From the history of the mankind it’s known that during all times breastfeeding was given specific attention and until now this subject is very urgent. All the community is aware that breast feeding is important and it must be preserved for the maximum time. The article provides data on the unique components of the breast milk that make it indispensible in all respects for the baby.

This article provides general data on the anatomy of the skin of young children, which determines the incidence of skin diseases of different genesis and the need to use highly efficient and safe products for care and treatment. The role of the pantothenic acid in the human body and its potential use in dermatology and cosmetology is shown. The results of the D-Panthenol own performance studies on the treatment of skin injuries of different genesis from infants (300 children between 1 month to 2 years of age) are presented. Justification is provided for indications and contraindications against the use of the ointment depending on the type of the skin injury.

Breast milk is the optimal nutrition for baby of the first year of life. The composition and value of the individual components of breast milk are revealed and studied. This allows one to improve new infant milk formula for infants, who for various reasons are unable to receive breastfeeding. Because the energy needs of the child in the first year of life are high and it’s with the fat component of the diet it gets up to 50% of the energy adaptation of the fat component of the mixture is important, in particular, addition of beta-palmitic acid. The consumption by babies of formulas with beta-palmitic acid promotes digestion of fat and calcium; contributes to increase in the concentration of bifidobacteria and lactobacilli, formation of soft stools. These effects facilitate digestion, promote bone mineralization and reduce the duration of crying.

6 449 schoolchildren aged 6 to 18 years living in various parts of Saint-Petersburg were examined with the purpose to study the physical development of children. To assess the level of growth processes international normative Z-score scales for the length of the body (WHO Growth Reference 2007) were used.

The majority (65.4%) of the surveyed children and adolescents revealed the average physical development. The number of schoolchildren whose length of body exceeds the average value was higher (26.1 per cent) than the number of schoolchildren with below-average growth (8.5 percent; p < 0.001). High rates of body length in boys were more common (7%) than among girls (4,5%; p = 0.001). Frequency of short stature in girls was higher (1.2%) than in boys (0.7 percent; p = 0.03). Age-specific analysis showed that the average body length at the age of 12 was more common in boys, at an older age in girls. The lowest average level of physical development in boys is at the age of pubertal growth leap (12–15). In girls the highest rate of the number of teenagers with the average level of physical development is among high school girls (16–18) on achievement of the definitive body size. In all groups a shift in the distribution of the variants differing from the average level of physical development in the direction of the higher body length is observed. The obtained results indicate the need for the in-depth analysis of the factors that cause deviations in physical development with subsequent development and implementation of preventive measures. 

The problem of introduction of complementary foods continues to be debated both in academic circles and among practitioners. The most relevant is the discussion on the optimal timing and sequence of the introduction of individual products, individual planning of the diet of children with food allergies, a possibility of using products of complementary foods in the complex treatment of functional digestive disorders and various deficient states, as well as the role of new products in the formation of eating behavior of the child. In the conversation the employees of the Department of Pediatrics of RMANPO chaired by Professor Irina Nikolaevna Zakharova tried to answer frequently asked questions regarding introduction of complementary foods to the infants.

Children with vitamin D insufficiency are characterized by antiviral and antibacterial immunity. And, contrariwise, supplements of vitamin D have immunomodulating and anti-inflammatory action, and protect the child body from infection. The data of the evidence-based medicine testify the importance of the use of vitamin D to prevent and to treat tuberculosis, chronic bronchitis, prevention of respiratory tracts infections, including those caused by RSV (respiratory and syncitial virus) and Group A virus.

According to the established tradition in April 2017, in the department of pediatrics of the Russian Medical Academy of Postgraduate Education of the Ministry of Health of the RF (Zakharova I.N., Chief of department, MD, Prof., Chief Pediatrician of the Central FO of the RF) a scientific and practical seminar with participation of Russian and Bulgarian specialists Clinical Homeopathy and Practical Medicine: Experience of International and Russian Experts was held devoted to use of homeopathy in pediatrics. We met participants of this seminar and asked to speak about the seminar.

This article presents the epidemiology, etiopathogenesis and classification of chronic tonsillitis. It consistently discusses the modern methods of treatment, particularly the use of Tonsilotren in drug therapy regimens. The results of multicenter randomized controlled clinical trials, the purpose of which was to identify and evaluate the effectiveness and tolerability of Tonsilotren are being given. It is concluded that Tonsilotren is an efficient, modern tool for pathogenetic treatment of patients with chronic tonsillitis, and it can be recommended in the modern scheme of treatment of chronic tonsillitis.

Symptoms of diseases of the upper respiratory tract are manifestations of general intoxication and local pathological changes such as running nose and coughing, and it is the cough that takes the first place as the reason for applying to the doctor. This article shows the results of a clinical performance study of cough therapy, using Dyshi warming gel for children. Ninety children aged 3–7 years with infectious diseases of the upper respiratory tract (URT) participated in the study. When the unproductive cough persisted after five days of treatment additional therapy by warming products was indicated for children. The children of Group 1 (basic), in addition to standard therapy, used the Dyshi warming gel for children. Children of Group 2 (comparison group) received Dr. Mom Phyto Ointment. In Group 3 (control) – only standard therapy, without the use of other ether oil-based gel and ointments with warming effect. The effectiveness of treatment was assessed according to the clinical survey. On days 8–11 after the first examination in Group 1 compared to Group 2 a decrease in the day and night cough was noted by the Visual Analogue Scale by more than 4 points. There was a decrease of the duration of the disease therapy by 4 days (28.6%) in the group that used the Dyshi warming gel for children as opposed to the control group. The regression of daytime and night cough in the studied group was only reliably observed in Group 1 patients.

The article presents a comparative analysis of the clinical morphologic features of chronic polypous rhinosinusitis, statistically significant differences in different age groups are identified. Differences were detected in complaints among adults, the greater proportion comprised patients with complaints of difficulty in nasal breathing (98,2% and 78.1%, respectively, p < 0.05), discharge from the nasal cavity of mucous or muco-purulent character (84.1 and 41.1%, respectively, p < 0.05), decrease in acuity of smell (hypo – or anosmia) (58.5 and 11.1% respectively, p < 0.05).

Prevalence of Stage 2 and 3 dominated among adults (42.7% and 34.1%, respectively), among children - Stages 1 and 2 (29.1 and 56.6%, respectively), p < 0.05.

Thus, in children a more favorable course of the polypous process was identified in children that justifies the priority of conservative treatment for this group of patients with favorable prognosis of the effectiveness. 

Development of antibacterial agents became one of the greatest inventions of the previous century. The effective counteraction to infectious disease agents allowed saving lives of many patients. But in our day-to-day activities we face the reverse side of the widespread use of such drugs: growth of resistance to them and increase of side effects. This can’t but cause concern of the medical community. On the one hand, this problem was urgent at the end of the 90s when due to various reasons a process of development and implementation of new antimicrobials reduced. On the other hand, wide uncontrolled use of antibiotics due to their availability and low adequacy of prescription led to increase of resistance development to them of various microorganisms.

Acute respiratory viral infections take leading positions among diseases of the pediatric age. In the majority of cases they are accompanied by fever, catarrhal manifestations, nasal discharge, coughing. The major method to treat them is supportive symptomatic therapy, which is sufficient to relieve symptoms of the disease. But children with long-term persistent symptoms, development of post-viral or bacterial rhinosinusites require prescription of active and at the same time safe drugs contributing to relief of edema of the mucous tunic of the nasal cavity and paranasal sinuses, reduction of the mucus viscosity and simplifying its evacuation. Use of intranasal glucocorticosteroids, on the one hand, is limited by the age 12 years, and on the other hand, not all the parents agree to the prescription of these drugs in spite of the proved effectiveness and safety. Phytotherapy that today can compete with other products active against acute and chronic rhinosinusites and is recommended for application by international approvals gains greater popularity.

Acute upper respiratory tract infections maintain leadership in the overall morbidity patterns of the Russian Federation population. The highest prevalence of acute respiratory infections is reported in the pediatric population. For example, if in 2016 there were 21,703.38 cases of acute upper respiratory tract infections per 100,000 population nationwide, the incidence rate in children aged 0–14 years was 4.1 times higher and amounted to 88,621.04 per 100,000 [1].

The article provides the data on reasons of the dry coughing in children in various nosologic forms of diseases and practicability of prescription of non-narcotic drugs of central action.

Gut microflora is a dynamically developing ecosystem. One of the most effective methods to influence to the composition of intestinal microbiota and to restore its metabolic activity is probiotics use. Lately, multi-strain and multi-species probiotics gain greater popularity. The Russian and foreign experience of multi-strain and multi-species sinbiotic Bac-Set Baby and Bac-Set Forte application proves their effectiveness in correction of intestinal microbiota misbalance in functional GIT disorders, constipation and diarrhea in children. The results of studies in children and adult patients allow concluding the fact that Bac-Set Forte multiprobiotic is an auxiliary remedy in the treatment of metabolic syndrome, non-alcoholic fatty liver disease and non-alcoholic steatohepatitis.

The article described a typical clinical situation that is frequently observed in the pediatric practice and probably will be more prevalent as the incidence of the metabolic syndrome continues to grow. Modern data testifying that changes in the qualitative and quantitative composition of the intestinal microbiota result in dramatic changes of the metabolism in the body contributing to development and progression of obesity and various functional and chronic diseases of the digestive system. Prospects of corresponding methods of metabolic disease management are discussed, including those with use of a totally new class of multi-strain probiotics.

Jaundice in newborns is the most common symptom and in the vast majority of cases reflects the characteristics of bilirubin metabolism in the neonatal period. In healthy newborns there are two kinds of jaundice that do not require treatment and are caused by hyperbilirubinemia: physiologic and breastfeeding ones. Transient disturbance of the bilirubin clearance (indirect bilirubin conjugation) not affecting the child development lies at the core of a healthy newborn jaundice. Jaundice of breastfeeding differs by prolonged course (up to 2-3 months) while physical and psychomotor development of the child is not affected. However prolonged course (over 14 days of life) of jaundice requires determination of bilirubin and its fractions in dynamics to rule out more serious causes of hyperbilirubinemia.

The article presents data on the prevalence of infectious diseases in children in Russia and the frequency of use of antibiotic therapy. Special attention is given to the uncontrolled use of antibiotics that leads to antibiotic resistance, disruption of the symbiotic equilibrium of the microbiota, development of acute allergic reactions and other diseases. The modern tactics of treatment of children with antibiotic-associated diarrhea according to the international recommendations of ESPGHAN and ESPID is provided.

Clinicians and patients often confuse hypersensitivity, allergies and intolerances. Differences in terminology often lead to erroneous conclusions. This article proposes the terminology to split up symptoms that are very close to each other clinically, however are totally different in pathways.

Objective: to describe differences between the discussed terms for practitioners from the position of a pediatric gastroenterologist.

Results: many patients present with symptoms «related to food ingestion». We propose to use exactly that wording if it is impossible to establish specific pathogenic mechanisms underlying the clinical manifestations. We propose to understand the term intolerance as the clinical manifestations that occur in patients on the background of malabsorption of carbohydrates. Allergy refers to the involvement in the pathological process of IgE - and not IgE-mediated reactions resulting in clinical manifestations such as atopic dermatitis or allergic colitis with the appearance of blood in the stool. Unfortunately, primary care physicians don’t have possibilities to diagnose non-IgE-mediated allergies. A positive provocative test proves the presence of symptoms induced by food, but does not prove involvement in the pathological process of the immune system. The term «hypersensitivity» involves immunological mechanisms and should not be used in this case. The pathophysiologic mechanism of many symptoms that occur when eating remains unclear. The same symptom can be caused by allergies or it can be a manifestation of functional disorders of the gastrointestinal tract, such as infant intestinal colic, gastroesophageal reflux and constipation that occurs on the background of infant feeding products based on cow’s milk. In practice, the term functional is used in that case, if the pathophysiological mechanism inducing the symptom can be explained. The distant outcome of allergies is significantly different from the outcome of functional disorders, therefore, correct differential diagnosis of these states is essential.

Conclusion: the phrase «a symptom that occurs when eating food,» should be used if its pathophysiological mechanism is not clear. Food intolerance should identify symptoms due to malabsorption of carbohydrates. The term allergy should be used in those cases when the pathological process is involved the immune system.

Currently there is conclusive evidence testifying that the microbiota of the gastrointestinal tract has an immune modifying and metabolic effect on the human body and determines expression of separate genes by means of some epigenetic mechanisms [1–3]. The peculiarities of a composition of the intestinal microbiota can predetermine peculiarities of the macroorganism metabolism hereby predisposing to the development of various disease, including inflammatory intestinal diseases, type 1 diabetes mellitus, disseminated sclerosis, disturbances of the autistic spectrum, cardiovascular and oncologic diseases, metabolic syndrome and obesity [4, 5].

The article provides information about frequency of the asthenic syndrome in the pediatric practice. The optimal therapeutic approach solving a number of tasks is offered: elimination of the liver overload by nitrous slag, elimination of urea from kidneys, elimination of endotoxication of blood, lymph and other liquid media of the body in order to prevent negative shifts in the work of skeletal musculature, cardiomyocytes, cells of the immune and nervous systems. The high preventive and therapeutic effectiveness of the citrulline malate (Stimol®) in asthenic states.

Atopic dermatitis (Ad) is a multifactorial skin disease. As shown by recent studies, a significant role in the pathogenesis of atopic dermatitis is a disturbance of the structural elements of the skin barrier, which contributes to skin xerosis, increase of its permeability to allergens and development of chronic inflammation. As a result, an allergic inflammation develops in the skin. Accordingly, in the treatment of atopic dermatitis great attention should be paid to effective external therapy. In the period of exacerbation of the skin process effective and safe external preparations are drugs of activated zinc pyrithione (APTS) - a line of Skin-Cap products. Use of APTS in atopic dermatitis in children leads to a significant reduction in the severity of inflammation, reduction of the area of skin lesions and severity of symptoms, reducing the need for additional administration of antihistamine and anti-inflammatory drugs, allowing you to reach persistent clinical remission.

In recent years, there has been an increase in atopic dermatitis all over the world. The disease is more common in highly developed countries, in cities, less often in rural areas and with a higher socioeconomic status, which implies insufficient exposure to infectious agents. Children attending preschool institutions with extensive contacts with their peers are less likely to have atopic dermatitis than their peers with a low index of infectious morbidity. In this article, the author provides a literature review of new pathogenetic factors in the development of atopic dermatitis, a mitigating effect of emollients in the therapy and prevention of atopic dermatitis in children, describes his own clinical experience.

Acute respiratory infections (ARI) occupy the first place in morbidity among children and among adults for the past many decades. In General, the treatment is assigned to doctors on the basis of examination of the patient, in the absence of laboratory data on etiological characteristics of the infection. In such cases, the doctor cannot predict the nature of the disease and the risk of possible complications. This leads to prescription of unnecessary drugs. For the treatment of ARI in pediatric population currently there are a large number of drugs with a broad spectrum of antiviral action. Often at the same time 2-3 antiviral drugs are prescribed with different mechanisms of action. This contributes to excessive drug treatment, a very undesirable one in pediatric practice. To reduce the risk of excessive drug load, it is desirable to use one substance with a complex effect on various factors of infectious-inflammatory process.

Over the last 50 years an approach to diagnosis and treatment of asymptomatic bacteriuria (BB) has changed. Previously bacteriuria was considered as a manifestation of an underlying pathology that must be identified and treated with antibiotics. However the accumulation and emergence of new scientific data to improve methods of research allowed understanding that the presence of BB in humans is not only harmful to health but rather on the contrary protects it from developing symptomatic urinary tract infection (UTI). Currently, many researchers turned to the study of BB, having unique data, showing that understanding this issue can help uncover previously unknown pathogenetic, immunological and genetic mechanisms of development of IMP, the result of which will be obtained and new opportunities for effective treatment. This is particularly important in the era of ubiquitous increasing microbial resistance to antibiotics.

The complexity of the situation in the treatment of acute inflammation of the oropharynx lies in the fact that there are still no standards for the treatment of this pathology, which clearly regulate the purpose of a given drug, a particular treatment regimen. Most of the drugs produced for the treatment of acute pharyngitis and tonsillitis refers to over-the-counter medications and are taken by patients without agreement with the doctor, which can lead to disruption of the oropharynx biocenosis and the formation of resistance of pathogenic bacteria. In the presented work, a modern method of diagnosis and treatment of acute inflammation of the oropharynx in children was proposed.

The article shows the main factors that have an effect on the intestinal microbiota. Most of the focus is on the slow recovery of Bifidobacterium population after antibiotic therapy with traditional azithromycin. The authors present the results of an open comparative study in children with rhinosinusitis to evaluate the efficacy and safety of traditional azithromycin and azithromycin with lactulose that is equivalent in antimicrobial activity, but superior in the safety profile, maintaining intestinal microflora balance and reducing the risk of antibiotic-associated diarrhea.

Study objectives: To conduct screening of alkaline phosphatase (ALP) levels; compare the frequency of detection of low ALP levels using different diagnostic systems; evaluate the possibility of introducing a single «cut-off point». Materials and methods: We analyzed 5472 ALP tests were from 01.08.2013 to 30.04.2017 (672 tests been done with diagnostic system Synchron (Beckman Coulter), 4800 tests been done with system ADVIA 1800 (Siemens Vista)). Results: Identified 67 (1.2%) tests (55 patients) with low values of ALP: among them 35 patients been treated with glucocorticoids; 4 with cytostatics; the rest patients without therapy (6 were in the debut of juvenile rheumatoid arthritis (3), acute leukemia (1), Kawasaki syndrome (1), erythema nodosum (1), 4 with chronic gastrointestinal diseases, and 3 with mild bronchial asthma , 2 – with infantile cerebral palsy, 1 – with premature sexual development). Low ALP values were detected more often in cases of Beckman Coulter system using (26, 3.87%) than Siemens Vista (45, 0.94%). The sensitivity of the «cut-off point» 150 U/l was 100%, specificity 75.18%; in case of «cut-off point» 100 U/l figures are 56.52% and 88.12%, respectively. Conclusion: low level of alkaline phosphatase is the main biochemical marker of hypophosphatasia; in the study, most cases of ALP reduction were associated with drug administration. Analyzing ALP level it is necessary to use ALP reference values specified by age and gender, as unified «cut-off points» have low specificity and/or sensitivity.

Beckwith - Wiedemann syndrome (ICD-10 code: Q 87.3) is a congenital disease characterized by macrosomia, macroglossia, hernia umbilical cord, overgrowth in the first few years of life, asymmetry of the body and a predisposition to embryonal tumor development. The disease was first described by American pathologist J.V. Beckwith in 1963 and, independently of him, by the German pediatrician H.R. Wiedemann in 1964. Thereafter, it was named the Beckwith-Wiedemann syndrome to honor of these scientists [1--4].

The article considers a clinical case of the grave course of the flu А(Н1N1)pdm09 with development of the viral and bacterial pneumonia and acute respiratory distress-syndrome (ARDS) in the baby. A description of the respiratory support is provided, the data on catamnesis in a year are given.

The article discusses approaches to therapy of acute respiratory infection (ARI) and flu. Some peculiarities of application of various non-steroid anti-inflammatory drugs in children are discussed. Data on effectiveness of paracetamol use in children with ARI and flu symptoms are provided.

In article we demonstrated the results of the complex assessment of the health status of children during the first year of life with congenital heart defects (CHD). We established a connection between the problems of obstetric history (miscarriage, abortion) and an increased risk of developing severe heart defects. In the group of children with CHD who required surgery for 1 year of life and who have mothers with obstetric history problems, the severity of the CHD in 55% [95% Cl 44,7÷65,0] of children was related to the impact of obstetric history problems on their mothers. We found out that the majority of children with CHD had low body weight by the end of 1 year of life. In the group of operated children, we found a significant increase in the proportion of children with a sharply disharmonious physical development due to a deficit in body weight. We identified that children with CHD requiring surgery for 1 year of life have a high risk of respiratory infections (ОR = 4,67 95% Cl [1,19 ÷ 18,35]). In addition, we found a positive relationship between the respiratory incidence and the degree of heart failure in children with CHD (r = 0,492, p<0,05). The data has been demonstrated the severity of hemodynamic disorders at CHD requiring surgical correction at an early age. The results of a comprehensive assessment of children’s health are important for developing algorithms for monitoring children with CHD in a pediatric outpatient clinic.

The article provides a justification of use of topical corticosteroids in therapy of atopic dermatitis (AtD) in infants and young children. The results of application of 0.1% of methylprednisolone aceponate in AtD children confirm high effectiveness, safety, minimal risk of adverse effects in this age group.

Most cardiac diseases, which are the leading cause of death and disability worldwide, come from the dysfunction of the autonomic nervous system. Autonomic dysregulation is the main pathogenic cause of the orthostatic dysregulation syndromes and neurotransmitter syncopal conditions. Overactivity of the sympathoadrenal department of the autonomic nervous system contributes to the development of type 2 diabetes mellitus, metabolic syndrome and obstructive breathing disorders during sleep, which are closely associated with the development of cardiovascular diseases.

The prevalence of the excessive weight and obesity increasing in the human population is a significant concern to the public health. The article provides a literature review devoted to pathophysiologic aspects of the obesity and vitamin D deficiency interconnection. A role of adipokines (leptin, adiponectin), cells of the immune system, proinflammatory cytokines in the pathogenesis of obesity and place of vitamin D as an endocrine and paracrine regulator of inflammatory processes in the fatty tissue. An important role of the vitamin D deficiency in the genesis of the insulin resistance is shown that underlies the fatty tissue accumulation and formation of the metabolic profile characteristic of obesity. Direct and indirect vitamin D effect on the insulin synthesis in the pancreatic gland and sensitivity to it of insulin receptors in the body tissues is demonstrated.

The article provides modern approaches to etiopathogenesis, diagnostics and therapy of the familial Mediterranean fever (periodic disease) in children, clinical and genetic aspects of the disease are considered.