BMC Pediatrics - Latest Articles

The impact of childhood acute rotavirus gastroenteritis on the parents' quality of life: prospective observational study in European primary care medical practices

Javier Diez-Domingo — 2012-05-31T00:00:00Z

Background: Rotavirus (RV) is the commonest cause of acute gastroenteritis in infants and young childrenworldwide. A Quality of Life study was conducted in primary care in three Europeancountries as part of a larger epidemiological study (SPRIK) to investigate the impact ofpaediatric rotavirus gastroenteritis (RVGE) on affected children and their parents. Methods: A self-administered questionnaire was linguistically validated in Spanish, Italian and Polish.The questionnaire was included in an observational multicentre prospective study of 302children aged <5 years presenting to a general practitioner or paediatrician for RVGE atcentres in Spain, Italy or Poland. RV infection was confirmed by polymerase chain reaction(PCR) testing (n = 264). The questionnaire was validated and used to assess the emotionalimpact of paediatric RVGE on the parents. Results: Questionnaire responses showed that acute RVGE in a child adversely affects the parents'daily life as well as the child. Parents of children with RVGE experience worry, distress andimpact on their daily activities. RVGE of greater clinical severity (assessed by the Vesikariscale) was associated with higher parental worries due to symptoms and greater changes inthe child's behaviour, and a trend to higher impact on parents' daily activities and higherparental distress, together with a higher score on the symptom severity scale of thequestionnaire. Conclusions: Parents of a child with acute RVGE presenting to primary care experience worry, distress anddisruptions to daily life as a result of the child's illness. Prevention of this disease throughprophylactic vaccination will improve the daily lives of parents and children.

Abernethy malformation: a case report

Ashish Pathak — 2012-05-29T00:00:00Z

Background: Abernethy malformation is a very rare congenital vascular malformation defined by diversionof portal blood away from liver. It is commonly associated with multiple congenitalanomalies. We present a case of Abernethy malformation, without associated congenitalanomalies from India.Case presentationA 5-year-old female child presented with short history of jaundice. A provisional diagnosis ofacute viral hepatitis was made in view of clinical presentation and local endemicity of viralhepatitis A. Persistence of jaundice on follow up after 4 weeks led to detailed investigations.Ultrasound and doppler study of abdomen revealed drainage of portal vein into inferior venacava. CT angiography was performed which confirmed the diagnosis of Type 1 b Abernethymalformation without associated major anomalies. We discuss the common clinicalpresentations, associated anomalies, diagnostic workup and treatment options of this disorder. Conclusion: The treatment of the patients with congenital porto-systemic shunts depends on the site of theshunt, associated congenital anomalies and the extent of liver damage but the prognosisdepends on the complications irrespective of anatomical type. However, the extent ofassociated abnormalities should not deter paediatricians to refer patients for treatment.Whenever possible closure of the shunt should be advised for cure or to preventcomplications. Only symptomatic type I patients with absence of possibility to close the shuntmay require liver transplant. Long-term follow-up is indicated for all patients.

Rare neonatal diabetes insipidus and associated late risks: Case report

Maximiliano Francisco Rivas-Crespo — 2012-05-28T00:00:00Z

Most cases of neonatal central diabetes insipidus are caused by an injury, which often resultsin other handicaps in the patient. The infant's prognosis will be determined by his or her ownearly age and disability as well as by the physician's skill. However, the rarity of thiscondition prevents the acquisition of personal experience dealing with it.A neonatal hemorrhagic stroke, caused by an aortic coarctation, caused right lower limbparesis, swallowing disability, and central diabetes insipidus in a term infant. The scant oralintake, as a consequence of his disability, caused progressive undernutrition which closed avicious circle, delaying his development and his ability to overcome the swallowinghandicap. On the other hand, nasal desmopressin absorption was blocked by several commoncolds, resulting in brain bleeding because of severe dehydration. This even greater braindamage hampered the improvement of swallowing, closing a second harmful circle.Moreover, a devastating central myelinolysis with quadriplegia, caused by an uncontrolledintravenous infusion, consummated a pernicious sequence, possibly unreported.The child's overall development advanced rapidly when his nutrition was improved bygastrostomy: This was a key effect of nutrition on his highly sensitive neurodevelopment.Besides, this case shows potential risks related to intranasal desmopressin treatment in youngchildren.

Adolescent nutritional awareness and use of food labels: Results from the national nutrition health and examination survey

Janet Wojcicki — 2012-05-28T00:00:00Z

Background: Awareness of federal nutrition programs and use of the nutrition facts label are associatedwith reduced risk for obesity and increased intake of fruits and vegetables. Relationshipsbetween nutrition programs, use of food labels and risk for overweight and obesityhave rarely been evaluated in adolescents. Methods: Using the National Health and Nutrition Examination Survey from 2005-6, we evaluated thefrequency of nutrition awareness of USDA and CDC nutrition programs and use of foodlabels in adolescents. Risk for overweight (BMI [greater than or equal to] 85-94th percentile) and obesity(BMI [greater than or equal to] 95th percentile) was assessed in relation to nutrition awareness and label reading. Results: Most adolescents (92.4%) were aware of the Food Guide Pyramid. Fewer (43.5%) wereaware of the 5-A-Day Program, and even less (29.3%) were aware of the Dietary Guidelinesfor Americans. Less than 25% of adolescents decided which foods to purchase by readingmaterial on the nutrition facts label. There were significant racial and ethnic differences inawareness of federal nutrition programs with Mexican-Americans having the lowest levels ofawareness of the US Dietary Guidelines for Americans and the Food Guide Pyramid incomparison with other groups. Non-Hispanic whites had higher and African-Americanadolescents had lower frequencies of reading fat information on the nutrition label incomparison to Mexican-American and other Hispanics. Awareness of other nutritionprograms or of other information on the nutrition facts label was not associated withincreased or decreased risk for overweight or obesity. Conclusions: Use of the nutrition facts panel information is low among US adolescents. Additionally, lessthan half of adolescents are aware of federal nutrition programs including the DietaryGuidelines for Americans. Future studies should evaluate avenues to make nutritioninformation more accessible to young Americans.

Characteristics of highly impaired children with severe chronic pain: a 5-year retrospective study on 2249 pediatric pain patients

Boris Zernikow — 2012-05-16T00:00:00Z

Background: Prevalence of pain as a recurrent symptom in children is known to be high, but little is knownabout children with high impairment from chronic pain seeking specialized treatment. Thepurpose of this study was the precise description of children with high impairment fromchronic pain referred to the German Paediatric Pain Centre over a 5-year period. Methods: Demographic variables, pain characteristics and psychometric measures were assessed at thefirst evaluation. Subgroup analysis for sex, age and pain location was conducted andmultivariate logistic regression applied to identify parameters associated with extremely highimpairment. Results: The retrospective study consisted of 2249 children assessed at the first evaluation. Tensiontype headache (48%), migraine (43%) and functional abdominal pain (11%) were the mostcommon diagnoses with a high rate of co-occurrence; 18% had some form of musculoskeletalpain disease. Irrespective of pain location, chronic pain disorder with somatic andpsychological factors was diagnosed frequently (43%). 55% of the children suffered frommore than one distinct pain diagnosis. Clinically significant depression and general anxietyscores were expressed by 24% and 19% of the patients, respectively. Girls over the age of 13were more likely to seek tertiary treatment compared to boys. Nearly half of children sufferedfrom daily or constant pain with a mean pain value of 6/10. Extremely high pain-relatedimpairment, operationalized as a comprehensive measure of pain duration, frequency,intensity, pain-related school absence and disability, was associated with older age, multiplelocations of pain, increased depression and prior hospital stays. 43% of the children takinganalgesics had no indication for pharmacological treatment. Conclusion: Children with chronic pain are a diagnostic and therapeutic challenge as they often have twoor more different pain diagnoses, are prone to misuse of analgesics and are severely impaired.They are at increased risk for developmental stagnation. Adequate treatment and referral areessential to interrupt progression of the chronic pain process into adulthood.

Static balance and function in children with cerebral palsy submitted to neuromuscular block and neuromuscular electrical stimulation: Study protocol for prospective, randomized, controlled trial

Soráia Kazon — 2012-05-16T00:00:00Z

Background: The use of botulinum toxin A (BT-A) for the treatment of lower limb spasticity is common in children with cerebral palsy (CP). Following the administration of BT-A, physical therapy plays a fundamental role in potentiating the functionality of the child. The balance deficit found in children with CP is mainly caused by muscle imbalance (spastic agonist and weak antagonist). Neuromuscular electrical stimulation (NMES) is a promising therapeutic modality for muscle strengthening in this population. The aim of the present study is to describe a protocol for a study aimed at analyzing the effects of NMES on dorsiflexors combined with physical therapy on static and functional balance in children with CP submitted to BT- A. Methods: Protocol for a prospective, randomized, controlled trial with a blinded evaluator. Eligible participants will be children with cerebral palsy (Levels I, II and III of the Gross Motor Function Classification System) between five and 12 years of age, with independent gait with or without a gait-assistance device. All participants will receive BT-A in the lower limbs (triceps surae). The children will then be randomly allocated for either treatment with motor physical therapy combined with NMES on the tibialis anterior or motor physical therapy alone. The participants will be evaluated on three occasions: 1) one week prior to the administration of BT-A; 2) one week after the administration of BT-A; and 3) four months after the administration of BT-A (end of intervention). Spasticity will be assessed by the Modified Ashworth Scale and Modified Tardieu Scale. Static balance will be assessed using the Medicapteurs Fusyo pressure platform and functional balance will be assessed using the Berg Balance Scale.DiscussionThe aim of this protocol study is to describe the methodology of a randomized, controlled, clinical trial comparing the effect of motor physical therapy combined with NMES on the tibialis anterior muscle or motor physical therapy alone on static and functional balance in children with CP submitted to BT-A in the lower limbs. This study describes the background, hypotheses, methodology of the procedures and measurement of the results.Trial registrationRBR5qzs8h

Hand hygiene instruction decreases illness-related absenteeism in elementary schools: a prospective cohort study

Claudia Lau — 2012-05-15T00:00:00Z

Background: Illness-related absences have been shown to lead to negative educational and economicoutcomes. Both hand washing and hand sanitizer interventions have been shown to beeffective in reducing illness-related absences. However, while the importance of handhygiene in schools is clear, the role of instruction in use is less obvious. The purpose of thisstudy was to compare absenteeism rates among elementary students given access to handhygiene facilities versus students given both access and short repetitive instruction in use,particularly during influenza season when illness-related absences are at a peak. Methods: A hand hygiene intervention was implemented from October to May during the 2009/2010academic year, including peak flu season, in two Chicago Public Elementary Schools amongstudents grades pre-kindergarten to eighth grade (ages 4-14). Classrooms were systematicallyassigned to an intervention or control group by grade (cluster design). Hand hygiene facilities(sanitizer and soap) were made available to all students. Students in the intervention groupalso received short repetitive instruction in hand hygiene every 2 months. Only absences as aresult of respiratory or gastrointestinal illness were used to establish illness-relatedabsenteeism rates. Percent absent days were calculated and bivariate analyses were performedto compare percent absent days among students given access to hand hygiene facilities versusstudents given both access and instruction. Prior to the intervention, teachers' perceptions ofstudents' hand hygiene were also evaluated. Teacher perceptions were analysed to describeattitudes and beliefs. Results: Data were collected and analysed for 773 students reporting 1,886 absences during the studyperiod (1.73% of total school days). Both the percent total absent days and percent illnessrelatedabsent days were significantly lower in the group receiving short instruction duringflu season (P = 0.002, P < 0.001, respectively). This difference peaked in during influenza(when intervention began) and declined in the following months. Teachers (n = 23) agreedthat hand hygiene is not performed properly among students and reported time constraints asa barrier to frequent hand washing. Conclusions: Adding hand hygiene instruction to existing hand hygiene practices improved attendance atpublic elementary schools during the flu season. Standardized and brief repetitive instructionin hand hygiene holds potential to significantly reduce absenteeism.

Longitudinal Evaluation of Transition Services ("LETS Study"): Protocol for outcome evaluation

Irina Tsybina — 2012-05-15T00:00:00Z

Background: Because of advances in medical treatment, most children with physical disabilities can expectto achieve near normal life spans. Typically, coordinated teams of health care providers inspecialized pediatric settings care for these children. As these children reach adulthood,however, the availability of services and expertise changes because the adult health caresystem has different processes designed to meet their specialized needs. Gaps in continuity ofcare during the transition from pediatric to adult services, and associated poor healthoutcomes are well documented. In response, new models of care are being introduced toaddress the complex process of health care transition. This paper describes a study protocolof a client-centered, prospective, longitudinal, mixed-method evaluation of linked model ofhealth care across the lifespan (the LIFEspan Model), offered by a pediatric rehabilitationcenter and an adult rehabilitation center.MethodThis project will include a process and an outcome evaluation of the LIFEspan Model. Theprocess evaluation will detail the specific service delivery that occurs with respect topreparation for transition and transfer of care through chart audits of pediatric medicalrecords and qualitative interviews with LIFEspan staff. The outcome evaluation will measurethe effect of the model on: 1) maintaining continuity within the health care system frompediatric to adult care; and 2) secondary outcomes related to health, well-being, socialparticipation, transition readiness, and health care utilization of youth with cerebral palsy andacquired brain injury. Standardized instruments will include Health Utilities Inventory,Assessment of Life Habits, Arc's Self-Determination, Assessment of Health-Related Qualityof Life, Partners in Health Questionnaire, Social Support Questionnaire, and Self-Efficacy forManaging Chronic Disease.DiscussionThe LETS study will be original in its undertaking of a prospective examination of outcomes1-year post-transition, use of multiple comparison groups, and absence of disability-relatedexclusion criteria ensuring that the transition experiences of varied populations of youngpeople and their families will be represented.Trial registrationwww.clinicaltrials.gov, ID NCT00975338

Factors associated with attention deficit/hyperactivity disorder among US children: Results from a national survey

Ravi Lingineni — 2012-05-14T00:00:00Z

Background: The purpose of this study was to investigate the association between Attention Deficit/Hyperactivity Disorder (ADHD) and various factors using a representative sample of US children in a comprehensive manner. This includes variables that have not been previously studied such as watching TV/playing video games, computer usage, family member's smoking, and participation in sports. Methods: This was a cross-sectional study of 68,634 children, 5-17 years old, from the National Survey of Children's Health (NSCH, 2007-2008). We performed bivariate and multivariate logistic regression analyses with ADHD classification as the response variable and the following explanatory variables: sex, race, depression, anxiety, body mass index, healthcare coverage, family structure, socio-economic status, family members' smoking status, education, computer usage, watching television (TV)/playing video games, participation in sports, and participation in clubs/organizations. Results: Approximately 10% of the sample was classified as having ADHD. We found depression, anxiety, healthcare coverage, and male sex of child to have increased odds of being diagnosed with ADHD. One of the salient features of this study was observing a significant association between ADHD and variables such as TV usage, participation in sports, two-parent family structure, and family members' smoking status. Obesity was not found to be significantly associated with ADHD, contrary to some previous studies. Conclusions: The current study uncovered several factors associated with ADHD at the national level, including some that have not been studied earlier in such a setting. However, we caution that due to the cross-sectional and observational nature of the data, a cause and effect relationship between ADHD and the associated factors can not be deduced from this study. Future research on ADHD should take into consideration these factors, preferably through a longitudinal study design.

Pediatricians' assessments of caries risk and need for a dental evaluation in preschool aged children

C. Marshall Long — 2012-05-04T00:00:00Z

Background: Risk-based prioritization of dental referrals during well-child visits might improve dental access for infants and toddlers. This study identifies pediatrician-assessed risk factors for early childhood caries (ECC) and their association with the need for a dentist's evaluation. Methods: A priority oral health risk assessment and referral tool (PORRT) for children < 36 months was developed collaboratively by physicians and dentists and used by 10 pediatricians during well-child visits. PORRT documented behavioral, clinical, and child health risks for ECC. Pediatricians also assessed overall ECC risk on an 11-point scale and determined the need for a dental evaluation. Logistic regression models calculated the odds for evaluation need for each risk factor and according to a 3-level risk classification. Results: In total 1,288 PORRT forms were completed; 6.8% of children were identified as needing a dentist evaluation. Behavioral risk factors were prevalent but not strong predictors of the need for an evaluation. The child's overall caries risk was the strongest predictor of the need for an evaluation. Cavitated (OR=17.5; 95% CI = 8.08, 37.97) and non-cavitated (OR=6.9; 95% CI=4.47, 10.82) lesions were the strongest predictors when the caries risk scale was excluded from the analysis. Few patients (6.3%) were classified as high risk, but their probability of needing an evaluation was only 0.36. Conclusions: Low referral rates for children with disease and prior to disease onset but at elevated risk, indicate interventions are needed to help improve the dental referral rates of physicians.