The paediatrician and middle childhood parenting.

The 'forgotten years' of middle childhood, from age 6 to 12, represent a critical period in child development. Emotional, social and physical development during this time have a lifelong impact on health and adult contributions to society. Mental health conditions have displaced physical illness as the leading childhood disability. Positive parenting can improve child behaviour, prevent early-onset conduct problems and provide a buffer from adverse childhood events resulting in decreased toxic stress and improved health. Medical homes can play a key role in supporting parents with positive parenting skills that are practical, evidence-based and useful in everyday life. Paediatricians need to explore the domains that promote healthy development, including caring environments, fundamental needs and nurturing relationships. Our objective is to promote high-quality positive parenting through middle childhood by identifying opportunities for paediatricians to frame parenting discussions in the context of development, behaviour and safety and to provide access to valuable parenting resources.

Les « années oubliées ¼ de la phase intermédiaire de l'enfance, entre l'âge de six et 12 ans, sont une période critique du développement de l'enfant. Pendant cette période, le développement émotionnel, social et physique a des conséquences permanentes sur la santé et l'apport de l'adulte à la société. Les troubles de santé mentale ont remplacé les maladies physiques comme principale affection de l'enfance. Des pratiques parentales positives peuvent améliorer le comportement de l'enfant, prévenir les troubles des conduites d'apparition précoce et limiter les événements indésirables de l'enfance, réduisant ainsi le stress toxique et améliorant la santé. Les milieux médicaux peuvent beaucoup contribuer à soutenir les parents afin qu'ils acquièrent des compétences parentales positives pratiques, fondées sur des données probantes et utiles dans la vie quoti- dienne. Les pédiatres doivent explorer les sphères qui favorisent un développement sain, y compris les environnements attentionnés, les besoins fondamentaux et les relations aimantes. Afin de promouvoir des pratiques parentales positives de qualité tout au long de la phase intermédiaire de l'enfance, les auteurs visent à cerner les occasions que peuvent saisir les pédiatres pour structurer les discussions avec les parents sur le développement, le comportement et la sécurité et les orienter vers des ressources intéressantes sur ce type de pratiques.

Sleep patterns in children with ADHD: a population-based cohort study from birth to 11 years.

Associations between sleep duration and disturbance in infancy and early childhood and attention deficit hyperactivity disorder diagnoses were investigated. Data from the Avon Longitudinal Study of Parents and Children, a population-based prospective longitudinal birth-cohort study of children born in 1991-1992 in South-West England, were employed. Eight thousand, one hundred and ninety-five children were assessed using the Development and Well-Being Assessment. One hundred and seventy-three cases (2.1%) met criteria for attention deficit hyperactivity disorder. Parental report at eight time points showed children with attention deficit hyperactivity disorder slept less than peers. Absolute differences were small and mainly restricted to night-time sleep, with no strong evidence of differences from controls, except at 69 months [5 years 9 months; 12 min (95% CI: 5-19), P = 0.001], at 81 months [6 years 9 months; 15 min (95% CI: 8-22), P < 0.001] and at 115 months [9 years 7 months; 11 min (95% CI: 4-18), P = 0.001]. The attention deficit hyperactivity disorder group had more night-waking at every age, significant from about 5 years. When tracking children's sleep along a normative centiles chart, a shift in sleep duration from one centile to a lower centile was a useful predictor of attention deficit hyperactivity disorder. Age-specific decreases of >1SD in sleep duration across adjacent time points was a significant predictor of attention deficit hyperactivity disorder at 3-5 years (P = 0.047). In children with attention deficit hyperactivity disorder, shorter sleep duration and sleep disturbances appear early and predate the usual age of clinical diagnosis. The rate of change of sleep duration relative to an individual, rather than absolute sleep duration at any stage, may prove beneficial in identifying increased risk of attention deficit hyperactivity disorder.

Sleep patterns in children with autistic spectrum disorders: a prospective cohort study.

OBJECTIVE: To investigate longitudinal sleep patterns in children with autistic spectrum disorders (ASDs). STUDY DESIGN: Prospective longitudinal study using Avon Longitudinal Study of Parents and Children, an English cohort born in 1991-1992. Parental reports of sleep duration were collected by questionnaires at 8 time points from 6 months to 11 years. Children with an ASD diagnosis at age 11 years (n=73) were identified from health and education records. RESULTS: From aged 30 months to 11 years old, children with ASD slept for 17-43 min less each day than contemporary controls. No significant difference in total sleep duration was found in infancy, but from 30 months of age children with ASD slept less than their peers, a difference that remained significant after adjusting for sex, ethnicity, high parity and epilepsy. The reduction in total sleep was wholly due to changes in night rather than daytime sleep duration. Night-time sleep duration was shortened by later bedtimes and earlier waking times. Frequent waking (3 or more times a night) was also evident among the children with ASD from 30 months of age. Age-specific decreases of >1SD within individuals in sleep duration across adjacent time points was a predictor of ASD between 18 months and 30 months of age (p=0.04) and from 30 months to 42 months (p=0.02). CONCLUSIONS: Sleep duration in children with ASD is reduced from 30 months of age and persists until adolescence.

Childhood sleep duration and associated demographic characteristics in an English cohort.

STUDY OBJECTIVES: To provide reference data on sleep duration throughout childhood and explore the demographic characteristics associated with sleep. DESIGN: Population-based prospective longitudinal birth-cohort study. SETTING: South-West England, children born in 1991-1992 and followed since birth. PARTICIPANTS: Eleven thousand five hundred children with repeat measures of sleep from birth based on parent-reported questionnaires. Data on daytime and nighttime sleep duration and timings and night awakenings at 8 timepoints from age 6 months to 11 years. RESULTS: Total sleep duration steadily fell from 13 hours and 12 minutes during infancy to 9 hours and 49 minutes at 11 years of age. Compared with earlier studies, the younger children in this cohort slept for a shorter period. The variation in sleep duration was very wide: from 10 to 17 hours in early infancy, narrowing to 8.5 to 11 hours at 11 years. Half of the children at preschool age woke at least once during the night, but frequent waking (> 3 times) peaked in infancy (10% of all infants) and steadily declined in the preschool-aged years. Despite going to bed at the same time, girls slept consistently longer than boys (by 5-10 minutes). Children from low-income families went to bed later and woke up later, but there was little difference in total sleep duration. Children of younger mothers (< 21 years) slept longer, whereas children of older mothers (> 35 years) slept persistently less. Children in larger families tended to go to bed later, as did the minority group of non-White children in the cohort. CONCLUSIONS: Given the wide natural variation of sleep in the childhood population, any recommendations on optimal sleep duration at any age must take into account considerable individual variability.

Phantom limb pain relieved with different modalities of central nervous system stimulation: a clinical and functional imaging case report of two patients.

Phantom limb pain (PLP) is a type of neuropathic pain syndrome that has evoked much interest in scientific and clinical fields. The condition is often intractable and severely debilitating. Though there are anecdotal reports in the literature of successful management of individual cases with brain and spinal cord stimulation, it has not been possible to develop a system of management that is consistently successful, mainly due to the paucity of basic neurophysiological data about PLP and its pathways in the central nervous system (CNS). Functional imaging offers a way of collecting information about the basic mechanisms and pathways of PLP from patients without the excessive risk of more invasive penetrating electrode studies or the questionable reliability of animal data. There have been very few studies that have looked at the direct effect of CNS stimulation on regional brain activation and correlation with the pain state. We describe two cases of PLP that have been satisfactorily treated with CNS stimulation (motor cortex and then periventricular gray in one and spinal cord in the other) and have been subjected to single photon emission computed tomography (SPECT) studies when in pain and then during stimulation with recorded pain relief. We found that regardless of the site of stimulation in the CNS, pain relief is associated with blood flow changes in similar areas of the brain, mainly the parietal and cingulate cortex and also in the thalamic nuclei and the central gray matter. Further studies of this kind should reveal more about the complex mechanisms of PLP and other forms of neuropathic pain.