Halitosis en el niño y el adolescente / Halitosis in children and adolescents

La halitosis es el olor desagradable procedente de la boca, la nariz o las vías respiratorias. No suele ser un motivo de consulta directa en pediatría, pero con frecuencia es mencionada por la familia del paciente. En muchas ocasiones, los profesionales sanitarios no están suficientemente sensibilizados ante este tipo de molestia, y además la información sobre el tema es escasa. Sin embargo, este síntoma debe tenerse en cuenta, ya que puede ser la manifestación de diversos trastornos médico-odontológicos, además de la implicación social, económica y psicológica que puede tener, sobre todo en el adolescente. En este artículo se pretende revisar la bibliografía referente a la etiología, la fisiopatología, el diagnóstico y las diferentes opciones terapéuticas, incluidas las más novedosas, para facilitar su manejo en la práctica diaria pediátrica. Es necesaria la educación del paciente afectado y de sus familiares, de modo que sean ellos mismos quienes adopten unos hábitos higiénicos saludables y efectivos (AU)

Halitosis is an unpleasant odour emanating from mouth, nose or airway. This is not a usual reason for a direct consultation in pediatrics but is frequently mentioned by the patient´s family. On many occasions, health professionals are not concerned about this type of discomfort. Information about this problem is scarce. This symptom should be taken into account as it can be the manifestation of several medical and odontological disorders and for the social, economical and psychological implications, mostly in adolescents. The intention of this work is to revise bibliography about etiology, physiopathology, diagnosis and different therapeutic options of halitosis including the newest ones, in order to facilitate the daily practice at a pediatric level. The education of the affected patient is necessary in order to acquire healthy and effective hygienic habits to cope with the halitosis (AU)

Humidificadores domésticos: ¿qué se sabe de ellos? / Domestic humidifiers. What do we know about them?

La creencia popular transmite que la humedad ambiental alivia la sintomatología de las afecciones del aparato respiratorio. En el mercado existen diferentes tipos de humidificadores domésticos. Los padres los adquieren con el fin de aumentar el bienestar de sus hijos, sin saber, en la mayoría de ocasiones, si esta medida les aporta un verdadero beneficio. Los pediatras deberían ser los principales responsables de informar y orientar a las familias, pero el desconocimiento general sobre el tema y la escasa bibliografía existente lo dificultan. Esta revisión pretende mejorar el conocimiento sobre los humidificadores domésticos. Se define qué son, sus principales tipos, su funcionamiento básico, sus ventajas e inconvenientes y la importancia de su correcto mantenimiento. Se examinan las bases acerca de lo que es la humedad ambiental, cómo se modifica en función de la temperatura y cómo afecta a la salud humana. Finalmente, se sugiere que la humedad relativa óptima es del 40-60% por lo que debe medirse antes de usar un humidificador (AU)

[Domestic humidifiers. What do we know about them?]. / Humidificadores domésticos: 'qué se sabe de ellos?

Popular opinion assumes that environmental humidity relieves the clinical symptoms of respiratory tract diseases. Various types of home humidifiers are available on the market. Parents buy them in the belief that they will improve their children's well-being but are usually unaware of whether these devices provide a real benefit. Pediatricians should bear the main responsibility in the task of informing and guiding families in the use of home humidifiers but general lack of knowledge on the subject and the scarcity of published data make this task difficult. The aim of this review is to increase general knowledge of home humidifiers. We describe what they are, their main types, their basic functioning, advantages and disadvantages and the importance of suitable maintenance. We define what environmental humidity means, how it can change according to temperature and how it can influence human health. Finally, we suggest that optimal relative humidity is approximately 40-60 % and that it should be measured before using a home humidifier.

Uso del chupete: beneficios y riesgos / Pacifier use. Risks and benefits

El uso del chupete como objeto reconfortante en la infancia es una práctica ampliamente extendida en las sociedades civilizadas. La conveniencia de utilizar o no el chupete es una cuestión debatida. Algunos aspectos como su forma, material o el tiempo de empleo son polémicos. Existen numerosos datos acerca de posibles efectos beneficiosos, pero también una larga lista de procesos que se le han asociado. Su efecto tranquilizante es el aspecto beneficioso más ampliamente reconocido; la posible relación con una menor incidencia del síndrome de muerte súbita del lactante el más novedoso. Entre los riesgos de este hábito de succión no nutritiva destacan el fracaso de la lactancia materna, las malformaciones dentarias, la asociación con otitis aguda media de repetición y el riesgo de accidentes. El desarrollo de hipersensibilidad al látex, policaries, úlceras orales traumáticas o alteraciones del sueño son otros posibles riesgos. La asociación con un menor coeficiente de inteligencia en el adulto es discutida. La revisión de las ventajas y desventajas del uso del chupete no aporta datos suficientes para estimular ni prohibir este hábito, pero sí para realizar firmes recomendaciones en cuanto a no iniciar su uso antes de los 15días de vida, restringirlo a partir de los 8meses y suprimirlo al año. Los pediatras deben conocer y recomendar sólo los chupetes que cumplan las normas de seguridad (AU)

Imagen casual en una radiografía de abdomen / Casual image in an abdominal radiograph

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[Eyberg inventory of child behavior. Standardization of the Spanish version and its usefulness in ambulatory pediatrics]. / Inventario Eyberg del comportamiento en niños. Normalización de la versión española y su utilidad para el pediatra extrahospitalario.

OBJECTIVE: Taking into account the high prevalence of behavioral problems in the pediatric outpatient clinic, a need for a useful and easy to administer tool for the evaluation of this problem arises. The psychometric characteristics of the Spanish version of the Eyberg Behavioral Child Inventory (EBCI), [in Spanish Inventario de Eyberg para el Comportamiento de Niño (IECN)], a 36-item questionnaire were established. PATIENTS AND METHODS: The ECBI inventory/questionnaire was translated into Spanish. The basis of the ECBI is the evaluation of the child's behavior through the parents' answers to the questionnaire. Healthy children between 2 and 12 years of age were included and were taken from pediatric outpatient clinics from urban and suburban areas of Barcelona and from our hospital's own ambulatory clinic. RESULTS: The final sample included 518 subjects. The mean score on the intensity scale was 96.8 and on the problem scale 3.9. Internal consistency (Cronbach's alpha) was 0.73 and the test-retest had an r of 0.89 (p < 0.001) for the intensity scale and r = 0.93 (p < 0.001) for the problem scale. Interrater reliability for the intensity scale was r = 0.58 (p < 0.001) and r = 0.32 (p < 0.001) for the problem scale. Concurrent validity between both scales was r = 0.343 (p < 0.001). CONCLUSIONS: The IECN is a useful and easy tool to apply in the pediatrician's office as a method for early detection of behavior problems.

[Standardization of the Kent Infant Development Scale: implications for primary care pediatricians]. / Normalización de la Escala de Desarrollo Infantil de Kent. Implicaciones para la práctica pediátrica ambulatoria.

OBJECTIVE: The purpose of this study was the standardization of an infant assessment protocol based on behavioral observations of Spanish parents. The Kent Infant Development (KIDS) scale was translated into Spanish and named "Escala de Desarrollo Infantil de Kent" (EDIK). PATIENTS AND METHODS: The EDIK normative data were collected from the parents of 662 healthy infants (ages 1 to 15 months) in pediatric clinics. Infants born more than 2 weeks premature or who had serious physical or neurological illness were not included. RESULTS: EDIK raw scores of Spanish infants were converted to developmental ages by comparing them with the number of behaviors for each age group in the normative sample. We obtained the mean score and standard deviation for the full scale and different domains (cognitive, motor, social, language, and self-help). CONCLUSIONS: This study shows that EDIK is sensitive to differences in ages and a good instrument that allows one to make a classification between normal infants or those at risk. It should prove useful in developmental pediatric practice.

[A new method for evaluating psychomotor development based on information from parents. The Spanish version of the Kent Infant Development Scale]. / Nuevo método de evaluación del desarrollo psicomotor basado en la información de los padres. Versión española de la Kent Infant Development Scale.

OBJECTIVE: The purpose of this dissertation research was to design, standardize and validate the Spanish version of the Kent Infant Development Scale (KIDS). PATIENTS AND METHODS: This questionnaire is based on information obtained from the parents. It was translated into Spanish and named "Escala de Desarrollo Infantil de Kent" (EDIK). The EDIK normative data were collected from the parents of 662 healthy infants (ages 1 to 15 months) in pediatric clinics in Catalonia (Spain). RESULTS: Test-retest reliability (r = 0.99; p < 0.001), interjudge reliability (r = 0.98; p < 0.001) and internal consistency (Cronbach alpha = 0.9947) were determined. An "r' of 0.96 was obtained when EDIK scores were compared to their estimated developmental ages obtained from the Denver Developmental Scale. The correlation of the infants' chronological age and their EDIK was 0.96 (p < 0.001). CONCLUSIONS: The high reliability and validity correlation coefficients demonstrate the sound psychometric properties of the EDIK. It appears to be a useful and acceptable instrument in measuring the developmental status of infants by using the reports of their parents.

[Herpetic encephalitis in children. Study of 9 cases]. / Encefalitis herpética en el niño. Estudio de nueve casos.

Here we review nine cases of children with herpetic encephalitis (EH) admitted to the "San Juan de Dios" Hospital in Barcelona from 1976 to 1983. Of particular significance is the average age of 3,2 years, initial respiratory symptoms, fever and seizures in the majority of the cases. The EEG showed in every case short focal periodic activity from the 3rd to the 8th day of the illness, with normal CT-scan in 5 patients from the 5th to the 9th day. All the patients showed deterioration in the course of the illness, with serious sequels or death. We support an early herpetic encephalitis diagnosis and its treatment (ARA-A or Acyclovir) based on the clinical symptoms, the characteristic EEG, and a normal initial CT-scan. Antibodies levels and evolution will confirm or deny the diagnosis, without the need for a cerebral biopsy.