Increased plasma levels of pancreatic polypeptide and decreased plasma levels of motilin in encopretic children.

OBJECTIVE: Abnormalities of hormones affecting gastrointestinal motility have been found in "functional" disorders of the gastrointestinal system in adults. One such disorder of childhood, encopresis, is frequently associated with constipation, the treatment of which often eliminates the soiling. We hypothesized that hormones affecting gastrointestinal motility were different between encopretic patients and matched controls. METHODS: Ten encopretic patients were matched by age, race, and sex with controls who had no history of encopresis or constipation. After an overnight fast, each child consumed a meal of Ensure, the amount of which was based on body weight. Plasma levels of gastrin, pancreatic polypeptide, cholecystokinin, motilin, thyroxine, estrogen, and insulin were measured 20 and 5 minutes before the meal, and 5, 10, 15, 30, 45, 60, 90, 120, 150, and 180 minutes after the meal. RESULTS: Postprandial levels of pancreatic polypeptide remained consistently higher and peaked earlier (P < .05) for encopretic patients. The motilin response was lower (P < .03) for encopretic children than for controls. CONCLUSIONS: We conclude that pancreatic polypeptide and motilin responses to a meal are different in encopretic children than in children in the control group. These gastrointestinal hormone findings may in part explain and/or be the result of the severe constipation that frequently underlies the fecal soiling found in these patients. These findings also suggest the motility of the stomach and small intestine may be abnormal in encopresis.

Young children in recreational sports. Participation motivation.

More than 20 million children between ages 6 and 16 years participate in nonschool sports programs, with increasingly more programs being established for younger-age children. A questionnaire based on previous research with adolescent athletes was developed to determine participation motivation of 6- to 10-year-old children. Three hundred fourteen boys participating in a basketball program were interviewed privately with this instrument. Of the 12 participation motivation items, "learn to do my best," "learn and improve skills," "have a coach to look up to," and "get stronger and healthier" were most highly rated, whereas "win games" and "become popular" were rated least important. When responses of 6 and 7 year olds were compared with those of 9 and 10 year olds, older children rated "feel part of a team", "have fun and excitement" and "be with and make new friends" higher at a statistically significant level (p less than 0.05). Older children rated "win games" and "become popular" lower at a statistically significant level (p less than 0.05). The authors conclude that young children in this recreational sports program make significant distinctions in their participation motivation and that some aspects of participation that motivate them change as they grow older.

Coaches' goals for young children in a recreational sports program.

Almost all children participate in sports at some time, and programs are being established for even younger children. Adults who coach the children largely determine what the children's sports experience will be. Coaches' perceptions of what is important for the young children they instruct have not yet been carefully investigated. This study was designed, therefore, to determine coaches' goals for young children. Data were gathered by use of an attitude questionnaire administered to 29 coaches of a recreational basketball program of children ranging in age from 6 to 10 years old. Of the 12 goals, feeling part of a team, learning to do my best, and having fun and excitement were most highly rated as extremely important, while becoming popular was lowest rated as not important. Results revealed that coaches in general are able to clearly define their goals and priorities, and these goals seem developmentally appropriate for the children. However, coaches make little differentiation in goals based on age.

Encopresis responsive to non-psychiatric interventions. With remittance of familial psychopathology.

A case report of an adolescent with primary encopresis is presented in which the patient responded to standard medical interventions despite apparent significant psychopathology in the child and family. Psychological symptoms proved to be secondary and resolved with successful medical treatment and with attending to other concerns, such as this patient's school problems. Behavioral and medical literature related to encopresis is reviewed. It indicates that encopresis is associated more consistently with physiological abnormalities of the bowel rather than definable psychological disorders.

Application of pharmacokinetics in the diagnosis of chemical abuse in Münchausen syndrome by proxy.

The case of a preschooler who was chemically abused in Münchausen syndrome by proxy is presented. Though there were many clinical characteristics that raised suspicions of this syndrome, the definitive diagnosis was made by the application of pharmacokinetics during a hospital admission. This is the first reported use of this diagnostic approach to confirm this elusive disorder. Standard pharmacological equations can be used to provide this information from pharmacokinetic data which are readily available in most hospital settings.

The incidence of cognitive dysfunction in an encopretic population in children.

Cognitive testing was conducted in a clinical population of encopretic patients. Testing included the Weschler Intelligence Scale for Children-Revised (WISC-R), the Wide Range Achievement Test (WRAT) and the Bender Visual-Motor Gestalt Test (BVMGT). Although Full Scale, Verbal and Performance Intelligence Quotients on the WISC-R were not statistically different from general population means, subtests in Arithmetic (p less than 0.001), Digit Span (p less than 0.001) and Coding (p less than 0.05) were. There was also a high incidence of Verbal/Performance discrepancies and statistically significant differences on the WRAT in Spelling (p less than 0.01) and Arithmetic (p less than 0.01). Visual-motor integration was delayed two or more years in 43% of the patients on the BVMGT. These findings are consistent with the diagnosis of specific learning disabilities. An increased frequency of learning disabilities in an encopretic population may represent a subset of patients with a distinct syndrome in this disorder. These findings may point to the central nervous system (CNS) as the common point of pathology for the encopresis and learning disabilities, or reflect a common insult to both the CNS and gastrointestinal tract. Since histories in these patients did not reveal significant pregnancy or neonatal risk factors, this association could be related to genetic or environmental issues. Health professionals should be alert to the possibility of an increased incidence of learning disabilities in their encopretic patients. Further controlled studies are needed to determine if this finding is present in other settings, and if so, to determine the etiology.