Challenges in management of irritable bowel syndrome in children.

Irritable bowel syndrome (IBS) is a common cause of recurrent abdominal pain (RAP) in children and can be a debilitating experience for both child and family. Organic causes of RAP symptoms such as celiac and inflammatory bowel diseases should be excluded before a diagnosis of IBS is made. Treatment consists of dietary manipulation, drugs, and stress management.

Clinical update: recurrent abdominal pain in children.

Recurrent abdominal pain (RAP) is common in children and most cases have a non-organic cause. Diagnosis is made by excluding other serious causes, and early referral and intervention help ensure a better outcome. RAP can cause significant anxiety in parents and carers, who can become overwhelmed by fear of serious disease and feel helpless by being unable to relieve their child's pain.

Clinical update: vomiting in infants.

Vomiting is very common in infants and is mostly caused by non-serious conditions. However, community practitioners may come across infants with serious causes of vomiting, requiring prompt referral. Bilious vomiting should always raise suspicion of a surgical cause and needs urgent assessment by the paediatric/surgical team.

Assessment of childhood obesity in secondary care: OSCA consensus statement.

This expert opinion provides detailed guidance on assessing obesity in secondary paediatric practice. This guidance builds on existing recommendations from National Institute of Health and Clinical Excellence in the UK, and is evidence based where possible. Guidance is provided on which obese children and young people are appropriate to be seen in secondary care and relevant history and investigations, and guidance on when further investigation of causes and obesity-related comorbidity is appropriate.

Classification of body composition in 11-14 year olds by both body mass index and bioelectrical impedance.

This study investigated the prevalence of obesity in 1671 Caucasian 11-14 year olds using body mass index (BMI) and fat percentage (F%). Age and sex-related criteria for both BMI and F% were applied to characterise the individuals as normal, overweight/overfat or obese. Using BMI, 5.

Clinical and economic impact of using macrogol 3350 plus electrolytes in an outpatient setting compared to enemas and suppositories and manual evacuation to treat paediatric faecal impaction based on actual clinical practice in England and Wales.

Objective: To estimate the clinical and economic impact of using macrogol 3350 plus electrolytes (macrogol 3350; Movicol; Movicol Paediatric Plain) in an outpatient setting compared to enemas and suppositories and manual evacuation to treat paediatric faecal impaction.

Methods: A chart review was undertaken to extract clinical outcomes and resource use from the case notes of a cohort of children aged 2-11 years with faecal impaction who initially received either macrogol 3350 (in an outpatient setting) or enemas and suppositories or manual evacuation for initial disimpaction. Five centres across England and Wales participated in the study.

Rotavirus infection: a systemic illness?

Candy discusses a new study in that challenges the view that in children with rotavirus diarrhea, the virus is confined to the upper small intestine.

Treatment of faecal impaction with polyethelene glycol plus electrolytes (PGE + E) followed by a double-blind comparison of PEG + E versus lactulose as maintenance therapy.

Objectives: To assess the efficacy of polyethylene glycol 3350 plus electrolytes (PEG + E; Movicol) as oral monotherapy in the treatment of faecal impaction in children, and to compare PEG + E with lactulose as maintenance therapy in a randomised trial.

Patients And Methods: An initial open-label study of PEG + E in the inpatient treatment of faecal impaction (phase 1), followed by a randomised, double-blind comparison between PEG + E and lactulose for maintenance treatment of constipation over a 3-month period (phase 2) in children aged 2 to 11 years with a clinical diagnosis of faecal impaction.

Results: Disimpaction on PEG + E was achieved in 58 (92%) of 63 of children (89% of 2-4 year olds and 94% of 5-11 year olds) without additional interventions.