Snoring, sleep disturbance, and behaviour in 4-5 year olds

Parents of 996 children aged 4-5 years identified consecutively from the Oxford health visitor register were asked to complete a questionnaire about breathing disorders during sleep. A total of 782 (78.5%) was returned. Ninety five (12.1%) children were reported to snore on most nights. Habitual snoring was significantly associated with daytime sleepiness, restless sleep, and hyperactivity. The questionnaire responses were used to select two subgroups, one at high risk of a sleep and breathing disorder and a control group. These children (132 in total) were monitored at home with overnight video recording and oximetry, and had formal behavioural assessment using the Conners scale. Seven (7/66) children from the high risk group and none from the control group had obvious sleep disturbance consequent on snoring and upper airway obstruction. Thus our estimate of the prevalence of sleep and breathing disorders in this age group is 7/996 or 0.7%. The high risk group had significantly higher nocturnal movement, oxygen saturation dip rates, and overnight pulse rates than the controls. Maternal but not paternal smoking was associated with the high risk group. Parents and teachers thought those in the high risk group were more hyperactive and inattentive than the controls, but only their parents thought them more aggressive. Significant sleep and breathing disorders occur in about 0.7% of 4-5 year olds. Children whose parents report snoring and sleep disturbance have objective evidence of sleep disruption and show more behaviour problems than controls.     

Suicidal ideation among urban nine and ten year olds

Little is known about rates and correlates of suicidal ideation among nonclinical samples of preadolescents from low-income urban backgrounds. Using the Children's Depression Inventory, we measured suicidal ideation in 131 preadolescent urban children (49% female, 90% African American/Caribbean) participating in an ongoing prospective longitudinal study of prenatal cocaine exposure and children's outcome. Suicidal ideation was reported by 14.5% of the children in this sample at 9 to 10 years of age. Children's reports of depressive symptoms, exposure to violence, and distress symptoms in response to witnessing violence were associated with suicidal ideation, but prenatal cocaine exposure, parent-rated child behavior, and caregivers' psychological distress symptoms were not. Suicidal ideation may be more prevalent among preadolescents from urban, low-income backgrounds than clinicians suspect, particularly among children exposed to violence.     

Maternal depression, child frontal asymmetry, and child affective behavior as factors in child behavior problems

BACKGROUND: Despite findings that parent depression increases children's risk for internalizing and externalizing problems, little is known about other factors that combine with parent depression to contribute to behavior problems. METHODS: As part of a longitudinal, interdisciplinary study on childhood-onset depression (COD), we examined the association of mother history of COD, child frontal electroencephalogram asymmetry, and affective behavior with children's concurrent behavior problems. RESULTS: Children in the COD group had higher anxious/depressed and aggressive problems than did children in the control group, but this was qualified by a COD-by-asymmetry interaction effect. For COD but not control children, left frontal asymmetry was associated with both anxious/depressed and aggressive child problems. Children with left frontal asymmetry and low affect regulation behavior had higher anxious/depressed problems than did those with high affect regulation behavior. Boys with left frontal asymmetry had higher aggressive problems than did those with right frontal asymmetry. CONCLUSIONS: In children of mothers with COD, physiological and behavioral indices of affect regulation may constitute risks for behavior problems.     

Maternal depression, child behavior, and injury.

BACKGROUND: Few data exist on the effect of maternal depression on child injury outcomes and mediators of this relationship. OBJECTIVE: To examine the relationship between mothers' depressive symptoms and medically attended injuries in their children and the potential mediating role of child behavior. DESIGN/ METHODS: A cohort of mother-child dyads from the National Longitudinal Study of Youth followed from 1992 to 1994. The primary exposure variable was maternal depressive symptoms as measured by the Center for Epidemiologic Studies Depression Scale in 1992. Child behavior was assessed by the Behavior Problems Index externalizing subscale. Logistic regression was used to examine the relationship between depressive symptoms, child behavior, and injury reported in the prior year in 1994. RESULTS: 94 medically attended injuries were reported in the 1106 children (8.5%); two-thirds were sustained in the home environment. Maternal depressive symptoms significantly increased the risk of child injury; injury risk increased 4% for every 1-point increase in depressive symptoms (adjusted OR 1.04, 95% CI 1.01 to 1.08, p=0.02). Increasing maternal depressive symptoms also increased the risk of externalizing behavior problems (adjusted OR 1.06, 95% CI 1.03 to 1.09), but externalizing behavior problems did not significantly mediate the relationship between maternal symptoms and child injury. CONCLUSIONS: Increasing depressive symptoms in mothers was associated with an increased risk of child injury. Child behavior did not significantly mediate the association between maternal depressive symptoms and child injury in this cohort. Greater recognition, referral, and treatment of depressive symptoms in mothers may have effects on child behavior and injury risk.     

Insulin dependent diabetes in under 5 year olds.

Insulin dependent diabetes mellitus presenting in children under five years old exhibits several clinical and management features that differ from diabetes presenting in older children. In this review of the current population of the Oxford children''s diabetes clinic, children with diabetes diagnosed aged 0- less than 5 years are compared with those diagnosed aged 5- less than 10 years to illustrate these differences. The mean annual age specific incidence of diabetes for children aged 0- less than 5 is 9.9/100 000 compared with 13.8/100 000 for the children diagnosed aged 5- less than 10. Although children with diabetes currently aged less than 5 comprise only 8% of the clinic population, such children ultimately make up 41% of the total number of children with diabetes aged under 15 attending the clinic. Diabetes diagnosed in children under the age of 5 seems to have increased in incidence over the past 10 years, exhibits a male preponderence (1.5:1), and shows an unusual seasonal variation in incidence with an autumn/early winter trough, late winter/early spring peak, and the absence of mid-summer trough seen in other age groups. First degree family history was positive in 16% of children diagnosed under the age of 5 compared with 10% of the group diagnosed aged 5- less than 10. In none of these children was the mother the affected relative.     

A new approach to cancer in 15-25 year olds

The specificity of adolescence and early adulthood with people suffering from cancer requires adapted and specific care by nursing teams. The paediatric oncology and medical oncology teams at the Institut Curie in Paris, faced with such issues, have been working more closely together to create a special unit for 15-25 year olds.     

The sodium and potassium intake of 3 to 5 year olds.

The sodium intake of preschool children in their home environment was investigated and the major sources of sodium other than added table salt identified. Thirty five children from a Southampton general practice were studied. Twenty four hour urinary sodium excretion was measured as a reliable indicator of daily total sodium intake. The daily intake of sodium other than that from added table salt, and of potassium and other nutrients, was also calculated from three day dietary diaries collected using the household measures method. Median excretion of sodium was 62 mmol/24h (range 28-105, 28 urine collections) and of potassium was 25 mmol/24 h (range 14-46). The sodium:potassium ratio was 2.7 (1.4-5.2). From the diaries, the average daily intake of sodium was 68 mmol (32-98) and of potassium was 47 mmol (24-95), and the sodium:potassium ratio was 1.4 (0.5-2.7) (median and ranges, 35 children). Foods contributing more than 30 mmol sodium to one day''s intake were mainly processed convenience foods.     

Urinary excretion of pyridinium crosslinks in healthy 4-10 year olds

Urinary pyridinoline and deoxypyridinoline, pyridinium crosslinks released during breakdown of mature collagen, might serve as useful markers of bone resorption. Before their role can be identified, reference values must be established. In this study, free pyridinoline (f-Pyr), free deoxypyridinoline (f-DPyr), and creatinine (Cr) were measured in first morning void urine samples from 250 girls and 265 boys between the ages of 4 and 10 years. Overall, there was a decrease in f-Pyr:Cr and f-DPyr:Cr ratios with increasing age in both sexes, but there was a wide range of values for individuals of similar ages. Further studies are required to assess whether urinary pyridinium crosslink excretion is sufficiently deranged in conditions affecting bone metabolism for the measurement of these compounds to be of clinical value.     

Is water out of vogue? A survey of the drinking habits of 2-7 year olds

OBJECTIVE--To survey the drinking habits of young children with reference to the consumption of plain water, and to estimate the proportion of a child's recommended energy intake contributed by drinks. DESIGN--A prospective survey. SETTING--Health centres, mother and toddler groups, and infant schools in and around Southampton. SUBJECTS--39 preschool and 66 infant schoolchildren. INTERVENTIONS--Parents kept a diary of all drinks consumed by the child over 48 hours. Parents were interviewed with a questionnaire about the drinking habits of their child. MAIN OUTCOME MEASURES--The type of drinks and volume of fluid consumed over 48 hours; the proportion of a child's recommended energy intake consumed through drinks. RESULTS--72.5% of the preschool group and 50% of the infant school group never drank plain water. Squash was by far the most frequently consumed drink. 15% of the preschool group consumed just under 50% of their recommended daily energy intake in drinks. CONCLUSIONS--Young children consume large quantities of squash which constitutes a substantial energy supply. It is possible that they are conditioned at an early age to the sweet taste of drinks that may be no nutritional benefit to them.     

Wegener's granulomatosis in a 7 year old child

A 7 year old boy presented with a history of recurrent episodes of sinusitis and otitis. He developed paresis of the external muscle of his right eye with exophthalmos. A biopsy of his sinus mucosa demonstrated necrotizing granulomatous involvement of the membranes with the presence of multiple giant cells interspersed in zones of fibrosis. A diagnosis of Wegener's granulomatosis was entertained. However the absence of pulmonary and renal manifestations did not allow for a definitive diagnosis to be made. He later developed hematuria and a renal biopsy demonstrated a renal lesions consistent with Wegener's granulomatosis. He has responded well to Cyclophosphamide and Prednisone therapy.     

Poor co-ordination in 5 year olds: a screening test for use in schools

A simple standardized screening test (South Australian Motor Co-ordination Screening Test, SAM Test) was developed to screen for poor co-ordination in 5 year olds. This SAM Test, which can be used by teachers, nurses and doctors, has explicit pass/fail criteria and has classified correctly 90% of children. The McCarthy Motor Scales, which are time consuming and limited to use by psychologists, were used to categorize 60 poorly co-ordinated and 60 normal children. The 120 children thus selected were tested on 19 items covering gross and fine motor skills. Statistical analysis to determine which items best discriminated between the two groups found the following five gross motor items to be most effective: one leg balancing, hopping, heel-toe walking on line, jumping over ribbon and dropping ball and catching.     

Poor co-ordination in 5 year olds: A screening test for use in schools

A simple standardized screening test (South Australian Motor Co-ordination Screening Test, SAM Test) was developed to screen for poor co-ordination in 5 year olds; This SAM Test, which can be used by teachers, nurses and doctors, has explicit pass/fail criteria and has classified correctly 90% of children. The McCarthy Motor Scales, which are time consuming and limited to use by psychologists, were used to categorize 60 poorly co-ordinated and 60 normal children. The 120 children thus selected were tested on 19 items covering gross and fine motor skills. Statistical analysis to determine which items best discriminated between the two groups found the following five gross motor items to be most effective: one leg balancing, hopping, heel-toe walking on line, jumping Over ribbon and dropping ball and catching.     

Urinary excretion of pyridinium crosslinks in healthy 4-10 year olds.

Urinary pyridinoline and deoxypyridinoline, pyridinium crosslinks released during breakdown of mature collagen, might serve as useful markers of bone resorption. Before their role can be identified, reference values must be established. In this study, free pyridinoline (f-Pyr), free deoxypyridinoline (f-DPyr), and creatinine (Cr) were measured in first morning void urine samples from 250 girls and 265 boys between the ages of 4 and 10 years. Overall, there was a decrease in f-Pyr:Cr and f-DPyr:Cr ratios with increasing age in both sexes, but there was a wide range of values for individuals of similar ages. Further studies are required to assess whether urinary pyridinium crosslink excretion is sufficiently deranged in conditions affecting bone metabolism for the measurement of these compounds to be of clinical value.     

Atopy, bronchial responsiveness, and symptoms in wheezy 3 year olds.

Fifty children with at least one hospital admission for acute lower airway obstruction in the first 2.5 years of life were assessed at 3 years of age to determine the relationship between atopy, bronchial responsiveness, and the pattern of their symptoms. Bronchial responsiveness was measured by assessing the effect of inhaled metacholine, using the change in transcutaneous oxygen tension (PtCO2) as an indirect measure of response. Symptom patterns were defined by the number of wheezing episodes associated with colds and the presence or absence of cough or wheeze unrelated to viral infections. Forty per cent of the children were found to be atopic by skin prick test or history. In contrast to the situation found in older children and adults, the non-atopic children had significantly greater bronchial responsiveness (lower mean concentration of methacholine causing a 20% fall in PtCO2, the PC20) than the atopic children and significantly more of them had an onset of respiratory symptoms in the first year of life. Cough and wheeze in the absence of colds was more frequently found in the atopic children as was the use of continuous medication. However, the number of reported acute episodes of wheeze associated with colds was the same in the two groups. The findings of the study suggest that in this hospital based group of children, acute wheeze associated with colds in the first three years of life is independent of the finding of atopy and that bronchial responsiveness in this age group may have a different pathogenesis from that in older subjects.