Hyperlipidämien im Kindes- und Jugendalter

Disorders of lipid metabolism in childhood and adolescence are relevant risk factors for later development of cardiovascular diseases; therefore, the diagnostic work-up and treatment should be initiated early on. A positive family history is the first indication of hyperlipidemia (Synonym hyperlipoproteinemia, HLP). Testing of total cholesterol should be offered to every child or adolescent within the framework of a screening program, regardless of family history. Further diagnostic work-up in cases of suspected HLP includes a fasting blood sample for the determination of plasma lipids and other parameters in order to exclude secondary HLP as well as the measurement of the intima media thickness in the carotid artery. Therapy of HLP consists of a fat-modified diet, lifestyle changes and drug therapy options. The care of patients should be based on current guidelines and a close cooperation between the primary care pediatrician, pediatric dieticians and specialists from a pediatric lipid metabolism outpatient department.     

Kriminalität im Kindes- und Jugendalter

More than one fourth of all criminal offenders are younger than 21 years of age. The rate of child and adolescent criminality has risen markedly over the past 25 years. This is not only due to the actual increase in the number of criminal acts perpetrated by young delinquents but also the reduction in the estimated number of unreported cases. Spectacular offenses committed by juveniles and receiving wide media coverage, especially brutal crimes of violence, are not only inciting the general public in Germany these days. Recognition of children and adolescents at risk, who often grow up in a precarious social environment and attract attention due to early onset of social behavior disorders, is also a challenge for pediatricians as well as child and adolescent psychiatrists. This contribution addresses the causes, origins, frequency, and particular phenomena of dissocial/criminal behavior during the developmental years from the perspective of the child and adolescent psychiatrist active in both clinical and forensic settings and discusses measures for prevention, early diagnosis, and intervention.     

Extremitätenfrakturen im Kindes- und Jugendalter

Monatsschrift Kinderheilkunde - Frakturen im Kindes- und Jugendalter betreffen ein sich meist noch im Wachstum befindliches Skelett. Bei der Behandlung gilt es, die Dynamik dieses Wachstums in die...     

Hyperglykämie im Kindes- und Jugendalter

The ready availability of blood glucose measurement devices in everyday medical life often leads to the incidental discovery of hyperglycemic events, the long-term significance of which often remains unevaluated in the absence of additional tests. Although up to 4%–5% of children admitted to pediatric accident and emergency units present with transient hyperglycemia, only a minority of these subsequently develops diabetes or is already in a prediabetic stage. Both type 1 and type 2 diabetes, as well as rarer monogenetic forms of diabetes, can present as incidental hyperglycemia. Despite low incidence rates, a differential diagnostic work-up of incidental hyperglycemia is useful, since it may prevent severe diabetic events such as diabetic ketoacidosis; moreover, in the case of specific types of monogenetic diabetes, patients can use oral antidiabetic drugs and the further disease course can be predicted.     

Alkoholmissbrauch und -abhängigkeit im Kindes- und Jugendalter

Chronic alcohol use is associated with a wide range of somatic and psychiatric disorders and psychosocial impairments. Due to an increased vulnerability during brain maturation, children and adolescents are at high risk, in particular regarding the development of neurobiological alterations. Alcohol use is common among young people in Germany, as are problems caused by risky drinking habits such as binge drinking behaviour. Suicide rates and the frequency of suicide attempts by young people in connection with alcohol abuse have more than tripled; therefore, alcohol use among children and adolescents has become a major public health issue. Due to potentially permanent alterations in development, effective preventive strategies are mandatory.     

Motorische Leistungsfähigkeit im Kindes- und Jugendalter

The development of motor competencies is an important component of healthy development. In this paper, the motor fitness data of children and adolescents age 4–17 years are presented and analyzed. Data were obtained from the “Motorik-Modul” (MoMo) study, a representative cross-sectional sample of the 4–17-year-old boys and girls from Germany (N=4,529). Motor fitness was assessed using a standardized test profile. Conditional performance increase in both sexes during childhood, with a gender-specific differentiation in favor of boys at the onset of puberty. Over the course of adolescence, girls show only a slight performance increase. Regarding gross motor coordination, strong performance gains are getting evident in early and middle childhood. However, in late childhood and early adolescence, performance is characterized by decreasing growth rates; boys and girls of all ages show comparable coordinative performances. Girls show better flexibility than boys, in both sexes only minor performance fluctuations are getting obvious with age. The present motor fitness data show broad agreement with the literature but are more current and more resilient due to their comprehensive representativeness.     

Angststörungen im Kindes- und Jugendalter

Anxiety disorders are widespread in childhood and adolescence but not all anxieties need medical treatment. For example, anxieties can be a feature of normal development and shyness can simply be a character trait and not necessarily indicative of an illness. On the other hand the actual anxiety disorders are characterized by significant and enduring impairment that limit the normal development of a child. These are the most commonly occurring psychiatric disorders in childhood and adolescence. Included in this group of disorders are separation anxiety, specific phobias, social phobia, generalized anxiety disorder, panic disorder, agoraphobia, posttraumatic stress disorder and also more recently selective mutism. Multimodal methods are required for the diagnosis, involving behavioral observation, diagnostic interviews, symptom diaries and self-assessment rating questionnaires. Preventative measures are possible. The focus of behavioral therapeutic treatment methods is on confrontation with the situations inducing anxiety.     

Frühsommermeningoenzephalitis im Kindes- und Jugendalter

Background

The purpose of this study was to investigate the frequency and course of tick-borne encephalitis (TBE) in children and young adults (ages 1–15 years) in southwestern Germany.

Patients and methods

Clinical and epidemiological data from children were recorded by means of a questionnaire by Departments of Paediatrics in Baden-Württemberg and Southern Hessen.

Results

Between 1994 and 2003 a total of 124 children with TBE were recorded. Seventy-seven children (62%) had noticed a tick bite, and the first symptoms occurred an average of 7 days later. The disease had a biphasic course in 89 (72%) of the 124 children. TBE presented as meningitis in 80 children (64%), as meningoencephalitis in 43 (35%), and as encephalomyelitis in 1 child (1%). The most frequent neurological symptoms of meningoencephalitis were impaired consciousness (35%), ataxia (4%), and paresis of the extremities (2.4%) and cranial nerves (2.4%). Laboratory investigations revealed leukocytosis in the peripheral blood in 102 of the 124 patients (82%), elevation of the sedimentation rate in 102 (82%), and increased C-reactive protein in 92 (74%).

Conclusion

Even though the course of TBE is less dramatic, and its prognosis better, in children than in adults, there is just as much reason to protect children against TBE by active immunisation as there s to immunise adults in any area where any cases of TBE are known. The beginning of a vaccination course should be linked to the frequency of exposure through outdoor activities in areas where there is a risk of TBE.     

Sekundäre Prävention im Kindes- und Jugendalter in Deutschland

Background

Since 1971 a total of eight physical examinations for early recognition of relevant health conditions in children have been implemented in Germany and have since been expanded with three more examinations. The program aims at secondary prevention, aspects of primary prevention or health promotion are desirable but not included as an obligatory part.

Objectives

This article describes the aims and development of the program since its implementation, analyzes the changes and inclusion of new methods and target conditions.

Methods

This article is based on a review of the literature, analysis of the relevant documents of the Joint Commission of Physicians and Health Insurances, German state legislation and the public health examinations for school entry in Schleswig-Holstein.

Results

Limited evidence of beneficial effects is available for most of the target conditions, and screening for hearing and vision in an office-based setting lacks efficacy. Newborn hearing screening and ultrasound for hip dysplasia have been added to the program on the basis of the potential for better health outcomes. An additional examination at the age of 2 years was introduced in 2011 to counteract the increasing numbers of developmental and behavioral problems in childhood.

Discussion

Children and families have access to an extensive preventive health supervision program by office-based pediatricians or family physicians. The program appears to serve the family needs and is very well accepted. An integrated public health approach and multidisciplinary cooperation, including social and educational services, appear to be the most promising instruments to improve early preventive services for children and adolescents in Germany.

Conclusion

Representative data from large national cohort studies and high quality health services research are required to assess the benefits of early child health supervision for ethical and for health economic reasons.     

Gastroösophageale Refluxkrankheit im Kindes- und Jugendalter

Symptoms, diagnostic and therapeutic procedures, as well as the long-term prognosis of gastroesophageal reflux disease (GERD) show considerable differences in pediatric patients depending on their respective age. Particularly in infants symptoms are often unspecific, and differentiation is difficult between GERD, physiological reflux, and cows’ milk protein allergy. Patients with a high risk of GERD are children with a cerebral palsy or after repair of esophageal atresia, in whom the indication for upper endoscopy must be considered. Other diagnostic methods should be complementary applied according to age, symptoms, and the problem in question. Proton pump inhibitors are the first choice medication for children with proven GERD. However, in infants and young children, they should not be used without prior investigation. The need for antireflux surgery should be judged by a pediatric gastroenterologist together with a pediatric surgeon.     

Kardiologische Notf?lle im Kindes- und Jugendalter

Pediatric cardiac emergencies are less frequent than in adults and show specific age-dependent differences. Congenital heart disease diagnosed and treated or not can be found in early childhood, whereas acquired heart disease plays a role after the first year of life. All kinds and causes of myocardial dysfunction and cardiomyopathy occur in older children presenting as heart failure. Cardiac dysrhythmia can also be found in all age groups, being of supraventricular rather than ventricular origin. Coronary problems in childhood are rare in comparison with adulthood but can be a major problem in Kawasaki disease. Specific symptoms, such as cyanosis are infrequent so it is very important to rule out or diagnose a cardiac cause in an unclear emergency situation. Profound knowledge of pediatric cardiac disease is essential for emergency staff to diagnose and manage these situations in the best way possible.     

Respiratorische Notf?lle im Kindes- und Jugendalter

Dyspnoea, inspiratory stridor, wheeze, cyanosis and chest pain are common symptoms of respiratory emergencies in children and adolescents. The airways of infants and toddlers are narrow and soft and oxygen reserve is small. Muscle fatigue can quickly lead to respiratory insufficiency. Symptoms, diagnosis, differential diagnosis and therapy of foreign body inhalation, croup, epiglottitis, bacterial tracheitis, bronchiolitis and acute asthma are dealt with in detail.     

40 Jahre Lebertransplantation im Kindes- und Jugendalter

The development of pediatric liver transplantation (LTx) over the past decades has been a success story. As the established standard treatment for classical indications, such as biliary cirrhosis, LTx shows excellent long-term survival in the hands of experienced, highly qualified interdisciplinary treatment teams. The interdisciplinary team consist of pediatricians, transplantation surgeons, nursing personnel, intensive care specialists, anesthetists, physiotherapists, dieticians, speech therapists and psychosocial workers. In spite of this, a liver transplantation replaces a previously life-limiting disease with a new chronic disease status. With respect to the long-term perspectives, the prevention and recognition of complications after LTx have become even more important. In addition to ensuring a functioning transplant, the focus of care is on aspects of quality of life, rehabilitation, monitoring of therapy-associated side effects and strengthening compliance. The lack of donor organs necessitates an optimal utilization of all available resources, including splitting of suitable organs. With respect to novel innovative forms of therapy, the future will reveal to what extent the indications for pediatric LTx will change.