The findings of investigations published between 2000 and 2016 on the study of parental interaction with children with a risk of autism spectrum disorders (ASD) were analyzed. The article demonstrates that early parent-child interaction in such families has distinctive features and can be one of the significant factors of both the risk of ASD development in children at an early age and the compensation of their manifestations. At the same time, such characteristics of the parent-child interaction as maternal sensitivity (the ability to perceive and accurately interpret the child's attachment signals and be able to respond promptly and adequately to these signals) and synchronism (the coordination of movements, actions and other time-dependent indicators; joint attention) are not early markers of ASD development in a child. The authors noted that the issues of parent-child interaction are rarely studied, and the survey samples are limited.

A calcium deficiency is detected in more than 80% of children. This is the result of inadequate consumption of milk and dairy products which are the main food sources of calcium. There is a correlation between deficiency of calcium intake with food in childhood and the risk of osteopenia and osteoporosis in subsequent life periods. With insufficient exogenous intake of calcium, its concentration in the blood decreases which stimulates bone resorption. The factors that further limit the consumption of dairy products are lactase deficiency and cow's milk protein allergy. In order to ensure the intake of the necessary amount of calcium, it is advisable to use vitaminmineral complexes in children that contain not only a sufficient amount of calcium and vitamin D but also other micronutrients required for bone formation.

Background. To assign genetically engineered biologic drugs, we need data on the predictors for response to therapy. Prognostic factors for the response to tocilizumab in patients with juvenile idiopathic arthritis (JIA) without systemic symptoms are poorly studied.

Objective. Our aim was to reveal early predictors for the response to tocilizumab therapy in patients with JIA without systemic symptoms.

Methods. A retrospective cohort study enrolled patients with JIA without systemic symptoms who received tocilizumab therapy between July 2009 and August 2017. We assessed the association between the initial demographic, clinical, and laboratory parameters in patients and the best response (according to the ACR90 criteria) to treatment after a year.

Results. The study included 95 (girls 85%) patients; the mean age was 10.3 (6.0; 13.6). During the first year of therapy, 71 (75%), 55 (58%), 38 (40%), and 22 (23%) patients achieved the improvement according to ACR30/50/70/90 criteria, respectively; 22 (23%) patients reached disease inactive stage according to the Wallace criteria. When performing multivariate analysis, the following improvement predictors were revealed based on the ACR90 criteria after a year of treatment: decrease in serum C-reactive protein level during the first month of therapy [odds ratio (OR) 1.024; 95% confidence interval (CI) 1.007–1.051], decrease in disease activity score on the visual analogue scale according to the parent/patient assessment (OR 1.048; 95% CI 1.005–1.105), early onset of the disease (OR 0.38; 95% CI 0.16–0.72), persistent oligoarthritis according to the ILAR (OR 9.9; 95% CI 1.5–109.3). During the first year of tocilizumab administration, neutropenia was registered in one patient, leukopenia — in three cases, and urticaria — in one case.

Conclusion. The variant of JIA, the age at the disease onset, and the disease course pattern in the first month of tocilizumab therapy are the predictors of treatment efficacy throughout the year.

Background. It is necessary to study the microbial spectrum of urine in order to determine the features of the urinary tract infection (UTI) course and to make the right choice of a therapeutic approach. Objective. Our aim was to study the structure of urine microflora in children with community-acquired UTI and its change in the period from 1990 to 2015.

Methods. We conducted a continuous analysis of case histories of children admitted to hospital with UTI (pyelonephritis, cystitis, non-site specific urinary tract infection) in 1990, 2000, and 2015. We studied the results of triple (in succession) urine cultures. Shedding in a concentration of ≥ 10³ cfu/ml for primary pathogens, ≥ 10³ cfu/ml in boys and ≥ 10⁴ cfu/ml in girls for secondary pathogens, ≥ 10⁵ cfu/ml for doubtful pathogens considered to be a diagnostically significant one.

Results. Members of the family Enterobacteriaceae were the main causative agents of the UTI in 1990 (found in 90.4% of 502 samples), 2000 (in 79.7% of 632 samples), and 2015 (in 67.6% of 801 samples, df = 2, p < 0.001). Escherichia coli remained the most common microorganism, the isolation rate of which decreased from 79.9% in 1990 to 39.5% in 2015 (p < 0.001). In the period from 2000 to 2015, there was a decrease in the frequency of urine detection of Enterobacter spp. (from 5.9 to 2.5%; p < 0.001) and Citrobacter spp. (from 5.2 to 1%; p < 0.001) and, on the contrary, an increase in the isolation rate of Proteus spp. (from 7.8 to 11.7%; p = 0.005), Klebsiella spp. (from 2.8 to 12.9%; p < 0.001) and Enterococcus spp. (from 1.8 to 19.1%; p < 0.001); the latter two — due to more frequent shedding in boys (by 10.5 and 19.9%, respectively).

Conclusion. The Enterobacteriaceae members, mainly E. coli and Enterococcus spp., remained the predominant UTI pathogens in children in 1990, 2000, and 2015. The isolation rate of E. coli has declined significantly in recent years, whereas that of Klebsiella spp. and Enterococcus spp. has increased.

Background. Children with infantile cerebral palsy (ICP) often have a physical developmental delay due to protein-energy malnutrition (PEM). The assessment of such abnormalities using different centile scales may lead to inconsistent results.

Objective. Our aim was to study the consistency in assessing physical development of children with ICP using regional and specialized centile scales.

Methods. The assessment of physical development with determination of the proportion of patients with PEM (weight-age and/or heightage values < 10th percentile) was carried out using regional centile scales and the Life Expectancy Project scales taking into account motor disorder levels (I–V) according to GMFCS. The assessment of motor disorders was performed by neurologists of healthcare organizations in 54 municipalities of the Sverdlovsk Region. The accounting period was from September 2016 to January 2017.

Results. According to regional centile scales, PEM was identified in 272 (35.7%) children; according to the Life Expectancy Project scales — in 56 (7.4%) out of 761 children with ICP (McNemar's criterion, p < 0.001). Using regional scales the following results were registered: children with GMFCS I had PEM 5 times less than children with GMFCS V — 10 (12.5%) and 107 (66%) cases, respectively (ꭓ² criterion, p < 0.001). When assessing physical development of children with specialized scales, PEM occurred in 4 (5%) patients with GMFCS I and 18 (11.1%) with GMFCS V (p < 0.001).

Conclusion. Specialized scales for assessing physical development less often indicate the presence of PEM in children with ICP. When using regional and to a much lesser extent specialized centile scales, the detection rate for PEM cases depends on the level of motor disorders.

Background. The prevalence of obesity in children continues to increase. The study of dietary habits of pre-school children allow to assess or establish the relationship between the dietary factor and obesity in this age group.

Objective. Our aim was to determine the relationship between dietary habits and obesity in pre-school children.

Methods. The study included pre-school children with primary exogenous obesity of the first degree and healthy children attending pre-school educational institutions. Based on the parent survey results, we determined the frequency of consumption of certain food groups, portion size (using the display material «Album of Meal and Food Portions»), the chemical composition, and energy value of diets (in the program «The Analysis of Human Nutritional Status»). The hygienic assessment of nutrition is performed in accordance with the age norms of physiological needs (NPNs) approved for the population of the Russian Federation.

Results. The energy value and content of basic macronutrients of food rations for children with obesity (n = 40) were 45–58% higher than the NPNs. In the structure of the fat component of diets for children with obesity, saturated fatty acids predominated which caloric quota was significantly higher than in healthy children (n = 40). In healthy children with a normal energy value of diets, the total fat was 12% higher and the total carbohydrates was 12% lower than the NPNs. A general negative trend in a part of excess (2.5–4.4 times higher than the NPNs) consumption of mono- and disaccharides was revealed. The study revealed that obesity was associated with frequent (> 5 times/day) consumption of bakery products [odds ratio (OR) 6.7 (95% confidence interval (CI) 2.4–18.2], confectionery products (> 3 times/day) (OR 28.8; 95% CI 7.4–111.8), and products with a high fat content (mayonnaise, cream butter, etc. > 2 times/day) (OR 10.3; 95% CI 3.7–29.0).

Conclusion. Obesity in pre-school children is associated with excessive and unbalanced nutrition with frequent consumption of bakery, confectionery, and high-fat foods.

Background. It is necessary to study the prevalence and risk factors of allergic rhinitis (AR) among pre-school children in order to develop a disease prevention strategy.

Objective. Our aim was to study the prevalence, clinical and allergological features, and risk factors for AR in pre-school children living in urban settings of the Altai Region.

Methods. At the screening stage, the study enrolled children aged 3–6 years attending pre-school educational institutions in 5 cities of the Altai Region. AR symptoms were determined using the ISAAC questionnaire. The AR was diagnosed if ≥ 2 symptoms (rhinorrhea, nasal breathing difficulty, itching in the nasal cavity, repetitive sneezing) lasted ≥ 1 h with a positive prick test and/or a blood level of specific IgE > 0.35 kU/L to at least one allergen (total 11).

Results. The prevalence of AR in urban children aged 3–6 years (n = 3,205) was 10.6%; 48% of them were previously diagnosed with AR. 85% of children had a persistent course of the disease; 69% had mild AR. Most often, there was established sensitization to house dust mites (61.6%), birch pollen (40.9%), and cat fur (19.4%). The risk factors for AR were family history of allergies [odds ratio (OR) 4.2; 95% confidence interval (CI) 3.5–5.9], masculine (OR 2.8, 95% CI 1.9–4.0), smoking parents (OR 1.8, 95% CI 1.2–2.9), nonadherence to a regimen/dosage of vitamin D3 intake in infancy (OR 1.8, 95% CI 1.2–2.8), presence of asthma-like symptoms (OR 10.2, 95% CI 7.2–14.5), and manifestations of atopic dermatitis (OR 6.0, 95% CI 4.2–8.5).

Conclusion. AR occurs in every tenth pre-school child (mainly of mild severity and persistent course), every second disease among them was diagnosed for the first time. Sensitization occurs to typical for childhood allergens. The risk factors for AR are family history of allergies, masculine, passive smoking, ignoring the recommendations of taking vitamin D3 in infancy, the presence of atopic dermatitis, and asthma-like symptoms.

Background. The early (in the first months of life) formation of atopic status and the development of allergies are not uncommon pathological conditions in a pediatrician's practice, requiring sufficiently studied and theoretically grounded measures for the organization of primary/secondary prevention.

Case Report. The parents visited a doctor with complaints of widespread skin rashes and troubled night sleep in a child from the age of two months. A burdened history of allergies of the child was traced through the female lineage (food allergy in the mother, maternal sister and grandmother). The perinatal period is complicated by acute respiratory infection in the third trimester and by maternal nutritional preferences (consumption of goat's and whole cow's milk). The delayed (on the 5th day of life) breastfeeding initiation, feeding with cow's milk-based formula, living next to an industrial enterprise, maternal choices of products with a high sensitizing potential not only during pregnancy but also during breastfeeding probably caused the early formation of atopic status — dry skin, widespread papular rash, microvesicles on the cheeks, hips, shins, scratching traces, serous-bloody crusts objectively defined at admission. The SCORAD scores corresponded to severe atopic dermatitis. The ImmunoCAP technology revealed high antibody titres to a number of products, including cow's milk and chicken egg proteins. Based on the findings, a therapeutic diet aimed at secondary prevention of allergic diseases, including respiratory allergies, was developed for the child.

Conclusion. A case of the early (from 2 months) formation of atopic status with the development of atopic dermatitis caused by polyvalent food sensitization is described. A therapeutic diet containing products with a low sensitizing potential was prescribed for the child. The suggested therapy including the diet should prevent the progression of an allergic disease.

The current knowledge of the causes and progression of epilepsy in patients with different types of mucopolysaccharidosis are presented. The article discusses the dynamics of electroencephalographic changes with age and in connection with the disease progression.

Preventive medical examinations of healthy children or mass prophylactic examinations of minors in the Russian Federation are governed by the orders of the Ministry of Health of Russia. The data on regulatory and organizational support for the prophylactic examination of healthy children is presented. The article provides a comparative analysis on the frequency of children examinations by a district pediatrician, consultations by specialty doctors as well as additional examinations in accordance with the orders of the Ministry of Health of Russia No.1346n and No.514n entered into force on January 1, 2018. The authors give comments on the proposals of MO Revnova et al. suggested in the article “Towards the Improvement of the System of Mass Prophylactic Examinations of the Child Population”.