Characteristics and outcome of impacted button batteries among young children less than 7 years of age in China: a retrospective analysis of 116 cases

Background

Ingestion of button batteries occurs in about ten persons per one million persons each year, with most of them children, and one in every 1000 battery ingestions leads to serious injuries. This study aimed to describe the clinical features and outcome of ingestion or inhalation of button batteries in children spanning a decade from January, 2006 to December, 2016 at a tertiary care hospital.

Methods

We reviewed the clinical records of children who sought treatment for inhaled or ingested button batteries at our hospital during the study period. Data on gender, age, time from ingestion to treatment, site of impaction, imaging findings, and outcomes were retrieved and analyzed.

Results

We identified 116 pediatric cases of ingestion or inhalation of button batteries. Their mean age was 26 months. The time from ingestion or inhalation of button batteries to treatment was 0.5 hours to 2 weeks. Ninety-seven (83.6%) button batteries were located in the nasal cavity, 13 (11.2%) in the gastrointestinal (GI) tract including 6 in the esophagus, and 7 in the stomach and lower GI tract, and 6 (5.2%) in the auditory tract. Twenty-one (21.6%) children with nasal button batteries had preoperative septal perforations and one (1.0%) had postoperative septal perforation. One child with esophageal button battery developed esophageal stricture and one died of sudden cardiac arrest perioperatively. One child had auditory damages in the right tympanic membrane and ossicles.

Conclusions

Inhalation or ingestion may occur in the nasal cavities, the esophagus and GI tract and the auditory tract. Prompt diagnosis and treatment are required for a satisfactory outcome and ingested or inhaled button batteries require different treatment protocols.

     

Extraction of esophageal foreign bodies in children: rigid versus flexible endoscopy

Purpose

Foreign body (FB) ingestion is a common and potentially serious problem in children. Both rigid (RE) and flexible (FE) endoscopic techniques are used for removal of esophageal FBs; however, there is no consensus amongst pediatric surgeons regarding the best method. This study reviewed our experience managing esophageal FBs using both techniques.

Methods

A 12-year retrospective review of children admitted with an esophageal FB between 1999 and 2012 was undertaken. Clinical data, management techniques, and complications were abstracted. Differences between these two groups were compared with standard statistical methods.

Results

657 children were treated for esophageal FB ingestion, of which 366 (56 %) were treated with FE. The most frequently ingested item was a coin (84 %), and FBs were most commonly lodged in the upper third of the esophagus (78 %). There was a slightly younger population in the FE group (4.0 vs. 3.3 years, p < 0.01), but otherwise no significant differences were found between the groups. The FB was successfully removed with the initially chosen technique in 97 % of patients.

Conclusions

Esophageal FBs may be successfully removed with either RE or FE. Since treatment failures were managed with conversion to the other technique, both procedures should be included in the training curriculum.     

Pattern of Pediatric Dermatoses at a Referral Centre

Objective

To determine the pattern of skin disorders seen among children attending a Medical College Hospital, Bangalore

Methods

All children 18 y and below attending the Pediatric Dermatology OPD with skin diseases between the period of January 2011 and June 2011 were included in the study.

Results

A total of 1,090 new cases (boys 589; girls 501) with 1,118 dermatoses were recorded during this period. Twenty eight children had more than one dermatoses. Most of the disorders were seen between 5 and 11 y age group. The most common dermatoses was infections and infestations (32.47 %) followed by eczematous eruptions and dermatitis (20.66 %), papulosquamous and related disorders (6.08 %) and pigmentary disorders (5.81 %). Insect bite reactions and papular urticaria formed 5.1 %. Acne was seen in 5.28 % of children followed by urticaria (3.67 %), photodermatoses 2.5 % and genetic disorders (3.04 %).

Conclusions

In the present setting bacterial infections and scabies still remained the most common pediatric dermatoses followed by molluscum contagiosum and atopic dermatitis. Childhood psoriasis contributed to major part of the study among papulosquamous disorders.     

Idiopathic Hypereosinophilic Syndrome in Children: 3 Cases with Review of Literature

Objectives

To highlight the varied clinical manifestations and management of idiopathic hypereosinophilic syndrome, a rare disorder in children.

Methods

Retrospective review of case records of 3 patients who were diagnosed to have idiopathic hypereosinophilic syndrome (IHES) in a tertiary referral centre between 1997 and 2010 was performed. These 3 children presented with different symptoms and the first case had cardiac involvement. All had very high absolute eosinophil count (cells/mm³) 43,206, 9,082, 2,925, respectively. Diagnosis was confirmed by bone marrow biopsy in all three cases and supported by liver biopsy in the first two cases and inguinal lymphnode biopsy in the last case. All 3 children responded to treatment with steroids, with only second patient requiring hydroxyurea to control disease.

Results

Case 1 and 2 are on follow up for 13 y and 10 y respectively and both are asymptomatic. Case 3 expired due to sepsis 1 mo after diagnosis.

Conclusions

Treatment with steroids with or without hydroxyurea gave good response in all 3 cases. Hence, they still remain the gold standard for the treatment of IHES in children.     

A 5-Year Hospital Prevalence of Child and Adolescent Psychiatric Disorders from Central India

Objective

To examine the 5-year hospital prevalence of child and adolescent mental disorders from Central India.

Methods

Using systemic random sampling method, of the 4410 families screened, 4278 children (607 aged 0 to 3 y and 3671 between 4 to 16 y) attending outpatient services of department of pediatrics at the tertiary rural hospital from June 2006 through December 2010 were evaluated. Standardized appropriate psychometric tools were used for both groups. Diagnostic interviews were administered and DSM-IV diagnoses were determined by consensus between two psychiatrists. A comprehensive hospital registration system provided the denominator.

Results

Of the 4410 families screened, 4278 (97 %) of the subjects completed interviews. The overall prevalence of psychiatric disorders was found to be 20.8 %. Most common psychiatric disorders in group A were mental retardation (5.6 %) followed by epilepsy (2 %) whereas in group B, depressive disorder (3.73 %) were followed by non-organic enuresis (2.18 %) and ADHD (1.7 %). Eighty one percent of the parents from group A and 83 % of parents from group B of the children affected with psychiatric disorders and neurobehavioral problems had reported that they have had never thought of taking psychiatric consultation for their children.

Conclusions

The results of the study have helped in bridging and supporting the propositions in child epidemiology in India and also have implications for clinical training and practice.     

Clinical and Ultrasonographic Measurement of Liver Size in Normal Children

Objectives

To measure the normal range of dimensions of liver in children of various age groups and to compare the liver measurement obtained by palpation-percussion, auscultation and ultrasonography.

Methods

This was a cross-sectional comparative study in which 500 normal (weight for height between ± 2 SD of WHO standards for children aged less than 5 y and BMI between ± 2 SD of WHO standards for children aged more than 5 y) children (0–15 y) divided in 5 age groups (100 in each age group). Subjects were enroled from normal hospital delivery neonates, children visiting immunization and well baby clinics, children visiting outpatient and inpatient department with minor illnesses and healthy school children.

Results

The normal range of dimensions of liver in children were estimated and percentile tables of liver size were established. Though the measurements obtained by clinical methods were significantly (P?<?0.001) lower than those obtained by ultrasonography, there was a strong correlation between clinical and ultrasonographic measurement. Palpation-percussion method could estimate the liver size within ± 1.0 cm of what was obtained by ultrasonography in 88 % of cases. In more than half of the study children (54.2 %), this estimation was within ± 0.5 cm.

Conclusions

Clinical methods of liver span estimation strongly correlate with ultrasonographic measurement. The performance of palpation-percussion method is better than that of auscultation. Clinical methods should continue to be used for the estimation of liver size.     

Risk Factors for Incomplete Immunization in Children with HIV Infection

Objective

To document the immunization rates, factors associated with incomplete immunization, and missed opportunities for immunizations in children affected by HIV presenting for routine outpatient follow-up.

Methods

A cross-sectional study of immunization status of children affected by HIV presenting for routine outpatient care was conducted.

Results

Two hundred and six HIV affected children were enrolled. The median age of children in this cohort was 6 y. One hundred ninety seven of 206 children were HIV infected, nine were HIV exposed, but indeterminate. Fifty (25 %) children had incomplete immunizations per the Universal Immunization Program (UIP) of India. Hundred percent of children had received OPV. Ninety three percent of children got their UIP vaccines from a government clinic. Children with incomplete immunization were older, median age of 8 compared to 5 (p?=?0.003). Each year of maternal education increased the odds of having a child with complete UIP immunizations by 1.18 (p?=?0.008)-children of mothers with 6 y of education compared to those with no education were seven times more likely to have complete UIP vaccine status. The average number of visits to the clinic by an individual child in a year was 4. This represents 200 missed opportunities for immunizations.

Conclusions

HIV infected children are at risk for incomplete immunization coverage though they regularly access medical care. Including routine immunizations, particularly catch-up immunizations in programs for HIV infected children maybe an effective way of protecting these children from vaccine preventable disease.     

Tuberculin Skin Test, Chest Radiography and Contact Screening in Children ≤5 Y: Relevance in Revised National Tuberculosis Control Programme (RNTCP)

Objectives

To ascertain the status of Tuberculin Skin Test (TST) in the children aged 0–5 y who are household contacts of adults having sputum smear positive pulmonary tuberculosis and also to study the relationship of TST and Chest X-Ray (CXR) and their relevance in contact screening under RNTCP setup.

Methods

This prospective hospital based clinical study was conducted at a tertiary level referral medical college in Northern India. Study subjects were 200 children ≤5 y of age who were household contacts of adults with sputum smear positive pulmonary tuberculosis. All these adult index cases were registered and taking regular treatment at RNTCP centre attached to a medical college. Demographic data collection, detailed clinical history along with clinical examination, growth assessment, TST and chest radiography (CXR) was done for every child.

Results

TST was positive in 39 % children and out of these 68 % of child contacts had CXR findings suggestive of tuberculosis. This correlation was found to be highly significant (p?<?0.001), especially in children less than 1 y of age. A high percentage of clinically asymptomatic children also had positive TST and CXR consistent with definition of TB disease.

Conclusions

Contact screening must be prioritized in RNTCP. Unlike presently, TST and CXR should be actively employed in RNTCP for contact screening.     

Delivering Sprinkles Plus through the Integrated Child Development Services (ICDS) to Reduce Anemia in Pre-school Children in India

Objective

To assess the effectiveness of micronutrient powder (MNP) supplementation in reducing anemia levels in children aged 6 mo to 6 y in India.

Methods

Sixty sachets of MNP (Sprinkles Plus) were administered flexibly over a 4 mo period to 17,124 children at anganwadi centers or at home through Integrated Child Development Services (ICDS). Compliance was monitored using compliance cards and an assessment of mother’s recall at post-intervention survey. Hemoglobin was measured in separate random samples of 1,786 children before and 1,782 children after MNP supplementation.

Results

Mean compliance rate was estimated at 56.4 % (based on mother’s recall) and 91.7 % (based on compliance cards) for children who received MNP at home. Mean compliance was 96.9 % (based on compliance cards) for children who received MNP at anganwadis. A significant reduction in anemia (50 % to 33 % in boys; p-value?<?.000; 47.4 % to 34.2 % in girls) was seen following MNP supplementation.

Conclusions

Integration of a flexibly administered MNP supplementation into the ICDS is effective in reducing and treating anemia in children 6 mo to 6 y age.     

Variation in Bowel Habits of Healthy Indian Children Aged up to Two Years

Objective

To study the normal bowel habits of healthy Indian children up to 2 y of age.

Methods

This cross sectional study was conducted in medical college associated teaching hospital in Delhi. Ethical clearance was obtained from Institutional Ethical Committee. A total of 500 infants and toddlers up to 2 y of age were recruited for the study. Data were collected by interviewing parents of the eligible children who came for immunisation using pre designed Performa.

Results

There was steady decline in stool frequency with increasing age. Maximum decline in stool frequency was noted after 1 mo of age. Variation in stool frequency between children was maximum in 0–3 mo of age and decreased with increasing age. Stools at 4 wk were usually semiliquid, watery and semisolid. By 6 mo of age 55 % infants were passing semisolid stools and 40 % were passing formed stools. At 24 mo of age, 89.2 % children usually passed formed stools.

Conclusions

This is the first study in India to date documenting the frequency and consistency of the stools of young children. These results make an important contribution to defining normal stool patterns in young Indian children.     

Predictive factors for successful balloon catheter extraction of esophageal foreign bodies

Introduction

Foreign bodies in the esophagus are common in children. Time from ingestion to presentation is variable, and may not be known. Our center usually performs Foley catheter balloon extraction under fluoroscopy as the first step to attempt removal to prevent all patients from going to the operating room. The efficacy of this procedure has been reported. However, information is lacking about the relationship between presentation variables and the likelihood of success.

Methods

After IRB approval, we performed a retrospective single-center review from January 1988 to August 2011 of children with an esophageal foreign body. Pearson’s correlation was used to evaluate the relationship between variables and successful balloon extraction for P < 0.05. A logistic regression was done to evaluate for independence.

Results

819 patients presented with esophageal foreign bodies, with a mean age of 3.3 years. 572 patients underwent balloon extraction, 83 % successful. Mean ingestion duration was 16.6 h with fluoroscopy time of 2.3 min and mean number of attempts was 1.5. Successful balloon extraction had a negative correlation with refusal to eat, respiratory distress, cough, wheeze, upper respiratory infection symptoms, stridor, fever, duration of ingestion >1 day, unwitnessed ingestion, fluoroscopy time and number of balloon catheter attempts. There was a positive correlation between success and both age and duration of ingestion <1 day. Independent predictive factors were number of balloon catheter attempts.

Conclusions

Patients with longer duration of ingestion, symptoms from the foreign body and increased number of removal attempts have a decreased likelihood of success with balloon catheter extraction and should not undergo prolonged efforts of removal.     

Hepatitis A in Children- Clinical Course, Complications and Laboratory Profile

Objective

To study the course and complications of hepatitis A in children.

Methods

Seventy eight children diagnosed as acute viral hepatitis A by IgM antiHAV were prospectively studied for involvement of other systems and complications.

Results

The mean age of children was 7.85?±?3.4 y. Jaundice was present in all the patients as this was the inclusion criteria. Fever was present in 82.1 %, hepatomegaly in 98.7 % and splenomegaly in 39.7 %. More than 5 fold rise in Aspartate transaminase (AST) and Alaninetransaminase (ALT), were seen in 62 cases (79.5 %) and 55 cases (70.5 %) respectively. Coagulopathy (Prothrombin time INR > 1.5) was observed in 12 cases (15.4 %) and abnormal APTT in 10 cases (12.8 %). Thrombocytopenia was observed in 5.1 % of children and 8.9 % had more than 2 hematological abnormalities. Ascites was noted in 35 cases (44.9 %), gallbladder wall thickening in 32 cases (41 %) and pleural effusion in 11 cases (14.1 %). Acute renal failure, acute glomerulonephritis and acute pancreatitis were present in 1 case (1.3 %) each. Raised CK-MB values more than 3 times the normal was noted in 5 cases (6.4 %). On follow up, most of the children recovered completely by 2 mo and prolonged cholestasis was observed in 2 of them. In the present study mortality was 1.3 % and it was attributable to fulminant hepatic failure.

Conclusions

Eventhough hepatitis A infection is a self-limiting disease, extrahepatic manifestations and mortality are not uncommon. All cases should be followed up till complete recovery and only a strong index of suspicion will enable us to recognize the complications.     

The Unforeseen Toll of Birth Defects and their Economic Burden at a Tertiary Care Public Institute in Mumbai

Objectives

To determine the proportion of patients with birth defects receiving indoor medical care and the economic burden incurred by the Institution in terms of cost of hospitalization.

Methods

This single center, prospective, observational study recruited children >28 d and <12 y of age with birth defect(s) not attributable to an acquired disease. Demographic data, maternal and antenatal data, nature of the defect and information about current and past hospitalization were recorded. Economic burden was estimated by computing bed charges and daily costs incurred by the Institution.

Results

Ninety-eight children (mean age was 3.18 y, M : F ratio was 2.4:1) with 268 birth defects represented 13 % of indoor admissions. The cardiovascular system was involved in 42.9 %. The defect was isolated in 58.2 % of cases and 41.8 % (9.2 % having Down syndrome) had multiple defects. Mean duration of hospital stay (11.23 d) of the birth defect cohort was significantly more (p value?=?0.0005) than other children (7.81 d). Average cost of stay for those with birth defects (18.3 % of the total cost) and other indoor patients was INR 23,481 and INR 16,328 respectively.

Conclusions

Birth defects are an emerging burden in referral centers, incurring one-fifth of the hospital expenditure, partly due to increased length of stay. The figure is an underestimate as the expenses are highly subsidized in a Public health facility.     

Pheochromocytoma Management,Outcomes and the Role of Cortical Preservation

Objectives

To evaluate the management and outcome of children with pheochromocytoma and determine the role of cortex preservation in cases of bilateral disease.

Methods

Retrospective review of children, below 12 y of age, with pheochromocytoma managed between November 2003 and December 2012 was done.

Results

Twelve patients, nine boys and three girls with median age 9 y were enroled. Eleven (92 %) had adrenal tumors and in one it was extra-adrenal. Five (42 %) had bilateral disease. Ten presented with hypertension, one with headache and one with abdominal pain and fever. All were stabilized pre-operatively with alpha and beta blockers and volume expansion. Six children with unilateral disease underwent total adrenalectomy. Out of five with bilateral disease, one child underwent bilateral total adrenalectomy and was later started on hormone replacement. Remaining four underwent total adrenalectomy on one side and partial on the other side. Post-operatively all became symptom free and normotensive and were off medications within 1 mo. Two children developed recurrence 1 mo post-operatively, one with an initial unilateral pheochromocytoma and one with paraganglionoma. At the last follow up, 10 out of 12(83 %) were disease free while two with recurrence are still awaiting surgery.

Conclusions

Surgical resection of pheochromocytoma is effective treatment to achieve cure and prolong survival. Cortex preservation should be done in bilateral disease as risk of recurrence in such cases seems to be of lesser significance as compared to the morbidity and mortality of adrenal insufficiency and consequent lifelong hormone replacement.     

Indian Children with Developmental Disabilities: Early versus Late Referral for Intervention

Objective

To study the age at referral, of children with neurodevelopmental disabilities to Child Development and Early Intervention Clinic and compare the neuromorbidity and socio-economic profile of the early and late presenters.

Methods

This retrospective observational study was conducted at Child Development and Early Intervention Clinic (CDEIC) located in Northern India. Case records of children enroled at CDEIC in last 5 y; with neurodevelopmental disabilities namely Mental Retardation/Global Developmental Delay, Cerebral Palsy, hearing and vision impairment were separated and studied.

Results

Two thousand and twenty cases were included in this study. 62.8 % presented before 3 y of age (early presenters) and 37.1 % presented at 3 y or more (late presenters). There was no difference in the overall rates and severity of mental retardation in early and late presenters. The proportion of children with quadriparetic cerebral palsy, hearing impairment, vision impairment and multiple disabilities was significantly more in early presenters. The early presenters had better parental education status, less number of siblings, better immunization status and more were delivered at a hospital and residing in urban areas.

Conclusions

Large numbers of children with neurodevelopmental disabilities are referred late for intervention services, leading to loss of opportunity for early intervention. Children with purely mental disability are the ones, most likely to be referred late. Socio-economic differences are significantly contributing to these delayed referrals.     

Prevalence and Pattern of Congenital Heart Disease in Uttarakhand, India

Objective

To find the prevalence and pattern of congenital heart disease (CHD) at a tertiary care hospital in Uttarakhand, India.

Methods

A thorough history and clinical examination was done for all the live births and children up to 18 y of age who presented to the institute over a period of 3 y from July 2008 through June 2011. Those suspected of having a CHD, were further evaluated with ECG, chest radiography and the diagnosis was confirmed by color Doppler echocardiography.

Results

Of the 36541 children examined, 312 were identified as having congenital heart defects, thus giving a prevalence of 8.54 per 1000 children attending hospital. Only one fifth cases were diagnosed in neonatal period and the diagnosis was delayed beyond infancy in more than half of the cases. Ventricular septal defect (30.45%), atrial septal defect (17.63%), patent ductus arteriosus (9.62%), pulmonary stenosis (6.41%), tetralogy of Fallot (5.45%) and transposition of great arteries (5.13%) were the commonest defects observed. Only 9.29% of children with CHD underwent definitive treatment.

Conclusion

The prevalence of CHD at a tertiary referral hospital in Uttarakhand India is 8.54 per 1000 children. VSD and TOF are the most common acyanotic and cyanotic congenital heart defects respectively.     

Risk Factors for Severe Acute Malnutrition in Children below 5 y of Age in India: A Case-Control Study

Objective

To determine the possible risk factors for severe acute malnutrition (SAM) in children below 5 y admitted in a hospital in north India.

Methods

This case-control study was conducted in a medical college hospital in children below 5 y of age. All cases of SAM (diagnosed as per WHO definition) between 6 and 59 mo of age were compared with age-matched controls with weight for height above -2SD of WHO 2006 growth standards. Data regarding socio-demographic parameters, feeding practices and immunization were compared between the groups by univariable and multivariable logistic regression models.

Results

A total of 76 cases and 115 controls were enrolled. Among the 14 factors compared, maternal illiteracy, daily family income less than Rs. 200, large family size, lack of exclusive breast feeding in first 6 mo, bottle feeding, administration of pre-lacteals, deprivation of colostrum and incomplete immunization were significant risk factors for SAM. Regarding complementary feeding, it was the consistency, rather than the age of initiation, frequency and variety which showed a significant influence on occurrence of SAM. Multivariate analysis revealed that the risk of SAM was independently associated with 6 factors, namely, illiteracy among mothers, incomplete immunization, practice of bottle feeding, consistency of complementary feeding, deprivation of colostrum and receipt of prelacteals at birth.

Conclusions

The present study identifies certain risk factors which need to be focused on during health planning and policy making related to children with SAM in India.     

Nutritional Status and its Correlates Among Tribal Children of Melghat,Central India

Objective

To find out the magnitude and epidemiological determinants of malnutrition among 0–6 y tribal children.

Methods

A community based cross sectional study was done in the villages of Melghat in central India. The information of 540 children in the age group 0–6 y was collected. The newly developed WHO growth standards were used to calculate conventional indices of malnutrition (underweight, stunting and wasting) and composite index of anthropometric failure (CIAF). Univariate and multiple logistic regression analysis were used to find out the correlates of malnutrition.

Results

The prevalence of malnutrition among these tribal children in terms of underweight, stunting, and wasting were 60.9 %, 66.4 % and 18.8 % respectively. Malnutrition in terms of composite index of anthropometric failure (CIAF) was 76.3 %. The important correlates of malnutrition that emerged out of this study were the age of child, age of mother less than 20 y at her first pregnancy, practice of not feeding colostrum, calorie deficit diet, anemia and morbidities like diarrhea and acute respiratory illnesses.

Conclusions

The prevalence of malnutrition was high in tribal children. The health care delivery at village level should be strengthened for early diagnosis and prompt treatment of anemia and other morbidities in children. The strategies are needed to delay the child bearing age in this community and improve breast feeding practices.     

Serotype Determination of Adenoviruses in Children with Respiratory Infection

Objective

To determine adenovirus serotypes among children with acute respiratory infection (ARI) in Khoozestan province, Iran during years 2010–2011.

Methods

One hundred sixty three nasopharyngeal swabs were collected from children between 1 and 15 y who were hospitalized for the acute respiratory infection. The viral DNA was extracted from the nasopharyngeal swabs and adenoviruses were detected by Nested PCR. Positive PCR samples were sequenced in order to confirm the adenovirus serotypes.

Results

Out of 163 samples, 30 (18.4 %) were positive for adenoviruses by nested PCR. Twenty two PCR products were sequenced and recognized as Ad5 and Ad2 serotypes including 19 (86.3 %) Ad5 and 3 (13.7 %) Ad2.

Conclusions

This study reveals that adenoviruses with Ad5 predominance are important cause of respiratory tract infection in children.     

Social Impact of Dialysis on Children and Their Families

Objectives

To evaluate the social consequences of dialysis on children and their parents.

Methods

From January through June 2012 short structured interviews with parents or caregivers of children on peritoneal dialysis (PD) or hemodialysis (HD) who were followed up at King Abdulaziz University Hospital, King Faisal Specialty Hospital and Research Center, or the Kidney Center at King Fahad Hospital were conducted. Data were analyzed using the Statistical Package for the Social Sciences.

Results

Thirty six children (22 boys and 16 girls) and their families were included. The mean (SD) age of the children was 11.5?±?6.87 y, and the mean (SD) duration of dialysis was 28?±?11.32 mo. Only one third of the families had the opportunity to choose the modality of dialysis. Both modalities of dialysis had a negative effect on fathers’ jobs in over 50 % of the cases. Similarly, both modalities of treatment had a considerable impact on the quality of care provided by the mothers to other family members. There was no difference between the two modalities on the frequency of admissions.

Conclusions

Both PD and HD had a negative impact on fathers’ jobs and on the level of care provided by mothers to the rest of the family.