Management of a Child with Reactive Attachment Disorder in the Dental Clinical Setting: A Case Report / Manejo de un niño con trastorno de apego reactivo en el entorno clínico dental: Reporte de un caso

ABSTRACT Reactive attachment disorder (RAD) is an early childhood mental health disease characterized by impaired social interactions and communication abilities, and neurological deficits in the child's developing brain. This disorder can significantly affect the pediatric patient's behavior in the dental setting. An uncooperative 9-year- old Mexican girl, who was residing in a temporary home, was referred by a general dental practitioner to the Postgraduate Pediatric Dental Clinic with her caretaker, requesting dental examination and treatment. The patient presented with a previous diagnosis of RAD with intellectual/social disability. With the psychiatrist's guidance, an exhaustive oral prophylaxis was carried out in the initial appointments, followed by diverse restorative treatments under the continuous application of behavioral management techniques. These restorative procedures included resin restorations and pit-fissure sealants, under local anesthesia and rubber-dam isolation, on the first four permanent molars. The entire treatment was completed in six weeks. The patient and her caretaker were provided with detailed educational and motivational strategies for improving the patient´s oral hygiene, and they also received nutritional advice. For control reviews and the reinforcement of preventive habits, future appointments were carefully scheduled. An interdisciplinary pediatric collaboration between the dentist, nurse, and psychiatrist was fundamental for improving the patient's oral health and general welfare.

RESUMEN: El trastorno de apego reactivo (RAD, por sus siglas en inglés) es una enfermedad de salud mental en la primera infancia caracterizada por interacciones sociales y capacidades de comunicación deterioradas y por déficits neurológicos en el cerebro en desarrollo del niño. Este trastorno puede afectar significativamente el comportamiento del paciente pediátrico en el entorno dental. Una niña mexicana de 9 años de edad, poco cooperadora, que residía en un hogar temporal, fue remitida a la Clínica de Odontología Pediátrica con su cuidadora, solicitando un examen y tratamiento dental. La paciente presentó un diagnóstico previo de RAD con discapacidad intelectual/ social. Con la orientación del Psiquiatra, se llevó a cabo una profilaxis oral exhaustiva en las citas iniciales, seguidas de diversos tratamientos de restauración bajo la aplicación continua de técnicas de manejo del comportamiento. Estos procedimientos de restauración incluyeron restauraciones de resina y selladores de fosas y fisuras, bajo anestesia local y aislamiento con dique de goma, en los primeros cuatro molares permanentes. Todo el tratamiento se completó en seis semanas. La paciente y su cuidadora recibieron estrategias educativas y motivacionales detalladas para mejorar la higiene oral y también recibieron asesoría nutricional. Para las revisiones de control y refuerzo de los hábitos preventivos, las citas posteriores se programaron cuidadosamente. Una colaboración pediátrica interdisciplinaria entre el dentista, la enfermera y el psiquiatra fue fundamental para mejorar la salud oral y el bienestar general del paciente.

Behavioural problems among schoolchildren in Nigeria

Background: Behavioural problems among schoolchildren can pose a burden on families and society. Objective: To determine the prevalence and pattern of behavioural problems among children living in Uyo, a town in South-South Nigeria. Methods: A cross-sectional study was carried out among 572 pupils from six primary schools selected randomly from private and government schools in Uyo. Pupils with a normal IQ were selected using a systematic sampling method. The Rutter behavioural scale for teachers (B2) was completed by their teachers, and that for parents (A2) was completed by the parents. Student's t-test was used to compare pairs of means, frequencies were compared using the chi-square test, and p<0.05 was taken as significant. Results: According to the teachers' scale 132 pupils (23.1%) had scores within the range indicating behavioural problems, compared with 103 pupils (18.0%) on the parents' scale. This was statistically significant (χ2=19.8, p=0.001). Pupils in government and private schools had mean scores of 7.4 (standard deviation (SD) 6.41) and 5.12 (SD 6.26) and 7.29 (SD 5.84) and 6.96 (SD 5.76), respectively. Behavioural problems were more common among children in government schools and among those in the lower socio-economic class. Boys had significantly higher mean scores than girls, and both scales showed more boys to be disturbed. Antisocial behaviour was commonest among boys and older children. Conclusion: There is a high prevalence of behavioural problems among primary school children in Uyo, with a predominance of antisocial behaviour. The government needs o provide appropriate services to deal with this state of affairs

Abuso sexual na infância e adolescência / Sexual abuse of children and adolescents

O abuso sexual na infância é definido com a situação em que a criança ou o adolescente é usado para satisfação sexual de um adulto ou adolescente mais velho, sendo a violência sempre presumida em menores de 14 anos. É um fenômeno universal que atinge todas as idades, classes sociais, etnias, religiões e culturas e pode ser considerado como qualquer ato ou conduta baseado no gênero, que cause dano ou sofrimento psíquico e sexual à vítima. No Brasil, a violência contra crianças e adolescentes é a primeira causa de morte na faixa etária de cinco a 19 anos e a segunda no período de um a quatro anos. Médicos pediatras e ginecologistas devem ser alertados e capacitados para lidar com questões ligadas ao abuso, tornando-se aptos a atuarem de maneira adequada. A questão do abuso sexual, por ter uma complexidade de fatores envolvidos, não pode ser explicada de forma reducionista ou determinista, devendo assim, ser valorizada a presença de uma equipe interdisciplinar no atendimento a esses pacientes. Neste estudo foi realizada uma revisão bibliográfica sobre o abuso sexual e suas repercussões.

Sexual abuse of children is defined as a situation in which a child or an adolescent is used for the sexual satisfaction of an adult or older adolescent with violence always being presumed for children younger than 14 years. This is a universal phenomenon that involves all ages, social classes, ethnic groups, religions and cultures and that can be considered as any act or conduct based on gender that will cause damage or psychic and sexual suffering to the victim. In Brazil, violence against children and adolescents is the first cause of death in the age range from five to nineteen years and the second in the age range from one to four years. Pediatricians and gynecologists should be alerted and prepared to deal with questions related to abuse, so that they may be qualified to act in adequate manner. Because of the complexity of the factors involved, the question of sexual abuse cannot be explained in a reductionist or deterministic manner. Thus, emphasis should be placed on the presence of an interdisciplinary team to take care of these patients. A review of the literature on sexual abuse and its repercussions was performed in the present study.

Street children in Alexandria: profile and psychological disorders

Today developed and developing countries are facing the problem posed by street children. The continuous and unrestrained exposure to the street and its associated lifestyles makes these children vulnerable to a range of health, social, and other problems. The aim of the present work was to assess the profile of street children and their living condition from different aspects, in addition to assessment of some psychological disorders among them. A cross-sectional study was conducted on 50 street boys present at El-Horreya institute for Children Community Development, which is a non-governmental organization in Alexandria. An equal control group of 50 school boys were selected at random from the first and second grades of one governmental boys preparatory school of the Middle District of Alexandria. Every child was subjected to an interviewing questionnaire. The Arabic version of Revised Ontario Child Health study scale, children Depression Inventory and the Cooper-Smith Self-Esteem Inventory, were used to identify children with conduct disorder, depression, and assess self-esteem, respectively. Anthropometric measurements including weight and height were measured for each street child and BMI was calculated. The present study revealed that more than half of street children [58.0%] came from large size families, about three-quarters [72.0%] reported insufficient income, most of them had low educated parents and unskilled fathers, 80.0% reported not living with both parents before coming to the institute, and 91.2% reported bad inter-parental relationship. Family history of drug abuse, alcohol intake, smoking, and imprison were significantly higher among street children compared to school children [p<0.001]. The present study showed that 74.0% of street children were smokers, 22.0% reported drug abuse, and 90.0% were dropped out of school. Family violence, beating, and beating without reason significantly increase the risk of being a street child [OR= 31.90, 2.0, and 44.58, respectively]. The risk of conduct disorder, depression, and low-self esteem were significantly more among street children compared to school children [OR= 44.59, 14.64, and 9.66, respectively]. The main cause of leaving home was beating, 80.0% lived in street after leaving home, 72.0% their main source of living was begging, and most of them faced problems in the street especially with the police. The results revealed that 92.0% were satisfied with the institute and 86.0% prefer to stay in the institute than returning to the street. Planning programs to prevent, protect, and rehabilitate street children are essential

Síndrome de la niña y el niño sacudidos: hallazgos anatomoclínicos / Shaken baby syndrome: anatomoclinic features

El síndrome del niño sacudido es una de las formas más severas de maltrato infantil que ocurre principalmente en niños menores de un año. Por la vulnerabilidad de las víctimas y por las secuelas que puede producir, incluyendo la muerte, es necesario, en el abordaje clínico, tener presente la sospecha diagnóstica ante lesiones de explicación insatisfactoria por parte de los encargados del menor. Asimismo si se trata de un abordaje médico legal deben tenerse las consideraciones necesarias para documentar las lesiones, tanto en el paciente vivo, como en los casos de homicidio, para colaborar con la administración de justicia. Para ello se debe tratar de implementar una metodología homogénea para la realización de dichas pericias, tanto en la parte clínica como patológico forense. En este artículo se describe la forma habitual de presentación clínica del síndrome del niño sacudido y se expone una guía básica para la realización de autopsias medico legales en casos de muertes por esta causa.

The shaken baby syndrome is one of the most severe presentations of child abuse that is seen in children especially under the first year of age. The great vulnerability of this group of patients and the serious consequences that they may encounter in the future, including death, are enough reason to inquire, during the clinical approach, about the possibility that the patient being attended may be a victim of physical abuse. From a medico-legal evaluation, it is pertinent to document and describe thoroughly the physical lesions in the living patient and in cases of homicide, in order to contribute scientifically in the administration of justice. For that reason it is essential to follow a uniform methodology in the management of both the clinical and the forensic assessment. This article reviews the usual clinical presentation of the shaken baby syndrome and proposes a basic guide to evaluate the autopsies in cases of deaths originated by this cause.

A síndrome da criança com o membro superior imobilizado para infusão venosa: uma contribuição da semiologia para o cuidado de Enfermagem / The child with an upper limb immobilized for intravenous infusion syndrome (a contribution form semiology for nursing care)

Estudo de natureza quanti-qualitativa que descreve a "síndrome da criança com o membro superior imobilizado par infusão venosa", fundamentada na incidência de sinais indicativos dos sentimentos de ansiedade, dor, medo e tristeza, observados em 123 crianças de 11 hospitais públicos e registrados num instrumento de observação, e que, além disto, conceitua as "síndromes da assistência de Enfermagem", termos que foram cunhados pela autora. Conclui-se que o comportamento do profissional de Enfermagem na técnica em apreço necessita ser revisto para evitar a referida síndrome, e com esta finalidade medidas profiláticas são sugeridas

Consultoria psiquiátrica infantil no Hospital São Lucas-PUCRS: perfil dos pacientes (1993-1997) / Child psychiatry consultation at HSL-PUCRS: patientïs profile (1993-1997)

O presente trabalho estuda 100 casos de consultoria em psiquiatria infantil no HSL-PUCRS, avaliando, além de variáveis sócio-demográficas, diagnósticos clínicos mais prevalentes nos casos em que foi solicitada consultoria e participação predominante das especialidades médicas...

La niñez: construyendo identidad / Childhood: building identity

Analiza, estudia y reflexiona sobre el hombre, la niñez, continuación a la primera infancia, etapa en la que el hombre aprende a interactuar socialmente y la escuela le va definiendo el mundo, los valores determinan sus inclinaciones personales y las normas se introyectan tratando de equilibrar las ansias de expansión y la sensatez de los límites. Estructurada en ocho partes: la salud en la niñez, desarrollo psicológico, desarrollo del arte, aspectos pedagógicos y psicopedagógicos del niño normal, la educación especial, aspectos psicopalógicos y psicoterapéuticos, problemática social y contextualidad en la niñez

effects of child labour on the attitude of children

This research has been conducted to study the effects of child labour on the attitudes and adjustment of children up to the age of 15 years. The total number of respondents was 120 [60 working and 60 non-working], belonged to different areas of Multan city. Rotter Incomplete Sentences Blank alongwith a demographic information questionnaire was administered to both groups to see their adjustment and attitude. For the analysis of data z-test and chi-square were applied. It was revealed that working children were maladjusted, had negative attitude toward themselves, others home and future as compared to non-working children