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Cow's milk allergy (CMA) is an immune-based disease that has become an increasing problem. The diagnosis and management of CMA varies from one clinical setting to another and represents a challenge in pediatric practice. In addition, because nonallergic food reactions can be confused with CMA symptoms, there is an overdiagnosis of the disease. In response to these situations, pediatric specialties from recognized institutions throughout Latin America decided to develop a clinical guideline for diagnosis and management of cow's milk allergy. These guidelines include definitions, epidemiology, pathophysiology overview, clinical and evidencebased recommendations for the diagnosis and treatment of CMA. They also include prevention and prognosis sections and identify gaps in the current knowledge to be addressed through future research.

Endocarditis caused by Streptococcus pneumoniae in children is an infrecuent disease, corresponding to 3-7 % of all cases reported. Pneumococcal endocarditis is a serious condition with a rapidly destructive nature and high fatality rate, demanding prompt medical and surgical treatment. We report a case an infant eleven years old who was admitted with endocarditis by S. pneumoniae, who presented with hearth failure and required surgery. A review of the literature of endocarditis caused by S. pneumoniae is presented.

Background: Different antibiotics, antagonist H2 and others have been used for elimination and/or eradication of Helicobacter pylori., Aims: Evaluate elimination of Helicobacter pylori with amoxicillin, bismuth subsalicylate and ranitidine; and the improvement of recurrent abdominal pain., Method: 20 children with recurrent abdominal pain associated to gastritis and histologic identification of Helicobacter pylori were studied under a period of 18 months (January 1992 to June 1993), at Instituto Nacional de Pediatría, México, D.F. All children were treated simultaneously with: Amoxicillin, 15 days, plus ranitidine and bismuth subsalicylate for one month., Results: Helicobacter pylori was eliminated in 14 of 20 children studied. All these children had an important improvement of recurrent abdominal pain., Conclusion: Elimination of Helicobacter pylori and clinical improvement was present in 14 of 20 children studied (70%).

We studied 100 healthy children looking for lactose malabsortion. We performed in all of them the lactose breath test. We found a 10% with lactose malabsortion. There was no correlation between lactose breath test and fecal reducing substances.