Nailbiting

Nailbiting is a common oral habit in children and young adults. It is estimated that 28 to 33% of children between the ages of 7 to 10 years and 45% of adolescents are nailbiters. The etiologies suggested for nailbiting include stress, imitation of other family members, heredity, a transference from the thumb sucking habit, and poorly manicured nails. Nailbiting is usually confined to the fingernails and most nailbiters bite all 10 fingers equally rather than selectively. Complications of nailbiting include damage to the cuticles and nails, secondary bacterial infection and dental problems. Treatment should be directed at any precipitating causes of stress. Reminders should only be used with the consent of the child. Care of the nails and cuticles, behavioral modification techniques, positive reinforcement, and regular follow-up are important aspects of treatment. Nailbiting, or onychophagia, is defined as the habit of biting one's nails and is a common oral habit in children and young adults. Nailbiting is embarrassing, unattractive, socially undesirable, and can predispose to the development of paronychia. Physicians are frequently consulted about nailbiting but not withstanding the prevalence of the problem, there is a surprising lack of literature on nailbiting. The purpose of this article is to familiarize the reader with the problem and to suggest appropriate approaches to treatment.     

Rectal adenocarcinoma following cranio-spinal radiotherapy for cerebellar medulloblastoma

The authors present a case of a 16-year-old female diagnosed with rectal adenocarcinoma 10 years after receiving cranio-spinal radiotherapy for a cerebellar medulloblastoma. While the risk of a second malignancy is recognised to be increased in children previously treated with radiotherapy, rectal adenocarcinoma is a rare presentation. A child presenting with symptoms of weight loss and a change in bowel habit in a patient who has previously received radiotherapy should alert practitioners to the possibility of a colorectal malignancy.     

Constipation/encopresis: a nursing perspective

Constipation/encopresis is a common pediatric problem. The purpose of this article is to describe this problem that has a tremendous negative impact on both child and family and to present a plan of care that has been used successfully with more than 2000 children. This treatment program involves clearing the impaction, using medication to overcome stool withholding, and establishing a regular bowel habit to keep the problem from returning. A knowledgeable, sensitive nurse practitioner usually can manage this problem independently and can greatly improve the quality of life of these children.     

SLEEP BEHAVIOUR STUDIED LONGITUDINALLY

ABSTRACT. Data on sleep behaviour have been extracted from a prospective longitudinal study of growth in a random sample of, originally, about 200 children, with annual examinations. The purpose was to assess to what extent data at 4 years on duration of sleep, night-awakening and habitual sharing of the parents'bed can predict conditions in these respects at 8, 12 and 16 years. The predictive power is slight in general concerning the first two variables, while the habit of sharing the parents'bed is rather more difficult to shake off, above all when the child has reached school age (6–7 years in Sweder).     

Antibiotic use in community-based pediatric outpatients in southern region of Brazil

The irrational use of antibiotics is incriminated for the escalating antimicrobial resistance problem worldwide. This cross-sectional survey was conducted to describe patterns of antibiotic use in community-based pediatric outpatients in the southern region of Brazil. A sample of children (29 days to 18 years of age) was selected from each community-based outpatient clinic. Information related to antibiotic use in the child was obtained by interview with their parents using a structured questionnaire. Of 489 children, 201 (41.1 per cent) had received at least one antimicrobial course in the previous 2 months. The most commonly prescribed antibiotic was amoxicillin (54.0 per cent) and broad-spectrum agents were used in 15.3 per cent of antimirobial courses. Acute respiratory infections were the most frequent diagnosis for antibiotic prescribing (91.2 per cent), but at least 39.5 per cent were conditions of presumed viral etiology. Antibiotic use in the previous 2 months was more likely in children younger than 2 years (PR 1.36, 95 per cent CI 1.10-1.69); with chronic diseases (PR 1.38, 95 per cent CI 1.10-1.75); with higher paternal education level (PR 1.38, 95 per cent CI 1.11-1.72); with parents' pressure on physician for antibiotics (PR 1.66, 95 per cent CI 1.05-2.64) and with parental self-prescribing habit (PR 1.47, 95 per cent CI 1.06-2.04). Antibiotic use in children increased with mother's age (p=0.03 for linear trend). In conclusion, antibiotic prescribing is very common in community-based pediatric outpatients in the southern region of Brazil and inappropriate use is frequent. The independent risk factors for antibiotic use are child's age under 2 years, the presence of chronic diseases in the child, older mother, higher paternal education level, parents' pressure on physician and parental self-prescribing habit.     

Association between household conditions and diarrheal diseases among children in Turkey: A cohort study

BACKGROUND: This aim of the present study was to estimate the frequency of diarrheal diseases among children as well as investigating the relationship between diarrheal diseases and household conditions and other factors. METHODS: The study was performed over 12 month period in Binevler Health Center, Gaziantep, Turkey. Five health stations were selected by using a sampling technique with probability proportional to size, and all households with children under the age of 5 years were visited. A questionnaire on diarrhea, household conditions, socioeconomic status of the family and individual characteristics of the children was applied to the mothers by doctors. Three composite indices, including household conditions, socioeconomic status of the family and individual status of the children, were prepared and a classification was made as good, mild or poor in order to better evaluate the results of the study. Daily recordings of diarrheal disease symptoms were made by the parents and these records were collected every month for 1 year. RESULTS: The annual mean incidence of diarrheal diseases was found to be 1.09 per child per year (median = 1). The mean was higher in children with poor household conditions (1.48 +/- 0.12) and with poor individual status (1.48 +/- 0.14), compared with good household conditions (0.76 +/- 0.07) and good individual status (0.71 +/- 0.08). The mean was also higher in children aged between 6 and 11 months (1.51 +/- 0.18), whose father graduated from primary school or lower (1.34 +/- 0.09) and with parents having no habit of washing their hands before taking care of the child (2.00 +/- 0.33). Person-month and case-month incidence rates of diarrhea were calculated to be 8.56 and 9.12%, respectively. CONCLUSIONS: Household conditions, individual status, age, education level of fathers and parents' habit of washing hands before taking care of the child were major factors affecting the incidence of diarrhea.     

Socio-demographic associations with digit and pacifier sucking at 15 months of age and possible associations with infant infection. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood

AIMS: To assess the prevalence of pacifier and digit sucking at 15 months of age and to investigate whether this habit adversely affects the health of 18 month old infants. STUDY DESIGN: Data collected via self-completion questionnaires from mothers forming part of the prospective, population based Avon Longitudinal Study of Pregnancy and Childhood. SUBJECTS AND METHODS: The mothers of 10006 infants gave information on their child's use of a pacifier and of digit sucking at 15 months of age and the presence of specific health symptoms at 18 months of age. Adjusted logistic regression was performed to identify any statistically significant associations between pacifier use, digit sucking or a combination of the two with possible infection. RESULTS: 36.3% of infants sucked a pacifier, 21. 3% their thumb or finger and 2.7% sucked both at 15 months. Statistically significant differences were observed among various socio-demographic variables. Mothers were more likely to give their child a pacifier if they were younger, had lower levels of education, experienced greater financial difficulties or lived in council housing (compared to owned/mortgaged). The opposite was apparent for digit suckers. After allowing for these possible confounding factors, pacifier users had a higher incidence of earache and colic compared to children with no sucking habit, however digit suckers had a lower incidence of these symptoms. Children who sucked both were significantly more likely to have reported wheezing, earache, and poor health in the past month. CONCLUSIONS: Significantly different sociodemographic characteristics were observed with pacifier suckers compared to those who sucked their thumb or finger. It is almost impossible to attribute the direction of causality between infection and a sucking habit. Further and more detailed studies are needed before any recommendations can be made based on the statistically significant associations found as they are unlikely to be of major clinical significance.     

The global obesity epidemic: snacking and obesity may start with free meals during infant feeding

Feeding is vital for survival. The brain has strong hunger and reward mechanisms that ensure optimal food intake for adequate nutrition. The drive for feeding is particularly strong in humans whose large brains require large energy support. This starts immediately after birth; the newborn child being able to taste sucrose and suck the sweet and fat from its mother's milk. At present, mothers are generally advised to breastfeed children as often as they like, which may be up to 15 times a day. At the same time, childhood obesity is rapidly developing. One reason for the rapidly increasing prevalence of childhood obesity may be overfeeding with snack food.

Conclusion: We hypothesize that non-rule breastfeeding favours the development of snacking throughout the day during childhood, a habit which in turn favours the development of obesity.     

Habit cough in children

Cough is one of the most common presenting complaints in childhood. Chronic cough has many possible causes, and this symptom often results in extensive investigations, treatments and anxiety. Habit (habit-tic) and somatic cough disorder (also known as psychogenic cough) is one of the more common underlying diagnoses eventually reached. Habit cough often follows an upper respiratory infection. It is a dry, repetitive, honking, disruptive cough. Characteristically, habit cough usually reduces with distraction, and disappears in sleep. A good detailed history and physical examination, coupled with (normal) basic investigations will usually suffice in diagnosing habit cough – it is important to avoid extensive investigations and unnecessary treatments. However, it is also imperative to note that some children may have both pathological and habit or psychogenic cough. The mainstay of management of habit cough is education and addressing any underlying psychosocial stressors. Various forms of psychotherapies and physiotherapies (cough suppression techniques) have been shown to be effective. With intervention, most children with habit cough will achieve complete resolution, or at least improvement in symptoms. This short article is aimed at healthcare professionals working with children and gives practical advice about investigation and management of suspected habit cough in children and young people.     

Non-nutritive suckling and use of pacifiers

One hundred and sixteen infants and children with normal development were studied for their non-nutritive suckling habit with special reference to pacifier suckling. The use of pacifier was more common among the lower socio-economic group (83.6%) and those residing in slums (58.6%). In 88.7% of cases it was the mother, family member, friend or relative who was responsible for introduction of pacifier to the baby with the aim to soothe the child. The other indications for use of pacifier were to facilitate dentition (60.0%) and nutritive function (18.1%). The use of pacifier in most of the cases was associated with chronic diarrhea (86.2%), respiratory illnesses (52.5%) and pica (10.2%). Defective dentition was noted only in 5.1% of children. The medical/paramedical staff were against the use of pacifiers.     

Urination and urinary tract infections in girls. 1. The pathogenetic significance of functional urination disorders

About 400 girls with non-obstructive urinary tract infection were submitted to special care for at least one year, mostly considerably longer, however. Being searched for functional micturition disturbances, more than one-half of them showed a habit of delaying the micturition until imperative desire to urinate. Girls with this habit had clearly more relapses of UTI than those voiding regularly.     

Developmental aspects of child care

As increasing numbers of women have entered the labor force, increasing numbers of children, particularly infants and toddlers, have become active participants in child care. Research and opinion regarding the effect of child care on infant emotional and social development is conflicting. Most infants in child care are securely attached to their parents; however, there is an increased risk of insecure attachment in infants in child care when compared to infants in home care. Participation in child care has been associated with both positive and negative outcomes in relation to social development. High-quality child care is associated with improved child outcome. The quality of child care can be assessed by characteristics such as low child-to-staff ratio, small group size, and training of child care providers. Families are in need of a greater variety of options to meet goals of economic stability and child rearing. It is the role of the pediatrician to monitor child well-being, to objectively advise parents as consumers of child care, and to encourage the availability of high-quality care to all children.     

Promoting Healthy Childhood Behaviors With Financial Incentives: A Narrative Review of Key Considerations and Design Features for Future Research

In the last decade, there has been a robust increase in research using financial incentives to promote healthy behaviors as behavioral economics and new monitoring technologies have been applied to health behaviors. Most studies of financial incentives on health behaviors have focused on adults, yet many unhealthy adult behaviors have roots in childhood and adolescence. The use of financial incentives is an attractive but controversial strategy in childhood. In this review, we first propose 5 general considerations in designing and applying incentive interventions to children. These include: 1) the potential impact of incentives on intrinsic motivation, 2) ethical concerns about incentives promoting undue influence, 3) the importance of child neurodevelopmental stage, 4) how incentive interventions may influence health disparities, and 5) how to finance effective programs. We then highlight empirical findings from randomized trials investigating key design features of financial incentive interventions, including framing (loss vs gain), timing (immediate vs delayed), and magnitude (incentive size) effects on a range of childhood behaviors from healthy eating to adherence to glycemic control in type 1 diabetes. Though the current research base on these subjects in children is limited, we found no evidence suggesting that loss-framed incentives perform better than gain-framed incentives in children and isolated studies from healthy food choice experiments support the use of immediate, small incentives versus delayed, larger incentives. Future research on childhood incentives should compare the effectiveness of gain versus loss-framing and focus on which intervention characteristics lead to sustained behavior change and habit formation.     

The compelling case for seat belts on school buses

The ability of seat belts to reduce injuries and fatalities in vehicular accidents has been established beyond question. Nevertheless, most school buses are not equipped with seat belts. The available evidence shows that seat belts would provide added safety for our children in school buses, just as they do in the family car. Moreover, the use of seat belts on school buses would foster a lifelong habit of seat belt use. By exerting their considerable influence in the community, physicians can contribute a great deal to the nationwide campaign to require the use of seat belts on school buses. If this campaign is successful, not only will our children ride their school buses in greater safety, but a whole generation of young Americans will learn a habit that is known to reduce drastically the number of tragic highway injuries and deaths.     

Habit strength of physical activity and sedentary behavior among children and adolescents

Internal reliability, convergent validity, and construct validity of the Self-Report Habit Index (SRHI) were examined with respect to physical activity (Study 1) and sedentary behavior (Study 2) among children and adolescents. Internal reliabilities of the SRHI proved to be high in both studies. The SRHI correlated significantly with behavioral frequency measures, as well as with known cognitive associates of these behaviors. Moreover, theory-based moderating influences of habit on the attitude-intention and intention-behavior relationships were identified. The study provides early evidence to support the concept of habit as being important in dealing with physical activity in children.     

Urination habits and urinary tract infections in girls. 3. Dependency of therapy results from length of therapy and from urination habits

Urinary tract infections in girls are promoted by abnormal micturition habit. Aside from applying antibiotics, the training of voiding discipline is very important for UTI prevention. The duration of medicamentous prevention should pay regard to the behaviour of micturition.     

Diet, physical inactivity and the prevalence of constipation throughout and after pregnancy

Few studies appear to have investigated the prevalence of constipation for all three trimesters of the gestative period, or indeed after birth. Using a prospective 4- to 7-day weighed food diary, International Physical Activity Questionnaire and 7-day bowel habit diary, dietary factors, physical activity levels and bowel habit parameters were assessed and examined concurrently at weeks 13, 25, 35 of pregnancy and 6 weeks post-partum. Ninety-four primiparous pregnant women were initially recruited, and 72, 59, 62 and 55 completed the first, second, third trimester and post-partum study stages, respectively. Key dietary factors and physical activity levels were compared between the constipated and non-constipated groups from each of the three trimesters and after parturition. Compared with non-constipated mothers-to-be, constipated participants consumed statistically significantly less water in the first trimester (P = 0.04), more food in the second trimester (P = 0.04), and less iron (P = 0.02) and food (P = 0.04) in the third trimester and after birth, respectively. No statistically significant differences were identified between light, moderate and vigorous physical activity levels when groups were compared. This study demonstrates that dietary factors may play a role in terms of preventing, or alleviating, bowel habit perturbations both throughout and after pregnancy. Further research is required to investigate the interrelationship between physical activity and constipation during and after pregnancy.     

Responding to Child Maltreatment: a Framework for Mapping Child Protection Agencies

While there is a growing number of international population surveys about rates of child maltreatment there is much less data on legal, health and social services responses to maltreatment. Agency surveys are a cost effective method for assessing this response in countries where there is limited administrative data available about child maltreatment reports, investigations and services. The first step in conducting such survey is to map out the network of agencies and organizations tasked with responding to child maltreatment, as part of a multi-stage sampling strategy to identify a representative sample of child maltreatment reports and investigations. This endeavor can be complex as a diverse universe of agencies are involved in protecting victimized children and supporting their families—government-run child protective services, child protection teams at hospitals, not-for-profit helplines, psychotherapists at private practices, and community-based child welfare organizations, to name a few examples. This paper offers a framework for mapping child protection along the dimensions of levels of authority, functions and processes. Beyond high-income countries with well-established child protection systems, it gives special consideration to informal structures such as councils of community leaders and non-governmental organizations’ consortiums in low-income countries.     

Beyond Bellagio: addressing the challenge of sustainable child health in developing countries.

Despite the hype and ostensible investments in child survival strategies, the state of child health in much of the developing world is alarming. Not only are global investments and support programmes for child health by the development agencies declining, but commensurate support for maternal and child health by poor countries themselves is poor. In order to make a meaningful contribution to maternal and child health and survival, a multi-pronged approach is needed which not only focuses on the proximal determinants of child health but also some of the underlying factors governing the status of women in society and expenditures on health and development.     

Beyond Bellagio: addressing the challenge of sustainable child health in developing countries

Despite the hype and ostensible investments in child survival strategies, the state of child health in much of the developing world is alarming. Not only are global investments and support programmes for child health by the development agencies declining, but commensurate support for maternal and child health by poor countries themselves is poor. In order to make a meaningful contribution to maternal and child health and survival, a multi-pronged approach is needed which not only focuses on the proximal determinants of child health but also some of the underlying factors governing the status of women in society and expenditures on health and development.