Search Results (134)

Background: Children with food allergy (FA) may develop eating difficulties that extend beyond medically required allergen avoidance, including food neophobia, selective eating, and avoidant/restrictive food intake disorder (ARFID)-related symptoms. This mixed-methods study aimed to assess ARFID symptoms, food neophobia, diet quality, and food-related psychological experiences in children with FA. Methods: Seventy children with confirmed FA were enrolled in an observational cross-sectional mixed-methods study conducted at a tertiary pediatric allergy center. Quantitative assessment included the Eating Disorders in Youth-Questionnaire (EDY-Q), the Italian Child Food Neophobia Scale (ICFNS), and the Mediterranean Diet Quality Index for Children and Adolescents (KIDMED). Qualitative data were collected from a purposive subsample of 26 children through semi-structured child-friendly interviews and drawing-based elicitation activities and were analyzed using inductive thematic analysis. Results: A positive EDY-Q screening result for ARFID-related symptoms was observed in 3 children (4.3%). Selective Eating showed the highest median EDY-Q domain score (median 1.50, IQR 0.67–4.00), followed by Food Avoidance Emotional Disorder (median 1.00, IQR 0.00–2.00) and Functional Dysphagia (median 0.00, IQR 0.00–2.00). Moderate food neophobia was observed in 45 children (64.3%), while 24 children (34.3%) were classified within the high food-neophobia category. KIDMED score was negatively correlated with EDY-Q total score (Spearman’s ρ = −0.302; p = 0.011), Selective Eating (ρ = −0.356; p = 0.002), and Functional Dysphagia (ρ = −0.238; p = 0.048). In an exploratory hierarchical regression, Selective Eating remained inversely associated with KIDMED after adjustment for demographic and FA-related covariates (β = −0.386; p = 0.002); however, the overall model did not reach statistical significance (p = 0.081), and the additional clinical covariates did not significantly improve model fit. Accordingly, the fully adjusted findings should be interpreted as exploratory. Qualitative analysis identified five themes: anticipatory fear of food and tasting, emotional memory of allergic reactions and generalization of risk, selective avoidance and food rigidity, reassurance-seeking and decision-making dependence, and ambivalent parental dynamics. Conclusions: Within this tertiary-care sample, positive EDY-Q screening results were uncommon, whereas broader food-related difficulties were identified. Pediatric FA assessment may benefit from attention to eating behavior, diet quality, and avoidance extending beyond confirmed allergens. Full article

Background: Infants born small for gestational age (SGA) are at increased risk of altered postnatal growth and early metabolic vulnerability. Early feeding practices may modulate these outcomes, but evidence from Eastern Europe remains limited. Objective: To evaluate the influence of birth weight and early nutrition on anthropometric outcomes at 2–3 years of age in former SGA infants in Romania, and to examine associations with allergies, respiratory infections, and food intolerances. Methods: We conducted a retrospective comparative study including two cohorts of term SGA infants born in a Romanian tertiary hospital in 2010–2011 (n = 600) and 2020–2021 (n = 508). Perinatal data were extracted from medical records; anthropometrics and feeding practices at 2–3 years were obtained via parental telephone interviews. BMI z-scores were calculated using WHO standards. Logistic regression models were used to identify predictors of overweight/obesity and selected health outcomes. Results: Breastfeeding increased markedly over one decade (59.1% vs. 35.5%, p < 0.001), as did appropriate complementary feeding (74.2% vs. 66.3%, p = 0.005). Obesity prevalence decreased from 29.5% to 22.4% at 2 years and from 32.7% to 20.7% at 3 years (both p < 0.001), while overweight prevalence increased slightly. In the historical cohort, mixed feeding (vs. formula) predicted overweight/obesity at 2 years (aOR 2.55, 95% CI 1.52–4.43, p < 0.001); the association was directionally similar but not significant in the contemporary cohort (aOR 1.62, 95% CI 0.75–3.47, p = 0.215). Breastfeeding was protective in both cohorts. Appropriate complementary feeding was associated with lower allergy prevalence in the historical cohort (14.8% vs. 24.8%, p = 0.004). Food intolerances increased over time (16.3% to 27.6%, p < 0.001), while respiratory infections showed no significant differences. Conclusions: In this Romanian SGA population, early feeding practices improved substantially over one decade and were associated with more favorable weight outcomes, including a notable reduction in obesity. Mixed feeding emerged as a potential risk factor for early overweight, whereas breastfeeding remained protective. Despite these improvements, former SGA infants continue to exhibit elevated risk for early-onset overweight and obesity, underscoring the need for targeted nutritional counseling and longitudinal monitoring. Full article

Background/Objectives: Cow’s milk allergy (CMA) is one of the most frequent food allergies in early childhood, yet its diagnosis remains a challenge. The Parent-Specific Cow’s Milk-Related Symptom Score (Pre-CoMiSS™) was developed in 2024 to assist parents in tracking possible cow’s milk-related symptoms in their infants. The aim of this qualitative study was to explore users’ experience with the Pre-CoMiSS™ tool, learn from their experience and identify areas for improvement. Methods: Participants were parents of infants aged up to 12 months who felt that their babies were experiencing possible feeding-related symptoms. Participants were selected from a local panel of potential parents in the UK and Sweden. Forty-five-minute interviews, led by experienced qualitative research moderators, were conducted using dedicated discussion guides and a frame-by-frame PDF version of the Pre-CoMiSS™ tool. Thematic analysis of the data was undertaken. Results: A total of 20 parents participated, 10 from the UK and 10 from Sweden. The Pre-CoMiSS™ tool was well received by parents from both countries. Parents found the tool’s results clear, useful, and easy to understand. However, some parents, especially from Sweden, expressed the need for additional guidance on next steps. Conclusions: Parents found the Pre-CoMiSS™ tool acceptable and easy to use, although some requested clearer guidance on next steps. These findings support further refinement and formal validation before clinical implementation. Full article

Background/Objectives: Of the approximately 8% of children in the United States (US) with food allergy (FA), roughly 40% report allergy to multiple foods. The ubiquity and intensity of FA management can impose psychosocial burdens on both pediatric patients and caregivers, which may be exacerbated among those allergic to multiple foods. However, little work has comprehensively estimated the burden of multi-FA in heterogeneous pediatric populations with clinically confirmed FA. Methods: Children with allergist-diagnosed, IgE-mediated FA were enrolled in the FORWARD multisite prospective cohort study. Psychosocial burden was assessed annually using the FA Quality of Life Questionnaire-Parent Form 10 (FAQL-PF10) and FA Independent Measure-Parent Form (FAIM-PF); psychosocial burden for caregivers was measured with the FA Quality of Life-Parental Burden (FAQL-PB) Questionnaire. Multilevel regression models estimated independent effects of the number of current FAs after adjusting for child age, gender, race, ethnicity, household income, caregiver education, atopic comorbidities, and recruitment site. Results: FA-related psychosocial burden increased linearly for patients and caregivers with each additional FA even after controlling for demographic factors such as age, gender, race, ethnicity, income, education, and other atopic conditions, as well as repeated observations within participants: FAQL-PF10 B = 0.082 (N = 2206; p = 0.004), FAIM-PF B = 0.152 (N = 2206; p < 0.001), and FAQL-PB B = 0.166 (N = 1081; p < 0.001). Conclusions: The psychosocial burden of pediatric FA increases monotonically with each additional current FA, highlighting opportunities for tailored psychosocial, behavioral, and pharmacologic interventions to improve FA-related outcomes among those most impacted. Full article

Background: During the firing stage of artisanal brick production, particulate matter and other pollutants are released into the air, to which children are particularly vulnerable. Objective: To compare the frequency of allergic diseases and impaired lung function among children exposed and unexposed to artisanal brick production. Methods: A cross-sectional comparative study was conducted among 386 children aged 6 to 14 years, recruited from a primary and a secondary school in Guanajuato, Mexico. Participants were classified as exposed (n = 193) or unexposed (n = 193) to artisanal brick production. Once parents and children voluntarily consented to participate, study procedures were initiated. Forced spirometry and anthropometric measurements were performed, and the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was administered. We assessed the frequency of respiratory symptoms, allergic diseases, and lung function abnormalities. We measured the frequency of respiratory symptoms, allergic diseases, and lung function abnormalities. Results: The mean age of the 386 children was 9.7 ± 1.7 years. Each group consisted of 103 girls and 90 boys. The most important risk factors for impaired lung function were living in the brickyard (OR = 6.9, 95% CI: 4.3–11.1; p = 0.001) and being male (OR = 3.6, 95% CI: 2.3–5.7; p = 0.001). The prevalence of impaired lung function was 13.5% in exposed and 4.1% in unexposed children (OR = 3.6, 95% CI: 1.5–8.1; p = 0.001). Most of the respiratory symptoms observed were obstructive and we found no difference in the frequency of allergic diseases, but respiratory symptoms were more frequent in exposed children. Conclusions: Respiratory symptoms and obstructive abnormalities in pulmonary function are more prevalent among children living in brickyards. Male sex and residence in the brickyard were the principal risk factors for impaired lung function. Full article

Background: The relationship between allergic status, SARS-CoV-2 infection, Long COVID, and post-restriction respiratory outcomes in children remains incompletely understood. This study aimed to explore the associations between allergic status and Long COVID, as well as between SARS-CoV-2 vaccination and post-restriction changes in allergic rhinitis (AR), asthma, and upper respiratory infections, in a pediatric tertiary-care cohort. Methods: We conducted a single-center, questionnaire-based observational study involving children aged 0–16 years, who were followed at the Pediatric Allergy Clinic of Umberto I Hospital in Rome. Parents completed an email-based questionnaire addressing SARS-CoV-2 infection, vaccination, persistent post-infectious symptoms, allergic diseases, and respiratory infections following restrictions. Analyses of Long COVID were limited to children with confirmed SARS-CoV-2 infection. Results: A total of 214 questionnaires were analyzed. Allergic status was not significantly associated with SARS-CoV-2 infection in the overall cohort. Among infected children, allergic status was independently associated with higher odds of Long COVID (adjusted OR 3.12, 95% CI 1.20–8.09; p = 0.019). Severe acute infection was also strongly associated with Long COVID (adjusted OR 6.84, 95% CI 2.72–17.21; p < 0.001). Complete vaccination was associated with lower odds of SARS-CoV-2 infection in the overall sample (adjusted OR 0.20, 95% CI 0.09–0.46; p < 0.001) but was not independently associated with Long COVID among infected children. After the removal of COVID-19 restrictions, 90.1% of allergic children reported worsening AR and 52.0% reported worsening asthma, with no significant association with SARS-CoV-2 infection or Long COVID. Group A Streptocossus (GAS) pharyngitis was reported in 50.0% and viral pharyngitis in 10.7% of the cohort, with no significant differences between allergic and non-allergic children. Conclusions: In this single-center, questionnaire-based pediatric cohort, allergic status was correlated with increased likelihood of Long COVID among children with confirmed SARS-CoV-2 infection; however, it was not associated with a higher risk of infection itself. Complete vaccination was linked to a reduced risk of infection, whereas no independent correlation with Long COVID was identified. Post-restriction exacerbation of allergic respiratory symptoms was prevalent, while the incidence of bacterial and viral pharyngitis did not vary significantly according to allergic status. Full article

Background: Asthma is one of the leading chronic inflammatory respiratory conditions affecting children under 5 years of age, especially those who reside in socio-economically disadvantaged and densely populated low- and middle-income communities. Methods: A cross-sectional analytical study was conducted to ascertain the prevalence of factors influencing asthma and wheeze among young children attending early childhood development centres in Alexandra Township. Data were collected using a self-administered modified International Study of Asthma and Allergies in Childhood questionnaire. The analysis was performed utilising STATA version 19. The study sample comprised 3265 young children and their parents or guardians. Results: The findings reveal that the prevalence of asthma and current wheeze was 17.52% and 35.56%, respectively, while the prevalence of a history of wheeze was 64.36%. In the multivariate analysis, a family history of asthma was identified as a risk factor for asthma (p < 0.001) and for current wheeze (p < 0.001) and historical wheeze (p < 0.001). Additionally, the use of pain medication and passing of public transport were seldom identified as risk factors for both asthma and wheeze. Furthermore, exposure to second-hand tobacco smoke (p = 0.025) was found to influence the occurrence of asthma. Conclusions: This study highlights the impact of individual, household, and environmental factors on asthma. The findings are critical for the implementation of preventive environmental health measures to address this issue, particularly in low- and middle-income countries with limited curative resources. Full article

Introduction: Food allergies and intolerances represent a growing pediatric health concern. While stress-related outcomes have received increasing attention, fatigue symptoms in children with food hypersensitivity remain insufficiently characterized. The aim of the study was to evaluate perceived stress and fatigue in children with food hypersensitivity. Material and Methods: We conducted an observational cross-sectional study including 339 children aged 1–18 years with specialist-confirmed food allergy, food intolerance, or mixed pathology. Data were collected through structured parent-reported interviews incorporating the Perceived Stress Questionnaire (PSQ) and the Fatigue Assessment Scale (FAS). Results: Children with food allergy had significantly higher perceived stress and fatigue scores compared to those with food intolerance (p < 0.05), with the highest levels observed in the mixed pathology group. Both perceived stress and fatigue scores increased with age, with adolescents showing the highest values. A moderate positive correlation was identified between stress and fatigue (r = 0.49, p < 0.0001). In multivariable analyses, higher stress and fatigue scores were significantly associated with age and diagnostic category, including mixed pathology, after adjustment for sex and anthropometric indicators. Higher scores were also associated with the presence of multiple clinical symptoms, such as sleep disturbances and concentration difficulties. Conclusions: Food hypersensitivity in children is associated with a significant psychological burden characterized by elevated perceived stress and fatigue, particularly in adolescents and in those with more complex diagnostic profiles. These findings highlight the importance of multidisciplinary management strategies integrating accurate diagnosis, nutritional counseling, and psychosocial support in order to address the broader impact of pediatric food hypersensitivity. Full article

Cow’s milk allergy (CMA) remains one of the most common food allergies in infancy, requiring the avoidance of cow’s milk and its derivatives. Breast milk is the best source of nutrition for infants. For those infants with CMA whose mothers are unable to breastfeed or choose not to, extensively hydrolysed formulas (eHFs) are widely recommended as first-line milk substitutes, whereas hydrolysed rice formulas (HRFs) are increasingly recognised as a viable alternative. This concept paper provides a healthcare professional (HCP) perspective on HRF, drawing on expert consensus from two meetings convened in 2025. Discussions noted the long history of safe and effective HRF use in Europe, its nutritional adequacy, and the evolving international guidelines supporting HRF as an alternative first-line option. A key meeting outcome was the development of a practical decision tree to help UK clinicians decide when HRF should be the preferred choice. Key considerations for its use in non-breastfed infants include the following: parental/caregiver stress related to persistent symptoms; ongoing symptoms despite multiple interventions; cultural and lifestyle choices; religious dietary requirements; and specialists’ recommendations. Secondary considerations highlighted by HCPs include the following: proven reactions whilst infants are breast-milk-fed together with parental request for formula; faltering growth; multiple symptoms; taste acceptance (older infants); and parental preference based on experience. The role of functional components, such as prebiotics and human milk oligosaccharides (HMOs), was noted in regard to the emerging evidence of benefits to the microbiome and immune development. The experts emphasised the importance of engaging HCPs across all levels of CMA care and addressing challenges in translating current guidance into treatment practice. It was concluded that, overall, HRF represents a nutritionally complete, plant-based alternative that has been shown to be well tolerated (taste, symptoms) in clinical studies. It can be used to broaden therapeutic options for infants with CMA in the UK who are not exclusively fed breast milk. Full article

Parabens, a prevalent class of endocrine-disrupting chemicals (EDCs), are ubiquitous in consumer products; however, their role in linking pediatric allergic phenotypes remains poorly understood. This case-control study analyzed paraben levels in urine and indoor dust as proxies for internal and external exposures and investigated their associations with allergic rhinitis only (AR Only), asthma only (AS Only), and comorbidities (AR&AS) among children in Shanghai. The concentrations for each of four paraben compounds were quantitatively measured, and multi-pollutant frameworks—including Bayesian Kernel Machine Regression (BKMR) and Weighted Quantile Sum (WQS) regression—were employed to characterize the mixture exposure and risk. Propylparaben (PrP) was detectable in 100% of urine samples and over 90% of dust samples, and the concentrations ranked the highest out of the four compounds in both samples. Benzylparaben (BzP) was detected in >70% of urine samples and over 50% of dust samples at relatively lower levels. Urinary PrP exhibited significantly positive associations with all phenotypes (OR in 2.18–2.92) and BzP with the AR&AS Comorbidity (OR = 3.55, 95% CI: 1.32–9.55). Dust-borne PrP was associated with AR Only (OR = 2.26, 95% CI: 1.16–4.43), indicating a potential “Portal of Entry” effect via direct nasal deposition. According to BKMR and WQS analyses, urinary PrP and BzP emerged as two primary risk drivers. Using interaction analysis, an additive synergistic effect was observed between urinary PrP and BzP with parental history of allergy, suggesting heightened vulnerability to paraben exposure in genetically predisposed subgroups. In conclusion, children with respiratory allergies were associated with higher exposure to PrP and BzP and exhibited higher susceptibility in those with a parental history of allergy. Full article

Background: Food allergy (FA) is an increasing public health concern with significant implications for child health and quality of life. Early introduction of allergenic foods has been shown to reduce the risk of food allergy development; however, maternal awareness and adherence to these recommendations remain inconsistent. This study aimed to assess maternal awareness and practices regarding the timing of allergenic food introduction among mothers residing in Makkah, Saudi Arabia. Methods: A descriptive cross-sectional study was conducted between November 2023 and March 2024 involving parents of children aged younger than 48 monthsin the Makkah region. Data were collected via a self-administered electronic questionnaire distributed through social media platforms. Results: A total of 391 parents participated. Parent-reported food allergy was identified in 11.3% of children, while 14.6% had eczema. Early introduction (<12 months) was more common for egg (43.3%) and wheat (71.1%) compared to peanut (28.9%), tree nuts (30.9%), sesame (30.9%), and seafood (28.9%). A considerable proportion of children had not been introduced to key allergenic foods even after 36 months, particularly peanuts (45.3%) and sesame (42.2%). Children with eczema were significantly more likely to have early introduction of egg (p = 0.035), tree nuts (p = 0.046), and seafood (p = 0.031). Similarly, children with a family history of food allergy had higher early introduction rates of tree nuts (55.3% vs. 44.0%, p = 0.043) and seafood (62.3% vs. 49.1%, p = 0.019). Only 25.8% of mothers were aware that early introduction might prevent food allergies, and just 22% reported receiving professional advice to introduce allergenic foods early. Conclusions: Maternal awareness regarding the timely introduction of allergenic foods in Makkah remains limited, with delayed introduction persisting beyond 36 months for several high-risk allergens. These findings underscore the need for targeted educational interventions and improved counseling by healthcare providers. Full article

Background/Objectives: Parents of preschool children may adopt dietary practices intended to promote height growth. However, the correlates of such practices in the general population remain unclear. Methods: This web-based cross-sectional study included 1362 mothers of Japanese children aged 3–5 years. Mothers were assigned to the height-related dietary practice group if they had ever used dietary practices to promote their child’s height growth; all other mothers were classified into the no-practice group. The questionnaire assessed child and parental characteristics, including anthropometric measurements, history of short stature (height < −2 SD at any time point), history of food allergy, maternal information-seeking behavior regarding child growth, and current dietary intake. Associations with height-related dietary practices were examined using a multiple logistic regression analysis. Results: In total, 531 mothers (39.0%) were classified into the practice group. Older child age, history of short stature, history of food allergy, and information-seeking behavior were positively associated with height-related dietary practices, whereas parental height was inversely associated. Milk and dairy products are the most frequently used foods for height promotion. Children in the practice group were more likely to meet the cutoffs for milk/dairy products and fish, but their overall attainment was low. In the analyses of retrospectively reported height SD score trajectories, no group-by-time interactions were observed. Conclusions: Height-related dietary practices were associated with growth-related concerns and parental characteristics rather than differential height gain over time. Health guidance may help parents adopt balanced diets that support overall nutrition and healthy growth rather than focusing on specific foods. Full article

Background: Food allergy [FA] is a growing public health concern among school-age children, with schools and childcare/daycare settings representing high-risk environments for accidental exposure and anaphylaxis. Objective: To systematically review evidence on digital health interventions supporting FA education, prevention, and management in school settings. Methods: A systematic search of PubMed, Scopus, Web of Science, and CINAHL was conducted to identify studies published between January 2015 and December 2025 [PROSPERO CRD420251185553]. Eligible studies evaluated e-learning, mHealth, or web-based programs targeting school staff, parents, or students. Results: Sixteen studies met inclusion criteria. Digital health emerged as a catalyst for professional development, interprofessional communication, and health equity within school communities. Interventions consistently improved knowledge, preparedness, and self-efficacy in anaphylaxis management among school staff, strengthened parental empowerment and communication with schools, and supported coping and inclusion among allergic children. Evidence on clinical outcomes; however, remains limited. Conclusions: Digital health can meaningfully enhance school preparedness and reduce inequalities in allergy management. Integrating digital tools into national school health frameworks—particularly where school nursing is not yet institutionalized—may represent a pivotal step toward safer, more equitable inclusion of children with food allergy. Full article

Background/Objectives: Special diets can be required for medical, religious, cultural, or ethical purposes. This study examined the relationship between the organization of school nutrition and the availability of special diet meals among students in public primary and secondary schools in Kraków (Poland). Methods: An observational study was conducted in 2022 using a web-based survey targeting managers of primary (n = 68) and secondary schools (n = 18), as well as parents of attending students (n = 1730). Factors associated with providing special diets were analyzed using generalized linear models with robust variance estimators. Results: According to school managers, the availability of special diet meals was associated with employing a dietitian responsible for menu planning, the presence of students with disability certificates, students’ participation in school meal programs, and higher per-child nutrition costs. Based on parental reports, 16.01% of all students followed a special diet, most often due to medical recommendations, with a higher prevalence observed among secondary school students (26.7%). Special diets were reported more frequently for children with food intolerances and allergies, obesity, chronic conditions, or disability certificates. Adjusted models also indicated slightly higher probabilities of being on a special diet among students attending secondary schools or sports classes compared with their peers. Conclusions: Improving the availability of special diet meals in schools requires legislative action, adequate funding, and institutional support, including investments in kitchen infrastructure and the employment of dietitians. These measures are particularly important in institutions enrolling children with disabilities to ensure equitable access to appropriate nutrition. Full article

Background/Objectives: The beliefs about a disease and its treatment determine how patients and caregivers manage and adapt to the illness. The study aimed to explore the QoL and mental health of children with food allergy (FA), and parental illness perception, analyzing influences of sociodemographic and clinical factors and associations between constructs. Methods: This cross-sectional study involved 79 parents of children (3–12 years) with FA, who completed the Food Allergy Quality of Life Questionnaire—Parent Form (FAQLQ_PF), Strengths and Difficulties Questionnaire (SDQ), and Brief Illness Perception Questionnaire (B-IPQ). Pearson correlation coefficient and multiple linear regressions were performed. Results: FAQLQ score was positively associated (0.28) with SDQ score, particularly internalizing problems (0.33), and with B-IPQ score (0.64), consequences for the child and parents (0.66), timeline (0.43), and emotional representation (0.63). SDQ score was negatively associated with parental control (−0.27) and coherence (−0.24), while internalizing problems were negatively associated with parental control (−0.23) and positively associated with timeline (0.24). A greater number of allergens was associated with a worse QoL (p < 0.05). Previous anaphylaxis was associated with higher illness identity (p < 0.05). An age between 7 and 12 years was associated with lower control and coherence. In the final model, higher scores on internalizing problems, timeline, and emotional representation were associated with poorer child QoL (p < 0.001). Conclusions: It is crucial to understand and explore illness perception, as well as focus on psychosocial–emotional aspects of FA in both children and parents. A multidisciplinary approach addressing medical and psychological aspects of FA should be implemented to ensure optimal QoL. Full article