Natrona County School District

Food allergy (FA) affects pediatric growth and psychosocial well-being. The relationship between FA and feeding difficulties is poorly understood. The current study sought to investigate feeding problems in children with parent-reported immunoglobulin # (IgE)–mediated FA and/or pediatric feeding disorder (PFD) compared with healthy children and to explore factors associated with feeding problems in children with FA.This is a matched, cross-sectional cohort study using deidentified data from a series of online surveys. Survey data from 352 parents of children aged 6 months to 7 years with parent-reported IgE-mediated FA and/or PFD were categorized into 1 of 3 cohorts: 50 children with only FA, 67 children with both FA and PFD, and 235 children with only PFD. Each cohort was individually matched to data from typically developing children also collected in the original studies based on age, sex, race, and socioeconomic characteristics.Secondary analysis was performed on deidentified data from surveys conducted between 2015 and 2017. The Pediatric Eating Assessment Tool (PediEAT) was used to obtain parent ratings of the child’s feeding problems.Children with FA exhibited more feeding problems compared with matched healthy children. Children with PFD had more severe feeding problems irrespective of comorbid FA. Older age, non-white race, increased medical comorbidity, and limited dietary variety were factors associated with feeding problems in children with FA.This study adds to evidence indicating increased prevalence of feeding problems in children with FA. Clinicians treating patients with FA should screen for feeding and growth concerns and consider referral to multidisciplinary feeding programs. Children with FA who consume a limited variety of foods may experience more feeding problems.Early identification and intervention for patients with feeding problems may help prevent behavioral problems from becoming more ingrained. Early identification of multiple risk factors may be helpful in engaging at-risk patients for early intervention strategies. A potential challenge noted by the authors is the limitation of the PediEAT tool for capturing subtle concerns about food-associated behaviors.

Many children with immunoglobulin E–mediated cow’s milk allergy (IgE-CMA) have spontaneous resolution. Previous prospective studies have reported spontaneous resolution rates of 53% to 57% by the age of 5 years. The current extension study sought to evaluate resolution rates of IgE-CMA through the end of adolescence.From a cohort of 13 019 Israeli infants observed from birth, 54 had IgE-CMA confirmed by an oral food challenge (OFC). Persistence of IgE-CMA at 5 years was diagnosed in 23 children via a positive OFC or a recent objective allergic reaction to milk. IgE-CMA status was reassessed at age 17 in these 23 patients.Patients were evaluated at 17 years by questionnaire. Resolution was determined by regular milk consumption without adverse reaction or a negative OFC. Persistence of allergy was defined by a recent objective reaction to milk and a positive skin test greater than or equal to 8 mm or by sensitization with milk serum–specific IgE testing greater than 15 kUA/L.Of the 23 patients with persistence of IgE-CMA at 5 years, 8 (35%) had spontaneous resolution of IgE-CMA between the ages of 5 and 17 years. Overall, 39 of the 54 patients (72.2%) initially diagnosed with IgE-CMA had spontaneous resolution by 17 years. Risk factors for persistence of IgE-CMA at 17 years included skin prick test greater than 6 mm at the time of diagnosis, no cow’s milk feeding in infancy, and wheezing on diagnostic OFC or in association with a clinical adverse reaction to milk. Seven patients experienced objective adverse reactions after 5 years. Associations in these patients included wheezing or anaphylaxis on diagnostic OFC or initial reaction and current asthma.Spontaneous resolution of IgE-CMA occurs beyond 5 years. Few patients with IgE-CMA experience objective adverse reactions by late adolescence. Respiratory symptoms with early milk ingestion and asthma in adolescence were associated with persistence of IgE-CMA and of being at risk for more severe adverse reactions to milk until adolescence.The results of this population-based natural history study are interesting and may inform education and intervention strategies. The authors note the small study size, population limited to Israeli patients, and limited follow-up between the ages of 5 and 17 years for some patients as potential limitations of the current study. The authors pose an interesting query about the timeline for achievement of resolution between the ages of 5 and 17 years. This is an area for potential future study.

Research findings regarding the impact of low achievement (LA) on the social status and social behavior of learning-disabled (LD) children have been equivocal. Reported findings suggested that a failure of previous studies to control for the impact of attention-deficit hyperactivity disorder (ADHD) may account for the lack of consensus among previous studies. The purpose of this investigation was to examine the relative contributions of LA, LD, and ADHD to problems in social status and social behavior. This was accomplished by assigning second- through sixth-grade boys to one of six groups: ADHD/LD, ADHD/LA, ADHD, LD, LA, and control. Results indicated that serious problems with peer rejection, peer popularity, and social behavior were the most strongly related to the combination of ADHD and LD. Discussion of the implications of current findings includes the importance of identifying appropriate behavioral and academic subgroups when investigating social status and behavior problems.