Abstract: Physicians are often asked to diagnose and treat infants with clinical signs of gastroesophageal reflux (GER) symptoms and in extreme cases gastroesophageal reflux disease (GERD). Some infants are left to work out their pain, regurgitation and vomiting until they outgrow the symptoms while others may undergo expensive, invasive endoscopic procedures in the operating room under general anesthesia. Initial treatment is often for infants to be placed on prescription adult acid reflux medications, which have limited benefits [1]. Drugs prescribed include: H-2 blockers such as ranitidine (Zantac), a proton pump inhibitor such as omeprazole (Prilosec) or lansoprazole (Prevacid). TOTS may cause aerophagia, a condition where the infant’s latch onto the mother’s breast or bottle allows the infant to swallow excessive amounts of air into the stomach during feeding. This aerophagia may be responsible for symptoms mimicking GER or GERD [2]. When these infants are examined for symptoms of GER the differential diagnosis of tethered oral tissues (TOTS) may not be addressed [3]. Tethered oral tissues may involve ankyloglossia (tongue-tied), maxillary and /or mandibular frenum lip-ties and in some instances buccal frenum ties. These tethered oral tissues (TOTS) prevent the infant from achieving a good seal onto the breast and or bottle with the resulting ingestion of excessive amounts of air.

Background: When assessing infants presenting with gastroesophageal reflux symptoms, aerophagia secondary to tethered oral tissues (tongue-ties ,Lip-ties) should be considered in the differential diagnosis since the release of these tissues may eliminate the need for invasive gastrointestinal investigations and pharmacologic treatment of gastroesophageal reflux.

Patient Pool: 340 infants ranging from 1 week to 3 months were referred for the evaluation and release of lingual and maxillary lips which were interfering with infant’s ability to achieve a good seal and latch onto the mother’s breast of infant bottle .The survey the parents completed indicated that 208 or 61% of the infants had signs of gastroesophageal reflux (GER) such as; vomiting, regurgitation, inability to sleep lying supine, fussiness, crying after nursing and morning congestion. Of the 208 infants 40% (83 infants) were or had been treated for GER with pharmacologic medications such as proton pump inhibitors or H2 blockers without any resolution of the symptoms.

Findings: All of the infants presenting with these signs and symptoms underwent laser revisions of the tethered attachments. Upon completion of the procedure and at a 48 hour post-surgical follow-up discussion with the parents 93% (194 infants) of the infants showed immediate improvements and were able to breastfeed successfully without signs or symptoms of GER. Survey returned at the end of two weeks post-surgery had similar results

Conclusion: Infants presenting with signs of GER should also be evaluated for restrictive tethered oral tissues (TOTS) such as ankyloglossia, lip and buccal ties. If they are present, strong consideration should be given to the release of these tissues as an initial approach. This may eliminate the need for pharmacologic treatment of GER.

Keywords: Breastfeeding, reflux, aerophagia, laser surgery, lip-ties, tongue-ties.

Abstract: Background: This investigation evaluated seasonal changes in preschoolers’ (3-5 years) sedentary time and physical activity (PA) during childcare.

Methods: Sixty-two children from 4 preschools in Fargo, North Dakota had their sedentary behavior and PA objectively assessed during 2 separate weeks of childcare. Children wore accelerometers for 5 consecutive days, once each in the fall (October/November) and winter (January/February). Separate analyses were conducted to evaluate seasonal changes in full-day, indoor only, and outdoor only sedentary time and PA during childcare.

Results: When expressed relative to accelerometer wear time, the full-day rate of sedentary time accumulation (minutes/hour) increased significantly from fall to winter (p < 0.001), while accumulation rates for all other PA variables (light PA, moderate PA, moderate-to-vigorous PA, and activity counts) significantly declined during this period (all p’s < 0.001). No significant changes in accumulation rates for sedentary time or PA (light PA, moderate PA, moderate-to-vigorous PA, and activity counts) were noted for either indoor or outdoor time between seasons.

Conclusions: Childcare-related sedentary time and PA can dramatically vary across seasons.

Keywords: Accelerometry, physical activity, pediatrics, public health, childcare.

Abstract: Delayed umbilical cord clamping and care practices have important implications for infant iron stores and neonatal survival. This is especially important in countries like Uganda, where there is a high prevalence of anemia in women and children coupled with a high newborn mortality rate. This study assesses cord clamping and care practices in home births in a coverage area of 12 health centers in 4 districts near Kampala, Uganda. We interviewed 147 women, most of who had at least primary school education and delivered their babies in the homes of traditional birth attendants. Only 65% of the persons conducting delivery washed hands, and most wore gloves. Most frequent cord ties were threads (86.7%), and glove rims (8.3%). Cords were cut with clean instruments in most (93.1%) deliveries. During cord clamping, newborn was positioned at a higher level than mother in 59%, delayed clamping (≥3mins) was reported in 52%. Combination of delayed clamping and positioning of newborn at mother’s level or lower was reported in only 19%. Substances used for cord care included surgical spirit (42.4%), local herbs (24.5%), powder (22.6%), ash (21.6%), saline water (10.3%), and tea (2.8%). Cord care instructions given most commonly were: cleaning with warm saline water (27%), spirit or antiseptics (25%), and herb application (7%). Awareness regarding cord infections was poor (20%). Mother’s education level, and age were not associated with cord clamping or care practices. Our study indicates scope for interventions to help improve hemoglobin levels in infancy. Education regarding cord care practices may reduce infections.

Keywords: Umbilical cord care, umbilical cord clamping, newborn care practices, home childbirth, maternal health services.

Abstract: Background: Child malnutrition is a major public health problem in Zimbabwe and it has been one of the leading causes of morbidity and mortality in children under five years of age in the City of Harare.

Methods: An analytic cross sectional survey was conducted on 342 mothers – child pairs of children aged 0 – 59 months in Harare’s suburbs between July and August 2014.The aim of the study was to identify factors associated with the high levels of stunting among children age 0 – 59 months. Bivariate and multivariate analyses were used to establish the risk factors for U5 years stunting.

Findings: A total of 29.2% of the children were stunted with (19.3% being moderately stunted and 9.9% severely stunted). More females (32.9%) were stunted compared to (25.9%) males. The main contributing factors for stunting among the children 0 - 59 months were found to be lack of mother’s education adjusted pOR=0.49 (95%CI: 1.04-3.27); being unemployed pOR=1.22 (95%CI: 1.08-2.03); residing in high density suburbs pOR=2.14 (95%CI: 1.61-7.55); child ever being hospitalized pOR=1.04 (95%CI: 1.01-2.14); breastfed after > 1 hour after birth pOR=1.11 (95%CI: 1.09-1.80); complementary feeds < 6 months pOR=1.30 (95%CI: 1.17-2.21); low birth weight pOR=1.46 (95%CI: 1.29-3.51) and having a poor dietary diversity pOR=1.07 (95%CI: 1.01-1.84).

Conclusions: Lack of mother’s education is the principal risk factor for stunting among the under five children in Harare exacerbated by unemployment of either the father or mother or relative, area of residence, feeding practices, birth weight, illness and infections and household dietary diversity.

Stunting is on the increase in Harare. The findings also revealed a high level of in-equalities in social determinants of health since stunting is related to socio-economic factors.

Recommendations: Any nutrition intervention has to use strategies that will comprehensively address the social determinants of health and improve the standard of living of households in the high density areas so as to have a ripple effect on the nutritional status of U5s.

Keywords: Stunting, mother-child pair, risk factors, social determinants of health.

Abstract:Background: Racial and ethnic disparities in physical activity (PA) are evident, with non-Hispanic Black and Mexican American children engaging in less vigorous activity than non-Hispanic White children. Collaborating with public health programs serving at-risk populations, such as the WIC program may be an effective way to promote the development of healthful PA behaviors among low-income preschool children and families. This paper explores WIC staff perceptions, attitudes, barriers, and facilitators related to PA levels and behaviors among low-income Latino preschool children and families, as well as the role the WIC program may play in promoting PA among low-income populations.

Methods: A qualitative study was conducted with a sample of WIC staff in the State of Rhode Island (RI), Northeast United States. Individual, semi-structured interviews were carried out with 21 WIC staff working directly with Latino clients enrolled in the WIC program. Thematic content analysis was used.

Results: The majority of WIC staff reported their Latino clients facing many barriers that limit their ability to be physically active, including busy and multiple shift schedules, lack of access to safe outdoor spaces, financial constraints to attending programs and recreational facilities, lack of transportation getting to safe outdoor spaces and facilities, etc. WIC staff identified several ways that the WIC program could increase the promotion PA among Latino families including partnering with local organizations such as the YMCA, Boys and Girls Club to provide increased access and opportunities for PA among low-income, Latino families.

Conclusions: Study findings add to the existing literature suggesting that the WIC program is an important venue for educating low-income, Latino children and families about the importance of establishing early healthy PA habits within the context of overall health and development. Findings also highlight the need for a continuing effort to integrate the promotion of PA as part of the WIC program. In addition, findings highlight WIC staff desire for additional training and resources in promotion of PA.

Keywords: Physical activity, sedentary behaviors, Latino, children, WIC program.