OBJECTIVES: To find out the etiology and outcome in terms of clinical improvement among children having esophageal stricture (ES). METHODS: This prospective study was conducted from July 2019 to ...March 2020 at Children’s Hospital, Multan, Pakistan on diagnosed patients of ES, ageing <15 years. Demographic details, different etiologies, location of the ES and treatment outcome were recorded. After initial management, endoscopy and dilatation was done at 6 weeks. Patients were followed-up for at least 12 weeks. RESULTS: Out of 32 children with ES, 19 (59.4%) were males. Mean age of children was 36.58±19.6 months. Twenty-four (75%) patients had proximal and 8 (25%) had distal stricture. Chemical burn (n=23; 71.9%) and esophageal atresia (n=4: 12.5%) were commonest causes of ES. Dilatation and surgery were performed in 21 (65.6%) cases followed by dilatation only in 10 (31.3%) cases and surgery alone in one (3.1%) case. In patients with chemical burns, majority (n=16/23; 69.6%) required both dilatation and surgery. Overall outcome of treatment options was good in 62.5% (n=20/32) patients. Outcome was good in 61.9% (n=13/21) of patients requiring both dilatation and surgery and 70% (n=7/10) in patients having dilatation alone (p=0.385). Outcome was good in 69.6% (n=16/23) of patients with chemical burns and 70% (n=7/10) in patients with dilatation only (p=0.385). Mortality rate was 3.1% (n=1). CONCLUSION: Chemical burn and esophageal atresia were the commonest causes of ES. Outcome of all procedures was good in 62.5% cases and had no significant relationship with causes and site of ES or types of treatment.
The Bruce treadmill protocol is an often-used exercise test for children and adults. Few and mainly old normative data are available for young children. In this cross-sectional observational study we ...determined new reference values for the original Bruce protocol in children aged 4 and 5 years. Furthermore, we compared the original protocol with the so-called ‘half Bruce’ protocol. In the Netherlands this half-Bruce protocol is often used for young children because of the rather large increments in workload in the original protocol. Seventy-eight healthy Dutch children participated. The maximal endurance time was the criterion of exercise capacity. The new reference values for the original Bruce protocol are presented as reference centiles. The mean (SD) endurance time using the original protocol was 10.2 (SD 1.5) min.; this was 9.4 (1.3) min. for the half-Bruce protocol. The mean difference was 50 seconds (95% CI: 29–71 s,
P
< 0.001). So, for children aged 4 and 5 years the endurance times obtained with the original and half-Bruce protocol are different and should not be considered interchangeable. Our new reference values can be used as reference values for the original Bruce protocol.
Airway inflammation is an early feature of asthma. Early detection and anti-inflammatory treatment may have important therapeutic impact. Exhaled nitric oxide is a noninvasive marker of airway ...inflammation. The current study investigated the association between exhaled nitric oxide and asthma, wheezing phenotypes, atopy and blood eosinophilia in a large group of 4-yr-old children from the general population. All children participated in the Prevention and Incidence of Asthma and Mite Allergy study, a birth cohort study of high-risk (atopic mother) and low-risk children in the Netherlands. Nitric oxide levels were successfully determined in 429 children. Although there was overlap in the distribution of values of children with and without asthma or atopy, mean values were higher in children with atopy or doctor's diagnosed asthma (geometric mean (ppb) 9.4 and 10.0, respectively) as compared to those without (7.7 and 7.9). Values were highest in atopic symptomatic children. Values were not associated with wheezing phenotype or blood eosinophilia. This study is one of the few large-scale epidemiological studies among 4-yr-old children from the general population showing that children with symptoms of asthma and atopy have higher levels of exhaled nitric oxide than those without.
Aim: To report findings about the Motor Performance Checklist (MPC) for 5‐year‐olds, a simple 12‐item instrument for assessing gross and fine motor skills, in a research study of neurodevelopmental ...outcomes after neonatal events.
Methods: We trained 10 examiners to use the MPC in a study of the outcomes of neonatal jaundice and dehydration in 339 5‐year‐old children. We compared MPC scores with those on the Wechsler Preschool and Primary Scale of Intelligence‐Revised (WPPSI‐R), the Beery–Buktenica Developmental Test of Visual‐Motor Integration‐Fourth Edition (VMI‐4), and a standard neurological examination, and compared failure rates on each MPC item across examiners. Parent concerns about their child’s development were addressed using the Parent Evaluation of Developmental Status (PEDS).
Results: Children who ‘failed’ the MPC had 7–10 points lower mean scores on the WPPSI‐R subscales (P = 0.001), 9–10 points lower mean scores on the VMI‐4 subscales (P = 0.001), and were almost twice as likely to have a ‘questionable’ neurological examination score (adjusted OR 1.86, 95% CI 1.00–3.53, P = 0.005). On the PEDS, only the concern about the use of arms and hands was significantly associated with MPC failure. We found significant sex differences on four of the 12 MPC items. We also found differences in failure rates by different examiners.
Conclusions: MPC scores correlated with other measures of neurodevelopment. Because of different failure rates across examiners, examiner terms need to be included if it is used in research studies.
Aim: This study aimed to determine which factors could influence (i) parents’ decision to seek medical consultatin and (ii) their preference for either public or private medical service in children ...with upper respiratory tract infection.
Methods: This cross‐sectional study was conducted at the Gombak district, which is an urban area in Malaysia. We randomly selected parents of kindergarten children aged 4–5 years to participate in this questionnaire survey. The main outcome measures were predictors of early medical consultation and type of service utilisation (public versus private).
Results: We achieved a response rate of 84.5% (n = 1033/1223). 64.1% sought early medical consultation and 70.9% preferred to consult a private doctor. Early consultation was predicated by the parent gender being male (OR 1.50; 95% CI 1.09, 2.05), non‐Chinese (OR 1.75%; 95% CI 1.10, 2.79), and those who preferred child specialists (OR 2.02; 95% CI 1.27, 3.23). Lower income group (OR 4.28; 95% CI 2.30, 7.95) and not having a regular doctor (OR 4.99%; 95% CI 3.19, 7.80) were predictors of using the public health services.
Conclusions: Parent's gender, ethnicity and income influenced their decision to seek early medical consultation for their children's respiratory illness while income and having a regular doctor could predict their choice of healthcare services.
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.
Every pre‐school child requires an adult to purchase and provide a variety of foods, to help ensure a balanced selection is included in the diet to avoid any nutritional deficiencies. Children under ...5 years have a greater demand for nutrients and energy to support the body's requirements for growth and development than at any other time throughout their life cycle. The paper critically reviews the main factors that influence food choices made by parents on behalf of their pre‐school child. Dietary deficiencies in inner city areas remain a challenge for the government, educators and health professionals. A particular concern is iron deficiency as the prevalence of anaemia is common especially in British pre‐school children from various family backgrounds. Poor parenting skills often exacerbate the problem, especially the early introduction of pasteurized cow's milk, poor weaning practices and lack of dietary knowledge. Therefore, improving education and understanding about the importance of iron could potentially improve dietary iron intake. Phase 1 of the study was completed in West Bridgford area of Nottingham in the UK. This part of the study aimed to determine parental knowledge with regards to the feeding of their pre‐school child. A questionnaire and a 3‐day diet history method were employed. These methods enabled the diet adequacy of the pre‐schoolers to be analysed by NetWISP software. This study highlighted that iron deficiency remains a cause for concern and should be further addressed. The Sure Start programme is a possible means of education as it has the potential to access parents from all socio‐economic classes. The programme can support and empower parents to become healthier consumers. Good dietary habits, established early in life, contributes to a positive start, and can be advantageous to individuals throughout their lifetime. Such long‐term changes will help contribute to a healthier nation that the government envisages for the future.
Synthesizing insights from psychology and philosophy with his own wide-ranging, experiences around the world, Dr. James Garbarino takes readers on a personalized journey into the dark side of human ...experience as it is lived by children.
PDF
