The behavior of the hospitalized child awaiting a surgical operation]

The literature and personal experience are referred to in an assessment of psycho-affective situations in hospitalised children awaiting non-emergency surgery (appendicectomy, adenotonsillectomy, inguinal hernia, phymosis, hypospadias, cryptorchidism). Psychological and somatic damage resulting from an absence of preparation before hospitalisation and during admission immediately prior to surgery is described. A method whereby this may be avoided as far as possible with the aid of relatives is described.     

Iron deficiency in hospitalized infants: study of the incidence of the nutritional factor]

We report an investigation on the iron status of 209 hospitalized 3-month--2-year-old infants over a 6-month period. Hematological parameters and infant feeding practice were determined: a total of 105 infants (50.2%) were found to be iron-depleted, with (24.8%) or without (25.4%) anemia. The mode of lactation appeared to be the main determining factor in iron deficiency, as shown by the fact that during the first months, breast feeding and consumption of an iron-fortified milk formula were 50% less frequent and of shorter duration in infants with iron deficiency than in normal infants. Incorrect diet was also more frequent in iron-deficient infants. It is concluded that iron deficiency in infants could be prevented by better informing mothers in order to encourage breast-feeding and develop the use of an iron-fortified milk formula until the infant reaches the age of one year.     

Effect of nutritional method on adaptation of the intestinal remnant after massive bowel resection

Adaptation of the intestinal remnant with hypertrophy/hyperplasia and increased absorption occurs, ultimately, after massive bowel resection. During the early postresection period, the rate of the adaptational process may be influenced by the method of nutritional support. Nutrients given by mouth may support a strong stimulus for hypertrophy but may be incompletely absorbed from the short intestinal remnant. Intravenous nutrition, while eliminating the need for intestinal absorption, may not support the hypertrophic process of that remnant. We tested the effect of different nutritional methods on the hypertrophic and functional adaptation of the intestinal remnant after 90% resection in the rat. The methods included oral feeding with regular rat chow, oral feeding with elemental diet, intravenous nutrition, and a combination of intravenous nutrition and oral feedings. Full thickness intestinal wall wet weight and mucosal wet weight, as well as in vivo L-valine absorption, were measured 9 days after operation. Resected subgroups were compared to sham-operated controls receiving similar diets. Increase in the weight of the intestinal remnant and its mucosa was noted in all resected subgroups receiving oral diets. Valine absorption per unit length and/or unit weight was significantly decreased in rats receiving oral diets alone and rats receiving a combination of intravenous and oral elemental diet. Significant increase in intestinal and mucosal weight without decrease in valine absorption was demonstrated in the animals receiving a combination of intravenous nutrition and regular chow diet. The results suggest that a combination of intravenous nutrition and ad libitum oral feedings with regular diet may represent the best method of nutritional support in the early postresectional period.     

儿科住院患者营养状况及营养风险调查

目的探讨使用儿科营养不良筛查方法(STAMP)评估患儿营养状况并进行营养风险筛查。方法采用STAMP调查住院患儿营养状况,以STAMP评分≥4分为高营养风险标准。结果 1 506例住院儿童中高营养风险患儿占26.56%,营养不良(不足)的检出率为19.12%,生长迟缓检出率为10.16%。各科室间儿童生长迟缓检出率的差异有统计学意义(P<0.05),其中儿内科生长迟缓检出率最高。仅有10.09%的患者接受营养支持,其中肠外营养(PN)支持率为7.84%,肠内营养(EN)支持率为2.92%,PN:EN为2.68:1。对有高营养风险住院患儿进行干预和管理后,高营养风险检出率从入院时的26.56%下降至出院时的21.71%,差异有统计学意义(P<0.05)。结论 STAMP评分法评估住院儿童的营养风险,能比较客观地反映患儿可能发生营养不良的风险;通过营养风险管理可改善患儿的营养状况。     

Assessment of nutritional status and nutritional risk in hospitalized Iranian children

Aims: This study aimed to define the nutritional state of children admitted to a tertiary Iranian hospital and to evaluate nutritional risk score tools in these children. Methods: The anthropometry of hospitalized and healthy children from the same community was determined. Three nutritional risk score tools were applied to all inpatients. Results: One hundred and nineteen inpatients were recruited along with a comparison group of 100 children. The prevalence of under‐nutrition in the inpatient group was 25.2% and 3% in the community group (p < 0.0001). Obesity/overweight was more prevalent in the community group than the inpatients (22% versus 2.5%: p = 0.04). Severely malnourished children had a longer hospital stay than those with normal nutrition (p < 0.0001). The nutritional risk score tools identified between 83% and 90% of the malnourished patients in the moderate and high‐risk groups. The STRONG_kids tool correlated more strongly with anthropometric measurements than the other tools. The length of hospital stay was associated with risk status (p = 0.004). Conclusion: Hospitalized Iranian children have higher rates of under‐nutrition than healthy children from the same community. NRS tools were able to identify children at nutritional risk; however, variable utility was observed. Further assessment of NRS tools in the developing setting is required.     

The needs of the sexually abused child

ABSTRACT. The incidence of sexual abuse in childhood, and its short and long term effects dictate that paediatricians increase their awareness of the needs of the sexually abused child. Case examples are given from experience at one children's hospital illustrating a range of situations which vary with the relationship of the abuser to the child. Factors thought to influence outcome are described. The needs demonstrated are correlated with management recommendations, including those made in a recent Australian report.     

51例儿童血液病患者膳食营养状况调查

目的：了解同期住院儿童血液病患者的膳食结构及营养状况,进行正确合理的膳食指导,制定切实可行的膳食治疗方案,促进疾病的恢复。方法：采用24 h膳食回顾和连续7 d膳食记录法,指导患儿家长按照范例详细记录其连续7 d早、中、晚三餐及加餐的食物种类和数量;用膳食数据库计算患者膳食中各种营养素的摄入量后进行评价。结果：大部分患儿能量及蛋白质的摄入不足,平均摄入量分别为1 825.81千卡/标准人日及67.68 g/标准人日,各占推荐摄入量的73.62%及81.34%;各病种之间维生素摄入差别较大,其中维生素E、核黄素摄入相对充足,维生素A、硫胺素、维生素C摄入不足;矿物质中钙、锌摄入严重不足,铁、硒摄入相对充足;能量及大多数其他各种营养素来源较合理。结论： 该期住院的血液病大部分患儿的能量、蛋白质、维生素A、硫胺素、维生素C、钙、锌摄入水平较低,膳食结构及营养素的摄入情况有待进一步改善。     

The needs of the abused child in the community

The development of community awareness of child abuse has followed medical awareness and is specifically concerned with prevention and early intervention. Contact between community services and 304 infants from a birth cohort in a poor socio-economic status, multi-ethnic urban municipality was documented to investigate how these services could provide effective community approaches to the problem. While perinatal and medical services provided fragmented care, the Maternal and Child Health Service was the only agency to contact all families, including those of the 21 abused or "at risk" infants. It is suggested that such local universal services should form the basis of a community approach to the needs of the abused or "at risk" child.     

Maternal nutritional knowledge and child nutritional status in the Volta region of Ghana

The relationship between mother's nutritional knowledge, maternal education, and child nutritional status (weight-for-age) was the subject of investigation in this study. The data were collected in Ghana on 55 well nourished and 55 malnourished mother-child pairs. A questionnaire designed to collect data on mother's knowledge and practices related to child care and nutrition was administered to the mothers. Data on mother's demographic and socio-economic characteristics as well as child anthropometric data were also collected. A nutrition knowledge score was calculated based on mother's responses to the nutrition related items. Bivariate analysis gave significant associations between child nutritional status and the following variables: time of initiating of breastfeeding, mother's knowledge of importance of colostrum and whether colostrum was given to child, age of introduction of supplementary food, and mother's knowledge about causes of kwashiorkor. The two groups also showed significant differences in their nutrition knowledge scores. Maternal formal education, and marital status were also found to be associated with child nutritional status in bivariate analyses. Further analysis with logistic regression revealed that maternal nutrition knowledge was independently associated with nutritional status after the effects of other significant variables were controlled for. Maternal education on the other hand was not found to be independently associated with nutritional status. These results imply that mother's practical knowledge about nutrition may be more important than formal maternal education for child nutrition outcome.     

The needs of the abused child in the community

ABSTRACT. The development of community awareness of child abuse has followed medical awareness and is specifically concerned with prevention and early intervention. Contact between community services and 304 infants from a birth cohort in a poor socio-economic status, multi-ethnic urban municipality was documented to investigate how these services could provide effective community approaches to the problem. While perinatal and medical services provided fragmented care, the Maternal and Child Health Service was the only agency to contact all families, including those of the 21 abused or "at risk'infants.
It is suggested that such local universal services should form the basis of a community approach to the needs of the abused or "at risk'child.     

Diagnosis of child and adolescent nutritional status

OBJECTIVE: To present a review on the methods for the assessment of child and adolescent nutritional status, emphasizing anthropometry and the various methods for the assessment of body composition; pointing out their advantages, limitations and risks. METHODS: Chapters of textbooks, theses, and articles relevant to the topic, as well as personal files and authors previous publications were selected. RESULTS: Anthropometry, which consists of the assessment of physical dimensions and global composition of the human body, has been regarded as the most frequently used isolated method for nutritional diagnosis, especially in childhood and adolescence, due to its ease of use, low cost and innocuousness. The most frequently adopted measurements aim at determining body mass, expressed by weight; linear dimensions, especially height; body composition and reserves of energy and proteins, estimated through subcutaneous fat and muscle mass. Laboratorial methods especially developed for the assessment of body composition are presented here. The justification for the use of methods that expose children and adolescents to ionizing radiation is also presented. CONCLUSIONS: On defining methods for the assessment of nutritional status, we should select those that better detect the nutritional deficiencies we want to correct, also taking into consideration their costs, level of personal skill required for their proper application, necessary time for application, acceptability by the studied population and possible health risks.     

Influences of early child nutritional status and home learning environment on child development in Vietnam

Early childhood development plays a key role in a child's future health, educational success, and economic status. However, suboptimal early development remains a global challenge. This study examines the influences of quality of the home learning environment (HOME) and child stunting in the first year of life on child development. We used data collected from a randomized controlled trial of preconceptional micronutrient supplementation in Vietnam (n = 1,458). The Bayley Scales of Infant Development‐III were used to assess cognition, language, and motor development domains at 2 years. At 1 year, 14% of children were stunted, and 15%, 58%, and 28% of children lived in poor, medium, and high HOME environments, respectively. In multivariate generalized linear regression models, living in a high HOME environment was significantly associated with higher scores (0.10 to 0.13 SD) in each of the developmental domains. Stunted children scored significantly lower for cognitive, language, and motor development (?0.11 to ?0.18), compared to nonstunted children. The negative associations between stunting on development were modified by HOME; the associations were strong among children living in homes with a poor learning environment whereas they were nonsignificant for those living in high‐quality learning environments. In conclusion, child stunting the first year of life was negatively associated with child development at 2 years among children in Vietnam, but a high‐quality HOME appeared to attenuate these associations. Early interventions aimed at improving early child growth as well as providing a stimulating home environment are critical to ensure optimal child development.