Clinical Treatment Of Children Research Articles

Research Progress on Integrated Chinese and Western Medicine Treatment of Tourette Syndrome in Children

Tourette syndrome is a common neuropsychiatric disorder that affects the physical and mental health of children. Early detection, diagnosis, and treatment are crucial to prevent serious impacts on the affected children, their families, and society. In recent years, there has been an increasing trend towards using a combination of methods in the clinical treatment of children with Tourette syndrome. This approach has achieved remarkable results, leading to a reduction in the rate of Tourette syndrome symptoms in children. In recent years, a combination of clinical methods has been used to treat children with Tourette syndrome, resulting in significant improvement in control rates. This article reviews the etiology of infantile Tourette syndrome and the progress made in Chinese and Western medicine treatments, providing a reference for further treatment of the condition.

Assessing the Impact of Electrosuit Therapy on Cerebral Palsy: A Study on the Users' Satisfaction and Potential Efficacy.

The aim of this study is to evaluate the effectiveness of electrosuit therapy in the clinical treatment of children with Cerebral Palsy, focusing on the effect of the therapy on spasticity and trunk control. Moreover, the compliance of caregivers with respect to the use of the tool was investigated. During the period ranging from 2019 to 2022, a total of 26 children (18 M and 8 F), clinically stable and affected by CP and attending the Neurorehabilitation Unit of the "Padre Pio Foundation and Rehabilitation Centers", were enrolled in this study. A subset of 12 patients bought or rented the device; thus, they received the administration of the EMS-based therapy for one month, whereas the others received only one-hour training to evaluate the feasibility (by the caregivers) and short-term effects. The Gross Motor Function Classification System was utilized to evaluate gross motor functions and to classify the study sample, while the MAS and the LSS were employed to assess the outcomes of the EMS-based therapy. Moreover, between 80% and 90% of the study sample were satisfied with the safety, ease of use, comfort, adjustment, and after-sales service. Following a single session of electrical stimulation with EMS, patients exhibited a statistically significant enhancement in trunk control. For those who continued this study, the subscale of the QUEST with the best score was adaptability (0.74 ± 0.85), followed by competence (0.67 ± 0.70) and self-esteem (0.59 ± 0.60). This study investigates the impact of the employment of the EMS on CP children's ability to maintain trunk control. Specifically, after undergoing a single EMS session, LSS showed a discernible improvement in children's trunk control. In addition, the QUEST and the PIADS questionnaires demonstrated a good acceptability and satisfaction of the garment by the patients and the caregivers.

Analysis of clinical drug use and construction of pharmacy service model for children with Kawasaki disease based on integration concept

ObjectiveThis study aimed to summarize and share the experience of clinical pharmacists in the clinical treatment of children with Kawasaki disease based on the “integration” concept. MethodsClinical pharmacists were actively involved in the treatment of children with Kawasaki disease by providing rational drug selection, adjustment advice, and pharmacological monitoring services. Hence, we proposed a pharmacy service model for children with Kawasaki disease based on the “integration” concept. ResultsThe pharmacy service model based on the “integration” concept was initially developed by applying integration perception to clinical medication practice, allowing the clinical pharmacist to assist the clinician in controlling the infection in children, and children were discharged from the hospital in good condition. ConclusionClinical pharmacists should initiate cooperation with the treatment team in clinical work and use their professional advantages to ensure that sick children meet the expectations in the medication treatment process to play a crucial role in clinical pharmacy services.

Efficacy of three different budesonide treatments in Chinese preschool children with recurrent wheezing

To explore and compare the clinical control of three atomized inhalation budesonide (BUD) regimens for Chinese preschool children with recurrent wheezing using Test for Respiratory and Asthma Control (TRACK) scores. A total of 474 preschool children with positive Modified Asthma Predictive Index (mAPI) were randomly assigned to a daily group (initially given inhaled BUD 1 mg once a day and assessed every 4 weeks; if symptom were well controlled for 12 weeks, the dose was reduced to 25–50% of the previous dose until afinal dose of 0.25 mg once a day, maintained until 52 weeks), an intermittent high-dose group (1 mg twice daily for 7 days starting early during a predefined respiratory tract illness) and an intermittent medium-dose group (0.5 mg twice daily as soon as they contacted allergens or experienced nasal congestion, a runny nose, cough or other suspicious respiratory symptoms and continuing until symptoms were reduced or risk factors were absent for 3 days) for 52 weeks of treatment. The TRACK questionnaire was administered every 4 weeks. When TRACK scores were ≥ 80, symptoms were considered to be controlled. The average TRACK scores of the three groups after treatment were significantly higher than those before treatment (P < 0.001). There were no significant differences in the average TRACK scores and control rate after treatment at every 4 weeks in the three groups (P > 0.05). Te number of systemic glucocorticoid courses, urgent care visits for wheezing, and wheezing episodes before and after treatment were significantly different within each of the three groups (P < 0.001), but not among the three groups (P > 0.05). In clinical treatment of children, one of the three treatment options can be selected according to the specific situation case of mAPI- positive recurrent wheezing children.

Speckle Noise Algorithm-Based Ultrasound Imaging in Evaluating the Therapeutic Effect of Blood Purification on Children with Kidney Failure and Analysis of Its Correlation with Serum Inflammatory Factor Levels.

The study focused on the therapeutic effect of clinical treatment on urinary calculi with kidney failure and its relationship with the serum inflammatory factor levels. 90 children with melamine urinary calculi were selected as research subjects. Of them, 52 cases were in group 1 (nonrenal failure), and 38 cases were in group 2 (combined with renal failure). In addition, 35 hospitalized children with no history of melamine-contaminated milk feeding during the same period were used as healthy controls. They all underwent ultrasound imaging examination based on the speckle noise algorithm, and the prognosis was analyzed. It was found that the peak signal-to-noise ratio (PSNR), structural similarity (SSIM), and local edge preservation index (EPI) of the algorithm in this study were significantly greater than other algorithms (P < 0.05). The admission age of the children in group 1 was significantly younger than that of group 2, the bilateral stone rate was significantly higher than that in group 2, and the difference was statistically significant (P < 0.05). Of the 52 children in group 1, the stone disappeared in 25 cases after treatment, the stone was reduced in 20 cases, and the stone remained unchanged in 7 cases. The total effective rate of treatment was 88.46%. Of the 38 cases in group 2, the stone disappeared in 22 cases after treatment, the stone was reduced in 12 cases, and the stone remained unchanged in 4 cases. The total effective rate of treatment was 89.47%. No difference was noted in blood urea nitrogen (BUN), blood creatinine (Cr), TNF-α, and C-reactive protein (CRP) levels in group 1, group 2, and the healthy control group (P > 0.05). Hence, the denoising algorithm in this study has better denoising effects on ultrasound images than traditional algorithms, with higher definition and less noise and artifacts. The clinical treatment of children with urinary calculi and renal failure is highly effective, the renal function and serum inflammatory factor levels return to the normal range, and the inflammatory response is weakened.

Application Value of Combined Diagnosis of Ultrasound, MRI, and X-Ray in Developmental Dysplasia of the Hip in Children.

Objective To explore the application value of the combined diagnosis of ultrasound, MRI, and X-ray in developmental dysplasia of the hip (DDH) in children. Methods Ninety children with suspected DDH admitted to our hospital from June 2017 to June 2020 were selected as the research objects to conduct a retrospective study. According to the age of the children, they were divided into a group with 0–6 months (group X), a group with 7–12 months (group Y), and a group older than 12 months (group Z), with 30 cases in each group. X-ray and high-frequency ultrasound were performed in all groups, and MRI examination was added to the children in groups Y and Z to compare the diagnostic value of the three imaging examinations in DDH children. Results No obvious differences in the general data and maternal risk factors were observed among the three groups (P < 0.05). The final comprehensive diagnostic results were taken as the gold standard, including 23 cases with acetabular dysplasia, 28 cases with subluxation of the femoral head, 31 cases with complete dislocation of the femoral head, and 8 non-DDH cases. The diagnostic accuracy of the three methods from high to low was MRI, high-frequency ultrasound, and X-ray, with obviously higher diagnostic accuracy of MRI than that of X-ray (P < 0.05). The ROC curves showed that the diagnostic efficacy from high to low was MRI + high-frequency ultrasound + X-ray, high-frequency ultrasound + X-ray, MRI, high-frequency ultrasound, and X-ray. Conclusion Ultrasound combined with X-ray has obvious advantages in the diagnosis of children at low months of age, while MRI has outstanding advantages in the diagnosis of children at high months of age. MRI combined with ultrasound and X-ray can significantly improve the diagnostic accuracy of DDH and provide objective data support for the clinical treatment of children.

Status and Safety Signals of Cephalosporins in Children: A Spontaneous Reporting Database Study.

Introduction: Cephalosporins are widely used in clinical treatment of children, but it is difficult to carry out clinical trials and there is no strong evidence of their safety. Therefore, adverse drug reactions (ADR) of cephalosporins can be a public health problem that deserves attention. Methods: ADR reports collected by the Hubei Adverse Drug Reaction Monitoring Center from 2014 to 2019 were analysed. The safety of Cephalosporins was described by descriptive analysis and three signal mining methods, including the reporting odd ratio (ROR), proportional reporting ratio (PRR), and comprehensive standard method (MHRA). Results: The findings indicated that the age groups of 0–1 and 2–3 years had the highest rates of reporting ADRs. Children aged 0–4 years reported more ADRs, while the proportion of severe ADRs was lower than the average (6.63%). Among the 37 cephalosporins, the severe ADRs of ceftezole, ceftazidime, cefoperazone/sulbactam, cefotaxime, ceftriaxone were reported more and the proportion of severe ADRs was higher. The proportion of severe ADRs of most cephalosporin compound preparations was higher than that of corresponding single components. A total of 99.18% of the cases improved after treatment. There were four deaths whose ADRs were mainly anaphylactic shock, dyspnoea, and anaphylactoid reaction. In signal mining, the three methods produced 206 signals that were the same, and 73 of them were off-label ADRs. Conclusion: ADRs were common but not serious in children aged 0–4 years. And the reported rate of serious ADRs in children aged over 4 years increased with age. ADR reports of ceftezole, ceftazidime, cefoperazone/sulbactam, cefotaxime, ceftriaxone were numerous and serious, and the safety of cephalosporin compound preparations in children was doubtful. Ceftezole may cause off-label ADRs including tremor, face oedema, cyanosis, pallor, rigors, and palpitation. The labeling of ADRs in children in cephalosporin instructions and the record of allergic history need to be improved.

Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020).

Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020).

Clinical Observation of the Effect of Erbium-Doped Yttrium Aluminium Garnet Laser on the Treatment of Pit and Fissure in Children

To apply erbium-doped yttrium aluminium garnet laser to the closure of young permanent teeth and pits, compare the total retention rate of sealants, and discuss whether erbium-doped yttrium aluminium garnet laser is suitable for clinical treatment in children. Sixty children with 6-9 y old and bilateral mandibular first molars with complicated sulcus were randomly divided into two groups: A and B. The self-half control method was used: group A children’s control side test teeth application of corundum The enamel was performed by enamel, acid etching, coating pit and fissure sealant, erbium-doped yttrium aluminium garnet laser enameloplasty was applied to the contralateral test teeth and pit and fissure sealant was applied; group B children’s control side test teeth were treated with group A. The contralateral test teeth were treated with erbium-doped yttrium aluminium garnet laser enameloplasty, acid etching, and coating pit and fissure sealant. The children were scored for treatment after surgery, and regular follow-up was performed to observe the retention of the sealant. 63.3 % of the children tested were willing to take the initiative to choose laser treatment. At the 3rd and 6th mo of follow-up, there was no significant difference in the total retention rate of the two groups of sealants (p>0.05); at the 12th and 18th mos of followup, the total retention rate of the sealant materials: laser+etchant group>traditional bur. The difference between the needle group and the laser group was statistically significant (p<0.05). Laser is a more acceptable treatment for children. Erbium-doped yttrium aluminium garnet laser is used in the formation of permanent enamel. It needs to be combined with acid etchant to enhance the retention of the sealant.

Distinct Skin Microbiota Imbalance and Responses to Clinical Treatment in Children With Atopic Dermatitis.

Background: Atopic dermatitis (AD) is a common cutaneous disease, associated with imbalances in the skin microbiota.Objective: To explore the characteristics of the cutaneous microbiota and its dynamic changes during clinical treatment.Methods: Cutaneous swab samples were collected from 51 AD patients before treatment, and 40 AD patients remained after a 2-week treatment with mometasone and mupirocin.Results: AD patients exhibited significant enrichments of Prevotella and Desulfovibrio as well as obvious reductions of Corynebacterium, Streptococcus and Parabacteroides. Based on the proportion of Staphylococcus aureus, the AD patients were further classified into S. aureus-predominant group (AD.S) and S. aureus-non-dominant (AD.ND) group. The AD.S group exhibited lower skin microbial diversity and higher atopic dermatitis (SCORAD) index. In the AD.S group, the cutaneous microbial diversity significantly increased from 2.9 ± 0.8 to 3.7 ± 1.0, while the relative abundance of S. aureus decreased from 42.5 ± 20.7 to 10.3 ± 28.4 after treatment. In contrast, no significant skin microbiota changes were detected in the AD.ND group.Conclusions: AD patients with predominant S. aureus had higher disease severity and lower microbiota diversity compared to patients in the AD.ND group. Mometasone and mupirocin therapy had significant effects on skin microbiota in AD.S patients, but had a paradoxical response in the AD.ND patients.

Clinical significance of aluminum phosphate gel in the prevention of gastrointestinal reactions caused by erythromycin in the treatment of Mycoplasma pneumonia

Objective To evaluate the clinical significance of aluminum phosphate gel in the early prevention of gastrointestinal reactions caused by erythromycin, in order to obtain better clinical treatment for children. Methods The clinical data of 110 children with Mycoplasma pneumonia from January 1, 2015 to December 31, 2016 in the pediatric ward of Anhui Provincial Hospital were collected.According to the treatment methods, the patients were divided into the observation group(60 cases) and the control group(50 cases). The observation group was mainly treated with erythromycin combined with aluminum phosphate gel, some of which were given cephalosporin anti-infection, montelustra sodium to reduce airway hyperreaction, hormone antiasthmatic, atomization inhalation and other supportive symptomatic treatment.The control group was mainly treated with erythromycin, some of which were given cephalosporin anti-infection, montelustra sodium to reduce airway hyperreaction, hormone antiasthmatic, atomization inhalation and other supportive symptomatic treatment.The age, body weight, pre-hospital course, white blood cell count(WBC), CRP, alanine aminotransferase(ALT), creatinine(Cr), urea nitrogen(BUN), length of stay, sex, montruster sodium granules, atomization, antibiotics, hormone use and gastrointestinal adverse reactions(abdominal pain, vomiting, nausea, diarrhea, inappetence) were compared between the two groups. Results A total of 110 children were selected, 60 cases in the treatment groups, including 38 males and 22 females, and the average age of children was (6.21 ± 2.26)years old.In the control group, there were 50 cases, including 23 males and 27 females, with an average age of (6.07 ± 2.61)years.The age, weight, pre-hospital course, WBC, CRP, ALT, Cr, BUN, days of hospitalization, etc.between the two groups had no statistically significant differences (all P>0.05). There were no statistically signifiant differences between the two groups in terms of sex, montruster sodium particles, atomization, antibiotics, hormone use, etc.(all P>0.05). The differences of abdominal pain, vomiting, nausea and diarrhea between the two groups were not statistically significant (all P>0.05). However, the difference of inappetence between the two groups was statistically significant (P<0.05). The incidence rate of gastrointestinal side effects(abdominal pain, vomiting, nausea, diarrhea, inappetence) of the observation group was 18.3 %(11/60), which of the control group was 48.0%(24/50), the difference was statistically significant between the two groups (χ2=11.064, P<0.05). Conclusion Aluminum phosphate gel can prevent gastrointestinal reactions induced by erythromycin in the treatment of Mycoplasma pneumonia, so that children get better treatment. Key words: Pneumonia; Mycoplasma; Universal precautions; Gastrointestinal tract; Aluminum phosphate gel; Erythromycin

Application of enhanced recovery after surgery in the treatment of children with congenital choledochal cyst

To explore the feasibility of enhanced recovery after surgery (ERAS) in treatment of children with congenital choledochal cyst. One hundred and thirty children with congenital choledochal cysts admitted in the Children's Hospital of Zhejiang University from June 2017 to June 2019 were divided into ERAS group (n=65) and control group (n=65) according to admission order. The intestinal tract condition during operation, time of operation, surgical results, time for eating after operation, abdominal drainage after operation, length of hospital stay after operation, total hospital expenses and complications were compared between two groups. Compared with the control group, the satisfaction of intestinal operation field, recovery of gastrointestinal function after operation,time required for the volume of peritoneal drainage fluid to be less than 50 mL,time of abdominal drainage tube removal, and length of hospital stay were all improved in ERAS group (P<0.05 or P<0.01).ERAS group had more peritoneal effusion after removal of abdominal drainage tube (P<0.01), but the incidence of edema after operation was lower (P<0.05). The satisfaction of parents in the two groups was similar, but the cooperation of parents in the ERAS group was improved (P<0.05) and the total cost of hospitalization was reduced (P<0.01). ERAS has advantages over the traditional scheme and can be used in the clinical treatment of children with congenital choledochal cyst.

Music Therapy and Other Music-Based Interventions in Pediatric Health Care: An Overview.

Background: In pediatric health care, non-pharmacological interventions such as music therapy have promising potential to complement traditional medical treatment options in order to facilitate recovery and well-being. Music therapy and other music-based interventions are increasingly applied in the clinical treatment of children and adolescents in many countries world-wide. The purpose of this overview is to examine the evidence regarding the effectiveness of music therapy and other music-based interventions as applied in pediatric health care. Methods: Surveying recent literature and summarizing findings from systematic reviews, this overview covers selected fields of application in pediatric health care (autism spectrum disorder; disability; epilepsy; mental health; neonatal care; neurorehabilitation; pain, anxiety and stress in medical procedures; pediatric oncology and palliative care) and discusses the effectiveness of music interventions in these areas. Results: Findings show that there is a growing body of evidence regarding the beneficial effects of music therapy, music medicine, and other music-based interventions for children and adolescents, although more rigorous research is still needed. The highest quality of evidence for the positive effects of music therapy is available in the fields of autism spectrum disorder and neonatal care. Conclusions: Music therapy can be considered a safe and generally well-accepted intervention in pediatric health care to alleviate symptoms and improve quality of life. As an individualized intervention that is typically provided in a person-centered way, music therapy is usually easy to implement into clinical practices. However, it is important to note that to exploit the potential of music therapy in an optimal way, specialized academic and clinical training and careful selection of intervention techniques to fit the needs of the client are essential.

Analysis of the development of human foetal nasal turbinates using CBCT imaging.

The morphological structure of the nasal cavity (NC) is important for endoscopic surgical treatment. The location of nasal turbinates, including the superior turbinate (ST), middle turbinate (MT) and inferior turbinate (IT), are well presented during the formation of the human NC in cone beam CT (CBCT) images. There is a complex relationship between the nasal sinuses, the maxillary sinus (MS), ethmoidal sinus and sphenoid sinus, during formation of the NC structure at the morphological level. There is a need to clearly define the relationships of these nasal elements at the ossification level, during development. We investigated the three-dimensional construction of human foetal NC elements, including ST, MT, IT and vomer, using CBCT images from 16weeks gestation (E16) to E31 (25 foetuses) and compared it to histochemical observations (E25). At the stage of ossification, the studied elements are elongated in the posterior region near the sphenoidal bone, showing that the locations of the ST, MT, and IT are important during formation of the NC. CBCT analysis revealed that the horizontal and vertical directions of nasal turbinates affect the formation of the human NC. The location and elongated development of the MT is one of the most important elements for NC formation. The relationship between the nasal sinus and nasal turbine at the level of ossification may provide useful information in clinical treatment of children.

Clinical treatment of severe pneumonia complicated with heart failure in children

Objective: This study aimed to investigate the clinical curative effects of dopamine and phentolamine on severe pneumonia complicated with heart failure in children. Methods: Fifty-eight children with severe pneumonia complicated with heart failure were selected as research objects. All of the patients were randomly divided into two groups, namely, control group (n=29) and observation group (n=29). The children in the control group were treated with dopamine, whereas the children in the observation group were administered with phentolamine based on the treatment in the control group. Clinical curative effects, time of improvement in clinical signs and changes in cardiac function before and after the treatment in both groups were observed and compared. Results: The total effective rate of the clinical treatment in children in the observation group was 96.55% which was significantly higher than that in the control group (68.96%). After the treatment was administered, the Heart Rate (HR), left ventricular end-diastolic diameter and left ventricular ejection fraction of the children were 119 ± 6 times/min, 32 ± 3 mm and 73% ± 10% in the observation group and 136 ± 9 times/min, 38 ± 4 mm and 58% ± 10% in the control group, respectively. After the treatment was given, the HR of the children in the observation group decreased significantly, the left ventricular end-diastolic diameter reduced and the left ventricular pumping ability significantly increased. The stable breathing time, disappearance time of pulmonary rales, time of improvement in HR, liver retraction time and hospitalisation time of children were 1.3 ± 0.6, 8.1 ± 1.6, 1.7 ± 0.5, 2.1 ± 1.2 and 10.1 ± 2.3 d in the observation group and 2.5 ± 0.4, 11.6 ± 1.5, 2.7 ± 0.5, 3.6 ± 1.2 and 14.3 ± 2.8 d in the control group, respectively. The time of improvement in each clinical sign in the observation group was significantly shorter than that in the control group. Conclusion: The clinical curative effect of dopamine combined with phentolamine in the treatment of severe pneumonia complicated with heart failure in children is clear and can significantly improve the cardiac function, enhance the left ventricular pumping ability and reduce the HR and left ventricular end-diastolic diameter of children. Thus, this effect can shorten the time of improvement in clinical signs of children. It can also reduce the hospitalisation time of children. Consequently, the suffering of children and the economic burden against children and their family members can be considerably alleviated. Thus, the effect has a high clinical application value.

An evaluation of clinical treatment in children with acute promyelocytic leukemia

Objective To evaluate the clinical effect of acute promyelocytic leukemia (APL) protocol clinically at Nanjing Children's Hospital(NCH) 2009. Methods The clinical data of 21 patients including 15 boys and 6 girls with APL admitted from January 2009 to December 2014 were collected, and all patients were treated with NCH-2009-APL protocol.Initial diagnosis information, early treatment response and long term follow-up were analyzed. Results The median age of this group was 7.15 years.The initial leucocyte count exceed 50×109/L in 4 cases, 1 case was between 10×109/L and 50×109/L, and 16 cases were less than 10×109/L.All cases had t (15; 17) chromosome and/or PML/RARA fusion gene positive, and 19 children got complete remission(CR) after the first course of induction therapy.One got CR after the second course of induction therapy, but 1 died in the early phase of induction therapy.The CR rate was 95.24%.The median time to get CR was 34 days.Overall 5-year event free survival rate was 95% after standard chemotherapy with NCH-2009-APL protocol.All cases had various degrees of infection in the phase of induced remission, DAE and IA.Only 1 case died, 1 case had severe lung injury after infection, and the remaining patients got well recovery.The central nervous system leukemia, bone marrow relapse or extramedullary recurrence were not found in this study. Conclusion Patients with APL have high CR rate and better prognosis with the protocol of NCH-2009-APL. Key words: Acute promyelocytic leukemia; Chemotherapy; Child

Die Versorgung von Kindern und Jugendlichen mit Geschlechtsdysphorie aus der Sicht internationaler Expertise

The clinical treatment of children and adolescents with gender dysphoria is still a controversial issue. The aim of this study was to get an overview of the knowledge and experience of international experts and to highlight shared views as well as differences in theoretical convictions and treatment approaches. Half-structured, guide-line based interviews were carried out with international experts in the field. The interviews were analyzed using qualitative content analysis (Mayring, 2010).

The Endocrinologist’s Office—Puberty Suppression: Saving Children from a Natural Disaster?

In the past few years, the introduction and rapid acceptance of puberty suppression has transformed the clinical treatment of children diagnosed with Gender Identity Disorder. This essay analyzes the narratives used by some advocates of this treatment, particularly the elements of saving children from the looming disaster of puberty and from future abject lives of violence and suicide as transgender adults. It briefly addresses the potential implications of this account for the well being of the children brought under clinical purview.

Phonological Complexity and Language Learnability

To extend formal models of language learnability to applications in clinical treatment of children with functional phonological delays. The focus of the narrative review is on phonological complexity. This follows from learnability theory, whereby complexity in the linguistic input to children has been shown to trigger language learning. Drawing from the literature, phonological complexity is defined from epistemic, ontological, and functional perspectives, with specific emphasis on the application of language universals in the selection of target sounds for treatment. The cascading effects of phonological complexity on children's generalization learning are illustrated, and frequently asked questions about complexity in treatment are addressed. The role of complexity in cognitive development is introduced to demonstrate the apparent robustness of effects.

Antibacterial Treatment Needed for Severe Early Childhood Caries

To assess the effects of a single 10% povidone iodine application as an adjunct to extensive surgical procedures in the clinical treatment of children with early childhood caries. Twenty-two children scheduled for dental treatment under general anesthesia were randomized into either an intervention group (10% povidone iodine), or a control group (phosphate buffered saline). Either povidone iodine or phosphate buffered saline was applied to teeth and soft tissues after prophylaxis and all operative dental procedures, followed by 1.23% acidulated phosphate fluoride gel. Saliva samples taken at baseline, and after 1 hour, 3 weeks and 3 months were assayed for mutans streptococci, lactobacilli and total viable bacteria. Caries lesions were recorded at baseline and at one year. Mutans streptococci and lactobacilli levels in the povidone iodine group were significantly reduced relative to baseline at 1 hour, 3 weeks and 3 months. At one year at least 60% of subjects had new caries lesions in each group, and there was no significant difference in caries increment between the two groups. Even prophylaxis, fluoride gel application and complete surgical treatment of caries at baseline were insufficient to prevent new caries in over 60% of the patients in these high caries risk infants. Although the one-time treatment with povidone iodine reduced mutans streptococci and lactobacilli levels for up to 3 months this therapy failed to additionally reduce future caries formation over one year, indicating that repeated antibacterial treatments will be needed to control high levels of cariogenic bacteria.