Boxing participation by children and adolescents: A joint statement with the American Academy of Pediatrics

Thousands of boys and girls younger than 19 years of age participate in boxing in North America. Although boxing provides benefits for participants, including exercise, self-discipline and self-confidence, the sport of boxing encourages and rewards deliberate blows to the head and face. Participants in boxing are at risk of head, face and neck injuries, including chronic and even fatal neurological injuries. Concussions are one of the most common injuries occurring in boxing. Because of the risk of head and facial injuries, the Canadian Paediatric Society and the American Academy of Pediatrics vigorously oppose boxing as a sport for children and adolescents. These organizations recommend that physicians oppose boxing in youth and encourage patients to participate in alternative sports in which intentional head blows are not central to the sport.     

Policy statement—Boxing participation by children and adolescents

Thousands of boys and girls younger than 19 years participate in boxing in North America. Although boxing provides benefits for participants, including exercise, self-discipline, and self-confidence, the sport of boxing encourages and rewards deliberate blows to the head and face. Participants in boxing are at risk of head, face, and neck injuries, including chronic and even fatal neurologic injuries. Concussions are one of the most common injuries that occur with boxing. Because of the risk of head and facial injuries, the American Academy of Pediatrics and the Canadian Paediatric Society oppose boxing as a sport for children and adolescents. These organizations recommend that physicians vigorously oppose boxing in youth and encourage patients to participate in alternative sports in which intentional head blows are not central to the sport.     

Plantar pressure measurement in children and youths during sports activities

The aim of this study was to consider whether changes occur in the foot area while under repeated physical stress and if they are age related. In addition it interests what consequences this might have in regard to proper shoe wear. The subjects for this study consisted of 15 children and youths aged between 4 and 16 years. The plantar pressure distribution and vertical ground reaction forces were measured before and after physical exercise. The subjects first ran a given distance wearing sport shoes, had a rest and then ran the same distance barefoot. The results showed marked age related differences after exercise. The pressure values were increased in all of the youths in the middle foot region. In comparison young children always exhibited an unbound gait pattern without any dynamic foot roll during heel strike or toe-off. The forefoot had ground contact from the beginning of the stance phase. To compensate for the lack of dynamic foot roll it is recommended that children wear a shoe with a soft sole and with sufficient space for toe movement. The sports shoe for youths should grip the heel and support the longitudinal arch to prevent an incorrect weight distribution.     

Sexual trajectories of abused and neglected youths

The study objective was to examine whether childhood abuse or neglect is associated with the age of onset of puberty and sexual and romantic behavior. A cohort of children (the Children in the Community study) was randomly selected and studied prospectively from childhood to adulthood. A sample of 816 youths were interviewed in their homes at a mean age of 14, 16, and 22 years in 1983, from 1985 to 1986, and from 1991 to 1994. The outcome measures included age of menarche, signs of male puberty, first being in love, dating, sexual intercourse, and pregnancy reported by youths. Child abuse and neglect were measured by official records and youth reports. A history of two or more incidents of sexual abuse was significantly associated with early puberty and early pregnancy after gender, class, race, paternal absence, and mother's age at the birth of the study child were controlled statistically. Public education regarding risk for premature sexual behavior among youths who have experienced sexual abuse is warranted. Efforts to prevent teenage pregnancy should include monitoring and educating sexually abused children as they enter puberty.     

Metabolic differences between Caucasian and African-American children and the relationship to type 2 diabetes mellitus

Type 2 diabetes mellitus (DM) has historically been considered an adult disease. However, the incidence of type 2 DM has increased dramatically in pediatric populations in recent years. This increase parallels the recent rise in childhood obesity and has been greatest among minority adolescents. Differences between African-American and white American youths are discussed, including risk factor differences that may help to account for the overwhelming number of African-American children with type 2 DM as compared with white children. African-American youths have higher rates of insulinemia, obesity, family history, and acanthosis nigricans than their white counterparts. In addition, despite similar declines in insulin action during puberty, there is no compensatory increase in insulin secretion in African-American children, contrary to the observation in white children. These differences are likely to have a genetic basis modulated by environmental and lifestyle influences. Treatment of type 2 DM should focus on identifying individuals at risk and instituting lifestyle changes to reduce the risk and stem the development of DM.     

EpiPen epidemic: suggestions for rational prescribing in childhood food allergy

There has been a marked increase in community concerns of the risk of food induced anaphylaxis in children and a consequent increase in the provision of the self or carer injectable epinephrine (EpiPen) (CSL Ltd, Parkville, Victoria, Australia)). The Australian use of EpiPens in children under 10 years has increased by 300% over 5 years with a crude rate of EpiPen provision of 1 per 544 Australian children aged under 10 years. However, the risk of a fatal reaction to food, particularly in preschool children, is remote (in Australia, an estimated one fatality in 30 years in the under 5-year-old population and two deaths in 10 years in the entire child population). It is therefore important to provide a perspective on the risk of death from food induced anaphylactic to parents and carers in view of the anxiety generated on this issue. The indications for provision of an EpiPen to children are not well defined. Six risk factors, which can be considered in evaluating the risk of a life-threatening reaction (age over 5 years; a history of respiratory tract involvement with the initial or subsequent reactions; a history of asthma requiring preventer medication; peanut or tree nut sensitivity; reactions induced by traces or small amounts of allergen; a strongly positive skin prick test) are proposed. It is suggested that the greater the number that are positive, the lower the threshold for provision of an EpiPen. In addition, instruction in EpiPen administration and the provision of both a clear and simple anaphylaxis action plan and a rational perspective on the remote risk of death is just as important as the provision of the device itself.     

Hospitalization trends among children and youths with perinatal human immunodeficiency virus infection, 1990-2002

BACKGROUND: Major improvements in disease progression among HIV-infected children have followed the adoption of combination antiretroviral therapy. METHODS: We examined trends in hospitalization rates between 1990-2002 among 3,927 children/youths with perinatal HIV infection, ranging in age from newborn to 21 years. We used Poisson regression to test for trends in hospitalization rates by age and year; binomial regression to test for trends in intensive care unit (ICU) admissions and hospitalization at least once and more than once, by age and year; and multivariate logistic regression to examine factors associated with hospitalization, ICU admission, and hospitalization longer than 10 days. RESULTS: Statistically significant downward trends in hospitalization rates and multiple hospitalizations were observed in all age groups from 1990-2002. The proportion of HIV-infected children/youths who were hospitalized at least once declined from 30.4% in 1990 to 12.9% in 2002, with a steady decline occurring after 1996, when the U.S. Public Health Service issued guidelines recommending triple-drug antiretroviral therapy (triple therapy) for HIV-infected children. ICU admissions declined significantly in all age groups except among children younger than 2 years. Logistic regression results indicated that black and Hispanic children/youths were significantly more likely to be hospitalized than white children/youths and that children/youths receiving triple therapy were significantly more likely to be hospitalized than therapy-naive children; the latter association was not observed among children monitored from 1997-2002. CONCLUSIONS: Substantial reductions in rates of hospitalization, multiple hospitalizations, and ICU admission have occurred among HIV-infected children/youths from 1990-2002, particularly after 1996, with increased use of triple therapy.     

Early childhood malnutrition predicts depressive symptoms at ages 11–17

Background: We examined the prevalence of depressive symptoms in Barbadian youth with histories of infantile malnutrition and in a healthy comparison group and the extent to which the effect of malnutrition was mediated/moderated by maternal depression. Methods: Depressive symptoms were assessed using a 20‐item scale administered to youths (11–17 years of age) who had experienced an episode of protein‐energy malnutrition (marasmus or kwashiorkor) during the first year of life and in a comparison group of healthy youths without a history of malnutrition. Their mothers completed the same questionnaire on the same test on three occasions when their children were 5–17 years of age at 2–5‐year intervals. Results: The prevalence of depressive symptoms was elevated among previously malnourished youth relative to healthy comparison children (p < .001). When youth depression scores were subjected to a longitudinal multiple regression analysis, adjusting for the effect of maternal depressive symptoms, significant effects due to the history of early childhood malnutrition remained and were not discernibly attenuated from an unadjusted analysis. We also found significant independent effects of maternal depressive symptoms on youth depressive symptoms. Conclusion: Early childhood malnutrition contributed independently to depressive symptoms in youths who experienced a significant episode of malnutrition in the first year of life. This relationship was not mediated or moderated by the effects of maternal depression. Whether the later vulnerability to depression is a direct effect of the episode of malnutrition and related conditions early in life or whether it is mediated by the more proximal neurobehavioral effects of the malnutrition remains to be determined.     

Deficits in school performance in children and adolescents with chronic asthma

At the time of their admission to the Buchenh?he Jugendorf asthma centre (an institution for medical, professional and social rehabilitation), an investigation was made into the cases of 186 children and youths (average age: 14.0), the majority of whom suffered from severe asthma. The investigation, focused on the patients' ailment symptomatology and its effect on school progress, showed that one third of the children had spent considerable time hospitalized in intensive care (an average of 4.4 x). Amongst other findings were: That one third on the children and youths had not taken part in sports, either at school or in their leisure time, that they had missed a lot of school (33 children had missed over 30%) and that the children and youths were an average of 1.29 years behind the normal school level. The investigation leads to the conclusion that the schooling situation of asthmatic children and youths should be taken into consideration within the chronic asthma treatment plan and that treatment periods that last too long bring about an irreversible school deficiency which could hinder the further development of the youth.     

Utilisation du questionnaire de fatigue chez de jeunes enfants sportifs : effets de l''activité sportive, de l''âge et du sexe

In children, fatigue induced by regular sport activity with important training sessions and competitions is still difficult to objective. The purpose of this study was to evaluate the fatigue induced by intensive training, with an auto-questionnaire of fatigue specially elaborated for sport children aged in 8 to 16 year-old, and the incidence of age, sex and the type of sport practiced. A study was conducted on 780 auto-questionnaires (QFES) distributed to 581 children, during 24 months in France (Rhône-Alpes-Auvergne). Results to the QFES are equivalent between sedentary and sport children. For 84.1% of them, no significant sign of fatigue was detected. No age effect has be seen, but girls presented a greater score of fatigue (+ 5.5%) compared to boys. When considering the specificity of sport, sex difference disappeared. On the contrary, in children with elevated score of fatigue, three domains were principally affected: physical signs, symptoms and motivation. The results obtained in this study assess the relevance of this questionnaire in evaluating sport induced fatigue. Prevention should mainly focus in sport children, in order to reduce potential risks of a sport activity practiced in exhausting conditions.     

Chronic illness, disability, and mental and social well-being: findings of the Ontario Child Health Study

Chronic childhood illness, disability, and psychosocial problems are receiving major attention in current pediatric care. Much of the evidence associating chronic physical problems and mental health and adjustment problems has come from clinic-based studies and is often inconsistent in its conclusions. This paper reports the findings of the Ontario Child Health Study, an epidemiologic survey of 3,294 children 4 to 16 years of age in the general community, concerning the relationship of psychiatric disorders and social adjustment problems among children with chronic illness, medical conditions, and long-term disability in contrast to children free of chronic physical health problems. Age- and sex-adjusted risks for psychiatric disorders and social problems, compared with those for healthy peers, were calculated: children with both chronic illness and associated disability were at greater than threefold risk for psychiatric disorders and considerable risk for social adjustment problems. Children with chronic medical conditions, but no disability, were at considerably less risk: about a twofold increase in psychiatric disorders but little increased risk for social adjustment problems was observed. A relative underuse of specialized mental health services by children who might benefit supports the opinion that all physicians in the community who care for children with chronic health problems should become skilled in the recognition of existing or incipient mental health and social problems and familiar with preventive and treatment approaches that may lessen the excessive burden of psychosocial problems among those with chronic ill-health.     

Indicators of Well-Being Among Children in the United States Child Welfare System

The second National Survey of Child and Adolescent Well-Being (NSCAW II) is a longitudinal study intended to answer a range of fundamental questions about the functioning, service needs, and service use of children who come in contact with the child welfare system. The study includes 5,873 children ranging in age from birth to 17.5?years old at the time of sampling. The current analysis summarizes the well-being of these children at NSCAW II baseline. Overall, children reported for maltreatment in 2008?C2009 were at higher risk for poor health and negative developmental, behavioral/emotional, and cognitive outcomes than children in the general population. Overall, 32.2?% of children from birth to 5?years old had a score indicating developmental problems. Among school-aged children and adolescents, 10.3?% showed some risk of cognitive problems or low academic achievement and 41.6?% exhibited risk of emotional or behavioral problems. Child well-being outcomes differed by age and gender but not by substantiation status or type of maltreatment. Proactively providing needed services at an early age to all children in need in the CWS is urged, because early services may well preempt these children??s need for extensive future developmental, mental health, and educational services.     

Forderung eines Rauchverbots in Autos mit Kindern

Many scientific studies have confirmed a clear association between exposure to secondhand smoke and severe health risks for children and adolescents. From the perspective of preventive pediatric and adolescent medicine and also under the aspect of child and youth protection, multiple measures are urgently necessary for reduction of this risk. A simple, highly effective and rapidly implementable measure demanded by the signing societies for pediatric and adolescent medicine and child protection, is to ban smoking and make it a punishable offence when children or adolescents are present in vehicles. These societies therefore support the the demands of the Federal Commissioner for Drugs Marlene Mortler, the German Medical Council and the German Cancer Research Center. Due to the high concentration of many, partly carcinogenic toxins, smoking in a vehicle must be considered a danger to childrens’ welfare and a severe risk to childrens’ health. In the long term in addition to a ban on smoking in vehicles when children are present, further preventive and interventional measures are necessary for protection of children and adolescents from exposure to passive smoking.     

The burden of asthma in children: an Australian perspective

The burden of asthma among children is high in Australia compared with many other countries. Recent data show that 14-16% of children report a diagnosis of asthma that remains a problem. Boys, children under the age of 5 years and urban indigenous children experience a greater burden of asthma than other children. More than one-third of children with asthma have sleep disturbance due to the illness and 60% have missed school and/or experienced other restrictions in their activities due to the disease. Despite this, there is continuing evidence of under-utilisation of effective treatment for the disease. Asthma is a major cause of healthcare utilisation among children. Since the early 1990s, there has been a decline in both hospitalisation rates and general practitioner consultation rates for asthma among children. It remains to be seen whether this favourable trend will continue and extend into the adult age range.     

Nasal carriage of Staphylococcus aureus in 4-6 age groups in healthy children in Afyonkarahisar, Turkey

AIM: Staphylococcus aureus is a common cause of disease, particularly for colonized persons. Although methicillin-resistant S. aureus (MRSA) infection has frequently reported, population-based S. aureus and MRSA colonisation estimates are lacking. Our objective in this report is to present the prevalance of S. aureus carriage among 4-6 age groups healthy children in our region. METHODS: Nasal samples for S. aureus culture were obtained from healthy children. Sociodemographic features and the data related with risk factors were obtained from the parents of the children. Nasal swabs were inoculated on to a variety of bacteriological culture media, which were then incubated at 35 +/- 1 degrees C for 16-18 h. Antimicrobial susceptibility testing of the isolates was determined according to Clinical and Laboratory Standard Institute (CLSI, 2005) guidelines. RESULTS: In this study 1134 children between 4 and 6 years old age were evaluated; 607 (53.5%) of the subjects were boys and 527 (46.5%) were girls. S. aureus was isolated in 322 (28.4%) subjects and MRSA was isolated in 3 (0.3%) subjects of them. All of the MRSA isolates were found in healthcare workers' children. CONCLUSIONS: This first assessment of this study is that nearly one third of the 4-6 age group healthy children population present nasal carriage of S. aureus in Turkey. However, it also shows that the rate of MRSA carriage remains low. In addition, it is considered that MRSA colonization may be a risk factor for healthcare workers' children.     

Association of overweight with asthma symptoms in Japanese school children

Background: Most studies regarding the association of obesity with asthma have been performed in the Western countries. This study is a nationwide survey conducted in Japan. Methods: A cross‐sectional and questionnaire‐based survey was performed among children aged 6–7, 13–14, and 16–17 years, using the ISAAC questionnaire. Overweight was defined as BMI ≥ 90th according to the reference values for Japanese children obtained during 1978–1981. Results: Of a total of 179 218 children, 149 464 replied to the questionnaire (response rate 83.4%). After omitting incomplete data, 139 117 were analyzed. In all the age groups, being overweight was associated with current asthma after adjustment for confounding factors (adjusted OR: 1.24 in children 6–7 years of age, 1.31 in those 13–14 years, and 1.32 in those 16–17 years). These tendencies were observed in both genders. Overweight was a risk factor for nocturnal cough, independent of current asthma in the older age groups (adjusted OR: 1.21 in children 13–14 years, and 1.17 in those 16–17 years). Conclusions: There is a clear association between obesity and current asthma in Japanese school‐aged children. Mechanisms through which obesity related with nocturnal cough might be different from those of obesity‐associated asthma.     

Behavioral risks for human immunodeficiency virus infection in adolescent medical patients

This paper is an examination of the extent to which adolescents in primary care indicated behavioral risk for human immunodeficiency virus infection, and the degree to which their clinic records reflected either awareness of such conditions or interventions for them. Levels of risk were assigned to the youths based on known risk factors in adult populations and arbitrarily selected natural breaks in the frequency of sexual behaviors. Of the sample, 3% were at high risk for human immunodeficiency virus infection because the adolescents engaged in prostitution, injectable drug use, male homosexual behavior, or had a sexually transmitted disease associated with genital ulcers or sores; 16% were at moderate risk because the youths had more than six sexual partners in the year preceding the interview or had nonulcerative forms of sexually transmitted disease; and the remainder were at low risk. Fewer than half of the youths at risk for human immunodeficiency virus infection sought or received help for any of their problem behaviors, while virtually all sought and received help for sexually transmitted diseases. Because a high proportion of the youths engaging in risky behaviors had sexually transmitted diseases, the most promising approach for prevention of human immunodeficiency disease infection is through health clinics that treat sexually transmitted diseases. These clinics could screen the youths for associated behavioral risk factors, and then offer preventive or interventive services.     

Three-wheel and four-wheel all-terrain vehicle injuries in children

In January 1988, sales of new three-wheel all-terrain vehicles (ATVs) were banned in the United States because of the high incidence of injury associated with their use, especially by children. Four-wheel ATVs remain on the market. A retrospective review of all ATV injuries seen in a level I pediatric trauma center was conducted to compare the nature and severity of injuries in three-wheel vehicles with those associated with four-wheelers. A total of 36 ATV injuries were seen from April 1986 to August 1988. All patients were less than 16 years of age; 72% were less than or equal to 12 years of age. Of the patients, 56% were boys; 44% were girls. Although 56% of incidents involved three-wheelers, a larger number of more serious injuries, defined as the presence of indicators of injury severity (eg, death, Injury Severity Score greater than or equal to 10, intensive care unit admission, or need for surgery), involved four-wheel vehicles. A total of 15 injuries occurred in 1987; 12 injuries, including the first death involving an ATV at the pediatric trauma center, occurred in the 7 months since the sales ban. Immature judgment and/or motor skills were the most common factors contributing to injury. Existing information regarding injuries involving three-wheel ATVs is supported by our data, according to which it is suggested that four-wheel vehicles may be dangerous in the hands of immature or unskilled operators less than 16 years of age. Injury prevention efforts should be directed at prohibiting any ATV use by persons less than 16 years of age.     

Long-term outcome of elastic stable intramedullary fixation (ESIF) of femoral fractures in children.

In 1993 a prospective data collection of all femoral fracture in children below 16 years of age was initiated in 4 hospitals in the Netherlands. Follow-up was at least two years, with the aim to evaluate leg length discrepancies (LLD). Over a period of 10 years, we included 136 patients < 16 years of age with femoral fractures. Seventy-one patients who were treated with an ESIF-(Elastic Stable Intramedullary Fixation) nail were studied: 44 boys and 27 girls, between the ages of 3-16 years, 23 of which had multiple injuries. Five patients had a Ist or IInd degree open fracture. The average length of stay (LOS) of children with an isolated fracture, was 10 days, and in case of multiple injuries: 12 days. Intra-operative complications were: a broken drill in 2 and an open reduction in 6 cases. Two patients with superficial wound infection were successfully treated with antibiotics. Seven patients had knee complaints of the nails, of which 3 had actually been displaced. Three other patients showed displacement of the nails at X-ray, but had no complaints. At six months follow-up, at the time of removal of the nails, 10 patients had a leg length discrepancy (LLD) exceeding 10 mm. Three children had a clinically significant rotational deformity at this time. Two and a half years after injury 6 patients showed a persistent LLD of more than 10 mm. In all 6 the fractured limb was longer. At ten years of follow-up the LLD persisted in 5 patients. One patient had a persistent clinically significant rotational deformity of more than 10 degrees . The advantages of ESIF-nails are: reduction of hospital stay and rapid mobilisation. The disadvantages: two operations (for insertion and removal) with a risk of complication. Long-term follow-up, preferably till growth stops, is necessary to conclude whether persistent lengthening of the fractured limb remains a problem.