constipation in school-age children and adolescents. Symptoms independently associated with constipation were abdominal pain (64% vs 43.3% of control) and straining (22.9% vs 6.3%). The prevalence of constipation was significantly higher in those with stressful life events such as father’s alcoholism (adjusted OR 1.91, 95% CI 1.27–2.89, P = 0.002), severe illness of a close family member (adjusted OR 1.77, 95% CI 1.12–2.80, P = 0.014), hospitalization of the child for another illness (adjusted OR 1.68, 95% CI 1.22–2.31, P

AIM: To assess the knowledge of general pediatricians througout Indonesia about the diagnosis and treatment of childhood constipation. METHODS: A comprehensive questionnaire was distributed to general pediatricians from several teaching hospitals and government hospitals all over Indonesia. RESULTS: Data were obtained from 100 pediatricians, with a mean of 78.34 ± 18.00 mo clinical practice, from 20 cities throughout Indonesia. Suspicion of constipation in a child over 6 mo of age arises when the child presents with a decreased frequency of bowel movements (according to 87% of participants) with a mean of one bowel movement per 3.59 ± 1.0 d, hard stools (83%), blood in the stools (36%), fecal incontinence (33%), and/or difficulty in defecating (47%). Only 26 pediatricians prescribe pharmacologic treatment as first therapeutic approach, while the vast majority prefers nonpharmacologic treatment, mostly (according to 68%) The preferred nonpharmacologic treatment are high-fiber diet (96%), increased fluid intake (90%), toilet training (74%), and abdominal massage (49%). Duration of non-pharmacological treatment was limited to 1 to 2 wk. Seventy percent of the pediatricians recommending toilet training could only mention some elements of the technique, and only 15% was able to explain it fully and correctly. Lactulose is the most frequent pharmacologic intervention used (87% of the participants), and rectal treatment with sodium citrate, sodium lauryl sulfo acetate, and sorbitol is the most frequent rectal treatment (85%). Only 51% will prescribe rectal treatment for fecal impaction. The majority of the pediatricians (69%) expect a positive response during the first week with a mean (± SD) of 4.1 (± 2.56) d. Most participants (86%) treat during one month or even less. And the majority (67%) stops treatment when the frequency and/or consistency of the stools have become normal, or if the patient had no longer complaints. CONCLUSION: These data provide an insight on the diagnosis and management of constipation in childhood in Indonesia. Although general pediatricians are aware of some important aspects of the diagnosis and mangement of constipation, overall knowledge is limited. Efforts should be made to improve the distribution of existing guidelines. These findings highlight and confirm the difficulties in spreading existing information from guidelines to general pediatricians.

Aim Regurgitation, infantile colic and functional constipation are common functional gastrointestinal disorders (FGIDs) during infancy. Our aim was to carry out a concise review of the literature, evaluate the impact of these common FGIDs on infants and their families, and provide an overview of national and international guidelines and peer‐reviewed expert recommendations on their management. Methods National and international guidelines and peer‐reviewed expert recommendations on the management of regurgitation, infantile colic and functional constipation were examined and summarised. Results Regurgitation, infantile colic and functional constipation cause frequent parental concerns, lead to heavy personal and economic costs for families and impose a financial burden on public healthcare systems. Guidelines emphasise that the first‐line management of these common FGIDs should focus on parental education, reassurance and nutritional advice. Nutritional advice should stress the benefits of continuing breastfeeding, while special infant formulas may be considered for non‐breastfed infants with common FGIDs. Drug treatment is seldom required, with the exception of functional constipation. Conclusion By providing complete and updated parental education, reassurance and nutritional advice, healthcare professionals can optimise the management of FGIDs and related symptoms and reduce the inappropriate use of medication or dietary interventions.

Recurrent urinary tract infection (UTI) in children is a well-known risk factor of chronic kidney disease. Periurethral area is normally inhabited by non-pathogenic flora, such as Bifidobacterium sp., and pathogenic flora from gastrointestinal tract, such as Escherichia coli (E. coli), which can cause UTI. Dysbiosis between pathogenic and non-pathogenic bacteria leads to infections, but studies regarding dysbiosis and recurrent UTI have not yet been documented. To estimate the proportional differences between gastrointestinal E. coli and Bifidobacterium sp. in children with recurrent UTI, a cross-sectional study was conducted in children from age six months to

Cow’s milk protein allergy (CMPA) is a food allergy mostly suffered by children aged 3 years that can be mediated by IgE or non-IgE or both. The prevalence of CMPA in children is heterogeneous between populations. Meta-analysis study showed that the prevalence was 2-3% in infants and 1% in children aged 6 years. Although the prevalence is quite small but proper management is very important because it affects the quality of life of children and to avoid the risk of anaphylactic reaction that threatens life. Therapy for CMPA is to avoid cow's milk protein and its derivatives; it is also recommended for breast-feeding mothers to do the same. Therapeutic milk formulas that can be given is extensively hydrolyzed formula (eHF) or soy infant formula (SIF). The selection of formula became adebate, especially about the safety, effectiveness and cost. Keywords: cow milk protein allergy, soy infant formula, extensively hydrolyzed formula

OBJECTIVE: To investigate the efficacy of probiotics added to oral rehydration solution and zinc in the treatment of acute infectious diarrhea in Indonesian children. METHODS: A prospective randomized double blind placebo-controlled trial was performed to test the efficacy of a probiotic food supplement in 112 children in the Kenari subdistrict, central Jakarta, aged 6-36 mo with acute infectious diarrhea and moderate dehydration. The supplemented group was given standard therapy (oral rehydration solution and zinc) and the probiotic strains Lactobacillus (L.) rhamnosus R0011 1.9?×?109 colony forming units (cfu) and L. acidophilus R0052 0.1?×?109 cfu/d for 7 d, while the control group was given standard therapy and placebo. RESULTS: Median duration of diarrhea was 68.5 h (range 13-165) in the supplemented and 61.5 h (range 21-166) in the control group (P?=?0.596). Median daily frequency of defecation until diarrhea stopped was 5.0 in the supplemented vs. 5.5 in the control group (P?=?0.795). CONCLUSIONS: This probiotic food supplement tested did not reduce the duration of acute infectious diarrhea as compared to oral rehydration and zinc.

Background Despite the WHO and UNICEF recorrunendations, the well-known breastfeeding benefits, and the efforts to promote and support breastfeeding; exclusive breastfeeding by Indonesian mothers remains low and contributes to high infant mortality rates.Objective To elucidate the fac tors that influence mothers' choices for infant feedingMethods This qualitative study was conducted as part of a nationwide survey. The study included 36 in-depth interviews of mothers with infants aged 0-11 months, and health care professionals, including general practitioners, pediatricians, and midwives. This study was performed between 0 cto ber - November 2 0 l 0 in both rural and urban areas of 4 provinces in Indon esia.Results We found that most mothers intended to breastfeed and had positive perceptions of breastfeeding. However, mothers faced many challenges in the practice of exclusive and proper breastfeeding. Additionally, the perceived definition of exclusive breastfeeding varied among the participants, leading to n on-exclusive breastfeeding attitudes. The most frequent reasons for mothers to introduce additional milk formula or food were the perception of an inadequate milk supply, infant dissatisfaction or fu ssiness after feeding. Different perceptions were also demonstrated in different regions and the varying levels of socioeconomic status. Health care practitioners (HCPs) were the most reliable source for giving adequate information, but unfortunately, they were not easily accessible and provided inconsistent information. Consequently, closely-related family members were the major contributors of information to a mother'schoice of infant feeding; because they were easily accessible.Conclusion Factors influencing mothers in their breastfeeding practices are their basic knowledge, demographic and socioeconomic status, as well as the availability of support from closelyrelatedfamily members, friends, and HCPs.

Effective implementation of evidence-based practice guidelines has the potential to improve quality of hospital care for children. To achieve this in Indonesia, a locally adapted version of the WHO Pocket Book of Hospital Care for Children was published in 2009.To document implementation of the Pocket Book in Indonesia and to compare uptake in health facilities in which there has been a quality-improvement approach involving audit and feedback with uptake in settings in which there has been only passive dissemination.Indonesian district health offices, district hospitals, health centres with beds, and medical schools were surveyed by telephone, and an online and telephone survey of paediatricians was conducted. Health facilities in four provinces were visited, and key stakeholders were interviewed. Health facilities were assessed on availability of the guidelines, use by staff, and their incorporation into hospital procedures and activities.There was evidence of use of the Pocket Book across Indonesia, despite limited funding for implementation. Its distribution had reached all provinces; 61% (33/54) of health facilities surveyed had a copy of the guidelines. Hospitals involved in a related quality audit were more likely to report use of the guidelines than hospitals exposed to passive dissemination, although this difference was not significant. Of 150 paediatricians sampled, 109 (73%) reported referring to the guidelines in their clinical practice. The guidelines have been incorporated into the postgraduate paediatric curriculum in four of 13 universities sampled.There was encouraging evidence of uptake of the Pocket Book in Indonesia following local adaptation, nationwide mailing distribution and small-scale local implementation activities.

Purpose: Regurgitation is known to peak at the age of 3-4 months, with a sharp decrease around the age of 6 months. Little is known about the natural evolution of infants who still regurgitate after the age of 6 months. Methods: Hundred thirty-one infants older than 6 months regurgitating more than once a day were followed for a period of 3 months. Results: According to our data, gastroesophageal reflux disease (GERD) is seldom at this age. Most of the infants regurgitated 3 or more times/day and spit up an estimated volume of more than 15 mL. Eighty-five parents were educated regarding frequency of feeding. There were only 6 infants that still had frequent regurgitation (＞3 times/day) despite an appropriate feeding schedule. The Infant GER Questionnaire score reached a score of 0 in 50% of the infants after one month of follow-up and in 81.9% at the third month of follow-up. There was an increase of the “weight for age z-score” trends in infants that still regurgitated at the end of follow-up and a declining z-score in infants that no longer regurgitated. An explanation may be that infants that regurgitate drink larger volumes than infants who do not regurgitate. Conservative treatment (reassurance, dietary treatment, behavioral advice) resulted in a significant better outcome than natural evolution. Conclusion: Regurgitation that persisted after the age of 6 months, strongly decreased during a 3-month follow-up with conservative treatment. GERD is rare in this age group; therefore, anti-reflux medication is only seldom needed.

Objective: To evaluate the incidence of small bowel bacterial overgrowth (SBBO) in children treated with omeprazole, and to test whether probiotics influence the incidence. Methods: A double-blinded, placebo-controlled trial was performed in 70 children treated orally during four weeks with 20 mg omeprazole per day. Lactobacillus rhamnosus R0011 (1.9 × 109 cfu) and Lactobacillus acidophillus R0052 (0.1 × 109 cfu) were simultaneously given daily to 36 subjects (probiotic group), while 34 subjects received placebo (placebo group). The diagnosis of SBBO was based on the development of suggestive symptoms, in combination with a positive glucose breath test. Results: After one month of proton pump inhibitor (PPI) treatment, 30% (21/70) had a positive breath test suggesting SBBO; of these 62% were symptomatic. Five children developed SBBO-like symptoms, but had a negative breath test; and 44 (63%) were symptom free and had a negative breath test. There was no difference in the incidence of positive breath tests in the probiotic versus the placebo group (33% vs 26.5%; p = 0.13). Conclusions: Since symptoms suggesting SBBO developed in 26% of PPI-treated children, and since the glucose breath test was abnormal in 72% of these, this side-effect should be more frequently considered. The probiotic tested did not decrease the risk to develop SBBO. Resumo: Objetivo: Avaliar a incidência de SBID em crianças tratadas com omeprazol e testar se os probióticos influenciam essa incidência. Métodos: Um ensaio duplo-cego controlado por placebo foi realizado em 70 crianças tratadas oralmente, durante 4 semanas, com 20 mg de omeprazol por dia. Desses, 36 indivíduos receberam diária e simultaneamente Lactobacillus rhamnosus R0011 (1,9 × 109 cfu) e Lactobacillus acidophillus R0052 (0,1 × 109 cfu) (grupo probiótico), enquanto 34 receberam placebo (grupo placebo). O diagnóstico de SBID teve como base o desenvolvimento de sintomas sugestivos em combinação com um teste respiratório com glicose positivo. Resultados: Após um mês de tratamento com IBP, 30% (21/70) apresentaram um teste respiratório positivo sugerindo SBID; desses, 62% foram sintomáticos. Cinco crianças desenvolveram sintomas parecidos com os de SBID, mas apresentaram um teste respiratório negativo; 44 (63%) não apresentavam sintomas e tiveram teste respiratório negativo. Não houve diferença na incidência de testes respiratórios positivos no grupo probiótico em comparação ao grupo placebo (33% em comparação a 26,5%; p: 0,13). Conclusões: Como houve sintomas sugestivos de SBID em 26% das crianças tratadas com IBP e o teste respiratório com glicose deu resultados anormais em 72% delas, esse efeito colateral deve ser levado em consideração com mais frequência. O probiótico testado não reduziu o risco de desenvolver SBID. Keywords: (Hydrogen) breath test, Diarrhea, Flatulence, Omeprazole, Probiotic, Proton pump inhibitor, Small bowel bacterial overgrowth, Palavras-chave: Teste de hidrogênio no ar expirado, Diarreia, Flatulência, Omeprazol, Probiótico, Inibidor da bomba de prótons, Supercrescimento bacteriano do intestino delgado

Gastroesophageal reflux (GER) is the passage of gastric contents into the esophagus and is a normal physiologic process occurring several times per day in healthy individuals. In older children and adolescents, history and physical examination may be sufficient to diagnose gastroesophageal reflux disease (GERD).Endoscopically-visible breaks in the distal esophageal mucosa are the most reliable evidence of reflux esophagitis. Esophageal pH monitoring quantitatively measures esophageal acid exposure. Combined multiple intraluminal impedance and pH monitoring (MII-pH) measures acidic, weakly acidic, non-acidic and gas reflux episodes. MII-pH is superior to pH monitoring alone for evaluation of the temporal relationship between symptoms and GERER. Barium contrast radiography is not useful for the GERERD diagnosis, but may be used to detect anatomic abnormalities. Parental education, guidance, and support are always required and usually sufficient to manage healthy, thriving infants with symptoms likely due to physiologic GERER. Use of a thickened, commercially available anti-regurgitation formula by preference, may decrease visible regurgitation. Buffering agents, alginate and sucralfate, can be beneficial if used as needed for occasional heartburn. Proton-pump inhibitors (PPIs) are superior to histamine-2 receptor antagonists (H2RAs).

Background: A self-assessment questionnaire, the GERD-Questionnaire (GERD-Q) was used to determine the prevalence of GERD in adolescents, describe the related factors, and determine the impact on quality of life (QoL). Methods: The incidence of GERD was evaluated using the GERD-Q in adolescents aged 12-18 years. The Pediatric Gastroesophageal Reflux Disease Symptom Questionnaire and Quality of Life Questionnaire (PGSQ-A) for adolescents were additionally administered. Some factors considered related to GERD were also evaluated. Results: The 520 adolescents were included. The prevalence of suspected GERD, according to a GERD-Q cutoff score of ≥7 was 32.9%, and those drinking soda were 1.7 times more likely to have GERD (95% confidence interval, 1.3-2.2; p

Purpose Feeding tolerance is extremely important in preterm infants. This study aimed to evaluate whether preterm infants receiving Lactobacillus reuteri DSM 17938 would develop fewer symptoms of feeding intolerance. Secondary outcomes were duration of parenteral nutrition, time to reach full feeding, length of hospital stay, sepsis, necrotizing enterocolitis (NEC), diarrhea, and mortality. Methods This double-blind randomized controlled trial of L. reuteri DSM 17938 versus placebo included 94 neonates with a gestational age of 28-34 weeks and birth weight of 1,000-1,800 g. Results Feeding intolerance (vomiting and/or distension) was less common in the probiotic group than in the placebo group (8.5% vs. 25.5%; relative risk, 0.33; 95% confidence interval, 0.12-0.96; p=0.03). No significant intergroup differences were found in proven sepsis, time to reach full feeding, length of hospital stay, or diarrhea. The prevalence of NEC (stages 2 and 3) was 6.4% in the placebo group vs. 0% in the probiotic group (relative risk, 1.07; 95% confidence interval, 0.99-1.15; p=0.24). Mortality rates were 2.1% in the probiotic group and 8.5% in the placebo group, p=0.36). Conclusion The administration of L. reuteri DSM 17938 to preterm infants was safe and significantly reduced feeding intolerance. No significant differences were found in any other secondary outcomes.

Background Untreated gastroesophageal reflux can cause reflux esophagitis, a condition characterized by damage to the esophageal mucous layer due to exposure to caustic gastric contents. Manifestation of esophagitis in young children include feeding problems, irritability, and back􀀳arching. Persistent esophagitis may cause growth failure, gastric bleeding, and anemia. Reflux esophagitis should be considered an etiology of feeding problems, especially in children with a history of gastroesophageal reflux during infancy. Objective The purpose of this study is to detennine the prevalence of reflux esophagitis in children with feeding problems. Methods A cros-sectional study was done in November 2007 to April 2008. Children under 5 years of age with feeding problems and a history of regurgitation or vomiting started from age 6 months or more underwent endoscopy and biopsy examinations. Reflux esophagitis was diagnosed based on the Los Angeles classification of endoscopic examination. Results Reflux esophagitis was diagnosed in 18 of 21 children with feeding problems and a history of regurgitation or vomiting. Most subjects were boys aged 12 to36 months. Feeding problems has lasted for more than 6 months, regurgitation or vomiting for more than 12 months, and suffered from mild malnutrition. Vomiting was observed to be a common symptom in children with reflux esophagitis. Conclusion The prevalence of reflux esophagitis in children with feeding problems and a history of regurgitation or vomiting started from age ≥ 6 months is high, therefore it will influence treatment.

Aim: Although domperidone is used frequently to treat infant regurgitation, efficacy data are scarce. Cisapride was previously used in the same indication. Methods: Domperidone and cisapride were compared in an investigator-blinded, prospective comparative trial by evaluating (a) the frequency of regurgitation, (b) acid reflux and (c) cardiac side effects in infants regurgitating >4 times/day since >2 weeks and with reflux-associated symptoms of discomfort, after conservative treatment failure. Results: Within the first treatment week, the frequency of regurgitation decreased in both groups, more rapidly in the cisapride group: the median regurgitation decreased from 6.22 to 3.50 in the cisapride group versus from 4.80 to 3.70 in the domperidone group. The decrease in regurgitation was still significant after 1 month: cisapride from 6.22 to 1.55 versus domperidone from 4.80 to 1.25. However, the natural decrease in the incidence of regurgitation induced by age should also be considered. The median reflux index decreased after 1 month in the cisapride group from 3.60 to 1.75 versus from 2.70 to 2.45 in the domperidone group. One child treated with cisapride developed a significant QT prolongation. Conclusion: The decrease in regurgitation was comparable in both groups, although acid reflux decreased more in the cisapride group. Cisapride induced QT prolongation in one infant.

Purpose: Lactose intolerance (LI) is perceived to be frequent in Asia and has been reported to have considerable impact on dietary intake, nutritional status and the quality of life. We aimed to gather information from healthcare professionals on the perceived incidence, diagnosis and management of LI in 1 to 5 year old children in Southeast Asia.Methods: An anonymous electronic survey was sent randomly among healthcare professionals registered in the database of the pediatric societies in Thailand, Indonesia, and Singapore between June and October 2016.Results: In total, 259 health care professionals responded of which 45.5% (n=118) were from Thailand, 37.4% (n=97) from Indonesia and 16.9% (n=44) from Singapore. Of the participants who responded (n=248), primary LI prevalence among children 1 to 3 years of age was estimated to be less than 5% by 56.8%. However, about 18.9% (n=47) answered they did not know/unsure. Regarding secondary LI, 61.6% of respondents (n=153) estimated the prevalence to be less than 15%. But again, 10.8% (n=27) answered they did not know or unsure. Rotavirus gastroenteritis was ranked as the top cause for secondary LI. There was considerable heterogeneity in the diagnostic methods used. The majority of respondents (75%) recommended lactose-free milk to manage primary and secondary LI.Conclusion: More education/training of pediatricians on this topic and further epidemiological studies using a more systematic approach are required.

Objectives: The aim of the study was to review published evidence and the opinion of practising clinicians on the prevalence and long-term health consequences of functional gastrointestinal symptoms in infants younger than 12 months. Methods: PubMed was searched from inception to November 2014 to find articles reporting the prevalence and long-term health outcomes of infantile colic, regurgitation, functional constipation, functional diarrhoea, and dyschezia in infants younger than

Disorders of gastric motility are generally manifested by an abnormal rate of gastric emptying. The emptying process of the stomach is very complex, and knowledge is limited to the observation that gastric emptying rate is a highly variable phenomenon, and that delayed gastric emptying is frequently the case. The advances in the knowledge of the physiology of gastric muscle and enteric nerves, and the recognition of the patterns of organization of smooth muscle contractions gave a new input to the study of gastric motility. The gastric emptying can be monitored in various ways, such as manometry, scintigraphy, or electrogastrography (EGG). Recently, EGG has received more attention. There is correlation between the EGG signal obtained from body surface electrodes and signals obtained directly from electrodes locates in the gastric muscle (serosal records). Some studies showed an association between EGG-findings and gastric motility disorders, and indicate that EGG is a reliable, non-invasive, useful method to detect gastric myoelectric activity.

Background: Standard distal esophageal pH monitoring data are sometimes within normal ranges in children with clinically suspected gastroesophageal reflux disease. Therefore, the authors hypothesized that the amount of acid reflux reaching the proximal esophagus may be greater in some subgroups of patients than in healthy controls or in other subgroups of patients. Methods: The parameters of 24-hour pH monitoring in the proximal part of the esophagus were analyzed in 120 symptomatic infants in who the reflux parameters in the lower esophagus were clearly within normal ranges (reflux index < 5.0%). The infants were classified into four patient groups: excessive regurgitation (n = 41); inconsolable crying (n = 31), apparent life- threatening event (ALTE) (n = 18), and chronic respiratory disorders (n = 30). The control group consisted also of 120 infants. The following parameters were calculated: reflux index, the number of reflux episodes, the number of reflux episodes lasting longer than 5 minutes, the duration of the longest reflux episode, and the acid clearance time (ACT, duration of reflux episodes divided by number of reflux episodes). Results: The patients with chronic respiratory disorders were significantly older than the patients in the other groups and the controls. In the distal esophagus, there was no statistically significant difference between the reflux parameters. As could be expected, every parameter was statistically (paired t test, Wilcoxon signed-rank test) significantly smaller in the proximal than in the distal esophagus, except for the ACT in infants who presented with inconsolable crying. In the proximal esophagus, there was no statistically significant difference between the different patient subgroups or controls, except for the number of reflux episodes in the group with chronic respiratory disorders and the group with inconsolable crying, applying one-way analysis of variance. As determined by applying the Mann-Whitney test, the number of reflux episodes in the upper esophagus was significantly higher in the group with chronic respiratory disorders than in the other patient groups and controls. Therefore, the authors' data do not support the hypothesis that reflux reaching the proximal esophagus is a frequent cause of ALTE. However, the data may suggest that the number of reflux episodes reaching the proximal esophagus in children with chronic respiratory disorders and with distal pH monitoring data within normal ranges may be increased. Whether this finding reflects reality or a statistical coincidence, or is influenced by the older age of this patient group, needs further evaluation. Conclusions: In theory, dual simultaneous esophageal pH monitoring in the distal and proximal esophagus may increase the diagnostic accuracy of pH monitoring in infants. Our results do not support a substantial advantage of a systematic application of this new technique, especially not in infants presenting with ALTE, excessive regurgitation, or inconsolable crying. In the subgroup of patients with chronic respiratory disorders, more data are needed before conclusions can be determined and recommendations can be made.

Background: Oesophageal pH monitoring is considered to be the gold standard investigation in the diagnosis of gastro-oesophageal reflux disease. Results of pH monitoring in regurgitating infants, however, may be within normal ranges. Therefore it was hypothesized that prolonged buffering of gastric acidity caused by milk-feeding may falsely normalize the pH data. Therefore, it may be relevant to omit the periods of gastric acid buffering in the analysis of the oesophageal pH monitoring data. Methods: Combined gastric and oesophageal pH monitoring (Digitrapper Mark III, two-channel antimony electrode, Synectics) was performed in 90 consecutive infants, 0.5–10 months old, who were referred to the unit by outdoor paediatricians for pH measurement. The data were analysed in three different ways. The reflux index (RI), or the percentage time that the pH in the oesophagus was < 4.0, was calculated in three different ways: (i) the total duration of the investigation; (ii) excluding 90-min postprandial periods, starting from the beginning of a feeding; and (iii) excluding all periods with a gastric pH > 4.0, which are the periods of gastric buffering with a theoretical impossibility of recording an oesophageal pH < 4.0. Results: The mean duration of the pHmetries was 19.20 ± 2.01 h (A; mean ± 1 SD), with a RI of 5.38 ± 5.39% (B; median 3.45%). If the 90-min postprandial periods were not considered, the mean duration decreased to 12.21 ± 2.41 h (C; P(A vs C) < 0.001), with an oesophageal RI of 6.82 ± 6.57% (D; median: 4.65; P(B vs D) = NS; r (B vs D) = 0.97). If all periods with a gastric pH > 4.0 were elminated, the duration available for analysis of the data with a gastric pH < 4.0 was 12.53 ± 4.00 h (E; P(A vs E) < 0.001; P(C vs E) = NS), with an oesophageal RI of 7.06 ± 7.52% (F; median: 4.50; P(B vs D vs F) = NS; r(B vs F), (D vs F) = 0.96). Conclusion: Overall the data do not support a benefit from including periods of gastric buffering in the routine analysis of oesophageal pH monitoring data. Therefore standardoesophageal pH monitoring should be with a single electrode and should not include periods of gastric buffering.

Background Breast milk is the best and most ideal food for babies because it contains all nutrition needed for their optimal growth and development. Babies who receive breast milk will have strong immune system, good brain development, and closer emotional bonding with their mothers. Considering the importance of breast milk, Indonesian government has been campaigning to endorse exclusive breastfeeding up to six months in the last four years. To date, there is no national data available to evaluate the exclusive breastfeeding program. Therefore, Indonesian Pediatric Society (IDAI) conducted a national survey on breastfeeding to investigate exclusive breastfeeding rate in Indonesia.Objective To find out the prevalence of exclusive breastfeeding in Indonesia.Methods This study included 22 provinces in Indonesia and targeted on mothers with infants aged 0-11 months. For the quantitative portion of the study we used simple random sampling design to get the prevalence from the population. For the qualitative interview data we used a stratified random sampling design to ensure that each infant age group was well represented. Survey location in each province was selected based on defining the capital city to be urban area and its sub-urban areas to be rural. This study was performed between October – November 2010.Results We found that the prevalences of breastfeeding among baby 0-11 months was quite high which were 91%, 86%, and 72% in infants aged 0-3 months, 0-6 months, and 6-11 months, respectively. Interestingly, the prevalence of breastfeeding in urban area was higher than in rural area for infants aged 6-11 months. However, despite the high prevalence of giving breast milk, less than half of mothers gave breast milk exclusively, to babies aged 0-3 months and to those aged 0-6 months. The awareness to exclusively breastfeed was greater for urban mothers than for rural ones in those with infants aged 0-6 months. Mothers with high socioeconomic status had the highest prevalence of exclusive breastfeeding. The prevalence of breastfeeding without formula was still the highest up to 12 months but the role of giving formula was increasing especially in rural area. The prevalence of breast milk introduced as the first milk was around 60%. Java and Sumatra had lower prevalence of breast milk introduced as the first milk compared to Kalimantan and Sulawesi. We also found that mothers started giving solid food from an early age, especially in rural areas. With increasing age, the frequency of giving breast milk declined in both urban and rural areas.Conclusion The overall prevalence of exclusive breastfeeding up to 6 months of age in Indonesia was 49.8%. Maternal unemployment and high family socioeconomic status were associated with longer duration of breastfeeding.

Background Gastroesophageal reflux (GER) is reported to be one of the most common causes of chronic recurrent cough (CRC). In Indonesia, so far there is no published data concerning GER in children with CRC. Objectives To determine the prevalence of GER in children with CRC in general, and asthma in particular; and to describe the clinical profile associated with GER in these children. Methods This was a cross sectional study on children with CRC who were investigated for GER using 24-hour esophageal pH monitoring. GER was graded based on reflux index (RI) stated in pHmetry results i.e., mild (RI=5-10%), moderate (RI>10-20%), and severe (RI>20%). Results Among 48 children with CRC, GER was detected in 22 (46%) of them (mild GER in 14, moderate in 3, and severe in 5 children). In 35 children with asthma, which is the most frequent cause of CRC in our hospital, GER was detected in 15. The prevalence of GER increased parallel with the frequency of cough episodes i.e., 10/27 in children with infrequent episodes of cough, 4/ 10 in children with frequent episodes of cough, and 8/11 in children with persistent cough. Clinical profiles associated with GER in these children were persistent/ frequent episodes of CRC and undernutrition. Conclusions The prevalence of GER in children with CRC was 46%, and in those with asthma was 15/35. The clinical profiles associated with GER are persistent/frequent episodes of CRC and undernutrition [Paediatr Indones 2004;44:201-205].

Background Breast milk is the ideal food for infants. According to the 2007 Indonesian National Household Health Survey, only 23% of mothers exclusively breastfeed for six months.Objectives To determine the rate of exclusive breastfeeding in Indonesia, to evaluate factors associated with infant feeding practices, and to compare the nutritional and developmental status between exclusively-breastfed and formula-fed infants.Methods A survey was conducted in hospitals located in 17 provinces in Indonesia. The rate of exclusive breastfeeding was calculated. Many variables were investigated as potential predictors for exclusive breastfeeding using a multivariable logistic regression analysis. Further analysis was performed to compare the nutritional and developmental status between exclusively breastfed and formula-fed infants at the time of survey.Results From 1,804 infant subjects, the overall rate of exclusive breastfeeding was 46.3%, ranging from 10.5% in East Java to 66.9% in Jambi. Predominant breastfeeding, complementary feeding, and formula feeding rates were 14.3%, 8.6%, and 30.7%, respectively. Maternal unemployment was associated with a longer duration of breastfeeding (P=0.000). There were significantly more formula-fed infants who were undernourished compared to exclusively-breastfed infants (14% vs. 8%, P=0.001). There were also significantly more infants in the formula-fed group who had abnormal head circumference compared to those in the exclusively-breastfed group (9% vs. 6%, P=0.031). Child development, as assessed by the Pre-screening Developmental Questionnaire, was similar between the two groups (P=0.996).Conclusion The overall rate of exclusive breastfeeding in Indonesia is 46.3%. Maternal unemployment is associated with longer duration of breastfeeding. Exclusive breastfed infants have significant better growth and head circumference compared to formula fed infants, while the development is similar between the two groups.

Objectives: To determine the natural history of infant regurgitation during the first year of life. Methods: Parents recorded prospectively the frequency of regurgitation for 1 week before consultation during the first year of life. A sub-group analysis according to the method of feeding was planned. Results: A total of 130 infants of an original sample of 163 (80%) newborns were followed up for 1 year. Daily spilling was highest during the first month of life (73%) and decreased gradually to 50% during the fifth month of life. During the first 2 months of life, 20% of the infants regurgitated more than four times per day. After the age of 12 months, only 4% of the infants had daily regurgitations. Exclusively breastfed infants did regurgitate less than partially breastfed infants. Weight gain was influenced by the frequency of regurgitation, especially in partially breastfed infants. Conclusion: Regurgitation in infancy is common, decreasing from birth, and tends to disappear by 12 months of age. Weight gain during the first 4 months of life is decreased in infants who regurgitate more than four times a day. Our data suggest that exclusively breastfed infants regurgitate less than partially breastfed babies.

BACKGROUND: Regurgitation is frequent in infants. We evaluated changes in regurgitation among patient groups fed standard formula, standard formula subsequently thickened with cereal, or formula manufactured with bean gum as a thickening agent. PATIENTS AND METHODS: A prospective, blinded, randomised 1-month intervention trial evaluating the efficacy of parental reassurance of the regurgitating child in combination with 3 formula interventions--standard infant formula (group A); 5 g of rice cereal added to 100 mL standard formula (group B); and formula manufactured with bean gum as a thickening agent (group C)--was performed in 60 infants presenting with more than 4 episodes of regurgitation and/or vomiting per day during the week before inclusion. Formula intake, infant comfort, stool aspects, and weight gain were evaluated. All of the infants and data recorded by parents in a diary were evaluated weekly by a blinded health care professional. RESULTS: At baseline, groups A, B, and C were similar for all of the parameters. After the 1-month intervention, regurgitation/vomiting decreased significantly in all 3 groups (P

Background Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. Increasing prevalences have been reported in Asian adolescent populations, however, there have been few reports on Indonesian adolescents. Objective To investigate the prevalence of IBS and associated factors among adolescents in Jakarta. Methods This cross-sectional study included senior high school students in a district of Jakarta. Students were asked to fill questionnaires based on the Rome III criteria for IBS. They were then divided into groups: those with IBS and those without IBS, for the purposes of comparison. Results Out of 232 adolescents (145 females and 87 males) with mean age of 16.06 (SD 0.91) years, 14 (6.0%) had IBS. Eleven out of 14 adolescents with IBS reported upper abdominal pain as well as periumbilical/lower abdominal pain. Irritable bowel syndrome was not associated with socioeconomic status, food and drink habits, the use of antibiotics, or scolding as a parental form of discipline. However, a significant higher proportion in the use of corporal punishment was found in IBS adolescents compared to the non-IBS (P=0.034). In addition, stress related to scolding, as a parental form of discipline was more likely to be found in the IBS group than in the non-IBS group (P=0.019). Conclusion The prevalence of IBS among adolescents in Jakarta is 6%, which is lower compared to those of other Asian countries. Corporal punishment at home and stress related to scolding at home are found to be associated with IBS.

D-dimer is a molecule as result of breaking down of excessive fibrin formation from the activation of coagulation system. There is evidence of increased activation of coagulation in patients with acute leukemia which was showed by the increment of d-dimer levels. Objective To evaluate the incidence of activation of coagulation system in children with acute leukemia before receiving chemotherapy. Method This cross-sectional study was performed at Dr. Cipto Mangunkusumo Hospital. All newly-diagnosed children with acute leukemia were included in this study, prior to their receiving any chemotherapy treatment. Blast count, prothrombin time (PTT), activated partial thromboplastin time (APTT), and D-dimer levels were examined after the diagnosis was confirmed by morphology and immunophenotyping studies on bone marrow specimens. Results Out of 22 subjects, 13 subjects had increased D-dimer values. The median D-dimer level of this elevated group was 1,000 (range 500-14,700) ng/mL. In the acute myeloblastic leukemia (AML) patients, activation of coagulation was found in 7 out of 8 subjects. The median D-dimer levels was 950 (range 100-14,700) ng/mL. In the acute lymphocytic leukemia (ALL) patients, 6 out of 14 subjects had increased activation of coagulation with median D-dimer level of 300 (range 100-3,800) ng/mL. Nine out of 10 subjects with blast cells on peripheral blood smear had a median D-dimer level of 1,000 (range 500-3,800) ng/mL. Both PT and APTT were found normal in all subjects. Conclusion Activation of coagulation system occurs at the time of diagnosis as shown by increased D-dimer levels. The characteristics of activation of coagulation system are different between ALL and AML subjects, as well as between subjects with positive and negative blast counts on peripheral blood smears. Despite the increased activation of coagulation, PT and APTT remain normal. (Paediatr Indones. 2014;54:227-31.).

Dietary consumption of soy varies worldwide. In Asia, people traditionally consume large quantities of soy, while in Europe, soy is not part of the traditional or daily eating habits. The USA is a major soy producer. The mean intake of isoflavones by an adult is 8 - 50 mg/day in Asia but only 0.5 - 3.5 mg/day in the Western world.1 The soy intake of a vegetarian is 3 - 12 mg/day and a vegan achieves an intake of 15-60 mg/day.2 In the early 1900s, soy-protein preparations were the only option for the treatment of cow's milk protein allergy (CMPA) . The first report of the use of a soybean -based formula for infants dates from 1909.3 Most soy drinks are not enriched with zinc, iron, calcium, phosphorous, methionine, or carnitine. Soy drinks also do not contain soy isolate. Soy products that do not fulfill the criteria to be an infant formula are not adapted for infant feeding.

Background Glucocorticoids play an important role in the treatment ofacute lymphoblastic leukemia (ALL), but can cause side effects such as suppression of the hypothalamic-pituitaryadrenal (HPA) axis. Suppression of the HPA axis causes adrenal insufficiency, disturbs the cortisol response to stress, and may be a cause of morbidity and mortality in children with ALL. Objective To evaluate adrenal function in children with ALL after induction chemotherapy with high dose glucocorticoids. Methods The adrenal function of 20 children with ALL was evaluated using a standard dose (250 μ g) adrenocorticotropin hormone (ACTH) test performed before and after a 6 week of treatment with glucocorticoids induction phase chemotherapy, which was followed by a week period tapering off. Adrenal insuffien cy was defined as blood cortisol level of < 18 μg/dL Results Adrenal insufficiency was found in 14/20 subjects after the induction phase followed by a week period of tapering off. Median cortisol levels pre- and post-stimulation before induction phase were 14.72 (range 2.0 1- 46. 1) μg/dL and 29.29 (range 21.65 - 55 .15) μg/dL, respectively. Median cortisol levels pre- and poststimulation after induction phase were 5.87 (range 0.2 - 20.53) μg/dL and 10.49 (range 0.33 - 28.69) μg/dL, respectively. Clinical signs and symptoms did not differ between those with and without adrenal insufficiency. Conclusion Of 20 children with ALL, 14 develop adrenal insufficiency after a 6-week induction therapy with glucocorticoids and followed by a week period of tapering off. No specific clinical signs and symptoms are identified to be related to the adrenal insufficiency.

As gastro-oesophageal reflux disease (GORD) in infants and children is a motility disorder which differs in pathophysiology and clinical course from GORD in adults, prokinetics should be considered the drug of choice in certain circumstances. Indeed, cisapride may result in improvement of feeding tolerance in premature infants. Cisapride has a better tolerability profile than a 'wait-and-see-if-improvement-comes-spontaneously' policy or the other therapeutic options available. A careful and critical review of published data suggests that cisapride may have a QTc-prolonging effect. However, provided the precautions for cisapride administration are followed, the QTc-prolonging effect remains consistently without clinically relevant adverse effects. Correct dosage and avoidance of concurrent treatment with macrolides and/or azoles are the most relevant tolerability recommendations in children. Although there is a need for a prokinetic with better efficacy, cisapride is currently the prokinetic with the best benefit-to-risk ratio available. Thus, withdrawal of cisapride would result in a significantly increased risk for severe complications in infants and children with GORD or other gastrointestinal motility disorders such as chronic intestinal pseudo-obstruction, gastroparesis and feed intolerance in premature infants.

Gastro-oesophageal reflux is a frequent, aspecific phenomenon in infants and children. The recommended approach in infants with uncomplicated regurgitation consists of reassurance of the parents and, if this fails, dietary recommendations in formula-fed infants. If, despite these efforts, symptoms persist, administration of prokinetics, such as cisapride, is recommended prior to investigations such as oesophageal pH monitoring. Oesophageal pH monitoring is also recommended to document gastro-oesophageal reflux disease in children with unusual presentations such as chronic respiratory disease. Today, cisapride is the drug of choice because it has the best efficacy and safety profile. In infants and children presenting with symptoms suggesting oesophagitis, endoscopy of the upper gastrointestinal tract is recommended. If there is severe oesophagitis, acid suppression with histamine H2-receptor antagonists or proton pump inhibitors in combination with prokinetics, are recommended. In life-threatening situations, or in patients that are resistant to or dependent on acid-suppressive medication, a surgical procedure such as laparascopic Nissen procedure should be considered.