The article tells the history of the All-Russian Society of Pediatricians. It presents the results of studying scientific papers, statutes of the Society, reports, articles and resolutions of the congresses of the RSFSR pediatricians. These materials revealed a little-known fact: the All-Russian Society of Pediatricians that was functioning from 1959 to 1994 had a predecessor — the RSFSR Society of Pediatricians that had been working for the period of 1933 to 1940. Moreover, in hard times of the Great Patriotic War and the first postwar years, the management of the All-Russian Society was functioning as the All-Union Society until the Congress VI held in 1947.

Objective: Our aim was to clarify and standardize the definitions of the term "social pediatrics."

Methods: Terminological analysis, functional interpretative content analysis and method of expert assessments.

Results: We found 86 definitions of the term "social pediatrics" in the Russian and foreign scientific sources (1939 to 2015). The earliest publication (1945) on social pediatrics was found in the PubMed database. After excluding duplicate and similar definitions, 24 logical definitions were included in the final analysis. Between 1970 and 1979, the highest number of foreign publications related to social pediatrics (PubMed) was found giving the grounds for considering this period the time of the official development of social pediatrics as a branch of science and practice abroad.

Discussion: The definitions under the study compose a picture of a broader interpretation of the term "social pediatrics" in Europe, including different children healthcare levels (state, public, individual), while, for example, in Canada, the emphasis shifts towards a purely practical sphere — primary medical care with social pediatrics applied to vulnerable groups of children. Content analysis identified the main categories of social pediatrics in the presented definitions that were recorded in the developed matrix table.

Conclusion: Based on the conceptual and categorical apparatus of social pediatrics, including a "holistic approach to healthcare," "social determinants of children's health," "preventive component," "children in difficult circumstances of life," "multidisciplinary approach/interagency cooperation," "system approach (to the organization of healthcare)," "health support," "psychosocial support," and "rights of the child," we introduced our own definition of social pediatrics. Preventive component of social pediatrics is recognized as one of the most important features according to both the content analysis and experts.

Despite the fact that orphan (rare) diseases are characterized by a very low prevalence rate, a considerable number of people worldwide suffer from these diseases. The United States and the European Union developed a variety of economic and administrative incentives for pharmaceutical companies to produce orphan drugs, but their effectiveness is difficult to assess because of the small sample volume and complex organization of clinical trials. The average cost of orphan drugs is 5 times greater than that of the drugs used in the treatment of other diseases. Pricing mechanisms on orphan drugs are still poorly understood.

The review examines the diagnosis, prevention and treatment of Hirschsprung-associated enterocolitis in children operated for colonic agangliosis. It describes the features of microbiota in these patients, the role of Clostridium difficile in the etiology and pathogenesis of pathological conditions, options of perioperative antibiotic prophylaxis, and drug prescription timing. Analysis of original research results has shown that the issue of optimization of the perioperative antibacterial therapy in reconstructive surgery for colonic agangliosis in children is relevant at the moment.

Background: Rational nutrition management in infants under 3 years is an important part of their adequate development at this age and in future.

Objective: Our aim was to evaluate awareness of pediatricians and parents concerning rational nutrition management in infants under 3 years.

Methods: 300 pediatricians and 300 parents of infants under 3 years who live in Moscow, Ivanovo, and Yaroslavl were enrolled in pilot survey.

Results: Pediatricians' recommendations on child nutrition management satisfied the majority of parents (252; 84%), however, less than half of families (135; 45%) followed them. In other cases the child's ration depended on mother's opinion on the matter (96; 32%) and on child's food preference. «Unhealthy» food such as groceries and provision, processed food, spices, seafood, fast food, chocolate, candies, and sweets as well as soda was included in child's ration at the age of 2 and its consumption frequency increased significantly at the age of 3. Pediatricians strongly recommended special dairy for infants from the age of 1 (known as the 3rd formula). In fact, only half of children in Moscow eat them, and 27–30% of children in Ivanovo and Yaroslavl.

Conclusion: Harmful breach of nutrition management in infants under 3 years is detected. Evidently, parents are not competent on the question. Optimization of educational activities performed by pediatricians, medical stuff, and mass media is required.

Background: In Russian schools, children are provided with meals, and certain categories of students get free meals. However, not all school students eat regularly.

Objective: Our aim was to study the role of school meals in physical development of children and adolescents.

Methods: The survey of schoolchildren aged 8–18 years (Voronezh) revealed two groups of students who eat at school regularly (Group 1) and on occasions (Group 2). We calculated Z scores of body length and body mass index (BMI) using ANTHROPlus software. Nutritional status was determined based on the values of standard BMI deviations ( +2, +2 to +1, -1 to -2, -2). Health groups were formed according to the Children Health Comprehensive Assessment Instruction.

Results: 484 schoolchildren (students of grades 3–11) were examined. 251 (52%) school students had regular meals at school. Regular meal frequency decreased from 69% in the group of 8–10 year old students to 30% in the group of 15–18-year-olds. Z scores of body length in students of Groups 1 and 2 did not differ (0.44 ± 1.00 and 0.30 ± 1.00, respectively; p = 0.124). At the same time, children in Group 1 had higher Z scores of BMI (0.44 ± 1.30 and 0.12 ± 1.30, respectively; p = 0.007). In Group 1, the incidence of overweight and obesity decreased from 40% in group of 8–10 year old students to 15% in 15–18-year-olds, in Group 2 — from 35 to 18%, respectively; incidence of malnutrition increased from 9 to 24% in Group 1 and from 11 to 15% in Group 2. In Group 1, the number of students with health group III or IV was smaller (30% compared to 42% in the control group; p = 0.005).

Conclusion: Regular meals at school are an important, but not critical factor in the physical development of children. The absence of regular meals at school may be a risk factor for chronic diseases in schoolchildren.

Background: The article discusses a controversial issue of time for the introduction of complementary feeding for exclusively breastfed infants.

Objective: Our aim was to determine the best time to begin complementary feeding of exclusively breastfed infants. 

Methods: Cohort observational study. We assessed actual nutrition and chemical composition of diets of infants, nalyzed anthropometric indicators, as well as clinical and biochemical parameters of blood.

Results: The study included 203 infants. 112 of these infants were breastfed up to six months of age (exclusive breastfeeding or mixed feeding with the amount of breast milk of not less than 150–200 ml) and 91 infants were bottle-fed with adapted milk formulas. More than half of breastfed infants with complementary feeding introduction time of 4 and 5 months of age — 55 (57%) and only 4 (10%) exclusively breastfed infants received all necessary complementary foods by the age of 9 months. By the age of 9 months, diets of exclusively breastfed infants were 30–35% deficient in proteins, carbohydrates and energy, and 45% deficient in fat. Introduction of complementary feeding from the 4th month, rather than from the 5th or 6th month, reduces incidence of breast feeding in children aged 9 months up to 44% (p = 0.003). In the group of infants exclusively breastfed up to 6 months of age, the lowest concentration of ferritin in serum [median 28.0 (16.4; 45.0) ng/ml] was observed in this age. In this group, infants with unbalanced diets at the age of 9 months had the ferritin concentration of 11.7 (8.4; 22.6) ng/ml.

Conclusion: The best time to begin complementary feeding of exclusively breastfed infants can be considered the age of 5 years.

Background: Comparability of the quality of medical care for children in different types of in-patient hospitals remains a subject of debate.

Objective: Our aim was to compare the quality of emergency hospital care for children with severe traumas in pediatric and non-pediatric in-patient hospitals.

Methods: Retrospective cohort (continuous) research. We analyzed medical records of intensive care patients (form 003/u) with severe traumas at the age of 1 month to 18 years hospitalized to in-patient hospitals of Rostov Oblast in 2010–2014. The quality of medical care was assessed according to duration of diagnostic maneuvers that led to the diagnosis and surgical activity (frequency of surgical interventions for the condition that led to hospitalization).

Results: We analyzed the data on 134 children with severe mechanical traumas hospitalized to pediatric (n = 29) and non-pediatric (n = 105) in-patient hospitals. Lifethreatening traumas (Pediatric Trauma Score 8 points) were recorded in 26 (90%) and 79 (75%) children, respectively (p = 0.127). The duration of the diagnosis stage in two groups was 135 (120; 160) and 140 (110, 210) minutes, respectively (p = 0.548). Surgical activity was higher in pediatric in-patient hospitals: surgical interventions were performed in 16 (55%) children compared to 37 (35%) cases in the group of children admitted to non-pediatric hospitals (p = 0.052).

Conclusion: The quality of emergency in-patient hospital care for children with severe traumas in pediatric and non-pediatric hospitals does not differ significantly.

The article describes the proposed current clinical classification of breast diseases and pathology in childhood and adolescence. The classification is based on the analysis of data obtained from the examination and follow-up monitoring of 6,126 children for up to 8 years. The clinical classification is recommended for widespread use in the work of primary care physicians who conduct follow-up monitoring. The use of this classification creates groups for referral to specialists for further examination and further treatment and follow-up monitoring. The classification is based on the separation of physiological (normal conditions) and pathological processes, as well as on temporary deviations from normal development (temporary conditions not leading to pathological processes) and anomalies in development of mammary glands and nipple-areolar complex. If any abnormalities are suspected, a patient shall be sent to a mammologist for further examination and US scanning. Control of growth and development of mammary glands in childhood and adolescence ensures early detection of abnormalities and allows necessary remedial measures to protect reproductive health.

Enteropathic acrodermatitis is a disease associated with inborn zinc metabolism disorders. It is characterized by skin lesions around natural body orifices (periorificial dermatitis) and limbs (acrodermatitis), alopecia and diarrhea. Symptoms are associated with zinc deficiency due to malabsorption of this trace element in the small intestine. The article describes a case of enteropathic acrodermatitis in a boy aged 18 months with severe skin lesions and diarrhea. The patient has two mutations in the SLC39A4 gene in a compound heterozygous state not previously described in the world literature. The effect of the zinc drug treatment was observed within a few days.

Crohn's disease is a severe relapsing disease that requires the coordinated work of doctors of various specialties — gastroenterologists, surgeons, radiologists, and endoscopists. The strategy of a multidisciplinary team is economically and clinically viable. The main principles of work in the multidisciplinary team are a recognized need and availability of specialists for each other, regular joint meetings, and presence of local standards and common approaches. The joint work of experts helps to develop an individual plan for the management of patients according to the severity and form of the disease, as well as to prevent complications and new relapses. The article presents a clinical example of the management of a patient with Crohn's disease complicated by perianal lesions. The implementation of the multidisciplinary team concept has prevented the disability of the child.

The article describes a case of late diagnosis of mucocutaneous lymphonodular syndrome (Kawasaki syndrome). At the beginning of the therapy, the child had fever, conjunctivitis, stomatitis, rash, solid swelling of hands and feet, and coronaritis with the development of aneurysms. The article describes the successful use of normal human immunoglobulin for intravenous administration at a dose of 2 g/kg body weight per course in combination with acetylsalicylic acid at the dose of 80 mg/kg per day. After 3 days of treatment, the rash disappeared; limb swelling and symptoms of conjunctivitis significantly reduced; and laboratory parameters of disease activity became normal (erythrocyte sedimentation rate, C-reactive protein concentration). After 3 months, inflammation in the coronary arteries was stopped. After 6 months, a regression of coronary artery aneurysms was recorded. No adverse effects during the immunoglobulin therapy were observed.

Behcet's disease is a type of systemic vasculitis of unknown etiology characterized by recurrent erosive and ulcerative lesions of the mucous membrane in the mouth and genitals and pathological processes in the joints, central nervous system, and gastrointestinal tract. Polysystemic clinical manifestations, relatively rare occurrence, especially in childhood, and absence of pathognomonic laboratory signs make this disease difficult to verify. The diagnosis of Behcet's disease is especially complicated in cases where the intestinal symptoms are presented as initial or predominant manifestations of the disease, because they are often erroneously regarded as inflammatory bowel diseases. It should be added that the diagnosis of Behcet's disease is based on a set of classification/diagnostic signs that can develop for 5–6 years or more. The article presents a case of juvenile Behcet's disease demonstrating the complexity of the search for diagnosis. A brief literature review discusses the current view on the problem of diagnosis, pathogenesis, clinical presentation, and treatment of the disease in pediatric practice.