[The physician and the handicapped child].
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Adolescent↗
Biomedical subjects
R H Largo
Publications and source records attributed to R H Largo.
[Sleeping behavior between the ages of 2 and 18. Longitudinal study].
Sleeping behavior was investigated in 320 Swiss children 2 to 18 years of age. The data were based on the First Zurich Longitudinal Study (1954-1980). The incidence of resistant behaviour at bedtime increased from 8 to 40% between age 2 and 10. Evening wakefulness was observed in 20% of the 2- to 7-year-old children, and in 40-50% of the older children. The incidence of night waking decreased from 40-50% in the preschool period to 20% at age 12.20% of the 2 to 4-year-old children and only 1% of the 12-year-old children woke up every night. Evening wakefulness and night waking were observed in some children over periods of several years. Up to age 5 the incidence of "bad dreaming" was 60%, subsequently it decreased to about 25%. Somnambulism was observed in 5% of the children. None of the described sleeping behaviors showed sex differences.
Adolescent↗
[The development of sleep behavior within the first 5 years of life].
Sleep behavior between 1/2 and 5 years in 320 Swiss children of the first Zurich longitudinal study is reported. The average length of night sleep between 1/2 and 5 years was 11 to 12 hours. Day sleep was noted in 96% of the children between 6 and 24 months, and in 20% at age 5. The total length of sleep between 6 and 18 months was 15 hours per 24 hours. It diminished to 12 hours at age 5. There was a large individual variability of day sleep and of night sleep at all ages. Positive correlations were found between the lengths of day sleep at different ages and between the lengths of night sleep at different ages. The length of day sleep and that of night sleep was negatively correlated between 2 and 5 years. Evening wakefulness was observed in 16% and night waking in 40 to 50% of all children. 18% woke up at least once each night. Night wakening between 2 and 5 years was positively correlated. In about half of the children with evening wakefulness and/or night wakening these sleep behaviors were considered as abnormal by the mothers.
Child, Preschool↗
[Weight, length and head circumference of the newborn infant and their relationship to maternal and infant factors. Standards for intrauterine growth].
Means, standard deviations and smoothed percentiles of fetal weight, length and head circumference at birth, and weight of the placenta between 26 and 44 weeks of gestation are presented. The data are based on 5136 single and 208 twin, live-born newborn infants delivered at the cantonal Hospital Winterthur between 1969 and 1974. The percentile curves differ considerably from those of the widely used "Lubchenco-Curves". Fetal weight correction factors for maternal weight, parity and sex of the child are given. Among the various maternal and infantile variables influencing fetal growth, gestational age and maternal weight were found to be the most significant ones affecting weight and length of the newborn. Parity and sex of the child were of moderate, maternal height and nationality of minor importance.
Birth Weight↗
Evaluation of perinatal growth. Presentation of combined intra- and extrauterine growth standards for weight, length and head circumference.
The evaluation of perinatal growth requires different approaches depending on the chronological age of the infant. Basically, three periods of perinatal growth are to be distinguished: Intrauterine period: Growth during this period can be estimated by intrauterine growth standards representing fetal growth parameters at birth. Transitional period: Growth during the first 6 to 12 days of life is of transitional nature. It is characterized by large individual variations and does not follow any growth standards. Extrauterine period: After the 6th to 12th day of life growth rates are distinctly higher than those of intrauterine growth. Thus, intrauterine growth standards can not be applied to extrauterine growth, and separate growth standards are required to evaluate growth during this period. In this article combined intra- and extrauterine growth standards for weight, length and head circumference in boys and girls between 28 weeks of gestation and 8 weeks after term are presented. These growth standards are based on the Winterthur Newborn Study (1962-1974) and the Second Zurich Longitudinal Study (1974-1980).
Birth Weight↗
Analysis of the growth spurt at age seven (mid-growth spurt).
A statistical analysis of the mid-growth spurt from the data of the First Zurich Longitudinal Study is presented. A small but significant mid-growth spurt was found in most height and length measurements and in some girth and width measurements, such as chest circumference, bihumeral and biiliac width. The mid-growth spurt seemed to be slightly more pronounced in boys than in girls. The peak of the mid-growth spurt occurred between 6.5 and 8.5 years. The height of the peak varied from 0.3 to 0.7 cm/year for the different measurements (estimated from the smoothed median velocity curves). In a peak-centered analysis a mid-growth spurt of standing height was observed in two thirds of the children. It occurred about one year earlier in girls than in boys, and averaged 1.4 cm/year. The data indicate that the mid-growth spurt is due to a transient increased growth rate of the bones, particularly the long bones, and possibly of fat and muscle tissue. In contrast to the growth spurt of the extremities, the spurt of the rump height is not a true growth phenomenon, but the result of a postural change occurring at about 6.5 years of age.
Adolescent↗
Developmental progression in play behavior of children between nine and thirty months. I: Spontaneous play and imitation.
The developmental progression of play behavior was studied cross-sectionally in 85 children at eight age-levels between nine and 30 months. In a structured play situation, three major play patterns were distinguished: (1) exploratory play (at the end of the first year); (2) functional play (beginning of second year); and (3) representational play (after 15 months). Sequential play first occurred at 21 months. Play behavior with spatial characteristics was also observed: relational and container play between nine and 15 months, and understanding of spatial relationships, stacking and grouping between 18 and 24 months. There was a significant relationship between spontaneous and imitative play behavior; the greatest affect was displayed when the demonstrated behaviors matched the child's developmental level of play.
Age Factors↗
Developmental progression in play behavior of children between nine and thirty months: II: Spontaneous play and language development.
The relationship between play behavior displayed in a structured play situation and language development was studied cross-sectionally in 85 children at eight age--evels between nine and 30 months. There were no correlations between types of play behavior, in particular functional play (appropriate use of objects on the child's own body), representational play (appropriate use of objects on a doll or another person), or symbolic play (substitution of present objects for absent ones) and speech measures such as total number of words and of vocalizations, number of different words and different vocalizations, and number of sentences. Identification of objects upon verbal request was not related to any type of play behavior, but comprehension of verbal requests for functional or representational play was postively correlated with the display of functional or representational play. The children did not respond to verbal requests for functional or representational play unless these types of play behavior were part of their spontaneous play repertoire. Understanding of prepositions seemed to be related to spatial concepts expressed in play behavior, such as container play or arranging chairs around a table and setting the table.
Child Development↗
[The crying infant].
The different types of crying which can be observed in the healthy and in the sick infant are described. Recent findings on behavioral and electrophysiological research are reviewed which led to a better understanding of the characteristics and possible causes of the different crying behaviors as well as of the effectiveness of therapeutical interventions.
Crying↗
[Development of intestinal and bladder control from birth until the 18th year of age. Longitudial study].
The development of bowel and bladder control from 0 to 18 years of age in 321 Swiss children of the Zurich Longitudinal Study (1955-1976) is described. 3% of the children had started toilet training by the age of 1 month and 96% by 12 months. Bowel control was completed in 32% at age one, in 75% at age two and in 97% at age three. Complete bladder control by day and at night was established in none of the children at age one, in 20% at ages two and three and in 90% at age five. About one quarter of the boys and one tenth of the girls had a period of incomplete bowel or bladder control between 6 and 18 years. During the prepubertal period, the annual incidence of enuresis was 7-15% in boys and 7-10% in girls, and that of encopresis 2-4% and 1-2% respectively. Some combination of enuresis diurna, enuresis nocturna and encopresis were found in 7% of all children, although in most children, these events did not occur simultaneously. With the exception of primary diurnal enuresis, the different types of enuresis and encopresis were more frequent in males than in females. By the onset of puberty, encopresis resolved in all children and enuresis persisted in only a few children. The role of toilet training and the etiologies and pathogenesis of enuresis and encopresis are discussed from a development point of view.
Adolescent↗
Analysis of the adolescent growth spurt using smoothing spline functions.
Height growth velocity curves between 4.5 and 17.75 years were estimated, using smoothing spline functions, for 112 boys and 110 girls from the Zurich Longitudinal Study (1955--1976). Parameters characterizing the growth process, such as peak height velocity and age at peak height velocity, were calculated directly from the estimated curves. The variability of parameters describing the adolescent growth spurt is large, both between and within sexes. Peak height, defined as increase of height velocity during the growth spurt, and age at peak height velocity both characterize the sex difference in growth in a highly significant manner. Peak height of at least 4 cm/year is found in 70% of the boys, but in only 11% of the girls. The age at peak height velocity averages 12.2 years in girls and 13.9 years in boys and has a wide range of 5.7 years and 3.8 years respectively. The sex difference in adult height of 12.6 cm is composed of the following 4 factors: +1.6 cm caused by more prepubertal growth in boys, +6.4 cm by the boys' delay in spurt, +6.0 cm by the more extensive spurt in boys and -1.4 cm by more post-spurt growth in girls. Correlations between parameters indicate that the adult height depends neither on the duration of growth, nor on the duration and height of the peak. Minimal pre-spurt height velocity and peak height velocity, but not peak height, are age- and height-dependent. Partial correlations given adult height reveal two compensating mechanisms between growth in the prepubertal and in the pubertal period. Small prepubertal height and low height velocity with respect to adult height are followed by a late adolescent spurt and vice versa. Small height at the onset of the spurt with respect to adult height is followed by a longer lasting, but not higher spurt and vice versa.
Adolescent↗
Head growth and changes in head configuration in healthy preterm and term infants during the first sex months of life.
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Body Height↗
Longitudinal study of bowel and bladder control by day and at night in the first six years of life. I: Epidemiology and interrelations between bowel and bladder control.
The development of bowel and bladder control by day and at night during the first six years of life in 320 Swiss children in the Zurich longitudinal study (1955--1976) is described in detail. A scoring system was used which included intermediate stages of control. With toilet-training started in 96 per cent of the children during the first year of life, bowel control was completed in 32 per cent at age one, in 75 per cent at age two and in 97 per cent at age three. Complete bladder control by day and at night were established in none of the children at age one, in 20 per cent at ages two and three and in 90 per cent at age four. Complete bowel control and complete bladder control by day and at night were found in 5 per cent at age two, in 11 per cent at age three, in 77 per cent at age four and in 91 per cent at age six. The significant relationships between bowel control, bladder control during the day and bladder control at night (p less than 0-001) demonstrate that the same developmental process acts in bowel and bladder control. Highly correlated to each other, first bowel control develops, then bladder control by day and finally bladder control at night. The relevance of these interrelations for toilet-training and for the management of enuretic and encopretic children is discussed.
Child↗
Longitudinal study of bowel and bladder control by day and at night in the first six years of life. II: The rôle of potty training and the child's initiative.
The rôle of potty training and the child's own initiative to use the pot were evaluated in 320 Swiss children in the Zurich longitudinal study (1955--1976). Initiating potty training in the first months of life has a short-term effect on bowel control, but no effect on bladder control by day or at night. Frequent daily prompting to use the pot results in a higher percentage of completely bowel-trained children, and of children partially but not completely dry during the day. It has no influence on bladder control at night. Asking for the pot is part of the maturation process of bladder control. A child who does not ask for the pot may not soil himself but is unlikely to be dry by day nor, especially, by night. The child's asking for the pot cannot be induced by frequent prompting.
Child↗
[Visual acuity at puberty and eye dominance at the age of 10].
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Adolescent↗
MRI following severe perinatal asphyxia: preliminary experience.
In 30 children suffering from severe perinatal asphyxia an attempt was made to determine the early prognostic signs of severe hypoxic-ischemic brain injury with magnetic resonance imaging (MRI). Ten early (1-4 days of age), 16 intermediate (2-4 weeks of age), and 38 late MRI (older than 1 month of age) procedures were performed on a 2.35 T MR-system. Severe cerebral necrosis was suspected by T2 hyperintensity of the white matter, with blurred limits to the cortex in early MRI, and was confirmed by T1 hyperintensity of the cortex in intermediate MRI. Severe cerebral necrosis was established at 3 months of age. Of the 11 children with this pattern (group A), 8 had severe and 3 had moderate cerebral palsy on subsequent examination. Thirteen children (group B) had normal late MRI scans; none developed severe cerebral palsy or marked mental retardation. Two children (group C) had focal ischemic lesions. Four children had intracranial hemorrhage (group D). Groups A and B did not differ in the severity of their perinatal histories and findings, suggesting that MRI during the first 3 months is of significant prognostic value.
Asphyxia Neonatorum↗
Statistical characterization of the pubertal growth spurt.
BACKGROUND: This is a methodical investigation into the problem of estimating parameters for the pubertal spurt (PS). The variability involved in determining the timing, intensity and duration of the PS for height, leg height and biiliac width is estimated via a realistic simulation. Further, a decomposition of adolescent growth into a component due to the pubertal peak and one due to ongoing prepubertal velocity is evaluated. METHODS: Data for 120 boys and 112 girls are available from 4 weeks to adulthood. The curve-fitting method is kernel estimation for distance, velocity and acceleration. RESULTS: The age of peak velocity and the age of stopping of the PS are well determined. In contrast, the age of onset of the PS is less well determined. Intensity is less variable for the parameter peak velocity than for maximal acceleration. It is feasible to decompose adolescent growth into a component due to the pubertal peak and one due to ongoing prepubertal growth. CONCLUSIONS: Nonparametric curve-fitting methods which do not rely on a parametric growth model can be successfully used to extract individual characteristics of the PS.
Adolescent↗