The Polish Society for Paediatric Gastroenterology, Hepatology and Nutrition developed guidelines for breastfeeding. The mission of the Society is active
promotion and support of breastfeeding. Evidence for the recommendations was obtained by adapting trustworthy guidelines developed by scientific
societies, renowned institutions, and expert organizations. Exclusive breast-feeding during the first 6 months of life is a desirable goal. Among others,
the document details the benefits of breastfeeding, contraindications, recommendations for breastfeeding and introduction of complementary feeding.

Vitamin K plays a central role in hemostasis, and its deficiency leads to disturbances in coagulation and bleeding. Bleeding of vitamin K deficiency in the neonatal period and infancy (ang. Vitamin K deficiency bleeding, VKDB) previously called hemorrhagic disease of the newborn.

Polish Society of Urology (PTUD) and the Polish Society of Pediatric Nephrology (PTNefD) set up a Group of Experts, who made the adaptation of the recommendations of the International Children's Continence Society (ICCS) to the condition of the Polish health care. ICCS international recommendations have been developed based on the opinions of experts and not classified their strength. The guidelines include descriptions of key terms relating to micturition disorders, the diagnostic principles defined disease entities and their treatment.

Exclusive breastfeeding is an optimal and recommended way of providing nutrition for infants up to 6 months of age. Older infants should receive
complimentary food together with continued breastfeeding. Hypogalactia is one of the most significant causes of early termination of breastfeeding.
In case of reported milk insufficiency, physicians should assess breastfeeding performance, exclude treatable medical causes of hypogalactia and
provide information regarding correct feeding techniques. Mothers often seek remedies, which may increase milk production and usually they choose
herbal remedies. Therefore, appropriate knowledge about available herbal galactogogues, their efficacy and safety, may be useful in everyday practice.

Allergic diseases are a common problem in the pediatric population. Patients with allergic diseases are at increased risk of contracting severe infectious
diseases. Patients with bronchial asthma are at increased risk of invasive pneumococcal disease, pertussis, and complications of influenza. In patients
with atopic dermatitis, the risk of bacterial complications in the course of chickenpox is increased. The criteria for vaccination eligibility in this group
do not differ from the general population. Only anaphylactic reaction to a vaccine component or to a previous dose is an indication to resign from
the administration of these vaccines. In some cases, particularly children, a vaccination may be postponed due to exacerbation of an allergic disease
or intensification of its treatment. However, every effort should be made to ensure that children are vaccinated in accordance with the vaccination
program. To achieve this aim, vaccination programs should be expanded to additional prophylaxis.

Puberty is a period in human life, which is one of the stages of a lifelong evolution of the hypothalamic – pituitary – gonadal axis. At this time, hormonal
and somatic changes occur, leading to sexual maturity and fertility. They are a result of two independent processes – adrenarche (hypothalamic
– pituitary – adrenal axis) and gonadarche (hypothalamic – pituitary – gonadal axis). The maturation process is complex, and it is determined by
a number of environmental, genetic and socio-economic factors, including the important role of the nutritional status. There are two basic groups
of disorders: precocious puberty and delayed puberty. In our latitude, we consider physiological the appearance of symptoms of maturing after
reaching the age of 8 for a girl, and 9 for a boy. Delayed puberty is recognized when a girl aged 13 and a boy at the age of 14 have no symptoms of
maturation.

Short stature is a common reason for referral to pediatric endocrinologists. Majority of children do not have an underlying pathology and receive
a diagnosis of constitutional delay of growth and puberty or idiopatic short stature but other etiologies include hormonal disorders, nutritional deficits,
chronic illnesses or CNS pathologies. Several genetic disorders may lead to short stature as well as genetic mutations in numerous genes may cause
hormonal deficiencies. The purpose of genetic and molecular evaluation is to provide accurate diagnosis which facilitate medical management, provide
prognosis and recurrence risk counseling for the parents/guardians. Here we describe the genetic aspects of short stature.

Pneumococcal infections are dominant health problem of the populations of all continents. Around the world diseases associated with
a pneumococcal infections are the cause of death of approximately 1.6 million people a year, including approximately half a million children
under 5 years of age. The cause of these deaths is mainly pneumonia, rather that the much less common invasive pneumococcal disease
(IPD). Children up to 2 years of age could be protected against IPD with two conjugate vaccines. PCV10 and PCV13 vaccines cover respectively
48.7% and 74.4% of all IPD cases up to 2 years of age (www.koroun.edu.pl). However, for the protection against pneumococcal pneumonia,
sinusitis and recurrent acute otitis media (AOM) mucosal immunity is required. PCV13 vaccine provides protection of the mucous membranes,
in particular by reducing pneumococcal carriage, thereby inhibiting the spread of infection to the entire population. This results in a decrease
in the incidence of invasive and non-invasive pneumococcal infections in all age groups – vaccination produces herd immunity. On the other
hand, introduction of universal vaccination with the PCV10 vaccine, which has a limited ability to reduce the carriage, is the cause of increased
infections with antibiotic-resistant 19A serotype in the population of patients over 2 years old, observed in countries where PCV10 is administered.
The Paediatric Group of Experts on the Protective Vaccinations Programme by the Minister for Health recommends that the PCV13 vaccine be included
in the mandatory vaccinations programme in children up to 2 years of age, considering the widest range of protection that it provides as well as the
health benefits for the whole unvaccinated population.

Nocturnal enuresis (NE) or bedwetting is a common condition in children. According to clinical history and clinical examination, children with NE can
be subdivided into monosymptomatic nocturnal enuresis (MNE) and non-monosymptomatic nocturnal enuresis (NMNE). Record in the diary of voided
volumes and volume of nocturnal diuresis may give additional information, useful for precise of diagnosis and precise choice of treatment options.
In monosymptomatic nocturnal enuresis, there are only two treatment options – the alarm and desmopressin or combined therapy – the alarm together
with desmopressin. After successful treatment of nocturnal enuresis can improve of self esteem and quality of life of children with MNE.

Acute kidney injury is potentially a life-threatening condition, defined as an acute and reversible increment in serum creatinine concentration, which
may be associated with a reduction in urine output. In recent years, the criteria for diagnosis of acute kidney injury have been modified and improved.
There are attempts to develop early, pre-emptive identification of kidney damage with evaluation of the new specific renal biomarkers. In case of renal
replacement therapy, currently the continuous extracorporeal techniques are preferred and start to replace classic hemodialysis or peritoneal dialysis.

This article is a brief summary of typical symptoms and current guidelines of treatment of sepsis in childhood. Guidelines are based on the recommendations
by the “Survival Sepsis Campaign” and contain: early recognition, oxygen administration, fluid resuscitation, and antibiotic administration, the use of
catecholamines, source control and adjunctive therapy. The success of treatment depends strongly on the time from first symptoms to recognition, and
the speed and appropriateness of therapy in the initial hours after sepsis develops.

Juvenile systemic lupus is a chronic inflammatory autoimmune disease and genetic, epigenetic, environmental and hormonal factors play a role in
its aetiopathogenesis. The age on onset is of vital significance for a course and prognosis of this disease. Falling ill before puberty is associated with
a predominant role of genetic factors and immaturity of the immune system. Pubertal manifestation indicates the leading role of sex hormones. Juvenile
systemic lupus has a severe, aggressive course with involvement of vital organs such as kidneys, haematopoietic system and nervous system. Systemic
symptoms such as fever, body weight loss, asthenia, dermal lesion, and bone and joints pain may precede organ lesions or appear simultaneously.
Long-term treatment with glucocorticosteroids, or immunosuppressive therapy with cyclophosphamide, mycophenolate mofetil, and cyclosporine
A or biological agents, is necessary. Treatment should be conducted in specialised centres and must be individualised depending on the disease activity,
with a special aim of steroid sparing. Visceral lupus is a destructive disease with regard to physical and mental health alike. Along with treatment lasting
for many years this disease has irreversible effects on the growth and functions of the body, reduces the quality of life, disturbs the psychoemotional and
social development of young people.

Kawasaki disease (KD) is a systematic vasculitis of children that affects small- and medium-sized arteries with predilection to coronary arteries. The
aim of this article was to summarize data about gastrointestinal manifestation of KD. Although gastrointestinal (GI) involvement does not belong
to the classic criteria, abdominal pain, vomiting or diarrhea were observed in 1/3 of patients. Elevated alanine aminotransferase were noted in
almost all patients with abdominal pain and in few cases with conjugated hyperbilirubinemia. Gallbladder hydrops was found in about 15% of KD
patients. Gallbladder abnormality was associated with resistance to intravenous immunoglobulin. The prognosis in KD depends mainly on cardiac
complications. In almost all cases the resolution of GI symptoms and laboratory abnormalities was observed. Gastrointestinal symptoms can be the
initial presentation of KD. The difficulty in diagnosing KD with incomplete manifestation can lead to delay in appropriate treatment increasing the risk
for complications, especially coronary artery abnormalities.

Episodes of vulvovaginitis are quite common in prepubertal girls, in most cases do not cause complaints and are self-limiting. Usually, the excessive
growth of regular bacterial vaginal flora – nonpathogenic bacteria – is the cause of vaginal discharge. If the infection sustained more than 3 weeks
or a child has vulvar irritation or complaints, bacterial swab should be taken and treatment on the base of antibiogram ought to be introduced, especially
if specific bacteria is grown in the culture: Streptococcus pyogenes, Staphylococcus aureus or Haemophilus influenzae. Prepubertal girls do not have yeast
vulvovaginitis with exception of diaper dermatitis. Pediatrician is involved in diagnosis and treatment of vulvovaginal infections in such children, recurrent
infections and bloody discharge should be consulted with gynecologist, otherwise.

Intestinal micorbiota is a key factor influencing human’s health. Proper colonization at birth, or even during prenatal period plays a crucial role in
optimal functioning of a human body. It has been believed that infant’s gut is sterile until delivery. Currently there is more and more evidence that
newborns immediately after delivery are already colonized, which is the proof for the presence of bacteria in the intrauterine environment. Thus
proper intrauterine health conditions may influence the microbiota and thus fetal developement before birth. Knowledge about role of both, prenatal
and postnatal factors on the composition of the intestinal microbiota in infants is important, due to the long-term impact on a child. It is known that
dysbiosis is a risk factor for several diseases. Modulation of the intestinal microbiota by pre- and probiotics can be an important therapeutic strategy
in the prevention of these conditions

Fetal alcohol syndrome (FAS), as a clinical consequence of the effect of alcohol intake during pregnancy was first described in the literature in 1968 by
P. Lemoine. The work on the description of specific birth defects associated with FAS continued with Jones and Smith (1973) identifying four areas of
impairment resulting from toxic effects of alcohol on the developing fetus. Patients Fetal Alcohol Spectrum Disorders (FASD) are a diagnostic challenge
because of the heterogeneity of symptoms associated with structural and functional damage to the brain. In Poland there is lack of a uniform standard
diagnostic procedure regarding FASD. The answer to these needs may be the Washington 4-Digit Diagnostic Code proposed by Prof. S. Astley and coworkers.
This system is constantly perfected, its last revision took place in 2004. In Poland this diagnostic tool has been available from 2012. The diagnosis by 4-Digit
Diagnostic Code involves multidisciplinary cooperation, in which the neuropsychological and neurodevelopmental evaluation plays an important part.
It determines the functioning of the central nervous system, which may significantly change the final diagnosis.

The gastrointestinal tract is inhabited with multiple microrganisms, thought to be even greater in their number compared to human body cells. The
intestinal microbiome is essential for normal gastrointestinal function. It also modifies the function of immune cells. There is growing evidence for impact
of intestinal microbiome on the function of our intestinal and central nervous system. The paper summarizes proposed mechanisms through which the
intestinal microbiome may influence nervous system of man and may modify human behavior. Current evidence for the role of intestinal microbiome in
pathogenesis of particular diseases like colics, autism spectrum disorders, ADHD, anorexia and appetite dysfunction was also discussed.

The report presents 5 cases of late onset vitamin K deficiency bleeding (VKDB) in infants. Authors described very serious consequences of lack of
proper prophylaxis or discontinuation of oral supplementation of vitamin K in breast-fed children. A thorough diagnostics in cases with reported
alarming symptoms and in infants with risk factors for VKDB is as much important. It should concern especially exclusively breast-fed children with
prolonged jaundice or infants suffered with cholestasis.

The optimal food for infants is the mother’s own milk. If it is not available, the food of choice is milk from a human milk bank (HMB).
The aim of the study was to characterize the population of donors, determine their motivation to share their milk and try to determine the impact of
the donation milk to HMB on the length of lactation.

Material and Methods: The study involved 124 donors who gave the milk to the HMB in the period: April 2012 to March 2015. Data were obtained
from HMB documentation and from the survey, which was conducted between June to July 2015.

Results: 124 donors have given to the HMB 1,083 liters of milk. We obtained the responses from 104 (84%) of donors. 59 (57%) of them are inhabitants
of the big city. 62 women (60%) are middle-aged (25-35 years). Among 71 (68%) of donors with many children 35 of donors ended their lactation and
36 women are still breast-feed their own children. In this group 54% of women prolonged their lactation.
Donors mostly make the decision about donation milk to HMB on their own, guided by altruistic need to help sick children.

Conclusions: Donating the excess of milk to HMB is well perceived by donors, due to a positive attitude to help those in need. The impact on the
length of feeding her own child requires long-term observation.

Patients with Kawasaki disease (KD) may have a hepatobiliary manifestation ranging from asymptomatic increase in liver enzymes to severe cholestatic
hepatitis and/or acute acalculous cholecystitis (AAC).
We present a case report of 7-year old boy with cholestasis in course of KD. From the beginning of the KD the boy suffered from abdominal pain and
constipation. The patient was treated with intravenous immunoglobulin (IVIG) and 6 weeks after first symptoms he presented cholestasis with increased
levels of liver enzymes. The ursodeoxycholic acid therapy was implemented. Because of the abdominal pain with cholestasis the MRI was performed and
revealed hepatomegaly, splenomegaly, enlargement of the pancreas, the gallbladder distention with wall thickness and the dilatation of the bile ducts.
Because of persistent jaundice and itching patient was transferred to our center. Rifampicin was added to the therapy. The endoscopic retrograde cholangiopancreatography
with sphincterotomy was performed. During the follow up the cholestasis subside and control ultrasound one year later reveled
normal liver with undiluted gall bladder and bile ducts.

Influenza is an acute, infectious disease which may lead to severe complications, need for hospitalization, or may be a cause of death. Flu is uncommon
illness of the newborns but course of illness might be really severe. This case report describe full-term newborn admitted to neonatal intensive care
unit with severe respiratory failure, hypotensia and fever. Finally after two hours of intensive mechanical ventilation, patient died two hours after
admission.