Child Health Supervision Research Articles

Health Supervision for Children and Adolescents With Sickle Cell Disease: Clinical Report.

Sickle cell disease (SCD) is a group of complex genetic disorders of hemoglobin with multisystem manifestations. The scope of this clinical report is such that in-depth recommendations for management of all complications is not possible. Rather, the authors present an overview focused on the practical management of children and adolescents with SCD and the complications that are of particular relevance to pediatric primary care providers. References with detailed commentary provide further information. Timely and appropriate treatment of acute illness is critical, because life-threatening complications may develop rapidly. Specialized comprehensive medical care decreases morbidity and mortality during childhood. The provision of comprehensive care is a time-intensive endeavor that includes ongoing patient and family education, periodic comprehensive evaluations and other disease-specific health maintenance services, nursing support, psychosocial care, and genetic counseling. Ideally, this care includes comanagement by the pediatrician or other pediatric primary care provider and a team of specialist SCD experts: Hematologist, other pediatric specialists, advanced practice providers, nurse specialists, social workers, patient navigators, and educational liaisons.

Health supervision for children and adolescents with 16p11.2 deletion syndrome.

Rare genetic conditions are challenging for the primary care provider to manage without proper guidelines. This clinical review is designed to assist the pediatrician, family physician, or internist in the primary care setting to manage the complexities of 16p11.2 deletion syndrome. A multidisciplinary medical home with the primary care provider leading the care and armed with up-to-date guidelines will prove most helpful to the rare genetic patient population. A special focus on technology to fill gaps in deficits, review of case studies on novel medical treatments, and involvement with the educational system for advocacy with an emphasis on celebrating diversity will serve the rare genetic syndrome population well.

0980 A Child with Achondroplasia, Cervicomedullary Junction Compression, Severe Obstructive Sleep Apnea and Pulmonary Hypertension

Abstract Introduction Achondroplasia is a short stature autosomal dominant skeletal dysplasia. Children with Achondroplasia are at risk for multiple medical comorbidities including sleep disordered breathing due to midface hypoplasia and craniocervical junction compression. Recent guidelines from American Academy of Pediatrics on health supervision of children with achondroplasia recommend routine clinical screening for symptoms of obstructive sleep apnea (OSA) and craniocervical junction compression in which case a polysomnogram should be considered. Report of case(s) The patient is a now 15 month old male who was initially seen in sleep medicine clinic at age 4 months for snoring and respiratory distress while awake. Polysomnogram 2 days later demonstrated severe OSA. The study demonstrated an oAHI of 25.1/hour, O2 nadir of 77%, and TcCO2 with evidence of significant hypoventilation with TcCO2 max of 67mmHg. This was adequately treated with supplemental oxygen. The patient subsequently presented to the emergency department at age 7 months with hypoxemic respiratory failure and signs of right heart failure and was started on CPAP. Echocardiogram demonstrated significant pulmonary hypertension. Subsequent CPAP titration study during admission demonstrated adequate treatment of OSA and his pulmonary hypertension significantly improved with the patient requiring no pulmonary hypertension treatment at discharge. At age 9 months, the patient was again admitted with hypoxemic respiratory failure and subsequent brain MRI demonstrated foramen magnum stenosis requiring subsequent surgical decompression. He was discharged on CPAP, however, was not tolerating this at home. Therefore, repeat polysomnogram was obtained that demonstrated severe OSA that was not responsive to supplemental oxygen. The patient was then started on BPAP therapy which he has since been tolerating well. Conclusion Children with achondroplasia are at increased risk for sleep disordered breathing and craniocervical junction compression. Our patient experienced significant complications from OSA at a young age. His sleep apnea worsened significantly in a short period making it unresponsive to previous treatment recommendations. There is a need for further studies to determine better screening guidelines for craniocervical junction narrowing and OSA. This case highlights the dynamic nature of sleep disordered breathing in achondroplasia and need for close follow up and monitoring of symptoms at all clinical encounters. Support (if any)

Health Supervision for Children and Adolescents With Marfan Syndrome

Marfan syndrome is a heritable connective tissue disorder that affects many different organ systems. In some cases, features of Marfan syndrome can be recognized at birth, but the majority will have manifestations that emerge throughout childhood and into adulthood. Significant morbidity and mortality are associated with this syndrome, and its features are best managed using a multidisciplinary approach. This clinical report is designed to assist the pediatrician in recognizing the features of Marfan syndrome as well as caring for the individual with Marfan syndrome to maximize their health and quality of life.

Financial impact of a specialized Down syndrome clinic: Implications and support for institutional support of specialty care clinics.

Individuals with Down syndrome (DS) have specific health care needs and require additional screening and surveillance for commonly associated conditions. The American Academy of Pediatrics (AAP) Committee on Genetics has provided clinical guidance in "Health Supervision for Children and Adolescents with Down Syndrome." Many DS specialty centers (DSC) have been created, in part, to help ensure adherence to these guidelines. The primary purpose of this work is to determine the financial impact of a specialized DSC. A retrospective chart review was completed for all patients seen in DSC for fiscal year 2018 (June 2018-June 2019). Charts were reviewed to ascertain the financial impact of a DSC to a healthcare system by calculating total downstream charges (using CMS Chargemaster) as a surrogate marker for financial impact. Five-hundred-seventy-four patient encounters were conducted; 99 were new patient visits. Annual charges totaled $1,399,450. The 1-5-year-old age group accounted for greater than half of all charges. The greatest proportion of charges resulted from sleep studies and other diagnostic testing (55%). DS clinics are extremely helpful in ensuring that children receive guideline-based care. Taking into account downstream revenue, specialized DSCs are also financially beneficial to the institutions with whom they are affiliated.

Health Surveillance in a Down Syndrome Specialty Clinic: Implementation of Electronic Health Record Integrations During the Coronavirus Disease 2019 Pandemic

To address gaps in routine recommended care for children with Down syndrome, through quality improvement during the coronavirus disease 2019 (COVID-19) pandemic. A retrospective chart review of patients with Down syndrome was conducted. Records of visits to the Massachusetts General Hospital Down Syndrome Program were assessed for adherence to 5 components of the 2011 American Academy of Pediatrics (AAP) Clinical Report, "Health Supervision for Children with Down Syndrome." The impact of 2 major changes was analyzed using statistical process control charts: a planned intervention of integrations to the electronic health record for routine health maintenance with age-based logic based on a diagnosis of Down syndrome, created and implemented in July 2020; and a natural disruption in care due to the COVID-19 pandemic, starting in March2020. From December 2018 to March 2022, 433 patients with Down syndrome had 940 visits. During the COVID-19 pandemic, adherence to the audiology component decreased (from 58% to 45%, P<.001); composite adherence decreased but later improved. Ophthalmology evaluation remained stable. Improvement in adherence to 3 components (thyroid-stimulating hormone, hemoglobin, sleep study ever) in July 2020 coincided with electronic health record integrations. Total adherence to the 5 AAP guideline components was greater for follow-up visits compared with new patient visits (69% and 61%, respectively; P<.01). The COVID-19 pandemic influenced adherence to components of the AAP Health supervision for children with Down syndrome, but improvements in adherence coincided with implementation of our intervention and reopening after the COVID-19 pandemic.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

Genital Examination of the Prepubertal Female: Essentials for Pediatric Nurse Practitioners.

Assessment of nutrition and its effect on scholastic performance of school going children in rural field practice area of Jhalawar Medical College, Jhalawar, Rajasthan

Background: Health is a universal human need. School going children constitute one-fifth of the total population and are the future of the nation. The health supervision of school going children is necessary and can help identify the magnitude of morbidity and malnourishment in a community. Malnutrition is associated with significant morbidity, mortality and economic costs in developing countries. In most part of our country, the children in rural areas are nutritionally deprived and are prone to illnesses. A child who is undernourished owing to socioeconomic or other reasons is prone to get diseases and often misses classes and therefore may not perform well in the examinations. Objectives of current study were to assess the nutrition of children attending a government school in rural field practice area of Jhalawar Medical College and to study the association of nutritional status with scholastic performance.Methods: A cross-sectional study was done among children studying in the Government School of Mandawar, Rajasthan. Demographic and socio-economic variables were obtained. Their nutritional status was calculated in terms of weight for height and weight for age and were assessed clinically for presence of any diseases. Attendance and grades were obtained from class teacher to assess the scholastic performance.Results: Out of 122 students studied, based on the anthropometric measurements, dietary intake and physical examination, nutrition status was found good among 77 (63%) students and poor in 45 (37%) students. Students with good nutritional status are more likely to have good scholastic performance.Conclusions: Nutrition impacts the attendance and grades of the students.

Health Supervision for Children and Adolescents With Down Syndrome.

Health Supervision for Children and Adolescents With Down Syndrome.

Oxidant-antioxidant balance in girls with precocious puberty: a case–control study

ABSTRACT This case–control study aims to evaluate the oxidant-antioxidant balance in girls having central precocious puberty (CPP) and premature thelarche (PT). Thirty-four girls having CPP, 24 girls having PT, and 49 healthy growing girls between 7 and 9 years of age admitted to child health supervision were enrolled. Total antioxidant and oxidant capacity, myeloperoxidase, catalase, superoxide dismutase, total thiol, native thiol, and disulfide levels were analyzed in serum samples. Low total oxidant status (<12.0) was found to be highest in the CPP group, lowest in the control group, and the PT group was in between them. After controlling bone age and z score for body mass index, generalized linear models revealed lower oxidative stress index values in the CPP and the PT groups than the control group. Other studied parameters did not differ among groups. Precocious puberty in girls is associated with some changes in the oxidant-antioxidant status.

Daily and Weekly Iron Supplementations to Improve Iron Status in Infants: A Randomized Controlled Trial

Background: Iron deficiency anemia screening and iron supplementation in infants aged 6 to12 months are recommended in the Guideline in Child Health Supervision. Objective: To evaluate the effectiveness of weekly iron supplementation compared with daily supplementation in improving the iron status in infants. Materials and Methods: A single-blind randomized controlled trial was conducted in infants aged 6 months visiting the Well Child Clinic between May 2019 and November 2020 at Burapha University Hospital, Chonburi, Thailand. The intervention consisted of either daily or weekly iron supplementation combined with iron-rich complementary food promotion for six months. The outcomes were the differences of serum ferritin and hematological variables before and after being iron supplemented. Results: Sixty-nine of the six-month-old healthy infants were randomized to receive either 10 mg Fe/day as the daily group or 30 mg Fe/week as the weekly group. Forty-five infants with 24 in the daily group and 21 in the weekly group completed the intervention. After the six-month period of iron supplementation, the average differences of serum ferritin in the daily and the weekly group were 10.85 (–13.19, 34.49) and –9.31 (–23.86, –2.30) ng/mL, respectively (p=0.012). The average differences of hemoglobin in the daily and the weekly group were 0.58±0.82 and 0.08±0.59 g/dL, respectively (95% CI 0.06 to 0.93; p=0.026). Conclusion: Daily iron supplementation of 10 mg/day is more effective than 30 mg weekly iron supplementation in improving iron status and hemoglobin level in the Thai infants. Keywords: Anemia; Ferritin; Infants; Iron deficiency; Iron supplementation

Do the Children of Mothers with Optimum PICCOLO Scores Have Better Denver II Test Results?

Aim:Positive parenting skills, especially mother–child interactions, are associated with positive effects in countless areas of child development. We aimed to evaluate mother–child interactions in children with developmental delay compared to those with age-appropriate development.Material and Methods:Children aged 1-5 years admitted to the outpatient clinic for child health supervision were evaluated for the study. A 10-minute video recording was obtained while the participant mother–child couple played together in a room. Children were divided into 3 developmental groups using the Denver Developmental Screening Test II (DDST-II); as age-appropriate, questionable, and delayed. Mother–child interaction was assessed using the “Parenting Interactions with Children: Checklist of Observations Linked to Outcomes” (PICCOLO) tool.Results:A total of 142 children, whose developmental status was evaluated according to DDST-II and were grouped as age-appropriate (59), questionable (39), and delayed (44), were included in the study. The mean age of the children was 29.0 ± 11.9 months. The median PICCOLO score was 43 (interquartile range (IQR)=36-47) in the age-appropriate developmental group, 44 (IQR=35-51) in the questionable group, and 36 (IQR=32-45) in the delayed group. When adjusted for child’s age, gender, presence of a sibling, maternal age, mother’s education level, mother’s occupation, and household size, multiple logistic regression revealed higher rates for optimum responsiveness and encouragement domains, and total scores in age-appropriate and questionable groups, than in the delayed development group (P < .05).Conclusion:Supporting all areas, especially the responsive and encouragement domains in mother–child interactions, may improve child development.

AAP Publications Reaffirmed or Retired

Policy Statement. Point-of-care ultrasonography by pediatric emergency medicine physicians. Pediatrics. 2015;135(4). Available at: www.pediatrics.org/cgi/content/full/135/4/e1097. Reaffirmed September 2019Technical Report. Point-of-care ultrasonography by pediatric emergency medicine physicians. Pediatrics. 2015;135(4). Available at: www.pediatrics.org/cgi/content/full/135/4/e1113. Reaffirmed September 2019Policy Statement. Consumption of raw or unpasteurized milk and milk products by pregnant women and children. Pediatrics. 2014;133(1):175–179. Available at: https://pediatrics.aappublications.org/content/133/1/175. Reaffirmed November 2019Policy Statement. Off-label drug use in children. Pediatrics. 2014;133(3):563–567. Available at: https://pediatrics.aappublications.org/content/133/3/563. Reaffirmed November 2020Technical report. Prevention of drowning. Pediatrics. 2010;126(1):e253–e262. Available at: https://pediatrics.aappublications.org/content/126/1/e253. Reaffirmed February 2019Clinical report. Child sex trafficking and commercial sexual exploitation: health care needs of victims. Pediatrics. 2015;135(3):566–574. Available at: https://pediatrics.aappublications.org/content/135/3/566. Reaffirmed October 2020Clinical report. Management of food allergy in the school setting. Pediatrics. 2010;126(6):1232–1239. Available at: https://pediatrics.aappublications.org/content/126/6/1232. Reaffirmed October 2020Policy statement. HIV testing and prophylaxis to prevent mother-to-child transmission in the United States. Pediatrics. 2008;122(5):1127–1134. Available at: https://pediatrics.aappublications.org/content/122/5/1127. Reaffirmed October 2020Clinical report. Suicide and suicide attempts in adolescents. Pediatrics. 2016;138(1):e20161420. Available at: https://pediatrics.aappublications.org/content/138/1/e20161420. Reaffirmed October 2020Technical report. SIDS and other sleep‐related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics. 2011;128(5):e1341–e1367. Available at: http://pediatrics.aappublications.org/content/128/5/e1341. Reaffirmed October 2020Policy statement. SIDS and other sleep‐related infant deaths: expansion of recommendations for a safe infant sleeping environment. Pediatrics. 2011;128(5):1030–1039. Available at: http://pediatrics.aappublications.org/content/128/5/1030. Reaffirmed October 2020Policy statement. Pediatrician-family-patient relationships: managing the boundaries. Pediatrics. 2009;124(6):1685–1688. Available at: https://pediatrics.aappublications.org/content/124/6/1685. Reaffirmed October 2020Clinical report: Attention-deficit/hyperactivity disorder and substance abuse. Pediatrics. 2014;134(1):e293–e301. Available at: https://pediatrics.aappublications.org/content/134/1/e293.full. Reaffirmed October 2020Clinical report: Health supervision for children with sickle cell disease. Pediatrics. 2002;109(3):526–535. Available at: https://pediatrics.aappublications.org/content/109/3/526. Reaffirmed September 2020Policy statement. Postnatal corticosteroids to prevent or treat chronic lung disease following preterm birth Pediatrics. 2010;126(4):800–808. Available at: https://pediatrics.aappublications.org/content/126/4/800. Reaffirmed September 2020Policy statement. Children’s Health Insurance Program (CHIP): accomplishments, challenges, and policy recommendations. Pediatrics. 2013;133(3):e784–e793. Available at: https://pediatrics.aappublications.org/content/133/3/e784. Reaffirmed August 2020Policy statement. Guiding principles for pediatric hospital medicine programs. Pediatrics. 2013;132(4):782–786. Available at: https://pediatrics.aappublications.org/content/132/4/782. Retired August 2020

Brief Musculoskeletal Screen and Patient Education for Down Syndrome-Associated Arthritis

Down syndrome (DS) is one of the most common birth defects in the United States with resulting in an estimated birth prevalence of 12.6 per 10 000 live births.1 DS is characterized by a heterogenous phenotype that results from a dosage imbalance of genes on human chromosome 21.2 Due to the heterogenous phenotype, broad presentation of presenting symptoms, and complex needs of the child with DS, the American Academy of Pediatrics (AAP) published a clinical report for the health supervision of children with DS.3 The report discusses age-appropriate guidance on when to screen for specific conditions, when to refer to specialty care for evaluation, and anticipatory guidance for families as their child with DS ages. Inflammatory arthritis in children with DS was first described in 1984 and was termed Down syndrome arthropathy,4 however, the term Down syndrome-associated arthritis (DA) has been recommended to better describe the inflammatory nature of the disease.5 Studies have shown that DA is under-recognized with a delay in diagnosis.6 Most patients present with polyarticular (5 or more joints with arthritis), rheumatoid factor (RF), and anti-nuclear antibody (ANA) negative disease.6 There are reports that DA is more prevalent than juvenile idiopathic arthritis (JIA),5,7 which is the most common pediatric rheumatologic disease.8 Additionally, DA appears more aggressive than JIA with more bone and joint damage at presentation, and despite aggressive therapy with disease modifying antirheumatic drugs (DMARDs) and biologic therapy, disease burden is higher for those with DA compared to JIA.9 Despite this the American Academy of Pediatrics does not mention arthritis or screening for arthritis in the clinical report for health supervision of children with DS. In a national survey of Down syndrome clinic providers, 77% responded that they were aware of the risk for inflammatory arthritis in DS, however, less than half educated families about the risk, which is likely due to the lack of guidance around screening and evaluation for DA.10 The uncertainty and lack of guidance in screening for DA is a gap in the medial literature. Our objective was to develop and pilot a brief musculoskeletal screen for DA and our secondary objective was to provide education to families about DA.

Assessment of Down Syndrome-Associated Arthritis: A Survey of Down Syndrome Clinic Providers.

Down syndrome (DS) is one of the most common birth defects in the United States1 and is characterized by a heterogenous phenotype that results from a dosage imbalance of genes on human chromosome 21.2 This results in an increased incidence of infections, malignancy, autoinflammatory, and autoimmune conditions.3 Due to the heterogenous phenotype and complex needs of the child with DS, the American Academy of Pediatrics put out a clinical report for the health supervision of children with DS.4 This report gives information and guidance on when to screen for specific conditions and when to refer to specialty care for evaluation. Inflammatory arthritis in children with DS was first described in 19845 and is termed Down syndrome-associated arthritis (DA). Studies have shown that DA is under-recognized with a 19-month average delay in diagnosis,6 and most patients present with polyarticular (5 or more joints with arthritis), rheumatoid factor (RF), and anti-nuclear antibody (ANA) negative disease.6 There are reports that DA is more prevalent than juvenile idiopathic arthritis (JIA),7,8 which is the most common pediatric rheumatologic disease.9 Despite this the American Academy of Pediatrics does not mention arthritis or screening for arthritis in the clinical report for health supervision of children with DS. In a survey of pediatric rheumatologists asked how they evaluate for DA, it was found that most use a combination of clinical history, physical exam, laboratory tests, and imaging studies,10 however, there is currently no standardized approach for the assessment of DA. Additionally, it is unclear how primary care providers assess for DA prior to presentation to subspecialty care. Our objective was to describe the current practices of Down syndrome clinic providers approach to assessment and diagnosis of DA.

A Mobile App, KhunLook, to Support Thai Parents and Caregivers With Child Health Supervision: Development, Validation, and Acceptability Study

BackgroundIn Thailand, children born in government hospitals receive a maternal and child health handbook (MCHH). However, when a new MCHH edition is released, those with the previous editions do not have access to the updated information. A mobile app is an appealing platform to fill this gap. We developed a mobile app called “KhunLook” as an interactive electronic MCHH intended to assist parents in child health supervision.ObjectiveThis study describes the user requirements and development of the KhunLook mobile app, validity of parents’ growth assessments, and parents’ evaluation of feasibility and acceptability of the app.MethodsPhase 1 was a qualitative study using individual interviews. The interview data were used to revise the prototype. In phase 2, parents were randomly assigned to assess their children’s growth with the app or the MCHH. The outcomes were compared to those of the physician’s assessment, and congruence was determined. In phase 3, parents evaluated the feasibility and acceptability of the app in comparison to the MCHH through a web-based survey.ResultsFour health care providers and 8 parents participated in phase 1. Two themes were identified: (1) the mobile app potentially counters parents’ infrequent use of the MCHH with accuracy, attractiveness, convenience, and simplicity, and (2) health supervision needs to be standard, up-to-date, and understandable. KhunLook was publicly launched with a family page and 7 key features: growth and nutrition, development, immunizations, oral health, reminders for the next appointment, memories, and health advice. In phase 2, 56 parents participated in the growth parameter assessments; 34 were in the App group and 22 in the MCHH group. The outcomes of the growth parameter assessments between parents and physicians in both the App and MCHH groups were not significantly different. The congruence proportions were higher in the App group for weight and head circumference, but the differences were not statistically significant. In phase 3, 356 parents from all over Thailand participated in a web-based survey. Parents rated the app feasibility as “very easy to easy” to use at higher proportions than the MCHH in all health assessment domains (growth, development, and immunizations) and ease-of-use domains with statistical significance (P<.001). The KhunLook app received a significantly higher mean score (8.59/10) than the MCHH (7.6/10) (P<.001). Most parents (317/356, 89.0%) preferred the app over MCHH. Further, 93.5% (333/356) of the parents stated that they would continue to use the app and 96.9% (345/356) would recommend others to use it.ConclusionsKhunLook, a Thai mobile app for child health supervision, was developed, validated for growth assessments, and was well accepted for ease-of-use by parents. Further studies should be conducted with a large scale of users, and the impact of this app on health behaviors and health outcomes must be evaluated.

Losing Ground: Current Medicaid Policy Threatens Children's Access to Health Care

From 2008 through 2016, the number of uninsured children in the United States decreased from 7.6 million to 3.6 million ( Alker and Roygardner, 2019 Alker J. Roygardner L. The number of uninsured children is on the rise. 2019 Google Scholar ). However, since 2017 that trend has reversed. Over 4 million children are now uninsured—the highest rate of uninsured children since the implementation of the Affordable Care Act (ACA)—and over one-quarter of these children are aged under 6 years ( Burak et al., 2019 Burak E.W. Clark M. Roygardner L. Nation's youngest children lose health coverage at an alarming rate. 2019 Google Scholar ). According to the periodicity schedule for preventive pediatric health care, children should have 30 well-child visits from birth through 21 years of age, with 15 of these visits occurring from the first weeks of life through 6 years of age ( Hagan et al., 2017 Hagan J.F. Shaw J.S. Duncan P.M. Bright futures: Guidelines for health supervision of infants, children and adolescents. fourth ed. American Academy of Pediatrics, Elk Grove Village, IL2017 Google Scholar ). These visits provide preventive care, including developmental assessment, screening, and immunizations, offer anticipatory guidance to parents, and promote trusting relationships with health care providers. When children lack health insurance coverage, they often go without preventive services and experience suboptimal health outcomes ( Flores et al., 2017 Flores G. Lin H. Walker C. Lee M. Currie J.M. Allgeyer R. Massey K. The health and healthcare impact of providing insurance coverage to uninsured children: A prospective observational study. BMC Public Health. 2017; 17: 553 Crossref PubMed Scopus (10) Google Scholar ). Eileen K. Fry-Bowers, Associate Professor, University of San Diego, Hahn School of Nursing and Health Science, San Diego

Quality of life and comprehensive health supervision for children with Down syndrome in Thailand.

Children with Down syndrome often require several specialty doctors and multidisciplinary teams for their associated anomalies. This may impact their quality of life and creates gaps in treatment monitoring. No studies have yet been conducted in Thailand to measure their quality of life and level of comprehensive health supervision. Therefore, we aimed to study the quality of life among children with Down syndrome and determine if they receive comprehensive health supervision for their condition. In this descriptive research, data were collected from a medical record review of children with Down syndrome during a 1-year period in our Pediatric Outpatient Clinic; 50 children and 39 caregivers participated. Mean total quality of life score of the children was 67.9/100 points. The children had the highest scores (73.6 ± 12.8) in emotional functioning and the lowest (57.2 ± 25.6) in cognitive functioning. It appears that the quality of life may be lower in Down syndrome patients than in Thai children without it. Regarding health supervision, all 50 were screened for thyroid function, and 48 received cardiac evaluations. However, only 17 (34%) received "complete basic assessment" of 5 screening combinations with developmental evaluations and growth monitoring. Furthermore, none received "comprehensive" evaluations for all recommended conditions. While these findings show a need for health supervision improvement for children with Down syndrome within our hospital, they may also be indicative for most care facilities throughout Thailand.

Feeding difficulty and gastrostomy tube placement in infants with Down syndrome.

The objectives of this study were to determine if any specific clinical signs, symptoms, or comorbidities could reliably predict underlying feeding difficulty and need for further evaluation (i.e., video swallow study, VSS) in infants with Down syndrome, to establish the prevalence of gastrostomy tube placement (G-tube), and to determine if any clinical signs, symptoms, or comorbidities correlated with a higher risk for needing placement of a G-tube. An electronic medical record retrospective chart review of 73 children with Down syndrome born between January 2013 and March 2017 and seen in Nationwide Children's Hospital's multidisciplinary Down Syndrome Clinic included demographic information, medical history, and results of studies and specialist evaluations. Descriptive statistics were utilized to summarize the data. Comparisons were performed to identify factors which differed between feeding difficulty vs. no feeding difficulty and G-tube placement vs. no G-tube placement. "Feeding difficulty" was the only feeding term established by the AAP guidelines which was consistently noted in charts of children with feeding abnormalities. Infants with feeding difficulty had increased use of medical services and more abnormalities on specialist evaluations and studies. Congenital heart disease, cardiothoracic surgery, obstructive sleep apnea, and hypothyroidism did not differ significantly between the groups assessed. Our cohort had a prevalence of 13.7% for requiring G-tube placement in their first year of life.Conclusion: The currently established clinical tools for determining which patients may benefit from radiographic evaluation lack sufficient sensitivity to detect all individuals with feeding difficulty. Due to the high prevalence of abnormal VSS results and high rate of G-tube placement, universal radiographic screening for individuals with Down syndrome could be considered, even in the absence of obvious clinical signs or symptoms. However, determining how to balance this with cost, availability, and radiation exposure may be difficult.What is Known: • Feeding difficulty in children with Down syndrome can lead to significantly increased morbidity, such as poor weight gain, failure to thrive, aspiration, persistent respiratory symptoms, andrecurrent pneumonia. • The AAP has established a clinical tool regarding which objective signs and symptoms should lead to a radiographic swallowing assessment within their Health Supervision for Children with Down Syndrome Clinical Report.What is New: • A comprehensive assessment of clinical signs, symptoms, and common comorbidities in infants with Down syndrome has not previously been correlated with presence of feeding difficulty nor necessity for gastrostomy tube placement, including whether or not the terms used in the AAP guidelines encompass the sensitivity required to detect all infants with feeding difficulty. • The prevalence of gastrostomy tube placement in children with Down syndrome has not previously been established.

Protective role of breastfeeding status, chronic health problems, and temperament of children in maltreatment by mothers.

In order to reduce parental violence against children, it is necessary to establish risk factors associated with maltreatment of children in different societies. This study aims to evaluate the impact of mother-child characteristics on self-reported mother's maltreatment (physical or emotional abuse) against pre-school children. The general characteristics of mother-infant pairs and maternal knowledge and attitudes about violence were taken using a questionnaire at routine child health supervision. Overall, 244 mother-infant pairs were enrolled and mothers described their child as easy-going (27.0%), normal (61.1%), and naughty (11.9%). Of all mothers, 32.8% had been exposed to violence in their childhood. According to maternal self-reports, 82.4% of the mothers abused their children emotionally and 24.6% physically. Multiple logistic regression analysis revealed that older child age, naughty or normal defined child, maternal exposure to violence during her childhood period were identified as predictors. Older child age, breastfeeding for less than 6 months, and naughty-defined child were associated with elevated odds ratio of physical abuse; however, those with a chronic disease were less likely to be abused. Pediatricians should be aware of the fact that older preschool children, being breastfed for less than 6 months, and naughty children could be at risk for victimization.