Dog bites in urban children

As a result of a perceived increase in pit bull injuries, all children who presented to The Children's Hospital of Philadelphia during 1989 for evaluation of dog bite injuries were prospectively studied. Epidemiologic information was collected from parents, either at the time of visit or by phone on the following day. A total of 168 children were enrolled; the mean age was 8 years. Males outnumbered females 1.5:1. Most (61%) injuries occurred in or around the home and involved dogs known to the patient (77%). Types of injuries included abrasions (33%), punctures (29%), and lacerations (38%). Thirteen bites had associated complications; nine developed infection. Twelve (7%) children required admission to the hospital. More than 12 different purebreeds or cross-breeds were identified as perpetrators, including German shepherds (n = 35), pit bulls (n = 33), rottweilers (n = 9), and Dobermans (n = 7). Most (54%) animals were contained (ie, leashed, fenced, in-house) at the time of injury. Fewer (46%) were provoked prior to biting. Significantly more pit bull injuries (94% vs 43%, P less than .001) were the consequence of unprovoked attacks and involved freely roaming animals (67% vs 41%, P less than .01). Children aged 5 or younger were more likely to provoke animals prior to injury than were older children (69% vs 36%, P less than .001). It is recommended that families with young children be the target of pet safety education and that measures be sought that would lead to early identification of a potentially dangerous dog and restrict ownership.     

Immigrant and Native Children in Germany

Resident foreign citizens in Germany, a country that cannot deny its character as a country of immigration, number around 6.7 million out of Germany’s total population of 82.4 million inhabitants. Relative to the native population, the age structure among people with migration background is shifted considerably younger. The share of children living with parents who have a migration background is quite large: More than 1 million children under 17 years of age are foreign citizens. This paper draws a portrait of immigrant children in comparison to native children. Data being analysed for this purpose make clear that children with migration background are disadvantaged in most sectors of life: Large shares of these children grow up in households with difficult financial straits and under less than optimal housing conditions. Young children with migration background face disadvantages in preschool and many are held back due to limited German language proficiency. Children and youth in foreign-born families tend to start school later and repeat classes more often. Children with migration background are not adequately supplied with health care, mainly because they and their parents less often participate in early diagnosis and preventive care. Youth with migration background are more involved in violent crimes.     

Childhood accidents--an endemic of epidemic proportion.

Information about accidental injury to children was obtained by studying children who presented at hospitals in South Glamorgan during a 6-month period. Just under 10 000 children who lived in the area presented at hospital, which, if extrapolated means that 20% of children each year might be expected to attend hospital after an accident. The majority (71%) of children needed only simple investigation, treatment, or reassurance. The distance between the site of the accident and the hospital was directly related to the number of children presenting. The most common cause of injury was a fall, but dog bites also caused concern. Bicycle injuries were more common than police statistics indicate. We conclude that accident and emergency departments should give special attention to children.     

Recurrent abdominal pain in primary care: study of functional recurrent abdominal pain

Pediatricians find that in daily clinical practice they are frequently visited by parents with children that have recurrent abdominal pain. Clinical experience has demonstrated that, after performing all relevant diagnostic tests, no medical condition justifying such investigations is involved in more than half of these disorders. Consequently, these disorders are called functional recurrent abdominal pain. The dramatic nature of their children's symptoms often leads parents to seek urgent medical consultations and ask for additional complementary tests; in serious cases, these disorders can lead to prolonged hospitalization with no proven therapeutic efficacy and which pose an additional risk for the child's mental health. In most patients, psychological factors are involved which play a key role in the onset and persistent nature of abdominal pains. Consequently, a psychopediatric approach preserving therapeutic continuity should be adopted. For these reasons, we consider a review of the psychiatric and psychological aspects involved in this disorder to be opportune.     

Immediate sensitivity of asthmatic children to dog allergens

The occurrence of dog hypersensitivity in 203 unselected asthmatic children was investigated by means of skin prick test, provocation test and RAST. The history of past and present exposure to dogs, symptoms in contact with dogs, and the effects of dog avoidance were recorded. The amount of dog dander antigens was measured from dust samples from 67 homes using counter-immunoelectrophoresis. A history of past or present dog hypersensitivity was obtained for 120 subjects (59%). The skin prick test was found to be a sensitive method for diagnosing dog hypersensitivity, when a standardized allergen extract was used. The results of the skin prick test correlated well with the provocation test (r = 0.832) and the RAST (r = 0.777). A positive (greater than or equal to ++) skin reaction was observed in 56% of the subjects, a positive (class greater than or equal to 1) RAST in 69%, and a positive provocation test with the same extract in 41% of the subjects. The occurrence of dog hypersensitivity was not significantly associated with past or present exposure to dog at home. However, the children who were exposed to a dog at home during early childhood developed dog hypersensitivity symptoms significantly earlier and had dog hypersensitivity slightly more often than the subjects with a later exposure or no exposure to dog. Significant amounts of dog dander antigens were found even in dust samples from homes where dogs had never been kept. The effect of dog avoidance on dog dander-specific IgE levels was studied from sera obtained from 24 subjects. Steadily high and even rising levels were observed in cases when a strict avoidance of dogs was reported by the patient. Dog saliva was found to be a more potent and more species-specific source of dog allergens, in comparison with a commercial dander extract, according to skin prick test and RAST inhibition studies.(ABSTRACT TRUNCATED AT 250 WORDS)     

Having children after surviving cancer in childhood or adolescence - results of a Berlin survey

OBJECTIVE: To assess the desire to have children, the actual number of children, and children's health in a survey of 752 adult survivors of paediatric or adolescent cancer in Berlin, Germany. PATIENTS: The German Childhood Cancer Registry ( Deutsches Kinderkrebsregister, DKKR) listed 752 paediatric cancer patients who had been treated in 1 of the 2 paediatric oncology centres in Berlin since 1980 and were 18 years of age or older at the time of the survey. METHODS: A 4-page questionnaire assessing pubertal development, fertility, the desire to have children, the actual number of children, and children's health was sent to 574 former patients located using data from the DKKR and German Residents' Registration Office. RESULTS: In total, 45% (n=260) of patients (140 women, 120 men) returned the questionnaire. The mean age was 10.9 years at the time of diagnosis and 24.3 years at the time of the present survey. Various aspects of puberty were assessed to evaluate pubertal development. Of all study participants, 77% indicated a general desire to have children. Reasons given for not having children included 'Still too early to have children' (67%), 'Fear that my child will develop cancer' (9%), and 'Fear that cancer will recur' (6%). Transient amenorrhoea, lasting from 1 to 30 months, occurred in 25 of 74 patients after chemo- and radiotherapy. Five of 136 participants indicated that they had already reached menopause. Seventeen per cent of all participants or their partners had already been pregnant. The miscarriage rate was 13%. Thirty participants gave birth to or fathered a total of 41 children, of whom 40 were healthy and 1 was born with a foot deformity (Pes equinovarus). Among participants' children, mean weight at birth was 3 458 g, and mean head circumference was 35 cm. DISCUSSION: The desire to have children was lower among our survey participants than in the general population of the same age (77% vs. 90%). Participants' fears that their children might develop cancer or that their own cancer might recur are often unfounded. Paediatric cancer survivors, relatives, and attending physicians should be well informed about this issue by paediatric oncologists. The proportion of miscarriages, mean weight at birth, and mean head circumference at birth in our study were comparable to the German general population. OUTLOOK: We intend to conduct a nationwide survey entitled 'Fertility after Chemo- and Radiotherapy in Paediatric and Adolescent Patients' (FeCt). The aim is to gain valuable data with a larger number of participants and more statistical power to determine whether specific cytotoxic drugs or radiation increase the risk of infertility, and if so, at what doses. For the study, the DKKR has the addresses of more than 5 000 former patients in Germany who are now adults. The results will be used to plan future treatment optimisation studies, and to assess the need for prophylactic measures in cases where fertility-compromising therapies are unavoidable. This nationwide survey 'FeCt' will be supported by the Deutsche Kinderkrebsstiftung.     

Childhood asthma and exposure to indoor allergens: lowmite levels are associated with sensitivity

The prevalence and level of sensitivity to indoor allergens were studied in relation to current exposure at home in 124 children with perennial asthma living in three climatic zones of Sweden. The house dust mite (HDM) allergen levels were higher in the South than in the North (p < 0.001), while cat and dog allergen levels tended to be higher in the North than the South (n. s.). Thirty-four percent of the children were sensitive to the HDM Dermatophagoides pteronyssinus , as determined by IgE antibodies in vitro, 27% were sensitive to D. farinae , 57% to cat and 55% to dog. Sensitivity to HDM was significantly more prevalent in Southern, than in Central and Northern Sweden (p=0.001) where the children were more often sensitive to pets (cat p=0.005, dog p= 0.002). A significant association between the concentration of Der p I and Derf I in the house dust and both the prevalence of sensitivity to HDM and the IgE antibody levels against mites was found even at concentrations well below the commonly suggested risk level for sensitisation of 2 μg/g dust. No relationship was found between pet allergen concentration in the home dust and sensitivity to pets, possibly because of exposure outside home, e. g. in schools and meeting places for leisure activities. Similarly, there was no consistent association between the level of mite or pet allergen exposure at home and asthma severity as judged by symptom and medication score. The study indicates that there is no threshold value for sensitisation to mite allergens in asthmatic children, and therefore, dust allergen levels at home should be kept as low as possible in homes of children at risk for asthma.     

Dog bites in children less than fourteen years old in Turin

BACKGROUND: The purpose of this study was to describe the epidemiology of injuries caused by dog bites treated in the emergency department of OIRM from January 1, 1997 to December 31, 2000. METHODS: Data on dog's attacks were obtained from declaration forms filled in the emergency department. RESULTS: 253 children were observed: 145 boys and 118 girls. The mean age was 6.4 years. The peak incidence was in children aged 3 to 8 years old. Fifty-six children (22.31%) required admission to the hospital. Thirty-five were younger than 5 years. Injuries to the face (29.48%), hands (14.55%), legs (9.33%) were more common. The prognosis was 5 (18.97%), 7 (21.74%) and 10 (16.6%) days. Twenty-five children had prognosis over fifteen days (9.88%). Children aged 5 or younger presented most face and hand lesions while children aged 6 to 14 years had most hand, legs and arms injuries. Tetanus and rabies prophylaxis were administered only in 4 and 2 cases respectively, while immunoglobulin anti tetanus were administered in 5 children. The great number of attacks occurred during the summer months, with a peak in June and July. CONCLUSIONS: More attention should be paid to the prevention of dog bites. Pediatricians should advice parents about the risks of interactions with dogs.     

Behavioral assessment of child-directed canine aggression.

OBJECTIVE: To characterize behavioral circumstances of bites to children by dogs presented to a veterinary behavior clinic. METHODS: Retrospective case series examining medical records of dogs presenting by referral to a university veterinary hospital for aggression and which had bitten a child <18 years old. Behavioral data included age of victim, familiarity with dog, and circumstances of bites. RESULTS: Records of bites to 111 children were examined. Children <6 years old were most commonly bitten in association with resource guarding (44%), whereas older children were most commonly bitten in association with territory guarding (23%). Similarly, food guarding was the most common circumstance for bites to familiar children (42%) and territory guarding for bites to unfamiliar children (53%). Behavioral screening of the 103 dogs examined revealed resource guarding (61%) and discipline measures (59%) as the most common stimuli for aggression. Anxiety screens revealed abnormalities in 77% of dogs. Potential contributory medical conditions were identified/suspected in 50% of dogs. When history before presentation was known, 66% of dogs had never previously bitten a child, and 19% had never bitten any human. Most dogs (93%) were neutered, and 66% of owners had taken their dogs to obedience training classes. CONCLUSIONS: Most children were bitten by dogs with no history of biting children. There is a high rate of behavioral abnormalities (aggression and anxiety) in this canine population. Common calming measures (neutering, training) were not routinely effective deterrents.     

Playground Interactions for Preschool-Age Children with Special Needs

Forty-five typically-developing children and 19 children with special needs, ages 3 to 5 years, were observed interacting on the playground. Observers recorded three types of play engaged in by the children. These included: (1) playing alone, (2) playing with a teacher, or (3) playing cooperatively with a peer(s). Scan-sampling was the observational technique used by observers. This technique required a snap-shot observation of a child at play for 10 seconds. Results indicated that children with special needs engaged in less cooperative play and were observed playing alone or with a teacher more often than their typically-developing peers. Furthermore, children with special needs often arrived on the playground later than their typically-developing classmates; consequently, they had fewer opportunities to be involved in play with peers. Field notes made by observers indicated that in some instances teachers used effective strategies to facilitate the inclusion of children with special needs in cooperative interactions. Results and observations are discussed and recommendations for practice and future research are provided.     

Pediatric emergency transport and the private practitioner

A mail survey of 182 pediatricians and 92 family practitioners in Pennsylvania was conducted to determine their methods of transport of seriously ill children from their offices to referral centers and their involvement with professional transport services. Although most physicians (93.1%) stated that they had professional services available to them (at their office location), more than half (53.8%) indicated that the patient's family automobile was their most commonly used method of transport of ill children to tertiary care centers. This was true regardless of the disease entity involved, including suspected epiglottitis. Practice setting had little influence on transport method. However, in general, younger children were judged to need ambulance transport more often than older children. Reasons cited for not using professional transport from the office included a perceived better efficiency of the family car (61.8%), the prohibitively high expense of professional transport (9.8%), and failure to consider professional transport (6.5%). Further study of this component of office preparedness is suggested.     

Who Profits Most from Early Parental Investments? The Effects of Activities Inside and Outside the Family on German and Turkish Children’s Language Development

This paper analyses the effects of direct and indirect early parental investments on the German-language development of 3–5-year-old children of Turkish immigrants and native German children. Since Turkish parents are on average less proficient in German than native parents, it is hypothesised that Turkish children cannot profit as much as German children from activities inside the family (e.g., frequency of parental reading to child). For the same reason, activities outside the family (e.g., attendance at playgroups) might then be of special importance for their acquisition of German-language skills. Used for the empirical analyses are the data of the project ‘Preschool Education and Educational Careers among Migrant Children’, which includes a repeated measure of children’s German vocabulary over a one-year period. It is demonstrated that German children can profit more than Turkish children from activities inside the family, while the opposite is true regarding activities outside the family. Additional analyses with the Turkish sample show that a higher frequency of activities inside the family improves Turkish children’s German vocabulary only under the condition that their parents have a good command of German. The findings indicate that activities outside the family are a very effective means of fostering development of the second language among migrant children.     

Pain and the Guillain-Barré syndrome in children under 6 years old.

During a 15-year period, 29 children, under the age of 6 years, with acute Guillain-Barré syndrome were seen at our institution. A review of their charts revealed that pain was a symptom in all patients and was present on admission in 79% of cases. Pain was often the most important symptom and led to misdiagnosis in 20 patients (69%). In 11 of these children, symptoms were present for more than a week before the correct diagnosis was made. The most common pain syndrome was back and lower limb pain, present in 83% of patients. Pediatricians should consider Guillain-Barré syndrome in their differential diagnosis when faced with a child who has lower limb pain and areflexia.     

Nonaccidental trauma and failure to thrive.

Charts were reviewed of 140 children who were discharged from Denver General Hospital (DGH) with diagnoses of nonaccidental trauma or failure to thrive. These children were all enrolled in a neighborhood health program. It was found that boys and girls were affected equally and that most of these children were under 3 years of age. In relation to their representation in the Neighborhood Health Program, more white children were abused or failed to thrive than children from other racial groups. A disproportionate number of children had birth weights under 2,500 gm as compared to children born at DGH. Young parents who were raised in disrupted families were involved in child abuse more frequently than were individuals from more stable families. Bruising was the most frequent injury and was most prevalent among boys under 3 years of age. Fractures were the second most common injury and occurred equally among boys and girls. There appeared to be a seasonal variation in the incidence of abuse.     

DOG HYPERSENSITIVITY IN ASTHMATIC CHILDREN

ABSTRACT. The occurrence of dog hypersensitivity in 203 unselected asthmatic children was investigated by means of the skin prick test, the provocation test and RAST. The history of past and present exposure to dogs, symptoms in contact with dogs, and the effects of pet avoidance were examined. The amount of dog dander antigens was analyzed by counter-immunoelectrophoresis from dust samples from 67 homes. A history of past or present dog hypersensitivity was obtained from 120 subjects (59%). A positive (≧++) prick test reaction was observed in 113 (56%), a positive provocation test result in 84 (41%) and a RAST class ≧ 1 in 140 (69%). The serum levels of IgE antibodies to dog dander correlated significantly with serum total IgE and the frequency of asthmatic attacks. The occurrence of dog allergy was not significantly associated with past or present exposure to dogs at home. However, the children who were exposed to dogs during the first year of life had dog allergy more often than those with late or without exposure. Significant amounts of dog dander antigen were also found in dust samples from homes where dogs have never been kept. Serum samples from previous years were available from 24 patients. Rising or steadily high levels of IgE antibodies to dog dander were observed even in subjects who strictly avoided dogs. The results show that dog hypersensitivity is an important cause of allergic disorders in asthmatic children, and that the common presence of dog dander antigens in our environment may induce dog allergy even without direct exposure to dogs.     

Corticosteroid therapy in atopic diseases of children? (author's transl)]

Of 416 children suffering from different atopic diseases who were admitted as in-patients in a German aero-biological childrens clinic, 69.2% had previously received corticosteroid therapy. According to dermatological findings, 81.9% of these patients developed undesirable side effects. Of the children whose atopic dermatitis was treated prolonged with topical corticosteroids, also irreversible body changes developed through the transcutaneous absorptive processes, which were more evident and appeared more often in girls than in boys.     

The management of pain in children

There are now safe and effective techniques which can decrease significantly the amount of pain a child will experience in an acute care setting. For such techniques to work, however, the importance of pain management in children must be recognized. It should be assumed that anything that will hurt an adult will also hurt a child and that children are, in fact, often more sensitive to hospital procedures than are adults. Pain assessment should be a part of the child's care plan, and developmentally appropriate ways of recognizing pain should be in place in all hospitals that care for children. Behavioral and pharmacologic techniques should be tailored to the needs of the individual child. The skill of physicians should be assessed not only by their cure of illnesses, but by the comfort they provide in the process.     

The dangers of premature extubation after severe birth asphyxia

Abstract The records of all 91 neonates with asphyxia who were referred to the Royal Children's Hospital in 1982 and 1983 were reviewed and information was obtained on their subsequent neurological outcome. Thirty children had been extubated after their initial resuscitation, before transfer to the Royal Children's Hospital; 21 of these children had been extubated despite the fact that they had taken more than 5 min to take their first breath, and 11 (52%) of them died (while none of the nine infants who breathed within 5 min died). A paediatrician was involved with two-thirds of the 21 children who were extubated despite having more than 5 min to breathe. Twelve children required cardiac massage; seven of them were extubated and then reintubated before transfer, and six of the seven infants died. These findings suggest that many paediatricians are not aware of the importance of continuing ventilatory support in neonates who have suffered a severe asphyxial insult. Asphyxiated babies who require cardiac massage, and babies who do not start breathing within 5 min of birth, should not be extubated as soon as they have established regular respiration; they should remain intubated and be transferred to an intensive care unit.     

Pediatric dog bite victims: a need for a continuum of care

The authors assessed the ongoing needs of 34 pediatric dog bite victims and their families 1 month after receiving care in a pediatric emergency department. More than 70% of the parents noted at least 1 new concerning behavior in their children, and more than 85% of the parents also endorsed concerns about their own reactions. Half of the parents believed that children, in general, might benefit from interventions to help with postbite fears and nearly three quarters felt that families would benefit from education regarding dog bite prevention. The majority (85%) of the parents believed that additional supportive services could be offered effectively at emergency department or pediatric office/clinic visits. A template for a dog bite information card is presented.