Pediatrician最新文献

Many systemic and congenital diseases include ocular manifestations. Some are primarily ocular in importance, while others have a multiple-organ spectrum. The specific entities are the more frequently encountered diseases in a hospital or pediatric office practice.

Occupational therapy in pediatric rehabilitation focuses on the effects of diseases and of the environment on a child's abilities to function successfully in daily life settings (home, school and playground) and roles (family member, student, etc.). In this paper, the process of pediatric occupational therapy, from assessment to discharge planning, is briefly described. Pediatric occupational therapy intervention strategies including treatment, environmental adaptation, and systems change are presented and illustrated. Three case studies highlighting occupational therapy intervention are discussed.

Caring for HIV-infected children under 13 years of age poses a serious and steadily increasing challenge to our society. Children with AIDS face devastating medical and psychosocial problems. Because of the unique implications for the entire family when a child is found to be HIV-infected, the health care profession is obliged to confront complex legal and psychosocial issues heretofore unparalleled in modern medicine. Decisions that concern schooling and daycare for the asymptomatic but HIV-seropositive individual are often influenced more by public frenzy than scientific information. Issues regarding reproductive choice and responsible parenthood are all confounded by debilitating and eventually fatal illness in infected parents. Problems of custody and foster care require innovative strategies to avoid further burden to an already stressed system. AIDS has become a disease for which research is standard of care. Access to experimental protocols is complicated by geographic location, public funding, and complexities of informed consent. The responsibility of the physician to an individual patient must be considered, and must be given its proper place within the broader responsibility to science and society.

Among the special moral concerns applicable to the management of HIV infection in childhood are those relating to consent, confidentiality and the child's rights to medical care and to opportunities for normal development. There may be conflicts of interest between the parents and the child both in connection with natural parents (mother-infant transmission) or with legal guardians, particularly when parental rights have been transferred to state agencies. Although the number of children with HIV infection or suffering from AIDS and its related conditions is small, there is a need for more understanding and for more comprehensive guidance about the ethical problems arising in this group of victims.

General psychosocial issues must be considered in facilitating the development of children with chronic illnesses and disabilities. A coping model and the developmental stages can be used as a framework to regard the impact of disabling conditions on children and the interventions that encourage psychosocial growth. Health professionals are encouraged to recognize the key role that they can play in promoting effective coping and growth for disabled children and members of their families and to incorporate psychosocial interventions into their practice.

Vision problems can interfere with the process of learning. However, vision problems are not the cause of learning disabilities. If a child or adolescent is diagnosed as having a learning disability, refraction and eye muscle function must be assessed. If no disorders are found or, if found and corrected, the treatment of choice for the learning disability is special education.

Studies measuring psychosocial outcome in children and adolescents have shown that head injury leads to cognitive impairment which is directly related to the severity of injury in those with very severe head injury. Psychiatric disorders are also related to the severity of injury but here the relationship suggests that mediating factors are involved. No specific pattern of post-traumatic psychological/psychiatric dysfunction emerges from the studies, but it is clear that, as with adults, psychosocial recovery lags behind physical. Head injury affects the functioning of the young person in the family, at school, and within the wider community, often resulting in a secondary handicap of low self-esteem. The multitude of deficits which are a consequence of severe head injury present a challenge for rehabilitation specialists. A multi-disciplinary, multi-specialist, and multi-agency response is required. As a result, families are often presented with a bewildering array of treatments and programmes at different agencies. A case manager can be helpful in ensuring the appropriate use of available resources and can be the one professional in charge of a coordinating case record.

Schedule-dependent sleep problems tend to increase as the youngster moves from middle childhood through preadolescence and into adolescence. This is partly because the youngster becomes more independent and parental control over both the selection of particular sleep schedules and the consistent maintenance of these schedules across weekends diminishes. Even accurate descriptions of the existing problem may become difficult to obtain. Nevertheless, specific syndromes are common and may be identified and treated. There may be increased demands at both ends of the sleep period leading to later bedtimes, earlier wakings, insufficient sleep, and daytime sleepiness. Periods of wakefulness confined to one portion of the night (beginning, middle, or end) may occur if sleep requirements are overestimated. Insomnia coupled with trouble waking may imply a circadian phase shift abnormality or a 'school-refusal' variant. And, variable sleep difficulties may be seen in a youngster with irregular schedules and poor sleep hygiene. Guidelines to the understanding, evaluation, and treatment of these syndromes are presented.