Parental perception of overweight and underweight in children and adolescents

Aims: To compare the parental perception of overweight and underweight in their children to objective criteria, based on body mass index (BMI), waist circumference and triceps skinfold thickness, and to explore the effects of potential determinants. Methods: Logistic regression of anthropometric measurements, socio‐demographic characteristics and self‐reported parental height and weight on the parental perception of their child’s weight status in 3770 children aged 2–19. Results: Seventy per cent of overweight/obese children and 40.8% of underweight children were perceived having normal weight by parents. In 2‐ to 5‐year‐old overweight children, 91.2% were considered to have normal weight. For a given BMI, primary school age children, adolescents and girls had a higher probability to be assigned as overweight, whereas adolescents and girls had a lower probability to be assigned as underweight. Overweight parents more readily assigned their children as underweight, but there was no effect of parental educational level or parental underweight. Conclusion: Parental ability to recognize overweight or underweight in their offspring was generally poor. The findings emphasize the need for objective criteria based on physical measurements in the routine follow up of children, as parental ability to recognize weight problems in their children is nonreliable.     

Advantages and limitations of day surgery in children in a developing country

Day surgery (DS) especially in children, has been widely accepted by surgeons, and the benefits to the patients, parents, and hospital have been well-established. It has become particularly popular among working parents and is accepted by hospital administrators. Proper case selection, preoperative assessment, and proper parent counselling, choice of anaesthesia, postoperative analgesia, and follow-up advice are essential for a successful outcome. This paper records our experience with 465 infants and children who underwent DS at Government Stanley Hospital and two semi-charitable trust hospitals in Madras during the years 1985–1986. The overall acceptance of the programme was excellent, with minimal complications and a fallout rate of 9.6%. The advantages of DS in our environment are discussed. Accepted: 20 October 1997     

Parental depressive and anxiety symptoms during pregnancy and attention problems in children: a cross‐cohort consistency study

Background: Maternal depression and anxiety during pregnancy have been associated with offspring‐attention deficit problems. Aim: We explored possible intrauterine effects by comparing maternal and paternal symptoms during pregnancy, by investigating cross‐cohort consistency, and by investigating whether parental symptoms in early childhood may explain any observed intrauterine effect. Methods: This study was conducted in two cohorts (Generation R, n = 2,280 and ALSPAC, n = 3,442). Pregnant women and their partners completed questionnaires to assess symptoms of depression and anxiety. Child attention problems were measured in Generation R at age 3 with the Child Behavior Checklist, and in ALSPAC at age 4 with the Strengths and Difficulties Questionnaire. Results: In both cohorts, antenatal maternal symptoms of depression (Generation R: OR 1.23, 95% CI 1.05–1.43; ALSPAC: OR 1.33, 95% CI 1.19–1.48) and anxiety (Generation R: OR 1.24, 95% CI 1.06–1.46; ALSPAC: OR 1.32, 95% CI 1.19–1.47) were associated with a higher risk of child attention problems. In ALSPAC, paternal depression was also associated with a higher risk of child attention problems (OR 1.11, 95% CI 1.00–1.24). After adjusting for maternal symptoms after giving birth, antenatal maternal depression and anxiety were no longer associated with child attention problems in Generation R. Moreover, there was little statistical evidence that antenatal maternal and paternal depression and anxiety had a substantially different effect on attention problems of the child. Conclusions: The apparent intrauterine effect of maternal depression and anxiety on offspring‐behavioural problems may be partly explained by residual confounding. There was little evidence of a difference between the strength of associations of maternal and paternal symptoms during pregnancy with offspring‐attention problems. That maternal symptoms after childbirth were also associated with offspring‐behavioural problems may indicate a contribution of genetic influences to the association.     

Prediction of anxiety symptoms in preschool‐aged children: examination of maternal and paternal perspectives

Background: Little is known about risk factors for anxiety in young children. The current study investigated the value of a set of theoretically derived risk factors to predict symptoms of anxiety in a sample of preschool‐aged children. Methods: Mothers (n = 632) and fathers (n = 249) completed questionnaires twice, 12 months apart. Measures were selected to assess several risk factors derived from current theory, including parental negative affectivity, child inhibition, parent overprotection, and impact of life events. Results: Even at this young age anxiety across 12 months was moderately to highly stable (r’s = .75 and .74 based on maternal and paternal report respectively). Over and above this stability, according to maternal report, anxiety at 12 months was significantly predicted by prior maternal overprotection, impact of negative life events, child’s inhibition, and maternal negative affectivity. According to paternal report, anxiety at 12 months was significantly predicted by prior paternal overprotection and impact of negative life events. The models did not differ significantly for girls and boys. Conclusions: The results support theories of the development of anxiety, especially the role of parental and external environmental factors, and point to possible targets for prevention of heightened anxiety in young children.     

Thoracoscopic surgery in children in the Kyushu area of Japan

Background:  Recently, minimally invasive thoracoscopic surgery has offered several options for both the diagnosis and surgical treatment in the field of pediatric surgery. This report reviews the surgical experience in order to assess the problems including the complications, encountered during thoracoscopic surgery in children under 15 years of age in the Kyushu area, Japan.
Methods:  From 1993 to 2005, 153 boys and 103 girls underwent thoracoscopic surgery for chest disease. Pertinent information included number of operations for each year, sex, age, indication, treatment procedure, follow-up duration, cause of conversion to thoracotomy, method of treatment, and complication.
Results:  There has gradually been an increase in the number of operations every year. These included procedures for funnel chest, n = 121; pneumothorax, n = 25; mediastinal tumor, n = 25; palmar hyperhydrosis, n = 23; neuroblastoma, n = 11; and cystic lung disease, n = 10. A large portion of the surgery was for patients under 1 year of age excluding neonates. Approximately half of the procedures were for the excision of a neuroblastoma. Approximately half of the patients older than 5 years of age underwent Nuss procedure for funnel chest. Almost all of the pneumothorax and palmar hyperhydrosis surgery was for patients 14 or 15 years old. Three patients required a conversion to a standard thoracotomy. Six complications occurred. There was no mortality associated with the thoracoscopic surgical procedures.
Conclusions:  Thoracoscopy is a useful diagnostic and therapeutic tool for both infants and children. Various thoracoscopic complex procedures have been performed both safely and effectively.     

Social anxiety in childhood: the relationship with self and observer rated social skills

BACKGROUND: Social anxiety of childhood is a common and pervasive problem. Traditional approaches to treating these difficulties have focused on providing afflicted children with social skills training. This approach has met with some, but not complete success. Recent reconceptualisations of social anxiety in the adult literature have emphasised the role of negative cognition regarding one's own social skills. Experimental evidence has demonstrated that a misperception of social skills, rather than a skills deficit per se, may be most pertinent to the understanding of social anxiety. This study set out to examine the relationship between self and observer ratings of social skill, and social anxiety in children. METHOD: One hundred and ten non-referred schoolchildren aged 8-11 years were asked to give a two-minute speech to a video camera, after which they were asked to rate their performance on a number of social skill dimensions. Neutral observers also watched the videos and rated each child on the same dimensions. RESULTS: There was very little correlation between social anxiety level and observer ratings of children's social skills. Indeed, some very anxious children achieved high observer rated social skill scores. State socially anxious children self-reported that their social skills were poorer than less anxious children. However, other than looking more nervous than less anxious children, the social skills of the high anxious children were indistinguishable from those of their less anxious peers. CONCLUSIONS: Socially anxious children may not necessarily lack social skills. Rather, their deficits may relate to nervousness and appraisals of their skills. Treatment programmes for these children should take care to assess social skills carefully before prescribing social skill remediation, and should consider employing a cognitive element to tackle negative misperceptions of subjective social skill.     

Separation anxiety disorder in children: disorder-specific responses to experimental separation from the mother

Background: Separation anxiety disorder (SAD) is one of the most common anxiety disorders in childhood and is predictive of adult anxiety disorders, especially panic disorder. However, the disorder has seldom been studied and the attempt to distinguish SAD from other anxiety disorders with regard to psychophysiology has not been made. We expected exaggerated anxiety as well as sympathetic and respiratory reactivity in SAD during separation from the mother. Method: Participants were 49 children with a principal diagnosis of SAD, 21 clinical controls (CC) with a principal diagnosis of anxiety disorder other than SAD, and 39 healthy controls (HC) not meeting criteria for any current diagnosis. Analyses of covariance controlling for age were used to assess sympathetic and parasympathetic activation (preejection period and respiratory sinus arrhythmia) as well as cardiovascular (heart rate, mean arterial pressure, total peripheral resistance), respiratory (total breath time, minute ventilation, tidal volume, end‐tidal CO₂, respiratory variability), electrodermal, and self‐report (anxiety, cognitions, symptoms) variables during baseline, 4‐min separation from, and reunion with the mother. Results: Children with a diagnosis of SAD were characterized by elevated self‐reported anxiety responses to separation and increased sympathetic reactivity compared with CC and HC groups. The SAD group also displayed greater vagal withdrawal and higher reactivity in multiple cardiovascular, respiratory, and electrodermal measures compared with the HC group, while corresponding responses were less in the CC group and not significantly different from the other groups. Conclusions: Separation from the mother elicits greater autonomic, respiratory, and experiential responses in children with SAD. Our findings based on brief experimental separation demonstrate differential subjective and physiological manifestations of specific anxiety diagnoses, thus supporting the validity of the diagnostic category of SAD.