Multiple co-occurring conditions of children with feeding problems were empirically reduced to 3 patterns of comorbidities. Comorbidity patterns were largely unrelated to weight status and child or parent mealtime behavior problems. This suggests that medical and developmental conditions confer general, rather than specific, risk for feeding problems in children.

In an analysis of data from a registry of pediatric patients with CD, we found that among those with significant and progressing disease at or shortly after presentation, early surgery is difficult to prevent, even with early use of biologics. Early use of biologics (<3 mo of diagnosis) can delay later disease progression to stricturing and/or penetrating disease, but this affect could become evident only years after initial management decisions are made.

Patients with extensive disease started taking 5 mg/kg of IFX were more likely to require dose escalation compared to those with limited or moderate disease. All of the patients with moderate and extensive disease started taking 10 mg/kg of IFX remained on this dose. These results suggest that patients with more extensive disease may benefit from higher initial IFX dosing as it relates to durability of the treatment.

Healthy responses to stressors Mohammadreza Hojat, PhD Take primary responsibility for lifelong learning to improve knowledge, skills and practice performance through familiarity with general and rotations specific goals and objectives and attendance at conferences Lucian Leape, MD Participate in identifying system errors and implementing potential system solutions Lorelei Lingard, PhD Provide appropriate supervision Lorelei Lingard, PhD Self-awareness of one's own knowledge, skill, and emotional limitations that leads to appropriate helpseeking behaviors Lorelei Lingard, PhD Trustworthiness that makes colleagues feel secure when one is responsible for the care of patients Lorelei Lingard, PhD The capacity to accept that ambiguity is part of clinical medicine and to recognize the need for and to utilize appropriate resources in dealing with uncertainty Salvatore Mangione, MD Perform complete and accurate physical examinations Debra Rotor, DrPH, MPH Interview patients and families about the particulars for the medical condition for which they seek care, with specific attention to behavioral, psychosocial, environmental, and family unit correlates of disease David Stern, MD The entire professionalism competency domain Advocate for quality patient care and optimal patient care systems Rachel Yudkowsky, MD, MHPE Perform complete and accurate physical examinationsPrevious studies 9-10 have shown declination in interpersonal communication skills with advancing medical education. This may not be surprising given that the emphasis on t eaching medical interviewing skills is limited to early in the undergraduate medical education curriculum. Given that competence is a habit 11 and that skill maintenance depends on " deliberate practice" 12 , the continued focus on t hese foundational skills throughout the graduate medical education years is important. Additional ConsiderationsWhat characteristics aid a physician in becoming one who participates in education of patients and families? One study looked at characteristics, capacities, and skills that distinguish physicians as good at patient communication/education. 9 In this particular study, the term "capacities" refers to physicians' values, beliefs, and intentions concerning the patient. Thus, capacities encompass constructs such as compassion, empathy, respect, honesty, and integrity. In this study, the patients were adolescents, and the components that appear to be necessary to educate and communicate with this group of pediatric patients are empathy, nonjudgmental attitude, and self-reflection. 9 In pediatrics, physicians must utilize the principles outlined above, but they must also modify and be flexible with regard to various ages, developmental stages and literacy levels.

Constipation in otherwise healthy infants and children is a common problem despite confusion about how to precisely define constipation and constipation-related disorders. Constipation may, rarely, be a sign or symptom of a more serious disease or a diagnosis defined only by its symptoms and without any structural or biochemical findings. In the latter case it is classified as a functional gastrointestinal disorder (FGID). FGIDs are defined as disorders that cannot be explained by structural or biochemical findings. The Rome Foundation has standardized diagnostic criteria for all FGIDs. The Rome criteria are based on the available research as well as the clinical experience of the Foundation’s assembled experts. The most recent report, Rome IV, described clinical criteria and diagnostic tools and encouraged more rigorous research in the area of FGIDs. The true incidence and prevalence of constipation is difficult to know because it may be treated at home using home remedies or diagnosed at a visit to a primary care provider or to a subspecialist pediatric gastroenterologist. The most recent attempts to define the prevalence of all pediatric FGIDs have been made using the Rome IV criteria. The defined FGID entities that may be associated with the complaint of constipation are infant dyschezia, functional constipation, and nonretentive fecal incontinence. The term encopresis, omitted from Rome IV, is defined by the American Psychiatric Association (APA) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The 3 Rome-defined (constipation-related) entities and the APA entity of encopresis are the focus of this review.

Background: Entrustable professional activities (EPAs) are critical activities performed by medical professionals, which can be observed and assessed. Adding on to common EPAs for all pediatric subspecialty trainees, specialty-specific EPAs for pediatric gastroenterology, hepatology, and nutritional fellowship were developed by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) EPA Task Force. Methods: Having developed specialty-specific EPAs, building EPA assessments is the next logical step, as EPAs are included under a larger umbrella of competency-based assessment. Thus, the NASPGHAN EPA Task Force and Training Committee collaborated on an assessment tool and associated curricular resources to aid in tracking trainees’ progression to entrustment within individual EPAs and readiness for independent practice. Results: This manuscript reports the development of an EPA assessment tool, including guiding principles and the theory behind the assessment tool, with a focus on simple, meaningful assessments that can provide crucial performance feedback to trainees. In addition, curricular resources were developed, based on the assessment tool, to support training. Ultimately, it is the hope of the NASPGHAN EPA Task Force and Training Committee that this tool can aid training programs in providing formative feedback for trainees, and can be used by training programs and clinical competency committees for summative evaluation.

Pediatric feeding and swallowing disorders are common. Given the multiple and overlapping factors playing major roles in the development of normal feeding and swallowing, a multidisciplinary team approach is recommended to provide a comprehensive assessment and directed therapy. Patient care is provided in a coordinated and collaborative fashion, thus providing the most efficient and easiest access to care. In this regard, the quality of care for children with feeding and swallowing problems is improved.

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