Use of standardized body composition measurements and malnutrition screening tools to detect malnutrition risk and predict clinical outcomes in children with chronic conditions
Adolescent; Child; Female; Humans; Male; Risk Factors; Child Preschool; Anthropometry; Chronic Disease; screening; Child Development; pediatric patients; body composition; Body Composition; clinical outcomes; malnutrition; nutritional risk; Child Nutrition Disorders/diagnosis
BACKGROUND: Better tools are needed to diagnose and identify children at risk of clinical malnutrition. OBJECTIVES: We aimed to compare body composition (BC) and malnutrition screening tools (MSTs) for detecting malnutrition on admission; and examine their ability to predict adverse clinical outcomes [increased length of stay (LOS) and complications] in complex pediatric patients. METHODS: This was a prospective study in children 5-18 y old admitted to a tertiary pediatric hospital (n = 152). MSTs [Pediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), and Screening Tool for Risk of Impaired Nutritional Status and Growth (STRONGkids)] were completed on admission. Weight, height, and BC [fat mass (FM) and lean mass (LM) by DXA] were measured (n = 118). Anthropometry/BC and MSTs were compared with each other and with clinical outcomes. RESULTS: Subjects were significantly shorter with low LM compared to reference data. Depending on the diagnostic criteria used, 3%-17% were classified as malnourished. Agreement between BC/anthropometric parameters and MSTs was poor. STAMP and STRONGkids identified children with low weight, LM, and height. PYMS, and to a lesser degree STRONGkids, identified children with increased LOS, as did LM compared with weight or height. Patients with complications had lower mean ± SD LM SD scores (-1.38 ± 1.03 compared with -0.74 ± 1.40, P < 0.05). In multivariable models, PYMS high risk and low LM were independent predictors of increased LOS (OR: 3.76; 95% CI: 1.36, 10.35 and OR: 3.69; 95% CI: 1.24, 10.98, respectively). BMI did not predict increased LOS or complications. CONCLUSIONS: LM appears better than weight and height for predicting adverse clinical outcomes in this population. BMI was a poor diagnostic parameter. MSTs performed differently in associations to BC/anthropometry and clinical outcomes. PYMS and LM provided complementary information regarding LOS. Studies on specific patient populations may further clarify the use of these tools and measurements.
Lara-Pompa NE; Hill S; Williams J; Macdonald S; Fawbert K; Valente J; Kennedy K; Shaw V; Wells JC; Fewtrell M
American Journal of Clinical Nutrition
2020
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1093/ajcn/nqaa142" target="_blank" rel="noreferrer noopener">10.1093/ajcn/nqaa142</a>
Attention Bias Modification Treatment for Pediatric Anxiety Disorders: A Randomized Controlled Trial
Depression; Management; Children; Diagnosis; Adolescents; Anxieties; Attentional bias; Care and treatment; PSYCHIATRY; THREAT; Anxiety in children; Child & adolescent psychiatry; childhood; Clinical outcomes; FACIAL EXPRESSIONS; INDIVIDUALS; Influence; MANIPULATION; VULNERABILITY
Objective: While attention bias modification (ABM) is a promising novel treatment for anxiety disorders, clinical trial data remain restricted to adults. The authors examined whether ABM induces greater reductions in pediatric anxiety symptoms and symptom severity than multiple control training interventions. Method: From a target sample of 186 treatment-seeking children at a hospital-based child anxiety clinic, 40 patients with an ongoing anxiety disorder who met all inclusion criteria were enrolled in the study. Children were randomly assigned to one of three conditions: ABM designed to shift attention away from threat; placebo attention training using stimuli identical to those in the ABM condition; and placebo attention training using only neutral stimuli. All participants completed four weekly 480-trial sessions (1,920 total trials). Before and after the attention training sessions, children's clinical status was determined via semi-structured interviews and questionnaires. Reduction in the number of anxiety symptoms and their severity was compared across the three groups. Results: Change in the number of anxiety symptoms and their severity differed across the three conditions. This reflected significant reductions in the number of anxiety symptoms and symptom severity in the ABM condition but not in the placebo attention training or placebo-neutral condition. Conclusions: ABM, compared with two control conditions, reduces pediatric anxiety symptoms and severity. Further study of efficacy and underlying mechanisms is warranted. (Am J Psychiatry 2012; 169:213-220)
Eldar S; Apter A; Lotan D; Perez-Edgar K; Naim R; Fox NA; Pine DS; Bar-Haim Y
American Journal Of Psychiatry
2012
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1176/appi.ajp.2011.11060886" target="_blank" rel="noreferrer">10.1176/appi.ajp.2011.11060886</a>