Selective mutism: are primary care physicians missing the silence?

To survey parents of children with selective mutism (SM) in regard to (1) the role of the primary care physician in the diagnosis of SM; (2) the social and school consequences of SM; and (3) their opinion of the effectiveness of different treatment modalities, a 39-item written survey was mailed to 27 parents with at least one child diagnosed with SM on the basis of diagnostic and statistical manual IV-text revision (DSM IV-TR) criteria. Twenty-seven parents (100%), with a total of 33 children with SM, completed the survey. There were 24 girls and 9 boys. The mean age when parents had strong concerns about symptoms of SM was 3.8 years, but diagnosis did not occur until nearly a year later. Twenty-three (69.7%) of the children with SM were never diagnosed accurately or referred by their primary care physicians. SM caused important school/social problems for 17 (51.5%) of the children. Speech therapy was provided for 36.4% of children and was thought to have been helpful for 30% of them. Behavior modification was the treatment for 45.5% of children and perceived to be helpful for 66.7% of them. Selective serotonin re-uptake inhibitor pharmacotherapy was prescribed for 17 (51.5%) of the children and believed to be effective for 11 (65%) of them. Primary care physicians in this study rarely diagnosed accurately or referred children with SM in a timely fashion, even though symptoms of the condition were generally very apparent and parents had expressed concern. Behavioral modification, pharmacotherapy with SSRIs, and early intervention are viable treatment options. Early diagnosis is key to preventing long-term effects of this condition.     

Trends in psychopathology across the adolescent years: What changes when children become adolescents,and when adolescents become adults?

Background: Little is known about changes in the prevalence of psychiatric disorders between childhood and adolescence, and adolescence and adulthood. Methods: We reviewed papers reporting prevalence rates of psychiatric disorders separately for childhood, adolescence, and early adulthood. Both longitudinal and cross‐sectional papers published in the past 15 years were included. Results: About one adolescent in five has a psychiatric disorder. From childhood to adolescence there is an increase in rates of depression, panic disorder, agoraphobia, and substance use disorders (SUD), and a decrease in separation anxiety disorder (SAD) and attention‐deficit hyperactivity disorder (ADHD). From adolescence to early adulthood there is a further increase in panic disorder, agoraphobia, and SUD, and a further decrease in SAD and ADHD. Other phobias and disruptive behavior disorders also fall. Conclusions: Further study of changes in rates of disorder across developmental stages could inform etiological research and guide interventions.     

Which children receive grandparental care and what effect does it have?

Background:  Grandparents are increasingly involved in the care of young children, but little is known about factors associated with this type of care, or its implications for children's behavioural development.
Methods:  We used information collected from 8752 families in the Avon Longitudinal Study of Parents and Children (ALSPAC) on grandparent involvement when the study children were aged 8, 15 and 24 months; potential maternal and family predictors of grandparent care; and behavioural outcomes at age 4 years.
Results:  Forty-four percent of children were regularly cared for by grandparents at each age. Throughout the sample, key correlates of grandparent care were maternal age and education. In families without access to paid help with childcare, the child's ordinal position, maternal employment, the mother's recall of parenting by her own mother and the reasons for choosing the type of childcare were also associated with variations in grandparent care. Grandparent care was associated with some elevated rates of hyperactivity and peer difficulties at age 4, but these were largely attributable to variations in the types of families using grandparent care.
Conclusions:  The popular belief that the extended family is no longer an important part of British life is not borne out by this study. Grandparents played a significant role in the care of their young grandchildren. The modest behavioural sequelae of extensive grandparental care differ from those reported for group-based day care.     

How frequently and with what symptoms are children presented to the pediatrician?

Author prepared and processed 1500 computerised questionnaires in which primary-school children parents were asked about their knowledge of symptoms of childrendisease and habits: "how to consult with physicians". The questionnaire was divided 3 parts: in the first one general questions and some problem in connection with high-temperature, in the second one about symptoms, and in the third group pains were mentioned located in organs and different body-parts of children. The majority of parents accepted these questions and gave good answers and prepared some additional suggestions. Other group of parents having very bad habits relation to symptoms, and "how to consult with doctors and call duty-system". Author emphasized the very important role of data processing system for the further health organisation and health education.     

Drug utilisation in very preterm infants: any changes during the past decade?

BACKGROUND: Improved standards of perinatal care for preterm infants led to decreased hospital mortality rates during the past decade. However, studies investigating changes in drug utilisation in neonatal intensive care units (NICU) during this period are missing. OBJECTIVE: The aim of the present study therefore was to evaluate the most frequently used groups of drugs in preterm infants treated in NICUs and to analyse potential changes in drug utilisation over a period of ten years. METHODS: Drug utilisation patterns in 164 preterm infants born between 1989 and 1990 (group I; gestational age 27.2+/-1.2 weeks, birth weight 970+/-145 g) were compared to those in 113 preterm infants born between 2001 and 2004 (group II; gestational age 26.9+/-1.65 weeks, birth weight 930+/-253 g, mean and standard deviation each) with need for postnatal mechanical ventilation. RESULTS: Significant changes in drug utilisation patterns were observed for complete courses of antenatal corticosteroids (40 vs. 51.5%), diuretics (78 vs. 36.6%), surfactant (63.3 vs. 75%), methylxanthines (89.9 vs. 56.7%), sedatives/analgesics (82.4 vs. 91.5%) and catecholamines (38.3 vs. 52.4%) (group II vs. group I each). Postnatal corticosteroids were applied more often in group II (17.4 vs. 13.4%). However, duration of postnatal corticosteroid treatment has decreased (6 d vs. 13 d). The use of antibiotics remained unchanged (100 vs. 98.9%). Comparison of clinical outcome variables showed a decreased duration of mechanical ventilation and a significantly increased survival rate. CONCLUSION: Drug utilisation patterns in preterms have changed considerably during the past decade. Improved standards of care and shorter duration of mechanical ventilation may be operative.     

Digital rectal examination and the primary care physicians: a lost art?

Digital rectal examination (DRE) in children is crucial to differentiate between simple (habitual) and complicated constipation. Previous experience suggests that primary care physicians (PCPs) avoid DRE in children with constipation before referral. We evaluated the rate of DRE performance by West Virginian PCPs in patients referred to our gastroenterology clinic. Data were collected from the physicians' referral letters and parental reports. We found that the vast majority (85%) of WV-PCPs do not perform DRE before referring their patients, resulting in missed diagnoses and treatment. We concluded that the lack of DRE in children with constipation may result in unnecessary referral to the specialist. To improve standard of care for children with constipation, an educational campaign for PCPs is clearly warranted.     

Characterization and burden of Campania children health migration across Italian regions during years 2006–2010: chance and/or necessity?

Background

To evaluate medical, economical and sociological variables underlying avoidable pediatric migration from Campania region.

Methods

Analysis of years 2006–2010 hospital discharge records, extracted from the archive of Regional Health Agency (ArSan), classified by Major Diagnostic Categories, Aggregate Clinical Codes, Discipline of dismissal, Local Health Authorities of residence, and age group 0–14 years (excluding those of healthy newborns). Sociological variables were evaluated by questionnaires.

Results

A total of 68,316 hospital discharge records were released by extra-regional structures. Major diagnostic categories and Discipline of dismissal indicated that the most implicated diseases (nervous system and mental disorders, hematology-oncology, and bone diseases) were not always of very high complexity. The total cost paid by the Campania Region was 124.700.000 Euros. The need for more specialized hospital pediatric units and/or with more pediatric subspecialties in the native region was pointed out by most of the self-administered questionnaires.

Conclusions

Pediatric migration is an important phenomenon with evident implications. The identification of the most concerned sub-specialties here reported can give useful information aiming to assist in the improvement of the existing pediatric resources in Campania region in the wider context of the national global child health advancement.