Repercusión psicológica y social de los padres y madres de niños con dificultades de alimentación / Psychological and social impact on parents of children with feeding difficulties

Objetivos: La prevalencia de niños con dificultades en la alimentación (NDA) o malos comedores es alta en nuestro medio, si consideramos la opinión de los padres. Aunque en la mayoría no observamos enfermedad orgánica o repercusión nutricional, es frecuente que este problema repercuta en la dinámica familiar. Nos proponemos estimar su impacto en el estrés, la calidad de vida y el estado de salud psicológica familiar.Métodos: Estudio de casos (NDA) y controles (controles sanos y controles con trastornos digestivos o controles enfermos). Se evaluó el estrés parental y el riesgo de afectación psicológica en estas familias, mediante escalas validadas (Parent Stress Index Short Form y General Health Questionnaire de Goldberg) y una encuesta de opinión a los padres. Resultados: Se recogieron un total de 238 encuestas: 102 correspondientes a controles sanos, 88 con trastornos digestivos y 48 de NDA. El 45,8% de los padres de NDA se consideraban desatendidos por su pediatra y el 47,9% no estaban de acuerdo con sus recomendaciones. El 54,2% de ellos encuentra limitaciones en su vida social, el 25% problemas de pareja, el 47,9% se sienten juzgados por los demás (12,5% por sus propias parejas) sobre cómo manejan la alimentación de su hijo y un 37,5% habían solicitado o considerado ayuda psicológica. Todos estos problemas fueron significativamente más frecuentes que en los controles. Padres y madres de los NDA presentaron con mayor frecuencia riesgo de ansiedad/depresión según el General Health Questionnaire de Goldberg: un 54,2% según valores de referencia (odds ratios ajustadas frente a controles sanos 4,18; intervalo de confianza del 95% [IC95%]: 1,96 a 8,87; frente a controles enfermos odds ratio 6,25; IC95% 2,79 a 13,98) y un 33,3% según los valores de nuestros controles sanos. Asimismo, presentaron mayores puntuaciones de estrés (Parent Stress Index Short Form) que los controles sanos (diferencia de medias ajustada 21; IC95% 12,19 a 29,81) y controles enfermos (AU)

Objectives: The prevalence of feeding disorders (FDs) and picky eating in children is high in our region, based on the parents’ perceptions. Although organic disease or a nutritional impact is rarely observed in these children, the problem frequently has an effect on family dynamics. We aimed to estimate the impact of these disorders on the stress level, quality of life and psychological health of families. Methods: Study of cases (FDs) and controls (healthy controls and controls with digestive disorders or sick controls). We assessed parental stress and the risk of psychological distress in these families using validated scales (Parent Stress Index Short Form and Goldberg's General Health Questionnaire) and a parental opinion survey. Results: We collected a total of 238 surveys, 102 corresponding to healthy controls, 88 to controls with digestive disorders and 48 to children with FDs. We found that 45.8% of parents in the FD group felt neglected by their paediatricians and 47.9% did not agree with the paediatrician's recommendations. In addition, 54.2% reported limitations to their social life, 25% problems in their relationship, 47.9% feeling judged by others (12.5% by their own partner) for how they managed mealtimes, and 37.5% having sought or considered seeking psychological support. All these problems were significantly more frequent compared to controls. Based on the Goldberg's General Health Questionnaire, the risk of anxiety and depression was more frequent in parents in the FD group: 54.2% compared to the reference (adjusted odds ratio compared to controls, 4.18; 95% confidence interval [CI], 1.96-8.87; odds ratio compared to sick controls, 6.25; 95% CI, 2.79-13.98) and 33.3% compared to the healthy control group. They also had higher stress scores (Parent Stress Index Short Form) compared to the healthy control group (adjusted mean difference, 21; 95% CI, 12.19-29.81) and the sick control group (adjusted mean difference, 20; 95% CI, 9.81-30.19).

Psychological and social impact on parents of children with feeding difficulties.

OBJECTIVES: The prevalence of feeding disorders (FDs) and picky eating in children is high in our region, based on the parents' perceptions. Although organic disease or a nutritional impact is rarely observed in these children, the problem frequently has an effect on family dynamics. We aimed to estimate the impact of these disorders on the stress level, quality of life and psychological health of families. METHODS: Study of cases (FDs) and controls (healthy controls and controls with digestive disorders or other illness). We assessed parental stress and the risk of psychological distress in these families using validated scales (Parent Stress Index Short Form [PSI-SF] and Goldberg's General Health Questionnaire [GHQ-28]) and a parental opinion survey. RESULTS: We collected a total of 238 surveys, 102 corresponding to healthy controls, 88 to controls with digestive disorders and 48 to children with FDs. We found that 45.8% of parents in the FD group felt neglected by their paediatricians and 47.9% did not agree with the paediatrician's recommendations. In addition, 54.2% reported limitations to their social life, 25% problems in their relationship, 47.9% feeling judged by others (12.5% by their own partner) for how they managed mealtimes, and 37.5% having sought or considered seeking psychological support. All these problems were significantly more frequent compared to controls. Based on the GHQ-28, the risk of anxiety and depression was more frequent in parents in the FD group: 54.2% compared to the reference (adjusted odds ratio [aOR] compared to controls, 4.18; 95% confidence interval [CI], 1.96-8.87; OR compared to sick controls, 6.25; 95% CI, 2.79-13.98) and 33.3% compared to the healthy control group. They also had higher stress scores (PSI-SF) compared to the healthy control group (adjusted mean difference [AMD], 21; 95% CI, 12.19-29.81) and the sick control group (AMD, 20; 95% CI, 9.81-30.19). CONCLUSIONS: Parents of children with FDs have a high level of stress and risk of anxiety and depression, with repercussions at the social, family, couple and work levels. The relationship with the paediatrician may also be affected.

Edema agudo del pulmón en una gestante / Acute pulmonary edema in a pregnant woman

El edema agudo del pulmón es la acumulación de líquido en los alvéolos pulmonares que impide la normal oxigenación de la sangre y ocasiona hipoxia tisular. Se trata de una urgencia médica que debe identificarse y tratarse rápidamente para evitar una alta mortalidad materna y perinatal. Con el objetivo de describir las características de un caso de edema agudo del pulmón en una gestante, se presentó el tema, ocurrido en el Hospital Docente Ginecobstétrico de Guanabacoa en el mes de febrero del año 2014 y su posterior evolución. La paciente de 39 años de edad, sin antecedentes patológicos personales con historia obstétrica de G5 P1 A3, que a las 36 semanas comenzó con cifras de presión arterial elevadas y acude al cuerpo de guardia por cefalea e hipertensión arterial. A la postre inicia con disnea, tos y expectoración espumosa diagnosticándose un edema agudo del pulmón, para lo cual se aplica tratamiento médico y la interrupción del embarazo por cesárea, obteniéndose recién nacido de 2100g y Apgar 9-9. La evolución de la paciente fue satisfactoria y el recién nacido, aunque bajo peso, evolucionó satisfactorio. El edema agudo del pulmón es una complicación obstétrica en la que siempre debemos pensar.

Acute pulmonary edema is the accumulation of fluid in the alveoli that prevents normal oxygenation of the blood and causes tissue hypoxia. This is a medical emergency that should be promptly identified and treated to avoid high maternal and perinatal mortality. The issue was presented in order to describe the features of a case of acute lung edema in a pregnant woman, who was treated at the Gynecobstetric Teaching Hospital in Guanabacoa from February 2014 and her subsequent evolution. The 39-year-old woman, with no personal medical history and with G5P1A3 obstetric history, began to have high blood pressure at 36 weeks and she came to the emergency room due to headache and hypertension. Eventually she started with dyspnea, cough, and frothy expectoration. Acute lung edema was diagnosed. Medical treatment and pregnancy termination by caesarean section was applied, resulting in a 2100g newborn with Apgar 9-9. This patient´s evolution was satisfactory and the newborn, although underweight, evolved satisfactory. Acute pulmonary edema is an obstetric complication which we should always keep in mind.