Precipitants of constipation during early childhood

BACKGROUND: Childhood constipation is a common problem, accounting for 3% of visits to pediatric clinics and 30% of visits to pediatric gastroenterologists. Estimates of the prevalence of childhood constipation vary from 0.3% to 28% with younger children being affected most often. We were unable to find any studies that specifically examine the causes of constipation in young children. Our objective of the study was to determine precipitants to constipation during early childhood. METHODS: Findings from 125 families visiting their primary care physician for the first time with a child aged between 2 and 7 years with the complaint of constipation were compared with findings from 95 children between 2 and 7 years without any history of constipation. Parents answered questions concerning family history, toilet training, and bowel habits. Parents of constipated children were asked to describe events that occurred during the 3 months before the onset of constipation and whether these events contributed to the child's constipation. RESULTS: The age and sex of children who did and did not suffer from constipation were comparable (P > .3). When compared with control children, constipated children were no more likely to have a parent (30% vs 40%, P = .14) or sibling (17% vs 14%, P = .54) with a history of constipation. Constipated children did not begin toilet training earlier than did control children (28 +/- 7 vs 27 +/- 6 months, P = .30). When compared with parents of control children, parents of constipated children reported more difficulties with toilet training (P < .001). Parents of constipated children indicated their children had more difficult and more painful defecation experiences than did parents of control children (P < .001), and constipated children were more likely to express worry about future painful defecation than were control children (P < .001). Parents of constipated children described a number of events that occurred before the onset of constipation; however, they did not consider many of the events important contributors to the constipation. Painful defecation was the event most often reported as causing the constipation. CONCLUSION: Painful defecation is the primary precipitant of constipation during early childhood. Parents should be counseled to be attentive to such experiences and taught to intervene quickly to lessen the risk that their child will develop persistent constipation or fecal soiling.     

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。     

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。     

Associations of Physical Activity and Dietary Behaviors With Children's Health and Academic Problems*

BACKGROUND: We examined the associations of physical activities and dietary behaviors with children's health and academic‐behavioral problems. METHODS: We employed a Community‐wide Children's Health Assessment and Planning Survey to examine physical activity, healthy meals, health status, and academic‐behavioral problems in 3708 children 7 to 14 years of age. Statistical associations were examined with chi‐square test and logistic regression analysis; we calculated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Among these children, 30.2% were overweight‐obese, 11.0% had academic problems, and 7.9% had behavioral problems. Children classified as healthy eaters were more likely to exercise ≥4 days/week (79.1% vs 64.6%, OR: 2.08, 95% CI: 1.14 to 2.49), less likely to be overweight‐obese (27.7% vs 44.6%, OR: 0.48, CI: 0.31 to 0.73), less likely to have academic problems (9.1% vs 16.1%, OR: 0.57, 95% CI: 0.41 to 0.79) and behavioral problems (6.9% vs 13.9%, OR: 0.46, 95% CI: 0.32 to 0.66) compared with their less healthy eating peers. Physical activity and healthy meals were associated with an improved health status (p < .001). However, the proportions of children taking unhealthy meals or choosing sedentary lifestyle increased as the cohorts progressed (p < .05) from childhood (7 to 8 years) to adolescence (13 to 14 years). CONCLUSIONS: Healthy (or unhealthy) lifestyle behaviors are significantly interrelated. Children who take healthy meals and exercise often are associated with better health and fewer academic and behavioral problems. Unfortunately, taking unhealthy meals and sedentary lifestyle characterize a growing proportion of young adolescents. Thus, curbing unhealthy lifestyle behaviors should start in early childhood.     

宫颈癌治疗对患者排便功能影响的研究

目的了解宫颈癌患者治疗后排便功能异常的发生情况及治疗方式对宫颈癌患者治疗后排便功能的影响。方法选取2018年12月至2019年4月就诊于首都医科大学附属北京妇产医院妇科肿瘤门诊、宫颈癌治疗后随访时间≥3个月的患者,进行关于排便功能的问卷调查。根据不同治疗方法分为3组:手术治疗组(A组,47例)、放(化)疗组(B组,144例)、手术加放(化)疗组(C组,40例)。比较3组患者排便功能异常情况。结果231例宫颈癌治疗后随访患者中有118例(51.08%)发生排便异常,其中17例发生便秘(7.36%);104例患者发生放射性直肠炎(56.52%)。A组便秘的发生率高于B组(17.02%vs 3.47%,P<0.05),A组与C组便秘发生率比较,差异无统计学意义(P>0.05);B组放射性直肠炎发生率显著高于C组(63.89%vs 30.00%,P<0.05)。结论宫颈癌患者治疗后排便功能异常较为常见,应引起临床医师重视。与单纯手术相比,术后辅助放(化)疗不增加便秘的发生率。与单纯放疗患者相比,手术后放(化)疗患者放射性直肠炎发生率更低。     

Incidence and remission rates of overweight among children aged 5 to 13 years in a district-wide school surveillance system

OBJECTIVES: To monitor annual changes in weight status, we determined incidence and remission rates of overweight among school-aged children with longitudinal school-based surveillance. METHODS: We estimated 1-year changes in weight status among students enrolled in public schools in Cambridge, Mass. Physical education teachers measured height and weight annually. Adjusted odds ratios (ORs) were estimated via multivariate logistic regression, accounting for repeated observations of individual children across years. RESULTS: The 1-year incidence of overweight was 4%, and the remission rate was 15%. Among overweight children, 85% remained overweight at a 1-year follow-up, while 18% of children at risk for overweight became overweight. Overweight incidence rates were higher among children aged 7 and 8 years than among those aged 11 to 13 years (boys: OR=1.68; 95% confidence interval [CI]=1.14, 2.47; girls: OR=1.86; 95% CI=1.25, 2.77). CONCLUSIONS: Both incidence and remission rates were higher among younger children. Children who were at risk for overweight were more likely to change their weight status than those who were already overweight. Our results support targeting overweight prevention efforts toward younger children and children at risk for overweight.     

Association of school nutrition policy and parental control with childhood overweight

BACKGROUND: Schools and parents may play important roles in preventing childhood obesity by affecting children's behaviors related to energy balance. This study examined how school nutrition policy and parental control over children's eating and physical activity habits are associated with the children's overweight/obesity (hereafter overweight) status. METHODS: Data were analyzed from a total of 246 pairs of children and parents who were recruited in the 2008‐2009 academic year from 10 randomly selected public secondary schools in Indiana (school response rate = 66.7%; participant response rate = 73.5%). Logistic regression analyses were performed to examine odds ratios of different levels of school nutrition policies and parental control with and without adjusting for sociodemographic characteristics. RESULTS: Children who attended schools where soda pop (OR = 3.79, p < .01) and non‐low‐fat salty snacks (OR = 2.46, p = .05) could be purchased were more likely to be obese than those at schools where such items were not sold. Children whose parents rarely or never ensured that their child was avoiding eating too many sweets (OR = 2.33, p = .08), avoiding spending too much time watching TV (OR = 2.24, p = .06), or engaging in physical activity (OR = 2.35, p = .09) were more likely to be obese than children whose parents did so always or most of the time. CONCLUSIONS: School nutrition policy and parental control over children's eating and physical activity habits are associated with the children's overweight status.     

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。     

Food insecurity and gender are risk factors for obesity

OBJECTIVE: Examine relationships between adult obesity, childhood overweight, and food insecurity. DESIGN: Cross-sectional retrospective study. SETTING: Community settings in Hartford, Connecticut. PARTICIPANTS: Convenience sample of 200 parents and their 212 children, aged 2-12. MAIN OUTCOME MEASURES: Adult obesity (Body Mass Index [BMI] > 30), childhood overweight (BMI-for-age > 95(th) percentile), and household food security (U.S. Department of Agriculture module). ANALYSIS: Chi-square tests between weight status and socioeconomic characteristics. Multinomial regression analyses to determine risk factors for adult obesity and childhood overweight. RESULTS: Over half of parents (51%) were obese, and almost one-third of children (31.6%) were overweight. Over half of households were food insecure. Food insecure adults were significantly more likely to be obese as those who were food secure (Odds Ratio [OR]=2.45, p = .02). Being a girl and having an obese parent doubled the likelihood of children being overweight (OR=2.56, P = .01; OR=2.32, P = .03). Children with family incomes below 100% of poverty were half as likely to be overweight as those with higher incomes (OR=.47, P = .05). Food insecurity did not increase odds of childhood overweight. CONCLUSIONS AND IMPLICATIONS: Obesity prevention programs and policies need to address food insecurity and gender as key risk factors.     

腹部热敷配合按摩促进早产儿胎粪排出的效果观察

目的探讨腹部热敷配合按摩对促进新生儿胎粪排出的效果。方法以80例早产儿为研究对象,随机分成对照组和实验组,每组40例,对照组给予新生儿常规护理,实验组在常规护理基础上实施腹部热敷配合按摩。观察并记录两组新生儿首次胎粪排出的时间、首次排出胎粪的重量及出生24 h内胎粪排出次数。结果实验组患儿首次排便时间明显早于对照组(p<0.05),首次排出胎粪的量多于对照组(p<0.05),出生24 h内胎粪排出的次数多于对照组(p<0.01)。结论对早产儿早期进行腹部热敷配合按摩能促进早产儿胎粪排泄及胃肠道功能的成熟,防止胎粪排泄延迟发生相关的并发症。     

中山市儿童期超重对青少年肥胖影响的队列研究

目的 了解广东省中山市7~18岁儿童青少年肥胖的发病率,探讨儿童期超重对青少年肥胖的影响。方法 于2005年对中山市一年级小学生体检测量身高、体重,连续随访10年(1次/年),共有2 188名中山市小学一年级到高中一年级学生作为回顾性队列研究对象。使用2018年颁布的《学龄儿童青少年超重与肥胖筛查》 (WS/T 586-2018) 评价超重及肥胖,并计算肥胖的检出率及发病率,采用χ²检验和log-binomial模型分析儿童期超重对青少年肥胖的影响。结果 小学一年级学生肥胖的检出率为4.89%,小学四年级时达到最高为6.99%,高中一年级时为4.43%。肥胖的发病率在小学二年级时最高为1.83%,高中一年级时降低到0.74%。小学一年级时超重的学生在高中一年级时肥胖累积发病率是小学一年级时正常体重学生的8.85倍(9年的累积发病率41.33% vs.4.67%,RR=8.85,95%CI:6.12~12.78)。结论 从小学一年级到高中一年级期间,儿童期肥胖发病率较高。儿童期超重明显增加青少年肥胖的风险。肥胖干预应该从儿童期开展,尤其应该重点关注超重的儿童。     

凝结芽孢杆菌TBC169片在治疗小儿便秘中的作用

目的:观察爽舒宝(凝结芽孢杆菌TBC 169片)治疗小儿便秘的临床疗效。方法:将121例便秘的小儿随机分为观察1组42例、观察2组39例和对照组40例,3组均进行调节饮食和调节排便习惯等基础综合治疗4周,观察1组给予爽舒宝4周,观察2组给予爽舒宝2周,2~3片/次,3次/d,加水2~5 mL溶解后口服。于用药后2周、4周观察记录排便间隔时间、大便性状和排便恐惧心理等改善情况,于8周时随访观察便秘复发情况,然后统计分析3组的显效率和总有效率。结果:观察1组、观察2组的显效率和总有效率显著高于或高于对照组,组间差异有统计学意义(P<0.01或P<0.05);观察1组的显效率和总有效率高于观察2组,组间差异有统计学意义(P<0.05)。未发现不良反应。结论:在基础综合治疗的同时应用爽舒宝治疗小儿功能性便秘疗效显著。     

乳果糖口服液联合聚乙二醇电解质散剂在便秘患者行结肠镜检查前肠道准备中的应用

目的：分析研究乳果糖口服液联合聚乙二醇电解质散剂在便秘患者行结肠镜检查前肠道准备中的应用。方法抽取2015年1月～2016年6月我院接受结肠镜检查的106例便秘患者,随机分为两组,各53例。对照组口服聚乙二醇电解质散剂;观察组在此基础上联合使用乳果糖口服液。对两组患者首次排便时间、肠道清洁时间、排便次数及肠道清洁效果、不良反应进行统计分析。结果观察组肠道准备情况、清洁效果均显著优于对照组,差异有统计学意义（P＜0.05）;观察组不良反应发生率为7.55%,与对照组5.66%相比,差异无统计学意义（P＞0.05）。结论乳果糖口服液联合聚乙二醇电解质散剂用于便秘患者结肠镜检查前肠道准备中,可有效缩短肠道清洁时间、提高肠道清洁效果,且具有一定安全性,值得推广运用。     

儿童超重和肥胖与血压、血脂及血糖异常的相关性研究

目的：探讨儿童超重肥胖与血脂、血糖异常之间的相关性。方法测量320例儿童身高、体质量、血压,采集空腹静脉血测定血糖（Glu）、血清总胆固醇（TC）。根据BMI指数水平,将320例儿童分为正常对照组和超重肥胖组,比较各组儿童血压、血脂、血糖的差异。结果本次研究对象男生165例,女生155例,超重肥胖儿童共56例,超重肥胖率为17.50%的超重肥胖率为17.50%。超重肥胖儿童在性别分布方面,与正常对照组无显著性差异（P〉0.05）。超重肥胖组儿童在高血压、高血糖、高血脂方面的发生率分别为25.0%、19.6%、25.0%,均与正常对照组有非常显著的差异（P〈0.001）。结论对心脑血管等慢性疾病进行早期预防时,应从儿童抓起,将肥胖超重儿童这一群体作为重点干预对象,并加强健康教育。     

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。     

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。     

Bowel habit,diet and body weight in preadolescent children

Background: The possible influence of diet and body weight on bowel habit in children is unknown. The present study aimed to investigate the inter‐relationships between bowel function, excess body weight and dietary intake in a group of preadolescent children. Methods: Eighty‐four preadolescent children aged 7–10 years were recruited [mean (SD) age 9.7 (1.0) years]. All children completed a bowel habit diary, examining specific parameters of bowel function and a weighed food inventory concurrently for seven consecutive days. Height and weight measurements were also taken. Children were grouped according to whether they met dietary recommendations and by overweight status; differences in bowel function between the groups were then analysed. Results: Children who exceeded reference values for fat were more likely to report an incidence of straining to start (P = 0.005) and pain during defaecation (P = 0.021). Subjects who met protein recommendations were less likely to report incomplete evacuation (P = 0.000) and those who met zinc recommendations were less likely to report pain during defaecation (P = 0.044). Excess body weight (according to International Obesity Task Force cut‐offs) was also associated with poor bowel habit, with overweight and obese children reporting lower defaecation frequency and a higher incidence of straining and feelings of incomplete evacuation, although these findings were not statistically significant. Defaecation frequency in healthy children was 1.4 defaecations per day compared to 1.2 defaecations for overweight and obese children. Conclusion: A poor diet that fails to meet dietary recommendations as well as being overweight and obese appears to be associated with increased defaecation problems in preadolescent children.     

儿童功能性便秘与心理行为因素的相关性研究

【目的】 探讨儿童功能性便秘患儿心理行为及气质、家庭环境特征,为儿童功能性便秘的预防和心理干预提供依据。 【方法】 确诊为功能性便秘的106例患儿和212例健康对照组儿童,由其家长填写Achenbach儿童行为量表(CBCL)、儿童气质量表、家庭环境量表-中文版(FES-CV)、儿童多动行为调查表。 【结果】 1)功能性便秘组儿童行为问题发生率(22.64%)高于健康对照组(12.26%)(P<0.05),4~5岁功能性便秘男童体诉、不成熟、攻击三个因子得分和女童社交退缩、抑郁、肥胖、分裂样四个因子高于对照组相应因子得分(P<0.05);6~11岁功能性便秘男童抑郁、强迫性、多动、攻击性四个因子得分和女童分裂样强迫性、体诉、违纪三个因子得分高于对照组相应因子得分(P<0.05)。2)功能性便秘组儿童在规律性、适应度、坚持度和注意分散度四个气质维度得分低于对照组(P<0.05)。3)家庭环境方面功能性便秘患儿的亲密度、知识性、独立性、控制性四个方面得分低于正常对照组,矛盾性方面的得分高于对照组。(P<0.05)。 【结论】 功能性便秘儿童行为问题发生率高,有独特的气质特点,家庭环境不良,应给予心理干预。     

Weight status in childhood as a predictor of becoming overweight or hypertensive in early adulthood

OBJECTIVE: To assess the extent to which weight status in childhood or adolescence predicts becoming overweight or hypertensive by young adulthood. RESEARCH METHODS AND PROCEDURES: We conducted a prospective study of 314 children, who were 8 to 15 years old at baseline, and were followed up 8 to 12 years later. Weight, height, and blood pressure were measured by trained research staff. Incident overweight was defined as BMI>or=25 kg/m2 among participants who had not been overweight as children. RESULTS: More male subjects (48.3%) than female subjects (23.5%) became overweight or obese between their first childhood visit and the young adult follow-up (p<0.001). Being in the upper one half of the normal weight range (i.e., BMI between the 50th and 84th percentiles for age and gender in childhood) was a good predictor of becoming overweight as a young adult. Compared with children with a BMI<50th percentile, girls and boys between the 50th and 74th percentiles of BMI were approximately 5 times more likely [boys, odds ratio (OR)=5.3, p=0.002; girls, OR=4.8, p=0.07] and those with a BMI between the 75th and 84th percentiles were up to 20 times more likely (boys, OR=4.3, p=0.02; girls, OR=20.2, p=0.001) to become overweight. The incidence of high blood pressure was greater among the male subjects (12.3% vs. 1.9%). Compared with boys who had childhood BMI below the 75th percentile, boys between the 75th and 85th percentiles of BMI as children were four times more likely (OR=3.6) and those at above the 85th percentile were five times more likely (OR=5.1) to become hypertensive. DISCUSSION: High normal weight status in childhood predicted becoming overweight or obese as an adult. Also, among the boys, elevated BMI in childhood predicted risk of hypertension in young adulthood.     

护理干预对急性心肌梗死患者排便的影响

目的探讨护理干预对急性心肌梗死患者排便的影响效果。方法对我科收治的40例急性心肌梗死患者随机分组,观察组在常规护理的基础上,进行疾病宣教及健康教育指导,对照组按疾病护理常规进行护理。结果观察组三天内排便率为60%,五天内排便率为95%;对照组三天内排便率为10%,五天内排便率为50%。两组有显著差异(P<0.05)。结论对急性心肌梗死患者采取护理干预措施,可以减少便秘率,避免患者因便秘而诱发的并发症。