General Pediatric Outpatient Clinic Research Articles

Internet health seeking behaviour of parents attending a general paediatric outpatient clinic: A cross-sectional observational study

Introduction Our aim was to examine the internet health seeking behaviour of parents attending a general paediatric outpatient clinic. For this purpose, the proportion of parents going online to obtain child health information, the most commonly used online resources, and factors having an influence on internet usage were identified. Methods This cross-sectional observational study was conducted at a general paediatric outpatient clinic in Vienna, Austria. Data collection was done by means of an anonymous questionnaire containing 14 items. A total number of 500 questionnaires were collected. Results Among parents visiting the outpatient clinic, 94.4% use the internet to obtain child health information in general and 21% to be informed about the reason for consultation. Most commonly used online resources are Google (91.4%), websites run by doctors (84.8%), Wikipedia (84.7%), health portals (76.4%), the outpatient clinic's homepage (76.4%), as well as health forums and communities (61.9%). Younger parents (p = 0.022) and parents of younger children (p < 0.01) display a higher tendency to use the internet for child health information purposes. Mothers and fathers (p = 0.151) as well as parents with different completed educational levels (mothers: p = 0.078; fathers: p = 0.388) do not differ in this behaviour. Discussion Important reasons for high internet use might be the inexperience of young parents regarding child health as well as the frequent infections, vaccinations, and preventive check-ups which are associated with young age of children. In contrast to former findings relating to health seekers in general, internet usage of parents is independent of their sex and educational level.

Psychological Impact of Nocturnal Enuresis on Self-esteem of School Children

Bedwetting is the cause of significant psychosocial stress especially in older children. Aim: The study aimed to assess the psychological impact of nocturnal enuresis on self-esteem of school children. Design: Descriptive research design was used in this study. Setting: The study was conducted in El-Menoufya University Hospital, in Egypt, which consisted of 18 outpatient clinics. The pediatric outpatient clinic of Shebin El-Kom, El-Menoufia University Hospital it is general pediatric outpatient clinic for all children disorders not just for enuresis. Sample: This is a convenient sample of 140 of children representing almost half of the total attendants with nocturnal enuresis during three months duration. The total number of the sample was 70 children of nocturnal enuresis. Tools: For data collection, an interview questionnaire was used to assess socio demographic data, children knowledge about enuresis, psychological impact of enuresis on the children regarding depression and social isolation, self-esteem inventory scale for the children. Finding: The results of the study showed there were no significant difference between gender and their positive self-esteem. In addition, there were no significant difference between psychological problems of the studied children and their positive self-esteem. Conclusion: This study concluded that children in this age have poor knowledge in relation to enuresis. In addition, most of studied children had law self-esteem. Recommendations: According to this study it is recommended that raise community awareness about nocturnal enuresis through educating adolescents in school and universities about nocturnal enuresis, development of health educational program for mothers of enuretic children. Also pediatric nurse, psychiatric nurse, community health nurse and school health nurse offer counseling services for the mothers and their children regarding nocturnal enuresis.

G468(P) The majority of referrals from gp to general paediatric outpatient clinic could be managed by alternative methods

Aims Audit 100 referrals made to a hospital general paediatric outpatient clinic from General Practice to assess (i) Appropriateness (ii) Possible alternative methods of management Implement alternative and innovative methods of management using a multi-professional approach Improve quality of care for patients Methods Using a proforma, each referral was assessed by 3 people: A Paediatrician (taken from a pool of 3 Consultants), A GP physician (taken from a pool of 2) and A Paediatric nurse specialist Results 76–97% of patients seen in paediatric general outpatients could have been managed with at least one alternative method. The range reflects variation in assessor’s opinions (Figure 1 and Table 1). Conclusions The majority of cases seen in general paediatric outpatients in this sample did not require secondary care. Importantly, this study suggests that, with the support and partnership of secondary care, General Practice has the potential to be able to provide a safe, more rapidly accessible and cost-effective paediatric service than that currently being offered at the level of a general paediatric outpatient clinic. In terms of our progress: (i) Telephone hotline will be rolled out shortly (ii) Rapid access clinic opens in April 2015 (ii) Roll out of Community nurses (multi-professional approach) (iii) Development of email service and virtual clinic (iv) Increased support for GPs

Prevalence of Attention Deficit Hyperactivity Disorder in Children

Objectives: The aim of the study was to determine the prevalence of attention deficit hyperactivity Disorder (ADHD) and associated risk factors among children were attended the general pediatric outpatient clinic of Menoufia University Hospital. Background: Attention deficit hyperactivity disorder is the most commonly seen developmental disorders, with significant impacts on the child's social, psychological, and scholastic functioning. Methods: The study was conducted on 600 children (5 - 12 years ) were attended the general pediatric outpatient clinic of Menoufia University Hospital . All studied patients were subjected to adequate history taking, full clinical examination, a questionnaire regarding socioeconomic, family and maternal variables and a parent-completed, ADHD Rating Scale of attention deficit hyperactivity symptoms was used. Results: The study revealed that the prevalence of probable ADHD in our study was 19.7%. and was higher in males than in females with a ratio 2.7:1. The most common type of probable ADHD was the combined type and the least frequent type was the inattentive type. There were many factors that were sought to be associated with increase possibility of developing ADHD. Conclusion: The present study shows a high prevalence of probable ADHD in children. our study also revealed that probable ADHD was associated with many risk factors, prevalence was high in the male sex, living in urban areas, low socioeconomic families, large family size, living with a single parent, family history of ADHD, preterm children, low birth weight and bottle fed children.

Breastfeeding policy and practices at the general paediatric outpatient clinic of a teaching hospital in Lagos, Nigeria.

BackgroundHospitals have a role to play in supporting, protecting and promoting breastfeeding. The aim of this study was to describe hospital breastfeeding policy and practices and breastfeeding rates among mothers attending General Paediatric Outpatient Clinic at a tertiary hospital in Lagos, Nigeria.MethodsThis was a cross-sectional study involving paediatric nurses and doctors, as well as the mothers who brought their child to the General Paediatric Outpatient Clinic. Two sets of questionnaires, different in content, were administered to doctors and nurses, and to mothers of children aged 6-24 months, to assess hospital policy and breastfeeding rates, respectively. Stepwise multiple logistic regression analysis was used to examine factors associated with duration of breastfeeding.ResultsAlthough the hospital had a written breastfeeding policy copies of the policy were not clearly displayed in any of the units in the Paediatric department. Almost half the staff (48%; 60/125) were not aware of the policy. The hospital had no breastfeeding support group. Nearly three quarters (92/125) of the staff had received lactation management training. 36% (112/311) of mothers exclusively breastfed for six months, 42% (129/311) had stopped breastfeeding at the time of the survey. 67% (207/311) of babies were given infant formula, 85% (175/207) before 6 months. Women who had antenatal care in private hospitals and were Christian were more likely to breastfeed exclusively for 6 months. Low maternal education was the only factor associated with breastfeeding longer than 12 months.ConclusionBreastfeeding practices and policy implementation at this outpatient clinic were suboptimal. We have identified a need for interventions to increase knowledge of the benefits of breastfeeding and to provide support for its longer term duration. We suggest that BFHI be considered across all facilities concerned with infant and early child health to disseminate appropriate information and promote an increase in exclusive breastfeeding for six months as well as the duration of breastfeeding.

A Prospective Randomised Control Study: Reduction of Children's Pain Expectation Using a Picture Book during Blood Withdrawal

Blood drawings are very painful and stressful for children. In a prospective control group study we investigated if using a picture book could reduce the children's pain expectation. In addition, the children's pain experience and the observed pain behaviour was monitored. Block-randomization were used and 120 children at the age of 6-12 years who were visiting the general pediatric and coagulation outpatient clinics were included in this study. Pain expectation and experience were assessed with the Face-Pain-Scale-Revised and the pain behavior with the Faces-Legs-Activity-Cry-Consolability Scale. Multivariate covariance analysis was used for data analysis. The results showed that with statistical controlling the influence of the primary pain expectation (baseline) the pain expectation before blood withdrawal was reduced significantly (p=0.001) and effectively (ES=0.56) using the picture book. Children who received no local anaesthesia reported that they felt less pain during blood drawing after reading the picture book. The few children with local anaesthesia reported no benefit from the picture book. The observed use of local anaesthesia was very heterogeneous. The results recommend the usage of this picture book in everyday practice, if the use of local anaesthesia could not be used in an appropriate way.

Relationship between maternal pathology and infant social withdrawal: Analysis of a 268-outpatient population

Objective: Sustained withdrawal is a sign of infant distress and may be determined by extreme conditions like organic pathology or relationship problems. The Alarm Distress Baby Scale is the best instrument to identify withdrawal in infants between 2 and 24 months of age. The aim of this study was to assess the association between infant social withdrawal behavior and maternal pathology in the perinatal period. Method: The target sample of the study was 134 mother-child couples examined at the Policlinico Agostino Gemelli General Pediatric Outpatient Clinic and Psychiatric Outpatient Clinic, in Rome. We analyzed the relationship between withdrawal behavior and psychological and organic prenatal/postnatal pathology, using the Chi Square exact test. Results: When the mother suffers from both organic and psychological pathologies in the perinatal period, the risk of withdrawal is increased: the probability of infant withdrawal behavior is increased by maternal organic postnatal pathology by 14 times, by maternal psychological postnatal pathology by 9 times, and by maternal psychological postnatal depression, measured by Edinburgh Postnatal Depression Scale, by almost 4 times. Conclusion: Increased or sustained withdrawal reactions can be observed in unsatisfactory mother-child interaction. Maternal risk factors should be strictly considered in the pediatric clinical evaluation.

Herbal medicine use in a group Taif children, Saudi Arabia

SUMMARY AIM: In fact, herbs can be particularly safe and effective for children because herbs tend to be so much gentler than pharmaceutical alternatives. The present study aims to assess the therapeutic use and the prevalence of herbal remedy in Taif children, Saudi Arabia. METHODS: Cross-sectional, qualitative survey and a questionnaire of 15 close-ended questions written carefully and directly were used for this study. 300 parents completed the questionnaire who attended the general pediatric out-patient clinics of 3 central hospitals in Taif. Data were collected daily from 8 am to 4 pm for 2 months period from 15 October to 15 December 2012. RESULTS: The present study revealed a reasonable proportion of the respondents used herbs for their children. About (58.0%) of parents used herbs for their children for the past four months earlier and about (70.3%) used herbs for their children in the past. The most commonly used herbs were; anise (24.7%) and fenugreek (14.7%). CONCLUSION: Herbal remedy is used in mid-range in Taif during childhood. To achieve high therapeutic safety, it is important to ask parents explicitly about such use and using natural medicines under the supervision of a qualified practitioner.

Testing of a Web-Based Program to Facilitate Parental Smoking Cessation Readiness in Primary Care

To test the efficacy of a self-administered web-based computer intervention designed to facilitate readiness to alter tobacco use or secondhand smoke exposure among parents of children visiting a pediatric primary care clinic. The computer program included an assessment of the participant's smoking behavior and personalized feedback. Self-identified smoking parents of children presenting to a general pediatric outpatient clinic completed measures of motivation and readiness to cease smoking. Participants were then randomly assigned to complete the computer program or receive treatment as usual. One month after completing the intervention, participants were contacted either in person or by phone to complete measures of motivational readiness to engage in smoking cessation. Compared to treatment-as-usual parents, intervention parents reported increased readiness to change their smoking at follow-up. This effect appeared to strengthen, favoring the intervention condition, when analyses included only those participants who identified at baseline that they were contemplating quitting smoking in the next 6 months. Results of this small study supported the integration of a brief computerized tobacco intervention in the pediatric primary care setting and provided some evidence for efficacy. Brief, self-administered, and computer-based interventions such as this can be disseminated and deployed at relatively little cost or burden to existing practices, which makes small effects more meaningful and justifiable. Future investigations should investigate this intervention with larger samples and with expanded measures of parent smoking behavior.

Unmet Developmental, Behavioral, and Psychosocial Needs in Children Attending Pediatric Outpatient Clinics

In this study of children attending general pediatric hospital outpatient clinics, we aimed to examine the proportion of (1) children with developmental and behavioral concerns; (2) parents with mental health problems; and (3) families with less than adequate psychosocial resources. We were also interested in the extent to which pediatricians discussed these problems with parents. This was a cross-sectional study of families with children aged 4 to 8 years attending pediatric outpatient clinics at the Royal Children's Hospital, Melbourne. The Strengths and Difficulties Questionnaire, Parents' Evaluation of Developmental Status, Kessler-6 Scale for Psychological Distress, and Family Resource Scale were administered postvisit to assess development and behavior, parental mental health, and psychosocial resources. Parents were asked whether these issues were discussed during the consultation. A total of 162 families participated. Behavioral concerns were identified in 26% of children and concerns about language and motor development in 24% and 11%, respectively. Only 39% of consultations included discussion about development and 46% about behavior. Almost two-thirds (64%) of families reported less than adequate psychosocial resources, yet fewer than 10% of consultations included discussion of this, and only 7% addressed parental mental health. Parental perception of reasons why concerns were not discussed included "not relevant" (47%) and "the doctor did not bring it up" (21%). Only 2% of parents "didn't want to discuss the concern." A high proportion of children and families attending pediatric outpatients have unidentified concerns in development and/or behavior, and parents have mental health or psychosocial issues; these concerns are often not discussed, and thus opportunities for timely intervention are missed.

Plasma glial fibrillary acidic protein levels in children with sickle cell disease

To determine if glial fibrillary acidic protein (GFAP) is associated with brain injury in children with sickle cell disease (SCD), we measured plasma GFAP among cross-sectional groups of unselected children with SCD, subsets of children with SCD and normal brain MRI or MRI evidence of cerebral infarct, healthy pediatric controls, and adults with brain injury. Children with SCD had higher plasma GFAP than healthy pediatric controls (mean concentrations 0.14 ± 0.37 vs. 0.07 ± 0.08 ng/mL; P 5 0.003); also, 16.0% (16/100) of children with SCD and cerebral infarct had GFAP elevations above the 95th percentile of healthy pediatric controls (P 5 0.04). Although not statistically significant, children with SCD and cerebral infarct had more elevated GFAP levels than with SCD and no infarct (16/100, 16.0% vs. 14/168, 8.3%; P 5 0.07). Children with SCD and acute brain ischemia had a higher proportion of elevated GFAP than SCD children with normal MRI (3/6, 50% vs.8.3%; P 5 0.01). GFAP was associated with elevated systolic blood pressure in the preceding year and correlated positively with white blood cell count and negatively with age and performance IQ. Plasma GFAP is elevated among children with SCD and may be associated with subclinical brain injury.

Faecal calprotectin concentrations in children with functional gastrointestinal disorders diagnosed according to the Pediatric Rome III criteria

To determine if faecal calprotectin concentrations vary with different entities of functional gastrointestinal disorders (FGID) in children. Children (4-15 years) who were consecutively referred by general practitioners to four general paediatric outpatient clinics for the evaluation of recurrent abdominal pain were assessed according to a research protocol which included clinical examination, a minimum set of blood, urine and stool tests, and clinical reassessment after 6-9 months. The diagnoses of FGID were based on the parent version of the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III. Of the 152 patients included, 142 children were diagnosed with FGID. Of these, 126 (89%) provided a stool specimen for quantification of calprotectin. The median calprotectin concentrations were at or lower than 16 mg/kg which was at the lower detection limit and there were no differences between the FGID subgroups. Nine children (7%) had slightly raised values. The faecal calprotectin concentration is within normal limits in FGID and does not vary with different FGID entities suggesting that bowel inflammation is not a significant part of the pathogenesis in FGID.

Diagnosing Pediatric Functional Abdominal Pain in Children (4–15 Years Old) According to the Rome III Criteria: Results From a Norwegian Prospective Study

To determine the proportion of referred children with nonorganic abdominal pain who meet the criteria for 1 or more diagnoses of functional gastrointestinal disorders (FGID), explore the distribution of diagnoses according to the revised pediatric Rome III criteria (PRC-III), and to investigate reasons for failure to meet these criteria. We recruited children (4-15 years) consecutively referred by general practitioners to 4 general pediatric outpatient clinics for the evaluation of recurrent abdominal pain. FGID diagnoses were based on the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III version, completed by parents. To exclude organic disease, all patients underwent medical investigations and were reevaluated at follow-up after 6 to 9 months. Of the 152 patients included, 142 (93%) had functional abdominal pain. Of these, 124 (87%) met the criteria for 1 or more diagnoses according to the PRC-III: 66% met the criteria for 1, 29% for 2, and 5% for 3 diagnoses. Irritable bowel syndrome was the most common diagnosis (43%) and overlapped with aerophagia in 16 children (38% of the children with overlapping diagnoses) and with abdominal migraine in 14 (33%). In the 18 patients (13%) not fulfilling the PRC-III for any FGID diagnosis, the main reason was insufficient pain frequency (83%). Of the referred children with functional abdominal pain, 87% met the PRC-III for specific diagnoses. This supports the use of these criteria as a diagnostic tool. The significant overlap between different FGIDs, however, makes it unclear whether some of the diagnoses represent distinct disorders or artificial categories.

Soroprevalência da doença celíaca em ambulatório pediátrico, no nordeste do Brasil

Celiac disease is a common problem affecting children and adults, for which early diagnosis and treatment prevent complications and deaths. Seroprevalence studies in our environment are still scarce. To determine the seroprevalence of celiac disease by using human tissue antiendomysial and anti-transglutaminase antibodies, among children and adolescents who were attended at a general pediatric outpatient clinic. This was a seroprevalence study of descriptive cross-sectional design. First, assays for guinea pig tissue anti-transglutaminase antibodies were performed. Subsequently, in the positive cases, assays for human tissue antiendomysial and anti-transglutaminase antibodies were performed. The seroprevalence of celiac disease by means of anti-guinea pig tissue anti-transglutaminase antibodies was 5% (42/831; 95% CI: 3.76%-6.90%). Considering three positive tests, the seroprevalence was 1.9% (16/831; 95% CI: 1.83%-1.97%). The concordance of human anti-transglutaminase with antiendomysial was 71%. The seroprevalence of celiac disease was high. Serological screening for celiac disease among children and adolescents who present signs and/or symptoms compatible with celiac disease should be performed routinely, as well as in groups already known to be at risk, given the high seroprevalence of celiac disease observed in our environment.

Epidemiology of Chronic suppurative otitis media in Nigerian children

Chronic suppurative otitis media is an important cause of morbidity and mortality in the tropics and is characterized by persistent or recurrent otorrhoea. This prospective study was carried out with the aim of determining the incidence and the associated epidemiological factors of the disease in this environment. The study was conducted at the general paediatric outpatient clinic over a one year period (2004-2005) amongst children aged 1month to 14 years with persistent ear discharge of 6 weeks or more. Fifty-three subjects were included in this study giving a hospital prevalence of 0.51%. The disease was most prevalent in children whose ages were six years and below. Higher proportions of subject were associated with low socioeconomic status, poor housing, indoor pollution, unilateral ear disease and central perforation of the ear drum. Complication rate was 5.7% with one case of otogenic tetanus and two cases of subperiosteal mastoid abscess. Mortality rate was 0%. In conclusion chronic suppurative otitis media is still an important cause of morbidity in children in the tropics. Further studies are required to confirm the various factors highlighted in this study as associated risk factors for the disease in this environment.

Dieting in children: a population‐based study in children aged between 9 and 12 years

Dieting can be a burden for the child and can have side effects. Insight into dieting is therefore important. A recent study showed that 13.7% (95% CI 11.5-15.9%) of the children referred to a general paediatric outpatient clinic were or had been on a diet. However, it is unknown how many children in a random population are or have been on a diet. Parents of children in the fifth grade of primary schools in the Dutch province of Friesland were asked to complete a structured questionnaire. From 2500 questionnaires 90% were returned. Two hundred and thirty-one children aged between 9 and 12 years had been on a diet (10.3%, 95% CI 9.0%-11.6%). A cow's milk free diet was used most frequently (50% of the dieting children). Other diets were: diets excluding additives (16%), peanuts (16%), sugar (15%) and lactose (11%). The use of diets by children in a general population is widespread: one in every ten children was or had been on a diet. Due to the known health risks associated with diets excluding one or more foods, such diets should only be advised by healthcare professionals.

Detecting emotional and behavioural problems in paediatric clinics.

Children with chronic illness have increased rates of mental health problems and psychological difficulties often present as physical conditions. This prevalence survey aims to determine whether children attending general paediatric out-patient clinics are at increased risk of suffering from emotional and behavioural disturbance and whether there is an unmet need for psychiatric liaison to paediatric clinics. Participants were 307 children aged 5-15 years attending a representative sample of paediatric out-patient clinics in one UK hospital. A national community sample of 10,438 children aged 5-15 years was used as a comparison group. Parental ratings of child behaviour were obtained using the Strengths and Difficulties Questionnaire (SDQ). Doctors rated the extent of any emotional difficulties using a modification of the SDQ 'impact supplement'. Children attending paediatric out-patient clinics were more than twice as likely (OR = 2.3, 95% CI 1.7-3.1) to score in the abnormal range of the SDQ. Of the 60 (20%) children with a probable psychiatric disorder only 15 had received specialist help from Child Mental Health Services. There were no gender differences in the profile of difficulties with emotional symptoms being particularly evident in both boys (OR = 2.85, 95% CI 1.97-4.11) and girls (OR = 3.04, 95% CI 1.92-4.70). The risk of psychiatric disorder was highest among those children with brain disorders attending neurological clinics (OR = 5.8, 95% CI 2.5-11.3). Clinicians only identified emotional or behaviour problems in a quarter of those children with parent-rated disorder. There is an increased prevalence of emotional and behavioural disturbance in children attending paediatric out-patient clinics. The SDQ could be added to routine paediatric assessments to aid appropriate referral of children with a possible psychiatric disorder to child mental health services.

Use of the internet by parents of paediatric outpatients

Aims: (1) To establish how many parents of children seen in paediatric outpatient departments use the internet to find information about their child’s medical condition. (2) To ascertain what information...

Dieting in children referred to the paediatric outpatient clinic.

Dietary interventions are sometimes necessary, even in young children; however, adhering to a diet can cause medical and psychosocial problems. Therefore, insight into frequency, reasons, and effectiveness is important. To establish the prevalence of dieting in children referred to a general paediatric outpatient clinic, parents of newly referred patients were given a structured questionnaire. Excluded were children whose parents did not speak Dutch, those younger than 3 months and emergency cases. Of 1826 patients, 907 (511 boys, 56%; median age 5 years, range 0-18 years) were included; 124 (13.7%, 95% CI 11.5%-15.9%) were or had been on a diet, more boys than girls (82/511 versus 42/396, P=0.02). In 60% of patients, the diet was started before the age of 2 years, 50% had been dieting longer than a year. Diets most used were: cow's milk free (62%), egg-free (20%), lactose-free (14%), no sugar (20%) and no colouring additives (20%). Reasons for dieting were gastrointestinal (51%), dermal (51%) and behavioural (27%) symptoms or complaints. Dieting was considered effective by the parents in 65% of cases and 61% reported no problems. One in eight children, referred to a general paediatric outpatient clinic is or has been dieting. Most parents reported positive effects with no problems. Some children were on a difficult-to-keep diet with serious medical and psychosocial implications, without being tested. Scientific evidence for dieting should be sought and the results discussed with the parents.

Bullying, physical disability and the paediatric patient.

This study compared the rates and types of bullying in two groups of paediatric outpatients: those attending the Child Development Centre with conditions affecting their appearance or gait and a control group of those attending a general paediatric outpatient clinic with conditions not associated with visible abnormality. The children completed Olweus' self report bullying questionnaire anonymously. Using logistic regression analysis, the most important variables found to increase a child's chance of being bullied were having fewer friends, being alone at playtime, being male and requiring extra help in school. Significantly more of the group from the Child Development Centre were bullied during the term. However, there was no indication that the children attending the Child Development Centre with a visible disability were more likely to be victims than the control group once these four factors were taken into account.