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Objectifs : Parmi les troubles alimentaires chez les enfants, la part de la dysoralité est mal connue et, par conséquent, mal reconnue par les praticiens. Dans une population d’enfants âgés de 0 à 18 ans, notre objectif est de déterminer la proportion et de préciser les caractéristiques des enfants atteints par un syndrome de dysoralité sensorielle au sein de sujets ayant consulté pour des troubles alimentaires. Méthodes: les enfants sélectionnés rétrospectivement ont été rencontrés à la consultation de pédiatrie pour des troubles alimentaires et évalués par une kinésithérapeute spécialisée dans les troubles de l’oralité aux Cliniques universitaires Saint-Luc. Les données examinées, de type anamnestique anthropométrique et clinique, visent à permettre la distinction des troubles alimentaires de type fonctionnel et sensoriel, d’en dégager des associations éventuelles, ainsi qu’une prévalence. Outre définir leur spécificité, il est important de les mettre en relation avec des antécédents néonataux, des répercussions sur le développement global et l’évolution de la croissance de l’enfant ainsi que la prise en charge choisie. Résultats et conclusions : Nous avons mis en évidence un syndrome de dysoralité sensorielle chez 71% des sujets de l’étude. Des facteurs associés tels que des actes médicaux invasifs et un RGO ont été mis en évidence dans la moitié des cas. Les troubles se développent surtout lors de la diversification alimentaire avec la variation des textures. L’évaluation oro-faciale permet de souligner des problèmes fonctionnels, l’importance du réflexe nauséeux et de la sensibilité aux textures. Au terme de l’évaluation, massages intra-buccaux, conseils et suivi des enfants sont souvent proposés aux patients pour les soutenir dans le dépassement de leurs difficultés. Nicotine is the major substance responsible for the appearance of physical dependence at the smoker by its action on nicotinic brain cholinergic receptors. The binding of nicotine to these receptors enable the release of neurotransmitters that take part in the reward system of the brain. The dependence can be measured via clinical data (Fagerström test, number of cigarettes smoked /day). Tobacco impregnation is evaluated by the dosage of the rate of CO and nicotine metabolites. Nicotine is metabolized in the liver by CYP2A6 to cotinine. This one is itself metabolized to trans-3’hydroxycotinine/cotinine by this same cytochrome. There are several polymorphisms for CYPA26. The trans-3’hydroxycotinine/cotinine ratio is stable for a person and reflects the enzymatic activity of CYPA26. This ratio ranks smokers as slow or fast metabolizers. The higher the trans-3’hydroxycotinine/cotinine ratio is and the greater the cytochrome activity and nicotine clearance will be. Nicotine and its metabolites are specific markers of smoking. Cotinine is the gold-standard because it’s sensitive, specific and has a long half-life. In this study, we analyzed the relationships between the clinical and biological parameters of smokers. Clinical data used are the length of smoking, the number of cigarettes smoked /day and the Fagerström test score. The biological parameters studied are the rate of CO, the cotinine and trans-3’hydroxycotinine concentrations are the trans-3’hydroxycotinine/cotinine ratio. The data were included in the first consultation and two follow-up visits. Our results show that, initially, cotinine is positively correlated with the level of CO and the number of cigarettes smoked. The number of cigarettes smoked is the most predictive marker of cigarettes consumption at follow-up and is negatively influenced by the trans-3’hydroxycotinine/ cotinine ratio. A higher trans-3’hydroxycotinine / cotinine ratio is associated with a lower CO level and a lower number of smoked cigarettes during follow-up. A correlation can be found between the biological markers and the initial smoking status. At follow-up, the number of cigarettes smoked initially is the main predictor of the number of cigarettes smoked and is influenced by the trans-3’hydroxycotinine /cotinine ratio.

Feeding and Eating Disorders of Childhood

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Avoidant/restrictive food intake disorder (ARFID) is a common eating disorder diagnosis that describes children and adults who cannot meet their nutritional needs, typically because of sensory sensitivity, fear of adverse consequences and/or apparent lack of interest in eating or food. This book is the first of its kind to offer a specialist treatment, specifically for ARFID. Developed, refined and studied in response to this urgent clinical need, this book outlines a specialiZed cognitive-behavioral treatment: Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder (CBT-AR). This treatment is designed for patients across all age groups, supported by real-life case examples and tools to allow clinicians to apply this new treatment in their own clinical settings.https://www.cambridge.org/core/books/cognitivebehavioral-therapy-for-avoidantrestrictive-food-intake-disorder/9F00DB41FFD73BD36D705A1FFCE06670#fndtn-information

Feeding and Eating Disorders --- Cognitive Therapy --- therapy --- methods --- Cognitieve gedragstherapie --- Eetstoornis