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Background This longitudinal study explored the relationship between trajectories of maternal depressive symptoms and offspring’s risk behavior in adolescence contributing to an extremely scarce literature about the impacts of maternal depression trajectories on offspring risk behaviors. Methods We included 3437 11-year-old adolescents from the 2004 Pelotas Birth Cohort Study. Trajectories of maternal depressive symptoms were constructed using Edinburgh Postnatal Depression Scale (EDPS) from age 3 months to 11 years. We identified five trajectories of maternal depressive symptoms: “low” “moderate low”, “increasing”, “decreasing”, and “chronic high”. The following adolescent outcomes were identified via self-report questionnaire and analyzed as binary outcome –yes/no: involvement in fights and alcohol use at age 11. We used logistic regression models to examine the effects of trajectories of maternal depressive symptoms on offspring’s risk behavior adjusting for potential confounding variable. Results Alcohol use and/or abuse as well as involvement in fights during adolescence, were not significantly associated with any specific trajectory of maternal depressive symptoms neither in the crude nor in the adjusted analyses. Conclusion Alcohol use and involvement in fights at age 11 were not associated with any specific trajectory of maternal depression.

Objective: The objective of this study was to evaluate the health-related quality of life in children and adolescents with autoimmune hepatitis. Methods: A cross-sectional assessment with the Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0) was completed for 80 patients with autoimmune hepatitis and 45 healthy controls. Demographic data, prednisone dose, disease remission state, disease severity, and abdominal pain were also evaluated. Results: Based on the child self-reports, physical, emotional, school, and total scores were significantly lower in autoimmune hepatitis patients when compared with controls (p 0.05). Autoimmune hepatitis patients who received a prednisone dose below 0.16 mg/kg/day at the time of the interview showed significantly higher physical scores than those who received a dose similar to or above 0.16 mg/kg/day (87.5 [50–100] vs. 75 [15.63–100], p = 0.006). Conclusions: Reduced scores in the physical, emotional, and school domains were observed in pediatric autoimmune hepatitis patients compared to control patients. Abdominal pain and corticosteroid dose negatively influenced the health-related quality of life in children and adolescents with autoimmune hepatitis. Resumo: Objetivo: Avaliar a qualidade de vida relacionada à saúde em crianças e adolescentes com hepatite autoimune (HAI). Métodos: Foi concluída uma avaliação transversal com o Inventário Pediátrico de Qualidade de Vida 4.0 (PedsQL 4.0) para 80 pacientes com hepatite autoimune e 45 controles saudáveis. Os dados demográficos, a dose de prednisona, o estado de remissão da doença, a gravidade da doença e dor abdominal também foram avaliados. Resultados: Com base nos autorrelatos das crianças, os escores físico, emocional, escolar e total foram significativamente menores em pacientes com hepatite autoimune em comparação com os controles (p < 0,05). Com base nos relatos dos pais, apenas os escores físico e total foram significativamente menores em pacientes com hepatite autoimune em comparação com os controles (p < 0,05). Uma análise adicional em pacientes com hepatite autoimune com dor abdominal no mês passado revelou escores médios físico, social e total significativamente menores (p < 0,05). Nenhuma diferença foi observada com base no estado de remissão da doença ou na gravidade da doença (p > 0,05). Os pacientes com hepatite autoimune que receberam uma dose de prednisona abaixo de 0,16 mg/kg/dia no momento da entrevista mostraram escores físicos significativamente maiores que os que receberam uma dose semelhante ou acima de 0,16 mg/kg/dia [87,5 (50-100) em comparação com 75 (15,63-100), p = 0,006]. Conclusões: Escores reduzidos nos domínios físico, emocional e escolar foram observados em pacientes pediátricos com hepatite autoimune em comparação com pacientes do grupo de controle. Dor abdominal e dose de corticosteroide influenciaram negativamente a qualidade de vida relacionada à saúde em crianças e adolescentes com hepatite autoimune. Keywords: Quality of life, Autoimmune hepatitis, Childhood, Adolescence, Chronic disease, PedsQL 4.0, Palavras-chave: Qualidade de vida, Hepatite autoimune, Infância, Adolescência, Doença crônica, PedsQL 4.0

Objective: Understanding the distal (≤ 6 years of age) and proximal (between 6 years of age and early adolescence) factors in adolescent risk behavior is important for preventing and reducing morbidity and mortality in this population. This study sought to investigate the factors associated with the following adolescent risk behaviors: i) aggressiveness and violence, ii) tobacco, alcohol, and illicit substance use, iii) depressive behavior and self-harm (including suicidal ideation and attempts), iv) sexual risk behavior, and v) multiple risk behavior. Methods: A systematic review was conducted to identify longitudinal studies that examined factors associated with adolescent risk behaviors. The PubMed, PsycINFO, and LILACS databases were searched. Results: Of the 249 included studies, 23% reported distal risk factors, while the remaining reported proximal risk factors. Risk factors were related to sociodemographic characteristics (neighborhood, school, and peers), family patterns, and the presence of other adolescent risk behaviors. Conclusion: Distal and proximal factors in adolescent risk behavior that are not exclusively socioeconomic, familial, environmental, or social should be explored more thoroughly.

RESUMO Objetivo: Revisar evidências atuais da relação entre transtorno obsessivo compulsivo e dificuldades alimentares. Métodos: Revisão das bases Science Direct e PubMed no período entre 2007 e 2017 em inglês, português e espanhol, com os termos em associação “transtorno obsessivo compulsivo” e “picky eating/dificuldade alimentar”. Foram selecionados apenas estudos de coorte, caso controle ou transversal, realizados em qualquer país, com crianças, adolescentes e/ou adultos e de qualquer tamanho amostral. Foram excluídos os artigos de opinião. Resultados: Cerca de 245 artigos foram selecionados e apenas 4 foram incluídos no estudo, segundo critérios de seleção. Os trabalhos descrevem essencialmente que há diferença no comportamento seletivo entre os sujeitos com e sem transtorno obsessivo compulsivo, com tendência para exacerbação de sintomas como nojo, ansiedade e escore de inflexibilidade de comportamento alimentar nos pacientes com esse transtorno. Conclusões: Existem sintomas compartilhados entre transtorno obsessivo compulsivo e dificuldade alimentar. O estudo alerta aos profissionais que acompanham pacientes com dificuldades alimentares para a importância da investigação de possíveis comorbidades psiquiátricas. ABSTRACT Objective: To review current evidence on the relationship between obsessive-compulsive disorder and feeding difficulties. Methods: Review the Science Direct and PubMed databases between 2007 and 2017 in English, Portuguese and Spanish. The search terms, used in association, were “obsessive compulsive disorder” and “picky eating/feeding difficulty”. Cohort, case control and cross sectional studies were included that analyzed children, adolescents and/or adults of any sample size from any country in the world. Opinion articles were excluded. Results: Around 245 articles were selected, and only 4 were included in this review, according to previous criteria. Results from the studies essentially described that there is indeed a difference in “picky” behaviors between subjects with and without obsessive-compulsive disorder. Patients with obsessive-compulsive disorder tend to have exacerbated symptoms of disgust, anxiety and a higher eating behavior inflexibility score. Conclusions: Obsessive-compulsive disorder and feeding difficulties patients share common symptoms. The present study alerts health professionals who follow patients with feeding difficulties as to the importance of investigating possible psychiatric comorbidities.

Background Given the positive influence of responsive caregiving on dietary habits in childhood, to raise awareness of caregivers regarding their behavior is crucial in multidisciplinary care on infant feeding. Objectives To identify the most common responsive and non-responsive feeding practices in mothers of children with feeding complaints, as well as to seek associations between practices and caregivers' profile. Methods Cross-sectional study with 77 children under 18 years old, with complaints of feeding difficulties. Data were collected during interviews with mothers: child age, gender, duration of exclusive breastfeeding, presence of organic disease, dynamics of bottle use, self-feeding practices and posture at meals, use of appropriate feeding equipment; basic information about the mothers (parity and level of education), caregiver feeding style, presence of coercive feeding, frequency and characteristics of family meals. Statistical analysis considered significance level at 5%. Results The non-responsive profile predominated among mothers (76.2%, with the Authoritarian style being the most prevalent-39.7%). The responsive profile was characterized by absence of coercive feeding, stimulation of self-feeding practices, use of appropriate feeding equipment and meal environment, with interaction at meals. Non-responsive profile consisted of both inadequate environment and posture at meals, use of distraction and coercive feeding, lack of shared meals, and disregard for children's hunger signals. Only the habit of sharing meals with children was associated with mothers' profile, and considered a protection factor against non-responsive care (OR 0.23; 95% CI 0.06-0.88). Both Authoritarian (p = 0.000) and indulgent mothers (p = 0.007) breastfed exclusively for longer time than negligent ones. There was a higher level of interaction with children in "responsive" parental style (OR 0.056; p = 0.01) compared to other feeding styles. Conclusion Results highlight the need for educational interventions focused on caregivers' behaviors.

Background Delays in gross motor development, sensory processing issues, and organic and behavioral problems are known to interfere in the development of feeding skills (FS); and—therefore—in the success of the process of feeding a child. Children with feeding difficulties (FD) commonly present inadequacy of FS. Objectives Assessment of five FS in Brazilian children with FD, and search of associations with types of FD. Methods Cross-sectional study with 70 children below 10 years old. Data were obtained from medical records: age, gender, age at texture transitions, feeding phase (breastfeeding, weaning to solids or full solids) at first complaint; characteristics of the meal (duration, environment, and shared meals with adults), self-feeding practices, use of feeding equipment and bottle, mouthing, feeding position and FD diagnosis. Skills were categorized according to standards for age. Chi-Square, Anova Test (or non-parametric equivalent) and Multinomial logistic regression tests were used, with a significance level of 5%. Results There was no difference in FS (p > 0.05) or in the number of FS inadequateness (p = 0.84) according to FD diagnosis. The majority (94%) of children presented at least one delayed development of FS; 1/3 presented delays in more than half of the FS. The most prevalent inadequacies in FS were inadequate feeding position (73.5%), prolonged bottle feeding (56.9%), and inadequate self-feeding practices (37.9%). Feeding complaints first appeared at 10.9 ± 11.4 months, and picky eating was the most prevalent type of FD (37.1%). Most children were fed in inadequate environments (55.2%), without the company of adults (78%). Transition to solid foods occurred at 16 ± 5.6 months. Multinomial logistic regression showed no difference in likelihood of presenting any type of FD compared to picky eating, according to FS. Age at texture transition both from breastfeeding to complementary feeding (p = 0.95), and from complementary feeding to solid foods (p = 0.43) did not vary according to FD diagnosis. Conclusion FS development or number of FS inadequateness did not vary according to FD diagnosis. Identification of these inadequacies could help the discussion for multi-professional treatment of patients with FD.

Background Iron deficiency anemia and feeding difficulties (FD) are common issues in childhood, reinforcing the concern about the risk of micronutrient deficiencies. FD do not necessarily reflect nutritional deficiencies, since they may or may not relate to specific nutrient sources. The objective of the study is to describe the prevalence of iron depletion and iron deficiency anemia in children with FD and to seek associations with diagnosis and its markers. Methods This is a cross-sectional study with 68 patients (convenience sample). The following data were assessed through medical records: age (months), gender, exclusive breastfeeding duration (months), birth weight (kg), iron supplementation, hemoglobin (Hb), ferritin, and C-reactive protein (CRP) levels, repertory of foods consumed (food inventory and 3-day food record analysis), and diagnosis of FD. Data were classified according to references for age and were analyzed using correlation tests, Student’s t test, ANOVA and chi-square test, or its nonparametric equivalents. A significance level of 5% was considered. Results Iron depletion and anemia were identified in 10.1 and 6% of children, respectively. Picky eating was diagnosed in 35.3%. Food repertory consisted on average of 21 foods, with null correlation to Hb and ferritin. The average fortified milk intake was 517 ml/day, with null correlation to Hb. There was no effect of diagnosis of FD on Hb (p = 0.18) or ferritin (p = 0.52). The same was verified in the children without supplementation, to both Hb (p = 0.54) and ferritin (p = 0.08). Conclusions No evidence of association between diagnosis of FD or repertory of foods to anemia or iron depletion was found, which could be a reassuring factor for caregivers. Reproduction in large scale as well as inclusion of dietary intake variables is suggested for further research.

Objectives: to review the prevalence of family meals and its impact on BMI and eating habits during childhood and adolescence. Methods: reviews are from Bireme / Lilacs / Scielo / Cochrane and Pubmed, between 2000-2016 with descriptors "family meal or mealtime", "behavior", "nutrition or diet or consumption or eating", and "child or children or adolescence"; performed by two independent examiners, according to the systematic steps in English and Portuguese. The articles were selected based on prevalence and/ or discussion between nutritional variables. 2,319 articles were found, which 15 were selected all in English: systematic reviews (n=2), cross-sectional studies (n=8), longitudinal studies (n=8); all related to children (n=5), adolescents (n=6) and both (n=5). Results: the mean of shared meals was 1x/day, with a prevalence of 27 to 81%. Most studies (n=13) reported the beneficial impact on BMI, higher consumption of fruit and vegetables, protein, calcium and a lower consumption of sweets and sugar sweetened beverages, family union and self-regulation of appetite. Conclusions: having daily family mealtime has beneficial effect on the nutritional status and children and adolescents' eating behavior.