Diagnosis and outcome of Hirschsprung’s disease: does age really matter?

Although Hirschsprungs disease (HD) typically presents in the newborn period, it is often diagnosed in older children, in whom the presentation and management remain poorly defined. We hypothesized that older patients with HD have a milder variant of the disease with an improved prognosis compared with those diagnosed earlier. Children with HD (1995–2001) were divided into Group I (diagnosis before 30 days) and Group II (after 30 days). Patients with total colonic disease were excluded. There were 66 patients; 47 in Group I and 19 in group II. Mean age at diagnosis was 7.1±1.3 days (range 1–30 days) versus 27±10 months (1.3 months–19 years). Older children differed mainly in the symptoms at presentation and the length of the involved segment of aganglionosis. Surgical strategies were applied equally in both groups. Complications, including postoperative enterocolitis, occurred equally, but the length of stay and costs were lower in Group II. The delayed diagnosis of HD does not worsen outcomes of older children with HD. This finding implies that these children have a milder form of the disease, perhaps because of adaptation to the aganglionic state.     

Comparative validity assessment of five activity monitors: does being a child matter?

The purpose of this study was to determine the effects of age and leg length on the energy-expenditure predictions of five activity monitors. Participants (N=86, ages 8-40 years) performed three progressive bouts of treadmill activity ranging from 4 to 12 km/hr. Differences between measured energy expenditure (VO2) and activity-monitor-predicted energy expenditure were assessed across five leg length categories to determine the influence of leg length. Accelerometer counts or pedometer steps along with age, weight, and leg length accounted for 85-94% of measured energy expenditure. The addition of age and leg length as predictor variables explained a larger amount of variance in energy expenditure across all speeds. Differences in leg length and age might affect activity-monitor validity and, therefore, should be controlled for when estimating physical activity energy expenditure.     

Child maltreatment trends in the 1990s: why does neglect differ from sexual and physical abuse?

Substantiated cases of child maltreatment have declined more than 20% since a peak in 1993. However, although sexual abuse and physical abuse showed significant declines during the 1990s (47% and 36%, respectively), neglect fluctuated, with only a small overall decline during this period (7%). Available data suggest that at least part of the declines in sexual and physical abuse is likely to be real. Some evidence also suggests that a decline in neglect may have been masked in some states. Possible sources for declines in child maltreatment include direct prevention efforts, economic improvements, more aggressive criminal justice efforts, dissemination of psychiatric medication, and generational changes. Public health models suggest that population-level prevention initiatives are the most promising options for further reducing maltreatment rates. However, better epidemiological and evaluation research will be needed to identify the key factors.     

Substitute care in child welfare and the risk of arrest: does the reason for placement matter?

This study sought to investigate whether the reason for placement was associated with the subsequent risk of arrest. The author has focused on youth entering care for reasons of maltreatment and for child behavioral problems. The author stratified the sample based on a history of juvenile delinquency. The sample was diverse and included youth between 8 and 16 years of age with at least one episode in a substitute care child welfare setting (n = 5,528). Approximately 23% of youth were placed in child welfare for reasons others than maltreatment; specifically child behavioral problems. Youth placed for behavioral problems were significantly more likely to live in congregate care facilities, experience placement instability, and more likely to experience at least one arrest. A prevailing argument is that child welfare offers a broader range of family-based services as compared with the secure settings of juvenile justice. High rates of congregate care placement reported in the current study indicate that family-based services are infrequently associated with youth placed for behavioral problems in child welfare. High rates of subsequent arrest indicate that the congregate care approach for youth with behavioral problems in child welfare is limited.     

Ankyloglossia: does it matter?

Ankyloglossia is an uncommon oral anomaly that can cause difficulty with breast-feeding, speech articulation, and mechanical tasks such as licking the lips and kissing. For many years the subject of ankyloglossia has been controversial, with practitioners of many specialties having widely different views regarding its significance. In many children, ankyloglossia is asymptomatic; the condition may resolve spontaneously, or affected children may learn to compensate adequately for their decreased lingual mobility. Some children, however, benefit from surgical intervention (frenotomy or frenuloplasty) for their tongue-tie. Parents should be educated about the possible long-term effects of tongue-tie while their child is young (< 1 year of age), so that they may make an informed choice regarding possible therapy.     

ADHD: does parenting style matter?

Attention deficit hyperactivity disorder (ADHD) is a condition typically arising in childhood, which untreated, can have consequences reaching into adolescence and beyond. Effective pharmacological treatment is available and has become widespread in the West. Outcomes for both the child with ADHD and the parent may be influenced by the nature of interaction between them. The authors of this article aim to review published research examining the interaction between parents and their children with ADHD. A PubMed search was conducted of studies written in English between 2000 and 2007 with the keywords ADHD and parenting. Child ADHD elicits high levels of parental stress and maladaptive parenting. The presence of parental psychopathology is common and influences the parent's response to the child's ADHD symptoms. Optimizing parent-child interaction and parental psychiatric status may improve outcomes for both parent and child.     

Infant mandibular fractures: are you considering child abuse?

Mandibular fractures in infants are rare and difficult to detect. Causes include motor vehicle accidents, falls, and physical abuse. Historical, physical, and imaging aids to diagnose mandibular fractures and to differentiate abuse from accident are discussed. Three-dimensional computed tomographic scans are the preferred method of imaging. In addition, a thorough workup for physical abuse is needed.     

Apparent life-threatening event or child abuse?

Children with apparent life-threatening events (ALTEs) often pose a diagnostic and management dilemma in a pediatric emergency department. Although the term ALTE is nonspecific and symptoms are vague, it may have alarming connotations and may signal serious life threatening conditions. It may be a subtle presentation of child abuse. We report an infant who was presented with an ALTE and subsequently determined to have subdural hematoma caused by nonaccidental injury.     

Which injuries may indicate child abuse?

Making the decision as to whether an injury is a result of child abuse or not is stressful for both the family involved and the clinical team. It is not a decision that is taken lightly, and with an increasing expectation by the investigating agencies, lawyers and the public in general, to ensure that it is based on explicit 'evidence', clinicians need to be up to date with the latest scientific publications in the field. This article aims to summarise the current evidence in relation to all physical injuries except those pertaining to the central nervous system, which will form a separate article. It will examine the pattern of accidental and abusive bruises, fractures, burns, abdominal injuries and oral injuries focusing on discriminating features and necessary investigations.     

Hyponatremic seizures in infancy: association with retinal hemorrhages and physical child abuse?

We present two cases of infants with hyponatremic seizures who had an unexpected finding of retinal hemorrhages. A review of the literature found no prior association between hyponatremic seizures and retinal hemorrhages. The retinal hemorrhages found in the first patient were a result of shaken baby syndrome (SBS) and associated with long bone fractures and a subdural hematoma. The second patient had retinal hemorrhages and cerebral edema, presumed to be a result of SBS. We suggest that children who become hyponatremic owing to neglect, lack of education, or intentional water poisoning may be at risk for other forms of child abuse. Additional research needs to be done to further elucidate the relationship between hyponatremic seizures and child abuse.