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PubMed2006

Building a new world: habits and practices of healing following the death of a child.

The goal of this interpretive phenomenological study is to describe and understand significant habits and practices developed by families bereaved from the sudden and unexpected loss of their children. Data were primarily collected through the interviewing of 15 family members in seven families. At least four interviews were conducted with each family. Family members were interviewed both together and separately. The analysis of the data illuminated the development of significant and meaningful family practices. These practices acknowledged the death of the children, integrated their loss into the everyday lives of these families, allowed for continuing connection, and were of utter importance as they contributed to family healing.

Adaptation, Psychological↗

PubMedDate not supplied

The effectiveness of CASAs in achieving positive outcomes for children.

Using a quasiexperimental design, this study evaluated the effectiveness of CASAs in achieving positive outcomes for children, and examined the process variables believed to lead to permanency for children. Data were collected from court and CASA program files over a two-year period on 200 children, who were compared to children without CASA volunteers on outcome and process variables. Findings indicate that CASAs may have helped reduce the number of placements and court continuances children experienced, and that more services were provided to children with CASAs than to those without. Additional research is needed to further evaluate the impact of CASA services on children.

Child↗

PubMed2005

Clinical features and biochemical data of Caucasian children at diagnosis of autoimmune hepatitis.

OBJECTIVE: Evaluation of systematic epidemiological data regarding clinical characteristics, sex distribution and autoantibody pattern in Caucasian children with autoimmune hepatitis (AIH). STUDY DESIGN: Data of 142 children presenting with AIH (97 girls and 45 boys) have been analysed for their clinical, serological, and histological profile. RESULTS: Clinical findings were jaundice (58%), unspecific weakness (57%), anorexia (47%), abdominal pain (38%) and paleness (26%). One hundred and three children (73%) (68 girls, 35 boys, 1.9:1) had AIH type 1 and 35 patients (25%) (27 girls, 8 boys, 3.4:1) type 2 due to specific autoantibodies. Four children could not be classified. Histology of 122 children revealed active hepatitis in 64 (52%), cirrhosis in 46 (38%), and mild inflammatory activity in 12 individuals (10%). The most prevalent HLA type was B8. CONCLUSION: In our cohort the prevalence of AIH was half as frequent in boys as in girls. Type 1 was the most frequent diagnosis (73%) and was more prevalent in older children. Type 2 was equally age distributed. The clinical presentation of AIH in children was unspecific and type I and type II could only be differentiated by the determination of the specific autoantibodies. Ninety percent of patients presented with high inflammatory activity or liver cirrhosis.

Adolescent↗

PubMed1998

Improving the quality of healthcare for children: implementing the results of the AHSR research agenda conference.

OBJECTIVE: To describe the rationale, development, content, and results of the AHSR-sponsored conference on developing a research agenda focused on improving the quality of care for children. DATA SOURCES AND METHODS: Planning documents, background papers, and conference proceedings. PRINCIPAL FINDINGS: The conference developed the research agenda focused on (1) monitoring the health of children; (2) evaluating the efficacy and effectiveness of health services for children; (3) assessing the quality of healthcare provided to children; (4) improving the quality of healthcare within health systems; (5) assessing the performance of community systems for children; (6) exploring the impact of different financial incentives on the provision of pediatric healthcare; and (7) developing and disseminating clinical practice guidelines and other information to physicians, families, and consumers. Specific issues and research questions in each area are also presented. Strategies for implementing the research agenda are presented and include: (1) expanding the child health services research workforce; (2) developing child healthcare quality improvement research centers; (3) conducting research in specific high-priority areas; (4) focusing research on improving the health of vulnerable populations; (5) improving child health data and collection systems at the national level; (6) developing better community health monitoring for children; (7) building and supporting research networks and a consortium of research users; and (8) developing a coordinated interagency federal effort to advance this agenda and to provide accountability for its completion. CONCLUSION: The proposed research agenda should be a national priority so that all Americans can be assured that children are receiving the best quality of care that the United States can provide.

Child↗

PubMed2000

Does breast-feeding protect against childhood obesity?

The impact of breast-feeding on overweight and obesity in children at school entry was assessed in a cross sectional study in Bavaria in 1997. The school entry health examination enrolled 134,577 children. Data on early feeding were collected in two rural districts (eligible population n=13,345). The analyses were confined to 5 or 6 year old children with German nationality. The main outcome measures were overweight (BMI>90th percentile for all German children seen at the 1997 school entry health examination in Bavaria) and obesity (BMI>97th percentile). Information on breast-feeding was available for 9206 children of whom 56% had been breast-fed for any length of time. In non breast-fed children the upper tail of the BMI distribution was enlarged as compared to the breast-fed children whereas the median was almost identical. The prevalence of obesity in children who had never been breast-fed was 4.5% as compared to 2.8% in ever breast-fed children. A clear dose response effect for the duration of breast-feeding on the prevalence of obesity was found: 3.8%, 2.3%, 1.7% and 0.8% for exclusive breast-feeding for up to 2, 3 to 5, 6 to 12 and more than 12 months, respectively. The results for overweight were very similar. The protective effect of beast feeding on overweight and obesity could not be explained by differences in social class or lifestyle. The adjusted odds ratios of breast-feeding for any length of time was 0.71 (95% CI 0.56-0.90) for obesity and 0.77 (95%CI 0.66-0.88) for overweight. This data set did not allow to adjust for maternal weight, an important risk factor for obesity in children. Maternal overweight, however, could not explain the effect of breastfeeding on overweight and obesity in a similar study. The reduction in the risk for overweight and obesity is therefore more likely to be related to the properties of human milk than to factors associated with breast-feeding. The potential relevance of different components of human milk for the observed reduction in the risk for overweight and obesity is discussed. The preventive effect of breast-feeding on overweight and obesity is an important additional argument for the promotion of breast-feeding in industrialised countries.

Body Mass Index↗

PubMed2006

Soil ingestion in children and adults in the same family.

Ingestion of soil may be a potentially important pathway of exposure to environmental pollutants. Although several studies have estimated soil ingestion in children, data on ingestion in adults are sparse. The purposes of this study were to estimate soil ingestion in children aged 3 to 8 years and their parents, identify factors associated with increased ingestion, and compare ingestion rates within the same family. Food/liquid, excreta, and soil/dust samples were collected for the mother, father, and participant child for 11 consecutive days in 19 families. Soil ingestion was estimated using a mass balance approach. Soil ingestion levels in children were similar to those reported previously, whereas adult estimates were somewhat higher than previous estimates. Children's eating of dirt and parents' occupational contact with soil were associated with increased ingestion. Within families, soil ingestion levels in children and adults were not correlated, although this analysis was based on fewer than 19 participant families. Children's mean soil ingestion rates ranged from 37 to 207 mg/day depending on the tracer, with the highest values based on titanium as a tracer. Adult mean soil ingestion rates ranged from 23 to 625 mg/day depending on the tracer, with the highest value based on titanium as a tracer. Soil ingestion rate estimates were more variable in adults than in children.

Activities of Daily Living↗

PubMed2005

Socioeconomic status and health: do gradients differ within childhood and adolescence?

Socioeconomic status (SES) gradients may not be static across the lifespan, but instead may vary in strength across different life stages. This study examined the periods in childhood when SES and health relationships emerge and are strongest among US children. Data came from the National Health Interview Survey, 1994, a cross sectional, nationally representative sample of 33,911 US children ages 0-18. Parents were asked about family SES and child health status. Global health measures included overall ratings of child health, activity and school limitations. Acute conditions included childhood injuries and respiratory illnesses. For all global child health measures, lower family SES was associated with poorer child health in a gradient fashion (P < .001); these differences did not vary across age. For specific conditions, interaction effects of SES with age were found (P < .05). Interaction effects revealed that for injury and acute respiratory illness, expected SES gradients (lower SES with poorer outcomes) were evident during adolescence. In contrast, respiratory illness had a reverse SES gradient in early childhood. In sum, for global child health measures, associations of lower SES with poorer health throughout childhood suggest that factors that do not change with age (e.g., health care quality) may best explain overall health status. However, for acute conditions, the relationship between low SES and poor child health appears most consistently during adolescence. This suggests that normal development-related changes during adolescence, such as increasing peer group affiliation, may help explain these gradients. These patterns are important to understand for optimally timing interventions to reduce SES disparities in US children's health.

Adolescent↗

PubMed2004

Factors associated with Hb concentration in children aged 6-59 months in the State of Pernambuco, Brazil.

In 1997, the prevalence of anaemia was 40.9 % among children aged 6-59 months in the State of Pernambuco, north-east Brazil. Using the same sample of children, we have investigated possible reasons for this high prevalence. A representative sample was selected through a three-stage process: proportional systematic random sampling of municipalities in the State, systematic random sampling of census sectors within these municipalities, and finally, simple random sampling of households with children aged 6-59 months to obtain the sample of 650 children. Data collection included demographic, environmental, socio-economic and maternal variables, and nutritional status and dietary intakes of the children. Multiple linear regression analysis was based on a hierarchical model of factors associated with Hb concentration. The mean Hb concentration of children aged 6-23 months was 10 g/l lower than that of older children. In the regression analysis, child age explained 8.3 % of the variance in Hb concentration. The intake of bioavailable Fe explained a further 3.3, serum retinol 2.7, diarrhoea 2.4, water treatment 1.7, sanitation 1.3 and low birth-weight 0.5 %. The final model explained 23.4 % of the variance in Hb concentration. We conclude that child age, bioavailable-Fe intake, serum retinol concentration, diarrhoea, water treatment, sanitation and low birth-weight are independently associated with Hb concentration. In north-east Brazil, anaemia prevention programmes among children should focus on those aged <2 years and should consider feasible strategies to improve intakes of bioavailable Fe and vitamin A, and reduce infection. Supplemental Fe should be given to low birth-weight infants.

Age Factors↗

PubMed1989

Coaches' goals for young children in a recreational sports program.

Almost all children participate in sports at some time, and programs are being established for even younger children. Adults who coach the children largely determine what the children's sports experience will be. Coaches' perceptions of what is important for the young children they instruct have not yet been carefully investigated. This study was designed, therefore, to determine coaches' goals for young children. Data were gathered by use of an attitude questionnaire administered to 29 coaches of a recreational basketball program of children ranging in age from 6 to 10 years old. Of the 12 goals, feeling part of a team, learning to do my best, and having fun and excitement were most highly rated as extremely important, while becoming popular was lowest rated as not important. Results revealed that coaches in general are able to clearly define their goals and priorities, and these goals seem developmentally appropriate for the children. However, coaches make little differentiation in goals based on age.

Attitude↗

PubMed2004

Incorporating children's toxicokinetics into a risk framework.

Children's responses to environmental toxicants will be affected by the way in which their systems absorb, distribute, metabolize, and excrete chemicals. These toxicokinetic factors vary during development, from in utero where maternal and placental processes play a large role, to the neonate in which emerging metabolism and clearance pathways are key determinants. Toxicokinetic differences between neonates and adults lead to the potential for internal dosimetry differences and increased or decreased risk, depending on the mechanisms for toxicity and clearance of a given chemical. This article raises a number of questions that need to be addressed when conducting a toxicokinetic analysis of in utero or childhood exposures. These questions are organized into a proposed framework for conducting the assessment that involves problem formulation (identification of early life stage toxicokinetic factors and chemical-specific factors that may raise questions/concerns for children); data analysis (development of analytic approach, construction of child/adult or child/animal dosimetry comparisons); and risk characterization (evaluation of how children's toxicokinetic analysis can be used to decrease uncertainties in the risk assessment). The proposed approach provides a range of analytical options, from qualitative to quantitative, for assessing children's dosimetry. Further, it provides background information on a variety of toxicokinetic factors that can vary as a function of developmental stage. For example, the ontology of metabolizing systems is described via reference to pediatric studies involving therapeutic drugs and evidence from in vitro enzyme studies. This type of resource information is intended to help the assessor begin to address the issues raised in this paper.

Adult↗

PubMed2000

Effects of treatment for intestinal helminth infection on growth and cognitive performance in children: systematic review of randomised trials.

OBJECTIVE: To summarise the effects of anthelmintic drug treatment on growth and cognitive performance in children. DATA SOURCES: Electronic databases: Cochrane Infectious Diseases Group controlled trial register, Cochrane controlled trials register, Embase, and Medline. Citations of all identified trials. Contact with the World Health Organization and field researchers. REVIEW METHODS: Systematic review of randomised controlled trials in children aged 1-16 that compared anthelmintic treatment with placebo or no treatment. Assessment of validity and data abstraction conducted independently by two reviewers. MAIN OUTCOME MEASURES: Growth and cognitive performance. RESULTS: Thirty randomised controlled trials in more than 15 000 children were identified. Effects on mean weight were unremarkable, and heterogeneity was evident in the results. There were some positive effects on mean weight change in the trials reporting this outcome: after a single dose (any anthelmintic) the pooled estimates were 0.24 kg (95% confidence interval 0.15 kg to 0. 32 kg; fixed effects model assumed) and 0.38 kg (0.01 kg to 0.77 kg; random effects model assumed). Results from trials of multiple doses showed mean weight change in up to one year of follow up of 0.10 kg (0.04 kg to 0.17 kg; fixed effects) or 0.15 kg (0.00 to 0.30; random effects). At more than one year of follow up, mean weight change was 0.12 kg (-0.02 kg to 0.26 kg; fixed effects) and 0.43 (-0.61 to 1. 47; random effects). Results from studies of cognitive performance were inconclusive. CONCLUSIONS: There is some limited evidence that routine treatment of children in areas where helminths are common has effects on weight gain, but this is not consistent between trials. There is insufficient evidence as to whether this intervention improves cognitive performance.

Adolescent↗

PubMed2000

Pediatric pesticide poisoning in the Carolinas: an evaluation of the trends and proposal to reduce the incidence.

Studies from North and South Carolina on hospitalizations following pesticide exposure have shown that about 30% involve children. During 1990-1993, 29% of North Carolinians hospitalized for pesticide poisoning were children. Between 1971 and 1996, 28% to 37% of the patients hospitalized following pesticide exposure in South Carolina were children. Data from a South Carolina study, from the Association of American Poison Control Centers and the Vital Statistics of the US, suggest that pesticide poisonings in children are part of the overall problem of children being poisoned by household chemicals. Most poisonings occur in toddlers about 1-y-of-age. Pesticide-related fatalities in children have steadily decreased for the last 20-y while poisonings from other household chemicals have not decreased dramatically. The data suggest that increased public awareness of the risks of household chemicals could decrease that poisoning incidence.

Child, Preschool↗

PubMed2006

Behavioural and cognitive interventions with or without other treatments for the management of faecal incontinence in children.

BACKGROUND: Faecal incontinence is a common and potentially distressing disorder of childhood. OBJECTIVES: To assess the effects of behavioural and/or cognitive interventions for the management of faecal incontinence in children. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 1 February 2006). SELECTION CRITERIA: Randomised and quasi-randomised trials of behavioural and/or cognitive interventions with or without other treatments for the management of faecal incontinence in children. DATA COLLECTION AND ANALYSIS: Reviewers selected studies from the literature, assessed study quality, and extracted data. Data were combined in a meta-analysis when appropriate. MAIN RESULTS: Eighteen randomised trials with a total of 1168 children met the inclusion criteria. Sample sizes were generally small. All studies but one investigated children with functional faecal incontinence. Interventions varied amongst trials and few outcomes were shared by trials addressing the same comparisons. Combined results of nine trials showed higher rather than lower rates of persisting symptoms of faecal incontinence up to 12 months when biofeedback was added to conventional treatment (OR 1.11 CI 95% 0.78 to 1.58). This result was consistent with that of two trials with longer follow-up (OR 1.31 CI 95% 0.80 to 2.15). In one trial the adjunct of anorectal manometry to conventional treatment did not result in higher success rates in chronically constipated children (OR 1.40 95% CI 0.72 to 2.73 at 24 months). In one small trial the adjunct of behaviour modification to laxative therapy was associated with a significant reduction in children's soiling episodes at both the three month (OR 0.14 CI 95% 0.04 to 0.51) and the 12 month assessment (OR 0.20 CI 95% 0.06 to 0.65). AUTHORS' CONCLUSIONS: There is no evidence that biofeedback training adds any benefit to conventional treatment in the management of functional faecal incontinence in children. There was not enough evidence on which to assess the effects of biofeedback for the management of organic faecal incontinence. There is some evidence that behavioural interventions plus laxative therapy, rather than laxative therapy alone, improves continence in children with functional faecal incontinence associated with constipation.

Behavior Therapy↗

PubMed2006

Functional outcome after low-grade astrocytoma treatment in childhood.

BACKGROUND: The relatively high survival rate of patients with low-grade astrocytoma necessitates increasing attention to physical and psychosocial outcomes. The objective of the current study was to investigate functional outcomes among children who were treated for low-grade or pilocytic astrocytoma in different areas of the brain. METHODS: Functional outcomes were evaluated in the following domains: impairments, disabilities, handicaps, and quality of life (QOL). In a consecutive series, 38 children were included. Follow-up ranged from 3 years and 7 months to 11 years and 4 months after diagnosis. RESULTS: Approximately 61% of children had impairments and 10% had a severe disability. Handicaps were found in the domains of relationships, school, and behavior. Children who were treated for supratentorial tumors required significantly more special education, and children who were treated for infratentorial tumors had significantly more behavioral and social problems. QOL was decreased significantly in all domains except emotions. Children who had a diagnosis in adolescence reported a lower QOL in social functioning compared with younger children. Data analysis revealed that some deficits suddenly became apparent years after diagnosis. CONCLUSIONS: At long-term follow-up, children who had low-grade or pilocytic astrocytomas were found to have poor functional outcomes, depending on tumor site, age, and recurrence. Children without deficits may develop severe cognitive, social, and behavioral deficits years after diagnosis, because of the phenomenon of "growing into deficit." Therefore, the authors suggest a long-term follow-up of children who are treated for low-grade or pilocytic astrocytomas at a young age to detect and subsequently offer support focused on the medical and cognitive impairments as well as on the behavioral and social consequences of their disease.

Adolescent↗

PubMed2004

Colonic transit time--what is normal?

BACKGROUND: Constipation is a common problem in childhood, and various radiologic methods have been advocated for investigation. Colonic transit time (CTT) has been used in adults to investigate colonic motility, but few studies evaluate this method in children. Data on CTT in the normal paediatric population are scarce. METHODS: The colonic transit time was measured in 22 healthy children (median age, 10 years; range, 4 to 15 years) by Abrahamsson's method. Children took bolus ingestions of radiopaque markers on 6 consecutive days, and on day 7 a single abdominal x-ray was performed. This was evaluated for total and segmental colonic transit time. RESULTS: The mean total CTT was 40 hours, and the upper limit of normal (95th percentile) was 84 hours. The upper limit of normal for segmental transit time was as follows: 14 hours for the ascending, 33 hours for the transverse, 21 hours for the descending, and 41 hours for the rectosigmoid colon. CONCLUSIONS: CTT provides an objective measure to assess childhood constipation. To date, 6 studies using 5 different methods have been published reporting values for healthy children. Comparing these, Abrahamson's method has low radiation exposure and is well tolerated. This study contributes additional normal values in children.

Adolescent↗

PubMed1997

Spiritual care for children with cancer.

OBJECTIVES: To review literature pertinent to spirituality of children with cancer and to identify practical strategies for providing care for this dimension in children. DATA SOURCES: Nursing research and literature about pediatric nursing care and spirituality; theoretical formulations of Piaget, Fowler, and Erikson. CONCLUSION: Children diagnosed with cancer have unique spiritual needs that place them at risk for developing spiritual distress. With the diagnosis may come experiences of loss of normalcy, physical stamina, relationships, body image, and future goals. Spiritual care includes interventions that assist children to find meaning and purpose in life, to continue relationships, and to transcend beyond the self. IMPLICATIONS FOR NURSING PRACTICE: Spiritual care includes caregiver and child assessment and interventions appropriate to the developmental stages of infancy through adolescents. Tables outlining how this can be done by oncology nurses are included.

Adolescent↗

PubMed1980

Cardiopulmonary parameters during high PEEP in children.

There are a few reports of the application of high PEEP (PEEP greater than or equal to 15 cm H2O) infants and children. Data concerning cardiac index (CI), pulmonary venous admixture (Qsp/Qt), and arterial mixed venous oxygen content difference (avDO2) during mechanical ventilation with high PEEP have not been reported. Fourteen infants and children were treated with high levels of PEEP; 8 of these patients were monitored with pulmonary artery catheters. Cardiopulmonary data were obtained from these 8 patients and pulmonary barotrauma data were tabulated from all 14 patients. At highest PEEP, CI = 3.6 +/- 0.6 L/min x M2, avDO2 = 4,45 +/- 0.83 ml/dl and Qsp/Qt = 16.7 +/- 2.1%. One patient experienced severe cardiac depression unresponsive to therapy; it resolved when PEEP was lowered. Pulmonary barotrauma was a frequent complication. Pneumothroax occurred in 6 patients. No patient died from pulmonary barotrauma. We conclude that PEEP greater than or equal to 15 cm H2O can be used in infants and children to decrease Qsp/Qt toward normal; CI and avDO2 can usually be maintained in an acceptable range. Patients should be frequently monitored for pulmonary barotrauma.

Adolescent↗

PubMed2005

Pediatric gastrointestinal diseases: are drugs the answer?

Owing to the lack of large randomized controlled studies, which would produce level 1 evidence, to guide management of gastrointestinal disorders in children, data are often extrapolated from adult studies to aid in treatment strategies. However, there are unique aspects to the management of children and adolescents with these chronic diseases, including issues of growth, side effects, long-term outcomes and psychosocial factors that might not be considered in adult trials. There is a major need for increased research in this population. In the future, a better understanding of the pathophysiologic mechanisms of these diseases should guide the development of rational novel therapies with better safety profiles for children with gastrointestinal disorders.

Adrenal Cortex Hormones↗