Desarrollo puberal normal. Pubertad precoz / No disponible

La pubertad es el período final del crecimiento y maduración del niño en el que se alcanza la talla final y la madurez psicosocial y reproductiva. Se inicia en el sistema nervioso central por factores neuroendocrinos que activan el eje hipotálamo-hipofisario-gonadal y sus mecanismos reguladores. Estos factores actúan bajo control genético e influencia ambiental. La pubertad precoz se define como la aparición progresiva de signos puberales a una edad por debajo de 2,5 DS de la media para una población determinada. Puede ser dependiente de gonadotropinas (central) o independiente de gonadotropinas (periférica). La mayoría de los casos son de origen idiopático, aunque también puede estar causada por enfermedades orgánicas de severidad variable. Por la repercusión desfavorable que tiene en la maduración del niño se recomienda tratar adecuadamente(AU)

Puberty refers to the final stage of children’s growth and development in which adult height, reproductive and psychosocial maturity are reached. It is initiated in the central nervous system by neuroendocrine factors (under genetic control and environmental influence) that activate the hypothalamic- pituitary-gonadal axis and its regulatory mechanisms. Precocious puberty is defined as the progressive onset of pubertal signs at an age more than 2.5 SD below the mean of a population. It may be gonadotropin-dependent (central) or gonadotropin-independent (peripheral). Most of the cases are idiopathic, but occasionally the cause may be an underlying organic disease with variable severity. Treatment is recommended because of the negative effects it may have on the child’s development(AU)

[Knowledge of breastfeeding management among residents in pediatrics]. / Informe sobre el conocimiento de los residentes de pediatría en el manejo de la lactancia materna.

The staff of maternity wards and clinics for maternal and child health should receive appropriate basic and in-service training on the health benefits of breastfeeding and on lactation management. Pediatricians should not only be knowledgeable about the health, nutritional and physiological aspects of appropriate feeding, they should also be familiar with the mechanics of breastfeeding, its various psychosocial influences, possible difficulties and how to overcome them. To evaluate knowledge of breastfeeding among pediatrics residents throughout Spain, a survey was conducted. A total of 250 questionnaires were collected. Significant differences were observed among provinces. In most areas, residents' training was insufficient. To achieve an appropriate level of knowledge among pediatrics residents in a subject as important to mother and child health as breastfeeding, courses should be given and repeated at regular intervals. Professional associations should be actively involved in promoting appropriate training for health professionals.

Informe sobre el conocimiento de los residentes de pediatría en el manejo de la lactancia materna / Knowledge of breastfeeding management among residents in pediatrics

El personal sanitario de las maternidades o clínicas maternoinfantiles debe recibir una apropiada formación en cuanto a los beneficios para la salud del amamantamiento y manejo de la lactancia materna. Los pediatras no sólo deben conocer los aspectos nutricionales y psicológicos de la lactancia, sino que también deben estar familiarizados con la mecánica del amamantamiento, las influencias psicosociales, las dificultades que se presentan y cómo superarlas. Se realizó una encuesta para evaluar los conocimientos de los residentes de pediatría de toda España. Se obtuvieron 252 encuestas. Se observaron diferencias importantes entre provincias. En la mayoría de las zonas, la formación de los residentes fue insuficiente. Es necesario organizar cursos que se repitan regularmente, para que los residentes tengan un nivel de conocimientos adecuado en esta materia tan importante para la salud maternoinfantil. Las asociaciones profesionales deben participar activamente en organizar la formación de los profesionales de la salud (AU)

Secuelas endocrinológicas del tratamiento del cáncer infantil / Endocrine sequellae of childhood cancer survivors

Se presentan las secuelas endocrinológicas y auxiológicas, secundarias a radioterapia y quimioterapia, de 136 niños y adolescentes supervivientes de cáncer. Nuestro objetivo es elaborar un protocolo que facilite su seguimiento.Métodos: Se incluyeron en el estudio 136 niños (78 niños y 57 niñas), todos habían recibido radioterapia y/o quimioterapia, con/sin cirugía. Padecieron el tumor a la edad de 5.4 ñ 3.8 años (0.1-16). El estudio endocrinológico se realizó con 12.0 ñ 4.6 años de edad (2-22). Todos llevaban al menos 2 años en remisión. Recibieron radioterapia 71 niños (45 en el SNC). Dosis de radioterapia: 41 ñ 24.4 Gy (7-98).Resultados: Se observó una pérdida de percentil de talla de 13.5 puntos (centiles). Esta pérdida fue significativamente mayor entre los niños que recibieron radioterapia (18.9 puntos frente a 7.0 sin radioterapia). El peso sufrió un incremento de 5.5 puntos. Se detectaron las siguientes anomalías: talla baja no endocrina en 11 niños, déficit de GH en 19, patología tiroidea en 15, edad ósea/pubertad adelantada en 10, hipogonadismo en 11, y otras en 24 niños. Todas las alteraciones excepto el hipogonadismo fueron más frecuentes en los niños que recibieron radioterapia. El déficit de GH y la pubertad adelantada fueron más frecuentes entre los que recibieron irradiación craneal.Conclusión: Todos los niños supervivientes de cáncer precisan seguimiento a largo plazo (AU)

[Preliminary results of a therapeutic program for childhood obesity in primary health care]. / Resultados preliminares de un protocolo de obesidad infantil en atención primaria.

The high prevalence of childhood obesity in our society, its adverse consequences in the psychosocial development of the child, together with its risk of persistence into adulthood, prompted us to carry out this treatment program in our Primary Care Unit. It is based fundamentally on four aspects: diet, physical exercise, psychological and family support. Thirty children, between 4 and 14 years of age, were controlled for 11 months. These children's personal and family characteristics, their habits and psychological aspects were described. An average reduction of the IMC of 2.50 was obtained. The best results were obtained in children with two or more siblings, with a good adherence to the diet and with adequate family support. Sex, obesity of other family members, initial age, previous habits, etc., were not found to be influential. The importance of prevention and family collaboration is emphasized.

[Breast feeding in a metropolitan area: (I). Analysis of the current situation]. / La lactancia materna en un área metropolitana: (I). Análisis de la situación actual.

In order to elaborate a program to promote breast-feeding, it is necessary to know in advance the difficulties encountered by the mothers in the target population. For this purpose, we surveyed a sample of 400 mothers who were representative of those who gave birth in Móstoles in 1989. We found that 56% of the mothers did not exceed two months of breast-feeding. Breast-feeding was shorter in low-income families. Its duration was influenced by the husband's and grandmother's opinions and also by previous failure with elder siblings. Mothers made their choice of feeding method before getting pregnant. We also found that most health professionals acted unsatisfactorily. Other unfavorable factors included excessive insecurity of the mother and misinformation.

[Breast feeding in a metropolitan area: (II). Design for a promotion program]. / La lactancia materna en un área metropolitana: (II). Diseño de un programa de promoción.

Because of the importance of breast-feeding in the health of both the mother and child, and taking into consideration its poor situation at the present time, it seems fully justified to start a program to promote breast-feeding. This program basically will consist of training health professionals and in the improvement of both the mother's and hospital's practices. It is necessary to motivate health authorities and to curb the excess in formula promotion. Mass-media should be employed for the promotion of breast-feeding and a system should be implemented to obtain a proper record of the duration of breast-feeding.

[Importance of maternity routines in the success of maternal breast feeding]. / Importancia de las rutinas de la maternidad en el éxito de la lactancia materna.

Many of the problems that are associated with breast-feeding appear to be caused by various postnatal care procedures that take place in the majority of our hospitals. In order to identify these obstacles, a survey was carried out on a sample of 400 mothers whose children were born in Móstoles in 1989. The results were as follows: 1) The average duration of breast-feeding was 2.43 months (SD = 2.19 months). 2) The lower the baby's birth weight and the longer that he was kept in the hospital, the shorter the time that he was breast-fed. Two basic procedures in the hospital "norms" appear to contribute to the failure of breast-feeding. First, the provision of glucose water or formula bottles and second, a ridged feeding schedule. If the newborn was fed on demand in the hospital it tended to be continued once at home. In both the hospital and in the home, on demand feeding was strongly associate with successful breast-feeding. Some simple modifications to the Maternity departments are recommended.