Chronic constipation in overweight children

BACKGROUND: Obesity and functional constipation seem to share a common biopsychosocial model of causation. Though chronic constipation can significantly affect the quality of life of an overweight child, this association has not been highlighted in the literature. The purpose of this study was to compare the proportion of overweight children among children with chronic constipation with a control group of children with normal bowel habits. METHODS: Retrospective chart review with a control population. One hundred one consecutive children 5-18 years of age referred to the Subspecialty Clinic for functional constipation were the study group. The control group consisted of 100 consecutive children from the general pediatric practice seen for physicals and minor illnesses. Children with a body mass index (BMI) of >85 percentile from the National Institutes of Health (NIH) 2000 chart were classified as overweight. RESULTS: The control and study groups were statistically comparable in mean age (10.97 +/- 3.83 years and 8.07 +/- 2.56 years, respectively) and gender ratio (58 males in each group). Thirty children in the control group and 44 in the study population were overweight (p < .05). Among children with chronic constipation, the group of overweight children was male predominant (70.45% vs 47.36%, p < .05), had increased incidence of psychological/behavioral problems (45.45% vs 22.8%, p < .05), and was more likely to fail treatment (40.9% vs 21.05%, p < .05). There was no significant difference in the clinical profile of constipation, such as mean duration of constipation before presentation, sex ratio, incidence of painful defecation, and soiling and frequency of defecation between these 2 groups. CONCLUSIONS: There appears to be an association between chronic severe constipation and being overweight. Children with constipation are more likely to be overweight when compared with controls. Among children with chronic constipation, overweight individuals seem to constitute a distinct clinical group. This group is male predominant, has increased incidence of psychological/behavioral disorders, and is more likely to fail treatment.     

孤独症与正常儿童幼儿期亲子间分离事件和亲密行为与儿童玩耍方式的差异研究

目的：探索孤独症与正常儿童幼儿期经历亲子分离事件和亲密行为及儿童玩耍方式的差异。方法采用病例对照研究的方法，以符合美国精神障碍诊断与统计手册（DSM-IV）孤独症谱系障碍诊断标准的116例孤独症儿童为孤独症组，92例性别匹配的正常发育儿童为正常组。采用自编儿童幼儿期成长环境调查表，对两组儿童入3岁前的成长环境与玩耍方式进行问卷调查。结果孤独症组在“亲子长期分离”（18.1％）、“不与陌生儿童玩耍”（91.4％）、“偏好与异性玩耍”（20.7％）方面均高于正常组（6.5％、32.6％、6.5％），在“亲子间亲密动作”（21.8％）方面低于正常组（47.8％）。孤独症女童幼儿期经历“亲子长期分离”（36.8％）多于孤独症男童（14.4％）。结论孤独症儿童家庭幼儿期经历亲子分离事件更多，并呈现更少亲子间亲密行为，且孤独症女孩家庭更为明显。孤独症儿童与陌生儿童玩耍异常，尤其表现为同性交往下降。     

儿童功能性便秘的相关因素及其对气质、社会适应能力的影响

目的探讨儿童功能性便秘的相关因素及其对气质、社会适应能力的影响,进一步为功能性便秘的诊断及干预提供资料及依据。方法采用自制的儿童功能性便秘相关因素调查问卷表、3~7岁儿童气质量表、婴幼儿-初中生社会适应能力量表,选择2018年9月-2019年5月,年龄在3~5岁,因排便困难、排便不畅且符合儿童功能性便秘罗马Ⅳ诊断标准的103例患儿作为研究对象,同时选择来安徽医科大学附属省儿童医院门诊正常体检的94名健康儿童作为对照组。结果蔬菜水果食用少、饮水量少、运动量少、早期未进行排便训练、排便过失责备儿童、玩玩具时憋便是功能性便秘发生的相关危险因素(OR值分别为8.154、6.653、2.728、0.251、18.620、6.732,P<0.05)。气质维度方面,功能性便秘患儿与对照组儿童的规律性、趋避性评分差异有统计学意义(t=-10.48,-10.33,P<0.05)。在社会适应能力方面,功能性便秘患儿与对照组儿童的独立生活能力、集体活动能力评分差异有统计学意义(t=6.71,-3.03,P<0.05)。结论饮食习惯的调整、加强运动量、早期排便训练及精神压力的缓解对预防功能性便秘的发生具有较好的作用。除此之外,功能性便秘对儿童的心理行为发育及社会适应能力产生影响,家长应给予耐心的鼓励和引导,帮助患儿树立信心,不仅对功能性便秘的治疗会有更好的效果,也促进了儿童身心健康的全面发展。     

Toilet training in first children

Parents of 266 children were queried about the process they used to toilet train their first child. Results showed that they learned the training process most frequently from intuition, from their parents, and from friends with small children. Most children were put on the potty chair and were praised when successful. About three fourths of the parents responded that readiness of the child prompted initiation of toilet training. The largest number of children (42.6%) were 24 to 29 months old when training began and 30.5% were 18 to 23 months old. The mean ages for completion of training were between 24 and 27 months.     

儿童及青少年功能性便秘流行病学调查及危险因素分析

目的:调查广东省中山市4～16岁儿童及青少年功能性便秘的流行病学情况及其影响因素,为儿童及青少年功能性便秘的病因学研究及防治提供科学依据。方法:采用分层整群随机抽样调查法对广东省中山市5个镇(区)29所幼儿园、13所小学和7所中学的5 731例儿童及青少年进行问卷调查,包括诊断问卷及相关因素问卷。结果:广东省中山市4～16岁儿童及青少年功能性便秘总体患病率为6.98%,其中4～10岁组为7.61%、11～16岁组为6.12%。4～10岁组儿童功能性便秘的危险因素包括有便秘家族史、每日蔬菜及水果的摄入量及饮水量少、喜甜食、幼时因排便不良受到惩罚或训斥;11～16岁组儿童及青少年便秘的危险因素包括有便秘家族史,每日蔬菜水果的摄入量及饮水量少,喜饮广东凉茶,运动量小,憋便、不去排便,家庭不和,其OR值均>1。结论:儿童及青少年功能性便秘的危险因素较多,不同年龄段有所不同。针对不同人群采取具有针对性的措施可有效防治功能性便秘的发生。     

6岁以下儿童排便状况503例调查

【目的】 了解6岁以下儿童的排便状况。 【方法】 将2009年12月-2010年3月重庆医科大学儿童医院儿保科体检的6岁以下和部分幼儿园儿童作为调查对象。采用婴幼儿(0～2岁)及年长儿(2.1～6岁)两种问卷调查儿童的大便情况。 【结果】 90%以上1岁儿童排便次数(1次或2次/日)与性状接近成人。近2/5的婴儿排大便已定时(77/207,占37.2%),其中90.9%(70/77)6月龄前大便时间已较固定。503例6岁以下儿童中发生便秘者57例(11.3％),近3/5(59.6%)发生便秘的儿童中排便次数为1次/日。 【结论】 儿童排便状况与年龄有关。大便次数不是诊断便秘的主要依据。     

Yoghurt containing galacto-oligosaccharides, prunes and linseed reduces the severity of mild constipation in elderly subjects

OBJECTIVE: Constipation is a common problem in the elderly. Dietary fibre is recommended for its treatment. The aim was to examine whether yoghurt containing galacto-oligosaccharides (GOS), prunes and linseed relieve constipation in elderly subjects. DESIGN: A randomized, double-blinded, cross-over study. SETTING: Free-living subjects. SUBJECTS: A group of 43 elderly subjects with self-reported constipation (mean age 76 years, range 61-92 years, 32 females, 11 males). INTERVENTIONS: The study consisted of a 2-week baseline period and 2, 3-week dietary interventions, with a 2-week wash-out period between the interventions. During the interventions, the subjects ingested, in random order, 260 g/day of either control yoghurt or test yoghurt containing GOS (12 g/day), prunes (12 g/day) and linseed (6 g/day). The use of laxatives was controlled and only allowed after 2 days without defecation. RESULTS: Defecation frequency was 5.7 times/week during the baseline period. During the test yoghurt period, defecation frequency was higher (8.0 vs 7.1 times/week, P=0.011), defecation was easier (on the scale 0-3, 1.3 vs 1.5, P=0.010), and there was a tendency towards softer stools (on the scale 0-3, 2.1 vs 2.2, P=0.059) compared with the control yoghurt period. The subjects felt that the test yoghurt relieved constipation more effectively than the control yoghurt (P=0.005). The sum of gastrointestinal symptoms did not differ between the interventions. The use of laxatives remained constant throughout the study. CONCLUSIONS: Daily intake of yoghurt containing GOS, prunes and linseed reduced the severity of constipation in elderly subjects with mild constipation. SPONSORSHIP: Valio Ltd, R&D.     

Functional childhood gastrointestinal disorders. III. Constipation and solitary encopresis; diagnostic work-up and therapy

A detailed medical history in combination with a thorough physical examination, including rectal examination, form the cornerstone in the diagnostic work-up for children with functional defecation disorders. Additional investigations are often not informative and have only minor diagnostic or therapeutic implications. Medical therapy in children with functional constipation and solitary encopresis is primarily based on clinical experience. In both patient groups, the role of education, the use of diary cards and toilet training is important. In some patients behaviour interventions are important. Oral laxatives are the basis of treatment of children with functional constipation, whereas they are contra-indicated in children with solitary encopresis. In both groups, biofeedback training appears to be of little additional benefit. Long-term follow-up of children with functional defecation disorders shows that complaints continue far beyond puberty in many children.     

Effects of chicory inulin in constipated elderly people: a double-blind controlled trial

The impact of the daily consumption of 15 g chicory native inulin on fecal levels of bifidobacteria, stool parameters and quality of life of elderly constipated volunteers was investigated in a randomized, double-blind, controlled versus placebo clinical trial. The impact of supplementation on constipation was assessed with questionnaires on bowel motor function parameters, visual analogue scales on bowel symptoms and quality of life. Fecal bacteria counts were determined at the beginning and at the end of the supplementation. Inulin supplementation led to a significant increase in total fecal bacteria (P < 0.01) and bifidobacteria (P < 0.001) concentrations after 28 days of consumption. Volunteers (n = 25) in the inulin group reported increased satisfaction about digestion (P < 0.01) and reduced defecation difficulties (P < 0.001) during the supplementation. Slight gastrointestinal symptoms (flatulence) were reported but did not lead to discontinuation. Daily supplementation with 15 g inulin improves constipation and quality of life in an elderly population with constipation.     

Effectiveness of individually tailored calendars in promoting childhood immunization in urban public health centers

OBJECTIVES: We examined the effectiveness of tailored calendars in increasing childhood immunization rates. METHODS: Parents of babies aged birth to 1 year (n = 321) received individually tailored calendars promoting immunization from 2 urban public health centers. For each baby, an age- and sex-matched control was selected from the same center. Immunization status was tracked through age 24 months. RESULTS: A higher proportion of intervention than of control babies were up to date at the end of a 9-month enrollment period (82% vs 65%, P <.001) and at age 24 months (66% vs 47%, P <.001). The younger the baby's age at enrollment in the program, the greater was the intervention effect. CONCLUSIONS: Tailored immunization calendars can help increase child immunization rates.     

父母育儿因素与学龄前儿童功能性便秘的关系研究

目的 分析学龄前儿童功能性便秘与父母育儿因素的关系,以期为功能性便秘的预防与早期干预提供参考。方法 选取2020年9月至2021年3月在青岛大学附属医院儿童保健门诊就诊的功能性便秘儿童108例为研究对象,同时选取本院正常体检的324例健康儿童作为对照组,采用一般情况调查表、育儿压力量表、家庭教养方式问卷及儿童喂养问卷进行问卷调查。结果 母亲或父母均有便秘病史（OR=2.877,95%CI:1.390~5.953;OR =8.950,95%CI:2.297~34.866）、孩子兄弟姐妹便秘病史（OR=2.109,95%CI:1.483~3.000）、不良排便习惯（OR=3.780,95%CI:1.949~7.329）、排便不顺利时责备儿童（OR=4.719,95%CI:1.963~11.347）、育儿压力（OR=1.917,95%CI:1.314~2.795）、专制型家庭教养方式（OR=2.064,95%CI:1.257~3.391）、逼迫进食（OR =1.585,95%CI:1.112~2.260）是学龄前儿童功能性便秘的相关危险因素。父子互动>2h是儿童功能性便秘发生的独立保护因素（OR=0.240,95%CI:0.078~0.741）。结论 学龄前期儿童功能性便秘的发生与父母育儿因素有着密切联系,医务人员应增加对育儿层面的关注,增加对父母育儿压力的评估,指导家长形成正确的家庭教养方式,增加父子互动时间,并采取科学合理的喂养行为与排便训练行为,从而预防功能性便秘的发生,促进儿童身心健康发展。     

Psychosocial health and life-events – dynamical development in the short term. A follow-up study of children at four and six years of age

In this paper, (1) the psychosocial health in relation to (2) life-events was assessed among 156 children attending 20 schools by parents and teachers with the Child Behavior Checklist and the Caregiver-Teacher Report Form at the ages of four and six. Life-events were reported by parents. (1) According to the report, 93–96% children had no psychosocial problems. Parents and teachers report significant improvement of externalising (behavioural) problems and total problems in children with psychosocial problems at point of time 1. Teachers also report improvement of internalising (emotional) problems. Parents and teachers agree in 8–25% of the cases. (2) Of the children 46% experienced life events, no correlation was found with changes in psychosocial health. Findings may be explained by regular school attendance, resilience of the children and variability in the normative development. Remarkable dynamic is observed in change of psychosocial problems. Psychosocial development in early childhood is rather liable to change and life-events do not strongly influence psychosocial health.     

Which fourth-grade children participate in school breakfast and do their parents know it?

OBJECTIVE: To explore fourth-graders' school breakfast participation by gender and race (black, white) and examine the extent to which parents' responses to "Does this child usually eat school breakfast?" reflected their children's participation. DESIGN: Parents answered "yes" or "no" to the questions printed on consent forms. Observers documented which children participated in school breakfast on 26 to 51 randomly selected days per school during 24 weeks in the 1999-2000 school year. SUBJECTS: 357 children recruited from all 22 fourth-grade classes from 6 schools in 1 public school district. VARIABLES MEASURED: Participation rate, participation rate grouping [usually participated (>or=50% of days observed), did not usually participate (< 50% of days observed)]. STATISTICAL ANALYSES PERFORMED: Komolgorov-Smirnov tests, McNemar's test. RESULTS: Median participation rate was 37.5% overall. Distribution of participation rates differed significantly by race (K-S test, P <.001) but not gender. There was a significant difference in the percentage of parents who said "yes" or "no" compared to children's usual participation grouping (McNemar test, P <.001). Of parents who said "yes," 66% of children usually participated; of parents who said "no," 92% of children did not usually participate. IMPLICATIONS: Children, not parents, must be the source for learning about what children eat at school.     

Anti-tobacco socialization in homes of African-American and white parents,and smoking and nonsmoking parents

Purpose: To examine parental perceptions and behaviors with regard to teen smoking, comparing African-American and white parents, and those who did and did not smoke.Methods: Focus groups consisting of African-American and white parents who smoked provided initial in-depth information. A computer-assisted telephone survey of a biracial sample of 311 parents of children ages 8 to 17 years provided more generalizable information regarding parental beliefs and behaviors.Results: Nearly 50% of households either allowed teen smoking, had no ground rules, or had set restrictive rules but never communicated them to the children. Compared to white parents, African-American parents felt more empowered to affect their children’s behaviors and were more likely to actively participate in anti-tobacco socialization within the home (all p values < 0.01). Among the African-American parents, 98% reported 18 years or older to be an appropriate age for teens to make up their own minds about using tobacco, whereas 26% of white parents thought 16 years to be an appropriate age (p < 0.001). Parents who smoked reported more frequent rule-making than those who did not smoke (p = 0.02), but were more likely to believe that childhood tobacco use is inevitable (p = 0.01).Conclusions: Many parents are not engaged in anti-tobacco socialization in the home. Differences in the degree of parental participation may contribute to the variance in smoking prevalence between African-American and white children.     

学龄前儿童功能性便秘危险因素调查

目的:探讨深圳市学龄前儿童功能性便秘(FC)的流行病学情况及影响因素,为学龄前儿童功能性便秘的病因学研究及制定预防措施提供科学依据。方法:采用分层整群随机抽样调查法,在深圳市福田区幼儿园随机抽取1 050例儿童进行问卷调查,对确诊功能性便秘患儿进行临床分析。结果:深圳市福田区幼儿园儿童功能性便秘的患病率为3.81%,喜食肉类,根本不吃或偶尔吃一些蔬菜、水果,排便无规律,经常克制排便,排便恐惧,心情焦虑烦躁,遗传,肥胖等8种因素为慢性便秘最具可能性的危害因素,其OR值均>1。结论:强化对儿童功能性便秘的危害性和普遍性的认识,从学龄前儿童功能性便秘的危险因素入手,采取具有针对性的手段,制定确实可靠的预防措施,达到早期预防和早期治疗的目的。     

孤独症谱系障碍儿童家长压力及相关影响因素研究

目的 研究孤独症谱系障碍(ASD)儿童家长压力及相关影响因素,为缓解育儿压力及提升干预疗效提供依据。方法 选取复旦大学附属儿科医院儿保科首次诊断为ASD患儿家长为研究对象,并将同期诊断的精神发育迟缓/言语障碍和正常儿童家长作为对照组,分析不同组家长育儿压力的差异。采用家长育儿压力简表(PSI-SF)对家长压力值进行评定,一般育儿信息问卷调查相关育儿压力因素,0~6岁发育筛查测试(DST)评估ASD儿童发育商。结果 多数入组的ASD儿童伴随发育迟缓,存在智力及社会适应发育落后的几率高于运动发育。ASD组儿童家长在压力总分、亲子互动失调及困难儿童分量表得分显著高于精神发育迟缓/言语障碍儿童组家长及正常儿童家长(总分:100.67±15.08 vs 93.19±13.85 vs 82.61±17.68,F=43.85,P<0.05)。孤独症家长在育儿愁苦分量表压力值高于正常儿童家长(33.34±7.07 vs 29.77±7.47,P<0.05),与精神发育迟缓/言语障碍儿童组家长的差异不显著。增加父亲带养时间以及家庭经济收入,父母拥有更高的文化程度能帮助缓解家长育儿压力。结论 1)多数ASD儿童伴随发育迟缓,其家长承受着更高的育儿压力。2)增加父亲带养时间、引导父亲更多参与家庭干预,政府、社会对ASD儿童及家长投入更多的资金与教育支持,将对缓解患儿家长育儿压力以及提升干预疗效具有重要的作用。     

Parent's opinions on the diagnosis of children under 2 years of age with urinary tract infection

BACKGROUND: Urinary tract infection (UTI) in childhood can be diagnosed in 5% of febrile infants. Renal scarring is associated with increasing numbers of UTI episodes, and the incidence of renal scarring rises with each urinary infection. High levels of awareness of childhood UTI are important among both professionals and parents. Whilst problems for professionals in making the diagnosis have been explored, few data exist concerning parental understanding and perspectives. OBJECTIVES: The purpose of this study was to assess parental understanding of UTI in their child and identify any delay perceived in the diagnosis, along with identifying how helpful parents had found any information that they had been given. METHODS: Subjects were the parents of children aged <2 years being investigated in one out-patient department following proven UTI. A semi-structured questionnaire was given to parents at first attendance (quantitative data) and content analysis of qualitative data was carried out. RESULTS: Fifty-two out of 84 parents responded (response rate 64%), of whom 45 (86.5%) felt that they had been given a full explanation of the significance of UTI in childhood. Forty percent felt that clean catch was the easiest method of obtaining a urine sample from their child. Although the quantitative data were positive, several themes were identified in the qualitative data, relating to lack of awareness, delay in investigation by health professionals and issues regarding the information that had been imparted to parents. Parents would like more information about the illness that affects their child, and many would like this in leaflet form. CONCLUSIONS: Parents perceive low awareness levels and delays in investigation of UTI in childhood amongst health professionals. Increasing awareness about the importance of UTI in childhood, its incidence and management should be generated amongst health professionals who deal with young children. Parents need and would like more information about the disease and how to identify it, with guidance on urine collection. Further research is needed into whether educational strategies for either parents or health professionals are effective in identifying UTI earlier, and what the best methods of implementing these would be.     

Physicians' attention to parents' concerns about the psychosocial functioning of their children.

BACKGROUND: Epidemiological data indicate that approximately 20% of children have psychosocial problems, yet less than 2% of children are seen by mental health specialists each year. Primary care physicians tend to identify children with psychosocial problems when parents discuss concerns with them. OBJECTIVE: To examine factors related to physicians' attention to parental disclosures. DESIGN: Parents reported the psychosocial functioning of themselves and their children. Physicians reported the psychosocial functioning of 75 children and whether the parent disclosed psychosocial concerns to them. SETTING: Ambulatory care clinic of a community-based, university-affiliated, residency training program. PARTICIPANTS: Seventy-five parents of children aged 2 to 16 years who presented for routine primary care, and 26 physicians. MAIN OUTCOME MEASURES: Beck Depression Inventory (parental distress), Eyberg Child Behavior Inventory (child behavior problems), physician and parent report. RESULTS: Physicians identified 50.0% of children with clinically significant behavior problems. Logistic regression indicated that parental disclosure was the only significant predictor of physician identification (P < .002). When children had clinically significant behavior problems, physicians were more likely to report disclosures by parents (45.0% vs 5.7% for parents of children with and without behavior problems, respectively). Physicians were more likely to report parental disclosure when parents reported personal psychosocial distress (38.9% for distressed vs 5.7% nondistressed parents). CONCLUSIONS: Parental disclosure of concerns was a better predictor of physician identification of child psychosocial problems than was the presence of child behavior problems. Physicians responded more frequently to the disclosures of potential problems by parents of children with clinically significant psychosocial problems. They also attended more frequently to disclosures about behavior problems when the parent was also experiencing psychosocial distress.     

Use of Technology to Access Health Information/Services and Subsequent Association With WASH (Water Access,Sanitation, and Hygiene) Knowledge and Behaviors Among Women With Children Under 2 Years of Age in Indonesia: Cross-sectional Study

BackgroundWater access, sanitation, and hygiene (WASH) remain a public health concern in Indonesia. Proper WASH practices can decrease risk of stunting, wasting, and disease in children under the age of 2.ObjectiveThe purpose of our study is to examine if using technology to access health information and services among Indonesian women affects knowledge and behaviors regarding handwashing and defecation practices.MethodsOur study is an interview-based cross-sectional survey. Participants included 1734 mothers of children under 2 years of age. These women were randomly selected and interviewed as part of a 3-stage cluster sampling technique. Our study uses data regarding WASH knowledge which includes benefits of handwashing with soap, 5 critical times of handwashing, risks of open defecation, media of disease transmission, defecation locations, and risks of open defecation. Data regarding WASH behaviors were also included: handwashing with soap, type of latrine used at home, and where defecation took place. This investigation used adjusted and unadjusted logistic and linear regression models to determine differences in WASH outcomes between those who use technology to access health information and services and those who did not.ResultsOne result is that Indonesian women with children under 2 years of age who use technology to access health information and services are more likely to know the advantages of proper handwashing (odds ratio [OR] 2.603, 95% CI 1.666-4.067) and know the 5 critical times of handwashing (OR 1.217, 95% CI 0.969-1.528). Women who use technology to access health information are also more likely to know the risks of open defecation (OR 1.627, 95% CI 1.170-2.264) and use a type of toilet (such as a gooseneck or squat toilet) that limits risk (OR 3.858, 95% CI 2.628-5.665) compared to women who did not use technology to access health information.ConclusionsUsing technology to access health information and services was associated with an increase in handwashing and defecation knowledge. In the future, promoting mothers of children under 2 years of age to access health information through technology might be used to increase handwashing and defecation knowledge as well as safe defecation practices. However, further research should be done to determine how technology may increase the frequency of recommended handwashing behaviors.     

Parents' response to recurrent middle ear infection in their children

Recurrent ear infection in children during pre-school years is an important public health problem. Common advice given to parents is to minimize exposure of susceptible children to crowding and air pollution. This study aimed at investigating what changes parents undertake to improve the health of an otitis-prone child. Parents of children with greater than or equal to 5 events before age thirty months (index children; n = 198) and a matched control group (n = 396) were asked to fill in a questionnaire. Results show that 22.3% of index-families and 9.5% (p less than 0.001) of control families had changed one or more of the following conditions: working hours, child day-care, housing and smoking habits. In summary, index families and control families were remarkably similar given the striking difference in otitis media, a finding that rises concern.