Pediatrician最新文献

Spinal cord injury results in dramatic disturbances of motor, sensory and autonomic function. Every aspect of a child's life is significantly and usually irreversibly altered. As a condition with low incidence and protean manifestations, the acute care and rehabilitation of spinal cord injured children requires the specialized care, knowledge and experience of a multidisciplinary team found in regional centers. Functional outcome depends on the level and completeness of the spinal cord injury, comprehensive training and education, and the skillful prescription of adaptive technology and aids. Long-term care and management by rehabilitation personnel in concert with the primary care pediatrician will ensure the maintenance of functional independence and general health.

Children's competence to consent to medical treatment is discussed in terms of basic principles of child development and central concepts in the consent process. Case examples are presented to highlight current problems relevant to children's consent in medical treatment which pediatricians are likely to encounter.

Eye and vision screening is a prototype preventative health measure. Increased knowledge of eye diseases in children and their treatment mandates much earlier screening than was recommended in the past. Advances in testing permit both the adoption of simpler and faster routine techniques and the application of more sophisticated and accurate screening methods. A thorough vision/eye screening at 6 months of age has been added to the previous examination schedule which only required screening at birth and again at 3.5-4 years of age. The simple scrutiny of the red fundus reflexes in the pupil with a direct ophthalmoscope (Brückner test) provides superior screening for vision, binocular alignment and pathology in infants. The difficult-to-master cover test and its variants can be abandoned for screening purposes. In screening preverbal children, simple optotype charts (HOTV) are proving more efficient than the traditional 'tumbling E' game. Color vision testing should be added to the preschool examination. Vision screening in infants can be enhanced where resources permit by using new preferential looking tests and by employing sophisticated electrophysiological testing. Photographic screening methods based on the red reflex hold considerable promise for more efficient screening of children.

Burns, the most devastating injuries known, are the second leading cause of nonvehicular accidental deaths. Approximately one-third of these deaths occur in children less than 16 years of age. In this age group, burns are the number one cause of accidental death in the home. Successful rehabilitation begins with skilled initial management.

Fluoride mouthrinses have been demonstrated in controlled clinical trials to reduce the incidence of dental caries in children by an average of 35%. This practice has been demonstrated to be a safe and effective adjunct to individual and public health preventive dental programs. The risks of fluoride mouthrinse use are primarily related to acute and chronic ingestion of fluoride, and acute ingestion of ethanol. These and other minor risks are easily controlled by adult supervision of mouthrinse use. Claims of allergic reaction or adverse behavioral reaction to food dyes in mouthrinses have not been substantiated. Recently, mouthrinses have been investigated as contributing to the risk of oral cancer, but results of retrospective studies are equivocal, especially in the light of the stronger confounding variables of alcohol consumption and tobacco use. Fluoride mouthrinses remain a safe and effective means of controlling dental decay.

The chronically ill child presents many difficult challenges for all health care providers, including dentists. With 10-20% of all children in the United States having one or more chronic diseases or impairments, the lack of availability and utilization of dental services for this population group has been described as catastrophic. Barriers to essential care include the medical problem itself, dental school curricula, economics, apathy, and a lack of coordination of services between physicians, allied health care providers, and dentists. A number of common chronic illnesses and their specific dental treatment ramifications and requirements are discussed in detail. A thorough understanding and utilization of this information are essential for maximizing the quality and quantity of life for these special patients.

During the last decades it has been convincingly demonstrated that mutants streptococci and lactobacilli are of etiologic importance in dental caries. The knowledge has been applied in several clinical studies and the results show that microbiological examinations can be valuable adjuncts in the diagnosis, treatment and prevention of dental caries. Although dental caries has declined considerably, some children still develop high caries activity. It is important that such children are identified and given preventive treatment before they develop rampant decay. In this context pediatricians play an important role and the new microbiological knowledge can be a valuable tool.

Most paediatric medicines are prescribed in a liquid form that includes sugar in the formulation. Accumulating evidence, on a clinical and experimental basis, shows a significant association between the intake of sucrose-based medication and an increased incidence of dental caries. Many of the children on long-term medication for chronic medical problems are particularly at risk from the consequences of developing dental caries; dental disease, sepsis or treatment procedures can put the general health or even life of the child at risk. The need to use sucrose in medications should be reassessed; medicines containing sugar should be labelled accordingly; and medical and dental professionals should be aware of potential problems related to sucrose-based medications.

The use of smokeless tobacco (ST) within the United States has increased greatly in recent years, especially among adolescent boys and young men. Recent national data completed from several large scale studies indicate that 10-12 million Americans use some form of ST. Representing a significant systemic and oral health risk, ST usage can produce a wide range of negative effects on both soft and hard oral tissues. These oral conditions include bad breath, discolored teeth and restorative materials, excessive tooth surface wear (abrasion), decreased ability to taste and smell, gingival (gum) recession, advanced periodontal soft and hard tissue destruction, tooth loss, soft tissue erythema and leukoplakia. Long-term ST usage is directly correlated to an increased risk of cancer of the mouth, larynx, throat and esophagus. Much of the destruction of oral tissues is related to the localization of the tobacco quid; i.e., it is habitually held in only one spot in the mouth. Nicotine from ST can activate the sympathetic nervous system thereby significantly increasing heart rate, blood pressure, cardiac stroke volume and output and coronary blood flow. A common misconception is that ST is a 'safe' alternative to smoking cigarettes. Several recent Surgeon General's Reports list ST as being addictive. It is highly possible that ST users will 'graduate' to cigarettes if they eventually conclude that these products are socially unacceptable, inconvenient or out of vogue. Health professionals, educators, parents and schoolchildren need to be informed about the significant health risks associated with ST use.