The authors presented selected reports on liver disorders in children discussed at the 51st Annual Meeting of European Society for Paediatric Gastroenterology, Hepatology and Nutrition, 9-12 May 2018 in Geneva. 

Iron deficiency is the most prevalent single nutrient deficiency and is worldwide the most common cause of anemia. In Poland, no large epidemiological studies have been conducted determining the incidence of iron deficiency and iron deficiency anemia in children and no studies assessing the effects of prophylaxis or treatment of these conditions. The proposed recommendations have been prepared based on a review of medical literature of recent years as well as American and European recommendations. 

In April 2018 National Institute for Health and Care Excellence (NICE) published new guidelines for diagnosis and treatment of Lyme disease. Authors of the guidelines still take the position that both clinical symptoms and standard two-stage serologic tests are needed to diagnose borreliosis. However, NICE guidelines introduce significant novelties regarding clinical manifestations considered in diagnostics, interpretation of laboratory results and antibiotic dosage in the treatment of borreliosis. Authors of present review compared new NICE guidelines to recently updated (September 2018) Polish recommendations for 
 diagnosis and treatment of Lyme disease. 

An altered gut microbiota composition and/or activity (dysbiosis) contributes to allergy risk. Targeting gut microbiota by using probiotics, prebiotics and synbiotics (a mixture of pro- and prebiotics) has the potential to prevent or even treat allergic diseases. The aim was to systematically evaluate the effectiveness and safety of synbiotics for the management and prevention of allergy in children. The MEDLINE and The Cochrane Library (both up to September 2018) were searched for randomized controlled trials or their meta-analyses relevant to synbiotics. Data suggest that synbiotics (as a class) may be effective in the treatment of atopic dermatitis, particularly synbiotics with mixed strain of probiotic bacteria and in children younger than 1 year. The role of synbiotics in the prevention of allergy remain unclear. Not all synbiotics are equal. The clinical effects and safety of any of them should be evaluated separately. 

Neonatal and infant jaundice still poses a problem for the clinician and general practitioner doctor in proper diagnosis and implementation of the appropriate medical procedure. In clinical practice, we often meet overdiagnosis, unnecessary treatment implementation and thus increase in health care cost. On the other hand, cases of central nervous system damage caused by toxic effects of high bilirubin concentrations are still being described. Child’s health depends on proper jaundice diagnosis and optimal management of both prevention and treatment. The article is an overview of current knowledge on various types of jaundice diagnosis in neonatal and infancy period, taking into consideration the current recommendations in this area.

Proper diagnosis of jaundice in newborn and infant is crucial for implementing appropriate treatment and gaining positive therapy outcome. Treatment decision is based on determination of serum concentration and the speed of billirubin accretion in child’s blood, taking into consideration newborn maturity and age. Effective treatment prevents hyperbilirubinaemia complications which are crucial from child’s intellectual and physical development perspective. Despite having a lot of reference books, in practice there is great variability in the attitude towards hyperbilirubinaemia diagnosis and treatment. Both excessive treatment qualification in non-treatment cases and too liberal attitude towards high billirubin concentrations are observed. The article is the attempt to review current writings and recommendations in jaundice diagnosing and treating rules. The authors describe therapy methods and child’s care rules during treatment.  

Lactose in breast milk accounts for about 98% of the total carbohydrate content, which reflects its important biological role. Hypolactasia is considered to be the most frequent enzyme deficiency in humans, however, symptoms of lactose intolerance are observed much less frequently. The use of a longterm, strict lactose-free diet in patients with hypolactasia may lead to adverse health effects. The paper presents the importance of lactose in the diet, types of hypolactasia and methods of diagnosis and treatment of lactose intolerance, as well as possible adverse health effects of a long-term elimination lactose-free diet. 

Acute otitis media (AOM) is the second most common infection of infancy and early childhood. The peak incidence of illness is between 6 and 24 months of age, mainly in autumn and winter. Diagnosis is based on the interview and the otoscopic examination. Treatment is primarily symptomatic; antibiotic therapy is indicated only in specific situations. Complications are rare, even in children not treated with antibiotics. The article contains necessary information on the definition, etiology, course, and treatment of media (AOM) in children, useful in the work of a pediatrician. 

Transplantology is a quickly developing branch of medicine. Nowadays transplantation is believed to be the most effective treatment of end-stage failure of different solid organs such as kidneys, liver or heart. Acute cellular rejection (ACR) which used to be the main reason of graft lost occures less frequently owing to better diagnostic methods and immunosuppressive agents. Recently, attention has been colled to antibody-mediated rejection (AMR) as its etiopathogenesis and long-term influence on graft survival have not been understood completly. Tha aim of this paper is to present microscopic methods of diagnosis of AMR in most frequently transplanted soild organs such as kidneys, liver and heart based on actual recommendation. Standardy 

Diseases with skin lesions are frequent in the children. The first step of the diagnostic process of the diseases with skin lesions in children should include the general child status (vital signs) and the determination of the presence of the rash characteristic for meningococcal sepsis. The anamnesis should respect different etiology. The key to the appropriate diagnosis is adequate interpretation of the skin lesions. It should be based on establishing of the type of the skin lesions, their location on the skin, the dynamics of the process of the occurrence and the disappearance, as well as the presence of different symptoms. Skin eruptions could associate the gentle viral infections likewise bacterial sepsis or severe syndromes of hypersensitivity to drugs. 

Oligosaccharides are one of the most important components of human milk. These non-digestible substances promote growth of Bifidobacteria and are 
 necessary for development of proper composition of intestinal microbiota in infants and small children. The combination of short chain galacto-oligosaccharides and long-chain fructo-oligosaccharides (scGOS/lcFOS) in a proportion 9:1, used as infant and follow-on formulas supplement, mimics the composition and biological effect of human milk oligosaccharides. Among the prebiotics tested in clinical studies, the scGOS/lcFOS 9:1 formulas are the best known and their positive effects have been confirmed in over 30 publications. The scGOS/lcFOS supplemented formulas have beneficial effect on intestinal microbiota composition, as well as stool frequency and consistency, making them similar to stools of breast-fed infants. There are also many publications confirming the reduction of allergy and infectious diseases incidence in children fed with scGOS/lcFOS supplemented formulas. The paper summarizes the theoretical background on prebiotics and human milk oligosaccharides. The review of clinical studies on scGOS/lcFOS supplementation results has been also presented. 

Hashimoto’s thyroiditis is currently the most frequently diagnosed autoimmune disease, the most common disorder of the endocrine system and the most common cause of hypothyroidism in developed countries. It is a disease with complex, incompletely elucidated etiopathogenesis, ambiguous symptomatology and variable clinical course. Therefore, there is a lot of contradictions and inaccuracies in the general consciousness as well as in the available medical literature on this disease. This study is an attempt to explain the most common doubts by summarizing the review of the current literature on the etiopathogenesis of the disease, diagnostic criteria, treatment recommendations and new directions of research. 

Self-injury is defined as the intentional, not life-threatening, direct injuring of body tissue in socially unaccepted way. Prevalence rate is estimated to be over a dozen in adolescents, few percent in young adults and much lower in more advanced age. In DSM-5 non-suicidal self-injury (NSSI) is proposed as a condition for further studies. Diagnostic process should include physical examination and assessment of necessity of physical treatment; mental state 
 examination, including suicide risk assessment, assessment of frequency, severity and methods of self-injury and assessment of environmental risk and protective factors. In case of suicidality the patient should be referred to mental health hospital. In most cases however the psychological support and psychotherapy should be the first line treatment. Pharmacotherapy efficacy for NSSI needs further studies. Pharmacotherapy may be introduced for comorbid psychiatric conditions. 

Recommendations concerning changes in the way parents care for their child are often difficult to implement in everyday situations. Parents are the ones who are responsible for the success of this recommendations. Unfortunately, often the recommendations are not followed. This article is focused on discussing the reasons that may cause such difficulties and suggests ways to avoid them. Theoretical basis was illustrated by an example, where parents were given recommendations to change their behavior in order to resolve child’s feeding problems. 

Background: A child from an early age is exposed to many infectious diseases. The best protection against them are vaccinations. The vaccination schedule including mandatory and recommended vaccinations. The implementation of recommended vaccinations depends on the knowledge and awareness of parents, who make the decision about vaccination. Health education of parents is the best way to improve the implementation of the recommended vaccinations.

Purpose of the paper: The purpose of the paper is to analyze the factors causing the low recommended vaccinations coverage levels among children in Upper Silesia, with particular focus on vaccinations against influenza.

Material and methods: A group of 600 parents having children aged 0-6 years was included in the study. The study was conducted in randomly selected kindergartens in Bielsko-Biała, in the Pediatric Ward in Bielsko-Biała and in the Pediatric Clinic of Medical University of Silesia in Katowice. The method of research applied in the study was a diagnostic questionnaire designed by the researchers.

Results: The parents were informed by the doctor about the recommended vaccinations. The parents associated the lack of use of these vaccines with high costs. The parents who decided against vaccinating their child by the paid vaccine will not take such a decision in the future. The leading causes of the decision not to vaccinate against influenza was the parents’ lack of faith in the effectiveness of vaccines or the fact that the vaccine is not recommended by a doctor. The financial situation of the family, the age and education of the parents had a decisive influence on the way of the implementation of recommended vaccination

Conclusions: An important factor influencing the recommended vaccinations coverage in children was the high cost of the vaccines. The main reason for refusing to vaccinate children against influenza was the lack of the parents’ faith in the effectiveness of vaccination. The introduction of free recommended vaccinations would increase the level of vaccination. Recommended vaccination should be more intensely promoted by health professionals and media, especially those against influenza, through providing knowledge about the flu and its complications. 

Objectives: Evaluation of the dietary habits and nutritional status of women during pregnancy and breastfeeding and the level of mothers’ awareness 
 of breastfeeding.

Materials and methods: The study included 1024 mothers between 18 and 50 years old who were breastfeeding or are currently breastfeeding. A nationwide survey was conducted using the CAWI method.

Results: The largest group of mothers declared breastfeeding for more than a year and for 6 months, respectively 17% and 13% of the respondents. Only 21% of mothers declared exclusive breastfeeding for 6 months. More than half of the youngest women (18-24 years) declared they would stop breastfeeding due to inadequate breastfeeding self-efficacy. As many as 36% of mothers did not receive any information about the principles of nutrition while breastfeeding, and 28% were of the opinion that the nutrition of breastfeeding women has little or no effect on the health of the child. 60% of the respondents used to eat between meals, and the products most often consumed between meals included fruit and sweets.

Conclusions: A high percentage of overweight and obese women during pregnancy and breastfeeding should be considered a worrying phenomenon. 
 The awareness of mothers regarding the impact of breastfeeding on the health and the development of the child is insufficient. Regardless of many initiatives promoting the “gold standard” of infant nutrition, exclusive breastfeeding up to 6 months of age is accomplished in Poland by a small percentage of women. 

The following case report of the patient with feeding disorder is an illustration to article titled “Difficulties of applying the recommendations based on an example of problem with child’s feeding”, as it reflects the real difficulties encountered throughout medical care of the patient with feeding disorder. 

Rotaviruses remain the most commonly identified pathogens responsible for acute gastroenteritis in Poland as well as the first reason of hospitalization and outpatient consultations due to acute gastroenteritis. Almost every child up to 5 years of age has had or will suffer for at least one infection of this etiology. Although in most cases the infection presents as self-limiting gastroenteritis, it may be associated with complications, especially in patients at high risk of severe course of the disease. The article presents three clinical cases of severe rotaviral gastroenteritis and its’ complications to emphasize the need for immunization against rotaviruses, what minimize the sequelae of the natural infection.

DiGeorge syndrome (DGS) called the 22q microdeletion syndrome 22.2 is a pattern of malformations of different organs with a variable clinical view and one of the most common genetically conditioned diseases in humans. It occurs with a frequency of 1:2,000-4,000 live-born children. The main symptoms that suggest the diagnosis of the syndrome consist of congenital heart diseases, characteristic facial dysmorphism, palatal abnormalities, thymus-related immunity disorders and parathyroid disorders – hypocalcemia. The aim of the article is a clinical description of a boy with a late-diagnosed DiGeorge syndrome, despite the fact that abnormalities occurred in the early childhood. An additional symptom is the thymus cyst, which may be an independent disorder, but on the other hand may also be one of the rare symptoms of DGS. Knowledge of the most common congenital defects in children is very important in everyday medical practice. Early recognition of a genetic disease allows proper conduction of further diagnostic, therapeutic and rehabilitation procedures, appropriate prophylaxis of co-existing diseases, determination of prognosis, giving family advise as well as support. Determining the correct diagnosis of DGS in the first months of life is much more difficult, especially when congenital heart defects are absent.