Child9s Age Research Articles

Case-control study of risk of dehydrating diarrhoea in infants in vulnerable period after full weaning.

To investigate risk factors for dehydrating diarrhoea in infants, with special interest in the weaning period. Case-control study. Metropolitan area of Porto Alegre, Brazil. Cases were 192 children aged 0-23 months hospitalised with acute diarrhoea and moderate to severe dehydration. Controls were 192 children matched for age and neighbourhood who did not have diarrhoea in the previous week. Associations between dehydrating diarrhoea and child's age, type of milk consumed, time since breast feeding stopped, and breast feeding status. In infants aged < 12 months the risk of dehydrating diarrhoea was significantly higher in the first 9 months of life (P < 0.001), and in those aged 12-23 months the risk was again greater in younger children (12-17 months) (P = 0.03). The type of milk consumed before start of diarrhoea episode was strongly associated with dehydration independent of socioeconomic, environmental, maternal reproductive, demographic, and health services factors. Compared with infants exclusively breast fed, bottle fed infants were at higher risk (odds ratio (95% confidence interval) for cow's milk 6.0 (1.8 to 19.8), for formula milk 6.9 (1.4 to 33.3)). Compared with those still breast feeding, children who stopped in the previous two months were more likely to develop dehydrating diarrhoea (odds ratio 8.4 (2.4 to 29.6)). This risk decreased with time since breast feeding stopped. These results confirm the protective effect of breast feeding and suggest there is a vulnerable period soon after breast feeding is stopped, which may be of relevance for developing preventive strategies.

Slipped capital femoral epiphysis.

Slipped capital femoral epiphysis is the most common orthopedic hip disorder occurring in adolescence. In this condition, the femoral head (epiphysis) displaces, or slips, on the femoral neck through the region of the growth plate. This may result from traumatic forces acting on a normal growth plate (physis) or from ordinary forces acting on a weakened growth plate. In the latter situation, resistance to shear-type forces within the physis is decreased. This leads to the growth plate giving way when exposed to modest forces, such as running, skipping, or twisting. The femoral head may displace abruptly, analogous to a fracture, and may be exquisitely painful to the patient. Or, the femoral head may displace gradually, maintaining a stable relationship between it and the femoral neck, and may present clinically only as an ache in the groin. Regardless of the clinical presentation, the proper management requires urgent surgical intervention in an effort to avoid further displacement. Thus, early diagnosis is of utmost importance in the management of slipped capital femoral epiphysis. Epidemiology The general incidence of this condition is 1 to 3 per 100 000, with a slightly higher incidence in African-American children. Males are affected twice as often as females. The children are obese (the weight being 2 standard deviations above the mean for the child9s age) in 67% of cases.

The Child Who Has A Limp

A limp is defined generically as any deviation of child9s walking pattern from the expected normal pattern for the child9s age. Limping more commonly is unilateral than bilateral, and its many causes range in severity from malfitting shoes to highly malignant bone tumors. Specific reasons for limping fall into one or more of three categories: pain, weakness, and structural abnormalities. An antalgic gait may be caused by such painful conditions as synovitis of a major weight-bearing joint; infection of bone, joint, or soft tissue; neoplasia; or trauma from such things as repetitive microtrauma, a torn knee cartilage, or a chronic stress fracture. Musclle weakness can result from disuse atrophy or from a neurologic or a primary muscle disease. The structural or mechanical causes include limb length inequality, joint stiffness, and articular surface deformity. The anatomic origin of the limp may be the foot, ankle, leg, knee, thigh, hip, spine, or even the abdomen. It follows, therefore, that a careful and thorough history and physical examination are mandatory for the child who has a limp and that all of theses anatomic areas be evaluated carefully. The history should include the duration of the limp, the child9s or parents9 perception of its site of origin, if possible, and whether pain is associated.

Your child is dead.

OBJECTIVE--To determine parent9s views on how death of their children should have been handled. DESIGN--Retrospective questionnaire survey of parents who had experienced death of their child. SETTING--Charitable organisation of bereaved parents. SUBJECTS--150 bereaved parents, all members of the organisation, of whom 120 (80%) participated voluntarily in the study. MAIN OUTCOME MEASURES--Child9s age; date and cause of death; details of person breaking the news and handling of the interview; time parents spent with dead child, their attitude to requests for organ donation, and follow up support received. RESULTS--122 children9s deaths were described; the largest single group was due to road traffic accidents, 16 were suicides, and eight were murders. Twice as many interviews were rated as sympathetically or reasonably handled as badly or offensively handled (68 v 34). The interview ratings depended on the sensitivity and personal skills of the interviewers rather than on their previous contact or professional position; police were rated as more sympathetic than doctors and nurses. Of 109 respondents, 81 had seen their child9s body, 44 of whom thought that sufficient time had been denied. Of the 28 parents who did not see the body, 17 subsequently stated their regret. In 82 parents organ donation had not been discussed. Only 16 parents recorded any follow up support from hospital staff and very few support at the time. CONCLUSIONS--The consistency of the responses suggests a serious need to revise the in service training and education of the police and health professionals in their approach to informing of death; organ donation should be discussed sensitively and parents allowed time with their dead child with fewer restrictions.

Rheumatic diseases of childhood.

The pediatrician frequently encounters children and adolescents with musculoskeletal complaints that raise the possibility of rheumatic disease. The purposes of this article are: to review an approach to the evaluation of joint symptoms and to review the pharmacology, use, and adverse effects of nonsteroidal anti-inflammatory drugs. RHEUMATOLOGIC HISTORY Systematic collection of the historical details is fundamental in the evaluation of joint complaints (Table 1). Age and Sex The child9s age and sex provide initial clues. For example, suspicion that a young girl (less than 5 years of age) with knee swelling might have monoarticular juvenile rheumatoid arthritis is heightened simply because of her age and sex. (At onset of their disease, almost 20% of all patients with juvenile rheumatoid arthritis are young girls with pauciarthritis, most commonly involving the knee.) Suspicion that an older boy (10 years of age or older) with axioskeletal complaints might have an enthesopathy syndrome is increased, in part, because of age and sex. of the age and sex predilections of various rheumatic conditions is, therefore, helpful. Chief Complaint The chief complaint is often directive. For example, the complaint his knees hurt every night or his legs hurt at night is not characteristic of children who have juvenile rheumatoid arthritis or other well-defined inflammatory arthritides.

Neonatal Circumcision and Penile Problems: An 8-Year Longitudinal Study

The prevalence of penile problems was examined in a birth cohort of more than 500 New Zealand children studied from birth to 8 years of age. By 8 years, circumcised children had a rate of 11.1 problems per 100 children, and uncircumcised children had a rate of 18.8 per 100. The majority of these problems were for penile inflammation including balanitis, meatitis, and inflammation of the prepuce. However, the relationship between risks of penile problems and circumcision status varied with the child9s age. During infancy, circumcised children had a significantly higher risk of problems than uncircumcised children, but after infancy the rate of penile problems was significantly higher among the uncircumcised. These associations were not changed when the results were adjusted statistically for the effects of a series of potentially confounding social and perinatal factors.

Hereditary spastic paraplegia with amyotrophy and pes cavus.

<h3>Purpose</h3> Healthy Steps embeds a developmental specialist in medical primary care offices, offering information, screening, and a helping relationship for families with children aged 0 to 3 years. The purpose of this study is to assess the impact of Healthy Steps on early parenting outcomes in a clinic population. <h3>Methods</h3> Healthy Steps participants surveyed during well-child office visits around child9s age of 2 months. Identical survey administered during well-child office visit to comparison group of infants not enrolled in Healthy Steps, but seen in the same pediatric clinic. Survey was orally administered in either Spanish or English, and assessed demographic information in addition to outcome variables. Outcomes included parent report of safety practices, feeding practices, practices that promote development, and Emergency Room usage. <h3>Results</h3> Healthy Steps participants (n=40) and comparison infants (n=25), all less than 4 months old, were largely Latino with low levels of income, education, and marriage. Healthy Steps participants were significantly more likely to be first-born babies and to have foreign-born mothers. There was a trend toward more babies being put to sleep on their backs and less exposure to cigarette smoke in the Healthy Steps group. Healthy Steps babies were more likely to have initiated breastfeeding, and among those who had ceased breastfeeding, it had lasted an average of one week longer in the Healthy Steps group. However, they were no more likely to be breastfeeding by the time of the survey. Healthy Steps infants were less likely to have already received water, juice, and cereal. Those who had received cereal did so an average of 7 weeks later in the Healthy Steps group. There were no differences in the frequency of reading to, talking to, or cuddling baby; very high percentages in both groups did these things very frequently. Healthy Steps infants were far less likely to have been to a hospital emergency department. <h3>Conclusions</h3> The Healthy Steps program appears to have modest effects on some indicators of infant well-being. Small changes early in life have great potential to improve lives of those most in need.