Neonatal skull depression unassociated with birth trauma.
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Birth Injuries↗
Biomedical subjects
E C Perrin
Publications and source records attributed to E C Perrin.
Clinicians' assessments of children's understanding of illness.
Optimal communication between providers of child health care and their patients depends on appropriate expectations of what the children can understand. Recently the developmental stages in children's understanding of the mechanisms of cause, prevention, and treatment of illness have been delineated. We studied the accuracy of clinicians' knowledge of these developmental stages. Pediatricians, nurses, and child development students were asked to estimate the age at which children made typical responses to five questions regarding illness mechanisms. Clinicians usually overestimated the age of younger children and underestimated the age of older children; they correctly estimated children's ages less than 40% of the time. Child health care providers might communicate more effectively with their patients if they became more familiar with typical stages in children's understanding of illness concepts.
Adolescent↗
There's a demon in your belly: children's understanding of illness.
Knowledge of how children come to understand the processes of causation, prevention, and treatment of illness is needed to help health professionals and educators in their work with children. Healthy children attending kindergarten through eighth grade were asked a series of standardized questions about illness, and their responses were scored on a scale corresponding to Piaget's theoretical framework of cognitive development. Children's responses varied widely at all ages, but there was a consistent systematic progression in their understanding of illness-related concepts with age. Kindergarten children typically understand illness causation as quite magical, and/or as the consequence of their transgression of rules. At fourth grade, children believe all illness to be caused by germs whose very presence is sufficient to make a child sick. The complexity of the mechanisms that must interrelate to cause illness is not understood until eighth grade at the earliest. At approximately 12 or 13 year of age children begin to understand that there are multiple causes of illness, that the body may respond variably to any or a combination of agents, and that host factors interact with the agent to cause and cure illness. This sequence in the development of understanding about illness parallels conceptual development in other content areas such as physical causality, although it seems to lag a bit. The delineation of the concepts typical of children at each developmental stage, as provided in this paper, will help to guide educational efforts and future research.
Adolescent↗
Telephone management of acute pediatric illnesses.
To evaluate the telephone management of five common acute pediatric problems, a "programmed mother" made unidentified cells to five pediatric nurse practitioners, 28 pediatric house officers and 23 pediatricians in practice. Calls were tape recorded and scored for history taking, disposition and interviewing skill. Nurse practitioners averaged 79.6 per cent of the total possible theoretical score for history taking, house officers 69.1 per cent, and practicing pediatricians 52.6 per cent (P less than 0.001). For disposition, nurse practitioners averaged 71.1 per cent of the maximum score, in contrast to 60.1 per cent for house officers and 58.9 per cent for practicing pediatricians. Similarly, nurse practitioners had significantly higher (P less than 0.001) scores for interviewing skills. No significant differences were found among house officers in the first, second and third years in history taking, disposition or interviewing skills. We conclude that pediatric nurse practitioners manage common pediatric problems by telephone better than house officers or practicing pediatricians and that better training for this aspect of practice is needed.
Acute Disease↗
Parental perceptions of vulnerability of formerly premature infants.
This study explores a possible precursor of the vulnerable child syndrome, a constellation of behaviors thought to develop as a result of excessive parental anxiety. Healthy 3-year-old children who had been born prematurely were compared to children born at term, using a single instrument. Mothers of premature infants reported a significantly greater sense of vulnerability about their children than did mothers of term infants. Antecedents and correlates of vulnerability are explored. Mothers with more education reported a greater sense of vulnerability than did less well-educated mothers, while mothers who reported greater well-being and marital satisfaction reported a lower sense of vulnerability. A greater sense of vulnerability was associated with more behavior problems and more somatic and internalizing symptoms. The data have important implications for nurses caring for infants in neonatal intensive care units, as well as in pediatric ambulatory and hospital settings.
Child, Preschool↗
Competent kids: children and adolescents with a chronic illness.
The social and personal competence of children and adolescents with a seizure disorder or an orthopaedic condition was assessed by parents and teachers. The contributions to these assessments of characteristics of the child, the intensity of the illness, and the child's temperament were explored using a hierarchical regression model. Parents and teachers rated all children as functioning fairly well. Children with a seizure disorder were perceived as significantly less competent than were their healthy peers (P less than 0.05). Across health status groups, children received higher competence scores from their parents than they did from their teachers (P less than 0.05). Competence scores did not differ according to the age of the child. The patterns of variables that predicted ratings of competence differed according to illness type and rater. Indicators of illness intensity explained a larger share of the variance in competence ratings for children with a seizure disorder (25%) than for children with an orthopaedic condition (5%). For children in this latter group, temperament explained a much larger proportion of the variance in both parents' (29%) and teachers' (42%) ratings of competence than did the illness intensity variables.
Adolescent↗
Pediatric chronic illness.
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Achievement↗
Evening telephone call management by nurse practitioners and physicians.
History-taking, disposition, and telephone communication skills of pediatric nurse practitioners, pediatric house officers, and practicing pediatricians were assessed and compared. To evaluate the management of five common acute pediatric problems, a "programmed mother" made 148 unidentified calls to these health professionals during evening hours. The calls were tape recorded, and scored for history-taking, disposition, and interviewing skills. The scoring system, developed by a panel of 11 experts, assessed the relevance and completeness of each history obtained. Nurse practitioners averaged 79.6 percent of the total possible score, as compared to 52.6 percent for pediatricians (p less than .001). When disposition was similarly analyzed, the nurse practitioners scored significantly higher than pediatricians. Analyzing only those items of history-taking and disposition deemed most critical by the panel, nurse practitioners included 91 percent and pediatricians only 55 percent (p less than .001). Parameters of interviewing skill were scored by the interviewer and each author with agreement of 80 percent or above; nurse practitioners obtained significantly higher scores than pediatricians (p less than .001). Calls handled by nurses averaged 7.4 minutes, those by pediatricians 3.2 minutes (p less than .001). Nurse practitioners, it was concluded, can safely and effectively share responsibility with physicians for night and weekend telephone call coverage for a pediatric practice with adequate physician back up.
Child↗