Child Complainants Research Articles

Psychosocial interventions for recurrent abdominal pain in childhood.

This review supersedes the original Cochrane review first published in 2008 (Huertas-Ceballos 2008).Between 4% and 25% of school-aged children complain of recurrent abdominal pain (RAP) severe enough to interfere with their daily activities. No organic cause for this pain can be found on physical examination or investigation for the majority of such children. Although many children are managed by reassurance and simple measures, a large range of psychosocial interventions involving cognitive and behavioural components have been recommended. To determine the effectiveness of psychosocial interventions for reducing pain in school-aged children with RAP. In June 2016 we searched CENTRAL, MEDLINE, Embase, eight other databases, and two trials registers. We also searched the references of identified studies and relevant reviews. Randomised controlled trials comparing psychosocial therapies with usual care, active control, or wait-list control for children and adolescents (aged 5 to 18 years) with RAP or an abdominal pain-related functional gastrointestinal disorder defined by the Rome III criteria were eligible for inclusion. We used standard methodological procedures expected by Cochrane. Five review authors independently selected studies, assessed them for risk of bias, and extracted relevant data. We also assessed the quality of the evidence using the GRADE approach. This review includes 18 randomised controlled trials (14 new to this version), reported in 26 papers, involving 928 children and adolescents with RAP between the ages of 6 and 18 years. The interventions were classified into four types of psychosocial therapy: cognitive behavioural therapy (CBT), hypnotherapy (including guided imagery), yoga, and written self-disclosure. The studies were carried out in the USA, Australia, Canada, the Netherlands, Germany, and Brazil. The majority of the studies were small and short term; only two studies included more than 100 participants, and only five studies had follow-up assessments beyond six months. Small sample sizes and the degree of assessed risk of performance and detection bias in many studies led to the overall quality of the evidence being rated as low to very low for all outcomes.For CBT compared to control, we found evidence of treatment success postintervention (odds ratio (OR) 5.67, 95% confidence interval (CI) 1.18 to 27.32; Z = 2.16; P = 0.03; 4 studies; 175 children; very low-quality evidence), but no evidence of treatment success at medium-term follow-up (OR 3.08, 95% CI 0.93 to 10.16; Z = 1.85; P = 0.06; 3 studies; 139 children; low-quality evidence) or long-term follow-up (OR 1.29, 95% CI 0.50 to 3.33; Z = 0.53; P = 0.60; 2 studies; 120 children; low-quality evidence). We found no evidence of effects of intervention on pain intensity scores measured postintervention (standardised mean difference (SMD) -0.33, 95% CI -0.74 to 0.08; 7 studies; 405 children; low-quality evidence), or at medium-term follow-up (SMD -0.32, 95% CI -0.85 to 0.20; 4 studies; 301 children; low-quality evidence).For hypnotherapy (including studies of guided imagery) compared to control, we found evidence of greater treatment success postintervention (OR 6.78, 95% CI 2.41 to 19.07; Z = 3.63; P = 0.0003; 4 studies; 146 children; low-quality evidence) as well as reductions in pain intensity (SMD -1.01, 95% CI -1.41 to -0.61; Z = 4.97; P < 0.00001; 4 studies; 146 children; low-quality evidence) and pain frequency (SMD -1.28, 95% CI -1.84 to -0.72; Z = 4.48; P < 0.00001; 4 studies; 146 children; low-quality evidence). The only study of long-term effect reported continued benefit of hypnotherapy compared to usual care after five years, with 68% reporting treatment success compared to 20% of controls (P = 0.005).For yoga therapy compared to control, we found no evidence of effectiveness on pain intensity reduction postintervention (SMD -0.31, 95% CI -0.67 to 0.05; Z = 1.69; P = 0.09; 3 studies; 122 children; low-quality evidence).The single study of written self-disclosure therapy reported no benefit for pain.There was no evidence of effect from the pooled analyses for any type of intervention on the secondary outcomes of school performance, social or psychological functioning, and quality of daily life.There were no adverse effects for any of the interventions reported. The data from trials to date provide some evidence for beneficial effects of CBT and hypnotherapy in reducing pain in the short term in children and adolescents presenting with RAP. There was no evidence for the effectiveness of yoga therapy or written self-disclosure therapy. There were insufficient data to explore effects of treatment by RAP subtype.Higher-quality, longer-duration trials are needed to fully investigate the effectiveness of psychosocial interventions. Identifying the active components of the interventions and establishing whether benefits are sustained in the long term are areas of priority. Future research studies would benefit from employing active control groups to help minimise potential bias from wait-list control designs and to help account for therapist and intervention time.

Kids complain – do companies respond?

Purpose Most of the research on children’s consumer behavior focuses on pre-purchase processes, with brand choice typically being the last stage investigated. This paper aims to examine the outcome of children’s purchase decisions, with an emphasis on dissatisfaction and outcome resolution. Of particular interest was the comprehension level of the corporate communication and the extent to which clear, understandable communication influenced children’s ultimate satisfaction. Design/methodology/approach Eighty-seven children wrote authentic letters of complaint to manufacturers about a recent product purchase. The study examined what happened after the children complained – i.e. how companies responded to children, and how satisfied children were with the resolution and the overall complaint handling process. Two widely regarded readability formulas were used to measure the complexity of the written correspondence. Findings The present study suggests that child complainants are the most concerned with the bottom-line results of their communication efforts. Like adults, they want the problem corrected. Unfortunately, the majority of children did not feel fully satisfied with the corporate complaint handling process. Over one-third of the companies in the sample did not even bother to respond to children’s legitimate complaints, despite the fact that each child specifically asked the company to write back. Those firms which did were more likely to respond with a letter only than with a letter plus add-on. And the corporate letters, by and large, were written at an educational level which would preclude full understanding by the child. Research limitations/implications Because consumer complaint behavior is not randomly distributed in the population, the use of probability sampling was precluded. Published studies which have used consumer complaint letters as the data collection method have relied primarily on convenience sampling. In the present study, judgmental sampling was used to select children participants. Three criteria were applied. Children had to be aged between 10 and 13 years. Children had to have experienced dissatisfaction with a product purchase made over the previous six months. Children could not have taken any public action to resolve their dissatisfaction. But they had to be willing to write a letter of complaint at this point. It was considered of utmost importance that the letters used in this study be authentic. They had to be composed and penned by the children themselves. This criterion, coupled with the fact that the complaints were legitimate, avoided the obvious ethical dilemma associated with the use of fabricated letters. Practical implications It seems ironic that in the present era of consumer consciousness, corporations do not place greater emphasis on truly communicating with their customers, where communication is viewed as a process of establishing shared meaning. How can there be shared meaning when the message sender fails to consider the characteristics of the receiver – characteristics such as age and cognitive development? Businesses may argue that their corporate communication policies and practices are based on a concern for cost efficiency. This argument carries little merit, unfortunately. Even the federal government, through the Plain Writing Act of 2010, acknowledges the importance of using common, everyday words and plain English in all written documents. Social implications On the surface, American businesses state that they welcome customer feedback. The comments of children are more sought after now than ever before, particularly in the area of advertising and new product development. But the results of this study show that companies have a long way to go before they can claim to be truly receiver-oriented in their managerial communication policies. Perhaps this is why consumers – certainly child consumers – are only beginning to believe that when kids complain, companies will respond. Originality/value The vast body of complaint research focuses almost exclusively on adults. Despite their sophistication and marketing literacy, children are not miniature adults. It is not known whether the same models and findings with respect to adult complaint behavior apply to children. Unfortunately, there are very few studies of children’s complaint behavior and corporate responses.

Syndrome de vasoconstriction cérébrale réversible : une cause de céphalée en coup de tonnerre peu connue chez l’enfant

Reversible cerebral vasoconstriction syndrome (RCVS) is characterized by thunderclap headaches with diffuse segmental constriction of cerebral arteries that resolves spontaneously within 3 months. We report on a case of a 13-year-old boy presenting with acute severe headaches, triggered by physical exertion. His past medical history was uneventful. Moderate headache persisted between exacerbations for 4 weeks. He secondarily presented with signs of intracranial hypertension. Brain magnetic resonance angiography (MRA) revealed multifocal narrowing of the cerebral arteries. A glucocorticoid treatment was started based on the hypothesis of primary angiitis of the CNS. The symptoms rapidly improved, and repeat angiography at 3 months showed no vasoconstriction. Although pediatric cases are rare, RCVS should be considered in a child complaining of severe headache, especially after the use of vasoactive drugs or after Valsalva manoeuvres. RCVS is attributed to a transient, reversible dysregulation of cerebral vascular tone, which leads to multifocal arterial constriction and dilation. Physical examination, laboratory values, and initial cranial computed tomography are unremarkable, except when RCVS is associated with complications. Thunderclap headaches tend to resolve and then recur over a 1- to 4-week period, often with a milder baseline headache persisting between acute exacerbations. Angiography shows segmental narrowing and dilatation of one or more arteries, like a string of beads. Despite the absence of a proven treatment, important steps should be taken during the acute phase: removal of precipitants such as vasoactive substances, giving the patient rest, lowering blood pressure, and controlling seizures. Drugs targeted at vasospasms, such as calcium channel inhibitors, can be considered when cerebral vasoconstriction has been assessed. In most patients, the RCVS symptoms resolve spontaneously within days or weeks. Ischemic and hemorrhagic stroke are the major complications of the syndrome. A diagnosis of RCVS can only be confirmed when the reversibility of the vasoconstriction is assessed.

Professionals’ Perspectives about the Challenges of Using Interpreters in Child Sexual Abuse Interviews

Interpreters play a crucial role in many investigative interviews with child complainants of sexual abuse; however, little has been written about the interpreting process from the perspective of the interviewers. This study elicited interviewers’ perspectives about the challenges of using interpreters, with the aim of understanding how investigative interviews could be improved. The participants consisted of 21 investigative interviewers and prosecutors of child abuse cases (from a range of jurisdictions) who use interpreters on a regular basis. Thematic analysis of semi-structured interviews with the professionals about the interpreting process revealed two main challenges particular to child abuse interviews, namely the interpreters’ lack of preparedness to deal with the traumatic and sensitive nature of children's abuse histories, and an insufficient understanding of ‘best-practice’ child interview process. The recommendations focus on the need for more specialised training for, and screening of, interpreters, and more extensive use of pre-conferencing to familiarise children with the interpreter-mediated interview process.

Prosecutors’ reflections on sexually abused preschoolers and their ability to stand trial

Child sexual abuse (CSA) cases are notoriously difficult to investigate, and less than 10% of cases are prosecuted. We aimed to investigate prosecutors’ experiences of preparing for and prosecuting suspected CSA cases with preschool aged victims. Nine specialized child prosecutors (6 women, 3 men) took part either in individual interviews or in focus groups on this subject. The transcripts were analyzed thematically. The prosecutors said that children's testimony was sometimes held to an adult standard and that child complainants who expressed emotion could be perceived as more credible than their less expressive counterparts. CSA victims were identified as vulnerable victims who had difficulty telling their stories. Some of the interviewers were described as lacking in the ability to approach these children. The results imply that the reliability and credibility of sexually abused preschoolers and their testimony might be influenced by a number of verbal and non-verbal factors and that there are several obstacles preventing prosecutors from prosecuting these cases.

Identifying the characteristics of child sexual abuse cases that exit the criminal justice system before the forensic interview

Most child sexual abuse cases do not result in conviction; rather, they result in attrition at an earlier point in the system. Although research has looked at case characteristics associated with attrition at later stages of the system (i.e. the laying of charges and prosecution stages), to date, no research has studied the case characteristics associated with attrition as soon as a report has been made to authorities. The aim of this study was to determine the case characteristics (child complainant, suspect and additional case characteristics) associated with attrition when a case first enters the criminal justice system before a forensic interview is conducted. All child sexual abuse incidents reported to police in one jurisdiction of Australia in 2011 were examined. Three case characteristics were found to predict attrition: previous disclosure, abuse frequency and the child complainant’s age. Specifically, cases were more likely to result in attrition when the child had not previously disclosed the abuse to an adult, the abuse was a single incident rather than repeated, and a curvilinear relationship was found for child age. Cases involving children aged 7–12 years were less likely to result in attrition than cases involving younger (0–6 years) and older (13–15 years) children. This information should assist professionals and researchers in developing interventions to reduce the attrition when necessary during this early stage of the criminal justice system.

We are here because my child complained of being dizzy

This is a complaint often heard by primary health care providers. Just how often children complain of being dizzy or having balance problems is not clearly known. There are many possible etiologies for this set of symptoms, but estimates on which ones are most common are not available.The study by Li et al in this issue of The Journal provides a national estimate of the prevalence of dizziness and balance problems (DzBP) in 13- to 17-year-old children. Risk factors include older age, being a female, or non-Hispanic White. Headache/migraine, otitis media, and seizures were often associated with DzBP.Overall, only 36% of these children were seen by a healthcare professional and 29.9% received treatment. Of those describing their DzBP as moderate or “big,” 71.6% were seen and 62.4% received treatment. Almost 49% of children were told that their DzBP was due to “other” unspecified causes.The complaint of DzBP is common but more research is needed so that healthcare providers can be more effective in diagnosing and appropriately treating children with this complaint.Article page 240▶ This is a complaint often heard by primary health care providers. Just how often children complain of being dizzy or having balance problems is not clearly known. There are many possible etiologies for this set of symptoms, but estimates on which ones are most common are not available. The study by Li et al in this issue of The Journal provides a national estimate of the prevalence of dizziness and balance problems (DzBP) in 13- to 17-year-old children. Risk factors include older age, being a female, or non-Hispanic White. Headache/migraine, otitis media, and seizures were often associated with DzBP. Overall, only 36% of these children were seen by a healthcare professional and 29.9% received treatment. Of those describing their DzBP as moderate or “big,” 71.6% were seen and 62.4% received treatment. Almost 49% of children were told that their DzBP was due to “other” unspecified causes. The complaint of DzBP is common but more research is needed so that healthcare providers can be more effective in diagnosing and appropriately treating children with this complaint. Article page 240▶ Epidemiology of Dizziness and Balance Problems in Children in the United States: A Population-Based StudyThe Journal of PediatricsVol. 171PreviewTo study national prevalence of dizziness and balance problems in US children and explore associated risk factors and patterns of healthcare utilization. Full-Text PDF

Where There's Smoke, There's Fire: the Effect of Truncated Testimony on Juror Decision-making.

In countries that allow child complainants of abuse to present their direct evidence via pre-recorded videotape, the recording is sometimes truncated for relevance or admissibility purposes before it is presented to the jury. In two experiments, we investigated how this practice affects mock jurors' judgments of child credibility and defendant culpability when truncation omitted the child's less plausible allegations. Mock jurors read a transcript of a 6-year-old girl making an abuse allegation against the janitor at her school. Some jurors read this allegation only (truncated version), while others also read either one or two additional - but less plausible - allegations by the same child. Contrary to what we predicted, the presence of these additional allegations did not decrease jurors' belief in the core allegation, nor did it influence their judgments about the child complainant's honesty or cognitive competence. In fact, under at least one condition, reading additional, less plausible allegations made jurors more likely to pronounce the defendant guilty of the core allegation - even when jurors did not believe the additional allegations. This finding stands in stark contrast to prior research on jurors' evaluation of adults' testimony that includes implausible details. Future research in this area will help to elucidate the conditions under which the presentation of truncated testimony may or may not influence juror decision-making. Copyright © 2016 John Wiley & Sons, Ltd.

Children’s Knowledge and Imaginary About Robots

The aim of this paper is to investigate on children’s knowledge and imaginary about robots. To do so, we administered to 704 children from 17 classes of 8 elementary and secondary schools, a survey with close and open questions about their conceptualization of robots. To carry out this study we took as point of reference the theoretical framework of social representations. The main results are that children evaluate toys, robots and human-beings as significantly different on all the characteristics considered. More than toys, robots have mechanical movements, they move, are more intelligent than toys but they do not keep company to them. By contrast, human beings are perceived by children starting from their corporeity: they eat and sleep, move by themselves, are intelligent and speak, keep eye-contact and company. However, children complain about the fact that human beings do not play with them. The imaginary about robots that children receive from media is characterized by anthropomorphic shapes, bodies and by human-like cognitions, feelings and behavior. The more examples of visual products with robots children are able to evoke, the higher they evaluate robots on all human-like characteristics (e.g. it looks into my eyes). Hence, the tension between imaginary and knowledge can be confounding because the human-like features of fictional robots are more advanced than those reachable by the factual ones.

Potential Motive to Fabricate and the Assessment of Child Witnesses in Sexual Assault Cases

Sometimes, perceived credibility of a child's sexual assault allegation determines investigative and adjudicative decisions. Surprisingly, there is very little research on one common cross-examination technique used to discredit the child complainant; the presentation of a potential motive for the child to fabricate the allegation. In Experiment one, participants provided three reasons for complainant credibility after reading a mock child sexual assault case. Amongst participants’ first reasons, motive for the complainant to fabricate the allegation was the second most frequent response. In Experiment two, participants rated the honesty, accuracy and credibility of both the complainant and accused in a mock trial where a motive to fabricate was either present, absent, or not mentioned. Motive to fabricate had no effect on ratings of the complainant. However, when the evidence against the accused was strong, the accused was rated as more accurate, more honest, and more credible when a motive was present than when one was not. The forensic implications of the results are discussed.

Sleep Habit Among Elementary School Children in South Texas

SESSION TITLE: PediatricsSESSION TYPE: Slide PresentationsPRESENTED ON: Sunday, March 23, 2014 at 12:15 PM - 01:15 PMPURPOSE: Forming a healthy sleep habit is a significant challenge amongst developed society, and children are not immune to it either. We undertook this study to assess the prevalence of healthy sleep habits among Elementary school children in our community, and used a Children's Sleep Habit Questionnaire (CSHQ). METHODS: After obtaining permission from the appropriate school district and committee, children in 4th and 5th grade in two Elementary schools were surveyed by using CSHQ (validated tool). CSHQ assessed the children besides baseline in the domain of bedtime resistance, sleep onset and duration, sleep anxiety, nighttime awakening, and daytime sleepiness. RESULTS: 264 students were surveyed. 55.56% of children had difficulty in sleeping. Only 29.1% of children go to bed at the same time and only 23.48% of children are ready to sleep at their usual bedtime. 41.2% of children stay up late when parents think they are asleep. Only 31% of children fall asleep within 20 minutes. Almost 50% of children had some sleep anxiety. More than 50% of children wake up at night and have trouble falling asleep after waking up. Surprisingly 53% of children complain of waking up due to some type of pain. Only 20.5% of children usually have trouble waking up in the morning, whereas 33% of children stated that they feel refreshed after a night's sleep. CONCLUSIONS: Sleep disturbance starts at an early age. Attempts on sleep education need to be made at every level. CLINICAL IMPLICATIONS: Future studies to look at the sleep disturbances at an early age and design the education programs keeping in view of these disturbances may be helpful. DISCLOSURE: The following authors have nothing to disclose: Salim Surani, Amina Khimani, Sara Surani, Sreevidya Rao, Shyam SubramanianNo Product/Research Disclosure Information. Language: en

Dietary interventions for recurrent abdominal pain (RAP) and irritable bowel syndrome (IBS) in childhood

Between 4% and 25% of school-age children complain of recurrent abdominal pain (RAP) of sufficient severity to interfere with daily activities. It is unclear whether the diagnosis includes children with different aetiologies for their pain. For the majority no organic cause for their pain can be found on physical examination or investigation. Although most children are likely managed by reassurance and simple measures, a large range of interventions have been recommended.To determine the effectiveness of dietary interventions for recurrent abdominal pain in school-age children.The Cochrane Library (CENTRAL) 2006 (Issue 4), MEDLINE (1966 to Dec 2006), EMBASE (1980 to Dec 2006), CINAHL (1982 to Dec 2007), ERIC (1966 to Dec 2006), PsycINFO (1872 to Dec 2006), LILACS (1982 to Dec 2006), SIGLE (1980 to March 2005), and JICST (1985 to 06/2000) were searched . Where appropriate, search filters were employed. Researchers working in this area were asked to identify relevant studies.Randomised or quasi-randomised studies of any dietary treatment versus placebo or no treatment in school-age children with a diagnosis of RAP or functional gastrointestinal disorder based on the Rome II criteria.Two authors independently assessed trials for inclusion, assessed quality and extracted data. Where appropriate studies were pooled using a random effects meta-analysis.Seven trials were included in this review. Two trials, including 83 participants, compared fibre supplements with placebo (Christensen 1982, Feldman 1985), with data from one study reported in two papers (Christensen 1982, Christensen 1986). The pooled odds ratio for improvement in the frequency of abdominal pain was 1.26 (0.25, 6.29). Two trials, including 90 participants (Lebenthal 1981, Dearlove 1983) compared lactose-containing with lactose-free diets. Neither reported data in a form which could be used in the meta-analysis and the former trial had a loss to follow-up of 45%. We were not able to obtain further data for either trial. Three trials (Bausserman 2005, Gavronska 2007, Young 1997) comparing supplementation with Lactobacillus with placebo met the inclusion criteria but only two (Bausserman 2005, Gavronska 2007), including a total of 168 children, provided analysable data. The pooled odds ratio for improvement of symptoms was 1.17 (95% CI 0.62, 2.21).There is a lack of high quality evidence on the effectiveness of dietary interventions. This review provides no evidence that fibre supplements, lactose free diets or lactobacillus supplementation are effective in the management of children with RAP.

Assessment of Infants and Children with Symptoms Suggesting Otitis Media

Symptoms suggesting occurrence of otitis media (OM) in infants and young children are not always right. Objective: Assessment of those infants and children with symptoms suggesting otitis media. Patients & Methods: 113 infants and children were complaining of ear symptoms suggesting otitis media as well as 63 infants and children of same age and sex were not complaining of any of these symptoms suggesting otitis media, were fully investigated prospectively, by full clinical and ear, nose examination as well as swab culture from the ear discharge. Results: There was no statistical significant difference between the prevalence of otitis related symptoms and the risk factors in both groups. There was no correlation found between the otoscopic diagnosis of OM and the main complaint suggesting OM in the patients, mainly ear pain and ear discharge. There was a positive significant correlation between otoscopic diagnosis of OM and fever, diarrhea, and bronchiolitis (significance was at 0.01, 0.01 and 0.05 levels respectively). Conclusion: Otoscopic examination is very important in any infant or child complaining of ear pain, ear discharge or complaining of otitis related symptoms.

Children's testimony and the emotional victim effect

PurposeTwo experiments were conducted to examine the effects of (1) child victims’ emotional expression during testimony and (2) the camera perspective used to record the testimony, on judgements of credibility.MethodsLaw students (N = 155 in Experiment 1; N = 86 in Experiment 2) watched a child harassment complainant provide a statement in an emotional or neutral manner, presented using different camera perspectives: balanced focus (i.e., a shot portraying an equal focus on the child complainant and the interviewer) versus picture‐in‐picture (PiP; i.e., a shot portraying only the child with an inset window depicting both the child and the interviewer in the corner of the screen) in Experiment 1 and PiP versus child focus (i.e., a shot depicting only the child) in Experiment 2.ResultsAlthough no effect was found for camera perspective, the results provide support for an emotional victim effect (EVE); the child was perceived as more credible and truthful when communicating the statement in an emotional (vs. neutral) manner. Moreover, the results provide corroborating evidence for the assumption that the EVE rests on both cognitive (expectancy confirmation) and affective (compassion) mechanisms.ConclusionsThese findings extend previous research by showing that the EVE and its underlying mechanisms apply to judgements of child complainants in the context of non‐sexual crimes and appear to be robust against variations of camera perspectives. Legal implications are discussed.

Questioning Child Witnesses: Exploring the Benefits and Risks of Intermediary Models in New Zealand

The presumption of innocence is the primary value underpinning the trial. It is important to work out how to maintain the rights of defendants while better accommodating child complainants and witnesses in the pursuit of fact. One approach is to improve how children's evidence is challenged in order that the fact-finder may have a better opportunity to assess the evidence. This article looks at the viability of achieving this aim through the use of intermediaries to question children on behalf of counsel. Three intermediary models were explored through mock examinations of a “child” witness. Reflecting on these, the article documents some of the issues and the potential benefits and risks of different intermediary models to improve this questioning of children, particularly during cross-examination.

500 Dilatative Cardiomyopathy - Case Report

Background and AimsDilatative cardiomyopathy/DC/is a myocardium disease characterized by increased dimension of heart cavites and general weakening of the systolic function/the most frequently of the left ventricle/, with emersion ofsymptoms...

A Child with Tethered Cord Syndrome

Tethered Cord Syndome (TCS) refers to a group of neurological disorders related to malformations of the spinal cord, pulling of the spinal cord at the base of spinal canal. Tethered cord syndrome can be seen at any age but most often during childhood. A few children complain of diffuse pain in lower extremitiesor urological symptoms, 20% - 30 % of the patients will have a neurogenic bladder. A 9 years old girl, complained to have a flank pain and eneuresis. A mass is palpable at right flank. Ultrasound revealed duplex hydronephrosis and hydroureter with trabeculated bladder. Voiding Cystouretrography showed grade V vesicoureteral reflux (VUR) and neurogenic bladder appearance. Lumbosacral MRI demonstrated tethered cord with adjacent lipoma and spina bifida (Sains Medika, 4(1):89-96).

A pediatric case of reversible cerebral vasoconstriction syndrome with cortical subarachnoid hemorrhage

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare disorder characterized by acute onset, severe headache, with reversible vasoconstriction of cerebral arteries often accompanied by additional neurological symptoms. This syndrome is seen mainly in middle-aged adults, predominantly women. Herein, we report on a pediatric case of RCVS with cortical subarachnoid hemorrhage (SAH). A 12-year-old boy developed acute, severe headache with paralysis of lower extremities causing gait disturbance after administration of eletriptan. Brain magnetic resonance angiography (MRA) revealed multifocal narrowing of the cerebral arteries, whereas magnetic resonance imaging (MRI) demonstrated sulcal hyperintensity on fluid-attenuated inversion recovery, consistent with cortical SAH. The patient’s clinical symptoms resolved spontaneously after a few days and the MRI and MRA findings disappeared 3months later, suggesting a diagnosis of RCVS. Eletriptan might cause vasoconstriction of cerebral arteries. Although most patients with RCVS are adults and pediatric cases are rare, RCVS should be considered in a child complaining of severe headache.

Colorectal carcinoma in a ten-year-old girl: A case report

Colorectal carcinoma is very rare in childhood. In this case report, we depict a ten-year-old girl who presented with features of intestinal obstruction which turned out to be due to poorly differentiated mucin secreting adenocarcinoma of descending colon. Only increased awareness of this malignancy in this age-group and a high index of suspicion can help when a child complains of persistent pain of abdomen, altered bowel habits or rectal bleeding, and may provide diagnosis at an earlier stage, thereby improving the prognosis.

幼児期のめまい・平衡障害

Abstract Childhood vertigo and disequilibrium are overlooked in many cases because children rarely complain of them. Childhood diseases and conditions differ among neonates, infants, and school children. Examination procedures are not similar to those for adults. In clinical practice, many children are brought to the Department of Pediatrics (Neurology) or the Department of Orthopedics with delayed gait, muscle hypotonia, or frequent falling-down.In this symposium, we review the diagnosis and pathogenesis of vertigo/disequilibrium during early childhood, focusing on rare diseases such as benign paroxysmal torticollis.Childhood vertigo is classified into 2 types: vertigo that children complain of (sensory disturbance) and disequilibrium-related balance abnormalities (motor control disturbance). Children aged 4 to 5 years can complain of vertigo. Rotatory vertigo is frequent. Younger children rarely complain of it. In those aged 2 to 3 years, their mothers become aware of gait disorder, frequent falling-down, or muscle hypotonia.As information obtained from asking children questions is limited, it is also necessary to interview their mothers and evaluate the motor development process. Concerning balancing dysfunction, as the central nervous system is under development, the peripheral static-sense system, myelination/maturation of the central nervous system, process of functional integration, and learning/acquisition of gross and fine motor skills at each age must be considered.During early childhood, brain tumors, especially cerebellar/brainstem tumors, cerebellitis, and acute cerebellar ataxia should be considered. In addition, the presence of congenital nystagmus must always be considered.As a type of vertigo specific to this period, childhood benign paroxysmal vertigo is frequent: rotatory vertigo initially occurs at 1 to 4 years of age, and attacks persisting for a few seconds to minutes repeatedly appear. The tendency to fall down is marked. The mechanism of migraine may be involved. This type of vertigo reflects ischemia of the vestibular nuclei involving the pons to medulla oblongata. In most cases, a spontaneous cure is achieved within a few months to years. For diagnosis, a detailed inquiry is conducted, and children's parents are requested to record their states during vertigo attacks using a home video camera.Benign paroxysmal torticollis has been recognized as a type of vertigo resembling migraine. This disease is rare, but many children are first taken to the Department of Orthopedics due to torticollis. Repeated paroxysmal torticollis appears at 1 to 5 years of age, and a tendency to fall down is observed. Ocular displacement and gait disorder are also noted. However, these symptoms resolve with development. This disease may reflect ischemia of the tegmentum mesencephali and cajal interstitial nucleus, which are adjacent to the uncertainty zone.The incidence of migraine-related vertigo, including dizziness, is reportedly 50 to 70%. In particular, childhood basilar artery-type migraine is observed in 1- to 10-year-old children. It causes astasia/gait disorder, nausea, vision disorder, occipital pain, and other neurologic symptoms.For the diagnosis of childhood vertigo/disequilibrium, it is important to conduct careful a follow-up of motor development, select diseases to be considered with respect to age, and understand their characteristics. Although examinations are difficult in many cases, various examinations should be combined, and the features of vertigo/disequilibrium must be analyzed based on the results of a parent inquiry and videotape records of attacks.