Household Task Participation of Children With and Without Attentional Problems

Children with attention deficit/hyperactivity disorder (ADHD) often demonstrate problems in their participation in family occupations, such as household tasks, due to their needs for assistance and their behavior. Because participation in household tasks is part of family life and may be one way that families prepare children for adult roles, it is important to have a better understanding of the nature and extent of these difficulties. Forty-four parents of children in grades three through five (22 who had a child with ADHD and 22 whose child had no disabilities) completed the Children Helping Out: Responsibilities, Expectations, and Supports (CHORES) measure to provide quantitative and qualitative information about their child's participation in household tasks. Children with ADHD did not differ significantly from the comparison group in their frequency of participating in household tasks. Children with ADHD, however, required significantly more assistance with the tasks than did the comparison group. The results have implications for family occupations and children's occupational development.     

Sleep and Behavior Problems in Children With Epilepsy

We designed a cross-sectional study to examine the association between sleep and behavior problems in toddlers and preschool-age children with epilepsy. We found that 71 (78.9%) children slept less than 10 hours in a 24-hour period according to the actigraphy, with 75 (83.3%) children waking for more than an hour during nocturnal sleep. Twenty-five (27.8%) children usually or sometimes had an inconsistent bedtime, and 24 (26.7%) did not sleep the same amount each day. Twenty-nine (32.2%) and 18 (20.0%) children had an internalizing and externalizing problem in clinical range, respectively. Sleep anxiety was significantly (p < .01) associated with increased internalizing and externalizing problems, even after the relevant epilepsy variables were controlled for. Findings from our study suggest that screening of sleep and behavior problems should be part of routine epilepsy care to identify children with problematic sleep and unrecognized sleep disorders and those at risk of behavioral dysfunction.     

Problematic Sexual Behavior in Children

It is important for health care professionals to have a strong knowledge base of childhood sexual development, to know how to differentiate between problematic and normative sexual behaviors, and counsel parents accordingly given their assessment of the behaviors. A review of the literature suggests that sexual behaviors are a common occurrence in childhood, though some behaviors are rare regardless of age. Frequency of the behavior, developmental considerations, and the level of harm may help health care professionals assess whether the sexual behavior is typical or problematic. Research suggests that the development of problematic sexual behavior is related to a variety of child, family, developmental, and social factors. Recommendations for clinical care for this population are offered, and a case study highlights a health care professional's appropriate assessment and decision making.     

Mother-Child Interaction, Private Speech, and Task Performance in Preschool Children with Behavior Problems

The purpose of the present study was to explore patterns of mother-child interaction, children's private speech use, and behavioral self-regulation among a sample of preschool children identified by their preschool teachers as evidencing behavior problems. Forty preschoolers were classified into two groups (behaviorally at-risk and a matched comparison group) on the basis of teacher ratings of impulsivity, inattention, and hyperactivity. Children completed a magnet board puzzle task once in collaboration with their mother and once individually, and maternal and child speech and behavior were coded from videotapes. Although there were no group differences in children's behavior or speech during the collaborative session, nor were there differences in children's individual task performance or on-task attention, mother-child interaction involving behaviorally at-risk children was characterized by more other-regulation, negative control, less praise, and less physical withdrawal over time, compared to interactions involving comparison children. Behaviorally at-risk children, compared to controls, used more overt, task-relevant private speech during individual problem solving. Partially internalized private speech use among at-risk preschoolers was positively associated with task performance. Group differences rather than similarities prevailed in terms of the relations between maternal behavior, child speech, and child performance.     

Report of the Tennessee Task Force on Screening Newborn Infants for Critical Congenital Heart Disease

A member of the Tennessee state legislature recently proposed a bill that would mandate all newborn infants to undergo pulse oximetry screening for the purpose of identifying those with critical structural heart disease before discharge home. The Tennessee Task Force on Screening Newborn Infants for Critical Congenital Heart Defects was convened on September 29, 2005. This group reviewed the current medical literature on this topic, as well as data obtained from the Tennessee Department of Health, and debated the merits and potential detriments of a statewide screening program. The estimated incidence of critical congenital heart disease is 170 in 100,000 live births, and of those, 60 in 100,000 infants have ductal-dependent left-sided obstructive lesions with the potential of presentation by shock or death if the diagnosis is missed. Of the latter group, the diagnosis is missed in approximately 9 in 100,000 by fetal ultrasound assessment and discharge examination and might be identified by a screening program. Identification of the missed diagnosis in these infants before discharge could spare many of them death or neurologic sequelae. Four major studies using pulse oximetry screening were analyzed, and when data were restricted to critical left-sided obstructive lesions, sensitivity values of 0% to 50% and false-positive rates of between 0.01% and 12% were found in asymptomatic populations. Because of this variability and other considerations, a meaningful cost/benefit analysis could not be performed. It was the consensus of the task force to provide a recommendation to the legislature that mandatory screening not be implemented at this time. In addition, we determined that a very large, prospective, perhaps multistate study is needed to define the sensitivity and false-positive rates of lower-limb pulse oximetry screening in the asymptomatic newborn population and that there needs to be continued partnering between the medical community, parents, and local, state, and national governments in decisions regarding mandated medical care.     

外源性性早熟3例

例1，女，3．5岁，因乳房发育3个月，阴道出血2d就诊。既往服人参蜂皇浆约1年4个月，总量360～380mL。已停服5个月。身高96cm，体质量20kg，骨龄4～5岁，发育较同龄儿成熟，阔背，乳房TannerⅢ期，阴毛P1期，外阴着色，阴道出血。辅助检查：促卵泡素（FSH）4．3IU／L，黄体生成素（LH）3．1IU／L，催乳素（PAL）3．6mg／L，雌二醇（E2）365．6nmol／L，睾酮（T）2ng／L。B超示子宫内回声均质，可见内膜线样改变。促性腺激素释放激素（GnRH）刺激试验：静脉注射戈那瑞林25雌，LH：0min3．1IU／L，15、30、45、60、120、180min3．5～4．2IU／L，上升高度〈50％，支持假性性早熟。     

儿童行为问题干预的研究新进展

现从心理干预、家庭干预、社会技能训练干预、感觉统合训练干预4个视角探讨国内外近年来儿童行为问题干预的研究成果,在此基础上提出现有研究的问题与未来研究的展望。     

Sexual abstinence and the Sexual Abstinence Behavior Scale.

INTRODUCTION: Nurses may choose to promote sexual abstinence, particularly when they are working with young adolescents. However, it is difficult to know how to intervene because sexual abstinence has not been well defined in the literature. The purpose of this study was to evaluate the psychometrics of a four-item measure of sexual abstinence behavior (the SABS) that both registered nurses and advanced practice nurses may find useful in their practice. METHOD: African American, middle school students (n = 113) completed a self-administered questionnaire during their health education class. The questionnaire contained the SABS along with items assessing demographics, sexual behavior, and psychosocial variables related to sexual behavior. RESULTS: Psychometric analysis supported SABS reliability (alpha =.73) and validity. For example, SABS scores correlated with perceived negative consequences of teen sex (r = 0.38) and sexual abstinence self-efficacy (r = 0.48). DISCUSSION: Although the SABS is still in a preliminary stage of development, it is useful for assessment purposes and for directing registered nurses and advanced practice nurses toward specific behaviors they may want to promote when teaching sexual abstinence to their young adolescent patients.     

Work Experience and Style Explain Variation Among Pediatricians in the Detection of Children With Psychosocial Problems

ObjectiveTo assess whether variation in the proportion of children identified as having psychosocial problems by individual preventive pediatricians can be explained by pediatrician characteristics, over and above variations in the mix of children. Furthermore, to assess whether the characteristics of preventive pediatricians were related to the quality of problem identification.MethodsWe used data from approximately 3070 children ages 5 to 6 years who were assessed during a routine well-child visit by a preventive pediatrician in the Netherlands (response rate 85.2%). We obtained data about parent-reported child problems by using the Child Behavior Checklist (CBCL), sociodemographic background of the family, and characteristics of the preventive pediatrician. After each assessment, preventive pediatricians reported whether they had identified any psychosocial problem in the child. Multilevel logistic regression analyses were used to assess whether variation in the proportion of children identified by preventive pediatricians as having a psychosocial problem could be explained by the characteristics of preventive pediatricians and whether these characteristics were related to the quality of problem identification.ResultsPreventive pediatricians varied widely in the proportion of children identified as having psychosocial problems. Pediatrician characteristics such as work experience and work style (for example, on indication use of behavior questionnaires like the CBCL in routine care) explained about a quarter of this inter-pediatrician variation; child characteristics did not explain this variation even though characteristics like gender and parental education level were associated with likelihood of problem identification. More use of the CBCL and less use of the Teacher Report Form in routine care resulted in a better problem identification by preventive pediatricians. Work experience was not related to better problem identification.ConclusionsPreventive pediatricians identify psychosocial problems in children in a standardized way, but important inter-pediatrician variation remains. This variation may be reduced further and quality improved by changing their work style and targeted training.     

皮瓣转移术修复小儿皮肤缺损

对应用皮瓣转移术修复小儿皮肤缺损的６０例资料进行了回顾性分析，从中显示了皮瓣转移术明显优于皮片移植术的临床效果。重点讨论了皮瓣转移术式的选择及提高皮瓣存活率的方法。     

Improving child survival: Malnutrition Task Force and the paediatrician's responsibility

Malnutrition (underweight) contributes to approximately 60% of all child deaths, yet health professionals, policy makers, and donor agencies often fail to recognise its relevance to child survival. There is a need for the paediatric community to champion the importance of adequate nutrition for normal growth and development, and of placing sufficient emphasis on the prevention and treatment of malnutrition. Many severely malnourished children die from inappropriate treatment. Case fatality rates of 25-30% are commonly found and in some hospitals as many as 50-70% will die. Many of these deaths are avoidable. Weaknesses in health systems, inappropriate training of doctors and nurses, inadequate supervision, and lack of support for staff all contribute to compromised quality of care. The International Union of Nutritional Sciences, with support from the International Pediatric Association, Launched a global Malnutrition Task Force in 2005. The main objective is to ensure that an integrated system of prevention and treatment of malnutrition is actively supported as a fundamental aspect of care, and becomes an integral part of all training programmes.     

Online Sexual Solicitation of Children and Adolescents

Technological advances have exploded in the new millennium. The Internet provides many opportunities to enrich the lives of youth by providing greater access to learning opportunities, valuable resources, and positive social interactions with peers. However, the Internet is a relatively new and unregulated entity that can also place children and adolescents at risk for a variety of negative and potentially dangerous exposures. One such risk is online sexual solicitations and interactions with older adolescents, peers, and adults. This continuing education article will explore online sexual solicitation of child and adolescents in terms of definition, epidemiology, predictors, consequences, and implications for practice.     

Circumcision policy statement. American Academy of Pediatrics. Task Force on Circumcision

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided.