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units of botulinum toxin injected into the ipsilateral parotid gland. Ali et al 2008 and Sims and Suen 2013 reported complete resolution in three out of four patients treated with injection of 75 units of botulinum toxin into the ipsilateral parotid gland. The other patient had almost complete relief of symptoms with significant improvement in quality of life. The symptoms were found to begin to return gradually within three to five months and patients did not seek further injection until five to eight months 10 . There were no side-effects of the injection treatment reported. Conclusion Premium grade fish meal provides a protein and amino acid rich diet which promotes rapid growth free of dietary deformities or deficiencies Maternal feeding behavior is measured using both observations of family meals at home and questionnaires. When the child is 4–7 months of age ( t 0 and t 1), a videotape is made of the mother feeding the child one of the pureed foods of the feeding schedule. At all other time points, a family dinner is videotaped. These videos are coded by trained researchers/students for maternal sensitive feeding using the Ainsworth scale [ 95]. In addition, maternal responsiveness to child satiety cues is coded using a scale based on the Responsiveness to Child Feeding Cues Scale [ 96], and maternal pressure to eat is coded using a scale based on a large Dutch study that observed family meals in 4–6 year-olds [ 66].
The repeated vegetable exposure (RVE) intervention focuses on what to feed infants. The RVE intervention starts with vegetables only according to a 19-day feeding schedule as described by Barends and colleagues [ 26, 27], and further promotes vegetable exposure in the first year of complementary feeding until 16 months of age using a protocol developed specifically for the current study. We conducted a needs assessment and applied the Intervention Mapping (IM) process [ 78, 79, 80] to develop this protocol. Bartholomew Eldregde LKB, Markham CM, Ruiter RA, Kok G, Parcel GS. Planning helath promotion programs: an intervention mapping approach. San Francisco: John Wiley & Sons; 2016.CPD/Clinical relevance: This paper describes how first bite syndrome may present as a complication following surgery; general dental practitioners should be aware that it may represent the initial presentation of an underlying neoplastic process of the parotid gland or parapharyngeal space. Mallan KM, Fildes A, Magarey AM, Daniels LA. The relationship between number of fruits, vegetables, and noncore foods tried at age 14 months and food preferences, dietary intake patterns, fussy eating behavior, and weight status at age 3.7 years. J Acad Nutr Diet. 2016;116(4):630–7.
In light of today’s global obesity epidemic and related diseases, promoting healthy eating habits is essential [ 1]. Children as young as 1–3 years of age already eat too much energy-dense food and too little fruit and vegetables [ 2, 3, 4, 5, 6]. In the Netherlands, based on surveys between 2006 and 2014, estimates for the percentage of preschoolers failing to meet daily recommendations for vegetable intake vary from 40% up to an alarming 80% [ 2, 3]. Moreover, a recent experimental study showed that almost 40% of 4 year-olds fail to effectively regulate their own energy intake, showing a tendency to eat even though they are not hungry [ 7]. Poor eating habits, such as consuming too little vegetables and eating in the absence of hunger increase the risk of developing overweight and obesity, and related diseases such as type II diabetes [ 8, 9, 10, 11, 12], cardiovascular disease [ 13], and certain cancers [ 14]. Both children’s food preferences and their ability to self-regulate their energy intake are influenced by their direct environment already in the first two years of life [ 15, 16, 17, 18, 19, 20]. Therefore, promoting a healthy diet and healthy eating habits and behavior from infancy is essential. At this young age, parents bear primary responsibility for the diet of their children. The present article describes the study protocol and sample of a randomized controlled trial under the acronym Baby’s First Bites (BFB), aimed at (a) promoting vegetable intake and liking, and (b) promoting child self-regulation of energy intake, by advising parents what and how to feed their infants from the very start of complementary feeding. The primary goals of promoting vegetable acceptance and self-regulation of energy intake serve the purpose of reducing the risk of developing overweight in early childhood – our secondary outcome. Three interventions will be compared to an attention-control condition (1): a repeated exposure intervention motivating parents to repeatedly expose their children to the taste of a variety of vegetables during the first year of complementary feeding (2); a parenting intervention promoting sensitive parental feeding; and (3) a combined intervention promoting both repeated exposure to vegetables and sensitive feeding. Repeated exposure to a variety of vegetables from the start of complementary feedingSavage JS, Birch LL, Marini M, Anzman-Frasca S, Paul IM. Effect of the INSIGHT responsive parenting intervention on rapid infant weight gain and overweight status at age 1 year: a randomized clinical trial. JAMA Pediatr. 2016;170(8):742–9. During exclusive breast or formula feeding, the infant's intestinal microbiome contains a pre-ponderance of bifidobacteria and enterobacteriacae with smaller numbers of streptocci, lachnospiracaie, lactobacilli, and clostridial species. With the introduction of solids into the diet, bifidiobacteriae, enterobacterial, lactobacilli and clostridial species decline and the fiber fermenters lachnospiracaie, bacteriodes, and ruminococcace increase. There is also a fairly marked increase in the diversity of the fecal microbiome with the introduction of solids, and these changes appear independent of geographic location, mode of delivery, and whether the infant is breast and/or formula fed ( 52). Moreover, low microbial diversity early in life has been associated with an increased incidence of infantile colic, eczema, asthma and type 1 diabetes ( 53). Conclusions
Mennella JA, Daniels LM, Reiter AR. Learning to like vegetables during breastfeeding: a randomized clinical trial of lactating mothers and infants. Am J Clin Nutr. 2017;106:67–76. Baby’s First Bites will be the first trial explicitly testing the separate and combined effects of promoting the what and how of complementary feeding. By comparing three prolonged, intensive interventions, we will be able to draw firm conclusions on what is most important to focus on when promoting vegetable acceptance and children’s self-regulation of energy intake in early childhood; what food to offer, how to offer this food, or a combination of the two. Moreover, this will be the first trial to include an intervention specifically manipulating sensitive feeding practices without manipulating any other variables, evaluating its effects using both self-report and observational measures. This allows conclusions on whether this parenting practice will indeed promote healthier food preferences in children and will foster children’s ability to self-regulate their energy intake, as is often suggested in the literature.
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BDS, MFDS RCPSG, MFDS RCSEd, Core Trainee in Oral and Maxillofacial Surgery, St. John’s Hospital, Livingston Humans are the only mammals that feed our young complementary foods before weaning and the only primates that wean our offspring before they can forage independently ( 1). The human anomaly of early weaning is likely due to our slow post-natal growth and maturation which in turn are likely due to our brain size. The human brain is more than three times larger than our closest relative the chimpanzee. In human adults, the brain accounts for 2% of body mass but consumes 25% of resting energy expenditure. An average adult needs 600 kilocalories per day to feed his or her brain ( 2). In other primates, the brain consumes <10% of resting energy expenditure ( 3). Hawes DJ, Dadds MR. Assessing parenting practices through parent-report and direct observation during parent-training. J Child Fam Stud. 2006;15:554–67. Juffer F, Bakermans-Kranenburg MJ, Van IJzendoorn MH. Promoting positive parenting. An attachment-based intervention. Bornstein MH, editor. New York: Psychology Press; 2008.
As a result of feeding our young complementary foods, there does not appear to be a specific age for weaning in humans, and weaning is variable across cultures. In pre-industrial populations, complementary foods are usually started between 4 and 6 months and breast-feeding has completely ceased by 30 months however, in some cultures solids are started substantially earlier ( 1). In general, the more active women are in subsistence activities, the earlier supplementary foods are started however, there is variation that seems the result of the work women are expected to do ( 9). Chan L, Magarey AM, Daniels LA. Maternal feeding practices and feeding behaviors of Australian children aged 12-36 months. Matern Child Health J. 2011;15(8):1363–71. Kok G, Schaalma H, Ruiter RA, Van Empelen P, Brug J. Intervention mapping: protocol for applying healthy psychology theory to prevention programmes. J Health Psychol. 2004;9(1):85–98. Whether you first notice a sharp pinch, a nagging itch, or a painful sting, discovering a brand-new bug bite—sometimes instantly, but often only days later—is no fun. Some ache, some beg to be scratched, and the worst of the bunch do both. And often, you haven’t the slightest clue which critter could have been the culprit. Have a nasty bite you can’t attribute to a specific house bug or outdoor pest? We’re sharing bug bite pictures to help you properly identify the offender, and how to best treat the wound.Meijboom S, Van Houts-Streppel MT, Perenboom C, Siebelink E, Van de Wiel AM, Geelen A, et al. Evaluation of dietary intake assessed by the Dutch self-adminstered web-based dietary 24-h recall tool (Compl-eat tm) against interviewer-administered telephone-based 24-h recalls. Journal of Nutritional Science. 2017;19(6):e49. Magnetic resonance imaging (MRI) and ultrasound guided fine needle aspiration cytology were suggestive of a benign neuroma most probably arising from the vagus nerve. She proceeded to have surgical excision of the lesion, which was histologically confirmed as a Schwannoma, most likely arising from the ansa cervicalis. At a subsequent review appointment two months after her surgery she complained of pain over the left side of her face around her temporomandibular joint (TMJ) and she was noted to have mild Horner’s syndrome on the left side. After this feeding schedule has been completed, all families are provided with a total of 100 jars of age-appropriate fruits and/or meals with vegetables, depending on the condition they are in, up until the child is approximately 12 months of age (distributed on five different occasions; 20 jars per occasion). Parents are free to decide whether they want to feed their baby using homemade foods or the jars provided to them. The provision of these foods serves as a means to facilitate prolonged exposure to vegetables in the repeated vegetable exposure conditions by making sure age-appropriate meals containing vegetables are available to the families. Whether or not families use these jars and how much the child eats of these jars is reported by the mother. Timing of intervention sessions Chang SH, Jun BS, Choi JO, Kim JJ, Jang Y. Successful Treatment of a Case of First Bite Syndrome without Any Cause. World Journal of Neuroscience 2015; 5: 331-333.
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