Gastroesophageal reflux disease in infants: how much is predictable with questionnaires, pH-metry, endoscopy and histology?

Symptoms of gastroesophageal reflux disease (GERD) are common in infants. It is often difficult to discriminate between physiological and pathologic gastroesophageal reflux, although this discrimination is essential to determine which infants to evaluate and treat. OBJECTIVES: To identify the prevalence of reflux symptoms in infants and to evaluate the predictive value of a questionnaire and the correlation between pH study, histology and clinical score. METHODS: Parents of 100 unselected infants visiting the well-baby clinic and 100 infants suspected of having gastroesophageal reflux disease were asked to fill in a 35-item questionnaire. A validated score, the Orenstein I-GERQ, was applied for selected questions. All infants suspected of having gastroesophageal reflux disease underwent prolonged esophageal pH monitoring and 44 or 100 underwent upper gastrointestinal tract endoscopy with esophageal biopsy. RESULTS: Parents of infants with suspected gastroesophageal reflux disease reported significantly more regurgitation (68% versus 45%, P < 0.05) and crying (51% versus 20%, P < 0.01) compared with the parents of healthy infants. A pathologic pH study (reflux index > 10%) was found in 21 of 100 (21%) infants and was significantly associated only with pneumonia, apnea with fussing (P = 0.013 for both), defecation less than once a day (P = 0.033) and constipation (P = 0.05). Esophagitis was present in 17 of 44 (39%) and no one question was found to be significantly predictive. 38% of infants with a pathologic pH study had a normal esophageal biopsy and 53% of infants with histologic esophagitis had a normal pH study. Discordance between pH study and biopsies occurred in 14 of 44 (32%) patients. The Orenstein I-GERQ cut-off score failed to identify eight of 31 (26%) infants with gastroesophageal reflux disease. Conversely, the score was positive in 17 of 22 (81%) infants with normal biopsy and pH study and in 14 of 47 (30%) infants with normal pH study. CONCLUSIONS: Clinical symptoms, histology and pH study show poor correlation in infants. Clinical symptoms such as regurgitation and crying are less frequent in unselected infants than in infants suspected of gastroesophageal reflux disease. However, questionnaires are poorly predictive for the severity of gastroesophageal reflux disease, as they do not correlate with esophageal acid exposure as measured by pH-metry and with esophagitis as evaluated by histology of esophageal biopsies.     

Maternal mental health and infant dietary patterns in a statewide sample of Maryland WIC participants

The study's objective was to examine the relation between maternal mental health and infant dietary intake. A cross‐sectional, population‐based telephone survey was employed within a statewide sample of Maryland Special Supplemental Nutrition Program for Women, Infants and Children participants. A 24‐h diet recall was performed using the United States Department of Agriculture Automated Multiple‐Pass Method. Analyses presented were based on 689 mother–infant pairs. Overall, 36.5% of mothers reported introducing solids to their infants early (<4 months of age), and 40% reported adding cereal to their infant's bottle. Among 0–6‐month‐old infants, higher infant energy intake was associated with symptoms of maternal stress [β = 0.02; confidence interval (CI): 0.01, 0.04], depression (β = 0.04; CI: 0.01, 0.06) and overall maternal psychological distress (β = 0.02; CI: 0.003, 0.03). With early introduction of solids in the model, the significant associations between infant energy intake and maternal stress and maternal psychological distress became marginal (P‘s = 0.06–0.10). The association between infant energy intake and maternal depression remained significant (β = 0.03; CI: 0.01, 0.06). Among 4–6‐month‐old infants, intakes of breads and cereals were higher among mothers who reported more symptoms of stress (β = 0.12; CI: 0.04, 0.23), depression (β = 0.19; CI: 0.03, 0.34), anxiety (β = 0.15; CI: 0.02, 0.27) and overall psychological distress (β = 0.04; CI: 0.01, 0.07). Among 7–12‐month‐old infants, dietary intake was not related to mental health symptoms. Findings suggest poorer infant feeding practices and higher infant dietary intake during the first 6 months of age in the context of maternal mental health symptoms. Further research is needed to evaluate these effects on child dietary habits and growth patterns over time.     

Maternal ratings of infant intensity and distractibility: relationship with crying duration in the second month of life

OBJECTIVE: To investigate the relationship between infant temperament characteristics assessed at 4 weeks of age and the duration of infant crying and fussing during the second month of life. DESIGN: Families were enrolled in this prospective study during prenatal classes, and 60 infants completed the study. Temperament was assessed when the infant was 4 weeks of age using the Early Infancy Temperament Questionnaire, and crying and fussing was assessed on 16 days during the second month of life using a parent-completed infant behavior diary. RESULTS: Ratings of the total duration of infant crying and fussing correlated significantly with the sum score on the temperament questionnaire (r = 0.36; P =.005). A longer duration of crying and fussing was associated with infants with high intensity (r = 0.43; P =.001) and low distractibility (r = 0.37; P =.003). CONCLUSIONS: The finding that mothers rating their infants as having high intensity and low distractibility is associated with increased crying duration supports a growing body of literature suggesting that infants with high levels of crying are more reactive to sensory stimuli and harder to soothe than those who cry less. Physicians counseling parents of infants with persistent crying should recognize the infant characteristics associated with increased crying.     

Behavioral interventions reduce infant distress at immunization

OBJECTIVE: To assess the effectiveness of simple behavioral interventions at immunization on behavioral and biochemical indicators of distress in infants and parents in a primary care setting. DESIGN: Subjects were enrolled sequentially to control (standard care) and intervention groups. Intervention parents (n=57) were provided information about techniques to help their infants at immunization. Standard care parents (n=45) did not receive this information. Immunizations were videotaped and coded for infant and parent behaviors. Using a visual analog scale, parents rated their infant's and their own comfort at study enrollment, immediately after immunization, and at check-out. Saliva samples collected from infants and parents at study enrollment and at 15, 30, and 60 minutes after immunization were assayed for cortisol concentration by standard radioimmunoassay. Data were analyzed using chi2, analysis of variance, and general linear modeling. Patterns of salivary cortisol change after immunization were analyzed using hierarchical linear modeling. SETTING: A single, urban pediatric practice during 2 summers (1997 and 1998). SUBJECTS: Infants 2 to 24 months of age (n= 102) and their parents. MAIN OUTCOME MEASURES: Duration of infant distress (in seconds); parent use of behavioral intervention; infant and parent salivary cortisol concentrations (in nanomoles per liter). RESULTS: Intervention parents were more likely to use a behavioral technique with their infants before immunization (P<.05). Total infant distress was shorter for intervention infants at immunization (P<.01), and these infants were rated as more comfortable by their parents (P<.001) immediately after immunization. Salivary cortisol levels were lower for intervention infants at 15, 30, and 60 minutes after immunization (P<.05). CONCLUSION: Simple behavioral interventions before immunization are associated with reductions in behavioral and biochemical indicators of infant distress.     

Screening Infants For Neuroblastoma: The Parents' Perspective

Health visitors collected urine samples from 6–month-old infants in a feasibility study of infant screening for neuroblastoma. As part of the project's evaluation, a study was conducted of the parents' views and experiences of screening. Parents of the most recently screened infants were contacted: 85 (68% of those contacted) were interviewed. Despite intermittent media coverage and written and verbal information being available, parents' overall knowledge of neuroblastoma screening was poor. Thirteen percent reported that they did not know the purpose of the test. Approximately one-third of parents reported initial anxiety about the test. Where samples were repeated because of unsatisfactory results, this percentage increased to 41% for a first-repeat sample. Parents were willing to make considerable effort to provide samples for screening but worried unnecessarily because the information they were given was either inadequate or in an inappropriate format (ie, verbal instead of written).     

Parental emotional and time costs predict compliance with respiratory syncytial virus prophylaxis.

BACKGROUND: Two agents are effective in preventing respiratory syncytial virus (RSV) hospitalization in premature infants: RSV immune globulin (RSV-IG) and palivizumab. RSV-IG is associated with greater parental emotional and time costs, which may account for the more limited adherence to recommended monthly treatment with this agent. OBJECTIVES: To compare the emotional distress and time costs associated with RSV-IG and palivizumab treatments and to determine the influence of these costs on treatment adherence. METHODS: We surveyed parents of 82 infants who received RSV-IG (90% of eligible) and parents of 61 infants who received palivizumab (87% of eligible) at Arkansas Children's Hospital by telephone. We measured infant distress during treatment, parental distress, parental time costs, and adherence with recommended monthly prophylaxis. RESULTS: Half of parents of RSV-IG recipients witnessed their infant in distress during infusion, over half (61%) were upset by observing the needle stick, and 22% observed infusion in the scalp. Fewer than 5% of parents of palivizumab recipients observed their infant in distress or were themselves distressed during treatment. A quarter of parents took time off from work for RSV-IG or palivizumab treatment. RSV-IG recipients completed 62% of recommended monthly treatments compared with 86% completed by palivizumab recipients. Increased parental distress and time costs largely accounted for the reduction in adherence to monthly treatment among RSV-IG recipients. CONCLUSIONS: The emotional and time costs of RSV-IG treatment far exceed those of palivizumab and predict substantial differences in treatment adherence between the 2 agents. The impact of hidden costs on treatment adherence should be included in economic evaluations of medical procedures.     

At-home recovery following hospitalization for bronchiolitis.

OBJECTIVES: To characterize the at-home recovery of infants after hospitalization for bronchiolitis, the impact of recovery from this illness on the family, and the association between delayed infant recovery and parental satisfaction with hospital care. METHODS: Otherwise healthy infants less than 1 year of age admitted to 6 children's hospitals were eligible. Telephone interviews with 486 parents (85% of sampled), 1-2 weeks following discharge, addressed functional recovery, lingering symptoms, family disruption, returns to the emergency department, and parental recall of satisfaction with care. RESULTS: Two thirds of infants experienced difficulties with normal routines (feeding, sleeping, contentedness, liveliness) on the day of discharge. By 5 days at home, 22% continued to experience disruption in sleeping, and 16% in feeding routines. Coughing (56%) and wheezing (27%) were common 4 to 6 days after discharge. Parents who reported longer delays in return to normal family routines took additional time off work, kept their infants out of day care twice as many days, and were more likely to take their infants to the doctor or hospital for repeat medical care. Parents from families slower to return to a normal routine recalled the hospital stay less favorably. CONCLUSIONS: A small but important proportion of infants have a protracted recovery period following hospitalization for bronchiolitis. Delayed recovery is associated with parental work time loss and less favorable parental impressions of care in the hospital. Anticipatory guidance about home recovery could allow parents to plan for extended home care and improve satisfaction with hospital care.     

Parental psychological well-being and cognitive development of very low birth weight infants at 2 years

Aim: To assess the associations between cognitive development of very low birth weight (VLBW) infants and measures of parental psychological well‐being. Methods: In this prospective cohort study, 182 VLBW infants born 1/2001–12/2006 at the Turku University Hospital, Finland, were followed up. At 2 years corrected age, cognitive development of the child was assessed using the Mental Development Index of Bayley Scales, and both parents filled in validated questionnaires defining parental psychological well‐being (Beck Depression Inventory, Parenting Stress Index and Sense of Coherence Scale). Results: The cognitive delay of the infant was associated with paternal symptoms of depression (p = 0.007) and parenting stress (p = 0.03). Mothers of the infants with cognitive delay reported increased parenting stress related to the difficulty to accept the child (p = 0.001). Weak sense of coherence predicted depressive symptoms in both parents (p < 0.0001). Conclusion: Even if the fathers of VLBW infants experienced depressive symptoms less often than the mothers, the ability of the fathers to cope was significantly associated with the cognitive development of the infant. In addition, the fathers reported more parenting stress if the infant had a cognitive delay. The mothers reported more parenting stress related to accepting the VLBW infant with cognitive delay.     

Infants admitted to a neonatal intensive care unit: parental psychological status at 9 months

AIM: This paper reports on the 9-month follow-up of parents who had an infant admitted to neonatal intensive care unit (NICU) compared to parents of full-term health infants. The psychological status of the parent groups is compared and factors associated with status change are examined. METHODS: Prospective longitudinal study of random sample of 447 parents (mother and father with an infant admitted to the NICU and 189 parents (mother and father) with term infant not requiring NICU admission. Parents' depression and anxiety symptoms were assessed at infant birth and 9 months later. RESULTS: The increased levels of depression and anxiety symptoms evident in NICU parents after their infant's birth were no longer apparent by 9 months. Higher initial symptom severity and perceived quality of the couple relationship were most commonly associated with improvement. Other factors related to symptoms change were number of baby hospitalizations for fathers and being in the NICU, age and living with the infant's father or mother. CONCLUSION: For the majority of parents having an infant admitted to the NICU does not result in ongoing psychological distress.     

Early infant crying and sleeping problems: a pilot study of impact on parental well-being and parent-endorsed strategies for management

AIMS: Infant sleeping and crying problems are common and impact adversely on maternal mental health but their impact on paternal mental health is unknown. A consistent approach to managing such problems has not been identified. Parents may be able to identify useful management strategies, which could then inform the content of a prevention/early intervention approach to such problems. We aimed to determine the impact of infant behaviour problems on maternal and paternal mental health and management strategies that parents find useful. METHODS: Design: Pre-post intervention pilot. Setting: Paediatric outpatient clinic at the Royal Children's Hospital, Melbourne. Participants: 71 mothers and 60 fathers of infants aged 2 weeks to 7 months recruited from July 2004 to April 2005. Main outcome measures: Pre and post questionnaires measuring maternal and paternal well-being (Edinburgh Postnatal Depression Scale (EPDS)), parent report of infant behaviour problems, usefulness of consultation strategies. RESULTS: Three weeks post consultation, fewer parents reported that their infant's behaviour was still a problem (64% of mothers and 55% of fathers). Thirty per cent fewer mothers reported an EPDS score>12 (45% pre vs. 15% post clinic) while 11% fewer fathers reported an EPDS score>9 (30% pre vs. 19% post clinic). Most parents (80% or more) rated exclusion of medical causes and information about normal sleeping/crying as useful. CONCLUSIONS: Problem infant behaviours are associated with poor parental mental health. An intervention/prevention approach to infant behaviour problems should include fathers and contain information about normal infant sleeping and crying patterns and exclusion of medical causes.     

Exposure to tobacco smoke and infant crying

AIM: To examine the association of excessive infant crying with maternal smoking during and after pregnancy, paternal smoking, and smoking by other people in the living environment of the infant. METHODS: We collected data on infant crying and smoking in a Dutch national sample of 5845 infants aged 0-3 mo (response 62.8%). We defined excessive crying as crying over 3 h a day on more than 3 d of the preceding week. RESULTS: The prevalence rate of excessive crying was 4.0% (95% CI 3.5 to 4.5%). Excessive crying occurred more frequently among infants of fathers smoking 15 + cigarettes/d (odds ratio (OR) 1.99, 95% CI 1.38 to 2.86) and of mothers smoking 10 + cigarettes/d during pregnancy (OR 1.86, 95% CI 1.02 to 3.42). Infants whose parents were heavy current smokers or whose mothers had been so during pregnancy had a 69% higher prevalence of excessive crying than infants of non-smoking parents (rates: 6.3% and 3.7%, respectively; odds ratio 1.80; 95% CI 1.26 to 2.57). CONCLUSION: Parents stopping smoking may prevent excessive infant crying.     

Screening Infants For Neuroblastoma: The Parents' Perspective

Health visitors collected urine samples from 6-month-old infants in a feasibility study of infant screening for neuroblastoma. As part of the project's evaluation, a study was conducted of the parents' views and experiences of screening. Parents of the most recently screened infants were contacted: 85 (68% of those contacted) were interviewed. Despite intermittent media coverage and written and verbal information being available, parents' overall knowledge of neuroblastoma screening was poor. Thirteen percent reported that they did not know the purpose of the test. Approximately one-third of parents reported initial anxiety about the test. Where samples were repeated because of unsatisfactory results, this percentage increased to 41% for a first-repeat sample. Parents were willing to make considerable effort to provide samples for screening but worried unnecessarily because the information they were given was either inadequate or in an inappropriate format (ie, verbal instead of written).     

The impact of very premature birth on the psychological health of mothers

BACKGROUND: The birth of a very premature infant is a critical event in the life of a family and studies have shown that mothers of these infants are at greater risk of psychological distress than mothers of full-term infants. STUDY DESIGN: A total population study of mothers of preterm infants born at less than 32-week gestation at a tertiary referral hospital. SUBJECTS AND METHODS: Sixty-two mothers of very preterm infants (<32 weeks) participated in the present study which examines correlates of maternal depressive symptomatology at 1 month following very premature birth. Information was obtained from structured questionnaires completed by mothers at 1 month after infant admission to neonatal intensive care. RESULTS: Forty percent of the mothers reported significant depressive symptoms on the Edinburgh Postpartum Depression Scale (EPDS). Logistic regression analysis indicated that high maternal stress resulted in an increased likelihood of depressive symptoms (OR 1.15, CI 1.04-1.26, p<0.01). Higher levels of maternal education (p<0.05), and increased perception of support from nursing staff (OR 1.06, CI 0.88-1.00, p<0.05) resulted in decreased likelihood of depressive symptoms. CONCLUSIONS: The birth and subsequent hospitalisation of a very premature infant evokes considerable psychological distress in mothers. These results have implications for policy development in order to enhance family centred care in the neonatal intensive care.     

Die verlorene Gurtfixierung

We report the case of a 13 year old mentally handicapped boy who ingested a foreign body. The patient developed no symptoms, although the 4 cm long foreign body was located in the upper third of the oesophagus. The extraction of the foreign body was performed via endoscope without complications.The ingestion of foreign bodies by mentally retarded or handicapped children has a higher morbidity and mortality rate in comparison to healthy individuals. Typical clinical signs of foreign bodies can be missing or are misinterpreted in the context of the underlying handicap. Parents, caretakers, and health professionals should be aware of this. In order to avoid complications it is essential to listen carefully to the reports of parents/caretakers of mentally handicapped infants. Without the observation of the parents the foreign body could have been easily missed in the reported infant. Complications would have been very likely.     

Parental recall of infant medical complications and its relationship to delivery method and education level

Since relatively little is known as to why parents find it difficult to recognize when their high-risk infant ceases to be ill, this investigation examined parental reports of infant complications and the relationship these reports had with parental education level and method of delivery. Using a questionnaire format, 60 parents reported complications their infants experienced during NICU (neonatal intensive care unit) hospitalization. Maternal and paternal reports were comparable, although both significantly differed from actual diagnoses; parents underreported their infant's complications. Reported complications were not related to parental education level but were associated with method of delivery. Parents of Caesarean-section (C-section) infants identified a significantly smaller percentage of complications than did parents of vaginally delivered babies. It is suggested that (1) medical caregivers have the potential for helping parents more fully comprehend infant complications, (2) supplemental communication methods may be necessary for the task in (1), and (3) information communicated to parents may need to incorporate the current findings about parental education level and delivery method.     

The impact of childhood acute rotavirus gastroenteritis on the parents' quality of life: prospective observational study in European primary care medical practices

ABSTRACT: BACKGROUND: Rotavirus (RV) is the commonest cause of acute gastroenteritis in infants and young children worldwide. A Quality of Life study was conducted in primary care in three European countries as part of a larger epidemiological study (SPRIK) to investigate the impact of paediatric rotavirus gastroenteritis (RVGE) on affected children and their parents. METHODS: A self-administered questionnaire was linguistically validated in Spanish, Italian and Polish. The questionnaire was included in an observational multicentre prospective study of 302 children aged <5 years presenting to a general practitioner or paediatrician for RVGE at centres in Spain, Italy or Poland. RV infection was confirmed by polymerase chain reaction (PCR) testing (n = 264). The questionnaire was validated and used to assess the emotional impact of paediatric RVGE on the parents. RESULTS: Questionnaire responses showed that acute RVGE in a child adversely affects the parents' daily life as well as the child. Parents of children with RVGE experience worry, distress and impact on their daily activities. RVGE of greater clinical severity (assessed by the Vesikari scale) was associated with higher parental worries due to symptoms and greater changes in the child's behaviour, and a trend to higher impact on parents' daily activities and higher parental distress, together with a higher score on the symptom severity scale of the questionnaire. CONCLUSIONS: Parents of a child with acute RVGE presenting to primary care experience worry, distress and disruptions to daily life as a result of the child's illness. Prevention of this disease through prophylactic vaccination will improve the daily lives of parents and children.     

Serious illness in childhood: the different threats of cancer and diabetes from a parent perspective

OBJECTIVES: To compare the incidence of disease-related distress symptoms in parents of children with cancer and diabetes. STUDY DESIGN: A total of 675 parents of patients with cancer, patients with diabetes, and control subjects were assessed for 11 distress symptom clusters. Patient and control parent mean differences were tested by 2-tailed t tests; illness groups were compared by means of analysis of variance. Distress variations as a function of time since diagnosis were examined by regression analysis. RESULTS: The distress levels of patient parents exceeded those of control parents for global distress ( P <.0001) and for most symptom subcategories. Distress levels of parents of patients with cancer (CP) significantly exceeded those of parents of patients with diabetes (DP) in anxiety ( P <.0001), physical and psychologic distress ( P <.0001), depression ( P <.005), and loneliness ( P <.05). Levels in DP matched those of CP in uncertainty, loss of control/the patient, self-esteem, disease-related fear, and sleep disturbances. Distress levels were lower in CP most distant in time from diagnosis, whereas DP showed a reversed trend. CONCLUSIONS: Parental distress patterns in childhood illness depend on illness type and time passed since diagnosis. Symptom profiles verify the need for psychosocial attention at the initial shock after the cancer diagnosis and indicate long-term consequences for many parents. In pediatric diabetes, the persistence or intensification of distress over time is of specific clinical relevance.     

Fever associated with teething.

A relationship between teething and fever was sought by examining mothers' reports of the 20 days before the eruption of the first tooth in 46 healthy infants. Twenty infants had a fever of greater than 37.5 degrees C on day 0 compared with seven infants (or fewer) from day 19 to day 4. The danger of attributing fever to teething is emphasised.     

Neonatal end-of-life decision-making almost 20 years after the EURONIC study: A French survey

Nearly 20 years ago the EURONIC study reported that French neonatologists sometimes deemed it legitimate to terminate the lives of newborn infants when the prognosis appeared extremely poor. Parents were not always informed of these decisions. Major change has occurred since then and is described herein.Material and methodsA survey was conducted in the Île-de-France region, from 1 January to 31 January 2016. Professionals from 15 neonatal intensive care units (NICUs) were invited to complete a questionnaire.ResultsA total of 702 questionnaires were collected and 670 responses were analyzed. Knowledge of the law differed according to professional status, with 71% of MDs (medical staff, MS), compared with 28% of nonmedical staff (NMS) declaring that they had good knowledge of the law. Most MDs and NMS believed that withholding or withdrawing life-sustaining treatments (WWLST) could be decided and implemented after a delay. Half of them thought that WWLST would always result in death. Although required by law, a consulting MD attended the collegial meeting required before deciding on WWLST in only half of the cases. Parents were almost always informed of the decision thereafter by the physician in charge of their infant. The most frequent disagreement with parents was observed when WWLST was the option selected. In this case, most professionals suggested postponing WWLST, continuing intensive care and dialogue with parents, aiming at a final shared decision. Major differences were observed between NICUs with regard to the withdrawal of artificial nutrition and hydration. Finally, 14% of MDs declared that infant active terminations of life still occurred in their NICU. Major differences concern WWLST and active termination of life, whose meaning has been partly modified since 2001.ConclusionSeveral major changes were observed in this survey: (1) treatment withdrawal decisions are made today in agreement with the law; (2) parents’ information and involvement in the decision process have profoundly changed; (3) active termination of life (euthanasia) very rarely occurs; only at the end of a process in accordance with ethical principles and within the law is this decision made.