Child's Medical Condition Research Articles

Rapid Inpatient Behavioral Treatmentfor Choking Phobia in Children

Six children with acquired choking phobia who failed outpatient intervention were treated in a rapid, behaviorally based inpatient program that integrated in vivo exposure with contingency management. Motivation to eat feared foods was increased via the manipulation of appetite and hospital privileges (e.g., visits, TV). Children were required to eat small quantities of feared food to receive privileges, and failure to meet these requirements resulted in privilege suspension. Elimination of the choking phobia occurred within 3 days. This approach is appropriate for cases in which outpatient treatment fails, in which parents have made legitimate attempts at home-based treatment, or in which the child's medical condition warrants it.

Clinical significance of incidental magnetic resonance image abnormalities in mastoid cavity and middle ear in children

Objective: Magnetic resonance imaging of the head may reveal incidental findings in paranasal sinuses. The purpose of this study was to discover whether similar changes could be identified in the mastoid cavity and middle ear as well. Methods: A group of 50 children undergoing magnetic resonance imaging of the head for suspected intracranial pathology were prospectively gathered. Their parents completed a questionnaire concerning each child's medical history connected with acute otitis media. Otoradiologists evaluated the pictures for mastoid cavity and middle ear and paranasal sinus abnormalities. Results: In six (12%) children, magnetic resonance imaging detected abnormalities resembling acute inflammatory changes, although none had had acute otitis media during the preceding last 3 months. Abnormalities detected in the paranasal sinuses were not correlated with abnormalities in the mastoid cavity and middle ear. Conclusions: High signal intensity in magnetic resonance images from the mastoid cavity and middle ear may be incidental and without any clinical significance. These findings must be interpreted together with knowledge of the child's medical condition and clinical examination of the ears.

Impact of Parental Involvement in Life-Support Decisions: A Qualitative Analysis of Parents' Adjustment Following Their Critically Ill Child's Death

A retrospective, qualitative, preliminary study examined if parental involvement in a life-support withdrawal (LSW) decision impacts the perceptions and adjustment of parents whose child died in a pediatric critical care unit. Participants were parents whose child died following an LSW decision (11 mothers, 7 fathers) and parents whose child died without an LSW decision (5 mothers, 4 fathers). At 6 to12 months after their child's death, the two groups of parents were interviewed and asked to reexamine their perceptions of the following categories: understanding of child's medical condition, staff communication, support, and feelings of closure. Content analysis of the interview data indicated that in comparison to parents whose child died without an LSW decision, a significantly greater number of parents whose child died following an LSW decision were certain about their child's future health; believed that their child's quality of life would have been unacceptable; and reported less dissatisfaction with time spent with their child, fewer negative changes in family functioning, and more positive changes in feelings toward staff.

Medical Management of Spasticity in Children with Spinal Cord Injury

Spasticity is common problem in children with spinal cord injury. The impact of spasticity on the child's function, care, comfort, and medical condition should be assessed prior to the initiation of any treatment. Treatment is indicated if the spasticity interferes with the performance of self-care tasks, gait, wheelchair positioning, or transfer activities; disrupts sleep; or causes pain, discomfort, or deformity. No medication is uniformly useful in the treatment but medications must be considered.

EMOTIONAL DISTRESS IN CHILDREN OF HIGH‐CONFLICT DIVORCE

This study examines factors that contribute to the emotional distress of children whose parents experience an acrimonious divorce with conflict over custody and visitation issues. Information was gathered systematically from guardian ad litem reports on 105 children in order to explore the child's emotional distress in response to individual‐, parental‐, marital‐, and custody–related factors. Findings emphasize the impact of the level of marital conflict in predicting increases in the child's emotional distress. The child who witnesses domestic violence and experiences child malmatment suffers a powerful cumulative impact from these factors. which results in a steep increase in emotional distress symptoms. A cluster of relevantfactors taken jointly, including the level of marital conflict, violence against a partner or against the child, the parent's mental health, the child's medical condition, and the nature of visitation changes, all contribute signifcantly to the child's emotional distress.

Management of the young febrile child: a continuing controversy.

In 1975, Teele and colleagues1identified the risk factors for and occurrence of bacteremia in young febrile children presenting to a pediatric walk-in clinic. They found that 3.2% of children 4 weeks to 2 years of age were bacteremic and that the height of the temperature and white blood cell count were valuable predictors of bacteremia. The Teele report initiated a controversy regarding the management of young febrile children that continues today. Despite more than 20 years of research, the essential question remains unchanged—does obtaining a blood culture and initiating expectant therapy with oral or parenteral antibiotics prevent serious sequelae? In this issue of Pediatrics, Kramer and Shapiro2 argue that recently published guidelines for management of febrile children,3 which recommend blood culture and expectant therapy in infants and children with temperatures ≥39°C, are costly, intrusive, and do more harm than good.2 Good clinical practice guidelines have important attributes, including validity, reliability, and scheduled reviews.4 Since the publication of the fever guidelines there have been two developments that may affect their validity. First, there has been a dramatic reduction in the number of cases of meningitis, sepsis, and bacteremia specifically attributable to Haemophilus influenzae type B (Hib).5 The issue of expectant therapy and reduction in morbidity is now largely …

Parental overprotection and its relation to perceived child vulnerability.

A study of 280 parents with a child age 5-10 years examined the relation between and correlates of parental overprotection (less education, younger child age, being an only child) and parental perception of increased child vulnerability (history of life-threatening illness, child medical condition, first child). One-third of parents who considered their child vulnerable were also considered overprotective.

A comparison of the stressors experienced by parents of intubated and non‐intubated children

When children are ill enough to require admission to paediatric intensive care, parents may become distressed about their child's medical condition and this distress may be compounded by the unfamiliar nature of the highly technological environment. Parents of children who are sick enough to warrant intubation are particularly likely to be exposed to a frightening array of technological equipment. Seventy-one parents of intubated and non-intubated children completed the Parental Stressor Scale: Paediatric Intensive Care Unit (PSS:PICU). Overall the findings suggest that parents were most distressed (a) by the painful procedures to which their children were subjected, (b) by the sights and sounds of the intensive care unit and (c) by their children's reactions to intensive care. The behaviour of staff towards parents and the way that staff communicated with them caused the least distress. When the levels of stress reported by parents of intubated children were compared with those reported by parents of non-intubated children, different patterns of stress were found. Painful procedures were a source of greater stress to parents of intubated children whereas the behaviour of staff and the children's reactions to the intensive care experience caused greater stress to the parents of the non-intubated children. In general the findings suggest that the needs of parents of non-intubated children are being overlooked, with staff focusing more of their attention on the parents of intubated children.

Determinants of responsiveness in mothers of children with intraventricular hemorrhage.

Explored relationships between maternal responsiveness and parenting stress, family, medical, and demographic factors in mothers of children born prematurely at very low birth weights with intraventricular hemorrhage. Mothers of 82 2-year-olds completed self-report questionnaires and were observed interacting with their children in free play during a yearly assessment. Path analysis (LISREL) revealed that lower maternal responsiveness, measured by the Parent/Caregiver Involvement Scale, was associated with greater demographic disadvantage and with high parent-related stress on selected subscales of the Parenting Stress Index. Child-related parenting stress was not associated with responsiveness, and severity of the child's medical condition at birth was weakly related. Results are discussed in the context of this unique population, and relevant research and measurement issues.

Perceptions of pediatricians' helpfulness: a national study of mothers of young disabled children.

A national sample of 503 mothers of young children (up to six years of age) with developmental disabilities was surveyed to determine the extent to which their family pediatricians are helpful in providing information and support. The respondents ranged from lower-middle to upper class, with the mean SES reflective of middle socio-economic status. Their children had a variety of disabilities that qualified them to receive early intervention services. The majority of the mothers found their pediatricians helpful about issues related directly to their child's medical condition. However, few found them helpful with issues relating to the effect of the disability on their child's development, or to their own personal or family needs.

Determinants of Home Care Nursing Hours for Technology‐Assisted Children

In the 1980s home care, in contrast to hospital care, was reported substantially to reduce costs for third-party payers who provided funding for technology-assisted children. Savings were realized primarily because parents substituted for nurses, eliminating or reducing those costs. Third-party payers' savings thus were directly related to the number of hours parents assumed care. Because home care relies on parents doing some of the work of nurses, decisions regarding nursing hours must consider family factors in addition to medical factors. We evaluated the number of nursing hours 31 Minnesota families with technology-assisted children received, as well as the factors that determined the allotment of nursing hours. Most families (96.8%) received some hours of nursing hours. Most families (96.8%) received some hours of professional nursing care per day, and 16.1% received 24-hour care. Multiple regression, however, showed that family factors, rather than the child's medical condition, influenced the number of hours, with married, lower-income families with a younger child receiving the fewest. Further discussion and study are recommended to understand more fully the impact family factors have on the allotment of nursing hours and home care costs.