Parents' Attitudes toward Childhood Vaccines and COVID-19 Vaccines in a Turkish Pediatric Outpatient Population.

Vaccination hesitancy (VH) is an important public health issue. The determinants of parental decisions on whether to vaccinate their children are multidimensional and need to be carefully considered in the COVID-19 era. Our study aims to investigate the prevalence of VH among parents, parents' use of social media, and their attitudes toward the COVID-19 vaccine upon vaccine refusal. Materials and methods: Our participants were the parents of children admitted to hospitals in three different cities in Turkey between September 2021 and December 2021. The parents were asked to complete sociodemographic data and their attitudes toward COVID-19 diseases, the Parental Attitudes Toward Childhood Vaccines (PACV) scale, and the Attitudes Toward COVID-19 Vaccine (ATV-COVID-19) scale. Participants were categorized as "non-hesitant", with a score of <50, and "hesitant", with a score of ≥50. Results: A total of 1087 parents with a mean age of 33.66 (SD 9.1) years old participated in the study. VH was noted in 102 (9.38%) parents. Age, gender, education, and income levels did not significantly differ from one another, according to the PACV; however, parents who delayed vaccinating their children and indicated that social media had an impact on vaccination decisions were more hesitant. Parents who were male and had a family member diagnosed with COVID-19 showed more positive attitudes in the ATV-COVID-19. Parents who were hesitant about childhood vaccinations had lower positive attitudes toward the COVID-19 vaccine (2.84 ± 0.97) than parents who were not hesitant (3.77 ± 0.9). A total of 761 (70.14%) parents need more information about childhood immunizations. Conclusion: Parents who are hesitant about childhood immunization programs in Turkey have a less positive attitude toward COVID-19 vaccines and are affected by social media. Parents need information about vaccines, and because the controversy surrounding COVID-19 vaccines can diminish parents' confidence in routine childhood immunizations, understanding the complex causes behind vaccination hesitancy can help public health policy break through barriers and increase immunization rates.

Lead, mercury, and cadmium levels in breast milk and infant hair in the late period of lactation in Ankara, Turkey.

Lead (Pb), mercury (Hg), and cadmium (Cd) have known harmful effects on children's well-being. The object of this study was to measure the levels of heavy metals (Pb, Hg, and Cd) in breast milk and infant hair, connected environmental factors, and the impact on infant growth and development at 8 months. Seventy-four breast milk samples and 46 infant hair samples were analyzed. Cd, Pb, and Hg were detected in 99%, 91%, and 87% of breast milk samples, respectively. Cd levels were higher in the hair of infants in extended families, living in older houses and when there was a maternal history of anemia and postpartum anemia. Hg levels in breast milk were higher in Denver II suspicious/abnormal infants than in Denver II normal infants. Further biomonitoring studies and preventive measures should be conducted to minimize exposure to toxic metals in early childhood period.

Diagnosis and Treatment Approaches in Infantile Colic (IC): Results of a Survey Among Paediatricians in Turkey.

Background and Objective: Due to limited knowledge on the etiopathogenesis of infantile colic (IC) and the insufficiency of data regarding current treatments, different approaches emerge in terms of diagnosis, and treatment modalities globally and also in Turkey. The objective of this study was to observe how infantile colic is diagnosed and treated by paediatricians in Turkey. Methods: An anonymous electronic questionnaire was used to collect the respondents' opinions. The study questionnaire was comprised of 4 different sections with 56 multiple-choice questions covering demographic features, diagnostic approach, treatment preferences and response to treatment. Results: A total of 375 paediatricians responded to the survey. Fifty three percent of the participants stated that they established the IC diagnosis based only on their clinical experience. Factors that most affected the decision to start treatment were identified as parent discomfort, decreased family quality of life, and crying duration (68, 66, and 54%, respectively). Application of soothing methods, probiotics, and simethicone were identified as the most frequently used treatment modalities (frequency ranking; 81, 76, and 50%, respectively). Of the participants, 98% stated that they used probiotic as supplements, on the other hand, 72% of the participants indicated that they used simethicone as the only medical treatment to treat IC. The question about the participants' observations regarding the response to probiotic treatment was answered by 71% of the participants with decreased crying duration, while easier stool/gas passage and resolved digestion problems were the other frequent observations (54 and 49%, respectively). The observations related to the response to simethicone treatment also included decreased crying duration in addition to decreased crying periods after feeding and easier gas/stool passage (67, 47, and 44%, respectively). Conclusions: Survey results revealed that the majority of the paediatricians used their clinical experience alone to establish the diagnosis of IC and preferred probiotic supplements and simethicone as the only medical treatment to treat IC and they observed clinical benefits from them. Insights generated by this study will be helpful to guide future efforts to improve the management of infantile colic by paediatricians.

Vitamin D Deficiency in Children With Newly Diagnosed Idiopathic Epilepsy.

Several studies have shown a link between vitamin D deficiency and epilepsy. This study includes 60 newly diagnosed idiopathic epilepsy patients and 101 healthy controls (between the ages of 5 and 16). Each group was also divided into two subgroups according to seasonal changes in terms of months of longer versus shorter daylight. We retrospectively evaluated the levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone, and 25-OH vitamin-D3 in the study participants. Levels below 20 ng/ml were defined as vitamin D deficiency and levels of 20-30 ng/ml as insufficiency. There were no significant differences in age, gender distribution and levels of calcium, phosphorus, alkaline phosphatase and parathyroid hormone between the groups. The level of 25-OH vitamin-D3 in the patient group was significantly lower when compared to the control group (p < 0.05) (14.07 ± 8.12 and 23.38 ± 12.80 ng/ml, respectively). This difference also held true when evaluation was made according to seasonal evaluation (12.38 ± 6.53 and 17.64 ± 1.14 in shorter daylight and 18.71 ± 9.87 and 30.82 ± 1.04 in longer daylight).

Organochlorine pesticide residues in breast milk and maternal psychopathologies and infant growth from suburban area of Ankara, Turkey.

We aimed to determine the levels of organochlorine pesticides (OCPs) in the breast milk; to assess the effect of detectable OCPs on maternal-infant characteristics and; to evaluate the relation between OCPs and the maternal psychopathologies [Brief Symptom Inventory (BSI), Postpartum Bonding Questionnaire (PBQ), Mother-to-Infant Bonding Scale (MIBS) and Edinburgh Postnatal Depression Scale (EPDS)] and infant growth. DDT, beta-hexachlorocyclohexane (HCH), aldrin and heptachlor were detected in 89.3, 70.7, 58.7 and 34.7 % of the samples, respectively. Mothers with low monthly family income had detectable DDTs less frequently. The frequencies of detectable heptachlor epoxide were significantly higher in mothers with gestational nausea. Anaemic mothers had more frequently detectable alpha-HCH. Z scores of head circumference were inversely correlated with beta-HCH and DDT levels. The heptachlor epoxide levels were positively correlated with PBQ, MIBS and indexes of BSI. No relation was detected between EPDS and OCPs. Further studies are needed for changes in maternal psychopathologies.

Social prejudice hindering proper use of car safety seats.

The compliance of parents with child passenger safety (CPS) has been mainly explained by their level of knowledge. Social, ethnic and cultural factors have not been investigated in detail. This study investigated the rate of compliance of parents with CPS guidelines, as well as the factors hindering it. Parents of infants aged 2-10 days were enrolled. The proportions of families obtaining a car safety seat (CSS; 57%) and complying with CPS recommendations (2%) were very low. Most of the parents thought CSS were harmful for infants (mother, 57%; father, 63%), despite having already purchased one. Parents believed their children to be too small to use CSS and cannot sit in CSS because they should lie flat on their backs at all times. These prejudices may be due to the social and cultural circumstances specific to Turkey, or corresponding findings may be found in countries with similar socioeconomic status.

Relations of maternal psychopathologies, social-obstetrical factors and mother-infant bonding at 2-month postpartum: a sample of Turkish mothers.

BACKGROUND: The mental health of the mother influences early mother-infant relationship. This study aimed to explore the relations between maternal psychopathologies, particularly postpartum depression, social-obstetrical factors and mother-infant bonding. METHODS: One hundred and eighty-nine mother-infant pairs who participated in the longitudinal study entitled "Mother-Infant Care Study" were evaluated at the second month postpartum. The Brief Symptom Inventory (BSI) had been applied to all mothers in the first 3 days postpartum. At the second month postpartum, mothers were assessed with the Edinburgh Postpartum Depression Scale (EPDS), Postpartum Bonding Questionnaire (PBQ), and Mother-Infant Bonding Scale (MIBS). RESULTS: The mean maternal age was 25.1 (± 5.2) years. The EPDS scores were higher in the mothers who had been supported lifelong by a psychologist due to psychological problems, had a birth interval of ≤ 2 years, and had smoking habits at the second month postpartum. Mothers with a female infant had higher PBQ score than those with a male infant. The EPDS score was correlated positively with the PBQ and MIBS scores. There were positive correlations between the EDS scores and all subscales of PBQ and MIBS scores. Some subscales and indexes of the BSI were correlated with the PBQ, MIBS and EPDS scores. CONCLUSION: Identifying postpartum depression and other psychopathologies in mothers is critical for prevention of mother-infant bonding impairment in the early postpartum period.

Methylphenidate-induced acute orofacial and extremity dyskinesia.

Methylphenidate is a short-acting stimulant. In this article, the authors report a 7-year-old male patient who presented with orofacial and limb dyskinesia after his first dose of methylphenidate treatment for a diagnosis of attention-deficit/hyperactivity disorder; he was also receiving sodium valproate treatment for epilepsy. Orofacial dyskinesia appeared 5 hours after methylphenidate administration, persisted for 10 hours, and had completely resolved within 2 days. Although limb dyskinesia after methylphenidate is a commonly reported side effect, to the authors' knowledge this is only the second reported case to develop both orofacial and limb dyskinesia in the acute period after the first dose of methylphenidate. This case is reported to emphasize the potential side effects of methylphenidate, individual differences in drug sensitivities, and drug-receptor interactions via different mechanisms.

Prevalence of scalp disorders and hair loss in children.

Hair loss in children can have psychologic effects that interfere with a child's growth and development. In our case series, we evaluated 1003 children aged 0 months to 17 years who presented to the pediatric and dermatology outpatient clinics at Fatih University, Ankara, Turkey, from December 2009 through October 2010. The patients were routinely examined for scalp disorders and hair loss. We documented 69 patients with scalp disorders and hair loss, most commonly seborrheic dermatitis (SD), transient neonatal hair loss (TNHL), alopecia areata (AA), temporal triangular alopecia (TTA), and pityriasis amiantacea (PA); The clinical presentation of scalp disorders and hair loss in children varies widely and may be attributed to congenital or acquired causes. Hair loss in children can be associated with serious illness. Therefore, hair examination by a pediatrician or dermatologist is an important part of the physical examination.

Mercury exposure via breast-milk in infants from a suburban area of Ankara, Turkey.

The objective of this study was to evaluate mercury (Hg) levels in breast-milk in the postpartum 2nd month and to determine the relationship between Hg levels and sociodemographic parameters, maternal nutritional habits, presence of dental amalgam, maternal depression, maternal anemia, and growth status of infants. One hundred forty-four mothers residing in a suburban area in Ankara were invited at the 2nd month postpartum. A questionnaire concerning sociodemographic characteristics, vitamin intake during pregnancy and in the 2nd month postpartum, consumption of fish and viscera, smoking habits, and presence of dental fillings was applied. Hg could be detected in samples of 18% of the mothers, all levels of which were higher than the Hg limit in breast-milk reported by the World Health Organization. The Hg levels were higher in mothers who consumed viscera than in those who did not. Turkish women can still safely breastfeed their children, but Hg contamination in breast-milk should be monitored during the lactation period.

Zinc and copper concentrations in breastmilk at the second month of lactation.

We aimed to investigate zinc and copper concentrations in breast milk at two months postpartum and the relationship between these concentrations and the characteristics of mother infant dyads. A total of 142 mothers were enrolled. The median concentrations of breast milk Zinc and Copper were 625 ug/L and 239 ug/L, respectively. These concentrations were not related to maternal age, parity, smoking habits, iron and vitamin/mineral supplementation, birthweight, gestational age, or feeding type. The concentrations had no effect on anthropometric measurements of infants at two months of age.

Is routine abdominal ultrasonography necessary in macrosomic newborns with difficult delivery?

Adrenal hemorrhage is a relatively uncommon clinical problem of the newborn period. Clinical features of adrenal hemorrhage are variable. An abdominal mass, anemia, unexplained/persistent jaundice, bluish discoloration of the scrotum may be the presenting sign. Here, we presented a macrosomic infant (4150 gr) whose left side adrenal hematoma associated with asphyxia and early onset of hyperbilirubinemia. We concluded that the pediatricians should be considered abdominal US screening regard as internal hemorrhage in macrosomic newborns who delivered with difficult labor and then seen pathologic jaundice.

Problematic eating behaviour in Turkish children aged 12-72 months: characteristics of mothers and children.

OBJECTIVE: The aim of this study was to determine prevalence of problematic eating behaviour (PEB), associated risk factors, feeding practices including place of meal, variety of diet, and habits of consuming junk food, the mothers' perception of the child growth status in comparison to his/ her peers, and the effects on anthropometric measurements. METHODS: This study was carried out among children aged 12-72 months who attended the outpatient clinic in the Ihsan Dogramaci Children's Hospital between February-June 2007. Three hundred and thirty-one mothers of children were asked to complete an extensive questionnaire covering socio-demographic characteristics and their child's general eating behaviour and feeding practices at mealtimes. Children with PEB were identified based on their mothers' statements. RESULTS: Three hundred and thirty-one cases were 3.32 +/- 1.39 years old. One hundred thirty-five mothers reported having a child with PEB. The mothers described the children's problematic behaviour as: need to walk around with the child during mealtime (45.6%), watching TV during meals (41.9%), picky or fussy eating (39%), vomiting and/or retching (25.7%), retaining food in the mouth for a long time (20.6%), and not eating solid foods (11.8%). In children who had ate neither meat nor vegetables and fruits, took cod-liver oil-containing supplement during the course of the study, and had taken iron supplements in the first year of life, PEB was more frequent than in others. The mean z scores of weight for age (WAZ) were significantly lower in cases with PEB than without PEB. DISCUSSION: Counselling and supporting of the mother/caregiver could alleviate the effect of inappropriate solutions taken by families. Insistence on composing of the diet variety including especially vegetables, fruits and meat may be promoted by provision of alternative cooking/presentation samples to mothers of children who refuse some foods. Pediatricians should be alerted that lower WAZ values may be a warning indicating a problem which may cause stagnated growth in children with PEB.

Clinical characteristics and antibiotic resistance of Shigella gastroenteritis in Ankara, Turkey between 2003 and 2009, and comparison with previous reports.

OBJECTIVES: The aim of this study was to define the epidemiological, clinical, and antibiotic susceptibility patterns of Shigella gastroenteritis cases occurring during the years 2003-2009 and to compare results with those of the years 1987-2002. METHODS: A hospital-based study was conducted over a 22-year period. All 238 Shigella strains isolated between 2003 and 2009 were compared to 618 isolates from the period 1987-1994 and 218 Shigella strains isolated during 1995-2002 with regard to antimicrobial resistance patterns and patient clinical characteristics. RESULTS: The predominant species during all periods was Shigella sonnei, with an increasing predominance across the periods (64.0%, 71.5%, and 87.8%, respectively; p<0.001). Neither the prevalence of bloody diarrhea nor other clinical characteristics changed across the study periods, except for the prevalence of dehydration, which increased (11.0%, 20.6%, and 28.6%, respectively; p<0.001). During the period 2003-2009, 69.9% of Shigella were resistant to trimethoprim/sulfamethoxazole, 35.8% to ampicillin, and 4.7% to nalidixic acid. No case resistant to ciprofloxacin was detected. Multidrug resistance was also found to be similar in the last two periods (24.0% vs. 28.1%, respectively). CONCLUSIONS: There was both a microbiological and a clinical change in childhood Shigella gastroenteritis cases over the 22 years. The antibiotic resistance pattern appears to have remained stable over the last two periods. There is a need to re-examine the criteria and clinical management guidelines for suspected shigellosis cases.

Breast milk lead and cadmium levels from suburban areas of Ankara.

The objectives of this study were (1) to evaluate levels of lead (Pb) and cadmium (Cd) in the breast milk at 2 months postpartum, (2) to investigate the relationship between Pb and Cd levels in breast milk and some sociodemographic parameters and (3) to detect whether these levels have any influence on the infant's physical status or on postpartum depression in the mothers. Pb and Cd levels in breast milk were determined by Inductively Coupled Plasma Mass Spectroscopy (ICP-MS). The median breast milk concentrations of Pb and Cd were 20.59 and 0.67 µg/l, respectively. In 125 (87%) of 144 samples, Pb levels were higher than the limit in breast milk reported by the World Health Organization (WHO) (> 5 µg/l). Breast milk Cd levels were > 1 µg/l in 52 (36%) mothers. The mothers with a history of anemia at any time had higher breast milk Pb levels than those without a history of anemia (21.1 versus 17.9 µg/l; p=0.0052). The median breast milk Cd levels in active and passive smokers during pregnancy were significantly higher than in non-smokers (0.89, 0.00 µg/l, respectively; p=0.023). The breast milk Cd levels of the mothers who did not use iron and vitamin supplements for 2 months postpartum were found to be higher than in those who did use the supplements (iron: 0.73, 0.00 µg/l, p=0.023; vitamin: 0.78, 0.00 µg/l, p=0.004, respectively). Breast milk Cd levels at the 2nd month were correlated negatively with the z scores of head circumference and the weight for age at birth (r=-0.257, p=0.041 and r=-0.251, p=0.026, respectively) in girls. We found no correlation between the breast milk Pb and Cd levels and the Edinburgh Postpartum Depression Scale scores. Breast milk monitoring programs should be conducted that have tested considerable numbers of women over time in view of the high levels of Pb in breast milk in this study.

Why are they having infant colic? A nested case-control study.

We aimed to analyse infant (birth characteristics, feeding type, faecal enzyme activities) and environmental (maternal smoking, nutrition and psychological status, mother-child bonding, family structure, support for the mother, familial atopy) risk factors for infant colic and to follow infants with respect to physical growth, sleeping status up to 8 months of age in a nested case-control study. 660 mothers who delivered at Dr Zekai Tahir Burak Maternity Hospital, were enrolled within 3-72 h post delivery. Each infant with inconsolable persistent crying and four matched infants with no crying episodes were invited by phone to Hacettepe University Ihsan Dogramaci Children's Hospital at 30-45 days post partum. At 40-55 days, we examined the infants and gave mothers a questionnaire, including crying characteristics of the infants; 47 infants were diagnosed with colic and 142 as non-colic. When the infants were 7-8 months old, another interview was done. The colic group had higher proportions of less-educated (≤ 8 years) and smoking mothers, extended family and families with domestic violence than the non-colic group. The colic group of mothers had significantly higher rates of 'impaired bonding' in the Postpartum Bonding Questionnaire, higher scores on the Edinburgh Postnatal Depression Scale, higher scores for hostility subscales of the Brief Symptom Inventory and a more irregular sleep pattern than the non-colic group. No differences were revealed for faecal enzyme activities. At 7-8 months, the colic group was shorter than the non-colic group. Colic was associated with various perinatal factors (maternal education, smoking habits, cheese consumption, hostility scores and domestic violence) and having colic in infancy negatively affected the sleeping pattern and the height of the infant.

Factors associated with breastfeeding initiation time in a Baby-Friendly Hospital.

The purpose of this study was to investigate maternal, gestational, and neonatal features associated with the early initiation of breastfeeding. A descriptive study was done between July-October 2006 in the maternity ward of Dr. Zekai Tahir Burak Maternity and Research Hospital, a certificated Baby-Friendly Hospital. Babies with postpartum health problems and those hospitalized in the newborn intensive care unit were not included into the study. A total of 577 mothers participated within 4 to 36 hours' postpartum on a voluntary basis. The mothers completed a questionnaire about the gestational, maternal, neonatal, and first suckling characteristics. Of the 577 cases, 35.2% initiated breastfeeding within the first hour while 72.8% of them initiated breastfeeding within the first two hours of birth. In the multivariate logistic analysis, it was found that the factors affecting early breastfeeding status (within the first 2 hours of birth) were maternal illness during pregnancy, cesarean section and preterm birth. We concluded that the prevention of premature birth, limitation of cesarean section indication, management of maternal anemia, regular and effective pregnancy follow-up visits are important for the early initiation of breastfeeding.

Sensitivity and specificity of bloody diarrhea in shigella gastroenteritis.

The sensitivity and specificity of bloody diarrhea in the diagnosis of shigella gastroenteritis in a Shigella sonnei prevalent center was investigated. The shigella-proven gastroenteritis cases who were admitted to Hacettepe University Ihsan Dogramaci Children's Hospital Diarrheal Diseases Unit (Jan 2003 - Oct 2006) constituted the study group (n=65). Age- and sex-matched children admitting to the same center with non-shigella diarrhea constituted the control group (n=65). The sensitivity, specificity, and positive and negative predictive values of bloody diarrhea were found to be 30%, 100%, 100% and 58%, respectively. Sensitivity of bloody diarrhea in the diagnosis of shigella gastroenteritis was low in this center. New strategies and recommendations in the management of mild nonbloody cases are needed.