ABSTRACT
Institutional care, particularly when experienced early in life, is associated with delays in social and emotional development that often persist years after adoption. It has been hypothesized that compromise of the hypothalamic-pituitary-adrenocortical (HPA) axis due to adverse condition in institutions is a mediator of later emotional and behavioral problems. The first goal of our project was to investigate whether improvements in the social and emotional environment are associated with changes in HPA axis function. The second goal was to explore whether HPA alterations related to early social adversity were associated with more compromised general development and social and emotional functioning post adoption. Children adopted from Eastern European orphanages (N = 76, mean age was 17 months, SD = 5) were followed as part of an ongoing longitudinal study. Data, including diurnal cortisol patterns, were collected at two time points: baseline (within one month of adoption) and follow-up (six months later). Cortisol values were averaged over two days of saliva sampling after wake-up and before bedtime. We found that morning cortisol values increased between the baseline assessment (M = 0.27 µg/dl, SD = 0.13) and follow-up (M = 0.33 µg/dl, SD = 0.20), t(76) = -2.1, p<0.05. HPA functioning was not associated with general developmental level at either the initial or six months post-adoption assessments. However, dysregulation of the HPA axis (i.e., flatter diurnal pattern) at follow-up was associated with more behavioral and emotional problems. Overall, these results suggest that investigating specific physiological mechanisms is important in identifying children at risk for persistent social and emotional problems and in understanding the long-term consequences of early adversity. Future work should investigate whether disturbance in the HPA system is a heightened risk for long-term negative developmental outcomes.
Subject(s)
Adoption/psychology , Child, Institutionalized/psychology , Hypothalamo-Hypophyseal System/physiology , Pituitary-Adrenal System/physiology , Stress, Psychological/physiopathology , Child, Preschool , Circadian Rhythm/physiology , Female , Follow-Up Studies , Humans , Hydrocortisone/analysis , Infant , Longitudinal Studies , Male , Orphanages , Saliva/chemistry , Stress, Psychological/psychologyABSTRACT
Pediatric patients with brain tumors can loose 1 SD of height prior to beginning growth hormone (GH) therapy. The objectives of this study were to characterize the early growth failure, identify contributing factors and propose interventions. Five children were followed quarterly for 2 years to monitor auxological parameters, nutritional indices, and endocrine measuremnts. GH stimulation tests were done every 6 months to determine the timing of the onset of GH deficiency. The nadir for height velocity (HV) occurred 6 months after diagnosis. Poor gains in height correlated with decreased calorie count (p <0.001), poor weight gain (p <0.001), decreased BMI (p <0.001) and lowered leptin levels (p <0.001). All patients were able to secrete GH normally during this nadir of growth. Children treated for brain tumors demonstrate an early triphasic pattern of growth. Growth failure due to cachexia occurs first, then a second transient phase of normal growth is observed followed by a third phase of growth failure due to GH deficiency. Phase 1 is characterized by decreased HV, BMI, leptin levels and calorie counts. With recognition of this profile, the early growth failure might be preventable with aggressive nutritional rehabilitation.
Subject(s)
Body Height/radiation effects , Brain Neoplasms/radiotherapy , Cranial Irradiation/adverse effects , Growth Disorders/etiology , Human Growth Hormone/deficiency , Hypothalamus/radiation effects , Neoplasms, Neuroepithelial/radiotherapy , Antineoplastic Agents/therapeutic use , Body Height/drug effects , Brain Neoplasms/drug therapy , Cachexia/physiopathology , Child , Child, Preschool , Combined Modality Therapy , Female , Follow-Up Studies , Growth Disorders/blood , Growth Disorders/drug therapy , Hormone Replacement Therapy , Human Growth Hormone/therapeutic use , Humans , Hypothalamus/physiopathology , Leptin/blood , Male , Neoplasms, Neuroepithelial/drug therapy , Radiation Injuries/complications , SurvivorsABSTRACT
Internationally adopted children come from high risk environments that differ significantly from those of children born and raised in the United States. This can impact their developmental and parenting needs. Aware adoptive parents can do many things to lessen the effects of a highly deprived early start to life and encourage optimal development. However, preconceived ideas and myths about adoption often stand in the way of parental desires to provide the best for their newly adopted child. Pediatric nurses aware of these common myths can educate and support adoptive parents in the early identification of potential concerns and in addressing and ameliorating them. Preparation, planning, and use of professional resources, as needed, can assist parents in supporting the child's development and in achieving successful integration of the internationally adopted child into their new family.
Subject(s)
Adoption , Child Care/methods , Parents/education , Adoption/psychology , Attitude to Health , Child , Child Care/psychology , Child Development , Health Knowledge, Attitudes, Practice , Health Promotion , Health Status , Humans , Information Services , Internet , Love , Needs Assessment , Nurse's Role , Object Attachment , Parent-Child Relations , Parents/psychology , Pediatric Nursing/methods , Poverty/psychology , Risk Factors , Social SupportABSTRACT
BACKGROUND: Obesity and attention difficulties are known complications following surgical treatment for craniopharyngioma. Treatments to date have been largely disappointing. OBJECTIVE: To examine the use of the central nervous system stimulant dextroamphetamine sulfate to regulate appetite and subsequent weight gain in children treated for craniopharyngioma. SETTING: A multidisciplinary clinic specializing in pediatric brain tumors. PATIENTS: Five consecutive patients with significant weight gain and poor attention following surgical treatment for craniopharyngioma were selected for the study. INTERVENTION: Children enrolled in the study were treated with dextroamphetamine, and growth, laboratory, and behavioral assessments were conducted for 24 months. RESULTS: Mean +/- SD body mass index (weight in kilograms divided by height in meters squared) increased from 21 +/- 3.5 before the operation to 32 +/- 2.8 by the start of the protocol. Body mass indices remained stable throughout the protocol. No changes were observed in insulin levels or caloric intake, but the children were more active when taking dextroamphetamine. Parents noted a significant improvement in hyperactivity (mean +/- SD, 1.2 +/- 0.4 to 0.6 +/- 0.2; P =.05), scored with the Conners Parent and Teacher Rating Scales. Teachers noted a similar improvement. CONCLUSIONS: During dextroamphetamine treatment, weight gain stabilized in children who had experienced obesity following surgical resection for craniopharyngioma. In addition, parents and teachers noted significant improvements in children's overall activity and attention. Further studies are needed to determine if the improvements are stable and if earlier intervention can prevent the initial obesity.
