The Thai version of the Montreal Children's Hospital Feeding Scale (MCH-FS): psychometric properties.

OBJECTIVE: To standardize and evaluate the psychometric properties of the Thai version of the Montreal Children's Hospital Feeding Scale (MCH-FS). MATERIAL AND METHOD: The MCH-FS was translated and the cultural effects of the Thai version (Thai.MCH-FS) were reviewed. Caregivers of 200 children between the age of12 and 48 months were interviewed and completed the Thai.MCH-FS. In addition to demographic information, each child had a physical exam and anthropometric measures were taken. Each child was classified with or without feeding problems by at least two of three pediatricians who were blind to the results of the feeding scale. RESULTS: Internal consistency for reliability was high (Cronbach's alpha at 0.835). The area under the ROC curve was 0.864. With a discrimination score of 40, both sensitivity (72%) and specificity (80.67%) were at acceptable levels. Factor analysis resulted in three factors accounting for 52.3%. Of the 200 children, 150 children were classified with nofeedingproblems and 50 with feeding problems. There were no significant differences in the characteristics of the two groups; however the Thai.MCH-FS scores were significantly different for the two groups. CONCLUSION: The Thai version of the MCH-FS has been shown to be a valid and reliable short scale for detecting feeding problems in a pediatric care setting.

An optimal cut-off point of serum C-reactive protein in prediction of neonatal sepsis.

OBJECTIVE: To determine an optimal cut-off point of serum C-reactive protein (CRP) levels for prediction of neonatal sepsis. MATERIAL AND METHOD: A prospective cohort study of neonates aged from birth to 30 days old presenting with signs and symptoms of neonatal sepsis in neonatal intensive care unit (NICU) from January 2010 through December 2011 was performed. Neonates were assigned to either sepsis or normal group depending on blood culture status. Serial CRP (12-24 hours apart) and complete blood count were then analyzed using independent t-test, Wilcoxon rank-sum test and Receiver operating characteristic (ROC) curves. RESULTS: Of 53 neonates recruited into the present study, 26 (49%) were assigned to sepsis group and the remaining 27 (51%) were assigned to normal group. Baseline characteristics for the two groups were similar except for the higher amount of male participants in sepsis group (p-value 0.006). Most patients in sepsis group (7/26) demonstrated coagulase-negative staphylococci (CoNS) sepsis. The values of 1st CRP and 2nd CRP were significantly higher in sepsis group compared to normal group (p-value < 0.001 and 0.003). From ROC curves, at the cut-off points of 1st CRP > or = 1.90 mg/L and 2nd CRP > or = 1.25 mg/L, the sensitivity were as high as 92.6% and 96.3%, respectively, and the specificity were both at 100%. CONCLUSION: Serial CRP is safe as diagnostic tool to consider antimicrobial treatment in neonatal sepsis with sensitivity of 92.6% and 96.3% for the first CRP cut-off point > or = 1.90 mg/L and the second CRP > or = 1.25 mg/L with 100% positive predictive value. Moreover, these safety profiles might help in reducing overuse of antibiotics with negative predictive value 96.3%.

Infant toilet training in Thailand: starting and completion age and factors determining them.

OBJECTIVE: To study the age at which Thai infants start and achieve toilet training and its associated factors. MATERIAL AND METHOD: The parents of fifty infants in a research entitled "Bowel movements of normal Thai infants" were interviewed about age at which toilet training started, the process of toilet training and age at which infant successfully completed toilet training. RESULTS: Forty-seven infants from the 50 infants registered had data of the date of beginning toilet training. Five of them (10.6%) started toilet training at 4 months and 38 (80.9%) by 12 months. Most of the infants (73.7%) were initially trained when they showed urging signs. Only 45 infants had complete data of successful toilet training. Twenty-two cases (48.9%) were trained successfully by 12 months and most of them (16/22) succeeded within one month. The infants, who were not the first child and were taken care of by a well-educated mother, were found to start toilet training late. CONCLUSION: The youngest age at which normal Thai infants start to be toilet trained was 4 months. About 50% of the infants aged 12 months had successful toilet training. Being raised by a well-educated mother and a having a later birth order in a family were factors associated with late toilet training.

Bowel movements of normal Thai infants.

The aim of this study was to define the bowel movements of healthy Thai infants up to 12 months of age. Fifty infants were evaluated at 1, 2, 4, 6, 9 and 12 months of age. Data regarding bowel habits was recorded by parents daily for 2 days before coming to the hospital at each visit. The mean frequency of bowel movements per day was maximal (3.16 stools) during the newborn period and declined (1.59 stools) by the age of 12 months. At birth stool consistency was mostly runny, and became consistently more solid by 4 months of age. With increasing age, infants produced larger stools: mean volume of stool was 32.7 ml at 1 month of age and increased to 45.34 ml at 12 months. Infants started to have regular bowel movements at 4 months of age, most of them stopped having bowel movements at night by 3 months.

Successful treatment in a child with feeding problems and growth failure.

A 2-year-9-month-old boy presented with feeding disorder and poor growth. The clinicalpresentation was compatible with infantile anorexia, one of behavioral feeding disorders. The author proposed that the main cause of poor food acceptance and growth failure in this child was poor appetite. Treatments were composed of behavioral interventions, rescheduling meals and foods enrichment. Alternative managements by prescribing cyproheptadine as an appetite stimulant resulted in significant improvement of feeding behaviors and weight gain.

Prevalence and clinical characteristics of attention deficit hyperactivity disorder among primary school students in Bangkok.

Attention deficit hyperactivity disorder (ADHD) is an important disorder because it is the most prevalent chronic health condition affecting school aged children. Children with ADHD are at risk for academic and behavior problems. There are several studies in many countries worldwide. In Thailand, there have been a few published papers about ADHD. Most of them were studies in a clinically referred population. Four hundred and thirty-three first to sixth grade students from Wat Samiennaree School were included in this study. All children were administered Raven's progressive matrices test for estimation of intellectual functioning and were observed for their behavior in the classrooms by one researcher. Their demographic data was collected by questionnaires. The revised Conners rating scales were scored for each student. Students whose parents did not score the Conners parent rating scale were excluded. The parents of students, whose scores were positive for ADHD, were interviewed according to DSM IV criteria. 353 (81.5%) students from 433 were enrolled in this study. 23 students were diagnosed with ADHD making a prevalence of 6.5 per cent. There were 11 boys and 12 girls. The ratio of male to female was 1:1.09. The ADHD students had lower scores in mathematics than the group without this diagnosis with statistical significance (p = 0.006).

Feeding problems in healthy young children: prevalence, related factors and feeding practices.

The aim of this study was to determine the prevalence, characteristics, and factors related to feeding problems among normal children, and the differences in feeding practices between those with and without feeding problems. Caregivers of 402 healthy children aged between one and four years of age were interviewed by pediatricians involved in the research. Data included the child's medical history, food intake within a day, and feeding behaviors and practices. Parental socio-economic and demographic information, as well as information on parental education and occupation, and their concerns about feeding their children, was collected. Physical examination and anthropometric measurements were taken. The percentage of children identified as having feeding problems was 26.9%. The first child of a family had an increased risk of having feeding problems [P=0.032, odds ratio 1.68, 95% confidence interval (95%CI) 1.04-2.71]. Children with feeding problems were fed less frequently, were less likely to be fed at their own table or at the family table, and had mealtimes longer than 30 min when compared with children without feeding problems (P=0.015, 0.004 and 0.025, respectively). The results highlight that feeding problems in normally developing children are common. During consultations about feeding issues, pediatricians should focus on families with a first child. Topics such as frequency of meals per day, duration of mealtimes, and appropriate places for feeding should be discussed.