Ambulatory Child Health最新文献

Objective The bowel habit in the first few weeks is relevant in the assessment of symptoms which are often nonspecific and may or may not be indicative of underlying pathology. There is very little available data. We therefore undertook a study to investigate the normal bowel habit in healthy, term infants.

Design, setting and sample Infants were assessed by the health visitor at the initial contact (10–14 days) and at the 6-week check. Details of feeding method and bowel habit were collected by simple questionnaire.

Results A total of 238 infants were recruited after 14 exclusions; 87.3% of babies passed meconium within 24 and 99.2% within 48 hours of birth. The majority of infants at 2 weeks passed at least one stool every day (95.3%). At 6 weeks most babies (87.8%) continued to pass a daily stool, although the range widened, with 98.3% passing a stool within the range three or more per day to once every 3 days.

Implications for practice This study suggests in the first 2 weeks of life that most infants have a daily bowel motion. By 6 weeks, although the range has increased, 98.3% will have a bowel motion at least once every 3 days. This means a bowel frequency of less than every 3 days is unusual and requires consideration of underlying pathology.

Objective Sleep problems are common during infancy, and treatment programmes based on behavioural techniques have been reported to have high rates of short-term improvement (80–90%) when used with support from a therapist.

However, follow-up periods longer than 3 months are rare. The aim of this study was to describe the changes in sleep of 24 sleep-disturbed infants after an interventional sleep programme. Comparisons with a healthy control group were made for a follow-up period of 2.5 years.

Settings The case group was recruited from a parental questionnaire population study and sample of 2518 children aged between 6 and 18 months. The response rate was 83%. The group consisted of those 6–12-month-old children who fulfilled specific criteria for severe and chronic sleep problems (n = 27). A healthy control group was matched with regard to age and sex.

Methods The parents of the case group were offered a sleep programme based on the premise of controlled crying, and 24 families chose to participate. In addition to the behavioural technique, an interdisciplinary approach was used, taking the whole family situation into consideration. Sleep diaries and questionnaires were sent to cases and controls for follow-ups at 1 month, 1 year and 2.5 years, respectively, after admission.

Results One month after initiation of the treatment programme in the case group, significant changes had taken place. The average number of times the case babies

woke up had diminished from 6.0 to 1.8 times per night, and night-time sleep had

increased, on average by 67 minutes. A 92% rate of improvement was reported.

The changes were stable over time. Comparisons with the healthy controls after 1 year and after 2.5 years revealed no significant group differences in sleep characteristics. The families in the case group managed to maintain the achieved changes in infant sleep behaviour on their own; continuous therapist support was not necessary. This was true even for formerly depressed and psychosocially burdened parents.

Conclusions A combination of behavioural technique and interdisciplinary family work has positive and long-lasting effects in children with severe and chronic sleep problems.

Implication for practice Even severely sleep-disturbed infants coming from families with depression and psychosocial problems can be helped to sleep well with a relatively short but intense and multidisciplinary sleep programme.

Background Assessing the impact of children's exposures to environmental toxins is an emerging new subspecialty in clinical pediatrics. However, pediatric health professionals in practice may not be familiar with critical information necessary to diagnose and manage environmental toxic exposures in children.

Objective The objective of this study was to investigate the perceptions of pediatricians, nurses, and nurse practitioners regarding their own practices and educational needs concerning pediatric environmental exposures.

Methods Health professionals attending a general pediatric postgraduate course were administered a 22-item questionnaire on their practices and educational needs in children's environmental health.

Results A total of 93% of participants returned usable questionnaires. Within the previous 6 months, over 90% of pediatricians and nurse practitioners had diagnosed food poisoning; almost 50% had diagnosed lead poisoning; 50% had diagnosed a child's illness as due to exposure to a toxic chemical; and 24% had diagnosed ‘building-related illness.’ Although 90% of pediatricians and 82% of nurses and nurse practitioners stated that they routinely asked families about parental occupations, only 35% of both groups asked about parental hobbies. Only 58% of the groups asked about smoke detectors in the home, and only 18% of nurses and 9% of pediatricians queried families about their use of radon detectors. Over 70% of all three groups indicated a high interest level in the following postgraduate educational topics: taking in environmental history, breast milk contaminants, food allergies, food contamination, and illness related to tobacco smoke. Topics that did not garner as high an interest level included: childhood lead poisoning, radon poisoning, and building-related illness.

Conclusion Pediatric health professionals commonly diagnose environment-related illnesses, and they include such topics during well child care. They indicate a variety of educational needs concerning pediatric environmental health issues.

Implications for practice Health care professionals are increasingly asked by parents to include environmental toxins among the possible causes of a child's ill health. Our results suggest that clinicians recognize their own need for further training in the principles of pediatric environmental health. Further research is needed in determining which modalities are best suited to achieve such educational objectives.