Avoidant/restrictive food intake disorder (ARFID) in children causes emotional, psychosocial, and nutritional impairments that significantly affect families. While there is some evidence exploring parental experiences of ARFID, the perspectives of fathers remain underrepresented. Understanding the distinct roles and challenges faced by fathers is essential for to better understand what support may be required to ensuring a holistic, family-centred approach to care. The aim of this scoping review was to explore fathers’ experiences and role when supporting a child with ARFID in mealtimes and feeding. Following the PRISMA-ScR framework, a comprehensive search strategy was developed with an information specialist. Relevant qualitative and quantitative studies were identified, screened, and charted. Data were synthesised using content analysis to capture recurring themes. Of 174 records identified, 146 were screened, seven full texts reviewed, and five studies included. Three overarching themes were identified: (i) the psychological and emotional impact of ARFID (ii) societal expectations and (iii) communication and connection. This scoping review highlights that fathers play an active role in mealtimes and care for children with ARFID, yet their experiences remain underexplored. Evidence indicates high levels of stress and depression among fathers, whose voices are often unheard despite the positive impact of their involvement on patient outcomes. Traditional qualitative approaches may be insufficient to capture paternal perspectives, underscoring the need for more creative and inclusive research methods to ensure fathers are recognised as integral partners in the care of children with ARFID.

BACKGROUND:Immunonutrition examines how diet influences immune development. Complementary feeding represents a critical window for long-term health. We aimed to map evidence linking complementary feeding to immune outcomes, allergy, infection, and growth in infants and toddlers (≤ 3 years). We conducted a scoping review and evidence-gap mapping, following PRISMA-ScR. MEDLINE and Epistemonikos were searched from inception to November 2024. Concepts included diet diversity/patterns, feeding practices/models, and timing of allergen introduction, timing of complementary feeding, macronutrients, micronutrients, foods, supplementation, and ultra-processed foods. We included systematic reviews and recent primary studies meeting criteria. RESULTS:From 13,512 records screened, 108 systematic reviews were included, comprising 99 randomized controlled trials, 41 cohorts, 22 case-control, and 14 cross-sectional studies. Most reviews addressed nutrient intake, supplementation, or timing of allergen introduction, while fewer reviews explored diet diversity, foods, or ultra-processed food intake. Responsive complementary feeding was consistently associated with healthier growth and lower obesity risk, whereas restrictive practices showed adverse effects. Greater diet diversity was linked to reduced asthma and food allergy risk, though eczema findings were inconsistent. Western-style diets high in processed foods, fat, sugar, and meat correlated with higher allergy risk, while home-prepared diets were protective. Micronutrient supplementation (iron, zinc, vitamin D) reduced infection and anemia risk but had mixed effects on allergy. Early allergen introduction reduced food allergy incidence. CONCLUSIONS:Complementary feeding research now extends beyond calorie counting, macronutrients, and early allergen introduction to dietary patterns and early life nutrition that supports the microbiome. Evidence supports dietary diversity, timely food allergen introduction, and responsive feeding, while discouraging restrictive practices and ultra-processed foods. Future work should harmonize definitions and investigate plant-based diets, advanced glycation end products, and processed food exposures.

Background/Objectives: Cow’s milk allergy (CMA) is one of the most frequent food allergies in early childhood, yet its diagnosis remains a challenge. The Parent-Specific Cow’s Milk-Related Symptom Score (Pre-CoMiSS™) was developed in 2024 to assist parents in tracking possible cow’s milk-related symptoms in their infants. The aim of this qualitative study was to explore users’ experience with the Pre-CoMiSS™ tool, learn from their experience and identify areas for improvement. Methods: Participants were parents of infants aged up to 12 months who felt that their babies were experiencing possible feeding-related symptoms. Participants were selected from a local panel of potential parents in the UK and Sweden. Forty-five-minute interviews, led by experienced qualitative research moderators, were conducted using dedicated discussion guides and a frame-by-frame PDF version of the Pre-CoMiSS™ tool. Thematic analysis of the data was undertaken. Results: A total of 20 parents participated, 10 from the UK and 10 from Sweden. The Pre-CoMiSS™ tool was well received by parents from both countries. Parents found the tool’s results clear, useful, and easy to understand. However, some parents, especially from Sweden, expressed the need for additional guidance on next steps. Conclusions: Parents found the Pre-CoMiSS™ tool acceptable and easy to use, although some requested clearer guidance on next steps. These findings support further refinement and formal validation before clinical implementation.

Admissions to a paediatric intensive care unit (PICU) have increased by 15% in the last ten years. Most children admitted to PICU will require organ support, which may involve respiratory, cardiovascular or renal support. During this period, the majority will require enteral or parenteral nutrition (PN). As such, it is important to ensure optimal nutritional support from admission to discharge based on anthropometrical and biochemical parameters, clinical assessment and previous dietary intake. Nutrition assessment should include: Anthropometry, Biochemistry, Clinical, Dietary and Evaluation (ABCDE). Undernutrition in critically ill children is common, impacting morbidity, late mortality and length of PICU stay. Nutrition guidelines, including feeding protocols and paediatric dietetic care plans, significantly improve nutrition intake in some critically ill children, although they are of limited benefit in children with congenital heart disease.

Cow's milk allergy (CMA) remains one of the most common food allergies in infancy, requiring the avoidance of cow's milk and its derivatives. Breast milk is the best source of nutrition for infants. For those infants with CMA whose mothers are unable to breastfeed or choose not to, extensively hydrolysed formulas (eHFs) are widely recommended as first-line milk substitutes, whereas hydrolysed rice formulas (HRFs) are increasingly recognised as a viable alternative. This concept paper provides a healthcare professional (HCP) perspective on HRF, drawing on expert consensus from two meetings convened in 2025. Discussions noted the long history of safe and effective HRF use in Europe, its nutritional adequacy, and the evolving international guidelines supporting HRF as an alternative first-line option. A key meeting outcome was the development of a practical decision tree to help UK clinicians decide when HRF should be the preferred choice. Key considerations for its use in non-breastfed infants include the following: parental/caregiver stress related to persistent symptoms; ongoing symptoms despite multiple interventions; cultural and lifestyle choices; religious dietary requirements; and specialists' recommendations. Secondary considerations highlighted by HCPs include the following: proven reactions whilst infants are breast-milk-fed together with parental request for formula; faltering growth; multiple symptoms; taste acceptance (older infants); and parental preference based on experience. The role of functional components, such as prebiotics and human milk oligosaccharides (HMOs), was noted in regard to the emerging evidence of benefits to the microbiome and immune development. The experts emphasised the importance of engaging HCPs across all levels of CMA care and addressing challenges in translating current guidance into treatment practice. It was concluded that, overall, HRF represents a nutritionally complete, plant-based alternative that has been shown to be well tolerated (taste, symptoms) in clinical studies. It can be used to broaden therapeutic options for infants with CMA in the UK who are not exclusively fed breast milk.

BACKGROUND:Parents frequently consult health care professionals because of infant regurgitation, crying and stool consistency. OBJECTIVE:The Cow's Milk-related Symptom Score (CoMiSSTM) is an awareness tool for cow's milk allergy. We aimed to characterize the distribution of CoMiSS items in presumed healthy infants and developed centiles with these data. METHODS:Data from 2500 infants (median age 5.3 months [Q1-Q3: 2.6-8.8]) across 10 countries were analyzed by pooling individual-level data. RESULTS:Age distribution differed between countries (p < 0.001). Median (Q1; Q3) and mean (SD) total CoMiSS were 4 (2; 6) and 4 (2.6), respectively. Overall CoMiSS <10 was observed in 99%. Crying >3 hours/day occurred in 6.1% at 1-2 months, 4% between birth and 4 months, and <1.5% thereafter. Regurgitating > 5x/day occurred in 7-11% during the first 7 months (peak at 1-4 months: 16-17%) and decreased to <2-4% thereafter. Stool consistency accounted for 93.9% of the score. Atopic dermatitis and respiratory symptom scores are very low. CONCLUSIONS:CoMiSS is stable across age, with transiently higher crying and regurgitation scores below 4 months. CoMiSS ≥10 is uncommon in healthy infants. Age-specific CoMiSS centile charts provide a framework for interpreting common infant symptoms and identifying values warranting further evaluation. IMPACT:These data report on the prevalence of common manifestations in healthy infants and inform about normality according to age and different regions. Crying or distress and regurgitation scores are transiently more frequent during the first 4 months of life. Eczema and respiratory symptoms are seldom reported in presumed healthy infants. While caregivers and health care professionals consider regurgitation and crying or distress up to a certain limit as normal, atopic dermatitis and respiratory symptoms are not. These age-specific centile charts provide information on common infant symptoms and identify conditions that may warrant further evaluation.

Cow’s milk allergy (CMA) is one of the most common food allergies in infancy, with a prevalence of up to 7.5%. However, accurate diagnosis in primary care remains difficult due to overlapping symptoms with common infant behaviours and limited access to specialist allergy testing. Consequently, CMA is frequently over diagnosed, leading to unnecessary elimination diets, nutritional deficiencies, and increased parental anxiety. This paper introduces the EATERS-X framework, an enhanced, structured approach to obtaining an allergy-focused clinical history (AFCH) that aims to improve diagnostic precision and clinical decision-making in CMA. The tool expands upon the traditional EATERS method—comprising Environment, Allergen, Timing, Exposure, Reproducibility, and Symptoms—by incorporating an additional element, X, denoting treatment and healthcare response. Through clinical scenarios, we demonstrate how EATERS-X can be applied to distinguish between IgE-mediated, non-IgE-mediated, and mixed-type CMA, including subtypes such as food protein-induced enterocolitis syndrome (FPIES). While EATERS-X provides a practical and systematic framework for history-taking, its effectiveness is dependent on clinician training and appropriate clinical interpretation. In addition, the framework has not yet undergone formal validation against gold-standard diagnostic tests such as oral food challenges. Future prospective studies should evaluate the diagnostic reliability, inter-observer consistency, and clinical impact of EATERS-X across different healthcare settings. Integration of the EATERS-X approach in primary care aligns with current BSACI and EAACI guidelines and promotes structured, evidence-based, and patient-centred care. Future research should focus on validating the framework’s diagnostic reliability and exploring its applicability across a wider spectrum of allergic conditions.

The spectrum of non-IgE mediated conditions includes well-defined conditions like Food Protein-Induced Enterocolitis Syndrome (FPIES), Eosinophilic Oesophagitis (EoE), Food Protein-Induced Enteropathy, and Food Protein-Induced Allergic Proctocolitis, but also the more controversial food protein-induced dysmotility disorders like food protein-induced gastroesophageal reflux disease (FPGORD) and food protein-induced constipation (FPC). Typically, non-IgE mediated reactions are delayed, with symptom onset from hours to days after exposure to a culprit food. The diagnosis is mostly clinical, and food elimination followed by reintroduction is the primary diagnostic method. Apart from EoE, the diagnosis of these conditions remains challenging, and there is a need to develop specific diagnostic tests. Acute FPIES presents with distinct symptoms, but misdiagnosis is common due to poor recognition. In contrast, some presentations, particularly FPGORD and FPC, overlap with the common, often benign disorders of gut-brain interaction, previously known as functional gastrointestinal disorders. This raises concerns about overdiagnosis and can lead to an unnecessary restrictive diet in infants and breastfeeding mothers. A systematic approach to an elimination diet and the support of a registered dietitian/nutritionist are recommended to ensure nutritional adequacy, suitable alternatives, promote timely introductions when appropriate, support breastfeeding where required as well as prevent nutritional deficiencies and feeding difficulties. This publication aims to provide an update on the spectrum of non-IgE-mediated food allergic conditions and intends to provide clinicians with practical guidance on the diagnosis and management of each condition. The authors acknowledge the need for further research in a range of areas to inform best evidence-based practice.

The term "feeding difficulties" (FD) encompasses a range of phenotypes characterized by inadequate food intake and/or inappropriate eating habits for a given age. Eosinophilic esophagitis (EoE) is a chronic, immune-mediated condition often affecting children. It leads to esophageal dysmotility, potentially impacting feeding/eating. However, little is known regarding the true prevalence of feeding/eating difficulties in children with EoE. The main objective of this systematic review was to address this knowledge gap and determine the impact of FD in children with EoE. We searched eight international databases for all published studies from inception until March 2024. All publications were screened against pre-defined eligibility criteria and critically appraised by established instruments. The substantial heterogeneity of included studies precluded meta-analyses, so a narrative synthesis of quantitative data was performed. A total of 3442 abstracts were assessed, 29 underwent full-text screening. Ten studies met eligibility criteria and were analyzed. Across these, 18 different terms to define FD and 6 diagnostic tools were used. All included papers reported quantitative data on the FD prevalence in children with EoE, ranging from 13% to 75.3%. Concomitant IgE food sensitization/allergy was common (26.2%-88%) but its impact on FD occurrence was unclear. The current literature suggests that FD is prevalent among children with EoE, particularly those with associated IgE-mediated food allergies. However, the heterogeneity of terminologies and diagnostic tools makes drawing conclusions challenging, as it might have impacted outcomes. Further research and guidance on the diagnosis and management of FD in children with EoE are needed to appropriately identify and manage such patients.

Cow's milk allergy (CMA) remains one of the most common and complex paediatric food allergies. In the last decade, our understanding has advanced in terms of immunoglobulin E (IgE)-mediated CMA and focus is now also paid to non-IgE-mediated CMA, particularly in some Western countries where incidence rates are high. We have had significant progress in the last 10 years in relation to our understanding of existing supportive tests for IgE-mediated CMA, with the advancement of newer tests, such as the basophil activation test (BAT), which have shown great promise. However, little advancement has been made in terms of tests for non-IgE-mediated CMA, and controversy still exists around symptoms. Our understanding of the natural history of CMA has also advanced with more awareness of different phenotypes. While the mainstay of management remains cow's milk elimination, the importance of supporting breastfeeding and avoidance of unwarranted cow's milk elimination diets in breastfeeding mothers has been highlighted. For non-breastfed children, there has been some advancement in the formulas offered for the management of CMA, including the recognition of hydrolysed rice-based formulas and increased demand for nutritionally complete plant-based options, some of which are currently being assessed. The addition of pro, pre and synbiotics is considered safe to use, although research and guidance on routine use remain absent. Knowledge of tolerance induction from studies on the early introduction of peanuts has also highlighted the importance of a more active approach to managing CMA with the use of milk ladders, primarily in non-IgE-mediated CMA and baked milk (BM) introduction in IgE-mediated CMA. In addition, modulation of the microbiome and diet diversity during complementary feeding has been a major advancement in the last 10 years. While data on poor growth and feeding difficulties in children with CMA has not changed much, increased rates of obesity are now also reported. Finally, novel approaches, including oral immunotherapy, the use of milk ladders and earlier consideration of BM, have advanced somewhat in the last decade, although the risks and benefits of these novel approaches require further research. While CMA remains a complicated allergy to diagnose and manage, the evolution of science has advanced our knowledge and brought some novel innovations, which combined have enhanced our practice.

AIM:Different scientific societies published guidelines and recommendations on the diagnosis, treatment and prevention of cow's milk allergy (CMA). We aimed to compare the guidelines of the European Society of Gastroenterology, Hepatology and Nutrition (ESPGHAN) with the practices of Flemish paediatricians. METHODS:During 2023, 73 statements of the ESPGHAN CMA-position paper were submitted to 50 Flemish general paediatricians, who voted on these statements with the same methodology. If more than 25% of the paediatricians disagreed with the statements approved by ESPGHAN, the statements were considered 'rejected'. RESULTS:The applicability of guidelines might be limited since Flemish paediatricians rejected 25/73 (34%) of the statements endorsed in the ESPGHAN manuscript. CONCLUSION:The opinions of general paediatricians and ESPGHAN authors regarding the diagnosis, management and prevention of CMA differ substantially. Further research should investigate if this is due to lack of knowledge and comprehension of the available information, due to lack of applicability or application of the recommendations.

Healthcare organisations in the United Kingdom must comply with national standards for food and drink, including sustainable sourcing and minimisation, mitigation and management of food waste. Despite this, an estimated one in six plates of food served in hospitals are wasted daily, producing 12% of the UK food waste, equating to 6% of carbon dioxide emissions (CO2e) nationally, and a waste-management cost of £230m per annum. Within healthcare there is a move towards the implementation of “plant-based diets by default” to reduce the environmental impact, improve nutritional outcomes, and reduce costs. However, plant-based diets are often perceived as being difficult to prepare by caterers, less enjoyable and may result in more food waste. We conducted a scoping review to examine the influence of the social, medical, and physical environment on food intake during inpatient admission to a mental health hospital. Fourteen-studies were included. We identified five critical knowledge areas: i) food and socio-cultural environment, ii) evidence-based measures and strategies to reduce food waste, iii) economic food environment, iv) inevitability of weight gain and v) applications of theoretical models for behaviour-change. Future research should explore the development of a behaviour-change framework inclusive of training, education, and goal setting component for staff, patients, and visitors.

Background/Objectives: Worldwide, an estimated 20-30% of infants suffer from infant colic (IC), with excessive crying and unsettled behavior, during the first three months of life. These infants are often referred for a medical evaluation, but the pathogenesis of IC remains poorly understood. The aim of this narrative review is to critically appraise the available literature regarding the relation between IC and cow's milk allergy (CMA). Methods: A literature search using the search strings cow's milk allergy [MeSH Terms] OR food allergy [MesH Terms] AND colic [MeSH Terms] OR crying [MeSH Terms], limited to the English language, from inception to 15 June 2025, resulted in the identification of 135 articles. Of these, 18 clinical trials assessed the effect of a cow's milk elimination diet on IC. Results: The role of CMA in IC in the absence of other allergic manifestations remains uncertain. However, when standard treatment of infant colic has failed and when other allergic symptoms are present, CMA may be considered. A diagnostic elimination diet which includes a 2-4-week trial of maternal cow's milk elimination in breastfed infants or an extensively hydrolyzed cow's milk or hydrolyzed rice formula should be performed. If the elimination diet results in a significant decrease in symptoms, reintroduction of cow's milk protein into the diet is mandatory to fulfill the diagnostic criteria of CMA. Conclusions: Considering the limited current evidence, future research should prioritize large well-designed clinical trials with a focus on investigating CMA in colicky breastfed and formula-fed infants.

Undernutrition is defined as “a condition resulting from imbalanced nutrition or abnormal utilization of nutrients.” In this paper, the term malnutrition is used to refer to undernutrition. Malnutrition may be driven by poor socioeconomic conditions or by disease, and it is estimated that disease-related malnutrition (DRM) impacts up to 28% of hospitalized children in Europe. Malnutrition results in alterations in gastrointestinal function that lead to malabsorption of macro- and micro-nutrients. It can lead to altered gut motility and a deficiency of stomach acid, which can result in intestinal colonization by pathogens, causing diarrhoea and high burdens of intestinal infection. The presence of compromised gastrointestinal function in children with DRM is critical as it negatively impacts the efficacy of nutritional support and recovery. When choosing novel strategies and nutritional therapies for malnourished children, consideration should be given to gut-protective interventions that promote better treatment tolerance. When breastmilk is unavailable, whole protein feeds are currently considered as first-line treatment for malnutrition in children with a normal functioning gastrointestinal tract. However, peptide-based feeds have been associated with improved gastrointestinal tolerance and absorption, reduced diarrhoea, reduced inflammation, improved growth and have restored gut integrity compared with free amino acid and whole-protein feeds. At a recent meeting, experts in this area have identified significant research gaps in the literature on peptide-based feeds in children and possible gaps in clinical practice. Whilst the group acknowledges that further work is needed, this paper provides an overview on this topic to further drive research in this area.