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目的探讨婴幼儿睡眠启动相关问题的治疗方案。方法将2004年5~9月在上海儿童医学中心睡眠专科门诊就诊的85例睡眠启动相关问题的患儿随机分为行为干预组、苯海拉明组和苯巴比妥治疗组,分别在治疗开始后1周、4周及3个月对患儿的睡眠状况进行分析。同时通过问卷对婴幼儿睡眠启动相关问题的高危因素进行分析。结果3组治疗在3个月以内的疗效相仿,但是行为干预治疗在缩短入睡时间方面的长期疗效较为突出,而苯巴比妥治疗组短期对于戒除入睡依赖行为有一定的优势。影响婴幼儿睡眠启动相关问题发生的高危因素主要有抚养人状况、孕产史、家庭环境等。结论行为治疗与健康教育相结合可以作为治疗婴幼儿睡眠启动相关问题的首选方案。     

Effect of enhanced nutrition services with community-based nutrition services on the diet quality of young children in Ethiopia

Poor diet quality related to inadequate complementary feeding is a major public health problem in low and middle-income countries including Ethiopia. Low dietary diversity has been linked to negative health outcomes in children. To provide a package of interventions to close nutritional gaps through agriculture, the Sustainable Undernutrition Reduction in Ethiopia (SURE) programme was set up as a multi-sectoral initiative and the results of combined effects of community-based and enhanced nutrition services, compared to community-based alone, on diet diversity and diet quality of complementary feeding of young children are presented. The study used pre- and post-intervention design. Baseline (n = 4980) data were collected from May to July 2016, and follow-up (n = 2419) data from December 2020 to January 2021. From 51 intervention districts having the SURE programme, 36 intervention districts were randomly selected for baseline and 31 for the follow-up survey. The primary outcome was diet quality: minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). Comparing endline to baseline over the 4.5-year intervention, the use of standard community-based nutrition services of growth monitoring and promotion increased (16%–46%), as did enhanced nutrition services of infant and young child feeding counselling, and agricultural advising (62%–77%). Women involved in home gardening significantly increased (73%–93%); however, household production of food decreased yet consumption of most own-grown foods increased. Importantly, MAD and MDD increased four-fold. The SURE intervention programme was associated with improvements in complementary feeding and diet quality through enhanced nutrition services. This suggests programmes targeted at nutrition-sensitive practices can improve child feeding in young children.     

Underinvolved relationship disorder and related factors in a sample of young children

Background and aims

The interaction between the infant and the caregiver is stated to be very important in the development of a child. When there is inadequacy of interaction, several emotional and developmental problems can emerge. We aimed to investigate the socio-demographic and clinical features of children diagnosed with Underinvolved Relationship Disorder according to the DC:0–3R classification system.

Study design and methods

Four hundred and fifty seven children aged between 1 and 59 months, who had been admitted to an infant mental health clinic were assessed using the DC:0–3R classification system and the whole sample was divided into two groups, the group in which Underinvolved Relationship Disorder between the child and the caregiver had been detected (URD), and the group in which this had not been detected (NURD). These two groups were compared with regard to socio-demographic features, reasons for referral, primary diagnoses, relational disorders, medical/developmental conditions, psychosocial stressors and the Parent–Infant Relationship Global Assessment Scale (PIRGAS) scores of children.

Results

Language delay, insufficient social interaction and aggression were found to be significantly more frequent reasons for referral in URD. Disorders of Relating and Communicating (equivalent to the Pervasive Developmental Disorders in DSM IV) and Deprivation/Maltreatment Disorder were more frequent primary diagnoses, Verbally or Physically Abusive Relationship Disorder was significantly more frequent relational disorder in URD. Mild and moderate mental retardation were significantly more frequent in URD, and social environment, educational/child care and health-care access challenges were found to be more frequent psychosocial stressors in the parents of URD. The Mean PIRGAS scores were significantly lower in URD connoting that the parent–infant relationship is poorer.

Conclusions

The diagnosis of Underinvolved Relationship Disorder according to the DC:0–3R classification system is related to some developmental and psychosocial problems.     

Patterns of psychotropic medication use in very young children with attention-deficit hyperactivity disorder

Psychotropic medications are increasingly used for very young children. Patterns of use in a well-described group of children 3 years and younger with a diagnostic label of attention-deficit hyperactivity disorder (ADHD) reveal both reasons to use such medications and concerns about how these medications are used. Of 223 children with ADHD, more than half (n = 127) received psychotropic medications in an idiosyncratic manner, both in the specific medication and in use over time. Almost half of the children who were medicated did not have opportunities for monitoring as often as every 3 months, despite the fact that more than half received psychotropic medications for 6 months or longer. Children with comorbid mental health conditions and chronic health conditions were at greater risk for receiving psychotropic medications. These patterns of use demonstrate a compelling need for guidance in psychopharmacological treatment of very young children.     

Malignant pertussis in the young infant]

Pertussis remains in France the first cause of bacterial, infectious death in infant aged 10 days to 2 months. It is especially in this age group that malignant pertussis occurs. CASE REPORT: A 40-day-old infant was admitted in the intensive care unit with symptoms of bronchiolitis along with a 200 bpm permanent tachycardia. He presented a marked leukocytosis with lymphocytosis. On the second day, convulsions and coma occurred, followed rapidly by respiratory failure, with a subsequent deterioration due to the development of severe pulmonary hypertension. Circulatory failure caused the infant's death on the beginning of the 5th day. Pertussis was confirmed by PCR on nasopharyngeal swab. Intra-familial contamination was most likely. COMMENTS: Malignant pertussis is characterized by the very young age of patients, permanent tachycardia sine materia, dyspnea with early respiratory failure, frequent neurological symptoms, severe hyperleukocytosis and hyperlymphocytosis, and deep hyponatremia with oliguria and edema. Mortality remains superior to 75% despite the various treatments and life support measures that have been attempted. Adult pertussis, which represents one third of the cases of prolonged cough in this age group, is the main source of contamination of non-immunized young infants. This mode of transmission stresses the importance of the generalization of pertussis vaccine booster in early adolescence, which is recommended in France since 1998. Its extension towards the adult age is under study.     

Levels of gross and fine motor development in young children with autism spectrum disorder

The purpose of this study was to compare levels of gross motor (GM) and fine motor (FM) development in young children with autism spectrum disorder (ASD), and to compare their levels of GM and FM development with children with developmental delay (DD) without ASD. Thirty-eight children (ASD group: n = 19; DD group: n = 19) between 21 and 41 months of age were assessed using the Peabody Developmental Motor Scales, Second Edition (PDMS-2). Using PDMS-2 classifications as well as differences between standard scores, each child was placed in one of three motor profiles based on the child's relative levels of GM and FM skills (GM = FM,GM>FM, and GM相似文献   

Sport nutrition for young athletes

Nutrition is an important part of sport performance for young athletes, in addition to allowing for optimal growth and development. Macronutrients, micronutrients and fluids in the proper amounts are essential to provide energy for growth and activity. To optimize performance, young athletes need to learn what, when and how to eat and drink before, during and after activity.     

Malignant external otitis in children

Malignant external otitis in the pediatric population is primarily a disease of children with chronic illness or immunosuppression. The presence of severe, unrelenting otalgia, otorrhea with isolation of Pseudomonas aeruginosa, a markedly elevated erythrocyte sedimentation rate, and evidence of bone destruction on computed tomography scan should alert the clinician to the diagnosis. Unlike adults, children have a higher incidence of seventh nerve paralysis earlier in the course of the infection. They also manifest more frequent involvement of the middle ear with tympanic membrane destruction. The short interval between the onset of symptoms and facial nerve dysfunction highlights the necessity of prompt diagnosis and institution of anti-Pseudomonas therapy. Our review suggests that this destructive bacterial infection is an emerging clinical entity in children; 73% of the cases have been reported since 1980. Pediatricians should therefore be familiar with the clinical presentation of this treatable infection. Substantial morbidity could be alleviated by prompt diagnosis and early antibiotic treatment.