Pica: an important and unrecognized problem in pediatric dialysis patients.

OBJECTIVE: Pica is the compulsive consumption of non-nutritive substances, and this disorder may occur more frequently in dialysis patients. The purpose of our study was to determine the prevalence of pica and the associated demographic and metabolic characteristics. DESIGN: Retrospective, cross-sectional analysis. SETTING: Hospital-based, outpatient, pediatric hemodialysis unit. SUBJECTS: Eighty-seven pediatric patients on chronic dialysis therapy were interviewed. Sixty-seven patients were receiving hemodialysis, whereas the remaining 20 were maintained on peritoneal dialysis. The predominantly nonwhite (93%) patient population had a mean age of 17.2 ± 7.2 years. Dialysis efficiency, estimated by urea clearance per patient volume (Kt/V), averaged 1.5 ± 0.5. INTERVENTION: Standard patient interview and documentation of laboratory and dialytic parameters. MAIN OUTCOME MEASURE: Prevalence of pica and associated comorbid conditions. RESULTS: The survey indicated that 46% of patients experienced pica, further divided into simple "ice" pica (34.5%) versus "hard" pica (12.6%). Hard pica included the consumption of chalk, starch, sugar, soap, sand, clay, Ajax cleanser, sponge, wood, and potting soil. Patients on hemodialysis were 8.3 times more likely to have hard pica compared with those on peritoneal dialysis. Greater than 5 years on dialysis was associated with a 3.2 odds ratio of having pica (P = .02). Anemia was the most significant morbid association, occurring at an odds ratio of 4.4 (P = .001) for all pica and 10.6 (P = .004) for hard pica. CONCLUSION: Pica, therefore, is prevalent and potentially harmful, requiring further attention in the nutritional management of pediatric dialysis patients.

Insulin pump therapy and health-related quality of life in children and adolescents with type 1 diabetes.

OBJECTIVES: To compare the health-related quality of life (HRQOL) of youths on injection regimens to those prescribed insulin pump therapy and examine factors related to HRQOL in youths with type 1 diabetes. METHODS: An ethnically diverse group of youths (n = 160, ages 5-17 years) with type 1 diabetes and their caretakers completed family, parent, and child adjustment measures, as well as measures of generic- and disease-specific HRQOL. Metabolic control and regimen information were assessed through medical records. RESULTS: HRQOL was unrelated to regimen prescription. Child, family, and parent adjustment variables were significantly related to HRQOL, whereas other demographic and clinical variables were relatively less important. CONCLUSIONS: Present findings indicate that insulin pump therapy does not have negative implications for HRQOL. They also suggest that interventions aiming to improve HRQOL in this population should target child, parent, and family adjustment and not focus solely on disease-related outcomes.