Objectives Primary intestinal lymphangiectasia is a rare cause of protein losing enteropathy. It is usually seen in children less than 3 years of age. The disease is characterised by dilatation and engorgement of lymphatics in the small bowel due to congenital malformation of lymphatic channel or hypoplasia of lymphatics. Methods A 10 month old female child was admitted with a h/o persistent diarrhoea and generalised swelling of the body for 15 days. She was exclusively breastfed till 6 months, complementary feeding started thereafter. On examination, both eyelids were edematous with b/l pedal edema and abdominal distension. Investigations showed hypoalbuminemia, hypoproteinemia and thrombocytosis. Urine, stool examination and spot urine protein creatinine ratio were normal. USG abdomen showed mild ascites and edematous bowel loops. UGI endoscopy and biopsy showed multiple fragments of duodenal mucosa with subepithelium showing multiple dilated lymphatic spaces. The child was started on high protein, low fat diet with MCT, vitamin D, zinc and FFP transfusion. Child improved clinically with reduced edema and loose stools, hence discharged. I/v/o persistent thrombocytosis, we considered possibility of a rare syndrome, CHAPLE (Complement hyperactivation, Angiopathic Thrombosis and Protein losing enteropathy). However, CD55 level was normal and hence we also considered further evaluation for non -CHAPLE PIL but genetic work up could not be done. Results PIL should be considered as one of the differential diagnosis in a child presenting with anasarca. The main modality of treatment in our case was high protein, low fat diet and MCT supplements. Child was on regular follow up with pediatric gastroenterologist for about 3 months. Mother reported the baby had persistent loose stools and was treated at home and died before reaching a hospital. We have heard in literature about good outcomes in PIL as well as frequent relapses with chronicity. This acute life threatening event in PIL needs to be discussed regarding possibility of any thrombosis secondary to dehydration and thrombocytosis. Conclusions PIL is a rare condition seen in children less than 3 years. Early diagnosis with endoscopic visualization of the gut and biopsy of the small bowel may play a great role. Mainstay of treatment is high-protein, low fat diet with MCT supplement. Funding Sources None.

Objectives To assess the effect of maternal exposure to a specific food substance in the diet during her antenatal or postnatal period and comparing the acceptance of the same food in infant during feeding. Methods Mothers were recruited in JSS hospital, Mysuru, Karnataka when they came for antenatal visits after they have met inclusion criteria.Informed consent was signed by the mother after the study details and outcomes were explained by the principal investigator. Mothers were randomised into 3 groups: group A, group B and group C. Group A mothers were instructed to consume a diet containing 200 gm of spinach per meal 3–4 times in a week in their third trimester of pregnancy, group B mothers were instructed to consume 200 gm of spinach per meal 3–4 times in a week during the first three months immediate postnatal period and group C mothers served as controls as no dietary intervention were made. Mothers were advised regarding complementary feeding pattern to babies after 6 completed months as per IYCF guidelines .In addition, we modified the diet by introducing 30 gms of cooked spinach. The facial expression of the babies during each exposure was videotaped by the mothers which was then assessed by Neonatologist and Clinical psychologist. The principal investigator coded each video with a different assessment code and the results were analysed using Feeding infants behaviour and facial expression coding system (FIBFECS) scale.If a baby accepts the food without facial expression of distaste it is considered as ‘acceptance' in any exposure. If the baby does not accept the food, a maximum of 6 exposures on 6 different days is given .If the baby has facial expression of distaste even after 6th exposure, is accounted for as ‘unacceptance’ Results In comparision between the mothers, antenatally(gp-A) and postnatally (gp-B) with the control (gp_C), infants whose mother consumed spinach antenatally showed a higher rate of acceptance during complementary feeding with a significant p value of 0.025.Statistical analysis was done by ANOVA. Conclusions Exposure of flavours to babies antenatally or postnatally did show benefit in uptake of the food during complementary feeding. This indicates that the influence of the maternal feeding habits on the child's psychology does exists, and the idea that when the child is exposed repeatedly, the dislike to certain foods may decrease. Funding Sources None.

Objectives The thyroid hormone influences the physiological process of almost all organ systems in children .It is essential for modulation of cardiovascular, neurological, gastrointestinal and metabolic function. In children at the early ages, it influences growth, physical and neurological development. As it is a preventable cause of intellectual disability, prompt recognition and treatment of hypothyroidism is integral to optimize physical and neurodevelopmental outcome. Methods A 5 year 6 months old female child presented with history of 5 days of abdominal distension, fever and 1 episode of bloody stools. Examination showed icterus and bilateral pedal edema. Liver function test was deranged. Triglycerides and total cholesterol were elevated. Hepatitis serologies were negative. As there was no clinical improvement paediatric thyroid profile was requested which showed low T4 and significantly elevated TSH of 100 uIU/ml. Thyroid ultrasound was suggestive of thyroiditis .Anti-TPO antibodies were elevated. Treatment for Hashimoto's thyroiditis was initiated. Oral thyroxine was started at the dose of 5mcg/kg/day. The child improved symptomatically and icterus resolved. On follow up, her weight for height plotted was between −2 and −3 standard deviations and classified as moderate acute malnutrition. Diet counselling and nutritional supplements was initiated. Results Autoimmune thyroiditis is the most common cause of acquired hypothyroidism. Studies have shown thyroiditis to be linked with genetic loci such as CTLA-4, PTPN22. A goitre may not be present due to rapid immune-mediated destruction of the gland. Thyroid ultrasound is usually diagnostic. This child presented with jaundice, edema and abdominal distension. A post hepatitis sequelae was suspected but all serum markers were negative. Subsequently, hypothyroidism was diagnosed. On follow up, child was labelled as moderate acute malnutrition. This child is at risk for severe malnutrition; supplementary feeding and monitoring of growth curves should be done to ensure proper growth and development of the child. Conclusions Childhood malnutrition is a public health crisis and a major cause of mortality under five years of age. Prevention of severe malnutrition is a global health goal. In a country like India, health programmes should focus on maternal and child malnutrition. Funding Sources None.

Objectives 1. To assess whether maternal exposure to a specific food substance (spinach in our study) either antenatally or postnatally and repetitive exposure of the same in their children produces sustained acceptance of the same food. 2. To assess if the same information was dissipated among the peer groups of the mothers -Ripple effect. Methods Mothers recruited in our hospital for the randomized control trial assessing food acceptance in infants after the specific food exposure to mothers in the antenatal or postnatal period were re-enrolled in this study (following earlier study submitted to ASN). They were divided as Group A, Group B and Group C. Group A mothers were exposed to diet containing 200 grams spinach per meal 3–4 times in a week in their third trimester of pregnancy, Group B mothers were exposed to the same diet in the first three months immediate postnatal period and Group C mothers served as controls with no intervention. Informed consent was obtained from the parents and data was collected through phone calls by the principal investigator. The study was questionnaire based and focused on details of the child's diet and also assessed the ripple effect of the earlier study. Results In our study, the liking for spinach (in terms of consumption frequency of at least 3 times a week) was significantly better among children of Group A mothers 88.9%, 66.7% in children of Group B mothers compared to the control group of 27.8% with significant p-value of < 0.01. The results were similar in children of Group A and B mothers for the acceptance of other green leafy vegetables though the mothers were not exposed to the same in our previous study. Weight for age was significantly better in children of group A and group B. 44.4% of study subjects in these two groups were plotted between 50th −85th percentiles on WHO growth chart. The ease of feeding spinach and other green leafy vegetables was better in children of group A and B mothers compared to controls. 66.1% of the mothers were happy to propagate the knowledge of benefits of early exposure of specific food and better acceptance by their children to their peers (ripple effect). Conclusions Our study concludes that antenatal and postnatal exposure was beneficial. It also showed that early exposure to spinach showed ripple effect on acceptance of other green leafy vegetables in a sustained manner. Funding Sources None.