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Introduction: Allergy to cow s milk protein is the most common food allergy in children under the age of three years. A diet without milk or dairy products is potentially low in many nutrients and could put the child at risk of malnutrition and compromised growth. Dairy products are a major source of iodine in the Norwegian diet, and excluding dairy products may negatively affect iodine status. Insufficient iodine status during childhood could potentially be detrimental and put the child at risk for delays in mental development and poor growth. Objectives: The main objectives of this study was to investigate iodine intake and status along with growth in infants and young children under two years of age who were on a cow s milk protein free diet and to identify factors affecting iodine status and growth in these children. Methods: Fifty-seven infants and children under two years of age where included in a larger cross-sectional study on the nutritional status of children on cow s milk protein free diets (MILKID study). Two spot urine samples from were collected and analysed for iodine, together with a three day food record and a food frequency questionnaire on dietary sources of iodine. Urine iodine concentrations were compared to the WHO cut-off values for iodine deficiency. Weight, length and head circumference were recorded at birth and at inclusion in the study and compared to the Norwegian growth standard. Sub-group analyses were done on different feeding patterns, according to weaning status. Results: One third of the children had iodine deficiency according to urine iodine concentration (UIC). Children who were mainly breastfed were at highest risk and 58 % was classified as deficient. Dietary factors associated with iodine were intake of enriched baby cereals (r = 0.230, p = 0.02) and reaching RDI for iodine through diet (r=0.313, p = 0.03). Children of mothers who took supplement with iodine had higher urinary iodine concentrations, though this was not significant. Growth in length was compromised in boys, 11 % of the infants had weight for age z-score (WAZ) and BMI for age z-score (BMIZ) of ≤ -2 and 5 % length for age z-scores (LAZ) of ≤ -2 at inclusion and this was associated with food refusal and low appetite, but not associated with iodine deficiency. Conclusion: The present study demonstrates that the exclusion of cow s milk protein puts the child at risk of deficiency of iodine and poor growth, however the two conditions were not related. Infants reliant on breast milk as their main iodine source are at increased risk of iodine deficiency. Boys with feeding problems were at highest risk of growth failure.

Background: Coeliac disease is one of the most prevalent immune-mediated gastrointestinal disorders in children. Aim: To review the incidence and prevalence of paediatric coeliac disease, and their trends, regionally across Europe, overall and according to age at diagnosis. Methods: Systematic review and meta-analysis from January 1, 1950 to December 31, 2019, based on PubMed, CINAHL and the Cochrane Library, searches of grey literature and websites and hand searching of reference lists. A total of 127 eligible studies were included. Results: The prevalence of previously undiagnosed coeliac disease from screening surveys (histology based) ranged from 0.10% to 3.03% (median = 0.70%), with a significantly increasing annual trend (P = 0.029). Prevalence since 2000 was significantly higher in northern Europe (1.60%) than in eastern (0.98%), southern (0.69%) and western (0.60%) Europe. Large increases in the incidence of diagnosed coeliac disease across Europe have reached 50 per 100 000 person-years in Scandinavia, Finland and Spain. The median age at diagnosis increased from 1.9 years before 1990 to 7.6 since 2000. Larger increases in incidence were found in older age groups than in infants and ages

International audience; Objectives: Given a lack of a systematic approach to the use of breath testing in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimise its utility and safety. Methods: Nine clinical questions regarding methodology, interpretation, and specific indications of breath testing and treatment of carbohydrate malabsorption were addressed by members of the Gastroenterology Committee (GIC) of the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN). A systematic literature search was performed from 1983 to 2020 using PubMed, the MEDLINE and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes. During a consensus meeting, all recommendations were discussed and finalised. In the absence of evidence from randomised controlled trials, recommendations reflect the expert opinion of the authors. Results: A total of 22 recommendations were voted on using the nominal voting technique. At first, recommendations on prerequisites and preparation for as well as on interpretation of breath tests are given. Then, recommendations on the usefulness of H2-lactose breath testing, H2-fructose breath testing as well as of breath tests for other types of carbohydrate malabsorption are provided. Furthermore, breath testing is recommended to diagnose small intestinal bacterial overgrowth (SIBO), to control for success of Helicobacter pylori eradication therapy and to diagnose and monitor therapy of exocrine pancreatic insufficiency, but not to estimate oro-caecal transit time (OCTT) or to diagnose and follow-up on celiac disease. Conclusions: Breath tests are frequently used in paediatric gastroenterology mainly assessing carbohydrate malabsorption, but also in the diagnosis of small intestinal overgrowth, fat malabsorption, H. pylori infection as well as for measuring gastrointestinal transit times. Interpretation of the results can be challenging and in addition, pertinent symptoms should be considered to evaluate clinical tolerance.

International audience; Acute diarrhoea is a leading cause of morbidity and mortality in the paediatric population. Racecadotril is an antisecretory drug recommended as an adjuvant anti-diarrhoeal treatment.In the small bowel, the enzyme neutral endopeptidase (NEP) inhibits the action of enkephalins, which prevent water and electrolyte hypersecretion. By inhibiting NEP, racecadotril allows enkephalins to exhibit their antisecretory effects. Consequently, racecadotril reduces the secretion of water and electrolytes in the small intestine, without having an effect on intestinal motility. No serious adverse events related to racecadotril have been reported.Racecadotril has proven its efficacy as an adjuvant anti-diarrhoeal drug with a good safety profile. Its addition to oral rehydration solution (ORS) appears clinically beneficial and potentially leads to health care savings.