Medical Problem In Children Research Articles

Frequent nocturnal awakening in early life is associated with nonatopic asthma in children

Sleep deprivation has become a common phenomenon of the Western world and is associated with a variety of medical problems in children. This retrospective longitudinal analysis of a community-based birth cohort was undertaken to determine whether frequent nocturnal awakening during early life was associated with the development of childhood asthma. 2,398 children born to mothers recruited from the antenatal clinics of a single hospital in Perth, Australia during 1989-1991 were followed up at years 1, 2, 3, 6, 8, 10 and 14. Parent-completed questionnaires were analysed. The odds ratio for asthma at age 6 and 14 yrs in children with frequent nocturnal awakening during the first 3 yrs after birth was determined from multiple logistic regression. Following adjustment for asthma risk factors, co-sleeping and family stress, persistent nocturnal awakening was associated with nonatopic asthma at age 6 and 14 yrs (at age 14 yrs: OR 2.18, 95% CI 1.15-4.13) but not with atopic asthma. We found an increased risk of nonatopic asthma in children following frequent nocturnal awakening during the first 3 yrs of life. These hypothesis-generating data suggest the need for further systematic study of the effects of disordered sleep in early life on the development of asthma.

Hypertension in obese children and adolescents

Obesity, especially upper body fat distribution, has become an increasingly important medical problem in children and adolescents. Outcomes related to childhood obesity include, as in adult population, hypertension, type 2 diabetes mellitus, dyslipidemia, left ventricular hypertrophy, obstructive sleep apnea, orthopedic and socio-psychological problems. Obese children are at approximately 3-fold higher risk for hypertension from non-obese ones. Obesity-hypertension appears to be characterized by a preponderance of isolated systolic hypertension, increased heart rate and blood pressure variability, increased levels of plasma catecholamine and aldosterone, and salt-sensitivity. Lifestyle changes of weight loss, healthier diet and regular physical exercise are effective in obesity-hypertension control, though pharmacological treatment is frequently necessary. Screening for dyslipidemia and impaired glucose tolerance should be performed in paediatric patients with obese hypertension on regular basis, at least once annually or semiannually to discover metabolic syndrome and to prevent its increased cardiovascular risk. Of course, prevention of obesity is the primary goal.

‘Nutritional status of children with cerebral palsy in a Brazilian tertiary‐care teaching hospital’

SIR–Malnutrition is a common and worldwide medical problem in children with cerebral palsy (CP).1–5 Pediatric gastroenterologists and nutritionists have seen an increasing number of patients with CP requiring nutritional support in Brazilian clinics in the last few years. Any evaluation of current nutritional condition in children with CP should take into consideration the fact that these children are usually smaller than children at the same age due to their muscle hypotrophy and contracture. There is a lack of information regarding the nutritional status of Brazilian children with CP. This study reports data on growth parameters recorded in patients with CP seen at gastroenterology, orthopaedic, and neurology pediatric units in a Brazilian tertiary-care teaching hospital, between January 2004 and March 2006, from 58 cities of three states of Brazil. Data and the anthropometric measurements were obtained by a trained nutritionist observer with validity measurements after Review Board approval and the caregivers gave informed consent. The weight, height, triceps skinfold thickness (TST), mid-upper arm muscle area (AMA), and mid-upper arm fat area (MAFA) were converted into z-scores, and malnutrition was defined when the z-score was ≤–2.6,7 Data were recorded in the SPSS. Most of the children (80.7%) were unable to assume and upright posture. Some of them had scoliosis, involuntary muscle spasms, and poor cooperation so the height was estimated on the basis of knee height.1 One hundred and fourteen children were measured, 65 (57%) males and 49 (43%) females, aged from 2 to 12 years 11 months (median age 7y 4mo). Spastic quadriplegic CP was the most frequent type, found in 78 (68.4%) children. Fifteen (13.2%) patients were neurologically classified as mixed type, 10 (8.8%) children had spastic hemiplegia CP, eight (7%) had spastic diplegia CP, and three (2.6%) were classified as athetoid. The ataxic type of CP was found only in children with the mixed type of CP. According to the Gross Motor Function Classification System,8 96 (84.2%) were classified as Level V, eight (7%) as Level IV, six (5.3%) as Level I, and four (3.5%) as Level II. Anthropometric indicators (z-scores) mean and standard deviation were: –2.19 (SD 2.48) for weight; –1.66 (SD 1.50) for height; –1.04 (SD 1.34) for TST: –1.03 (SD 1.73) for AMA; and –1.15 (SD 1.41) for MAFA. Children with quadriplegia showed the most frequent malnutrition: 42 (72%) for weight; 31 (68.9%) for height; 25 (71.4%) for TST; 24 (68.6%) for AMA; and 31 (75.6%) for MAFA. Mean weight/age z-scores were significantly lower in children with the athetoid and mixed type of CP. However the mean height/age z-scores were significantly higher in children with hemiplegic CP. Children with athetoid CP presented the lowest MAFA values (p<0.001), whereas no significant difference was found for mid upper AMA. There was no significant difference in the anthropometric indicators for sex. This study showed that Brazilian children with CP are severely malnourished when compared to children with CP in other countries.4,9,10 Weight, height, and MAFA were lower compared to the National Center for Health Statistics reference curves. Weight/age z-score ≤–2 was observed in 50.9% of the children, height in 38.6%, and adipose tissue in 35.1%. One-third of the children presented with malnutrition in other anthropometric parameters, including TST (30.7%) and mid upper AMA (29.8%). Malnutrition was more severe in quadriplegic children with dysphagia, as reported by others studies.11,12 Two other situations contributed to the malnutrition in this study: the socioeconomic status, which was more frequently in D class with 53 children (46.5%), and the use of gastrostomy feeding, which was very low, with only seven children (6.2%).

Medical issues among children and teenagers with Down syndrome in Hong Kong

We examined the prevalence of medical problems in children and teenagers with Down syndrome in Hong Kong. Children with Down syndrome receiving care from seven regional hospitals were included and their hospital records were reviewed. A total of 407 patients, aged between 0.06 and 17.16 years were included. Cardiovascular problems were observed in 216 (53%), endocrine problems in 111 (27%), gastrointestinal problems in 46 (11%), haematological problems in 18 (4%), neurological problems in 27 (7%), sleep problems in 36 (9%), skeletal problems in 56 (14%), visual problems in 195 (48%) and auditory problems in 137 (34%). The prevalence of medical problems was high in children and teenagers with Down syndrome in Hong Kong and similar to previous findings elsewhere. Future studies on the local prevalence of medical problems in the adult population with Down syndrome would help to define their medical needs.

The management of sinusitis in children

Sinusitis is a common medical problem in children. The prevalence of penicillin-resistant S. pneumoniae infection has been increased during the last decade. The medical management is based on the choice of antimicrobial agents. This article reviews current literatures on the management of acute bacterial sinusitis and chronic sinusitis, with an emphasis on penicillin-resistant S. pneumoniae infection. This article also explores the potential pathophysiologic mechanisms of chronic sinusitis.

Evaluation of Internet use by paediatric orthopaedic outpatients and the quality of information available

Parents use the Internet increasingly for information about their children's medical problems. There is no quality control for medical information content. The goals of our study were to assess Internet awareness by families seen in paediatric orthopaedic outpatients departments and the type, quality and reliability of information available, using clubfoot as an example. Parents accompanying children to the outpatient's clinic were surveyed regarding the use of the Internet for medical information. They were asked about their ability to use the Internet, and whether this helped the consultation. To assess the quality of information available, the search phrases 'clubfoot' and 'club foot' were placed in the five most commonly used World Wide Web search engines. Web sites were evaluated for authorship, content and informational value using our own agreed scoring system, ranging from 0-100 points. Sixty-one percent of the questionnaires were completed, the mothers completed 67%. Eighty-four percent reported access to the Internet. Most found their searches useful and 26% were reminded of questions to ask at consultation. When a search for 'clubfoot' was carried out we found 11% of web sites were affiliated to academic institutions. There was a significant difference when the terms 'clubfoot' or 'club foot' were searched. Twenty-eight percent offered conventional information. Thirty-six percent of web sites were not related to congenital talipes equinovarus. The average information value was 26 points (0-98). Parents frequently use the Internet for information about paediatric orthopaedic consultations, prior to consultation. The quality of clubfoot information on the Internet is variable. The development of academic-based websites should be encouraged, as these offer the most useful information.

General medicine and surgery for dental practitioners Part 10: The paediatric patient.

Medical problems in children can cause unique difficulties for the safe provision of dental treatment.1 Such problems can affect the type and timing of dental treatment as well as methods of control of pain and anxiety. In this paper, conditions which influence the choice of anaesthesia as well as those which affect dental development are discussed.

Obesity hypertension in children: a problem of epidemic proportions.

Obesity has become an increasingly important medical problem in children and adolescents. In national surveys from the 1960s to the 1990s, the prevalence of overweight in children grew from 5% to 11%. Outcomes related to childhood obesity include hypertension, type 2 diabetes mellitus, dyslipidemia, left ventricular hypertrophy, nonalcoholic steatohepatitis, obstructive sleep apnea, orthopedic problems, and psychosocial problems. Once considered rare, primary hypertension in children has become increasingly common in association with obesity and other risk factors, including a family history of hypertension and an ethnic predisposition to hypertensive disease. Obese children are at approximately a 3-fold higher risk for hypertension than nonobese children. In addition, the risk of hypertension in children increases across the entire range of body mass index (BMI) values and is not defined by a simple threshold effect. As in adults, a combination of factors including overactivity of the sympathetic nervous system (SNS), insulin resistance, and abnormalities in vascular structure and function may contribute to obesity-related hypertension in children. The benefits of weight loss for blood pressure reduction in children have been demonstrated in both observational and interventional studies. Obesity in childhood should be considered a chronic medical condition that is likely to require long-term management. Ultimately, prevention of obesity and its complications, including hypertension, is the goal.

Parental Perceptions of Fever in Children

Fever is a common medical problem in children which often prompts parents to seek immediate medical care. The objective of this study was to survey parents about their knowledge and attitude concerning fever in their children. The study involved the random selection of Saudi parents who brought their febrile children to the emergency rooms or walk-in clinics of four hospitals in Riyadh. Parents of 560 febrile children were interviewed using a standard questionnaire to obtain sociodemographic information and current knowledge of fever. Approximately 70% of the respondents were female, and the ages of the most were in the range of 20-40 years. More than 80% of the parents had two or more children. More than 70% of parents demonstrated a poor understanding of the definition of fever, high fever, maximum temperature of untreated fever, and threshold temperature warranting antipyresis. About 25% of parents considered temperatures less than 38.0 o C to be fever, another 25% did not know the definition of fever, 64% felt that temperatures of less than 40.0 o C could be dangerous to a child, and 25% could not define high fever. Another 23% believed that if left untreated, temperatures could rise to 42.0 o C or higher, but 37% could not provide an answer, and 62% did not know the minimum temperature for administering antipyretics. Approximately 95% of parents demonstrated undue fear of consequent body damage from fever, including convulsion, brain damage or stroke, coma, serious vague illness, blindness, and even death. Parental misconceptions about fever reflect the lack of active health education in our community. Health professionals have apparently not done enough to educate parents on the condition of fever and its consequences, a common problem.

At Law: Job in Court

While the bioethics disputes that reach the courts frequently raise issues that are novel and perplexing, the problems are seldom truly philosophical. One exception are the so-called cases brought against health care professionals by children whose parents were misinformed about the children's medical problems at a time when their conception or could have been prevented. From Gleitman v. Cosgrove, the first case thirty-two years ago, the standing of plaintiffs to sue and the compensability of their injuries have been framed--and rejected--on what some judges have termed grounds. First, the courts reasoned, plaintiffs whose case amounts to saying they should never have been born lack standing to sue because they needed to be born in order to be able to bring their case: their claim is a contradiction in terms. The second barrier, as the New Jersey Supreme Court put it in that first case, is the impossibility of calculating damages: that jurors would be unable to compare a child's impaired existence with nonexistence, and more basically, that existence--no matter how burdened--is always preferable to nonexistence[l] Not for the courts is Job's curse, Let the day perish wherein I was born, nor his plaintive lamentation, Why died I not from the womb? Nonetheless, not long ago, it seemed as though the courts would slowly come to allow wrongful life claims by analogy to related cases. Several states, including New Jersey, ruled in favor of suits against physicians brought by children whose parents were denied information relevant to reproductive decisions. As the range and frequency of prenatal--and even preconceptual--medical interventions increase, more claims can be expected in which a negligent act was the direct cause ora child's injuries. In time, the application of standard tort principles in such cases would extend to the similar sorts of injuries that arise when a physician's negligent misstatement of a risk prevents parents from choosing to avoid or terminate a pregnancy. Second, the growing number of claims for of life, brought by patients who receive treatment that they (or surrogates speaking on their behalf) had rejected and who then survived in a painful and undignified state, seemed likely to receive favorable treatment by the courts because the deprivation of choice seems so egregious. Again, the similarity of these claims to so-called wrongful life cases would eventuate in judges coming to accept the latter cases as stating a cause of action for which relief may be granted when supported by appropriate facts. Yet despite a recent multimillion dollar judgment in New Jersey, current suits in a number of states are pointing in the opposite direction. Not only does remain a label applied to claims for which the law offers no redress, but some states have recently reduced parents' ability to bring so-called birth actions to recover the costs of raising a handicapped child who would not have been born but for the negligence of a physician or other provider. Further, the metaphysical objections to plaintiffs' standing to sue and incalculable damages that originated in wrongful life decisions have been transferred to the growing number of extension suits brought by patients kept alive by unconsented-to life-sustaining treatment. These cases expose the profound ethical tension between respecting patients' rights to control their health care (including the constitutionally guaranteed rights to abortion and to limit life-prolonging treatment) and preserving the rights and dignity of disabled persons against the denigration that some believe is implied by awarding damages here. The decisions also serve as a lamentable reminder of the wide gap between the high-flown rhetoric about patients' fundamental right to make medical decisions and judges' unwillingness to award damages when autonomy has been breached. …

Family member knowledge of children's medical problems: the need for universal application of an emergency data set.

Advances in medical care have led to a growing population of special needs children who are at risk for suboptimal care when they present to a physician with no previous knowledge of their medical history. This risk may be amplified in the emergency department setting when time-sensitive interventions must be initiated without immediate access to consultants or past records. Our purpose in this study was to evaluate caretakers' knowledge of their children's chronic medical problems and their ability to relate this knowledge to unfamiliar health care providers. Caretaker/child pairs presenting for specialty visits were surveyed. Questions focused on knowledge of the child's illness, medicine regime, and how to contact the specialist. Chart review confirmed responses of caretakers and provided sociodemographic information. Descriptive statistics and chi2 were used in data analysis. Of the 49 caretakers interviewed, 85% were parents, 53% were African-American, and 43% were Caucasian. One-half of the group received medical assistance. The mean age of the children was 55 months. Responses showed that 53% of caretakers were unable to provide their children's specific diagnoses. Of these, one half could provide a lay diagnosis whereas the remaining one half could only identify the organ system involved or that there was a problem. For children on medications, 29% of caretakers could not provide an accurate list. Name of the subspecialist and phone number of the subspecialty clinic was unknown by 25% of caretakers. No child wore medical identification jewelry. Caretakers are not always able to accurately relay vital information on their child's essential medical needs, a problem that may be compounded in emergency situations. The use of some form of independent identification and information set is needed to assure proper treatment of children with special health care needs encountering an unfamiliar health care provider.

Analysis of child abuse cases admitted in pediatric service in Japan II. Backgrounds of child abuse in non‐low birth‐weight infants

Child abuse of 126 non-low birth-weight (non-LBW) cases reported from pediatric clinics of major hospitals in Japan in 1986 were examined. Compared to LBW infants abused children's medical problems were few (25.4%) but the presence of step-parents and a history of rearing outside the home were evident (41.3%). The abuse of a child with medical problems by real parents showed similar characteristics to abuse of LBW, occurring at 0-1 and 4 years and two types of abuser's problems were apparent; one problem was the lack of child rearing ability and the other was the inability to cope with the stress involved in child rearing. In abuse of a child by step-parents, most abusers expressed emotional problems with their abused children. Child abuse by a real parent following a period of non-home care occurred soon after the child returned home, and abusers complained that the abused child did not take to its real parents. Abuse of a child without medical problems by real parents occurred at or around birth and indicated a poor ability to rear a child due to parental problems or low tolerance to cope with child rearing. Abuse both of a child and siblings by real parents implied a deficiency of understanding and inability in child rearing due to parental problems that may have resulted in abuse of the children at 0-1 year. It seems that two processes are critical in non-LBW child abuse as well as LBW child abuse.(ABSTRACT TRUNCATED AT 250 WORDS)

Fetal Environmental Toxins

The pediatrician often is asked by concerned parents whether their child's medical problems could be due to some type of exposure during pregnancy. Unfortunately, there seems to be an endless number of new and disturbing possibilities, such as video display terminals and electromagnetic fields, which are suggested regularly in newspaper articles, magazines, and the television news to be harmful. Experience has shown that many of these possibilities are false alarms, but much work is required before reassuring evidence becomes available. This review will summarize the current knowledge of "fetal environmental toxins" or human teratogens—terms that encompass an exposure during pregnancy that has a harmful effect on the developing fetus. Many different types of fetal environmental toxins have been identified (Table), including: • drugs taken by the pregnant woman, • infections during pregnancy, • maternal diseases, • hypoxia, • heat, and • heavy metals. The pediatrician evaluating the child who is reported to have had a harmful exposure in utero should be aware of the variety of potential effects of these exposures, including: • spontaneous abortion; • growth retardation, before and/or after birth; • microcephaly; • distinctive patterns of major and minor malformations; • isolated major malformations; • metabolic dysfunction, such as the diabetes mellitus that occurs in 30% of adults who had congenital rubella syndrome1; • cognitive dysfunction; • mental retardation;

Child abuse of one of a pair of twins in Japan

A nationwide survey in Japan on child abuse and neglect revealed that 10% of the victims were products of multiple births. None of the victims who were singletons had multiple-birth siblings, and only in a few cases were both twins abused. The findings indicated that one rather than both of a pair of twins was likely to be abused in Japan. Abuse of both twins was likely when there were serious parental or family problems, whereas abuse of one twin was associated with the child's medical problems or non-home care. There was no instance of abuse of a pair of twins when both were handicapped. Comparisons of the abused twin with the non-abused co-twin and examination of the abuser's attitude to the victim suggested that the difference between twins in their development or in their response to parents increased the stress of child-rearing and encouraged favouritism, which resulted in abuse of only one twin. Comparison by parents of children with their siblings may be a common factor in general child abuse because it is a natural thing for parents to do

Social and Medical Problems in Children of Heroin-Addicted Parents

Between January 1985 and December 1987, seventy-five children of intravenous heroin-addicted parents (one or both) were studied. Their ages ranged from 4 days to 14 years. All patients had suffered from several pediatric diseases. Three major types of problems were found among the children studied: infectious diseases, nutritional diseases, and parental neglect and/or disinterest. The most common diagnoses at discharge were gastroenteritis (24%), pneumonia (21%), malnutrition (17%), upper airway infectious diseases (13%), septicemia (12%), child abuse (4%), acquired immunodeficiency syndrome (3%), and other infectious diseases (24%). Their parents reported hepatitis B virus infection, acquired immunodeficiency syndrome (AIDS), and alcoholism. The unemployment rate among the fathers was 37%. Sixteen percent of mothers were prostitutes. There was an imprisonment record of 19% for mothers and fathers combined. A multidisciplinary approach for this group of children would make prevention possible and care less expensive.

Some Common Medical Problems of Children in Residential Care and Treatment

Some Common Medical Problems of Children in Residential Care and Treatment

Recurrent headaches in children: diagnosis and treatment.

Headaches are among the most common chronic medical problems of children. A minority of headaches in children have serious and/or lifethreatening causes including meningitis encephalitis, cerebrovascular malfunctions, hydrocephalus, subdural hematomas, brain tumors, carbon monoxide poisoning, and hypertension. The majority of headaches are in the category of migraines or tension headaches. The etiology of juvenile migraines is still uncertain, and multiple treatment options with varying results reflect this uncertainty. A new treatment option includes training the child with migraines or tension headaches, in relaxation and self-regulation of pain.

MTI Teleprograms Releases Videotaped Series on Children's Medical Problems

MTI Teleprograms Releases Videotaped Series on Children's Medical Problems

The Parents' Medical Manual

Of modest size and pleasing format, this book is an excellent guide and reference for educated parents concerning medical problems of children. The authors state in the preface that more than 400 physicians were consulted in deciding what to include in the book, and they have succeeded in including an explanation for, and the home treatment of, most common illnesses of childhood. It is hoped that sales will not be curtailed by a most unfortunate dust jacket. Prevention is stressed, not only in the first chapter entitled "Preventing Accidents and Poisonings," but throughout the book. On seeing a listing of 70 contribut ing authors for a book of about 400 pages, one fears finding a hodgepodge of writing styles and a variability in quality of chapters. Such is not the case here as the contributions are distributed fleetingly in the text, sometimes in a few sentences and at other times

Cat-Scratch Disease

A receptive mind, trained in investigative inquiry and steeped in experience with the medical problems of children, was responsible for the first recognition of cat-scratch disease. Serendipity was no part of the process. Robert Debré (Fig 1), Professor of Pediatrics at the University of Paris, writes: The story of the discovery of cat-scratch disease is quite a curious one. In 1931, my co-worker, Dr. G. Semelaigne, and I were struck by the case of a boy, aged 10 years, who was suffering from a suppurating adenitis in the epitrochlear region. There was no pain, heat, or sign of local inflammation, and we had the impression of a cold, fistulized adenitis similar in aspect to tubercular adenitis. However, its location was strange, as was the speed with which the lymph node had become fistulized. All in all, since tuberculosis was still quite common among French children at that time, we were