Pediatric Clinics of North America RSS feed: Current Issue. Pediatric Clinics of North America provides the latest clinical information on health issues for children and adolescents. Each bimonthly issue focuses on a single topic and is written by pediatricians with proven experience. You'll receive cutting-edge, expert reviews of current diagnosis and treatment that can be applied directly to your practice. In addition, you can earn valuable CME credits - up to 90 per year - with your subscription.http://www.pediatric.theclinics.com/?rss=yesElsevier Inc.en © 2009 Elsevier Inc. All rights reserved. Pediatric Clinics of North America0031-3955565October 2009 © 2009 Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.pediatric.theclinics.com/article/PIIS0031395509001333/abstract?rss=yesCME Author Disclosure and Accreditation Page10.1016/j.pcl.2009.10.001Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-2iiiiiihttp://www.pediatric.theclinics.com/article/PIIS0031395509001412/abstract?rss=yesContents10.1016/S0031-3955(09)00141-2Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-2viixhttp://www.pediatric.theclinics.com/article/PIIS0031395509001424/abstract?rss=yesForthcoming Issues10.1016/S0031-3955(09)00142-4Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-2xixihttp://www.pediatric.theclinics.com/article/PIIS0031395509001151/abstract?rss=yes We are honored to edit this issue on “Nutritional Deficiencies” in the Pediatric Clinics of North America. The last issue of Pediatric Clinics of North America addressing nutritional problems was published 7 years ago. We have highlighted a spectrum of nutritional deficiencies ranging from those occurring despite normal health to those associated with a variety of disease states. Our aim is to provide pediatric practitioners and trainees across the globe with a comprehensive and practical clinical review that links pathophysiology with clinical manifestations and management strategies.PrefacePraveen S. Goday, Timothy S. Sentongo10.1016/j.pcl.2009.09.001Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-2xiiixivhttp://www.pediatric.theclinics.com/article/PIIS0031395509001114/abstract?rss=yesNutritional deficiencies have always been a major consideration in pediatrics. Although the classic forms of many of the well-documented nutritional deficiencies are memorized during training as a physician, nutritional deficiencies that can occur in otherwise asymptomatic normally growing children are often overlooked. The two most common deficiencies seen in children who are growing normally are iron and vitamin D deficiencies. These deficiencies are surprisingly common and can have a significant impact on the overall health of a child. This article reviews these nutritional deficiencies and other less commonly seen deficiencies in children who are otherwise growing normally.Nutritional Deficiencies During Normal GrowthDavid L. Suskind10.1016/j.pcl.2009.07.004Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-210351053http://www.pediatric.theclinics.com/article/PIIS0031395509000868/abstract?rss=yesProtein energy malnutrition (PEM) is a common problem worldwide and occurs in both developing and industrialized nations. In the developing world, it is frequently a result of socioeconomic, political, or environmental factors. In contrast, protein energy malnutrition in the developed world usually occurs in the context of chronic disease. There remains much variation in the criteria used to define malnutrition, with each method having its own limitations. Early recognition, prompt management, and robust follow up are critical for best outcomes in preventing and treating PEM.Protein Energy MalnutritionZubin Grover, Looi C. Ee10.1016/j.pcl.2009.07.001Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-210551068http://www.pediatric.theclinics.com/article/PIIS003139550900114X/abstract?rss=yesPremature infants are a population prone to nutrient deficiencies. Because the early diet of these infants is entirely amenable to intervention, understanding the pathophysiology behind these deficiencies is important for both the neonatologists who care for them acutely and for pediatricians who are responsible for their care through childhood. This article reviews the normal accretion of nutrients in the fetus, discusses specific nutrient deficiencies that are exacerbated in the postnatal period, and identifies key areas for future research.Nutrient Deficiencies in the Premature InfantMalika D. Shah, Shilpa R. Shah10.1016/j.pcl.2009.08.001Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-210691083http://www.pediatric.theclinics.com/article/PIIS0031395509001102/abstract?rss=yesPediatric nutritional deficiencies are associated not only with poverty and developing countries, but also in children in the developed world who adhere to restricted diets. At times, these diets are medically necessary, such as the gluten-free diet for management of celiac disease or exclusion diets in children with food allergies. At other times, the diets are self-selected by children with behavioral disorders, or parent-selected because of nutrition misinformation, cultural preferences, alternative nutrition therapies, or misconceptions regarding food tolerance. Health care providers must be vigilant in monitoring both growth and feeding patterns to identify inappropriate dietary changes that may result in nutritional deficiencies.Nutritional Deficiencies in Children on Restricted DietsMidge Kirby, Elaine Danner10.1016/j.pcl.2009.07.003Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-210851103http://www.pediatric.theclinics.com/article/PIIS003139550900087X/abstract?rss=yesThe presence of nutritional deficiencies in overweight and obesity may seem paradoxical in light of excess caloric intake, but several micronutrient deficiencies appear to be higher in prevalence in overweight and obese adults and children. Causes are multifactorial and include decreased consumption of fruits and vegetables, increased intake of high-calorie, but nutritionally poor-quality foods, and increased adiposity, which may influence the storage and availability of some nutrients. As the obesity epidemic continues unabated and the popularity of bariatric surgery rises for severely obese adults and adolescents, medical practitioners must be aware of pre-existing nutritional deficiencies in overweight and obese patients and appropriately recognize and treat common and rare nutritional deficiencies that may arise or worsen following bariatric surgery. This article reviews current knowledge of nutritional deficits in obese and overweight individuals and those that commonly present after bariatric surgery and summarizes current recommendations for screening and supplementation.Nutritional Deficiencies in Obesity and After Bariatric SurgeryStavra A. Xanthakos10.1016/j.pcl.2009.07.002Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-211051121http://www.pediatric.theclinics.com/article/PIIS0031395509000844/abstract?rss=yesSince the identification of cystic fibrosis (CF) in the 1940s, nutrition care of patients who have CF has been a challenge. Through optimal caloric intake and careful management of malabsorption, patients are expected to meet genetic potential for growth. Yet factors beyond malabsorption, including nutrient activity at the cellular level, may influence growth and health. This article reviews nutrition topics frequently discussed in relationship to CF and presents intriguing new information describing nutrients currently being studied for their impact on overall health of patients who have CF.Nutrition Management of Pediatric Patients Who Have Cystic FibrosisSuzanne H. Michel, Asim Maqbool, Maria D. Hanna, Maria Mascarenhas10.1016/j.pcl.2009.06.008Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-211231141http://www.pediatric.theclinics.com/article/PIIS0031395509000820/abstract?rss=yesA significant proportion of critically ill children admitted to the pediatric intensive care unit (PICU) present with nutritional deficiencies. Malnourished hospitalized patients have a higher rate of complications, increased mortality, longer length of hospital stay, and increased hospital costs. Critical illness may further contribute to nutritional deteriorate with poor outcomes. Younger age, longer duration of PICU stay, congenital heart disease, burn injury, and need for mechanical ventilation support are some of the factors that are associated with worse nutritional deficiencies. Failure to estimate energy requirements accurately, barriers to bedside delivery of nutrients, and reluctance to perform regular nutritional assessments are responsible for the persistence and delayed detection of malnutrition in this cohort.Nutritional Deficiencies During Critical IllnessNilesh M. Mehta, Christopher P. Duggan10.1016/j.pcl.2009.06.007Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-211431160http://www.pediatric.theclinics.com/article/PIIS0031395509000819/abstract?rss=yesMalnutrition is common in infants and children with chronic liver disease (CLD) and may easily be underestimated by clinical appearance alone. The cause of malnutrition in CLD is multifactorial, although insufficient dietary intake is probably the most important factor and is correctable. Fat malabsorption occurs in cholestatic disorders, and one must also consider any accompanying fat-soluble vitamin and essential fatty acid deficiencies. The clinician should proactively evaluate, treat, and re-evaluate response to treatment of nutritional deficiencies. Because a better nutritional state is associated with better survival before and after liver transplantation, aggressive nutritional management is an important part of the care of these children.Optimizing Nutritional Management in Children with Chronic Liver DiseaseScott Nightingale, Vicky Lee Ng10.1016/j.pcl.2009.06.005Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-211611183http://www.pediatric.theclinics.com/article/PIIS0031395509001138/abstract?rss=yesIntestinal failure (IF) is the ultimate malabsorption state, with multiple causes, requiring long-term therapy with enteral or intravenous fluids and nutrient supplements. The primary goal during management of children with potentially reversible IF is to promote intestinal autonomy while supporting normal growth, nutrient status, and preventing complications from parenteral nutrition therapy. This article presents how an improved understanding of digestive pathophysiology is essential for diagnosis, successful management, and prevention of nutrient deficiencies in children with IF.Nutritional Deficiencies in Intestinal FailureCharmaine H. Mziray-Andrew, Timothy A. Sentongo10.1016/j.pcl.2009.07.005Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-211851200http://www.pediatric.theclinics.com/article/PIIS0031395509000832/abstract?rss=yesRefeeding syndrome (RFS) is the result of aggressive enteral or parenteral feeding in a malnourished patient, with hypophosphatemia being the hallmark of this phenomenon. Other metabolic abnormalities, such as hypokalemia and hypomagnesemia, may also occur, along with sodium and fluid retention. The metabolic changes that occur in RFS can be severe enough to cause cardiorespiratory failure and death. This article reviews the pathophysiology, the clinical manifestations, and the management of RFS. The key to prevention is identifying patients at risk and being aware of the potential complications involved in rapidly reintroducing feeds to a malnourished patient.Refeeding SyndromeJudy Fuentebella, John A. Kerner10.1016/j.pcl.2009.06.006Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-212011210http://www.pediatric.theclinics.com/article/PIIS0031395509000807/abstract?rss=yesGood clinical care extends beyond mere diagnosis and treatment of disease to appreciation that nutrient deficiencies can be the price of effective drug therapy. The major risk factors for developing drug-induced nutrient deficiencies are lack of awareness by the prescribing physician and long duration of drug therapy. The field of pharmacogenomics has potential to improve clinical care by detecting patients at risk for complications from drug therapy. Further improvements in patient safety rely on physicians voluntarily reporting serious suspected adverse drug reactions.Drug-Induced Nutrient DeficienciesLina Felípez, Timothy A. Sentongo10.1016/j.pcl.2009.06.004Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-212111224http://www.pediatric.theclinics.com/article/PIIS0031395509001448/abstract?rss=yesIndex10.1016/S0031-3955(09)00144-8Pediatric Clinics of North America 56, 5 (2009)2009-10-01Pediatric Clinics of North America2009-10-01565S0031-3955(09)X0005-212251238