Irrational feeding can lead to a child’s physical and intellectual development disorders, a decrease in the body’s ability to resist aggressive environmental factors.

Aim: to evaluate the physical development and nutrition of children aged 1–3 years living in Moscow.

Methods: 106 children aged 1–3 years were examined: group 1 (n = 59) was comprised of children aged 1–2 years, group 2 — children aged 2–3 years (n = 47). Anthropometric data was evaluated using AntroPlus (WHO software). The following Z-score figures were calculated: WAZ (body mass for age), HAZ (height for age) and BAZ (body mass index for age). Nutrition was evaluated by reproducing a 3-day food allowance (actual nutrition) using the Dietplan 6 software. Figures analyzed: the volume of consumed food, daily caloricity, the amount of consumed proteins, fats and carbohydrates.

Results: for the majority (76.4%) of examined children BAZ was between -2 and +1. 20% of children had an excessive body mass and obesity (BAZ > 1). Children with an excessive body mass demonstrated exceeding volumes of food consumption (by about 200–300g. per day, p < 0.001), protein consumption by 47.5%, fat consumption — 36.7% and caloricity by 21.3% (p < 0.001) as compared with the recommended consumption norms.

Conclusion: the revealed nutrition disorders in children aged 1–3 years (overeating and unbalanced diet) lead to an increased body mass and obesity. Children with high body mass indexes at birth and Z-score and BAZ at the time of the study can be attributed to the obesity risk group. The BAZ index is the most informative one in terms of evaluating the child’s nutritive status.

The clinical assessment of the motor system’s condition of a growing infant is often complicated due to the volatility of neurological symptoms.

Aim. The study was aimed to follow the ontogenesis of the motor function from the 33rd week of postconceptual life to the 36th week of postnatal life using linear and nonlinear parameters of the surface electromyography (sEMG).

Methods. The study was longitudinal by its design, selective, stratified and randomized. Premature (31/32 week of gestation) and term (38/39 weeks of gestation) infants were studied. Stratified by gestational and postnatal age, sex and neurological status.

Results. In the premature infants the sEMG had an appearance of that of the first day term newborn seen as «simplified pattern», low amplitude and spectral frequency. The temporal dynamics of sEMG parameters were slower in premature infants. In contrast, a fast increase of nonlinear sEMG parameters in term newborns within the first year of life may be an evidence for a complication of the sEMG signal. The linear sEMG parameters increased monotonously across the first life year. Maximal values of both linear and nonlinear parameters were characteristic for the 6th month of life. That might reflect the critical period of formation of the cortico-spinal pathways and manipulative motion.

Conclusion. The findings suggest the importance of the first two weeks of life in the development of musculoskeletal term infants, which is formed during the «adult» type of the motoneuron pool organization. At the same time, quantitative changes in sEMG (increase of amplitude) continued during all 36 months of the study, which indicates a continuing growth of skeletal muscles. sEMG in preterm infants features a more simple temporal organization. This suggests the continuing «intrauterine» pattern of the motor neuron pool work.

Despite modern achievements in child allergology, the question of evaluating tolerance formation and defining the safest time for expanding the child’s ration after an eliminatory diet remains open. This article contains the results of the authors’ own investigation concerning the practical meaning of specific immunoglobulins (sIg) class G4 as tolerance formation markers at food allergies in children. Thus, it has been found that high levels of sIgG4 are not only a favourable prognostic factor for light manifestations of food allergy, but also an index of a tolerance formation. The prevalence of high food allergy sIgG4 was statistically significantly higher in early age children from the comparison group than in patients with food allergy. Thus the authors suggest that the production of sIgG4 is a normal physiological process which hinders the development of hypersensitivity, while high levels of sIgG4 are evidence for the child’s immune system “contacting” this or that product. Clinical tolerance formation predictors define lighter clinical manifestations of food allergies, a non IgE-mediated form of food allergy and the retention of breastfeeding.

Heavy complications of systemic lupus erythematosus, such as the anti-phospholipin syndrome, generalized vaskulit and severe defeats of the central nervous system continue to remain relevant. There is a frequent development of side effects against high-dose therapy by glucocorticosteroids and cytostatics. In this regard the development of new methods of pathogenetic therapy, selectively influencing the segments of its pathogenesis, is vitally important. The article features a heavy case of systematic lupus erythematosus with central nervous affection where clinical and laboratory activity led up to the development of complications during the usage of the standard therapy schemes. The rapid and significant effectiveness of Rituximab in a complex treatment of heavy forms of systemic lupus erythematosus was demonstrated.

Colon melanosis is a rare pathology which is connected with a long intake of non-steroid anti-inflammatory medicines or purgative drugs containing antraglycozides. Colon melanosis is also detected at liver and pancreas diseases and colon cancer. The disease is rare for children. The article features a clinical observation of a melanosis case in a 15-year-old girl who suffered from constipation and had been taking senna drugs as purgatives without control for 6 months. The diagnosis was founded on the endoscopic image and was confirmed by a histological survey of the colon mucous.

Bronchial asthma is one of the most prevalent breathing illnesses. Today there is a sufficiently wide spectre of effective medicines with a good safety profile and an acceptable price. Despite this, a large number of patients receive inadequate treatment, which leads to a decrease in life quality, permanent bronchial obstruction and even death. In 2014 the Global Initiative for Asthma (GINA) significantly renewed its regularly issued Global Strategy for Asthma Management and Prevention. It includes relevant asthma information together with practical clinical recommendations. This article highlights the renovations published in the document in 2014 and 2015. The authors present modern approaches to child bronchial asthma diagnosis, including differential, together with the actualized treatment goals and principles. The criteria for evaluating the disease control and child asthma severity are also covered. The possible problems of achieving adequate control of the disease are also analyzed.

The problem of intestinal microbiota influencing the health of early aged children has become especially relevant over the past few years. On one hand, this is due to the significant worsening of the human environment ecology, on the other — due to the high prevalence of digestive disorders in children, especially premature ones. The introduction of modern high-informative molecular-genetic research methods (PCR-amplification with gene sequenation) made it possible to reveal the primary stage of human colonization by bacteria even at the stage of fetal ontogenesis and to thoroughly decode the microbiota structure in newborns and first-year babies. It is established, that the mothers microbiota has a direct effect on the quantity and quality of the child’s microbiota. The mother’s microbiota depends not only on her possessing inflammatory, but also metabolic diseases (obesity). There is also a direct correlation between the children’s microbiota and the wway they were born (microbiota is better in cases of natural birth), and these differences are prevalent after a number of months after birth. One of the main factors affecting microbiota after birth from the very first day is nutrition. Most studies earnestly confirm the role of breastfeeding in contributing to an optimal microbiocenosis in the child. Antibacterial therapy, being received by either the mother or the child has a negative effect on the colonization of the intestines by symbiont microbes. The negative impacts on the micro flora are especially significant for premature children especially those born with a very low and extremely low body mass. The ontogenesis of these children is most severed by malicious factors (infections followed by the necessity of a massive antibacterial therapy, hypoxia, surgical birth, forced artificial feeding) in connection with a general immaturity, including not yet fully-fledged body defense systems. Directive microbiota correction in premature children is an important condition for prevention and treatment of such severe diseases as sepsis necrotizing enterocolitis. For this reason, the usage of probiotics is considered as one of the promising practices of practical neonatology. The article contains an example of studying the effectiveness of probiotic therapy in premature babies with a combined perinatal pathology.

The widespread «off-label» drug use and the prescribing of unlicensed medicines in pediatric practice is a major health problem. The authors discuss actual regulatory and legal issues of «off-label» drug use in children in the US, Europe and Russia. The results of different population-based studies from many countries, showing the structure and frequency of «off-label» drug use in children, are summarized in this article. It is shown that such practice increases the risk of adverse drug reactions. The authors offer practical recommendations for a safer use of drugs in pediatric practice. The priority issue is conducting high quality clinical trials with the participation of children, improving national pharmacovigilance and the monitoring of off-label drug use, developing pediatric formularies, improving doctors’ knowledge and awareness of safety and efficacy of medicines in pediatric population.

Гемостаз представляет собой сбалансированную систему про- и антикоагуляционных механизмов, направленную на предупреждение кровотечений при повреждении кровеносных сосудов, с одной стороны, и неконтролируемого тромбообразования — с другой.

Hemocoagulative disorders comprise one of the relevant paediatric problems. The development of the hemorrhagic syndrome in babies is associated with severe complications, serious health disorders and a decrease in the survival rate. The article covers the issues of etiology, pathogenesis, clinical picture, differential diagnosis and treatment of hemorrhagic syndromes in babies. The authors describe the qualitative and quantitative differences in the in the plasma hemostasis between premature, mature newborns, early age children and adult patients. The study presents main diagnostic methods, which are based on using both routine tests for investigating the plasma hemostasis and second-level (supporting) tests available for the majority of paediatric facilities. The modern approaches to treating hemorrhagic states in early age children are also highlighted. Children with minimal hemorrhagic syndrome manifestations, as well as patients with liver diseases, cholestasis, cystic fibrosis, chronic digestive diseases who have been receiving antibiotic therapy for a long period of time should have an additional homeostasis system survey done in order to timely and correctly diagnose and correct hemorrhagic states. Risk group children are recommended for prophylaxis of vitamin K deficiency. The article is illustrates by 3 clinical observations.

Adhesive intestinal obstruction is one of the reasons of emergency conditions in children. The article discusses the problem of sintered ileus (SKN), from causes to treatment. It stresses the urgency of the problem of timely diagnosis SKN consisting of X-ray, ultrasound and endoscopic methods of investigation. Described are several classifications, based on which not only the differentiation of different types of SKN is carried out, but also the tactics of patients. Conservative methods of SKN treatment in children are presented as well as the use of laparoscopy, when conservative therapy is not effective, not only to evaluate the prevalence of adhesions in the abdominal cavity but also to remove the cause of intestinal obstruction.

Early and correct diagnostics of myocardial infarction in newborns is impossible without modern instrumental methods, among which echocardiography is the leading one. Hypokinesia, akinesia or dyskinesia of local segments of the heart ventricular wall is determined with echocardiography. We examined a 3-days-old baby with circulatory failure requiring cardiotonic support. On auscultation there was a heart murmur. It was an intracardiac conduction disoder and infarction-like changes on ECG, however, a convincing evidence to interpret the patient’s condition as myocardial infarction has not been received. Therefore, it was decided to conduct echocardiography. According to the results of echocardiography the presence of hyperechogenic diskinetic locus in the apical segment of the right ventricle (post-infarction scar), a local pericardial effusion in the same projection, hyperechogenic movable mass (thrombus) in the apical segment of the right ventricle were determined that together with the results of the ECG allowed us to set diagnosis myocardial infarction. Transthoracic echocardiography is one of highly informative methods; the data obtained allowed to correctly interpret the clinical picture of heart failure and to reveal the cause of the patien’st dependance on cardiotonic support.

The aim of this publication is a comparative analysis of the attitudes of paediatricians and parents towards vaccination and the vaccination calendar.

Methods. An online poll among mothers of children under the age of was carried out. 315 women at the age of 20–45 took part in the poll. They were all questioned about their attitude towards vaccination and the adherence to the vaccination calendar. 42 paediatricians contributed their opinion on the subject of vaccination calendar violations, unjustified medical rejections and the vaccination of their own children and themselves.

Results. The poll revealed a lack of correspondence between the parents’ idea of vaccination and the paediatricians’ attitudes towards vaccination calendar violations.

Conclusion. Educational programs for doctors and parents covering the topic of vaccination can provide an effective resistance to the present anti-vaccination lobby. At the moment, the key issues are the necessity to decrease unjustified medical rejections for vaccinations, a continuous attention to the child’s vaccination status (at any addressing) and informing the parents about the diseases which can be prevented through immunization.

Background. Acute respiratory infections (ARI) are leaders in the structure of general diseases of the population. In Russia, each year about 70 thousand ARI cases occur per 100 thousand child population. The maximum frequency of acute respiratory infections is noted at the age from 6 months to 6 years. Among this group, the highest incidence of acute respiratory infections is observed for children of preschool age. Viral infections are leading among the causes of acute respiratory disease (90%) and only a minor part of them consist of bacterial pathogens. Despite this, almost 25–85% of pediatricians prescribe to their patients antibiotics for acute respiratory infections.

The Aim. Analysis of the spectrum of antibacterial drugs used in acute nasopharyngitis in preschool children in an outpatient setting.

Methods. The study was formed by a representative group in the amount of 1248 outpatients preschool children. The article presents the nosological forms of acute respiratory infections to study the spectrum of applied systemic antibiotics in acute nasopharyngitis in preschool children in an outpatient setting.

Results. In the structure of ARI for the period 2009–2010, the incidence of acute nasopharyngitis dominates and is more than 60%. During pharmacoepidemiological analysis the frequency of using systemic antibiotics in children with acute nasopharyngitis on an outpatient basis was established. It was found that antibiotic therapy was applied in 43 (2009) and 37% (2010) ARI cases. Most often it were aminopenicillins, combined penicillins, macrolides, cephalosporins of the III-rd generation.

Conclusion. Given the prevalence of acute nasopharyngitis among ARI nosological forms, it should be emphasized that most of them are uncomplicated, which may serve as important basis for the rational use of systemic antibiotics on empirical choice in the conditions of outpatient care.

Introduction. 20–30% of the world population suffers from iron deficiency anemia. Despite the availability of diagnostic and therapeutic options, the real medical practice in relation to iron deficiency anemia remains on a suboptimal level. As a result, over the past 20 years there is no significant improvement in the iron deficiency anemia frequency in young children.

Objective. To analyze the existing care tactic for toddlers with iron deficiency anemia in a primary care setting and to identify the possible ferrotherapy mistakes.

Methods. A retrospective study of 135 3-year-old children with anemia in primary health care. The inclusion criteria was: documented low hemoglobin level as recommended by WHO in at least two sequential complete blood tests.

Results. Control complete blood count (CBC) was performed within 6 months of anemia detection in 70.4% cases. However, this control was performed during the optimal time only in 15.6% of cases. In 56.3% of cases the fact of ferrotherapy wasn’t documented. The onset of ferrotherapy after the first episode of low hemoglobin detection was in 19.3% of children. 29.6% of children received treatment with iron supplements in an adequate dose. Only in 11.9% of cases the dose of iron was lower than recommended. 30.4% of children had a relapse of iron deficiency anemia and up to 6% had multiple relapses. The average duration of iron deficiency anemia in children during the first three years of life was 6.4 months.

Conclusion. In the majority of cases the therapy of the majority of iron deficiency anemia in toddlers was delayed. The biggest problem is the lack of adequate hemoglobin levels monitoring.

Cow’s milk proteins (CMP) are the most often cause of allergy in young children. Despite the significant successes in laboratory diagnosis, which also cover allergy in children, food allergy is still a major discussion point in many cases. Successful CMP allergy treatment in children is largely dependant upon the early diagnosis and timely prescription of an eliminatory diet and is defined not only by the actions of specialists (allergologists and dietologists) but also of the primary level doctors. The minimal effective duration of the diet is established by evidence-based studies and is defined in consensus documents on treating children with CMP allergy. Further questions concerning diet duration are resolved according to each unique case. The continuation of a diet should be justified, therefore the necessity of eliminating certain products from a child’s diet is evaluated every 6–12 months. However, at the moment there are no clear ways to predict the duration after which tolerance would appear and thus the duration of a strict eliminatory diet for CMP allergic children. Until recently it was believed that 80–90% of CMP-allergic children form a tolerance over the first 3–5 years of life; however, according to the latest data, the body’s adaptation manifests later. In general, studies show that persisting CMP allergy is characterized by a severe family anamnesis concerning atopic diseases, a longer period between the beginning of CMP intake and the first allergy symptoms, a larger frequency of multiple food reactions and the presence of other allergies. With age a partial CMP tolerance may develop, when dairy products should be introduced in limited amounts. In such cases specialists recommend to introduce milk proteins in tolerable amounts (mainly as part of other products), which, as has been demonstrated, can contribute to the formation of tolerance, while retaining the diagnosis formulation.

Background: Pneumonia is one of the most frequent serious potentially life threatening childhood diseases. The criteria for diagnostics and treatment were designed long ago and are clearly articulated. Nevertheless, diagnostics and therapy happen most often during outpatient management.

Objective: The aim was to compare the diagnostic criteria of CAP among children in Russian and foreign guidelines and also to compare the incidence. Another aim is to find out the aptness to the Russian guidelines for the management of CAP among children.

Materials and methods: The comparative analysis of childhood pneumonia diagnostics and treatment guidelines have been recently published in a range of countries. We reviewed some recently published pneumonia recommendations. The timeliness and adequacy of hospitalization and treatment was analyzed for 167 hospitalized children with pneumonia diagnosed according to Russian and WHO recommendations. We also used the information about the quality of X-ray pneumonia diagnosis in 679 patients from hospitals in Barnaul, Ekaterinburg and Murmansk (PAPIRUS research project).

Results: We found a high percentage of late (5-th day and later) hospitalization of children with pneumonia (37 percent in 2002–2007 and 47 percent in 2013–2014) as well as a late ( 5 days) start of therapy (20 and 34 percent accordingly). In three regional hospitals only 27 percent of X-ray films of children treated for pneumonia were attested as meeting the pneumonia criteria. We found a high frequency of macrolides as a starting therapy in typical pneumonia which often had been ineffective. Amoxicillin/clavulanate and oral cephalosporins were also ineffective in doses < 45 mg/kg/day. A poor knowledge of the clinical features of atypical pneumonia was noted with a corresponding high frequency of -lactams as a starting medication.

Conclusion. Our data shows the importance of training paediatricians in modern pneumonia diagnosis and treatment.

The article deals with the problem of establishing communication between the paediatric nursing staff and their patients. It emphasizes the vital role of communication in the treatment process; analyzes the communication types and the typology of nurses offered by R. I. Hardy. The article shows how important the skill of understanding and listening to the patient is and what positive effect it has on establishing a psychological contact. Qualities obligatory for a nurse include patience and the ability to control oneself. This is hard to achieve because of a high degree of emotional stress, which arises as a result of communicating with patients, along with an increased irritability, exactingness and ailing touchiness. In the end, the personality, the style and methods of work and professional characteristics of a medical nurse are a necessary element of effective treatment together with correct diagnostics and prescriptions.

Более 130 ведущих детских врачей Российской Феде рации приняли участие в Европейском конгрессе педиатров — главном международном педиатрическом событии 2015 года, который состоялся 13–16 мая во Флоренции (Италия).

21 апреля 2015 г. в Москве состоялось заседание Экспертного совета по оптимизации подходов к диагностике и лечению гипофосфатазии — редкого наследственного заболевания, которое сопровождается изменениями костной системы, зубов и полиорганными проявлениями, имеющими в ряде случаев фатальный характер.

15 июля 2015 г. исполняется 80 лет со дня рождения Ивана Ивановича Балаболкина — доктора медицинских наук, профессора, заслуженного деятеля науки Российской Федерации, члена-корреспондента РАН.