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Biomedical subjects

P H Dworkin

Publications and source records attributed to P H Dworkin.

15 recordsLinked to original sources
PubMed1992

Infancy problem behaviors.

The goal of pediatric health supervision is to promote the optimal growth and development of children. Parent-infant interaction and parental attitudes toward their infant are important determinants of child development. Anticipatory guidance during child health supervision enables the pediatric provider to discuss developmental stages and demystify common stage-related behaviors, such as fussing, night-waking, repetitive movements, and clinging. Anticipating the emergence of such behaviors and issues may lessen parental anxiety and concern. When behavioral problems such as colic or sleep difficulties do arise, a consideration of developmental stage is helpful in suggesting specific management strategies. The successful implementation of developmentally-oriented approaches has benefits for the family and pediatric provider, including increased parental self-confidence, enhanced family functioning, and increased parental confidence in the pediatrician. Furthermore, by encouraging developmentally-oriented approaches, parents will be less inclined to adopt inappropriate or ineffectual behavioral management strategies.

Child Behavior Disorders↗
PubMed1989

School failure.

Numerous factors may contribute to a child's failure to learn. Certain causes of school failure, such as specific learning disabilities, mental retardation, sensory impairment, and chronic illness may be regarded as intrinsic characteristics of the child. Other causes, such as family dysfunction, social problems, and ineffective schooling, are characteristics of the child's environment. Still other influences on school performance, such as temperamental dysfunction, attention deficits, and emotional illness, may be viewed as the consequence of the interaction between the child and his or her environment. The reasons for a child's school failure must not be considered in isolation but rather within the context of social and environmental circumstances. Evaluation must consider the myriad of reasons for a child's school failure and attempt to identify "clusters" of adverse influences on school performance. Detailed information must be sought from the student, parents, and school system through the history and physical examination. Questionnaires are useful in data gathering. Ancillary methods of assessment that may be of value include neurodevelopmental screening and laboratory studies. Further investigations and referrals, particularly psychoeducational evaluation, are of major importance. Traditional roles of the pediatrician in school failure include the treatment of underlying medical conditions, counseling, the coordination of further investigations and referrals, and the facilitation of communication with community services and resources. Participation with other disciplines in the development of a child's educational plan is feasible and useful.

Achievement↗
PubMed1989

British and American recommendations for developmental monitoring: the role of surveillance.

Major British and American pediatric organizations have recently issued recommendations for developmental monitoring during preventive child health care. After initial inspection, similarities between the British and American recommendations are not apparent. For example, the Committee on Practice and Ambulatory Medicine of the American Academy of Pediatrics emphasizes the importance of assessing development during all child health supervision visits, whereas the British Joint Working Party on Child Health Surveillance discourages routine, repeated developmental examinations. Further analysis reveals, however, that such recommendations are compatible. Neither committee recommends the routine administration of developmental screening tests. Such recommendations are consistent with the lack of evidence to justify routine screening of all children for developmental problems. Instead, both committees suggest that developmental monitoring be performed by the process of surveillance. With developmental surveillance, the importance of eliciting parents' opinions and concerns, obtaining a relevant developmental history, and performing skilled, longitudinal observations of children is emphasized. The success of surveillance depends on the extent to which its implementation is enhanced through clinical practice, professional training, and research.

Child↗
PubMed1988

The preschool child: developmental themes and clinical issues.

The preschool years are a remarkable period of dramatic growth in the areas of physical, affective, and cognitive development. Physical development is characterized by a slow but steady rate of somatic growth and the mastery of motor skills that facilitate the child's achievement of autonomy and independence. Major themes in affective development include the achievement of autonomy and independence from family, a lessening of attachment to parents and the alleviation of separation anxiety, and the acquisition of impulse control and socialization skills. Cognitive development during the so-called preoperational period is best characterized by the mastery of language. The remarkable developmental gains achieved during this dynamic period culminate in a child who can function independently and competently and begin the major occupation of childhood--attending school. Health maintenance issues during the preschool years directly reflect the child's developmental stage. For example, nutritional issues reflect not only physical growth and motor skills, but also negativism and the child's struggle to achieve autonomy. Similarly, safety and injury prevention related to the "motor-minded" behavior so characteristic of children at this age, as well as the illogical, egocentric thought that predominates during this period of cognitive development. Examples of other stage-related issues addressed during health maintenance visits include discipline and behavior problems, sleep problems and night awakening, and toilet training. The unique aspects of development during the preschool years also have implications for other components of child health maintenance, including developmental screening, procedures and immunizations, and physical assessment. A number of clinical issues are of special significance during the preschool years. For example, the most common causes of children's short stature, constitutional delay in growth and familial short stature, may result in major parental concerns at this time. Recurrent otitis media is an important problem during this period of language acquisition. Among preschool children with urinary tract infections, the risk of an underlying structural anomaly of the urinary tract and the danger of irreversible renal damage is greater than for older children.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗
PubMed1987

Does developmental content influence the effectiveness of anticipatory guidance?

We conducted a prospective, controlled study to evaluate the value of discussing developmental stages with mothers while providing anticipatory guidance during health maintenance visits. Eighty-three inner city mothers and their healthy, first-born infants were recruited within three days of birth and randomly assigned to either a control or intervention group. All mother-infant pairs were seen by the same pediatric provider for health maintenance visits when the infants were 2 weeks, 2 months, 4 months, and 6 months of age. At each visit, anticipatory guidance for all mothers included discussions of such age-appropriate issues as nutrition, safety, sleep, and common problematic behaviors. For the 39 intervention group mothers, the basis for such information was explained through age-specific discussions of affective, cognitive, and physical development. Dependent variables measured after the 6-month visit included maternal-infant interaction; maternal perceptions of infant temperament, family adaptation and adjustment, and satisfaction with the infant's behavior and development; and maternal satisfaction with pediatric services. Analyses of variance demonstrated no significant effect of treatment group on any of the outcome measures. These results do not support the importance of routinely discussing developmental stages during anticipatory guidance and suggest that specific, age-appropriate issues may be discussed without emphasizing the developmental basis for such information.

Adult↗
PubMed1986

Educational readiness.

The early identification of children not yet ready to begin the formal task of classroom learning has been increasingly emphasized by educators, psychologists, pediatricians and parents. The pediatrician, as the professional concerned with monitoring children's growth and development, is uniquely suited to participate in the identification of such children. Effective participation requires recognition of the various factors influencing educational readiness, as well as the manner in which they fit together into a whole greater than the sum of its parts. Possible pediatric roles include screening children for educational readiness, as well as clinical problem-solving when issues or concerns arise.

Child Development↗
PubMed1979

Training in developmental pediatrics. How practitioners perceive the gap.

Ninety-seven randomly selected, board-certified pediatricians in five New England states were interviewed by two physicians to explore attitudes toward previous training and current sources of knowledge in developmental pediatrics. Formal training in development was rated as inadequate by 79%, of residency experience was viewed as highly valuable by only 30%, and 47% rated medical school as having no value. Although clinical experience was reported as a valuable source of knowledge by 99% of the sample, almost two thirds did not regard it as an adequate substitute for formal training. Frequent interdisciplinary communication was reported, and professional contacts were described as a highly valuable ongoing source of knowledge. Social class and size of practice did not correlate with differences in consultation patterns. A part-time longitudinal clinical experience for further education was preferred by 97%. Improved training with greater interdisciplinary content is needed.

Child↗
PubMed1979

Developmental-behavioral dysfunction in preschool children. Descriptive analysis of a pediatric consultative model.

A study of 79 preschool children referred to an interdisciplinary clinic because of behavioral problems and developmental concerns was done. Historical data and information regarding present functioning were collected using standard questionnaires. In addition to medical, neurological, and psychiatric examinations, every child received a neurodevelopmental assessment. When compared with a matched cohort of children from the community, the clinic population had a higher incidence of developmental concerns. Of 37 children referred because of "hyperactivity" or other behavioral concerns, 13 had previously undetected developmental concerns requiring specific interventions. Dysfunction in preschool children may be the result of an ongoing reciprocal interaction between constitutional predispositions and social and environmental factors. A comprehensive, developmentally oriented approach seems to be indicated in the assessment of these children. This may have implications for pediatric practice.

Affective Symptoms↗
PubMed1979

Primary care approaches to developmental disabilities.

Ninety-seven board certified pediatricians who spend at least 75% of their professional working hours involved in the delivery of primary care in New England were interviewed to explore their attitudes and current clinical approaches to developmental disabilities. The majority of the pediatricians relied exclusively on clinical judgment and general observations for assessing developmental problems in their offices. Responsibility for preschool screening for potential learning problems and the assessment of school failure were considered appropriate pediatric concerns. Reported customary approaches to a variety of developmental problems were not affected by the size of the practice nor by the socio-economic status of the patient population. Patterns of referral for consultation appeared to be more dependent on the nature of the suspected disorder than on the characteristics of the physicians or their practices. The need for more rigorous training in the developmental aspects of child health has been emphasized. In order to meet this challenge, more precise techniques for pediatric developmental assessment and more conclusive evaluations of specific interventions will have to be produced.

Attitude of Health Personnel↗