On 6-9 May 2015 in Amsterdam took place 48 Conference of the European Society of Gastroenterology, Hepatology and Nutrition Children (European
Society for Pediatric Gastroenterology, Hepatology and Nutrition, ESPGHAN).

Fermented infant formulas are based on cow’s milk fermented using lactic acid producing bacteria and are widely available in many European
countries. The formulas contain products of bacterial metabolism, but do not contain significant amounts of viable bacteria and
therefore may not be classified as probiotics. Previous publications indicated that they can be used safely in nutrition of neonates, infants
and young children and that they may have a beneficial effect on common GI-symptoms in infants. The results of a conducted by Szajewska
et al. systematic review of publications from the last 10 years regarding the effects and safety of the administration of fermented infant
formulas are presented below.

The article presents a case report of a 2-year old boy published in a recent issue of New England Journal of Medicine. Early-onset obesity developed
due to a mutation in the gene encoding leptin (homozygous transversion c.298G→T), leading to a change from aspartic acid to tyrosine at amino acid
position 100 (p.D100Y) and high immunoreactive levels of leptin, which is secreted but neither binds to nor activates the leptin receptor. The mutant
protein failed to reduce food intake and body weight in leptin-deficient mice. Treatment of the patient with recombinant human leptin (metreleptin)
rapidly normalized eating behavior and resulted in weight loss. A report on a different LEP gene mutation, also leading to a production of biologically
inactive leptin, is also presented in the article.

Coeliac disease (CD) defined as a permanent intolerance to gluten occurs in about 1% of the population, and is the most common chronic disease of the
gastrointestinal tract. CD develops at any age, often as non-classical or subclinical type. Gluten is the main external factor inducing CD in patients with
HLA-DQ2 and/or HLA-DQ8 genotypes, but its consumption does not fully explain CD pathogenesis. Recent studies indicate an important role of intestinal
dysbiosis in the development of coeliac disease. The present paper provides new insights into CD pathogenesis and describes definitions of clinical types
in accordance with the guidelines drawn up in Oslo in 2013.

In 2012 European Society of Pediatric Gastroenterology, Hepatology and Nutrition released the recommendation on diagnosis of celiac disease, which
stimulated other gastroenterologic associations to publish their own guidelines. Recommendations differ from each other in many important aspects
making them a good material for discussion in a context of adaptation to polish health care service conditions.

Currently, it is still (February 2015) recommended to avoid both early (less than 4 months of age) and late (7 or more months of age) gluten introduction
and to introduce gluten while the infant is still being breastfed to reduce the risk of coeliac disease. This paper summarizes new evidence on early
feeding practices and the risk of coeliac disease. These new data, mainly from randomized controlled trials, showed that infant feeding practices
(breastfeeding, time of gluten introduction) have no effect on the risk of developing coeliac disease during childhood. Therefore, an update of current
recommendations on gluten introduction is needed.

Gluten-free diet is the most effective method in treatment of celiac disease. Following the diet strictly and meticulously is the best prevention for a celiac
patient to avoid harmful health problems. Gluten-free diet means the complete absence of wheat, rye and barley in natural and processed foods as well as in
their derivatives. The necessity of elimination of major cereals used in food industry can lead to nutrition deficiency (Magnesium, Iron, Zinc, Calcium, Vitamin
D, Vitamins of group B and fiber). While gluten-free foods (bread, pastries and confectionery products, pasta, concentrates for baking bread and cake) can be
a source of saturated fats and simple sugars, they are low in proteins of high biological value, vitamins, minerals and fibre. Celiac patients are recommended
to eat various foods naturally gluten-free (labeled as “gluten-free food”), which are a valuable source of nutrients. Gluten-free diet should match all individual
requirements of a celiac patient (health state, knowledge, social-economical conditions and supplying options) and ought to be made to prevent vitamin and
mineral deficiency.

Although wheat is one of the most common food allergens in children, the natural history of the IgE-dependent allergy to wheat has been rarely discussed
in the literature. The paper contains the review of contemporary state of knowledge about the IgE-mediated wheat allergy in children.

Non-celiac gluten sensitivity is a condition where intestinal and extra-intestinal symptoms are triggered by gluten ingestion in the absence of celiac
disease and wheat allergy. In this article, we discuss the clinical picture, epidemiology and current understanding for the possible mechanisms of the
‘non-celiac gluten sensitivity’.

The article presents a non systematic review of the most recent publications on the subject of neurological syndromes in coeliac disease and noncoeliac
gluten sensitivity. Gluten ataxia and serological markers of neurological syndromes in gluten related disorders are also discussed. The differences
between the child and adult populations regarding the neurological syndromes induced by gluten are emphasized. Available data was the subject of
critical analysis.

Bronchitis is one of the most common childhood diseases. The highest percentage of cases is acute bronchitis, lasting up to 3 weeks. Group of chronic
infectious diseases of bronchi has been classified depending on the duration of symptoms and presence of irreversible structural damage of bronchi
as protracted bacterial bronchitis, chronic suppurative lung disease and bronchiectasis. While acute bronchitis should be diagnosed on the basis of
clinical examination, chronic bronchitis requires careful diagnostics and prolonged treatment.

We present current investigations on thrombocytopenia in children. Pathomorphology, clinical symptoms, diagnosis and treatment are given according
to current data from literature. Thrombocytopenia is divided into: morphology, occurrence and accompanying symptoms, which helps to make decisions
as to diagnosis and therapy. Methods of treatment of thrombocytopenia in neonates is also discussed, as well as latest data on treating acquired causes
of thrombocytopenia in children with primary immune thrombocytopenia.

Etiopathogenesis of calcium-phosphate (Ca-P) homeostasis disorders is very complex. The mutations of the extracellular calcium-sensing receptor gene are
responsible for different calcium homeostasis disorders with a wide range of clinical manifestations. We have focused on a problem of differential diagnosis.
The specialist tools are often necessary in a diagnostic process apart from a routine biochemical tests available for family doctors. The biochemical results in
pediatric populations should always be interpreted in relation to age-specific reference ranges.

Hypolactasia is a deficiency of lactase activity, which may lead to lactose malabsorbtion. Hypolactasia could be genetically determined (primary
hypolactasia) or secondary caused by e.g. intestinal dysbiosis, celiac disease, acute and chronic infections of the gastrointestinal tract. Despite widespread
primary hypolactasia, lactose intolerance, which is a set of symptoms appearing after ingestion of lactose, occurs much less frequently. The paper
discusses the importance of lactose biological function, the types of hypolactasia, diagnostic methods and management of lactose intolerance.

Iron (Fe) is an essential micronutrient that plays a critical role in many cellular functions and processes, including growth and development. As such,
having an adequate supply of iron (Fe), along with other microelements, is thought to be of particular importance for infants. Potential consequences
of iron deficiency during infancy include impaired development and altered long-term neurodevelopment. Observed impact and consequences of Fe
deficiency emphasize the importance of prevention, screening and treatment of this disorder in children. To effectively treat Fe deficiency it is necessary to
know the basic characteristics of available Fe supplements, such as their bioavailability and possible adverse effects, which significantly affect therapeutic
outcomes and patients’ compliance.

Teenage and young girls comprise the vast minority of patients treated by gynecologists. Treatment and care of a child or teenage girl varies in every
respect from that of an adult woman. Genital infections form one of the most common reasons for visits to gynecological clinics for girls, especially
between the ages of 3-10 years. Menstrual disorders may affect up to 75% of the teenage population. The most common reason for secondary
amenorrhea (50-75%) is functional hypothalamic amenorrhea and menstrual disorders related to hyperandrogenism – polycystic ovary syndrome. Stress,
excessive exercise, weight loss, and psychiatric disorders (Anorexia Nervosa, Bulimia Nervosa) compose some of the most important factors in diagnosing
menstrual disorders. Juvenile bleeding – defined as profuse uterine bleeding with blood clots, often lasting more than 10 days, blood loss greater than
80 ml, without any relation to other gynecological pathologies – is diagnosed in 20-30% of teenagers in adolescence.

The prevalence of food allergies is increasing. The most common food allergens include milk, egg, wheat, peanuts, tree nuts, soy, fish, and shellfish. Currently,
strict avoidance is standard of care. However, dietary elimination in food allergy may also have undesirable consequences. A comprehensive nutrition
assessment with appropriate intervention is warranted in all children with food allergies to meet nutrient needs and optimize growth.

Kawasaki disease (KD) is an acute self-limited vasculitis characterized by fever and coronary artery abnormalities. The incidence of KD is 8-112/100000,
a specially in children under 5 years of age. The symptoms of KD: fever longer than 5 days, rash, erythema of the lips and oral mucosa, bilateral
nonexudative conjunctivitis, cervical lymphadenopathy and changes in distal part of extremities. The diagnosis of KD is based on the presence of fever
and 4 of the 5 principal clinical features. In patients with coronary artery abnormalities less than 4 of principal clinical features is enough for diagnosis.
“Incomplete form” of KD when only 2 or 3 principal clinical features are present can be observed in 25% .There is no specific diagnostic test for KD.
In laboratory findings: leukocytosis, elevation of acute phase reactants (erythrocyte sedimentation rate, C-reactive protein), thrombocytosis and elevation
of serum transaminase are observed. The etiology of KD remains unknown. There is not causal treatment. During the acute phase of illness, Acetylsalicic
acid is administered at 50-100 mg/kg and intravenous immunoglobulin 2 g/kg. Coronary artery abnormalities – coronary aneurysm are observed in
15-25% of untreated and 5% of treated patients. Myocarditis and pericarditis are the possible cardiac complication. The angiographic resolution
of coronary aneurysm is possible, but this segments show persistent histological and functional abnormalities. It may cause the coronary artery stenosis
or occlusions. Prognosis in patients without coronary arteries abnormalities are good. Patients with coronary arteries abnormalities required cardiology
evaluation, long-term antiplatelet therapy, or coronary intervention in some cases.

Henoch–Schönlein purpura is an autoimmunologic inflammation of small blood vessels, classified as a type of leukocytoclastic vasculitis. In majority of
cases it is a self-limiting disease with good prognosis. Maculopapular rash over the extensor surfaces of the legs and buttocks, joint pain and oedema,
colicky abdominal pain, proteinuria and haematuria are the main symptoms of the disease. About 33% of all patients have recurrences of symptoms.
Nephrotic syndrome, renal impairment and hypertension at presentation are associated with poorer prognosis. The most serious outcome is chronic
renal impairment observed in 1-3% of all children with Henoch–Schönlein purpura within 10 year from the diagnosis. Most children do not require any
treatment or an administration of analgesics is a sufficient intervention. Corticosteroids may have good influence on the course of the disease but they
do not prevent nephropathy. Children with renal disease should be treated with corticosteroids and immunosuppressive drugs in a nephrology ward.

Alcohol consumed during pregnancy has teratogenic effects on the fetus and has a long-term effect on children’s development. According to the CDC
7.6% of pregnant women drink alcohol and 1.4% are alcoholics. The clinical symptoms observed in children of mothers alcoholics take the form of fetal
alcohol syndrome. It is a set of complex clinical signs associated with fetal exposure to alcohol consumed by the mother during pregnancy and consists of:
fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS), neurodevelopmental disorders related to alcohol (ARND) and birth defects associated
with alcohol. In addition to the typical set of features associated with FAS increasingly emphasizes the importance of late effects associated with exposure
to alcohol baby during pregnancy and family life. FAE (fetal alcohol effect) is expressed psychosocial disorders in infancy, early and late childhood.

Introduction: Probiotics are commonly available preparations of freeze-dried bacteria. It is believed that probiotics have health-promoting effects.
Among numerous indications to use probiotics, prevention of gastrointestinal complications occurring during antibiotic therapy is commonly recognized.
Objective: The aim of this study was to collect information about gastrointestinal complications in children treated with antibiotics, the expectations
of the parents in relation to probiotic administration and physician’s practice of probiotic recommendations.
Methods: A questionnaire survey was conducted in 13 primary care clinics. 13 doctors and 419 parents of children visiting the clinic due to infection
requiring antibiotic treatment participated in this survey.
Results: 13% of children received probiotic regularly. Only 8% of parents declared that their child had diarrhea during antibiotic treatment but still
up to 87% of parents expect that probiotic will be used during antibiotic therapy. More than half of physicians (7/13) estimate that gastrointestinal
complications of antibiotic therapy occur in less than 10% of children but most of them (9/13) always recommends the use of probiotics during antibiotic
therapy. In the opinion of doctors majority of parents expects that probiotics will be recommended during antibiotic treatment.
Conclusions: Even if physicians and parents estimate the incidence of diarrhea, accompanying antibiotic treatment not to exceed 10% the probiotic
supplementation has become standard practice recommended by doctors and expected by parents of children treated with antibiotics.

Introduction: Inflammation of the brain is a relatively rare disease, but it can occur with serious or life-threatening neurological squeals,
and therefore requires early diagnosis, and application of the appropriate treatment.
Objective: The study retrospectively analyzed the aetiology, clinical symptoms, and outcomes of encephalitis in children hospitalized in
the Department of Paediatrics, Nutrition and Metabolic Diseases at the Children’s Memorial Health Institute in the years 2005–2014.
Results: The study included 75 children of the median age 62 months. In majority of patients, encephalitis was induced by infectious
agents, predominantly by: herpes simplex (HSV) – 10 (13,3%), varicella zoster (VZV) – 9 (12%), and tick-borne encephalitis virus (TBEV)
– 5 (6,7%). Ten patients (13,3%) were diagnosed with acute disseminated encephalomyelitis (ADEM). The aetiology remained unrecognized
in 33 patients (43%). Upon discharge from hospital, 28 patients (37,3%) presented neurological disorders such as focal neurological signs,
epilepsy, impaired concentration and personality change. Three patients were in a vegetative state, and one patient died. Poor prognosis
was associated with longer hospitalization and the need for intensive care unit (ICU) support.
Conclusion: The cause of the majority of encephalitis remains unknown. It is often not possible to establish the aetiology of encephalitis
on the basis of clinical symptoms, imaging tests and examination of cerebrospinal fluid (CSF) alone. Research directed at identifying immunopathological
mechanisms gives hopes for better prognosis and more efficient management.

We present a case of 2 year-old girl with recurrent vomiting and cachexia in the course of tumor of the medulla oblongata.

Growth failure is a clinically important problem in children with chronic kidney disease (CKD). Many factors contribute to growth retardation
in children with CKD, including abnormalities in the growth hormone (GH) and insulin-like growth factor (IGF-1), malnutrition, acidosis
and other hormonal disorders. Since two decades growth failure in children with CKD is treated with recombinant human GH (rhGH).
Therapy with rhGH in uremic child is started in children above 3 years of age when child’s height is below 3-rd percentile for age and gender
and all other causes of growth failure have been excluded. We present a case of 4-year-old boy with autosomal recessive polycystic
kidney disease and compare his growth rate with his healthy twin brother. The problems with use of different growth charts such as Polish
representive national growth charts and WHO standard have been described.