The etiopathology of inflammatory bowel diseases (IBD) is still unknown and it is considered to be multi-factoral: a combination of genetic and environmental
factors, as well as dysbiosis and immunological impairment. One of the environmental factors associated with IBD is an improper diet. Therefore, dietary
management seems to be the first-line therapy for these diseases, especially in pediatric patients who require proper nutritional support for their optimal
growth and development. According to the recent data, The Polish Society of Pediatric Gastroenterology, Hepatology and Nutrition (PTGHiŻD) together with The Polish Pediatric Society of Clinical Nutrition (PTŻKD) prepared the guidelines of nutritional therapy in pediatric IBD. The group of experts has established the recommendation for clinical management of children with IBD.

This paper presents summary of current ESPGHAN recommendation for complementary feeding including content of complementary food, timing (also
allergenic products) and method of feeding in term infants.

In February 2017, a meta-analysis of 25 clinical trials on the role of vitamin D supplementation in respiratory infections was published in British
Medical Journal. Results and conclusions from the research were analyzed and discussed.

Management of chronic rhinosinusitis in children is a clinical challenge. Symptoms are often subtle and non-specific and this may result in overlooking of
the disease. A detailed symptoms assessment is crucial to recognize children with a high probability of CRS. It is recommended to confirm diagnosis by nasal
endoscopy and/or imaging study. CT is the examination of choice for the proper imaging of the paranasal sinuses. It is mandatory to perform CT of the
paranasal sinuses before planning surgery. Pharmacological treatment is a mainstream and first choice therapy for the children with CRS and should be
conducted for many months before considering surgery.

Parasitic diseases are a major problem of health and social development around the world. The most common parasitic skin diseases in children are scabies
and pediculosis. The clinical picture of parasitic skin diseases in children is often different than in adults, which may hinder or delay the correct diagnosis,
and thus the implementation of appropriate treatment, which in turn increases the risk of complications and the spread of infection. An important element
of antiparasitic therapy is properly performed decontamination of the environment and diagnosis and treatment of those around the patient. For this purpose,
it is important to proper communication between the doctor, the patient and his family. Early and properly carried out treatment plays a significant
role, because it prevents the possible spread of diseases and epidemics in nurseries, kindergartens and schools. This article is a summary of knowledge on
the most common parasitic diseases of the skin that occur in children.

International travels are connected with health hazard. Amount of travelers to the tropic regions of developing countries is still increasing. Traveling with
young children is becoming increasingly popular. Health risks of exotic travels are not commonly realized. Properly planned immunization can reduce the
risk of acquiring a dangerous disease. Planning vaccination before travel both epidemiological and personal risk factors should be considered. But even
the best prophylaxis does not protect in 100%. The article discusses vaccinations usually used in travel medicine and general rules useful in children and
teenagers travels.

The survival rate in pediatric hematooncology has significantly improved, not only thanks to the new possibilities of anticancer therapy, but also due
to the improvement in controlling the life-threatening states of emergency. The most common emergencies include hiperleukocytosis, leukostasis,
tumor lysis syndrome, syndrome of inappropriate antidiuretic hormone hypersecretion, increased intracranial pressure, spinal cord compression,
vena cava syndrome, superior mediastinal syndrome and neutropenic enterocolitis. The emergency states demand immediate therapeutic decisions
aimed at stabilizing the patient’s condition. This article describes a selection of clinical situations and their recommended treatment.

Sepsis and septic shock are one of the leading causes of admitting children to Pediatric Intensive Care Units. Early diagnosis and implementation of correct
treatment play a key role in prognosis. The right resuscitation may stop the development of the disease and in many cases may limit or even prevent the development of shock. The article presents the current modes of diagnosis and treatment at the early stage of sepsis and septic shock in children.

Food allergy is a common health problem. Recent epidemiological studies have shown a growing incidence of food allergy. However the cause of this phenomenon is not completely understood. Current studies are focused on understanding the immunological basis of food allergy and the identification of
environmental factors that may modify its course and the development of oral tolerance to food protein. The mechanisms of oral tolerance have not been
yet completely elucidated. It is known that the development of oral tolerance depend on many factors including genetic and environmental ones. Several
environmental factors i.e. probiotics, vitamin D3 and omega-3 acids may also play an important role in the promotion of oral tolerance. Identification of the
factors which can modulate the course of food allergy is a challenge for the contemporary medicine.

The ductus arteriosus is the important element of fetal circulation. After the birth spontaneous closure. Normally the spontaneous duct closure occurs within
the first day of life. In duct dependent congenital heart disease the PDA is important for pulmonary or systemic circulation. The PDA is one of the most
common congenital heart defect. The prematurity, low body weight and respiratory diseases increases the incidence of PDA. In this group of patients PDA
can be a reason of heart and respiratory failure. The poor weight gain, recurrent respiratory infections and exercise intolerance are the other symptoms of
PDA. The pulmonary hypertension can be a consequence of increase pulmonary flow. The therapeutic option for PDA are: pharmacologic management or
surgical ligation in neonates or percutaneous closure which is a method of choice in older children. The results of PDA treatment are very good and sustained,
the risk of complication is very low. PDA can be considered completely curable and patients completely healthy.

Infectious complications might significantly contribute to mortality in children undergoing chemotherapy. The objective of the paper is to present principles
of diagnostic, prophylactic and therapeutic strategy in the most frequent infectious complications in children with malignant diseases undergoing chemotherapy
and/or radiotherapy. From the clinical point of view, infections can be classified as: fever of unknown origin (FUO), clinically documented infections
(CDI) and microbiologically documented infections (MDI). With respect to etiology, there are bacterial, fungal, viral and parasitic infections. The basic diagnostic and prophylactic principle is multidirectional antimicrobial surveillance over patients and hospital environment, antibiotic-sparing policy, antimicrobial
control, antimicrobial stewardship and vaccination after completion of therapy. There are four strategies of therapeutic management of infections: prophylaxis,
empirical therapy, preemptive therapy and targeted therapy. Pharmacological prophylaxis is defined as administration of antimicrobial drugs in patients
with present risk factors. Empirical therapy is defined as administration of antimicrobial drugs in patients with neutropenia and persistent or recurrent
fever. Preemptive therapy is used in patients with neutropenia and specific clinical symptoms and/or biological markers of specific infection. Targeted antimicrobial therapy is used in patients with proven infection, confirmed by microbiological or histologic examination. This review presents current knowledge
on prophylaxis and therapy of viral and fungal infections in children in oncohematology settings, based on European guidelines.

This article presents the clinical usefulness and principles of cardiopulmonary exercise test (CPX, ergospirometry) in children. It highlights the wide
range of diagnostic possibilities of this test in pediatric population. CPX can be useful tool for the diagnosis of exercise symptoms such as shortness
of breath, chest pain, asthma, ect. CPX is also useful in monitoring the progression of the disease and effectiveness of the treatment in pediatric patients
with heart failure due to congenital heart disease, pulmonary hypertension or cardiomyopathy. Also the juvenile athletes can monitor the progress
of their training undergoing CPX regularly.
Pediatric group due to differences in anthropometric parameters requires a individualized approach to RAMP protocols (load increases) selection, so
that the whole test does not exceed 6-10 minutes. Interpretation of the results cannot be directly references to adult’s norms. There should be broad
population of children tested in order to create pediatrics standards of CPX.

Many methods are used in diagnostics of gastroesophageal reflux (GER) e.g. pH-metry, bilimetry, multichannel intraluminal impedance-pH, scyntygraphy,
radiology. MII-pH was recently proposed by the guidelines of the North American Society of Pediatric Gastroenetrolgy, Hepatology and Nutrition
and the European Society of Pediatric Gastroenetrolgy, Hepatology and Nutrition as the most accurate method for the diagnosis of gastroesophageal
reflux. The paper presents the rationale of MII-pH procedure and study protocol utilized in the center represented by authors.

Background: While capitation is the sole payment mechanism for services delivered by general practitioners and nurses in primary care system in Poland,
midwives’ remuneration relies on a mixed mechanism combining capitation and fee for service.

Aims of the study: To analyze the relationship between the financing mechanism and service delivery in preventive pediatric healthcare in Poland
among three aforementioned groups of medical professionals.

Method: National Health Fund data were used to assess the overall public expenditure on preventative pediatric primary care delivered by the three
groups. Service delivery rate and quality were analysed on the basis of an online parent questionnaire and official statistics.

Results: Midwives delivered 90% of the services required by healthcare standards, GPs – 61%, while nurses – 26%. Parents were most satisfied with midwives’ provision and least satisfied with nurses’ services.

Conclusion: Financial mechanism affects service delivery and quality in pediatric preventive care, with mixed mechanism promoting activity among
health professionals.

Cystic fibrosis (CF) is one of the most common autosomal recessive disorder. It is caused by loss-of-function mutations in the CF Transmembrane
Conductance Regulator (CFTR) gene. The diagnosis of CF should be based on the presence of characteristic clinical features and laboratory evidence. One of
the gastrointestinal presentations of CF is distal intestinal obstruction syndrome (DIOS). DIOS is a complete or incomplete intestinal obstruction caused by
viscid faecal material in the terminal ileum and proximal colon. Symptoms of DIOS can be misleading and suggest appendicitis or constipation. Treatment
is based on rehydration combined with stool softening laxatives. The article presents a case report of a 17-years old girl with a late manifestation of CF. The
only clinical symptom was a recurrent DIOS.

An intolerance of such sugars as lactose and fructose is a relatively frequent clinical problem. In spite of characteristic symptoms, sugar intolerance may not
be recognized by the patient as well as his doctor for a long period of time. In the article the epidemiology of the phenomenon, signs of intolerance of both
sugars (flatulences, stomachaches, intense postprandial bloating, infantile colic, postprandial discomfort), the simplest methods of recognizing (the test of
withdrawal period and provocation, the respiratory hydrogen test) and of therapy (dietetic treatment, passing the lactase as the supplement, keeping the
right proportion of glucose and fructose in the diet; 1:1) are described. The article also contains practical tables permitting easy access to information about
lactose content in different products as well as proportion of glucoses to the fructose in foods.