Investigating convergence of cardiac and behavioral indicators of distress during routine vaccinations over the second year of life.

There is considerable variability regarding the convergence between behavioral and biological aspects of distress responses in toddlerhood, and little research has investigated the convergence of these measures in high distress. The aim of the current study was to describe patterns of distress responses to vaccinations as indexed by both pain-related behavioral distress and heart rate (HR) at 12 and 18 months. Caregiver-toddler dyads were part of an ongoing longitudinal cohort observed during 12- (N = 158) and 18-month (N = 122) well-baby vaccinations. Parallel-process growth mixture models discerned two distinct groups at 12 months and three distinct groups at 18 months. All groups had comparable pain-related behavioral distress and HR responses post-vaccination, with most participants displaying high arousal and regulation to baseline levels following the vaccination. However, at 18 months, an important minority had a blunted response or did not regulate to a low level of distress by 3 min post-needle. Post hoc analyses revealed that higher baseline pain-related behavioral distress predicted membership in the majority groups at 12 and 18 months. These results highlight the developmental differences and variability in behavioral and cardiac indicators of distress regulation across the second year of life.

Effectiveness of a publicly funded clinical paediatric weight management program on obesity outcomes.

OBJECTIVE: To determine the effectiveness of a publicly funded, paediatric weight management clinic in decreasing obesity. METHODS: A retrospective chart review of patients four to 16 years of age, from 2006 to 2009, was performed at a medically supervised weight management clinic (n=121). Patients participated in monthly visits and were educated about the cognitive behavioural and nutritional aspects of weight management. RESULTS: The sample included 51 male and 70 female patients with a mean (± SD) initial age of 11.7±3.0 years. Patients participated in 6.4±6.5 visits (range one to 31 visits) over 13.7±15.5 months and 7.4% of patients discontinued treatment after their initial visit. Of the patients who attended the clinic >1 time, 66.1% attended for at least four months, 48.2% attended for >8 months and 33.0% attended for >1 year. Over the course of their treatment, patients experienced a weight gain of 3.8±9.5 kg, but a reduction in body mass index (BMI) percentile (-1.1±3.6%). Post-treatment, the prevalence of obesity decreased from 96.7% to 87.5%. Patients with longer treatment times (>12 months) attained significantly lower final BMI percentiles than patients with shorter treatment times; however, there was no difference in the rate of reduction. Initial treatment age, sex and medical conditions were not related to BMI percentile change. CONCLUSIONS: This paediatric weight management program effectively reduced the prevalence of obesity. Patients who had longer treatment times experienced greater reductions in obesity. Overall, the present study highlights that long-term patient attendance may be needed to better support paediatric weight management patients.

OBJECTIF: Déterminer l'efficacité d'une clinique pédiatrique publique de gestion du poids pour réduire l'obésité. MÉTHODOLOGIE: Les chercheurs ont effectué une analyse rétrospective des dossiers des patients de quatre à 16 ans dans une clinique de gestion du poids supervisée par des médecins (n=121), de 2006 à 2009. Les patients allaient à des rendezvous mensuels et recevaient de l'information sur les aspects cognitivo-comportementaux et nutritionnels de la gestion du poids. RÉSULTATS: L'échantillon était composé de 51 patients et de 70 patientes d'un âge initial moyen (± ÉT) de 11,7±3,0 ans. Les patients ont assisté à 6,4±6,5 rendezvous (plage de un à 31) répartis sur 13,7±15,5 mois, et 7,4 % d'entre eux ont mis un terme au traitement après leur premier rendezvous. Chez les patients qui avaient fréquenté la clinique plus d'une fois, 66,1 % l'avaient fait pendant au moins quatre mois, 48,2 %, plus de huit mois et 33,0 %, plus d'un an. Pendant la durée de leur traitement, les patients ont pris 3,8±9,5 kg, mais ont réduit leur percentile d'indice de masse corporelle (IMC, −1,1±3,6 %). Après le traitement, la prévalence d'obésité diminuait de 96,7 % à 87,5 %. Les patients traités plus longtemps (plus de 12 mois) obtenaient un percentile d'IMC final considérablement plus faible que ceux traités moins longtemps, mais on ne constatait pas de différence dans le taux de perte de poids. L'âge, le sexe et l'état de santé au début du traitement n'étaient pas liés au changement de percentile d'IMC. CONCLUSIONS: Ce programme pédiatrique de gestion du poids assurait une réduction efficace de la prévalence d'obésité. Les patients qui étaient traités plus longtemps devenaient moins obèses. Dans l'ensemble, la présente étude démontre qu'une participation plus longue au programme s'impose peut-être pour mieux soutenir la gestion du poids des patients d'âge pédiatrique.

Understanding the concurrent and predictive relations between child-led emotion regulation behaviors and pain during vaccination in toddlerhood.

ABSTRACT: The purpose of this study was to further our understanding of early childhood pain-related distress regulation. Concurrent and predictive relations between child-led emotion regulation (ER) behaviors and pain-related distress during vaccination were examined at 2 different ages using autoregressive cross-lagged path analyses. Toddlers were video-recorded at the 12- and 18-month routine vaccination appointments (12-month-old [N = 163]; 18-month-old [N = 149]). At 1, 2, and 3 minutes postneedle, videos were coded for 3 clusters of child-led ER behaviors (disengagement of attention, parent-focused behaviors, and physical self-soothing) and pain-related distress. The concurrent and predictive relations between child-led ER behaviors and pain-related distress behaviors were assessed using 6 models (3 emotion regulation behaviors by 2 ages). At 18 months, disengagement of attention was significantly negatively related to pain-related distress at 1 minute postneedle, and pain-related distress at 1 minute postneedle was significantly related to less disengagement of attention at 2 minutes postneedle. Parent-focused behaviors had significant positive relations with pain-related distress at both ages, with stronger magnitudes at 18 months. Physical self-soothing was significantly related to less pain-related distress at both ages. Taken together, these findings suggest that disengagement of attention and physical self-soothing may serve more of a regulatory function during toddlerhood, whereas parent-focused behaviors may serve more of a function of gaining parent support for regulation. This study is the first to assess these relations during routine vaccination in toddlerhood and suggests that toddlers in the second year of life are beginning to play a bigger role in their own regulation from painful procedures than earlier in infancy.

A randomized trial of rotavirus vaccine versus sucrose solution for vaccine injection pain.

OBJECTIVE: Sucrose solutions are analgesic in infants. Oral rotavirus vaccine contains sucrose, however, it is not known if it possesses analgesic properties. The objective was to compare the analgesic effectiveness of rotavirus vaccine to sucrose solution when administered prior to injectable vaccines. METHODS: Infants 2-4 months of age receiving oral rotavirus vaccine and two separate injectable vaccines on the same day were randomized to rotavirus vaccine (Rotarix) first followed by the injectable vaccines and sucrose (Tootsweet) afterwards, or vice versa. Pain was assessed by blinded raters using the Numerical Rating Scale (NRS, range 0-10) (parents, clinicians), or Modified Behavioural Pain Scale (MBPS, range 0-10) and cry duration (observers). Data were analyzed using t-tests or χ(2)-tests; Bonferroni correction was applied to correct for multiple comparisons, as appropriate. RESULTS: Altogether, 120 infants participated: 60 were randomized to rotavirus vaccine first. Groups did not differ in demographics, including; age (p=0.448) and sex (p=0.464). The mean pain score (standard deviation) for both vaccine injections did not differ between infants given rotavirus vaccine first versus sucrose solution first: observer MBPS, parent NRS and clinician NRS scores were 7.4 (1.6) vs. 7.7 (1.6), 4.9 (2.1) vs. 5.8 (2.1), and 4.2 (2.1) vs. 4.6 (2.2), respectively. Similarly, there was no difference between groups in cry duration. CONCLUSION: Rotavirus vaccine did not differ from sucrose solution in reducing injection-induced pain. Based on the findings, it is recommended that rotavirus vaccine be administered prior to injectable vaccines in infants aged 2 and 4 months.

Endodontic patency. How to get it. How to keep it. Why it is so important.

Complete elimination of the root canal contents is imperative for predictable endodontic success. Establishing and maintaining apical patency of the root canal system is critical for proper cleaning, shaping and obturating objectives, despite timidity about this region in the past. Contemporary concepts are discussed.