PubMed · 7273921
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R S Lourie. Primary prevention in infancy.. https://pubmed.ncbi.nlm.nih.gov/7273921/
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Nonretentive encopresis refers to inappropriate soiling without evidence of fecal constipation and retention. This form of encopresis accounts for up to 20 percent of all cases. Characteristics include soiling accompanied by daily bowel movements that are normal in size and consistency. An organic cause for nonretentive encopresis is rarely identified. The medical assessment is usually normal, and signs of constipation are noticeably absent. A full developmental and behavioral assessment should be made to establish that the child is ready for intervention to correct encopresis and to identify any barriers to success, particularly disruptive behavior problems. Successful interventions depend on the presence of soft, comfortable bowel movements and addressing toilet refusal behavior. Daily scheduled positive toilet sits are recommended. Incentives may be used to reinforce successful defecation during these sits. A plan for management of stool withholding should be agreed on by the parents/caretakers and the family physician before intervention.
We report on two boys, monozygotic twins born to normal and nonconsanguineous parents, presenting with an unusual facial appearance, cortical atrophy, dolichocephaly, short stature, cleft palate, micrognathia, prominent upper central incisors, bilateral Sidney line, minor foot deformities, unstableness in walking, early hypotonia, hyperreflexia, hyperactivity, psychomotor retardation, and severe delay in language development. These manifestations resemble those previously described in the Smith-Fineman-Myers syndrome.
We examined 10:30 a.m. salivary cortisol levels in twenty-four 2-year-old children at home, and then at several points during transition into preschool: Week 1, Weeks 6-9, and the 1st week following a month-long holiday break. Cortisol levels did not increase when the children first started school as compared to either home or later school levels. Cortisol levels were correlated across similar, but not across dissimilar, psychosocial contexts. Home levels were correlated wit more shy, anxious, internalizing behavior while the response to starting school was correlated with more assertive, angry, and aggressive behavior. Behavior was assessed using parent temperament reports, teacher reports, and observational measures. We conclude that HPA activity as indexed by salivary cortisol measures is differentially associated with behavior in familiar and novel contexts. Consistent with our prior work, shy/anxious behavior is not significantly associated with elevations in cortisol when young children enter new social situations.