bluuebunny/crossref_metadata_2025_split huggingface dataset:
Children's response to vaccine fluid injection versus needle puncture pain during routine immunization
Authors: Goodenough Belinda , Perrott David A , Dongen Katinka van , Brouwer Nanda , Champion G David 
Published: March 2003

ABSTRACTObjective To determine whether there is a significant and observable behavioural reaction in young children to the entry of vaccine fluid that is separate from the pain of needle puncture.Setting/sample Twenty‐four children, aged 4–6 years, undergoing routine outpatient immunization by intramuscular injection in an Australian paediatric teaching hospital.Measurement Facial, motor, vocal and verbal reactions, as well as global pain responses were coded by two independent observers as the needle entered the child's arm, and as the vaccine was injected from the syringe. Children and parents used the Faces Pain Scale to give a global rating of needle pain.Results A distinctive behavioural reaction to the vaccine injection phase of immunization was observed. While children's own needle pain ratings tended to be more extreme than those of their parents, the variance in children's global scores was best predicted by an independent observer's ratings of motor behaviour to needle puncture and vocal response to vaccine injection.Conclusions/implications for practice A significant pain‐related behavioural reaction may be observed in relation to the vaccine injection component of routine immunization. Preparation of children for routine immunization should not focus merely on pain due to needle puncture, but also on potential sensations associated with vaccine injection.
Parental and professional perceptions of the levels of disability in children with Down's syndrome
Authors: Bhattacharya Mukta , Sidebotham Peter 
Published: March 2003

ABSTRACTObjectives, subjects and methods A study was undertaken to determine whether parents of children with Down's syndrome view their child's levels of disability differently from their medical assessments. Questionnaires, based on a standard medical assessment were sent to the parents of 72 children with Down's syndrome aged 0–18 years. Data on the children's most recent medical assessment were obtained from the special needs module of the child health computer.Results From the 47 returned questionnaires, there were no significant differences in parental and professional assessments of the children's mobility, hand function or hearing. Parents rated their child's vision, behaviour, health and growth, and personal care as significantly more impaired than did the doctors, but rated their speech and language as less impaired.Conclusions This study suggests that there are some differences between parental and professional assessments of disability levels in children with Down's syndrome and that medical assessments could take a more family‐orientated approach.
Can a social service register of children with disabilities be used for planning services?
Authors: Colver Allan F , Atkinson Eve , Short David 
Published: March 2003

ABSTRACTObjective To compare a health and a social service register of children with disability in order to assess their potential for planning services.Design Descriptive.Setting Children with disability resident in North Tyneside, a Local Government Authority in England.Main variables studied Disability and its severity.Results There were 1692 children on the health register and 83 on the social service register. Only 20% of the children with the most severe disability were on the social service register. There was good agreement between parents' and paediatricians' rating of severity for the children with the most severe disability. Although the health register had details of all children with disability, it did not record details of current needs.Conclusions The social service register did not provide data about all children with disability, and in particular only listed 20% of the children with the most severe disability. Therefore, the social service register does not appear suitable for providing data for overall planning of services, although it is helpful in describing and co‐ordinating the care of a smaller number of children and families whose problems were active, complex and unresolved, and where social services had an active role.
A 2.5‐year follow‐up of infants treated for severe sleep problems
Authors: Thunström Malena 
Published: March 2003

ABSTRACTObjective Sleep problems are common during infancy, and treatment programmes based on behavioural techniques have been reported to have high rates of short‐term improvement (80–90%) when used with support from a therapist.However, follow‐up periods longer than 3 months are rare. The aim of this study was to describe the changes in sleep of 24 sleep‐disturbed infants after an interventional sleep programme. Comparisons with a healthy control group were made for a follow‐up period of 2.5 years.Settings The case group was recruited from a parental questionnaire population study and sample of 2518 children aged between 6 and 18 months. The response rate was 83%. The group consisted of those 6–12‐month‐old children who fulfilled specific criteria for severe and chronic sleep problems (n = 27). A healthy control group was matched with regard to age and sex.Methods The parents of the case group were offered a sleep programme based on the premise of controlled crying, and 24 families chose to participate. In addition to the behavioural technique, an interdisciplinary approach was used, taking the whole family situation into consideration. Sleep diaries and questionnaires were sent to cases and controls for follow‐ups at 1 month, 1 year and 2.5 years, respectively, after admission.Results One month after initiation of the treatment programme in the case group, significant changes had taken place. The average number of times the case babieswoke up had diminished from 6.0 to 1.8 times per night, and night‐time sleep hadincreased, on average by 67 minutes. A 92% rate of improvement was reported.The changes were stable over time. Comparisons with the healthy controls after 1 year and after 2.5 years revealed no significant group differences in sleep characteristics. The families in the case group managed to maintain the achieved changes in infant sleep behaviour on their own; continuous therapist support was not necessary. This was true even for formerly depressed and psychosocially burdened parents.Conclusions A combination of behavioural technique and interdisciplinary family work has positive and long‐lasting effects in children with severe and chronic sleep problems.Implication for practice Even severely sleep‐disturbed infants coming from families with depression and psychosocial problems can be helped to sleep well with a relatively short but intense and multidisciplinary sleep programme.
Training residents in pediatric literacy: impact on knowledge, attitudes and practice
Authors: Hazzard Ann , Dabrow Sharon , Celano Marianne , McFadden‐Garden Terri , Melhado Trisha 
Published: March 2003

ABSTRACTObjective To determine whether training in emergent literacy‐building techniques increases self‐reported literacy‐related knowledge, attitudes, and intervention with patients.Design Quasi‐experimental; prepost with intervention and comparison groups.Subjects/setting Pediatric resident continuity clinics in three urban locations, serving primarily low‐income patients. A total of 66 residents participated.Intervention Residents in the intervention group (n = 48) were scheduled to receive a half‐hour training session as part of their clinic didactic series. In addition, some intervention residents were exposed to other literacy‐related training such as Grand Rounds, readings, and individual modelling by a supervising physician related to specific clinic families. Residents in the comparison group (n = 18) received no literacy training.Measurement A demographic questionnaire was administered at pretesting. The Knowledge About Literacy Development and Attitudes Regarding Early Childhood Literacy Scales were administered prior to training and 6 months later. The Practice Activities questionnaire was administered at post‐testing only.Results Relative to 18 comparison subjects, 48 residents in the intervention group exhibited trends toward more frequent assessment of literacy milestones and more frequent literacy‐related anticipatory guidance. Specifically, the observation of modelling by a supervising physician was significantly related to an increased frequency of literacy‐related assessment and anticipatory guidance and to a trend toward more positive attitudes. Intervention and comparison residents did not significantly differ overall in knowledge or attitude gains. However, literacy‐facilitative attitudes were significantly correlated with frequency of literacy‐related anticipatory guidance.Conclusions/implications for practice Residents had fairly high initial levels of general literacy‐related knowledgeand positive attitudes about providing guidance in this area to parents.Exposure to specific training in this area does appear to lead to an increased likelihood of addressing these issues in practice. Modeling by a supervising physician may be a particularly important component of training that can help residents learn how to integrate literacy assessment with overall developmental assessment and family guidance.
Social gradients in child health: why do they occur and what can paediatricians do about them?
Authors: Spencer Nick 
Published: March 2003

ABSTRACTObjective To consider the impact of gradients in social risk factors on birthweight, child mental health and behavioural problems within a framework to guide paediatricians contributions to the prevention of adverse outcomes.Methods Review of fifty studies on the impact of varying levels of social risk.Results Many adverse child health outcomes show a finely graded pattern of risk from the least to the most disadvantaged children. Reduced mean birthweight and impaired child mental health are two important examples with implications for the life course. The cumulative and additive effects of risk and protective factors are the most likely explanation for social gradients.Conclusions/implications for practice Interventions aimed at modifying single risk factors are likely to have limited influence on social gradients. Health and social policies addressing underlying material and social inequalities are likely to have the greatest potential for modifying risk. Paediatricians have a role in advocacy and in ensuring equality of access to their services.
Childhood immunization in rural family and general practices: current practices, perceived barriers and strategies for improvement
Authors: Deutchman Mark , Brayden Robert , Siegel Carol D , Beaty Brenda , Crane Lori 
Published: March 2003

ABSTRACTObjective Immunizations are an important component of well child care, yet children around the world are commonly not fully immunized. The goal of this research was to assess current immunization practices, perceived barriers to immunization, and identify strategies that might improve immunization rates.Design setting and measurement Rural family and general practitioners in the 52 nonmetropolitan statistical area counties of Colorado who might include the care of children in their practice were surveyed regarding their immunization practices. Responses were used to identify ways in which these physicians comply with published standards for immunization practices and the barriers they perceived to immunization.Results Nearly all rural Colorado family and general practitioners provide services to children, and most currently provide immunizations. The majority send at least some of their patients to other sources of care for immunizations. Common deficiencies in immunization practices and patient barriers are similar to those encountered internationally. These include not immunizing at sick visits, not providing for ‘walk‐in’ immunizations, not making immunization available during evenings and weekends, failing to perform immunization screening at every visit and having no formal reminder or tracking systems. Patient barriers include cost, parental attitudes, language barriers, transportation and patient mobility. Provider barriers are lack of availability of immunization records (immunization tracking), low reimbursement rates, problems with keeping small volumes of vaccines, record‐keeping problems and their own failure to counsel parents about the importance of immunization, to immunize at sick visits and to screen for immunization status at all visits.Implications for practice Rural family physicians and general practitioners are well positioned to have a positive impact on childhood immunization rates, as they provide the majority of care to rural children. Better adherence to standards for immunization practice should help improve immunization rates. Problems related to reimbursement and immunization tracking are likely to remain.
Is preschool child health surveillance an effective means of detecting key physical abnormalities?
Authors: Bhrolchain Cliona Ni 
Published: March 2003

Method This was a prospective study of a 1‐year cohort of children born to mothers registered with 25% of general practices in Nottingham. A cohort of 2308 babies was followed up for 15–18 months. All referrals for five tracer physical conditions (undescended testes, congenital heart disease, squints, developmental dysplasia of the hip and congenital hearing loss) were followed up through hospital record systems and copies of child health surveillance reviews from the personal child health records. Results One thousand, nine hundred and seventy‐two (85%) of the initial cohort were followed up. Four hundred and thirteen (21%) children had been referred for one of the tracer conditions and 91% had been referred directly from child health surveillance reviews. Only 49 (12%) children needed treatment or follow‐up after assessment. The sensitivity of screening was high, ranging from 72% for congenital heart disease to 100% for developmental dysplasia of the hip and hearing loss. However, false positive rates were also very high, ranging from 60% for undescended testes to 97% for developmental dysplasia of the hip and hearing loss. Thus the positive predictive value of referral for dysplasia of the hip or hearing loss was only 5%, with a negative predictive value of 100%. In contrast, the positive predictive value for undescended testes was 67%, with a false negative rate of 14%. Eighty‐four per cent of those who needed treatment or follow‐up after assessment had been referred from the child health surveillance programme. The largest proportion of abnormalities was identified from the 6‐week review, but most referrals came from the neonatal review and the health visitor distraction test. Conclusion The majority of children with the five tracer conditions used in this study were identified during child health surveillance examinations.
Doctor–patient relationships in primary care: Doctor, help! My child has cancer.
Authors: Proops Rosalyn 
Published: March 2003

The following extracts are first, from an article by the mother of a child who had died of neuorblastoma. In it, she argued that her general practitioner, although generally supportive, should have taken more of the initiative in offering help during her child’s illness. Second, are extracts from her general practitioner’s response. The parent A call for help may be an obvious one, from parents trying to come to terms with their child having cancer, or a hidden plea from parents outwardly coping with the demands thrust upon them, but who are inwardly desperately struggling. Are both these calls for help recognized and responded to by their family doctor? Our family doctor, contrary to my expectations, did not maintain contact with us during our son’s illness until the final stages. We were surprised and hurt by his attitude and mistakenly took his lack of contact as a lack of interest. Regular contact with us should have been an integral part of his role as our family doctor. Poor communication is the root of many problems – communication between treatment centre and general practitioner; between local hospitals and general practitioner; and between general practitioner and family. The doctor At the base of these (contradictory thoughts and emotions) is the unique and multilayered relationship between general practitioner and patient, whether an individual or a family. We are still a long way from a satisfactory team approach to serious and terminal childhood illnesses . . .
Advising parents of asthmatic children on passive smoking: randomised controlled trial.
Authors: Reading Richard 
Published: March 2003

Objective A randomised controlled trial to investigate whether parents of asthmatic children would stop smoking or alter their smoking habits to protect their children from environmental tobacco smoke. Participants 501 families with an asthmatic child aged 2–12 years living with a parent who smoked. Intervention Parents were told about the impact of passive smoking on asthma and advised to stop or change their smoking habits to protect their child’s health. Main outcome measures Salivary cotinine concentrations in children, and changes in reported smoking habits of the parents 1 year after the intervention. Results One year after the baseline visit, a small decrease in salivary cotinine concentrations was found in both groups of children, but there was no significant difference between the groups. Overall, 98% of parents in both groups still smoked at follow‐up. However, there was a nonsignificant tendency for parents in the intervention group to report smoking more at follow‐up and to having a reduced desire to stop smoking. Conclusions A brief intervention to advise parents of asthmatic children about the risks from passive smoking was ineffective in reducing their children’s exposure to environmental tobacco smoke. If a clinician believes that a child’s health is being affected by parental smoking, the parent’s smoking needs to be addressed as a separate issue from the child’s health.
Oral versus initial intravenous therapy for urinary tract infections in young febrile children.
Authors: Jacobson Robert M 
Published: March 2003

Background The standard recommendation for treatment of young, febrile children with urinary tract infection has been hospitalization for intravenous antimicrobials. The availability of potent, oral, third‐generation cephalosporins, as well as interest in cost containment and avoidance of nosocomial risks prompted evaluation of the safety and efficacy of outpatient therapy. Methods In a multicentre, randomized clinical trial, the investigators evaluated the efficacy of oral versus initial intravenous therapy in 306 children 1 to 24 months old with fever and urinary tract infection, in terms of short‐term clinical outcomes (sterilization of the urine and defervescence) and long‐term morbidity (incidence of reinfection and incidence and extent of renal scarring documented at 6 months by 99mTc‐dimercaptosuccinic acid renal scans). Children received either oral cefixime for 14 days (double dose on day 1) or initial intravenous cefotaxime for 3 days followed by oral cefixime for 11 days. Costs were estimated using charge‐data. Results Treatment groups were comparable regarding demographic, clinical, and laboratory characteristics. Of the short‐term outcomes: (1) repeat urine cultures were sterile within 24 h in all 306 children, and (2) mean time to defervescence was 25 and 24 h for children treated orally and intravenously, respectively. Of the long‐term outcomes: (1) symptomatic re‐infections occurred in 4.6% of children treated orally and 7.2% of children treated intravenously; (2) renal scarring at 6 months was noted in 9.8% of children treated orally versus 7.2% of children treated intravenously; and (3) mean extent of scarring was ~8% in both treatment groups. Mean costs were at least twofold higher for children treated intravenously ($3577 versus $1473) compared with those treated orally. Conclusions Oral cefixime can be recommended as a safe and effective treatment for children with fever and urinary tract infection. Use of cefixime will result in substantial reductions of health care expenditures.
Autistic disorders in children with CHARGE association.
Authors: Stalker Deborah 
Published: March 2003

CHARGE association (Coloboma, Heart defect, choanal Atresia, Retarded growth and development, Genital hypoplasia and Ear abnormalities) is thought to arise following an insult during early embryogenesis, probably around day 20–24. The pathogenesis of autism is not fully understood, but abnormalities in brain metabolism have been detected in the brainstem, cerebellum and mesolimbic system. The association with learning difficulties is well known.The authors report the cases of three children with characteristic features of CHARGE association. Two of the children described had severe bilateral hearing loss and were assessed as having severe retardation; neither had any speech. The third had mild hearing impairment, an IQ of 80 and some verbal and sign language. All three fulfilled the criteria for autistic disorder (Diagnostic and Statistical Manual of Mental Disorders IV).
Stress experienced by mothers of Malaysian children with mental retardation.
Authors: Coghlan David 
Published: March 2003

Objective To compare parenting stress among Malaysian mothers of children with mental retardation and a control group, and to determine factors associated with stress. Method Seventy‐five mothers of children with mental retardation aged 4 to 12 years and 75 controls (paediatric clinic attenders without disabilities) participated in the Parenting Stress Index (PSI). Intelligence quotient (IQ) and Child Behaviour Checklist (CBCL) scores, together with socio‐economic data, were entered into a multiple stepwise regression analysis, using the PSI as the criterion. Results Mothers of children with mental retardation scored significantly higher than control subjects in both the child‐related domain (difference between means 26.1) and parent‐related domain (difference between means 15.0) of the PSI. The total child behaviour scores from the CBCL (p < 0.01), IQ scores (p < 0.01) and sibship size (p < 0.01) were associated with child‐related domain scores. For the patient‐related domain, CBCL (p < 0.01) and IQ scores (p = 0.01) remained important factors, but Chinese ethnicity (p < 0.01) and maternal unemployment (p < 0.01) were also significant predictors of stress. Conclusion A large proportion of mothers of children with mental retardation experienced substantial parenting stress, especially Chinese and unemployed mothers, and this warrants appropriate intervention.