Based on own clinical experience, it has been described the consecutive stages in diagnostic of coeliac disease, starting with the 1969 ESPGHAN congress
in Interlaken in Switzerland to last years.

Choline can be synthesized endogenously or ingested with food. The richest choline sources are eggs, meat, fish, and whole-grain products. Daily choline
requirements at the adequate intake level are 550 mg for men, 425 mg for women, and 450 mg and 550 mg for pregnant and lactating women, respectively.
Choline requirements may vary depending on the polymorphism of genes encoding the enzymes involved in choline and folate metabolism. Choline intake
in Poland has not been well described, but insufficient choline intake has been reported in many populations. Choline has several functions in the body. As
acetylcholine, it is involved in neuronal signaling, and as phosphatidylcholine it forms part of cell membranes. It is also important for lipid transport, and after
oxidation to betaine serves as a methyl donor in numerous methylation reactions, including the methylation of DNA. Adequate choline intake is of particular
importance during pregnancy, as it influences pregnancy outcomes and fetal development, decreasing the risk of neural tube defects. Since choline
affects the development of the brain and neural system, it has a long-term impact on memory and cognitive functions. Choline deficiency in adults results
in hepatic lipid accumulation and nonalcoholic fatty liver disease. Adequate choline intake thus seems important for human health in different life stages.

This document is an adapted to Polish conditions translation of the Paediatric Version of Allergy-focussed Diet History issued by the European Academy of
Allergy and Clinical Immunology (EAACI). It is a diagnostic and screening tool for paediatricians, allergists, dietitians and other medical professionals who
attend to patients with food allergy. The document prepared by the experts of the EAACI aims to improve the diagnosis of the allergy, selection of diagnostic
tests, and planning of the appropriate, long-term care of patients with food allergy.

The article discusses the latest American guidelines for the management of hypertension in children and adolescents prepared by the American Academy
of Pediatrics (AAP) and corresponding with guidelines of American Society of Hypertension (ASH) and American Heart Association (AHA) prepared for
adults. The presented guidelines is an update of the 2004 guidelines known as the 4th report. The authors of this text attempted to present the most important
changes included in the AAP position. It has been critically related to the positions of other scientific societies, including the Polish Society of
Hypertension and the European Society of Hypertension (ESH) and expert recommendations of the Children`s Memorial Health Institute.

The article summarizes the position paper of European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on
Nutrition on young child formulae, which are milk or plant-based products designed to partly satisfy nutritional requirements of children aged 1-3 years.

Certain probiotic strains have proven effect in treatment and/or prevention in some clinical indications in children. This paper presents summary of review
of current studies on the efficacy of probiotics, published in 2017.

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Diagnosis of cow’s milk allergy allows the treatment and elimination diet that reduces the risk of severe clinical symptoms. The diagnosis must be
accurate and the applied formula should bring complete resolution of symptoms, so that, in a holistic approach, proper development of the child
is ensured, nutritional needs are met and optimal quality of life is achieved. 2-4 weeks of using a extensively hydrolysed formula should bring a
complete resolution of symptoms of cow’s milk allergy from the digestive tract, skin and respiratory symptoms. Among allergic patients there are
children in whom treatment with a extensively hydrolysed formula will not be effective, and the source of sensitization are peptides present in the
formula with a high degree of hydrolysis (both casein and whey). Lack of improvement of the patient’s clinical status comparing to the initially observed
symptoms, alleviation/partial relief of symptoms or refusing to consume a extensively hydrolysed formula (no acceptance) are, apart from
severe symptoms, indications for the use of an amino-acid formula. The lack of relief of allergy symptoms when using a extensively hydrolysed
formula significantly affects the quality of life and may cause faltering growth.

In 2016 new Polish guidelines for management of community acquired respiratory tract infections were presented. They included recommendations
on the management of streptococcal angina, the most commonly occurring bacterial pharyngitis. The use of recommended diagnostic algorithms based
on clinical signs and symptoms, with minimal use of laboratory tests, may increase the rate of correct diagnoses and reduce abuse of antibiotics,
delaying the development of drug resistance in pathogens. In comparison with the 2010 guidelines, the new Polish recommendations restricted the
use of amoxicillin clavulanate in treatment of recurrent pharyngitis.

Procalcitonin is an acute phase parameter of features different from other inflammatory markers. Serum procalcitonin concentration is a specific and sensitive
marker of systemic bacterial infections. This test can be used in clinical practice in the diagnosis and monitoring of severe bacterial infections as well
as in the differentiation of bacterial and non-bacterial etiology of systemic inflammatory reactions.

Overuse of antibiotics in rhinosinusitis (RS) may result from the persistence of the out-of-date, false views on the pathogenesis of this disease in the medical
community. In the article, we referred to the most important, popular myths about RS, which include: the belief that healthy paranasal sinuses are a sterile
site, overestimating the importance of bacterial infection, and putting sterilization of nasal sinus as the main goal of the therapy. In fact, the mucous membrane
of healthy paranasal sinuses is colonized by numerous microorganisms that form microbiome, which is disturbed in RS, and the main cause of RS is
ongoing inflammation, not a bacterial infection.

Ichthyoses belong to the genodermatotic group and are characterized by disturbed keratosis and exfoliation of the epidermidis. In this article, we presented
the most often occurring congenital and hereditary ichthyosis. Diagnosis of these conditions is based on the clinical presentation (skin and other organ
symptoms), detailed medical and family history, skin biopsies and genetic tests. Management of ichthyosis mainly involves the use of topical moisturizers
and topical medications. In the treatment of congenital and hereditary ichthyosis, newborns are a particular group of patients.

Inborn errors of metabolism (IEM) are inherited genetic disorders of the metabolism of nutritional substances: aminoacids/proteins, carbohydrates and
fats. They belong to the diet-dependent diseases, which means that special nutritional management with eliminative diets is the main treatment to them.
However, dietary restrictions due to the metabolic blocks make patients with IEM more likely to develop nutritional and caloric deficiencies.
Such a special diet is established both by the metabolic dietician and the physician based on patient’s age, body mass and current metabolic state. So far,
objective tools for energy requirements and expenditure have not been widely used in patients with IEM.

Normal puberty is a long-term process that begins between 8 and 13 years of age in girls and between 9 and 14 years of age in boys. The hypothalamic-pituitary-
gonadal axis regulates puberty and reproduction of the initially immature organism. Both premature and delayed puberty are observed. The premature
puberty should be diagnosed when there are any secondary sexual characteristics in girls under 8 years of age and in boys under 9 years of age.
Among the causes of premature puberty are mild variants of premature puberty of unknown etiopathogenesis, including premature breast development,
premature development of pubic hair and premature menstruation. On the other hand, we consider delayed maturation when there is no breast development
in girls after age 13 and there is no enlarged volume of testicles above 3 ml in boys after 14 years. The most common cause of delayed puberty is constitutional
delayed of growth and puberty, but its pathological reasons should always be considered. Diagnosis and treatment of puberty disorders is difficult,
requires careful interviewing, accurate subjective examination, laboratory tests and often also imaging studies.

Ventricular septal defect (VSD) is a common congenital heart disease (approximately 20-40%). It can be an isolated abnormality or a component of complex
congenital heart disease. VSD is characterized by a left to right shunt through the interventricular septum, which results in an increased pulmonary
flow. Untreated it can be a reason of pulmonary hypertension – the most serious complication of the defect. VSD can be classified according to their localization.
Symptoms, natural history and management of VSD depend on the amount of interventricular flow, anatomical associations of the anomaly and
patient’s age. The anatomy of VSD, hemodynamic, clinical symptoms, diagnostic methods and treatment are presented. The cardiac surgery is a method
of choice for VSD treatment with very low periprocedural risk and very good long-term results. Over the past years transcatheter techniques for VSD closure
have been developed.

Inherited methylation disorders are a group of rarely reported, probably largely underdiagnosed disorders affecting transmethylation processes in the
metabolic pathway between methionine and homocysteine. Methylation disorders predominantly affect the liver, central nervous system and muscles.
Biochemical hallmark of this group of disorders is isolated hypermethioninemia but is not always present especially in early infancy. Plasma SAM and SAH
are key metabolites for the biochemical clarification of isolated hypermethioninemia. They are best markers for laboratory diagnosis of inherited methylation
disorders, investigation of which is unfortunately only performed in very few specialized metabolic laboratories in the world. Because concentrations
of SAM and SAH are in the nmol/L range, selective LC-MS/MS methods must be employed.

Chronic hepatitis B in children remains a major clinical issue for pediatricians. The article constitutes an up-to-day overview on epidemiology in Poland,
management and treatment of children affected with chronic hepatitis B.

Objective: Assessment of medical lifesaving procedures provided by Emergency Medical Services (EMS) and emergency medicine procedures provided in the Emergency Department (ED) at early hospital stage during or after the febrile seizures.

Material and methods: Retrospective analysis of hospital medical records of 176 children at age from 6 months to 5 years old, who were admitted because of febrile seizures (FS) to Specialized Health Care Centre for Mother and Child in Poznan.

Results: In analyzed group were 61,9% boys and 38,1% girls. In 52,3% of cases body temperature measurement was made by parents. In 163 cases (92,6%) pre-hos­pital care was provided by medical doctor assisted EMS, 7,4% by paramedic EMS, despite this 42,9% cases had no reported emergency medicine procedures. EMS body temperature measurement was made in 23,9% (mean result 39,1°C). Pharmacotherapy was used in 40,91% cases (acetaminophen, ibuprofen, benzodiaze­pines, phenobarbital). In ED body temperature measurement was made in 61,9% cases (mean result 38,5°C). In 25% of cases both antipyretic and anti-seizure drugs were used. The most frequently used anti-seizure drug was diazepam applied per rectum. Chain of body temperature measurement (parents → EMS → ED) was documented in 13 (7,4%) cases.

Conclusions: Procedures recommended for children with FS are insufficiently respected in pre-hospital and early-hospital stage. Periodic audit is need­ed for unsure that the procedures are respected. The current system of training and medical recording is insufficient. There is a need for public information campaign, systematic stuff training and unification of medical records and procedures globally.

The appearance of acute symptoms such as poor muscle tone, weak or absent deep tendone reflexes, limb paresis, presented after respiratory or digestive
system infection, may suggest Guillain-Barré syndrome (GBS). Preliminary diagnosis is based on clinical symptoms. The article describes two cases of patients,
who were diagnosed incorrectly and the final diagnosis was pyruvate dehydrogenase deficiency (PDHD). The authors highlight the need to consider
that rare disease in the differential diagnosing of Guillain-Barré syndrome. The clinical description of PDHD is presented.