Treatment Approach For Children Research Articles

Pediatric Migraine Prescription Patterns at a Large Academic Hospital

BackgroundHere we report the prescription patterns by drug type, age, and sex of patients at a large academic pediatric hospital. Because there are few guidelines based on outcome studies in pediatric migraine, physician treatment approaches in children vary. MethodsUsing the i2b2 query tool, we determined that over an approximately 4 year period, 4839 patients between the ages of 2 and 17 years were observed at Boston Children's Hospital for migraine with or without aura, 59% women and 41% men. ResultsThe most common medications prescribed to this population were sumatriptan, amitriptyline, topiramate, ondansetron, and cyproheptadine. ConclusionsOur findings support recent data regarding choices of medication in the pediatric population and additionally support current studies and future investigation into controlled trials in the pediatric population.

An intervention approach for children with Autism: Aquatherapy

Otistik bozukluk, yasamin ilk uc yilinda ortaya cikan, iletisim ve sosyal etkilesim sorunlari, sinirli/yinelenen ilgi ve davranislarla karakterize bir gelisimsel bozukluktur. Otistik bozukluk teshis olcutu, duyu, algi ve motor becerileri kapsayan sinirliliklar icermemesine ragmen yapilan calismalar ve gozlemler, otistik bozukluk tanisi almis bazi cocuklarin motor gelisiminde gecikmeler, fiziksel performans ve aktivite duzeylerinde dusukluk, duyusal uyarilara tepki sureclerinde otistik bozukluk gostermeyen cocuklara gore farkliliklar bulundugunu gostermistir. Alanyazinda, su ici etkinlikler cocuklarda fiziksel performansi arttirma, duyusal tepkileri duzenleme ve sosyal etkilesimi saglamada bir mudahale yaklasimi olarak kullanilmaktadir. Ancak, bu yararli etkilere ragmen, otistik bozukluk gosteren cocuklarda su ici etkinliklere yeterince yer verilmemekte ve uygulanmasi konusunda aileler, ogretmenler ve diger uzmanlarca bazi sorunlar yasandigi gozlenmektedir. Bu calisma; otistik bozukluk gosteren cocuklarda su ici etkinliklerin yararlari, yapilacak uyarlamalar ve izlenmesi gereken yaklasimlar, farkli yas gruplarinda yapilabilecek su ici etkinlik ve oyunlar ve etkinlik sirasinda alinmasi gereken onlemler uzerine odaklasmaktadir.

An intervention approach for children with Autism: Aquatherapy

Autistic disorder, a developmental disorder that appears during the first three years of life and is characterized by communication problems, social interaction deficits and repetitive/ restricted interests and behaviors. Although a diagnosis criterion of autistic disorders does not involve restrictions to cover sensory, perception, and motor skills, studies and observations indicated that some of the children with autistic disorder had delay for motor development, lower in physical performance and activity level, and differences in response process to the sensory stimulus than children without autistic disorder. Aquatherapy is utilized to improve physical performance, regulate to sensory stimulus, and providing social integration as intervention for children in literature. However, although these useful effects, aquatherapy not supplied enough to children with autistic disorder, and it is observed that family, teachers and other specialists have some difficulties about performing it. This study focuses on the usefulness of the aquatherapy, adopted measures and teaching strategies, examples of aquatic program and plays for different age groups and safety issues during activities.

Underlying mechanisms of writing difficulties among children with Neurofibromatosis type 1

Writing is a complex activity in which lower-level perceptual-motor processes and higher-level cognitive processes continuously interact. Preliminary evidence suggests that writing difficulties are common to children with Neurofibromatosis type 1 (NF1). The aim of this study was to compare the performance of children with and without NF1 in lower (visual perception, motor coordination and visual-motor integration) and higher processes (verbal and performance intelligence, visual spatial organization and visual memory) required for intact writing; and to identify the components that predict the written product's spatial arrangement and content among children with NF1. Thirty children with NF1 (ages 8-16) and 30 typically developing children matched by gender and age were tested, using standardized assessments. Children with NF1 had a significantly inferior performance in comparison to control children, on all tests that measured lower and higher level processes. The cognitive planning skill was found as a predictor of the written product's spatial arrangement. The verbal intelligence predicted the written content level. Results suggest that high level processes underlie the poor quality of writing product in children with NF1. Treatment approaches for children with NF1 must include detailed assessments of cognitive planning and language skills.

First experience of a single-stage simultaneous single access endoscopic surgery in a child with a disorder of sex development

A clinical case and treatment of a disorder of sex development (46XX, ovotesticular type) who underwent a simultaneous surgery including diagnostic laparoscopy using the single access endoscopic surgery followed by gonadectomy and the single-stage feminizing genitoplasty, is described. Endocrinology service needs for determination of treatment approach in children with disorders of sex development are closely entwined with capabilities of endoscopic surgery, particularly laparoscopy. It’s necessary to quickly determine the gonadal structure due to the high risk of malignancies while examining these patients. The most useful method is the direct visualization of the gonads in the abdominal cavity by laparoscopy. In these cases the single access endoscopic surgery technique reduces the trauma and is welcomed in pediatrics. From our point of view, the preference for the patients with disorders of sex development management with expected gonadal dysgenesis must be given to a single access endoscopic surgery.

Adults with Autism Spectrum Disorders

In the decades since autism was first formally described in the 1940s, there have been major advances in research relating to diagnosis, causation, and treatment approaches for children with this condition. However, research into prognosis, outcomes, or effective interventions for adults with autism spectrum disorders (ASDs) is much more limited. In this paper, we review studies of outcome in adulthood. The findings indicate that, as adults, many people with ASD, including those of normal IQ, are significantly disadvantaged regarding employment, social relationships, physical and mental health, and quality of life. Support to facilitate integration within the wider society is frequently lacking, and there has been almost no research into ways of developing more effective intervention programs for adults. Moreover, most of the research on outcome has involved relatively young people in their 20s and 30s-much less is known about outcomes for people with ASD as they reach mid-late adulthood. Systematic follow-up studies from childhood through adulthood are needed if we are to gain a better understanding of trajectories of development over the lifespan, to identify the factors that influence prognosis, and to determine how these factors exert their effects and how they may be modified to ensure a better future.

Análisis crítico de un artículo: antibióticos en otitis media aguda, ¿son necesarios?, ¿existe algún subgrupo que se beneficia?

Background: Acute otitis media (AOM) is one of the most common diseases in early infancy and childhood. Antibiotic use for AOM varies from 56% in the Netherlands to 95% in the USA and Australia. Objectives: To assess the effects of antibiotics for children with AOM. Search strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2008, issue 2) which contains the Acute Respiratory Infections (ARI) Group's Specialized Register; MEDLINE (1966 to June week 4 2008); OLDMEDLINE (1958 to 1965); EMBASE (January 1990 to July 2008); and Current Contents (1966 to July 2008). Selection criteria: Randomised controlled trials comparing 1) antimicrobial drugs with placebo 2) immediate antibiotic treatment with observational treatment approaches in children with AOM. Data collection and analysis: Three review authors independently assessed trial quality and extracted data. Main results: We found 10 trials (2928 children) from high income countries with low risk of bias. Pain was not reduced by antibiotics at24 hours, but was at two to seven days, (relative risk (RR) 0.72; 95% confidence interval 0.62 to 0.83). However four trials (1271 children) comparing antibiotics prescribed immediately rather than initial observation found no difference at three to seven days. Antibiotics did not reduce tympanometry, perforation or recurrence. The only case of mastoiditis was in an antibiotic treated child. Vomiting, diarrhoea or rash was higher in children taking antibiotics (RR 1.37; 95% CI 1.09 to 1.76). Individual patient data meta-analysis of a subset of the included trials found antibiotics to be most beneficial in children: aged less than two; with bilateral AOM and with both AOM and otorrhoea. Authors' conclusions: Antibiotics slightly reduce the number of children with acute middle ear infection experiencing pain after a few days. However, most (78%) settle spontaneously in this time, meaning 16 children must be treated to prevent one suffering ear pain. This benefit must be weighed against the possible harms: 1 in 24 children experience symptoms caused by antibiotics. Antibiotics are most useful in children under two years of age, with bilateral AOM, and with both AOM and discharging ears. For most other children with mild disease, an expectant observational approach seems justified. We have no data on populations with higher risks of complications.

A randomized control trial of interventions in school-aged children with auditory processing disorders

Objective: The primary purpose of the study was to compare intervention approaches for children with auditory processing disorder (APD): bottom-up training including activities focused on auditory perception, discrimination, and phonological awareness, and top-down training including a range of language activities. Another purpose was to determine the benefits of personal FM systems. Design: The study is a randomized control trial where participants were allocated to groups receiving one of the two interventions, with and without personal FM, or to the no intervention group. The six-week intervention included weekly one-hour sessions with a therapist in the clinic, plus 1–2 hours per week of parent-directed homework. Study sample: 55 children (7 to 13 years) with APD participated in the study. Intervention outcomes included reading, language, and auditory processing. Results: Positive outcomes were observed for both training approaches and personal FM systems on several measures. Pre-intervention nonverbal IQ, age, and severity of APD did not influence outcomes. Performance of control group participants did not change when retested after the intervention period. Conclusions: Both intervention approaches were beneficial and there were additional benefits with the use of personal FM. Positive results were not limited to the areas specifically targeted by the interventions.

Multimodality treatment approach in children with cerebral arteriovenous malformation—a survey in the Danish population

Arteriovenous malformations are not a common disease in childhood. A national survey was conducted to reveal the Danish incidence of the disease, presentation, choice of treatment, and outcome. Forty patients were admitted to any of the five neurosurgical centers during the years 2000-2008. A retrospective survey was conducted using hospital records. Twenty-three males and 17 females presented with AVM with a mean age of 11.3 (1 month-18 years). The incidence was found to be 0.4/100,000. Early fatal outcome was seen in three patients. Treatment was surgery (12), endovascular (5), radiosurgery (6), or a combination of the above (10). Four patients were treated conservatively. Complications of the treatment were seen in 27%. Occlusion rate was 74%. Good or excellent outcome was seen in 65%. A national survey may give a lower rate of success than in the specialized centers accepting patients more eligible for treatment. Still, the low number of children could call for centralization and collaboration in this population.

Treatment approaches in children with steroid sensitive nephrotic syndrome

Pediatric nephrotic syndrome (NS) is a chronic glomeruslar disorder, and if untreated, is associated with increased risk of life-threatening infectious, thromboembolism, lipid abnormalities, and malnutrition. The aim of the managesment of NS in children is to induce and maintain comsplete remission with resolution of proteinuria and edema without encountering serious adverse effects of therapy. Over 90% of cases in children with idiopathic NS and a majority of them will respond to steroid therapy. However, a substantial number of patients relapse frequently and become steroid dependent. The occurrence of frequent relapses necessitates clear therapeutic strategies in orsder to maintain sustained remission and minimize steroid toxicity. Numerous therapeutic regimens have been prosposed utilizing steroid sparing agents such as alkylating agents, principally, cyclophosphamide and chlorambucil, calcineurin inhibitors namely cyclosporin A and an immusnomodulatory drug, levamisole, with variable success and associated side-effects. Recently, mycophenolate mofetil (MMF), tacrolimus, the anti-CD20 antibody, rituximab, have emerged as new therapeutic options for the mansagement of steroid dependent NS in a few uncontrolled clinical trials. It is therefore important that the benefits and risks of these agents are weighed before considering their use in the treatment of patients with NS.

Responses to childhood trauma: An international perspective

Children throughout the world are exposed to traumatic events such as sexual or physical abuse, severe accidents, cancer or other life threatening illness, natural or man-made disasters, war, terrorism, the sudden death of a parent or close friend or relative, among other things. Recently, natural disasters have caused property damage and loss of life in locations throughout the world. This special issue summarizes interventions that have been used in the aftermath of traumatic events in diverse locations throughout the world. These include Greece (earthquakes, fires, and the H1N1 virus outbreak), Indonesia (earthquake), China (earthquake), Sri Lanka (tsunami), and the United States (hurricanes). In addition, a general discussion of empirically-based treatment approaches for children is provided. The amount and severity of childhood trauma is an issue that should concern school psychologists across the globe and the importance of including a diverse global perspective in designing and implementing interventions is stressed.

Retrospective Approach to Methylenetetrahydrofolate Reductase Mutations in Children

Methylenetetrahydrofolate reductase reduces methyltetrahydrofolate, a cosubstrate in the remethylation of homocysteine, from methylenetetrahydrofolate. Congenital defects, hematologic tumors, and intrauterine growth retardation can occur during childhood. This study evaluated clinical and laboratory treatment approaches in children diagnosed with methylenetetrahydrofolate reductase mutations. Our group included 23 boys and 14 girls, aged 103.4 ± 70.8 months S.D. Clinical findings of patients and homocysteine, vitamin B12, folate, hemogram, electroencephalography, cranial magnetic resonance imaging, and echocardiography data were evaluated in terms of treatment approach. Our patients' findings included vitamin B12 at 400.4 ± 224.6 pg/mL S.D. (normal range, 300-700 pg/mL), folate at 10.1 ± 4.5 ng/mL S.D. (normal range, 1.8-9 ng/mL), and homocysteine at 8.4 ± 4.7 μmol/L S.D. (normal range, 5.5-17 μmol/L). Eighty-eight percent of patients demonstrated clinical findings. In comparisons involving categorical variables between groups, χ(2) tests were used. No relationship was evident between mutation type, laboratory data, and clinical severity. All mothers who had MTHFR mutations and had babies with sacral dimples had taken folate supplements during pregnancy. To avoid the risk of neural tube defects, pregnant women with a MTHFR mutation may require higher than normally recommended doses of folic acid supplementation for optimum health.

Context therapy: a new intervention approach for children with cerebral palsy

To describe the development of context therapy, a new intervention approach designed for a randomized controlled trial. Therapists were trained to change task and environmental factors to achieve parent-identified functional goals for children with cerebral palsy. Therapists did not provide any remediation strategies to change the abilities of the child. Theoretical constructs were developed using dynamic systems theory and the principles of family-centered care. A primary therapist model was used. A three-step intervention strategy was developed. Therapists adhered to the treatment protocol. Parents participated in the development of both functional goals and intervention strategies. A therapy approach focusing on changing the task and the environment rather than children's impairments can be a viable treatment strategy and merits further investigation. The detailed description of the context therapy approach allows replication by both researchers and clinicians. Such intervention descriptions are an important methodological consideration in rehabilitation research.

(A130) Advantages of Apparatus of External Fixation in Severe Injuries of Extremities in Children

PurposeTo study advantages of external fixation in severe injuries of extremities in children.Material and Method305 children at the age from 3 to 17 years with polytrauma (ISS > 18) were studied. From them skeletal injuries took place in 198 patients, cranioskeletal trauma - 125, multiple bone fractures - 56, bone fractures + visceral trauma - 24. 44 children had open bone fractures or fractures accompained with vast defects of soft tissues. Operative interventions in polytrauma are divided into urgent, elective and delayded. Urgent intervention (according to vital indications) are conducted together with anti-shock therapy in massive blood losses (injury of spleen, liver), crushing of lungs, cardiac tamponade, intracranial compression. Elective interventions are prformed after stabilization of patient's state and after bringing him out of shock.ResultsSets for external fixation were used in acute period of trauma, in early and late posttraumatic period. Tipe of sets depended on character of injury and followed steps of treatment. Indications for external fixation in acute period and catabolic phase of traumatic disease were: 1. multiple fragmental fractures, 2. defects of bones, 3. vast defects of soft tissues, 4. long bone fractures accompained with severe brain trauma. Indications for external fixation in late period were mulunion, in postpond – ununion, deformations and shortening of extremities.ConclusionThe usage of external fixation was an effective approach in treatment of children with severe complicated injuries of extremities. Advantages of external fixation in conditions of polytrauma were undiscutable: management in force effects, absence of secondary dislocations, good conditions for debridment and follow restorative treatment, mobility of patients.

Hypnotherapeutische Behandlungsansätze bei funktionellen Bauchschmerzen im Kindes- und Jugendalter

Functional abdominal pain significantly impairs day-to-day function. It is one of the most frequent somatic complaints among children and adolescents. For most of those affected, despite some indication of their possible presence, physiological factors fail to explain the symptoms adequately. The increased level of psychological symptoms suggests that the focus should be on behavioural and psychological aspects. Brief hypnotherapeutic treatment methods show encouraging results. A review of the current literature; potential mechanisms of effective intervention and their practical applicability are discussed.

An investigation of the factors affecting handwriting skill in children with hemiplegic cerebral palsy*

Purpose. This study investigated the effects of sensory-perceptual-motor and cognitive functions on handwriting skill in primary-school children with left-hemiplegic cerebral palsy, compared with that of their healthy peers.Methods. The study included 26 children aged 8–12 years with left hemiplegic cerebral palsy and 32 typically developing children of similar age with dominant right hand. The Minnesota Handwriting Assessment was used to evaluate handwriting skill. The Bruininks–Oseretsky Test of Motor Proficiency was used to assess motor performance. Cognitive function was assessed by the Lowenstein Occupational Therapy Cognitive Assessment. The Ayres Southern California Sensory Integration Tests were used to assess visual perception, kinaesthesia and graphesthesia.Results. Statistically significant differences were found between the two groups in sensory-perceptual-motor and cognitive function and handwriting skill (p < 0.05). There were also significant correlations between handwriting parameters and upper-extremity speed and dexterity, proprioception, bilateral coordination, visual and spatial perception and, visual-motor organisation in children with cerebral palsy (p < 0.05).Conclusions. The results showed that left-hemiplegic children with cerebral palsy whose right sides were dominant were significantly less competent at handwriting than their right-dominant, healthy peers. It was found that the impairment in proprioception seen in the non-hemiplegic side in children with cerebral palsy, and also the impairment in bilateral coordination, speed and dexterity of the upper extremities, visual and spatial perception, visual-motor organization, and tactile-sensory impairments negatively affected their handwriting skills. In the treatment approaches for children with hemiplegic cerebral palsy, comprehensive sensory-perceptual-motor assessments that involve both extremities must be performed in detail at the earliest possible stage, in order to minimize the existing problems with early-treatment policies. Developing the sensory-perceptual-motor and cognitive function of hemiplegic children would thus be possible, and they would be able to develop handwriting skill as a tool for their academic lives as healthy peers.

Primary ciliary dyskinesia: a consensus statement on diagnostic and treatment approaches in children

Primary ciliary dyskinesia (PCD) is associated with abnormal ciliary structure and function, which results in retention of mucus and bacteria in the respiratory tract, leading to chronic oto-sino-pulmonary disease, situs abnormalities and abnormal sperm motility. The diagnosis of PCD requires the presence of the characteristic clinical phenotype and either specific ultrastructural ciliary defects identified by transmission electron microscopy or evidence of abnormal ciliary function. Although the management of children affected with PCD remains uncertain and evidence is limited, it remains important to follow-up these patients with an adequate and shared care system in order to prevent future lung damage. This European Respiratory Society consensus statement on the management of children with PCD formulates recommendations regarding diagnostic and therapeutic approaches in order to permit a more accurate approach in these patients. Large well-designed randomised controlled trials, with clear description of patients, are required in order to improve these recommendations on diagnostic and treatment approaches in this disease.

Multimodality treatment of cerebral AVMs in children: a single-centre 20 years experience

The purpose of this study was to review our experience with a multimodality treatment approach in the management of cerebral arteriovenous malformation (AVM) in children. We retrospectively analysed a consecutive series of 56 children who harboured a cerebral AVM and were treated at our institution between 1988 and 2008. During the whole treatment period, a combined treatment strategy, including microsurgery, endovascular treatment and gamma knife radiosurgery, was used. Of the 56 patients (median age, 14.0; range, 3 months-18 years) reported, 36 (64.3%) were admitted after AVM rupture; of these, only one AVM (1.8%) was considered untreatable. In 30.9% (17/55) of the treated patients, a single treatment measure was sufficient to attain angiographic cure of the AVM. Among these, six patients (10.9%) had microsurgical AVM resection, four patients (7.3%) underwent endovascular treatment, and another seven patients (12.7%) underwent radiosurgical management of the AVM. The majority of the population (38/55; 69.1%) underwent combined treatment: 21 patients (38.2%) received embolisation followed by radiosurgery of the remnant nidus, ten patients (18.2%) underwent embolisation with subsequent surgical resection of the residual AVM, three patients (5.5%) had radiosurgery after incomplete surgical AVM nidus resection and another four patients (7.3%) required a combination of all three treatment modalities to achieve permanent angiographic cure of the AVM. We observed good clinical outcomes (Glasgow Outcome Scale 5 and 4) in 94.6% of the children. Complete angiographic obliteration was achieved in 93.3% of the patients treated. A multimodality treatment approach in children harbouring cerebral AVMs leads to excellent angiographic and clinical outcomes.

Pediatric Constraint-Induced Movement Therapy: A Promising Intervention for Childhood Hemiparesis

Experimental and clinical evidence is accumulating that supports the assertion that the damaged human brain is capable of responding to sensory stimulation in a sufficient manner to result in sustainable and useful benefits. The intensity and duration of therapeutic maneuvers that elicit improvement are under active investigation. Recent studies in animals, adults, and children with hemiparesis have shown that constraint of the less involved upper limb coupled with a behavioral program that repetitively encourages graded unilateral movements can result in long-term “new” functional activities. Constraint-induced movement therapy (CIMT) is a promising approach for treatment of children with stroke-related hemiparesis from either prenatal or postnatal causes due to the enhanced neuroplasticity of the brain during early life.

Vitiligo: Treatment Approach in Children

CME Educational Objectives 1. Describe the psychosocial impact of vitiligo in the pediatric population. 2. Identify current treatment options for pediatric vitiligo. 3. Explain the indications for referral of a child with vitiligo to a dermatologist.