Therapeutic Management Of Children Research Articles

One year follow-up of cardiovascular profile and therapeutic management of children and adolescents with familial hyphercholesterolemia: Preliminary data from the Hellas-FH registry

One year follow-up of cardiovascular profile and therapeutic management of children and adolescents with familial hyphercholesterolemia: Preliminary data from the Hellas-FH registry

Update on the diagnosis and treatment of tuberculosis

According to World Health Organization estimates, more than 1 million patients aged less than 15 years develop tuberculosis (TB) each year worldwide. In some regions, up to 25% of new TB cases are caused by drug-resistant strains. Although Spain is considered a low-incidence country, several hundred children and adolescents develop TB each year. The importance of paediatric TB has been minimized for years due to the lack of microbiological confirmation in many patients and because these patients are not usually contagious. Nevertheless, in the past 15 years there have been major improvements in the epidemiological reporting of TB in children and adolescents, new immunodiagnostic tests have been developed, molecular methods that allow rapid microbiological diagnosis and detection of variants associated with drug resistance have become available, novel second-line antituberculosis drugs have been discovered, including for paediatric use, and the results of clinical trials have validated shorter courses of treatment for some patients. This document, developed by a group of experts from the Sociedad Española de Infectología Pediátrica and the Sociedad Española de Neumología Pediátrica, updates and complements the previous guidelines for the diagnostic and therapeutic management of children with TB in Spain based on the newly available scientific evidence.

Actualización del diagnóstico y tratamiento de la tuberculosis

According to WHO estimates, more than 1 million patients aged less than 15 years develop tuberculosis (TB) each year worldwide. In some regions, up to 25% of new TB cases are caused by drug-resistant strains. Although Spain is considered a low-incidence country, several hundred children and adolescents develop TB each year. The importance of paediatric TB has been minimized for years due to the lack of microbiological confirmation in many patients and because these patients are not usually contagious. Nevertheless, in the past 15 years there have been major improvements in the epidemiological reporting of TB in children and adolescents, new immunodiagnostic tests have been developed, molecular methods that allow rapid microbiological diagnosis and detection of variants associated with drug resistance have become available, novel second-line antituberculosis drugs have been discovered, including for paediatric use, and the results of clinical trials have validated shorter courses of treatment for some patients. This document, developed by a group of experts from the Sociedad Española de Infectología Pediátrica and the Sociedad Española de Neumología Pediátrica, updates and complements the previous guidelines for the diagnostic and therapeutic management of children with TB in Spain based on the newly available scientific evidence.

Coexistence of antithrombin deficiency and suspected inferior vena cava atresia in an adolescent and his mother \u2013 case report and clinical implications

BackgroundAntithrombin deficiency (ATD) is an autosomal dominant thrombophilia presenting with varying phenotypes. In pediatric patients with ATD, thrombosis typically develops during the neonatal period or adolescence. However, to date there are no consistent recommendations on the therapeutic management of children with ATD. Inferior vena cava atresia (IVCA) belongs to a range of congenital or acquired vena cava malformations and is described as an independent risk factor for thrombosis.The present case report explores two cases of combined ATD and IVCA in an adolescent and his mother.Case presentationA 14-year-old male presented with extensive deep venous thromboses (DVTs) of both lower extremities as well as an IVCA. The patient had previously been diagnosed with an asymptomatic ATD without therapeutic consequences at that time. His mother was suffering from an ATD and had herself just been diagnosed with IVCA, too.The DVTs in the adolescent were treated by systemic anticoagulation and catheter-directed local thrombolysis causing favourable results. Yet, despite adequate oral anticoagulation the DVTs in both lower extremities reoccurred within 1 week after the patient was discharged from hospital. This time, thrombolysis could not be fully achieved. Surprisingly, probing and stenting of the IVCA was achieved, indicating an acquired IVCA which could have occurred after undetected thrombosis in early childhood.Genetic analyses showed the same mutation causing ATD in both son and mother: heterozygote missense mutation c.248 T > C, p.(Leu83Pro), within the heparin binding domain of antithrombin. This mutation was never reported in mutation databases before.ConclusionsTo our knowledge this is the first case report discussing combined ATD and IVCA in two family members. Since ATDs present with clinical heterogeneity, taking a thorough family history is crucial for the anticipation of possible complications in affected children and decisions on targeted diagnostics and therapeutic interventions. Affected families must be educated on risk factors and clinical signs of thrombosis and need an immediate diagnostic workup in case of clinical symptoms. IVCA in patients with ATD could occur due to thrombotic occlusion at a very early age. Therefore, in case of family members with IVCA and ATD ultrasound screening in newborns should be considered.

What Is the Correct Way to Manage Children Requiring Gastrostomy? Single Center Experience

Children with complex medical issues often present different comorbidities that cause feeding difficulties. Gastrostomy is often helpful, and should be performed when nutritional supplementation is necessary for longer than 6 weeks. Recently, different techniques have been used for gastrostomy in children. The authors report on their experiences regarding the diagnostic and therapeutic management of children requiring gastrostomy. All patients managed in the last 10 years were reviewed, retrospectively. Everyone underwent investigation to exclude gastroesophageal reflux disease (GERD). A total of 148 patients: 111 cases (75%) were neurologically impaired patients, 18 (12%) had complex heart disease, 10 (6%) had metabolic diseases, 4 (3%) had fibrosis cystic, 4 (3%) had muscle disease, and one had chromosomopathy. After investigation, 49 patients had GERD. PEG was performed in 101 cases (68%), laparo-assisted gastrostomy was performed in 44 cases (29.7%), open gastrostomy was performed in three cases. At follow-up, all patients reported weight gain, but 13 cases had major complications. Currently, the surgeon has the possibility of choosing between several safe techniques for gastrostomy. In our experience, PEG is the most useful technique for patients without GERD, while a laparo-assisted technique is better for patients who require laparoscopic fundoplication.

Risk Factors of Persistent Hydrocephalus in Children with Brain Tumor: A Retrospective Analysis

Object: Hydrocephalus is one of the main complications of brain tumors in children, being present in about 50% of cases at the time of the tumor diagnosis and persisting up to 10–40% of cases after surgical resection. This is a single-institution retrospective study on the variables that may predict the need for treatment of persistent hydrocephalus in pediatric patients presenting with a brain tumor. Methods: Retrospective case note review of 43 newly diagnosed brain tumors in children referred between April 2012 and January 2018 to our regional pediatric neuro-oncology service was carried out. Diagnosis of hydrocephalus was carried out using both preoperative and postoperative MRI to determine Evans’ index (EI) and the fronto-occipital horn ratio (FOHR) from each scan. Simple logistic regression was used to analyze categorical variables as appropriate. A p value <0.05 was considered significant. Results: Forty-three children were analyzed, 26 males and 17 females with a median age at diagnosis 10.4 years (IQR: 5.2–13.5). Hydrocephalus was present in 22/43 children (51%) preoperatively; in 8/22 children (36%) with hydrocephalus undergoing tumor resection, hydrocephalus persisted also in the postoperative period. An EI >0.34 (p = 0.028) and an FOHR >0.46 (p = 0.05) before surgery were associated with a higher prevalence of persistent hydrocephalus and therefore to the need for a cerebrospinal fluid drain device in the postoperative phase. Conclusion: Preoperative identification of children at risk for developing persistent hydrocephalus would avoid delays in planning the permanent cerebrospinal fluid drain devices. This study finds that an EI >0.34 and an FOHR >0.46 at diagnosis could impact on the therapeutic management of children with hydrocephalus associated with brain tumors. Prospective and larger-scale studies are needed to standardize this approach.

Сучасні підходи до лікування запальних захворювань кишечника в дітей відповідно до останніх рекомендацій Європейської організації з вивчення хвороби Крона і коліту, Європейського товариства дитячих гастроентерологів, гепатологів та нутриціологів

Modern outpatient management of ulcerative colitis (UC) continues to be a difficult task, as 20% of children still need colectomy (there are no official statistics for Ukraine). Therefore, the European Organization for the Study of Crohn's Disease and Colitis (ECCO) and the European Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists (ESPGHAN), seeking to standardize the daily treatment of inflammatory bowel disease (IBD), have developed a protocol for the management and treatment of children with VC. Based on the analysis of medical research, followed by an evidentiary assessment of each provision, the 2012 recommendations were updated. The aim is to present the provisions of the updated protocol on therapeutic management of children with ulcerative colitis and to consolidate the material on a clinical case. Materials and methods. The article presents updated recommendations of ECCO and ESPGHAN (2018) on the treatment of COPD in children, the algorithm of induction and maintenance of remission of UC and COPD unclassified. A clinical case is given for an example of application of the algorithm of induction and support of remission of IBD at children, assessment of severity and the scheme of management of patients with this pathology is provided. Results and conclusions. The updated recommendations of ECCO and ESPGHAN facilitate the treatment of unclassified UC and IBD, provide a clear scheme for monitoring children with this pathology, which improves treatment outcomes and quality of life of young patients. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: ulcerative colitis, recommendations. children, anti-TNF, calprotectin, unclassified inflammatory bowel disease, monitoring, activity index, treatment.

Supervised Nasal Saline Irrigations in Otitis-Prone Children.

Objectives: To retrospectively investigate the impact of supervised daily nasal saline irrigations (NSI) with 0. 9% saline solution in children with a history of recurrent acute otitis media (RAOM).Methods: A retrospective pilot study was planned to evaluate the possible effect of supervised NSI in reducing the number of acute otitis media (AOM) episodes in otitis-prone children aged 1–5 years, compared to children not instructed to correct NSI performance.Results: Analysis was based on the data contained in 173 charts (57.3% males, mean age of 30.9 ± 7.3 months). 52.0% of children had not been instructed to perform NSI, while the remaining (48.0%) patients had received supervised NSI. At the 4-months follow-up visit a significant reduced number of AOM episodes (1.03 ± 0.14 vs. 2.08 ± 0.16; p < 0.001) as well as antibiotic treatments (1.48 ± 0.17 vs. 2.59 ± 0.18; p < 0.001) was documented in children receiving supervised NSI compared to those not instructed for NSI performance.Conclusions: These data suggest that NSI should be considered in the therapeutic management of children with RAOM, and should be routinely prescribed as a daily adjunctive treatment to reduce acute infectious exacerbations in otitis-prone patients. Accurate parents training is crucial in order to improve children compliance and treatment effectiveness.

Clinical significance and sonographic evolution of enlarged abdominal lymph nodes in children.

Paediatric evidence about the clinical implications of enlarged abdominal lymph nodes (EALN) is not univocal. The main purpose of our study was to evaluate the clinical significance and the morphological evolution of enlarged abdominal nodes in children with recurrent abdominal pain. All children with recurrent abdominal pain diagnosed with EALN were enrolled at the involved centres between September 2017 and June 2018. Number, size, localisation, shape and architecture of nodes were accurately recorded along with clinical and laboratory data at enrolment and after three and six months. A total of 38 children were enrolled. After the six-month study period, 58% of them had lymph nodes reduced in size, 13% had unchanged lymph nodes, and 29% had lymph nodes increased in size. Overall, we observed a gradual, albeit slight reduction in the average size of enlarged nodes over the six-month period. The extent of size changes was not correlated with any clinical parameter. Our data suggest that EALN are a non-specific finding, which is not worth a change in the diagnostic and therapeutic management of children with abdominal pain.

Use of a Pediatric Syncope Unit Improves Diagnosis and Lowers Costs: A Hospital-Based Experience

To assess the effect of a dedicated pediatric syncope unit on the diagnostic and therapeutic management of children with suspected syncope. We also evaluated the effectiveness of the pediatric syncope unit model in decreasing unnecessary tests and hospitalizations, minimizing social costs, and improving diagnostic yield. This single-center cohort observational, prospective study enrolled 2278 consecutive children referred to Bambino Gesù Children's Hospital from 2012 to 2017. Characteristics of the study population, number and type of admission examinations, and diagnostic findings before the pediatric syncope unit was implemented (2012-2013) and after the pediatric syncope unit was implemented (2014-2015 and 2016-2017) were compared. The proportion of undefined syncope, number of unnecessary diagnostic tests performed, and number of hospital stay days decreased significantly (P < .0001), with an overall decrease in costs. A multivariable logistic regression analysis, adjusted for confounding variables (age, sex, number of diagnostic tests), the period after pediatric syncope unit (2016-2017) resulted as the best independent predictor of effectiveness for a defined diagnosis of syncope (P < .0001). Pediatric syncope unit organization with fast-tracking access more appropriate diagnostic tests is effective in terms of accuracy of diagnostic yield and reduction of costs.

Diagnostic approach and therapeutic management of children affected by congenital cerebellar disorders

Diagnostic approach and therapeutic management of children affected by congenital cerebellar disorders

Systematic MRI in NF1 children under six years of age for the diagnosis of optic pathway gliomas. Study and outcome of a French cohort.

Optic pathway glioma (OPG) is the most common central nervous system tumor in children with neurofibromatosis type 1 (NF1), affecting 15-20% of patients. We reviewed the medical records of children systematically screened by ophthalmologic and MRI examinations to determine the influence of screening on the therapeutic management of children with OPG. Data were collected on 306 newly diagnosed cases screened with systematic MRI from January 2001 to July 2007. In the OPG group, we distinguished the asymptomatic or symptomatic groups according to their initial status. Forty-five patients had confirmed OPG (14.7%). Thirty-six patients (80%) were asymptomatic and nine (20%) were symptomatic at the time of diagnosis with visual symptoms in six cases. The average age at OPG diagnosis was 3.4 years with six patients (13%) over six years old. Average follow-up was 7.7 years. Progression was observed in 16 cases (35%). Most patient conditions were managed conservatively (87%). Six children (13%) were treated with chemotherapy due to worsening visual function. All of these children had severe or mild visual impairment at the end of follow-up. Our study does not support a clear benefit of systematic MRI screening in NF1 children under six years old. Systematic neuroimaging in our study did not influence therapeutic management. Although OPG diagnosis was made early, treatment with chemotherapy did not improve the final visual outcome. If MRI remains the best tool for the diagnosis of cerebral and spinal pathologies in the NF1 population, our current study questions the usefulness of systematic MRI screening for OPG diagnosis. Conversely, this study suggests that the indication of neuroimaging should be dictated by the results of annual clinical and ophthalmological assessments.

Bridging hypertension in children and adolescents with hypertension in adult individuals

There is growing awareness that in children also “essential” hypertension is the most prevalent form of blood pressure (BP) elevation, and that it may be associated with target organ damage. Evidence is also available that suggests that a child with hypertension has a higher probability of being hypertensive at an adult age than a child with normal BP levels. This suggests that pathophysiological mechanisms contributing to the development of hypertension in childhood might contribute to consolidate such a condition at an adult age. As in adults, in children being overweight or obese have become an epidemic problem associated with elevated BP. This is also the case for lack of physical exercise and excessive intake of sodium with food. It has to be emphasized that in children it is not only weight excess that is associated with increased BP, but the distribution of adipose tissue also plays a role. Among young subjects with similar body weight, those with a greater waist circumference are at a greater risk of having high BP, possibly due to humoral factors released by visceral fat. Indeed, increased insulin resistance (assessed through the HOMA index), increased leptin and uric acid levels are positively and independently associated with increased BP values in children and adolescents, while an inverse correlation has been found with plasma adiponectin levels. Another factor which might contribute to hypertension in childhood is a dysfunction of autonomic neural cardiovascular modulation, characterized by an increase in cardiovascular sympathetic and a reduction in cardiac vagal modulation, documented by a reduction of cardiac arterial baroreflex sensitivity, remaining significant even after adjustment for increased body weight. These considerations underscore the importance of using techniques for 24h ambulatory BP and heart rate monitoring in the diagnostic and therapeutic management of children and adolescents with hypertension aimed at assessing their hemodynamic reactivity and the related pattern of cardiovascular autonomic nervous modulation, in daily life conditions. Given the young age of the subjects being addressed, it is possible that pathophysiological factors contributing to hypertension might still be modifiable and that no structural cardiovascular changes have yet occurred in this age range, the appearance of which might make hypertension an irreversible condition. The hypertensive child therefore represents a challenge to the medical community for implementing interventions able to achieve true early cardiovascular disease prevention, besides being a potential model for a better understanding of the pathophysiological mechanisms underlying essential hypertension in adults.

Rapid-growing Tumor of the Cheek Mimicking a Malignant Tumor

In this case report, we describe a 5-month-old girl with a rapid-growing mass of the lower lip extending to the buccal cheek. After surgical interference, the diagnosis lipoblastoma was made. Dealing with a fast-growing tumor in an infant, lipoblastic tumors belong in the differential diagnosis, however, a malignant process cannot be excluded. Rapid-growing lipoblastoma of infancy is a very rare benign tumor of embryonic white fatty cells. Magnetic resonance imaging might help with the diagnosis and often shows a lesion composed mostly, but not entirely, of fat. In this case report, we want to draw attention to the problems with diagnosis and therapeutic management of children with lipoblastoma.

A Head-to-Head Comparison: “Clean-Void” Bag Versus Catheter Urinalysis in the Diagnosis of Urinary Tract Infection in Young Children

To compare the validity of the urinalysis on clean-voided bag versus catheter urine specimens using the catheter culture as the "gold" standard. This is a cross-sectional study of 303 nontoilet-trained children under age 3 years at risk for urinary tract infection (UTI) who presented to a children's hospital emergency department. Paired bag and catheter specimens were obtained from each child and sent for dipstick and microscopic urinalysis. Sensitivity and specificity were compared using McNemar's chi2 test for paired specimens and the ordinary chi2 test for unpaired comparisons. The bag dipstick was more sensitive than the catheter dipstick for the entire study sample: 0.85 (95% confidence interval [CI]=0.78 to 0.93) versus 0.71 (95% CI=0.61 to 0.81), respectively. Both bag and catheter dipstick sensitivities were lower in infants < or =90 days old (0.69 [95% CI=0.44 to 0.94] and 0.46 [95% CI=0.19 to 0.73], respectively) than in infants >90 days old (0.88 [95% CI=0.81 to 0.96] and 0.75 [95% CI=0.65 to 0.86], respectively). Specificity was consistently lower for the bag specimens than for the catheter specimens: 0.62 (95% CI=0.56 to 0.69) versus 0.97 (95% CI=0.95 to 0.99), respectively. Urine collection methods alter the diagnostic validity of urinalysis. These differences have important implications for the diagnostic and therapeutic management of children with suspected UTI.

Variable use of therapeutic interventions for children with human immunodeficiency virus type 1 infection in Europe

Although a range of antiretroviral drugs are available for use in children, the appropriate paediatric regimen remains unclear. In a survey to investigate policies and practices relating to the therapeutic management of children infected by the human immunodeficiency virus (HIV), a postal questionnaire was sent to a named paediatrician in 70 major HIV centres in 13 European countries in early 1998. A total of 64 paediatricians (91%) responded. Pneumocystis carinii pneumonia prophylaxis was found to be routine in all centres, although considerable variation existed regarding the time of starting and stopping therapy. Prophylaxis for fungal infections and recurrent bacterial infections was common, with cytomegalovirus prophylaxis being less frequent. Although most centres (89%) used all five currently available nucleoside analogues (ziduvodine, lamivudine, stavudine, didanosine, zalcitabine), there was considerable variability regarding the availability of protease inhibitors. Most respondents delayed initiation of antiretroviral therapy until evidence of disease progression was apparent. The initial prescription of 38% of clinicians was triple therapy and that of 57% prescribed double therapy. Policies varied regarding the modification to regimens in response to disease progression and emergence of side effects and drug resistance. Clinical practice was informed by a number of sources, including centre-specific and national guidelines. Most respondents affirmed the need for European guidelines. Approaches to the therapeutic management of paediatric human immunodeficiency virus infection differ across Europe.

CROSS-SECTIONAL SURVEY TO CHARACTERIZE THE CLINICAL COURSE AND MANAGEMENT OF CONSTIPATION IN A PRIMARY CARE PEDIATRIC SETTING WITHIN A HEALTH MAINTENANCE ORGANIZATION

81 Background: Children with constipation are managed by primary care providers (PCP) and/or specialists. Timing for referral to a specialist remains unclear. The purpose of this study is to characterize the clinical course and management of constipation in a primary care pediatric setting within a managed care organization. Methods: In a cross-sectional survey, we characterized the period prevalence of constipation, duration of clinical symptoms and therapeutic management of children, identified by questioning to have clinical constipation, during a well child care (WCC) visit. WCC visits transpired at 6 pediatric offices, staffed by 25 pediatricians, owned by the Fallon Clinic, an HMO in Central MA. To identify children with a clinical history of constipation, all parents of children (ages 1-14yo) were asked to complete a screening questionnaire, prior to seeing the pediatrician. An extensive follow-up (F/U) questionnaire was conducted by telephone within 3 months of WCC visit. Results: Over a 7 month period, screening questionnaires were distributed to the parents of 8093 children, undergoing consecutive WCC visits, with 6193 completed (76.5% response rate). 320 (5.2%) children were found to have clinical constipation, defined as: a recent history of bowel movements (BM)< every other day and at least 1 of the following: abdominal pain, soiling, painful defecation, withholding behavior and/or excessive large BMs. To date, F/U was completed on 261/320 eligible children (81.6%). 87(33%) children continued to exhibit a clinical history of constipation on F/U questionnaire: 87(100%) Bms <every other day for 36/36 (mean/median) months, 46(52%) abdominal pain for 23/12 months, 42(48%) soiling for 31/24 months, 38(43%) painful defecation for 26/24 months, 43(49%) withholding behavior for 23/12 months, Approximately, one third of these 87 children were receiving medication/high fiber supplements. Conclusion: Although the majority of constipation in children is self limiting, approximately one third of patients exhibit long term refractory constipation requiring further intervention.

Penetrating hepatic trauma in children: Operating room or not?

Nonoperative management has become widely accepted as the standard of care for patients with blunt hepatic trauma. Recent studies among adults have supported the use of nonoperative management of selective penetrating wounds to the hepatic bed in stable patients. The therapeutic management of children with penetrating injuries to the hepatic bed were evaluated to ascertain whether nonoperative management was a reasonable consideration in their care. The database of the National Pediatric Trauma Registry (NPTR) was reviewed for the period 1985–1994. ICD-9 codes 864.00 to 864.10 were used to select injury site, diagnosis, and, combined with Current Procedural Terminology (CPT) code data, to ascertain therapeutic interventions. The NPTR is a compilation of data from 61 pediatric trauma centers, currently held at Tufts University. The charts of 29,000 children were reviewed; of these, 1,147 sustained hepatic injuries, 132 (12%) of whom had a penetrating injury. The mechanism of injury was gunshot wound in 100 patients (76%) and stab wound in 32 (24%). The mean age of the children who had a penetrating injury was 12.7 years (range, in utero to 19 years). Six children were managed nonoperatively (5%), and 20 (15%) had negative laparotomy findings. Overall, 106 children sustained additional injuries that required surgical repair. There were 50 hollow viscous injury repair, 19 diaphragmatic repairs, 5 nephrectomies, 4 splenectomies, 4 pancreatic resections, and 43 significant hepatic repairs. The overall mortality rate was 9.8% (13 deaths). Nine of these patients died within 24 hours of injury. These data indicate that penetrating injury to the hepatic bed in children is associated with a high percentage of other organ injuries that require surgical intervention. This seems to be in direct contrast with the findings for adults, for whom the hepatic mass appears protective because of its larger size. The close anatomic proximity of the organs in a child's abdomen appears to make surgical intervention necessary for the majority of children with penetrating injury to the hepatic bed, and indicates that this approach should remain the standard of care for pediatric patients.

Lessons From the Lion's Den: Therapeutic Management of Children in Psychiatric Hospitals and Treatment Centers

Back to table of contents Previous article Next article ArticleNo AccessLessons From the Lion's Den: Therapeutic Management of Children in Psychiatric Hospitals and Treatment CentersLes BarrickmanLes BarrickmanSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.46.2.192AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Lessons From the Lion's Den: Therapeutic Management of Children in Psychiatric Hospitals and Treatment Centers." Psychiatric Services, 46(2), p. 192 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByNone Volume 46Issue 2 February 1995Pages 192-192 Metrics PDF download History Published online 1 April 2006 Published in print 1 February 1995

Physical conditioning in children with arthritis: Assessment and guidelines for exercise prescription.

To review the literature in the area of physical fitness and conditioning programs for individuals with chronic illnesses, and increase the awareness of the need to include fitness testing and conditioning programs in the therapeutic management of children and adolescents with chronic arthritis. This article provides a review of original research reports, information from principal texts, and review articles related to physical fitness testing and training in children. Several factors limit the exercise capacity of children with chronic arthritis, and studies report that these children have lower aerobic endurance and muscle performance than their peers. Preliminary studies suggest that fitness testing is safe for most children with arthritis, and physical conditioning programs, which appear to benefit adults with arthritis and children with other chronic illnesses, may also benefit children with arthritis. Easily administered, inexpensive field tests of fitness are available. Guidelines for prescribing physical conditioning programs are provided. The risks and benefits of increased exercise are discussed. Assessment of exercise capacity and muscle function and individualized prescription of physical conditioning programs are indicated for children with chronic arthritis, soon after diagnosis.