Serum aldolase and phosphocreatine kinase in umbilical cord blood.

Aldolase was estimated in the cord blood of 81 newborn infants and phosphocreatine kinase in 87 infants. There is a wide range in the results, with some values falling in the range reported in children with muscular dystrophy or of carriers of the disease. There is no correlation of the serum enzyme levels with the infant's birth weight. High levels of phosphocreatine kinase were found in infants of mothers with pre-eclamptic toxaemia. A single estimation of cord phosphocreatine kinase and aldolase is of little help in determining whether or not an infant has muscular dystrophy.

Infection-associated haemophagocytic syndrome in an infant.

We describe the case of an infant with haemophagocytic syndrome initiated by severe infection. The difficulties of diagnosing and managing the condition as well as its pathogenesis are discussed.

Plasma alkaline phosphatase activity and its relation to rickets in pre-term infants.

Sequential measurements of plasma alkaline phosphatase activity were made in 84 pre-term infants delivered before 38 weeks gestation. In 67% of infants, without evidence of rickets but in whom three or more measurements were made and the peak activity was less than 10 times the adult reference range, the activity rose to a peak and declined to previous levels, or lower. The time taken for these changes varied greatly. The range of values was inspected at each week of age, and in all but six cases the level did not exceed 10 times the upper limit of the adult reference range. Three infants had radiological evidence of rickets, and of the six cases in whom higher levels were found, only one had radiological evidence of rickets; the remainder did not. It is recommended that in the latter, the high plasma alkaline phosphatase activity should be regarded as evidence of subclinical bone disease.

Zinc deficiency: a problem with preterm breast milk.

We report a breast-fed preterm infant (31 weeks gestation) who developed nutritional zinc deficiency 13 weeks post delivery. Serial samples of his mothers breast milk from early lactation (2 weeks post delivery) contained very low zinc concentrations, although her serum zinc and sweat zinc concentrations were normal. Following the birth of her second baby at 38 weeks gestation, her breast milk contained normal amounts of zinc. We conclude that the low breast milk zinc values obtained following the first pregnancy may have been due to immaturity of the milk. Units that feed very low birth-weight babies preterm milk should check its zinc concentration or at least have a high index of suspicion for this nutritional deficiency.

Changing clinical picture of non-accidental injury to children.

The setting up of the South Glamorgan Area Review Committee and locally agreed procedures in 1974 has been associated with a considerable increase in observed moderately severe non-accidental injuries in children. The increase is in all age groups but is rising in older children. Most of the rise is likely to be due to increased community awareness. On the other hand, there has been a steady decrease in severe injuries, which may well be due to early recognition of minor or moderate injuries preventing the development of severe injuries.

Plasma zinc concentration and catch up growth in preterm infants.

Changes in plasma zinc concentration during the period of catch up growth were examined in 44 preterm infants. Blood samples were collected at birth, 6, 12 and 24 weeks. Plasma zinc concentration showed a mean of 13.6 mumol/l at birth and dropped to 9.8 mumol/l at 6 weeks and rose to 11.3 and 15.4 mumol/l at 12 and 24 weeks respectively. Plasma zinc concentrations showed significant correlation with weight velocity at 12 weeks. Male infants had significantly lower plasma zinc concentrations than females at 12 weeks. Infants of gestational age more than 32 weeks had lower plasma zinc concentrations at 12 and 24 weeks than those of earlier gestations. At the same time males were growing faster than females and also infants of gestational ages more than 32 weeks were growing faster than those born at earlier gestations. These observations, together with the finding that the decline in zinc occurred during the phase of rapid growth, suggest that growth is the predominant modulator of plasma zinc concentration.

Cranial diabetes insipidus in early infancy.

We report an infant who developed cranial diabetes insipidus after septicaemic shock. This condition should be considered in any child who suffers an acute collapse and it may be more common in the high risk neonate than has previously been recognised.

Parental responses to their developmentally delayed children and the South Glamorgan Home Advisory Service.

This study was undertaken to investigate how parents who have a child with some degree of handicap describe their child's behaviour and their own feelings and adjustment to having such a child. Their response was compared with that of parents of age-matched children without any known development difficulties. The parents and children were grouped according to the manifested handicap of the child (Down's syndrome, developmental quotient (DQ) greater than 65, DQ less tha 65 with/without limb dysfunction and normal controls). The children's ages ranged from 4 to 126 months and they all had received the South Glamorgan Home Advisory Service (HAS) at some time. Sixty-one families completed attitude and behaviour rating scales and parents were asked to express their preferences for prescribed services. The attitude and rating scales were also completed by twenty-five control families with normal children. A consistent trend was revealed towards increasingly favourable attitudes and feelings from past to future, and the DQ less than 65, with/without limb dysfunction, group was found to require further investigation in terms of provision of appropriate services. A distinct preference was shown for the South Glamorgan Home Advisory Service.

Benefits to Down's syndrome children through training their mothers.

This study investigated the hypothesis that training of mothers with Down's syndrome children would be beneficial both to the child and parents. The mothers were taught behaviour modification techniques based on learning theory and were given group discussions on dealing with their family or personal problems. The subjects were 16 mothers with a Down's syndrome child, divided into two groups on the basis of their child's sex and chronological and mental ages. The Griffiths Scale was used for assessment. The mothers in the treatment group received 12 sessions of training and group counseling over a 6-month period, whereas the control mothers received no additional attention except the usual routine from the general practitioner and health visitor. The result show clear gains to both the child and mother in the treatment group. The child improved, especially in language development as well as in the other areas, and the mother-gained more confidence and competence in her daily management of the child.

Evaluation of teaching methods in a home-based training scheme for developmentally delayed pre-school children.

Thirty-eight pre-school developmentally delayed children receiving the South Glamorgan Home Advisory Service were included in the study. The children were grouped according to developmental ability and manifesting problems. The effectiveness of three methods of teaching (activity charts, target setting, suggestion) were assessed under a balanced design. Weekly skill gain and increments on checklists were measured at the start and at the end of the study period. Parents' opinions on the different methods of teaching were requested and time samples of duration of home visiting were taken. On weekly skill gain, suggestion proved less effective than activity charts or target setting. Severely delayed children made least progress on weekly skill gains. Progress on checklists was independent of teaching method. However, group differences were observed in that severely delayed children (DQ range 22-61) and older (greater than 17 months) Down's syndrome children made least gains on the checklists. Activity charts were preferred by parents although they were also rated as being the most time consuming. Duration of home visits tended to be greater when activity charts were used. Implications of the findings are discussed with reference to ways of improving advice given to parents and alternative ways of evaluating pre-school educational programmes for particular groups of children.

Parents' report of family life with a developmentally delayed child.

This study was undertaken to investigate how parents who have a child with some degree of handicap perceive the effect of the child on family life. Also, a measure of parental health was taken. The parents' response was compared with that of parents of age-matched children without any known developmental difficulties. The parents and children were grouped according to the manifested handicap of the child [Down's syndrome, developmental quotient (DQ) greater than 65, DQ less than 65 with/without limb dysfunction and normal controls]. The children's ages ranged from 4 to 126 months and they all had received the South Galmorgan Home Advisory Service (HAS) at some time. Sixty-one families completed a questionnaire concerning family life and activities and Rutter's Malaise Inventory (Rutter et al. 1971). Thirty-one control families also completed the questionnaire and Malaise Inventory. The findings showed very little difference between the control group and handicapped groups and suggested that the presence of a delayed child in the family unit does not appear to change the family routine to any large extent. Parents of handicapped children were not found to suffer from significantly greater ill health when compared with the parents of normal children. The implication of the results is that provision should be made available for both fathers and mothers to play an equal part in the support facilities and guidance offered.

Brief intervention therapy for behaviourally disturbed pre-school children.

A group of children with behavioural difficulties were treated using behavioural techniques and were compared with a group of control children. The treated children had various behavioural difficulties including poor concentration, sleep problems adn non-cooperation with parents. They were treated in the home for periods up to 7 weeks, after a 2-week baseline observation period. Of nine families that started the treatment, two did not cooperate and one improved spontaneously. Videotape recordings of the child at play were made lasting 15 minutes and immediately prior to the psychologist's visits. The matched control children were investigated similarly. The videotapes were analysed to assess attention span, mother-child verbal interaction and cooperation. There was consideration improvement in attention span as the treated children's behavior became similar to the control children in four to five visits. The improvements lasted over the 3- and 6-month follow-up period. It is concluded that brief intervention behavioural treatment has considerable potential and is reasonably economical in terms of staff time.

Behavioural treatment of hyperactive children.

This study reports the value of behavioural treatment of hyperactive children. Twelve children with multiple behavioural problems, including concentration difficulties, were identified and treated during a 3-month period. Six of the children began treatment immediately; the other 6 children received similar treatment but after a delay of between 4 and 6 weeks. Children were seen at the clinic or in the home, depending upon the individual difficulties and geographical distances. Initially the families were seen weekly, but the frequency later was determined by the severity of the problems and the response to treatment. There was a significant improvement in the children's behaviour as reported by the parents, the home visitor, and videotaped recordings. During the initial period of beteen 4 and 6 weeks the treated children improved significantly, whereas the others, as yet untreated, showed no change. As soon as the treatment was introduced to the second group these children's behaviour also improved and to about same extent in 6 weeks as the treated children had in up to 12 weeks' treatment. This interesting observation suggests that a short period of treatment, only 6 weeks, may be sufficient for most children with hyperactivity. This is more feasible with the present-day resources of many departments.

Student-initiated revision in child health.

Most teaching of child health in Cardiff takes place in block attachments of 8 weeks. There is an introductory seminar of 2 days followed by a 6-week clinical attachment in a district general hospital in Wales, and then a revision period of one week designed to help students formalize and structure their basic knowledge and to clarify aspects of child health which they may have had difficulty in understanding. The revision programme has to take into account: the short time available, the small number of teaching staff, the most relevant basic knowledge and active participation by the student. This paper describes how this week has been improved through the use of student-initiated revision (SIR). The students' appraisal of this revision and in particular SIR is presented.

Fatty infiltration in the liver in medium chain acyl CoA dehydrogenase deficiency.

Fatty infiltration of the liver at postmortem examination has been recommended as a criterion for selection of infants who have died suddenly and unexpectedly for further biochemical investigation for disorders of fatty acid oxidation. We describe a boy with medium chain acyl CoA dehydrogenase deficiency who died four months after diagnosis and in whom only minimal hepatic fatty infiltration was found.

Catch up growth in preterm infants.

Seventy-one surviving infants were followed up from birth to 24 weeks of postnatal age. Their mean gestational age was 32 weeks with a range of 26-36 weeks and a standard deviation of 2.1 weeks. Their mean birth weight was 1,805 kg with a range of 0.675-2.5 kg and a standard deviation of 0.408 kg. Their weights, lengths and head circumferences were measured at birth, 6, 12 and 24 weeks. Curves for the mean weight, length and head circumference were produced and superimposed on the available intrauterine and extrauterine growth charts. The growth curves of the preterm infants did not show the flattening noted in the intrauterine curves towards term. The curve of the mean weight of the preterm infants started at the 50th centile for Gairdner & Pearson (1971) at birth to drop below that shortly after birth. At 40 weeks of postconceptional age the mean weight curve of preterm infants crossed the 50th centile and continued above it to reach the 90th centile at 60 weeks. The curves of mean length and head circumference started below the 50th centile at birth and crossed it at 40 weeks and continued above it to approach the 90th centile at 60 weeks. Growth velocity was calculated as a relative gradient using the straight line equation (y = a + bx), where y is the weight, length or head circumference, and x is the independent variable and here it is the group mean of the parameter at the corresponding ages. Catch up growth is taken as a relative gradient significantly greater than one. The first 24 weeks of postnatal life are defined as a period of catch up growth with the first 8 weeks as an interval of maximum head velocity.