Scientific Program

Conference Series Ltd invites all the participants across the globe to attend World Congress on Pediatric Nutrition & Child Health HOLIDAY INN PARIS - PORTE DE CLICHY 2 rue du 8 mai
Paris, France
.

Day 1 :

Keynote Forum

Alessandra Pellegrini

Alessandra Pellegrini, University of Pisa , Italy

Keynote: Post-orchiectomy active surveillance in testicular germ cells tumors in pediatric age: Which indications?

Time : 10:00 - 10:45

Conference Series Child Nutrition 2019 International Conference Keynote Speaker Alessandra Pellegrini  photo
Biography:

Alessandra Pellegrini was graduated in Pisa at the Faculty of Medicine and Surgery. She continued her training in France where she is doing specialization in General Medicine.

Abstract:

Aim of the Study: assessing the viability of post-orchiectomy active surveillance approach for testicular germ cells tumors.

Methods: we analyzed 52 patients who underwent surgery for testicular germ cell tumors from 2009 to 2014. The patients were divided by age in Group A (12 patients, age 0-14) and group B (40 patients, age 16-39). Inguinal orchiectomy was performed in all patients. Retroperitoneal lymphadenectomy was performed with orchiectomy in 4 patients (7.7%). Post-surgical management differed based on clinical stage and active surveillance or adjuvant therapy  was carried out.

Main Results: After an average 7 year follow-up, the overall survival rate is 100% and, to date, all of our patients are still alive. 2 years after surgery we recorded a total of 11 relapses (21,1%). 3 (12%) of them occurred in patients followed with active surveillance, while 8 (29,6%) of them occurred in patients who underwent active treatment.

Conclusions: we observed an excellent prognosis in both age groups and this confirms that testicular germ cell tumors are curable. We believe that active surveillance is an optimal option for tumors at Stage I, because of their low risk of relapse. However, post-surgical treatment should be taken into consideration for germ cells tumors with risk factors. 

Keynote Forum

Dilanyan Iona

Iona Dilanian, Vinnitsa National Medical University, Ukraine

Keynote: The caseof successfultreatmentof newbornwithextensiveIII degree thermal burn of the skin

Time : 11:00 - 11:45

Conference Series Child Nutrition 2019 International Conference Keynote Speaker Dilanyan Iona photo
Biography:

Dilanyan Iona has completed her PhD at the age of 35 years from Vinnitsa National Medical  University. She is the Head of Surgery of Odessa Regional Pediatric Hospital. She has published more than 25 papers in reputed Ukrainian journals. She has been study in SickKids Hospital Toronto Canada as a Physician-Observer in 2018. She is the EUPSA member.

Abstract:

The case of successful treatment in intensive care department of newborn of Odessa Regional Pediatric Hospital from 29.05.17 to 01.08.17 of the newborn with extensive thermal burn of the skin of the body and extremities is described. The baby went to the Hospital on the first day of life with contact thermal burn of the back, buttocks and extremities І-IIА-ІІB– III 40% (32%) of body surface in bad burning shock. The child passed thru the all stages of burning disease. There are 6 operations was applied in the baby. The common term of treatment in intensive care department was 56 days, 33 days from that was artificial breathing; total duration of treatment was 65 days. The child was discharged from the Hospital in good 

Keynote Forum

Chhaya Akshay Divecha

Chhaya Divecha, National University of Science and Tecnology, Oman

Keynote: Effectiveness of asthma educational intervention in improving asthma knowledge and attitudes of parents/ caregivers of asthmatic children.

Time : 11:45 - 12:30

Conference Series Child Nutrition 2019 International Conference Keynote Speaker Chhaya Akshay Divecha photo
Biography:

Chhaya Akshay Divecha has completed her Undergraduate as well as postgraduate (MD Pediatrics) from the reputed Seth G.S. Medical College & KEM Hospital at Mumbai , India.She has also obtained fellowships in Neonatal Intensive Care and Pediatric Intensive Care from the same reputed institution.She is currently assistant Professor in Pediatrics at College of Medicine, National University of Science and Technology (formerly Oman Medical College)at Sohar, Oman. She has more than 10 years of teaching experience and has published many papers in reputed journals as well as contributed to chapters in four textbooks.
 

Abstract:

Aims & Objectives: Research shows positive effects of asthma education in improving parental knowledge, self-management skills and reduced health care costs. Such studies are lacking in developing countries. We studied effectiveness of educational intervention in improving knowledge and attitudes of parents/caregivers of asthmatic children.
 
Methods: Study was conducted in Pediatric chest clinic of tertiary hospital (India) over 21 months after ethics committee approval. Recruited parents were randomized into interventional group (A) receiving education module and control standard group (B). Parents’ asthma knowledge and attitudes were assessed at baseline and 5 months post-enrollment using 25-item questionnaire. Detailed demographic data, clinical data and exacerbations during study were noted.
 
Results: 75 parents/ guardians fulfilling inclusion criteria were analyzed (cases/Group A:37 and controls/ Group B:38). 8.3% parents/caregivers were illiterate. Around 36.9% had family history of allergy/asthma. Mean scores at baseline and follow up were 8.37 and 11.06 respectively. Parents did better on knowledge items related to chronicity, family history, chronic cough, home administration of steroids in acute severe asthma and maintaining records of clinical/medications for good control. Intervention group (A) showed significant improvement in most attitude based questions post-intervention as compared to non-intervention group (B), especially in improved quality of life after inhalation therapy and improved prognosis post-childhood. There was no statistically significance in asthma severity and control between groups at follow up.
 
Conclusion: Small group education on asthma in parents/ caregivers improves their knowledge and attitudes. Health care plans should invest in pediatric asthma education and identify key personnel and opportunities in routine care to impart the same.
 

Keynote Forum

Amr Elsayed Kandil

Alexandria Pediatric Center & Gleem Pediatric Center, Alexandria, Egypt

Keynote: Pediatric Malnutrition

Time : 15:30 - 15:55

Conference Series Child Nutrition 2019 International Conference Keynote Speaker Amr Elsayed Kandil photo
Biography:

Amr Elsayed Kandil has obtained a diploma in The Professional Nutrition Specialist Program, School of Allied Health, Ashworth University, Georgia, USA. He has also completed the First and the Second Parts of Diploma in Clinical Nutrition & Metabolism, European Society for Enteral & Parenteral Nutrition & Metabolism (ESPEN). He spent one a half years working in the Pediatric Nutrition Clinic, North York General Hospital, Toronto, Canada under the supervision of Dr. Glenn Berall, Associate Professor, Pediatrics & Nutrition Sciences Departments, Faculty of Medicine, University of Toronto, Canada. He is now working as a Pediatric Nutrition Consultant, Alexandria Pediatric Center & Gleem Pediatric Center, Alexandria, Egypt
 

Abstract:

Pediatric malnutrition means the intake of calories and/or nutrients more or less than the requirements of the body. It is clinically presented in two main categories which are over-nutrition and under-nutrition. Overnutrition means the intake of calories more than the body needs. It leads to overweight and obesity which, if left untreated, may cause overweight-related diseases such as type 2 diabetes. Full medical, family and dietary history should be taken. Investigations should be done. Referral to a specialist to treat any underlying disease, Guide the parents to make their child adapts healthy options. Under-nutrition means the intake of calories and/or nutrients less than the body needs. It may cause failure to thrive which means failure to increase properly in weight and/or height. Failure to thrive includes three types which are organic, non-organic and mixed. Organic type is due to any organic disease such as celiac disease, cystic fibrosis. Non-organic type is due to wrong interactions between the caregiver and the child such as misinterpretation of hunger and satiety cues. Mixed type has both organic and non-organic elements. Failure to thrive can be diagnosed by taking full medical history, investigations for any possible organic disease and/or drug involved. Detailed dietary history should be taken. Physical examination for any signs of malnutrition, Measuring weight and height and plotting them on growth charts. Failure to thrive can be treated by treating any involved disease and making a referral if needed. Guide the parents towards the wrong behaviour, if any, and how to correct it. Any child who is malnourished or at risk should be promptly referred to a Pediatric nutrition specialist 

Keynote Forum

Nilesh Thakor

Associate Professor in Department of Community Medicine, GMERS Medical College, Vadnagar-Gujarat, India.

Keynote: Prevalence and determinants of obesity and overweight among school children of Ahmedabad city, Gujarat: A cross sectional study

Time : 15:30 - 15:55

Conference Series Child Nutrition 2019 International Conference Keynote Speaker Nilesh Thakor photo
Biography:

Nilesh Thakor has completed his MD in Community Medicine at the age of 25 years from Gujarat University, India. He is an Associate Professor in Department of Community Medicine, GMERS Medical College, Vadnagar-Gujarat, India. He has published more than 70 papers in reputed journals.
 

Abstract:

Background: Childhood obesity itself is a predictor of adult obesity and of higher than expected adult morbidity and mortality. Due to difficulty in the treatment of obesity in adults and the many long-term adverse effects of childhood obesity, prevention of childhood obesity has now been recognized as a public health priority.
 
Objective: to know the prevalence and determinants of obesity in school children of Ahmedabad city.
 
Methodology: The present cross sectional study was undertaken during July 2009 to April 2011 in randomly selected 10 schools of Ahmedabad city, Gujarat by Department of Pediatrics and Community Medicine of GMERS Medical College, Dharpur-Patan. Total 2562 children between the age group of 10 to 15 years were examined after taking written informed consent of their parents using predesigned, pre-tested, semi-structured performa. Anthropometric measurements were taken and BMI were calculated. The prevalence of overweight and obesity were determined based on the IOTF (International Obesity Task Force) criteria. Various determinants of obesity and overweight were studied by interviewing children. Thus collected data was analyzed using SPSS 17 (Trial version).
Nilesh Thakor, Pediatr Ther 2019, Volume 09 DOI: 10.4172/2161-0665-C5-094
 
Results: Out of 2562 children males were 54.09% and females were 45.9%. Prevalence of obesity and overweight was 5.62% and 9.99% respectively. Overall prevalence of obesity was more among female population (6.8%) as compared to that in males (4.62%). The  prevalence  of  obesity was  found  to  be  highest  among  15  years   age  group (8.22%). The prevalence of obesity and overweight was significantly higher amongst less active group (9.3 % and 13.95%, respectively) as compared to more active group. Prevalence of obesity and overweight was significantly higher in the group of children who spent >2 hours daily in front of television or computers. The prevalence of obesity and overweight was significantly higher amongst group of children who took daily calories above RDA (18.57% and 15.19% respectively) as compared to the other group. The prevalence of obesity and overweight was significantly higher in them (8.91% and 13.36%) as compared to those who took junk food less than or equal to 2 times per week (1.71% and 5.98% respectively). The prevalence of obesity and overweight among children having parents with history of obesity was 46.15% and 17.94%, respectively which was significantly higher than those without parental history of obesity (4.34% and 9.74%).
 
Conclusion: High prevalence of obesity and overweight in school children indicate an urgent need to increase awareness via education and motivation of all stakeholders. 

Keynote Forum

Sheryl Salis

Sheryl Salis is the Founder & Director of Nurture Health Solutions

Keynote: Medical nutrition therapy in type 1 diabetes

Time : 14:05 - 15:30

Conference Series Child Nutrition 2019 International Conference Keynote Speaker Sheryl Salis  photo
Biography:

Sheryl Salis is the Founder & Director of Nurture Health Solutions. She is a Senior Registered Clinical Dietician, Certified Diabetes Educator, Wellness Coach, Public Speaker, Lecturer, Author & Certified Insulin Pump Trainer, with a career spanning nineteen years, she has rich experience in the field of Type 1 Diabetes, Nutrition and Metabolic Disorders, and in the past has worked with leading Multinational Hospitals and Companies like Johnson & Johnson and Novo Nordisk. She is a consultant to the Juvenile Diabetes Foundation, Mumbai, India. She features as an expert Nutritionist on the Food Food Chanel. Her area of interest is Type 1 Diabetes, Insulin Pump Therapy and Carbohydrate Counting.
 

Abstract:

There is a steady rise in the number of individuals with type 1 diabetes now, previously known as Juvenile diabetes or Insulin Dependent Diabetes Mellitus (IDDM). Nutritional management is one of the cornerstones of diabetes care and education. Dietary recommendations for children with diabetes are based on healthy eating recommendations suitable for all children and adults and therefore, the entire family, A guide to the distribution of macronutrients, Carbohydrate 45% to 55% energy, Moderate sucrose intake (up to 10% total energy), Fat 30% to 35% energy, <10% saturated fat + trans fatty acids, Protein 15% to 20% energy Carbohydrate requirements in children and adolescents are individually determined based on age, gender, activity and previous intake. Clinical evidence suggests that individuals typically consume 45% to 50% energy from carbohydrate and can achieve optimal postprandial glycemic control with appropriately matched insulin to carbohydrate ratios and insulin delivery. Healthy sources of carbohydrate foods should be encouraged to minimize glycemic excursions and improve dietary quality. Addition of a moderate amount of protein to a meal containing predominantly carbohydrate can assist in reducing postprandial excursions. Substituting low-Glycemic Index (GI) for High-GI carbohydrate and increasing dietary fiber intake are other useful dietary option. Sucrose can provide up to 10% of total daily energy intake. A more flexible approach using individualized insulin to carbohydrate ratios (ICR), which enables the pre-prandial insulin dose to be matched to carbohydrate intake, should be used for children and adolescents on intensive insulin therapy. The ICR is individualized for each child according to age, sex, pubertal status, duration of diagnosis and activity. Although this method increases flexibility of the meal timing and the carbohydrate amount, mealtime routines and dietary quality remain important, for high fat and highprotein meals, combination bolus with sufficient insulin upfront to control the initial postprandial rise is needed. Pre- and post-prandial blood glucose testing at 3, 5 and 7 hours or continuous glucose monitoring systems can be useful in guiding insulin adjustments and evaluating the outcomes of changes to the insulin dose or timing
 

  • Pediatric Nutrition | Neonatal Nutrition | Child Healthcare

Chair

Mariel Poortenga

Michigan State University, USA

Speaker
Biography:

Alessandra Pellegrini was graduated in Pisa at the Faculty of Medicine and Surgery. She continued her training in France where she is doing specialization in General Medicine.

Abstract:

Aim of the Study: assessing the viability of post-orchiectomy active surveillance approach for testicular germ cells tumors.

Methods: we analyzed 52 patients who underwent surgery for testicular germ cell tumors from 2009 to 2014. The patients were divided by age in Group A (12 patients, age 0-14) and group B (40 patients, age 16-39). Inguinal orchiectomy was performed in all patients. Retroperitoneal lymphadenectomy was performed with orchiectomy in 4 patients (7.7%). Post-surgical management differed based on clinical stage and active surveillance or adjuvant therapy  was carried out.

Main Results: After an average 7 year follow-up, the overall survival rate is 100% and, to date, all of our patients are still alive. 2 years after surgery we recorded a total of 11 relapses (21,1%). 3 (12%) of them occurred in patients followed with active surveillance, while 8 (29,6%) of them occurred in patients who underwent active treatment.

Conclusions: we observed an excellent prognosis in both age groups and this confirms that testicular germ cell tumors are curable. We believe that active surveillance is an optimal option for tumors at Stage I, because of their low risk of relapse. However, post-surgical treatment should be taken into consideration for germ cells tumors with risk factors. 

Dilanyan Iona

Iona Dilanian, Vinnitsa National Medical University, Ukraine

Title: The caseof successfultreatmentof newbornwithextensiveIII degree thermal burn of the skin
Speaker
Biography:

Dilanyan Iona has completed her PhD at the age of 35 years from Vinnitsa National Medical  University. She is the Head of Surgery of Odessa Regional Pediatric Hospital. She has published more than 25 papers in reputed Ukrainian journals. She has been study in SickKids Hospital Toronto Canada as a Physician-Observer in 2018. She is the EUPSA member.

Abstract:

The case of successful treatment in intensive care department of newborn of Odessa Regional Pediatric Hospital from 29.05.17 to 01.08.17 of the newborn with extensive thermal burn of the skin of the body and extremities is described. The baby went to the Hospital on the first day of life with contact thermal burn of the back, buttocks and extremities І-IIА-ІІB– III 40% (32%) of body surface in bad burning shock. The child passed thru the all stages of burning disease. There are 6 operations was applied in the baby. The common term of treatment in intensive care department was 56 days, 33 days from that was artificial breathing; total duration of treatment was 65 days. The child was discharged from the Hospital in good 

Speaker
Biography:

Chhaya Akshay Divecha has completed her Undergraduate as well as postgraduate (MD Pediatrics) from the reputed Seth G.S. Medical College & KEM Hospital at Mumbai , India.She has also obtained fellowships in Neonatal Intensive Care and Pediatric Intensive Care from the same reputed institution.She is currently assistant Professor in Pediatrics at College of Medicine, National University of Science and Technology (formerly Oman Medical College)at Sohar, Oman. She has more than 10 years of teaching experience and has published many papers in reputed journals as well as contributed to chapters in four textbooks.

Abstract:

Aims & Objectives: Research shows positive effects of asthma education in improving parental knowledge, self-management skills and reduced health care costs. Such studies are lacking in developing countries. We studied effectiveness of educational intervention in improving knowledge and attitudes of parents/caregivers of asthmatic children.
 
Methods: Study was conducted in Pediatric chest clinic of tertiary hospital (India) over 21 months after ethics committee approval. Recruited parents were randomized into interventional group (A) receiving education module and control standard group (B). Parents’ asthma knowledge and attitudes were assessed at baseline and 5 months post-enrollment using 25-item questionnaire. Detailed demographic data, clinical data and exacerbations during study were noted.
 
Results: 75 parents/ guardians fulfilling inclusion criteria were analyzed (cases/Group A:37 and controls/ Group B:38). 8.3% parents/caregivers were illiterate. Around 36.9% had family history of allergy/asthma. Mean scores at baseline and follow up were 8.37 and 11.06 respectively. Parents did better on knowledge items related to chronicity, family history, chronic cough, home administration of steroids in acute severe asthma and maintaining records of clinical/medications for good control. Intervention group (A) showed significant improvement in most attitude based questions post-intervention as compared to non-intervention group (B), especially in improved quality of life after inhalation therapy and improved prognosis post-childhood. There was no statistically significance in asthma severity and control between groups at follow up.
 
Conclusion: Small group education on asthma in parents/ caregivers improves their knowledge and attitudes. Health care plans should invest in pediatric asthma education and identify key personnel and opportunities in routine care to impart the same.

Amr Elsayed Kandil

Alexandria Pediatric Center & Gleem Pediatric Center, Alexandria, Egypt

Title: Pediatric Malnutrition
Speaker
Biography:

Amr Elsayed Kandil has obtained a diploma in The Professional Nutrition Specialist Program, School of Allied Health, Ashworth University, Georgia, USA. He has also completed the First and the Second Parts of Diploma in Clinical Nutrition & Metabolism, European Society for Enteral & Parenteral Nutrition & Metabolism (ESPEN). He spent one a half years working in the Pediatric Nutrition Clinic, North York General Hospital, Toronto, Canada under the supervision of Dr. Glenn Berall, Associate Professor, Pediatrics & Nutrition Sciences Departments, Faculty of Medicine, University of Toronto, Canada. He is now working as a Pediatric Nutrition Consultant, Alexandria Pediatric Center & Gleem Pediatric Center, Alexandria, Egypt

Abstract:

Pediatric malnutrition means the intake of calories and/or nutrients more or less than the requirements of the body. It is clinically presented in two main categories which are over-nutrition and under-nutrition. Overnutrition means the intake of calories more than the body needs. It leads to overweight and obesity which, if left untreated, may cause overweight-related diseases such as type 2 diabetes. Full medical, family and dietary history should be taken. Investigations should be done. Referral to a specialist to treat any underlying disease, Guide the parents to make their child adapts healthy options. Under-nutrition means the intake of calories and/or nutrients less than the body needs. It may cause failure to thrive which means failure to increase properly in weight and/or height. Failure to thrive includes three types which are organic, non-organic and mixed. Organic type is due to any organic disease such as celiac disease, cystic fibrosis. Non-organic type is due to wrong interactions between the caregiver and the child such as misinterpretation of hunger and satiety cues. Mixed type has both organic and non-organic elements. Failure to thrive can be diagnosed by taking full medical history, investigations for any possible organic disease and/or drug involved. Detailed dietary history should be taken. Physical examination for any signs of malnutrition, Measuring weight and height and plotting them on growth charts. Failure to thrive can be treated by treating any involved disease and making a referral if needed. Guide the parents towards the wrong behaviour, if any, and how to correct it. Any child who is malnourished or at risk should be promptly referred to a Pediatric nutrition specialist

Nilesh Thakor

Associate Professor in Department of Community Medicine, GMERS Medical College, Vadnagar-Gujarat, India.

Title: Prevalence and determinants of obesity and overweight among school children of Ahmedabad city, Gujarat: A cross sectional study
Biography:

Nilesh Thakor has completed his MD in Community Medicine at the age of 25 years from Gujarat University, India. He is an Associate Professor in Department of Community Medicine, GMERS Medical College, Vadnagar-Gujarat, India. He has published more than 70 papers in reputed journals.

Abstract:

Background: Childhood obesity itself is a predictor of adult obesity and of higher than expected adult morbidity and mortality. Due to difficulty in the treatment of obesity in adults and the many long-term adverse effects of childhood obesity, prevention of childhood obesity has now been recognized as a public health priority.
 
Objective: to know the prevalence and determinants of obesity in school children of Ahmedabad city.
 
Methodology: The present cross sectional study was undertaken during July 2009 to April 2011 in randomly selected 10 schools of Ahmedabad city, Gujarat by Department of Pediatrics and Community Medicine of GMERS Medical College, Dharpur-Patan. Total 2562 children between the age group of 10 to 15 years were examined after taking written informed consent of their parents using predesigned, pre-tested, semi-structured performa. Anthropometric measurements were taken and BMI were calculated. The prevalence of overweight and obesity were determined based on the IOTF (International Obesity Task Force) criteria. Various determinants of obesity and overweight were studied by interviewing children. Thus collected data was analyzed using SPSS 17 (Trial version).
Nilesh Thakor, Pediatr Ther 2019, Volume 09 DOI: 10.4172/2161-0665-C5-094
 
Results: Out of 2562 children males were 54.09% and females were 45.9%. Prevalence of obesity and overweight was 5.62% and 9.99% respectively. Overall prevalence of obesity was more among female population (6.8%) as compared to that in males (4.62%). The  prevalence  of  obesity was  found  to  be  highest  among  15  years   age  group (8.22%). The prevalence of obesity and overweight was significantly higher amongst less active group (9.3 % and 13.95%, respectively) as compared to more active group. Prevalence of obesity and overweight was significantly higher in the group of children who spent >2 hours daily in front of television or computers. The prevalence of obesity and overweight was significantly higher amongst group of children who took daily calories above RDA (18.57% and 15.19% respectively) as compared to the other group. The prevalence of obesity and overweight was significantly higher in them (8.91% and 13.36%) as compared to those who took junk food less than or equal to 2 times per week (1.71% and 5.98% respectively). The prevalence of obesity and overweight among children having parents with history of obesity was 46.15% and 17.94%, respectively which was significantly higher than those without parental history of obesity (4.34% and 9.74%).
 
Conclusion: High prevalence of obesity and overweight in school children indicate an urgent need to increase awareness via education and motivation of all stakeholders. 

Sheryl Salis

Sheryl Salis is the Founder & Director of Nurture Health Solutions

Title: Medical nutrition therapy in type 1 diabetes
Speaker
Biography:

Sheryl Salis is the Founder & Director of Nurture Health Solutions. She is a Senior Registered Clinical Dietician, Certified Diabetes Educator, Wellness Coach, Public Speaker, Lecturer, Author & Certified Insulin Pump Trainer, with a career spanning nineteen years, she has rich experience in the field of Type 1 Diabetes, Nutrition and Metabolic Disorders, and in the past has worked with leading Multinational Hospitals and Companies like Johnson & Johnson and Novo Nordisk. She is a consultant to the Juvenile Diabetes Foundation, Mumbai, India. She features as an expert Nutritionist on the Food Food Chanel. Her area of interest is Type 1 Diabetes, Insulin Pump Therapy and Carbohydrate Counting.

Abstract:

There is a steady rise in the number of individuals with type 1 diabetes now, previously known as Juvenile diabetes or Insulin Dependent Diabetes Mellitus (IDDM). Nutritional management is one of the cornerstones of diabetes care and education. Dietary recommendations for children with diabetes are based on healthy eating recommendations suitable for all children and adults and therefore, the entire family, A guide to the distribution of macronutrients, Carbohydrate 45% to 55% energy, Moderate sucrose intake (up to 10% total energy), Fat 30% to 35% energy, <10% saturated fat + trans fatty acids, Protein 15% to 20% energy Carbohydrate requirements in children and adolescents are individually determined based on age, gender, activity and previous intake. Clinical evidence suggests that individuals typically consume 45% to 50% energy from carbohydrate and can achieve optimal postprandial glycemic control with appropriately matched insulin to carbohydrate ratios and insulin delivery. Healthy sources of carbohydrate foods should be encouraged to minimize glycemic excursions and improve dietary quality. Addition of a moderate amount of protein to a meal containing predominantly carbohydrate can assist in reducing postprandial excursions. Substituting low-Glycemic Index (GI) for High-GI carbohydrate and increasing dietary fiber intake are other useful dietary option. Sucrose can provide up to 10% of total daily energy intake. A more flexible approach using individualized insulin to carbohydrate ratios (ICR), which enables the pre-prandial insulin dose to be matched to carbohydrate intake, should be used for children and adolescents on intensive insulin therapy. The ICR is individualized for each child according to age, sex, pubertal status, duration of diagnosis and activity. Although this method increases flexibility of the meal timing and the carbohydrate amount, mealtime routines and dietary quality remain important, for high fat and highprotein meals, combination bolus with sufficient insulin upfront to control the initial postprandial rise is needed. Pre- and post-prandial blood glucose testing at 3, 5 and 7 hours or continuous glucose monitoring systems can be useful in guiding insulin adjustments and evaluating the outcomes of changes to the insulin dose or timing