Discomfort In Children Research Articles

Combined and alternating paracetamol and ibuprofen therapy for febrile children.

Health professionals frequently recommend fever treatment regimens for children that either combine paracetamol and ibuprofen or alternate them. However, there is uncertainty about whether these regimens are better than the use of single agents, and about the adverse effect profile of combination regimens. To assess the effects and side effects of combining paracetamol and ibuprofen, or alternating them on consecutive treatments, compared with monotherapy for treating fever in children. In September 2013, we searched Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; LILACS; and International Pharmaceutical Abstracts (2009-2011). We included randomized controlled trials comparing alternating or combined paracetamol and ibuprofen regimens with monotherapy in children with fever. One review author and two assistants independently screened the searches and applied inclusion criteria. Two authors assessed risk of bias and graded the evidence independently. We conducted separate analyses for different comparison groups (combined therapy versus monotherapy, alternating therapy versus monotherapy, combined therapy versus alternating therapy). Six studies, enrolling 915 participants, are included. Compared to giving a single antipyretic alone, giving combined paracetamol and ibuprofen to febrile children can result in a lower mean temperature at one hour after treatment (MD -0.27 °Celsius, 95% CI -0.45 to -0.08, two trials, 163 participants, moderate quality evidence). If no further antipyretics are given, combined treatment probably also results in a lower mean temperature at four hours (MD -0.70 °Celsius, 95% CI -1.05 to -0.35, two trials, 196 participants, moderate quality evidence), and in fewer children remaining or becoming febrile for at least four hours after treatment (RR 0.08, 95% CI 0.02 to 0.42, two trials, 196 participants, moderate quality evidence). Only one trial assessed a measure of child discomfort (fever associated symptoms at 24 hours and 48 hours), but did not find a significant difference in this measure between the treatment regimens (one trial, 156 participants, evidence quality not graded). In practice, caregivers are often advised to initially give a single agent (paracetamol or ibuprofen), and then give a further dose of the alternative if the child's fever fails to resolve or recurs. Giving alternating treatment in this way may result in a lower mean temperature at one hour after the second dose (MD -0.60 °Celsius, 95% CI -0.94 to -0.26, two trials, 78 participants, low quality evidence), and may also result in fewer children remaining or becoming febrile for up to three hours after it is given (RR 0.25, 95% CI 0.11 to 0.55, two trials, 109 participants, low quality evidence). One trial assessed child discomfort (mean pain scores at 24, 48 and 72 hours), finding that these mean scores were lower, with alternating therapy, despite fewer doses of antipyretic being given overall (one trial, 480 participants, low quality evidence) Only one small trial compared alternating therapy with combined therapy. No statistically significant differences were seen in mean temperature, or the number of febrile children at one, four or six hours (one trial, 40 participants, very low quality evidence). There were no serious adverse events in the trials that were directly attributed to the medications used. There is some evidence that both alternating and combined antipyretic therapy may be more effective at reducing temperatures than monotherapy alone. However, the evidence for improvements in measures of child discomfort remains inconclusive. There is insufficient evidence to know which of combined or alternating therapy might be more beneficial.Future research needs to measure child discomfort using standardized tools, and assess the safety of combined and alternating antipyretic therapy.

Supportive and palliative care of children with metabolic and neurological diseases.

To review the role of pediatric palliative care (PPC) for children with metabolic and neurological diseases. There is a growing body of literature in PPC, though it remains limited for children with metabolic and neurological diseases. Evidence indicates the benefit of PPC. Utilization of PPC programmes can facilitate communication, ensure that families are better informed, improve certainty with decisions, enhance positive emotions, result in fewer invasive interventions at the end of life, and have an impact on location of death. Barriers to utilization of PPC include concern about taking away hope and uncertainty about prognosis. Challenging areas for children with metabolic and neurological diseases include the identification of distressing symptoms and prognostic uncertainty. This article aims to review literature relevant to this group of children, as well as provide a framework when considering specific palliative care needs. PPC for children with metabolic and neurological diseases can lessen a child's physical discomfort and enhance parental certainty with decision-making. These areas along with other needs throughout the illness trajectory and bereavement are being increasingly met by the growing availability of PPC programmes.

Postoperative Discomfort of Dental Rehabilitation under General Anesthesia

To find out postoperative discomfort in children undergoing dental rehabilitation under general anesthesia (DRGA). This study involved 78 (4 to 10 year-old) healthy patients who were scheduled for DRGA and were needed extensive dental treatment because of severe caries, and showed high dental fear and/or behavioral management problems. The children had to be fit for DRGA administration by fulfilling the American Society of Anesthesiologists physical status I or II and no associated mental health or communication problems. Data were collected by structured interview either face to face (immediately post operation) or using a telephone (post operation after discharge). One of the study's investigators recorded all data related to the immediate postoperative period during the child's stay in the post-anesthesia care unit (PACU). The questionnaire consisted of questions related to postoperative problems experienced by the patient in the period after their day-stay attendance. The questionnaire, consisting of questions regarding and generally related to the child's activities. In addition, pain was assessed using the face, legs, activity, cry, consolability (FLACC) scale. The prevalence of postoperative problems was 46 out of 78 (59%). The mean FLACC score was 1.8 (SD=2.1). Some of the patients having more than one reported problem. Forty-one percent of the children showed nasal discomfort (P<0.01). Thirty-three percent and 43% of the children experienced throat or mouth discomfort. The most common experienced postoperative symptom after DRGA was bleeding. Nasal bleeding, however, was an uncommon complication and did not cause serious morbidity or mortality in children intubated nasotracheally. In addition, postoperative discomfort was related to number of the extractions. Children who had 4 or more extractions were more likely to experience pain. Findings associated with other bodily functions were assessed. Nausea and vomiting were reported in 20.5% of children. Twenty-six children (18%) had a fever. Thirty-nine (50.0%) parents reported that their children had problems eating. Post-operative discomfort was more with 4 or more extraction done under DRGA and that nasal bleeding was noted a uncommon post-operative symptom.

Screening preschool children with toothache: validation of the Brazilian version of the Dental Discomfort Questionnaire.

BackgroundThe Dental Discomfort Questionnaire (DDQ) is an observational instrument intended to measure dental discomfort and/or pain in children under 5 years of age. This study aimed to validate a previously cross-culturally adapted version of DDQ in a Brazilian children sample.MethodsParticipants included 263 children (58.6% boys, mean age 43.5 months) that underwent a dental examination to assess dental caries, and their parent that filled out the cross-culturally adapted DDQ on their behalf. Exploratory factor analysis (principal component analysis form) and psychometric tests were done to assess instrument’s dimensionality and reliability.ResultsExploratory factor analysis revealed a multidimensional instrument with 3 domains: ‘eating and sleeping problems’ (Cronbach’s alpha 0.81), ‘earache problems’ (alpha 0.75), and ‘problems with brushing teeth’ (alpha 0.78). The assessment had excellent stability (weighted-kappa varying from 0.68 to 0.97). Based on the factor analysis, the model with all 7 items included only in the first domain (named DDQ-B) was further explored. The items and total median score of the DDQ-B were related to parent-reported toothache and the number of decayed teeth, demonstrating good construct and discriminant validities.ConclusionsDDQ-B was proven a reliable pain assessment tool to screen this group of Brazilian children for caries-related toothache, with good psychometric properties.

Effects of Therapeutic Suggestion Under Anesthesia on Outcomes in Children Post Tonsillectomy

Tonsillectomy causes discomfort in children. Positive therapeutic suggestions (TS) may be given to patients while they are emerging from general anesthesia as a potential tool to decrease distress. This study examined impact of TS on outcomes, when delivered to children emerging from general anesthesia post tonsillectomy. A double blinded randomized controlled trial was conducted with 94 patient/parent pairs. TS and noise recordings were played via headphones post tonsillectomy upon arrival to the Post Anesthesia Care Unit until the child showed signs of waking. Pain scores at 30 minutes post extubation show significantly lower pain in the TS group, P = .04 (Mann Whitney U for independent samples). The TS group had 70% increased likelihood of receiving less intravenous (IV) opioid. TS may help lower pain in children post tonsillectomy and decrease demand for IV opioid pain management in the 4- to 8-year-old tonsillectomy population.

Quantitative Assessment of Cortical Auditory-tactile Processing in Children with Disabilities

Objective and easy measurement of sensory processing is extremely difficult in nonverbal or vulnerable pediatric patients. We developed a new methodology to quantitatively assess children's cortical processing of light touch, speech sounds and the multisensory processing of the 2 stimuli, without requiring active subject participation or causing children discomfort. To accomplish this we developed a dual channel, time and strength calibrated air puff stimulator that allows both tactile stimulation and sham control. We combined this with the use of event-related potential methodology to allow for high temporal resolution of signals from the primary and secondary somatosensory cortices as well as higher order processing. This methodology also allowed us to measure a multisensory response to auditory-tactile stimulation.

Combined and alternating paracetamol and ibuprofen therapy for febrile children.

Health professionals frequently recommend fever treatment regimens for children that either combine paracetamol and ibuprofen or alternate them. However, there is uncertainty about whether these regimens are better than the use of single agents, and about the adverse effect profile of combination regimens. To assess the effects and side effects of combining paracetamol and ibuprofen, or alternating them on consecutive treatments, compared with monotherapy for treating fever in children. In September 2013, we searched Cochrane Infectious Diseases Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; LILACS; and International Pharmaceutical Abstracts (2009-2011). We included randomized controlled trials comparing alternating or combined paracetamol and ibuprofen regimens with monotherapy in children with fever. One review author and two assistants independently screened the searches and applied inclusion criteria. Two authors assessed risk of bias and graded the evidence independently. We conducted separate analyses for different comparison groups (combined therapy versus monotherapy, alternating therapy versus monotherapy, combined therapy versus alternating therapy). Six studies, enrolling 915 participants, are included.Compared to giving a single antipyretic alone, giving combined paracetamol and ibuprofen to febrile children can result in a lower mean temperature at one hour after treatment (MD -0.27 °Celsius, 95% CI -0.45 to -0.08, two trials, 163 participants, moderate quality evidence). If no further antipyretics are given, combined treatment probably also results in a lower mean temperature at four hours (MD -0.70 °Celsius, 95% CI -1.05 to -0.35, two trials, 196 participants, moderate quality evidence), and in fewer children remaining or becoming febrile for at least four hours after treatment (RR 0.08, 95% CI 0.02 to 0.42, two trials, 196 participants, moderate quality evidence). Only one trial assessed a measure of child discomfort (fever associated symptoms at 24 hours and 48 hours), but did not find a significant difference in this measure between the treatment regimens (one trial, 156 participants, evidence quality not graded).In practice, caregivers are often advised to initially give a single agent (paracetamol or ibuprofen), and then give a further dose of the alternative if the child's fever fails to resolve or recurs. Giving alternating treatment in this way may result in a lower mean temperature at one hour after the second dose (MD -0.60 °Celsius, 95% CI -0.94 to -0.26, two trials, 78 participants, low quality evidence), and may also result in fewer children remaining or becoming febrile for up to three hours after it is given (RR 0.25, 95% CI 0.11 to 0.55, two trials, 109 participants, low quality evidence). One trial assessed child discomfort (mean pain scores at 24, 48 and 72 hours), finding that these mean scores were lower, with alternating therapy, despite fewer doses of antipyretic being given overall (one trial, 480 participants, low quality evidence)Only one small trial compared alternating therapy with combined therapy. No statistically significant differences were seen in mean temperature, or the number of febrile children at one, four or six hours (one trial, 40 participants, very low quality evidence).There were no serious adverse events in the trials that were directly attributed to the medications used. There is some evidence that both alternating and combined antipyretic therapy may be more effective at reducing temperatures than monotherapy alone. However, the evidence for improvements in measures of child discomfort remains inconclusive. There is insufficient evidence to know which of combined or alternating therapy might be more beneficial.Future research needs to measure child discomfort using standardized tools, and assess the safety of combined and alternating antipyretic therapy.

FAMILY PSYCHOLOGICAL SUPPORT DURING THE CHILD’S INPATIENT TREATMENT (BY THE EXAMPLE OF AN UROANDROLOGY DEPARTMENT)

научный биометрический журнал, который знакомит читателя с клиническими рекомендациями и особенностями применения лекарственных и вакцинных средств у детей, предоставляет исчерпывающую информацию о воздействии лекарственных средств на плод, о проводимых в

INTERRUPTER RESISTANCE IN PRESCHOOL CHILDREN: CLINICAL UTILITY IN ASTHMA MANAGEMENT

Asthma is the most common chronic disease affecting children in industrialized countries but it is greatly underdiagnosed in preschool children. In these patients, who are not able to collaborate in the execution of spirometry tests, it is possible to use interrupter resistance (Rint) technique. The aim of our study is to assess Rint utility in asthma management when integrated with clinical evaluation in preschool children. Data from 35 preschool children with recurrent wheezing and/or cough were collected. Case history, physical examination, in vitro and in vivo allergy testing were investigated. According to the presence or absence of symptoms in intercritical period they were divided into two groups, asymptomatic (A) and symptomatic (B). To assess respiratory function we used baseline and post-bronchodilator Rint. In group A (asymptomatic) baseline Rint was normal in 78,9% of children and increased in 21,1%. After bronchodilator (BD) administration there was a significant response in 52,6% of patients. In group B (symptomatic) baseline Rint was normal in 81,3% of children and increased in 18,7%. After bronchodilator administration there was a significant response in 56,3% of patients. Our results confirm that baseline Rint cannot be used to discriminate between healthy and sick children, therefore it is necessary to perform this test after administration of BD. In our patients, a significant response to BD permitted to objectify the discomfort of symptomatic children and to report a state of subclinical bronchial obstruction and/or bad perceptions of the severity of bronchospasm in asymptomatic ones, allowing to confirm previous therapeutic choices in some cases and to suggest different therapeutic strategies in others. Therefore, bronchodilator response measured by Rint should be systematically studied and further assessed in conjunction with clinical outcomes, in order to implement asthma management in children unable to produce reliable spirometry.

Development and Validation of a Thermal Discomfort Scale in Febrile Children During Sponging

Objectives: • To Develop and validate a scale to measure the thermal discomfort in febrile children undergoing sponging. • To Compare the thermal discomfort among febrile children undergoing either warm sponging or tepid sponging Materials and Method: This study consisted of two steps i.e preparation of a Thermal scale and the application of the scale to compare the thermal discomfort in a sample of febrile children undergoing either warm sponging or tepid sponging. It was conducted in two Phases. Qualitative approach for the preparation of scaleaQuantitative approach to compare the thermal discomfort. Result: The reliability of the instrument was estimated by Internal Consistency Reliability; Chronbach's alpha = 0.7534 ? 0.8, The result showed that this scale has an Ideal Reliability index of 0.8. There was significant difference between the discomfort scores of warm spongingatepid sponging (MW-U - 6381.50, P 0.0001) Conclusion: Thermal discomfort scale developed as a composite outcome and it can be utilized in clinical setting to measure the thermal discomfort in children. The also revealed that warm sponging is better than tepid sponging in reducing thermal discomfort in children.

Children's Discomfort during Noninvasive Cardiac Output Monitoring by Suprasternal Ultrasonographic Transducer

Objectives To investigate the level of discomfort/pain in children receiving Ultrasonic Cardiac Output Monitoring (USCOM), as compared to blood pressure measurement. Methods Healthy children, aged 3-12 years old, were recruited from kindergartens and schools as a part of the “Healthy children's vital signs and USCOM values” project. Oscillometric blood pressure was measured, followed by USCOM measurement. The discomfort experienced by the child during each intervention was assessed using the Wong-Baker FACES pain rating scale. The pain scores (scale from 0-5) were compared using Wilcoxon signed rank test. A difference in score of one point was considered to be clinically relevant. Gender differences in pain score were analysed using Mann-Whitney-U test. Results A total of 254 subjects (131 boys, 123 girls) were included. Mean age was 7.9 years with standard deviation (SD) of 2.4 years. The median pain score for USCOM measurement was 1.0 (95% CI=1.0 to 2.0) with interquartile range 1.0 to 2.0. The median pain score for BP measurement was 1.0 (95% CI,=1.0 to 1.0) with interquartile range 0.0 to 2.0. Overall, the pain score associated with USCOM was significantly higher than that associated with BP measurement. However, the difference fails to reach the minimum clinically significant difference of one-point. No significant difference was shown between boys and girls. Conclusion USCOM appears to be tolerated well by healthy children. The discomfort reported during USCOM measurement is comparable to that associated with blood pressure measurements.

Improving comfort in children with severe neurological impairment

Physical discomfort is a frequent and significant problem for children with severe neurological impairment (SNI) of the central nervous system. Such children have various problems that can result in discomfort, including spasticity, muscle spasms, and autonomic dysfunction. Children with SNI also have a significant rate of pain, and pain can trigger and worsen these other problems. It can seem a daunting task to determine the primary cause of discomfort given the overlap in features seen with each problem. There is the added challenge of a non-verbal population unable to indicate symptoms. Knowledge of sources of discomfort can help guide a step-wise approach to empiric treatment. The goal of this article is to provide an evidence-based framework for approaching symptom treatment in a population vulnerable to under-recognition and under-treatment of discomfort. Interventions include integrative therapies and medications, such as gabapentinoids, tricyclic antidepressants, alpha-agonists, and opioids including methadone. Awareness of potential sources of discomfort in children with SNI and the interventions available will expand our ability to improve comfort in this vulnerable group of children.

INTERRUPTER RESISTANCE IN PRESCHOOL CHILDREN: CLINICAL UTILITY IN ASTHMA MANAGEMENT

Asthma is the most common chronic disease affecting children in industrialized countries but it is greatly underdiagnosed in preschool children. In these patients, who are not able to collaborate in the execution of spirometry tests, it is possible to use interrupter resistance (Rint) technique. The aim of our study is to assess Rint utility in asthma management when integrated with clinical evaluation in preschool children. Data from 35 preschool children with recurrent wheezing and/or cough were collected. Case history, physical examination, in vitro and in vivo allergy testing were investigated. According to the presence or absence of symptoms in intercritical period they were divided into two groups, asymptomatic (A) and symptomatic (B). To assess respiratory function we used baseline and post-bronchodilator Rint. In group A (asymptomatic) baseline Rint was normal in 78,9% of children and increased in 21,1%. After bronchodilator (BD) administration there was a significant response in 52,6% of patients. In group B (symptomatic) baseline Rint was normal in 81,3% of children and increased in 18,7%. After bronchodilator administration there was a significant response in 56,3% of patients. Our results confirm that baseline Rint cannot be used to discriminate between healthy and sick children, therefore it is necessary to perform this test after administration of BD. In our patients, a significant response to BD permitted to objectify the discomfort of symptomatic children and to report a state of subclinical bronchial obstruction and/or bad perceptions of the severity of bronchospasm in asymptomatic ones, allowing to confirm previous therapeutic choices in some cases and to suggest different therapeutic strategies in others. Therefore, bronchodilator response measured by Rint should be systematically studied and further assessed in conjunction with clinical outcomes, in order to implement asthma management in children unable to produce reliable spirometry.

INTERRUPTER RESISTANCE IN PRESCHOOL CHILDREN: CLINICAL UTILITY IN ASTHMA MANAGEMENT

Asthma is the most common chronic disease affecting children in industrialized countries but it is greatly underdiagnosed in preschool children. In these patients, who are not able to collaborate in the execution of spirometry tests, it is possible to use interrupter resistance (Rint) technique. The aim of our study is to assess Rint utility in asthma management when integrated with clinical evaluation in preschool children. Data from 35 preschool children with recurrent wheezing and/or cough were collected. Case history, physical examination, in vitro and in vivo allergy testing were investigated. According to the presence or absence of symptoms in intercritical period they were divided into two groups, asymptomatic (A) and symptomatic (B). To assess respiratory function we used baseline and post-bronchodilator Rint. In group A (asymptomatic) baseline Rint was normal in 78,9% of children and increased in 21,1%. After bronchodilator (BD) administration there was a significant response in 52,6% of patients. In group B (symptomatic) baseline Rint was normal in 81,3% of children and increased in 18,7%. After bronchodilator administration there was a significant response in 56,3% of patients. Our results confirm that baseline Rint cannot be used to discriminate between healthy and sick children, therefore it is necessary to perform this test after administration of BD. In our patients, a significant response to BD permitted to objectify the discomfort of symptomatic children and to report a state of subclinical bronchial obstruction and/or bad perceptions of the severity of bronchospasm in asymptomatic ones, allowing to confirm previous therapeutic choices in some cases and to suggest different therapeutic strategies in others. Therefore, bronchodilator response measured by Rint should be systematically studied and further assessed in conjunction with clinical outcomes, in order to implement asthma management in children unable to produce reliable spirometry.

Children's discomfort in assessments using different methods for approximal caries detection

Because discomfort caused by different approximal caries detection methods can influence their performance, the assessment of this discomfort is important. Thus, this study aimed to evaluate the discomfort reported by children after the use of different diagnostic methods to detect approximal caries lesions in primary teeth: visual inspection, bitewing radiography, laser fluorescence (DIAGNOdent pen - LFpen) and temporary separation with orthodontic rubbers. Seventy-six children aged 4 to 12 years were examined using these methods. Their discomfort was assessed using the Wong-Baker scale and compared among the methods. Visual inspection caused less discomfort than did other methods. Radiography and the LFpen presented similar levels of discomfort. Older children reported higher discomfort using temporary separation, whereas younger children reported less discomfort with the LFpen. In conclusion, radiographic, temporary separation and LFpen methods provoke higher discomfort than visual inspection.

The effect of SonoPrep® on EMLA® cream application for pain relief prior to intravenous cannulation

The aim the study was to determine the effect of SonoPrep® on the delivery and analgesic effects of EMLA® cream prior to intravenous (iv) cannulation in a tertiary pediatric emergency department. Children aged between 5 and 10years were enrolled. Patients were randomized to receive either sonophoresis with SonoPrep® or sham sonophoresis followed by application of EMLA® cream for 5min prior to iv cannulation. The primary outcome measurement was the child's rating of pain immediately after iv placement, using a 10-cm visual analog scale (VAS). Parents or guardians and blinded researchers were additionally asked to rate their perception of the child's pain using the 10-cm VAS and the Wong-Baker Face scale. A total of 42 patients completed the study (21 in the study group, 21 in the control group). The baseline characteristics between the groups were similar. The VAS pain score was significantly lower in children treated with sonophoresis compared with the sham sonophoresis (median (percentiles 25th-75th), 20.0 (10.0-22.5) vs. 60.0 (31.0-87.5); p < 0.001). The parent's perception of the child's pain was significantly lower in the study group vs. the control group by the VAS (median (percentiles 25th-75th), 10.0 (10.0-20.0) vs. 50.0 (15.0-80.0); p < 0.001) and Wong-Baker Face scale (median (percentiles 25th-75th), 2.0 (2.0-2.0) vs. 4.0 (2.5-4.5); p < 0.001). The researcher's evaluation of the child's discomfort was also significantly lower in the study group (2.0 (1.0-3.0) vs. 4.0 (2.5-4.5); p < 0.001). The application of sonophoresis using SonoPrep® followed by the 5-min application of EMLA® cream showed significant benefit in young children in terms of pain reduction and patient satisfaction.

Efficacy and safety of a lidocaine/tetracaine medicated patch or peel for dermatologic procedures: a meta-analysis

BackgroundTo justify the use of the lidocaine/tetracaine medicated patch or peel as a preventive treatment for reducing pain and discomfort in adults and children. We reviewed randomized controlled trials (RCTs) to evaluate the efficacy and safety of the lidocaine/tetracaine medicated patch or peel compared with placebo.MethodsTen RCTs (574 patients) were included in this systemic review. Relevant studies were identified through searches of MEDLINE, SCOPUS and the Cochrane database library. The outcome was the adequacy of cutaneous anesthesia reflected in the patient's assessment of pain intensity during minor dermatologic procedures and adverse effects after application of the lidocaine/tetracaine medicated patch or peel versus placebo.ResultsThe efficacy of the lidocaine/tetracaine patch or peel was consistently very significantly beneficial 30 or 60 minutes after the application compared to placebo (Relative risk, RR: 2.5; Number needed to treat, NNT: 2.2). We did not identify any difference in the effectiveness of adequate analgesia between the lidocaine/tetracaine patch and peel (the number needed to treat or to harm, NNT 2.4 vs. 2.0). No serious side effects or adverse events were observed with the lidocaine/tetracaine medicated patch or peel and placebo. Minor skin reactions were transient and resolved without treatment (Odd ratio, OR: 1.4 and 95% confidence interval, CI: 0.9-2.1; NNT: 14.9).ConclusionsThe lidocaine/tetracaine medicated patch or peel is a well accepted, effective and safe method for minor dermatologic procedures based on pooled data of trials in terms of adequacy of cutaneous anesthesia and adverse effects.

Cognitive-behavioral treatment of persistent functional somatic complaints and pediatric anxiety: an initial controlled trial.

Children and adolescents who seek medical treatment for persistent physical distress often suffer from co-occurring anxiety disorders. Treatment options for this impaired population are limited. This study tests the feasibility and potential efficacy of a cognitive-behavioral intervention targeting pain and anxiety for youth with impairing functional physical symptoms and anxiety disorders presenting to pediatricians for medical care. Children and adolescents (aged 8-16) experiencing somatic complaints, without an explanatory medical disorder (i.e., functional), were recruited from primary care and specialty (gastroenterologists and cardiologists) pediatricians. Forty children, primarily with gastrointestinal symptoms, who met criteria for a co-occurring anxiety disorder, were randomly assigned to a cognitive-behavioral treatment addressing pain and anxiety, Treatment of Anxiety and Physical Symptoms (TAPS), or to a waiting list control. TAPS was found to be an acceptable treatment for this population and was superior to the waiting list condition. Eighty percent of children in TAPS were rated as treatment responders by independent evaluators compared with none of the controls. Overall, self- and parent ratings indicated reductions in children's somatic discomfort and anxiety following intervention. TAPS participants maintained clinical gains 3 months following treatment. The study supports the feasibility and preliminary efficacy of a cognitive-behavioral intervention targeting co-occurring physical distress and anxiety in youth presenting for medical treatment. Such an approach has the potential to exert broad impact on children's dysfunction and to minimize exposure to invasive, ineffective, and costly medical procedures and treatments.

The pattern of electronic game use and related bodily discomfort in Hong Kong primary school children

The present study examined the usage pattern of electronic game devices among primary school children in Hong Kong. Commonly used types of games devices were grouped into three main categories: large-screen/TV-based games, small handheld game devices and active game devices. A survey was conducted among 476 students in a local primary school, with 258 males and 205 females in the age range of 8–13. A self-reported questionnaire was administered at the school and students reported on the frequency and duration of play with eight types of common electronic game devices in the past month and any bodily discomforts associated with this activity. The results showed that use of several game devices (as many as 3–5 types) were common, with about 40% of the respondents being weekly users and 18% daily users. The design of the different electronic game controllers may affect the postures and muscle loading in the body in different ways, and prolonged exposure can lead to musculoskeletal symptoms. Nearly one third of the respondents (28.9%) reported some bodily discomfort associated with electronic game use. Neck discomfort was most commonly reported, followed by shoulders and fingers. Use of more than 2 h daily of small-screen handheld game devices significantly increased the risk of developing bodily discomfort in any region with an odds ratio of 4.75. The present results have highlighted the importance of monitoring primary school children’s exposure to electronic games, especially with small handheld devices, as this may have adverse effect on their musculoskeletal health.

A proposal to limit otoscopy to reduce unnecessary use of antibiotics: a call for research

Acute otitis media (AOM) is the most common bacterial infection in childhood, accounting for more than 10 million prescriptions written in the USA alone. Otoscopy is the only method to diagnose AOM, is difficult to perform in young children and has been found to be inaccurate. Otoscopy has certain risks, the most common of which are child discomfort, trauma to the external ear canal and parental anxiety. Current guidelines emphasize the importance of making an accurate diagnosis of AOM, which includes the presence of fever, otalgia or both. We propose a new strategy to limit the use of otoscopy to circumstances in which the pretest probability of AOM is high. We suggest indications for mandatory otoscopy and a flow chart outlining a proposal for limiting otoscopy in the management of AOM. Clinical research evaluating the rational use of otoscopy is encouraged to evaluate outcomes and acceptance of this proposal. Limiting otoscopy to clinical conditions in which the likelihood of AOM is high may reduce unnecessary pain and anxiety associated with the procedure, reduce rates of misdiagnosis and support the more judicious use of antibiotics.