Natremia of healthy term newborns at 48 h of life: influence of feeding patterns.

OBJECTIVES: To describe natremia in healthy term newborns and determine whether there is a relationship between blood sodium and feeding patterns. METHODS: All normal newborns, admitted to the nursery between January and March 2004 were eligible for this prospective cohort study. Inclusion criteria were: > or =37 weeks of gestational age, birth weight > or =2500 g, Apgar scores > or =7 at 5 and 10 min and normal physical examination. A capillary blood sample was taken at 48+/-12 h of life. RESULTS: Blood samples from 126 newborns were analyzed. Mean gestational age was 39.6 weeks, birth weight was 3414 g and weight loss at 48 h of life was 6.5% of birth weight. Mean capillary blood sodium was 141 mmol/L (SD 3.4). Exclusively, breast-fed newborns had statistically higher mean blood sodium (141 mmol/L, SD 3.0) than the non-exclusively breast-fed+formula fed group (139 mmol /L, SD 3.7). There was a significant linear association between blood sodium and the quantity of milk supplements received as well as between blood sodium and weight loss. CONCLUSIONS: Most newborns have blood sodium values within a narrower range than previously described in the literature. We also demonstrate that the exclusively breast-fed infants appear to have marginally but statistically higher values of blood sodium than non-exclusively breast-fed and formula-fed infants.

Long term effects of a home visit to prevent childhood injury: three year follow up of a randomized trial.

OBJECTIVE: To assess the long term effect of a home safety visit on the rate of home injury. DESIGN: Telephone survey conducted 36 months after participation in a randomized controlled trial of a home safety intervention. A structured interview assessed participant knowledge, beliefs, or practices around injury prevention and the number of injuries requiring medical attention. SETTING: Five pediatric teaching hospitals in four Canadian urban centres. PARTICIPANTS: Children less than 8 years of age presenting to an emergency department with a targeted home injury (fall, scald, burn, poisoning or ingestion, choking, or head injury while riding a bicycle), a non-targeted injury, or a medical illness. RESULTS: We contacted 774 (66%) of the 1172 original participants. A higher proportion of participants in the intervention group (63%) reported that home visits changed their knowledge, beliefs, or practices around the prevention of home injuries compared with those in the non-intervention group (43%; p<0.001). Over the 36 month follow up period the rate of injury visits to the doctor was significantly less for the intervention group (rate ratio = 0.74; 95% CI 0.63 to 0.87), consistent with the original (12 month) study results (rate ratio = 0.69; 95% CI 0.54 to 0.88). However, the effectiveness of the intervention appears to be diminishing with time (rate ratio for the 12-36 month study interval = 0.80; 95% CI 0.64 to 1.00). CONCLUSIONS: A home safety visit was able to demonstrate sustained, but modest, effectiveness of an intervention aimed at improving home safety and reducing injury. This study reinforces the need of home safety programs to focus on passive intervention and a simple well defined message.

The effectiveness of a home visit to prevent childhood injury.

OBJECTIVE: To examine the effectiveness of a home visit program to improve home safety and decrease the frequency of injury in children. We examined the effects of the program on 1) parental injury awareness and knowledge; 2) the extent that families used home safety measures; 3) the rate of injury; and 4) the cost effectiveness of the intervention. DESIGN: A randomized, controlled trial. SETTING: A multicenter trial conducted at 5 hospitals in 4 Canadian urban centers. PARTICIPANTS: Children <8 years old, initially enrolled in an injury case-control study, were eligible to participate. Intervention. Subsequent to a home inspection conducted to determine baseline hazard rates for both groups, participants in the intervention group received a single home visit that included the provision of an information package, discount coupons, and specific instruction regarding home safety measures. MAIN RESULTS: The median age was 2 years, with males comprising ~60% of participants. The experimental groups were comparable at outset in terms of case-control status, age, gender, and socioeconomic status. Parental injury awareness and knowledge was high; 73% correctly identified injury as the leading cause of death in children, and an intervention effect was not demonstrated. The adjusted odds ratios (ORs) for the home inspection items indicated that significant safety modifications only occurred in the number of homes having hot water not exceeding 54 degrees C (OR: 1.31, 95% confidence interval [CI]: 1.14, 1.50) or the presence of a smoke detector (OR: 1.45, 95% CI: 0.94, 2.22). However, the intervention group reported home safety modifications of 62% at 4 months and significantly less injury visits to the doctor compared with the nonintervention group (rate ratio: 0.75; 95% CI: 0.58, 0.96). The total costs of care for injuries were significantly lower in the intervention group compared with the nonintervention group with a cost of $372 per injury prevented. CONCLUSIONS: An intervention using a single home visit to improve the extent to which families use safety measures was found to be insufficient to influence the long-term adoption of home safety measures, but was effective to decrease the overall occurrence of injuries. Future programs should target a few, well-focused, evidence-based areas including the evaluation of high-risk groups and the effect of repeated visits on outcome.

Diurnal enuresis in childhood.

OBJECTIVE: To review the clinical classification of childhood diurnal enuresis, to describe the evaluation process, and to discuss principles of management. QUALITY OF EVIDENCE: An extensive literature review was performed with a MEDLINE search. Articles were selected according to date of publication, clinical relevance, and availability. Recent articles, cohort studies of at least 50 patients, and randomized clinical trials were preferred. Recent editions of classic textbooks were consulted. Evaluation and management activities discussed in this article are supported by original and relevant literature. MAIN MESSAGE: Most causes of childhood diurnal enuresis can be determined by a thorough history coupled with a complete physical examination and urinalysis and culture. Supplementary investigations include ultrasonography of the kidneys and bladder to screen for neurogenic bladder and urethral obstruction. When obstruction, ectopic ureter, or bladder dysfunction is suspected, voiding cystourethrography and urodynamic studies are needed. Evaluation of neurogenic bladder includes magnetic resonance imaging of the spine. Treatment is aimed at correcting poor toilet habits, preventing or treating urinary tract infections, and using appropriate medication. CONCLUSIONS: In most instances, diurnal enuresis in childhood is a benign condition with an easily identifiable cause and an excellent prognosis with time and appropriate treatment.

Pain evaluation in preschool children and by their parents.

The accurate assessment of pain in children constitutes a challenge for health professionals and, in the case of young children, parents are generally the main source of information. The objective of this study was to validate and to compare three pain scales in preschool children and their parents. A total of 104 children between 4 and 6 y of age and their parents participated in the study while undergoing an immunization procedure in the outpatient department of a tertiary pediatric care hospital. Three pain scales were used, the McGrath Facial Affective Scale (FAS), the Hester Poker Chip Tool (HPCT) and the Multiple Size Poker Chip Tool (MSPCT). There were 47 (45%) boys and 57 (55%) girls, with 54 (52%) 4-y-olds, 34 (33%) 5-y-olds and 16 (15%) 6-y-olds. Twenty-eight children (27%) had memories of pain experienced during a former hospitalization. Correlations were very high both in children (r = 0.78) and their parents (r = 0.96) when comparing immunization pain scores obtained from the HPCT versus the MSPCT. Correlations between McGrath's FAS and HPCT or MSPCT ranged from r = 0.34-0.43 in children and r = 0.38-0.39 in parents. There was a good correlation between parents and children during the immunization procedure on all three scales, with the highest correlation using the FAS (r = 0.76), followed by the MSPCT (r = 0.69), and the HPCT (r = 0.66). Subgroup analyses based on the criteria of age, sex and previous hospitalization showed no consistent relationship. Parents tended to underestimate their child's pain when using HPCT or MSPCT. It seems that both HPCT and MSPCT measure a similar dimension of pain, whereas the FAS addresses a different aspect of pain. Although parents play an important role in their child's pain assessment, they tend to underestimate the intensity of pain when using HPCT or MSPCT.

[Management and prevention of abuse in Quebec: a program of sociolegal pediatrics at the Sainte-Justine Hospital in Montreal]. / Prise en charge et prévention de la maltraitance au Québec: programme de pédiatrie sociojuridique de l'hôpital Sainte-Justine à Montréal.

In Quebec, the Child's Protection law protects the child from birth until 18 years of age when child abuse or neglect is suspected. Since 1990, the program of the Child Protection Clinic of Sainte-Justine Hospital (Montreal) offers a special unit for evaluation and prevention of child abuse and neglect, constituted by a multidisciplinary team including five pediatricians. About 500 children are referred each year in external consultations or from hospital units. In addition, the pediatricians participate in the "programme Santé-Enfance-Jeunesse", a prevention program in the Montreal area. They also act as expert witnesses in court. Thus Quebec's pediatricians fully participate in a child's protection with their activities in different levels of diagnosis, management and prevention of child abuse and neglect.

Pattern of child sexual abuse by young aggressors.

OBJECTIVE: The aim of the study was to determine whether sexual victimization of children by young aggressors differs from adult aggressors. METHOD: A case review was performed on medical records of children less than 12 years of age referred in 1992 to the Child Protection Clinic at a tertiary care pediatric hospital. RESULTS: Medical evaluation for sexual abuse was carried out on 316 children, 79% girls, 21% boys, mean age 6 +/- 2.7 years. Among known perpetrators, 39 were less than 16 years and 15 were between 16 and 19 years old. Young aggressors were more likely to abuse older female victims (p = .0009). They also were reported to engage in more genital/genital and genital/anal acts (p < .001). The aggressor's young age was found to be an important determinant related to a history of penetrative forms of sexual abuse (OR = 4.015, 95% C.I. 2.0581; 7.8319). Genital examination was specific for abuse (Adam's Class IV or V) in only 6.3% of victims, but significantly more often when the perpetrator was between 16-19 years old (p = .003). CONCLUSIONS: Adolescent aggressors appear to engage in more genital/genital and genital/anal sexual abuse than older aggressors. Victims of aggressors age 16 to 19 had a higher risk of having specific findings on the anal/genital examination.

Self-management teaching programs and morbidity of pediatric asthma: a meta-analysis.

BACKGROUND: Self-management teaching programs are becoming an important asset in the management of pediatric asthma. OBJECTIVE: The study was designed to evaluate the impact of self-management teaching programs on the morbidity of pediatric asthma. METHODS: The meta-analysis included randomized clinical trials, published between 1970 and 1991, addressing the outcome of morbidity. Studies were retrieved from searches of MEDLINE, American Journal of Nursing International Index, and Dissertation Abstracts Online Database. The quality of studies was assessed with the scale of Chalmers. The pooled effect size was calculated by the method of Hedges. RESULTS: The literature search retrieved 23 randomized clinical trials, but 12 studies had to be excluded. Global score of quality of studies (Chalmers' scale) was fair, 51.6% +/- 9.9%. As indicated by the effect size (ES) of the pooled studies, self-management teaching did not reduce school absenteeism (ES: 0.04 +/- 0.08), asthma attacks (ES: 0.09 +/- 0.14), hospitalizations (ES: 0.06 +/- 0.08), hospital days (ES: -0.11 +/- 0.08), or emergency visits (0.14 +/- 0.09). CONCLUSION: Self-management teaching programs do not seem to reduce morbidity, and future programs should focus more on intermediate outcomes such as behavior.

Parental and patient perceptions about encopresis and its treatment.

Treatment of encopresis in childhood is often a long and trying process. Children followed for secondary encopresis in a multidisciplinary clinic between 1984 and 1989 were sent a parent/child mail questionnaire seeking information on their understanding of encopresis as well as their opinions on current treatment modalities. Twenty-eight families responded (20 boys and 8 girls), the child's mean age was 9.8 years, and the mean time elapsed after diagnosis was 3.5 years. Parents and children reported that intestinal dysfunction (53%) and painful defecation (46%) were the most important causes of their encopresis. Treatment modalities including enemas were well accepted by both parents and children, with parents considering dietary changes the most useful treatment modality (p < .01). Children reported that regular "toilet routine" was the most helpful in reestablishing continence. Despite good comprehension of the problem and acceptance of the treatment modalities, the complete recovery rate after 3.5 years was only 35.7%, with no differences noted between responders and nonresponders. Encopresis is a chronic condition that persists in a significant proportion of patients, despite adequate patient and parental knowledge and patient acceptance of treatment.

Cariogenic feeding habits and fluoride supplementation during infancy and early childhood.

Parents of 240 children between nine months and three years of age were interviewed using a questionnaire in order to determine cariogenic feeding habits and fluoride supplementation. Mean age of weaning from the bottle was 14.6 months. After 18 months of age, children from minority ethnic groups were more frequently bottle-fed than French-Canadian children (p < .005). Giving a bottle in bed (34.6% of cases) was more often practised by less educated mothers (p = .007) or by minority ethnic groups (p = .002), and was seen as a cariogenic factor by 31% of parents. Fluoride was given in half of cases, mainly by highly educated mothers (p = .001) and was mentioned as a preventive measure by 27% of parents. Physicians should be aware of poor parental knowledge and practices of preventive dentistry, and must discuss cariogenic feeding habits and fluoride supplementation during well-baby visits.

Television and the 3- to 10-year-old child.

A questionnaire on the use of television was administered to the parents of 387 children aged between 3 and 10 years. All families owned at least one television set and 57.6% of families owned two or more sets, with one in the child's bedroom in 10.6% of cases. Television was turned on all day in 16% of cases, mostly in families with low level of parental education (P less than .01). Television was on at mealtime in 54.5% of cases; 45.2% of children were watching television for between 7 to 16 hours per week, and the heavy viewers belonged to families with low levels of maternal education (P less than .05). About one third of children watched television without any interdiction set by their parents. According to age, from 28% to 40% of children watched violence on television. Parents believed that television facilitates learning (65.3%) but were concerned about violence (22.7%) and commercials (7.4%). Finally, 63.3% of parents reported that they would like to obtain more information about television use. According to this survey, many children are watching television without any limits being set by their parents and are witnessing violent scenes at an impressionable and vulnerable age. The pediatrician should include at routine office visits parental guidance on the mediation of television effects through coviewing, content discussion with children, and program selection.

[Parental knowledge about their asthmatic children]. / Connaissances des parents d'enfants asthmatiques.

A questionnaire was administered to parents of 171 asthmatic children, and their knowledge of asthma was evaluated using a quantitative score. The mean age of children was 5 yr and the mean duration of their asthma was 3 yr. Each sign of the classical triad "noisy breathing, cough, indrawing" was mentioned by two-thirds of parents. Inhaled agents perceived as triggers of asthma were: animal hair (73.7%), dust (69.6%), pollen (60.2%), tobacco (44.4%), molds (14.6%). Other triggering agents mentioned were: stress (51.5%), infections (38%), exercise (13.5%). Mothers with college or university education knew more clinical signs of an attack (P less than 0.01) and more triggering factors (P less than 0.005). Parents satisfied with previous teaching knew more threatening signs of an attack (P less than 0.01). About 80% of those that used theophylline and 49.4% of those that used inhaled beta-2-agonists knew the correct mode of administration. Parents satisfied with previous teaching had better knowledge of the side-effects of theophylline (P less than 0.005) and beta-2-agonists (P less than 0.02). 58.5% of those that used cromolyn sodium did not know the mean duration of a therapeutic trial and 15% did not use it as prophylaxis. 57.1% of those that used oral corticosteroids did not know any side-effects of the drug. About half of the parents indicated that they would like to receive more information about the causes and the appropriate treatment of asthma. It was concluded that parental teaching should focus more on environmental and therapeutic issues.

Initial treatment of bacterial meningitis in Yaounde, Cameroon: theoretical benefits of the ampicillin-chloramphenicol combination versus chloramphenicol alone.

A prospective 6-month study in Yaounde evaluated 49 children aged from 2 months to 8 years, hospitalized with bacterial meningitis. They were randomly assigned to one of two initial treatment groups, either an ampicillin-chloramphenicol combination (group A) or chloramphenicol alone (group B). The majority of patients were infected with Haemophilus influenzae, and the majority of deaths were caused by Streptococcus pneumoniae. Altogether, 17.9% of Haemophilus influenzae isolates were ampicillin-resistant and 3.6% chloramphenicol-resistant. We found no isolate resistant to both antibiotics. Response to both treatments was similar in both groups. The theoretical risk of treatment failure with ampicillin was higher than with the ampicillin-chloramphenicol combination (p less than 0.05). There was no statistically significant difference between the risk of treatment failure with the ampicillin-chloramphenicol combination and the risk with chloramphenicol alone (p less than 0.05), but the latter was increased by the occurrence of chloramphenicol-resistant isolates of Streptococcus pneumoniae (11.1%). Although treatment with an ampicillin-chloramphenicol combination is four times more expensive than treatment with chloramphenicol alone, costwise it is also one-quarter the price of a third-generation cephalosporin (moxalactam). At present, the ampicillin-chloramphenicol combination can be suggested as the first choice for initial treatment considering both the epidemiological data and the cost/efficiency ratio in the area of Yaounde.

Hospital practices and breastfeeding duration: a meta-analysis of controlled trials.

Controlled clinical trials studying the influence of hospital practices on breastfeeding duration were combined using meta-analysis. Nine studies were selected. Supplementation demonstrated a negative clinical effect on breastfeeding duration that was not significant. Nursing support demonstrated a positive clinical effect on breastfeeding duration that was not statistically significant if there was no telephone follow-up, but was significant if there was telephone follow-up. Early contact revealed a positive clinical effect that was significant. We conclude that early contact and nursing support with telephone follow-up appear as enhancing factors of breastfeeding duration.

[Hospital practices and duration of breast feeding: meta-analysis]. / Pratiques hospitalières et durée de l'allaitement maternel: méta-analyse.

Clinical trials studying the influence of hospital practices on breast-feeding duration were combined in a meta-analysis. Nine studies were selected. The global quality score was poor, and varied between 11.6 and 71.5 (Chalmers' scale). The results of each study were pooled using Peto's method and showed the following findings. Supplementation demonstrated a negative clinical effect on breast-feeding duration which was not significant (OR: 0.77, 95% CI[0.59, 1.02] p greater than 0.05). Nursing support demonstrated a positive clinical effect on breast-feeding duration which was not statistically significant if there was no telephone follow-up (OR : 2.29, 95% CI [0.87, 6.02] p greater than 0.05), but was significant if there was telephone follow-up (OR : 2.01, 95% CI [1.37, 2.94] p less than 0.05). Early contact revealed a positive clinical effect which was significant (OR : 2.96, 95% CI [1.6, 5.22] p less than 0.05). In conclusion, early contact and nursing support with telephone follow-up appear as enhancing factors of breast-feeding duration.

[Prevalence of Aeromonas spp. pediatric gastroenteritis]. / Prévalence d'Aeromonas spp. dans les gastro-entérites de l'enfant.

A selective medium and biochemical tests were used to search for Aeromonas spp. in the stools of 536 children, more than 90% of whom had "gastroenteritis", seen at Sainte-Justine Hospital, Montreal, in June or July 1986. The organism was found in seven children, six of whom had bloody diarrhea. One of the six, a 6 1/2-year-old boy, required intravenous alimentation and later manifested ulcerative colitis; the other five recovered. The remaining child, a 14-year-old boy, had synovitis of the knee and spondylarthritis. Two of the seven carried other enteric pathogens. The authors discuss the pathogenicity of Aeromonas spp., which is not very marked in temperate climates, in human summer diarrhea and its possible role in the development of ulcerative colitis.

[Chronic sclerosing osteomyelitis (so-called Garré's). Review of 12 cases]. / Ostéomyélite chronique sclérosante (dite de Garré). Revue de douze cas.

This study reports 12 cases of chronic sclerosing osteomyelitis in children. The authors recall the past history of this disease and describe the clinical, radiological and pathological picture found nowadays. They insist upon the salient features that allow to differentiate this lesion from other types of infectious osteomyelitis and osteoid osteoma.