Child-rearing practices and nursing caries.

OBJECTIVE: To determine which child-rearing practices are associated with nursing caries. DESIGN: Cross-sectional study. SETTING: Hospital-based general pediatric clinic. PARTICIPANTS: Sequential sample of 110 healthy children aged 18 to 36 months. OUTCOME MEASURES: Feeding practices of children, limit-setting issues, and familial dental health were determined by maternal interview. Nursing caries were diagnosed by dental examination. RESULTS: Nursing caries were found in 22 (20%) of the children. Ninety percent of children with and without caries were bottle-feeding at 12 and 18 months of age. Ninety-one percent of children with caries and 84% without were still drinking a nighttime bottle at 18 months (P = .33). The mothers of children with caries were found to have fewer years of education, 8.9 vs 10.8 years (P = .02), and were more likely to have eight or more cavities, 55% vs 19% (P = .002). More infants in the caries group had been breast-fed, 72% vs 46% (P = .02), although length of breast-feeding was similar, 5.4 vs 6.7 months. Fewer children with caries drank fluoridated tap water, 27% vs 54% (P = .05), but there were no differences in topical fluoride use, dental hygiene practices, or visits to the dentist. CONCLUSIONS: These findings fail to substantiate a straightforward relationship between child-rearing practices and nursing caries and suggest that well-designed prospective studies are needed to clarify the etiology of early caries.

Influenza type A and B infections in hospitalized pediatric patients. Who should be immunized?

Medical records of 99 hospitalized pediatric patients whose respiratory viral cultures yielded influenza type A or B during the winter of 1988/1989 were reviewed. We compared the records of patients considered to be at high risk (n = 43) with those of patients considered to be at low risk (n = 56) to determine differences in morbidity and mortality and if vaccination was warranted. Sixty-six percent of high-risk patients had chronic pulmonary disease. Forty-four percent of the high-risk and 11% of the low-risk patients were hospitalized for 14 or more days. Nosocomial influenza infections were identified in 14% of the high-risk and 4% of the low-risk patients. Four of the high-risk patients and only one of the low-risk patients were intubated. Of the three deaths, two occurred in the high-risk group. None of the high-risk patients who experienced significant morbidity had been immunized. We need to immunize high-risk patients, particularly high-risk pulmonary patients.

Parental opinions on treatment decisions for myelomeningocele infants: a descriptive study.

Parents of MMC patients have strong attitudes and beliefs on specific issues. They believed in the need to be involved in decisions regarding their children and felt strongly that their role was central and was important as that of the physician. They believed also in the importance of providing both medical and nutritional care to handicapped infants with a minimum of government intrusion.

Psychological and social adjustment of obese children and their families.

The psychological and social adjustment of 30 obese children and their families was examined. Mothers completed the Child Behaviour Checklist and the Family Environment Scale; children completed the Self-Perception Profile for Children. The results consistently indicate that the obese children were less socially competent, had more behaviour problems, and had poorer self-perceptions than the non-obese normative samples. Families of obese children differed significantly from families in the non-distressed normative sample in that they interacted in a more negative way. The findings are discussed in terms of an 'at risk profile' and the implications for the behavioural treatment of obese children.

Timing and motivation in pediatric career choices.

A total of 257 third-year residents in pediatrics, internal medicine, and family practice were asked about their career goals for the year following their residency and in five years, and information was obtained from them about their motives for career choices. The authors specifically examined the following: humanitarian interests; intellectual motivation; service motives; and practical, personal, and financial considerations. The characteristics of the residency training program which may have influenced their career choices were also examined. A majority of the 214 pediatric residents said they had not considered going into pediatrics on entry to medical school. Of these residents, 109 planned academic pursuits for the following year, while only 81 of the 109 anticipated an academic career within five years. Intellectual stimulation, geographic location, and an "opportunity to clarify goals" were the three most frequently mentioned factors in choosing positions for the following year.

What do patients and parents want to know? What do they need to know?

Health, or patient, education is important in enhancing patient cooperation and compliance with medical regimens. When communication flows in only one direction (from the physician to the patient), education is relatively ineffective. The process of patient education should be viewed as a joint venture, in which the patient helps to determine what information should be provided. The physician must consider not only what the patient needs to know, but also what he or she wants to know. The physician should find out specifically what a patient on a particular occasion would like to have explained. If necessary, the physician can effect a bridge between the information that is deemed to be appropriate and the patient's perceived needs. Anxiety may block the patient's receptiveness to health care information. The physician can alleviate these fears by creating a "therapeutic alliance." A helpful tactic is to speak in language the patient can understand, keeping the message simple and specific. Timing is also crucial; the physician must be able to judge when a patient is ready to receive certain information. The degree of detail offered will depend on the patient's needs and preferences. The hallmark of a pediatric practice is an open mind and continued readiness to assess the patient's knowledge, receptiveness to additional health information, and current needs.

[Psychosocial care in the overall therapeutic concept of the management of children with chronic kidney diseases]. / Psychosoziale Betreuung im Gesamtkonzept der Behandlung chronisch nierenkranker Kinder.

In terms of physical health, degree of rehabilitation and the personal assessment of the affected patients, kidney transplantation represents the optimal therapy for children with chronic renal insufficiency. The best results are achieved by transferring organs from relatives. However, this can only be accomplished if medical treatment is accompanied and supported by continuous psychosocial care of the patient, the family and the treatment team. The problem of noncompliance requires special attention, since it may be the reason for rejection of transplants; it can, however, be recognized by preliminary preventive investigations and prevented by appropriate therapy. Our positive overall experience concerning parenthood following kidney transplants does not appear to justify dissuading such patients from having children if they so wish. However, we consider that especially young women who already have impaired function with a transplanted kidney should be advised of the risk of further deterioration during pregnancy, and that the possibility of reduced life expectancy should be discussed with these patients as a matter of urgency.

Physical and psychological follow-up on offspring of renal allograft recipients.

In light of concern regarding the effect of pregnancy on renal allograft recipients and the lack of information about their offspring, we studied ten infants born to eight allograft recipients (five female and three male). In all five female recipients, allograft function remained normal throughout pregnancy and the puerperium. Complications of pregnancy were minimal. Four patients were delivered by cesarean section, three for obstetrical reasons and one electively. Three of ten infants were premature births. There were no significant neonatal complications. At time of follow-up study, the offspring were 4 months to 6 8/12 years of age; physical examination was normal on all offspring. Developmental test results ranged from 82 to 131. Parents tended to be overly cautious and sought medical attention at the first sign of illness. Our data indicated no adverse effect on renal allograft function of the female recipients and no physical or developmental abnormalities in the offspring.

Renal retransplantation in children.

Evaluation of 75 cadaver donor retransplants revealed that the primary factor influencing allograft survival is patient responsiveness as reflected by sensitization with preformed cytotoxic antibodies. Actuarial allograft survival rates for nonpresensitized (less than 5%) and moderately presensitized (5 to 50%) recipients were significantly (P less than 0.01) better than those of highly presensitized (greater than 50%) recipients. Although HLA A&B antigen histocompatibility did not have a statistically significant effect on retransplant outcome, it appeared to influence allograft survival in the highly presensitized recipient. An approach to the management of children who lose an initial or subsequent allograft is indicated by these data.