Showing papers in "Pediatric Annals in 1986"

Etiologic factors in cerebral palsy.

Abstract: A variety of insults can cause cerebral palsy, but the dominant mechanism of damage is ischemic and/or asphyxial. Table 2 provides a rough estimate of the relative contribution of each of the several risk factor groups to the total burden of cerebral palsy. This table is only approximate both because of our lack of knowledge, and because risk factors often interact with one another. Cerebral palsy is frequently multifactorial in nature. For example the small-for-gestational age infant is both more likely to experience labor asphyxia, and is also more susceptible to its effects. The numerically largest etiologic grouping in cerebral palsy consists of pre-term/low birthweight infants, many of whom have experienced ischemic damage perinatally. The second largest grouping is infants born at term experiencing severe perinatal asphyxia. Congenital infections, and metabolic conditions such as hyperbilirubinemia certainly play some role in the genesis of cerebral palsy but genetic conditions as such rarely cause cerebral palsy. Some infants, if carefully studied, will prove to have a congenital brain malformation. The role of intrauterine ischemic events is at present not well understood, but is probably significant.

Vulvar Disorders in the Prepubertal Female

Abstract: Inspection of the vulva should be a routine part of well child care. Detection of poor perineal hygiene permits the establishment of good hygiene practices, which may prevent development of vulvovaginitis. Condylomata acuminata, molluscum contagiosum, herpetic vulvitis, and vulvovaginitis secondary to Neisseria gonorrhoeae, Gardnerella vaginalis, Chlamydia trachomatis, and Trichomonas vaginalis arouse suspicion of child sexual abuse, which must be addressed. Atopic dermatitis, psoriasis, lichen planus, and lichen sclerosis et atrophicus are often chronic and early diagnosis with appropriate treatment and follow-up contributes to the acceptance of the disease by parent and child. Early detection of the rare neoplasms of the vulva is essential to improved survival.

Childhood Sibling Loss: A Family Tragedy

Abstract: The loss of a significant object, the loss of a home (security, personal possessions, familiar space that has emotional meaning), the dislocation from one's home or land as occurs in wars or disasters, gives rise to stress-strain responses that may have short-term or long-term effects, eg, post-traumatic stress disorder. The hidden or neglected victims of such occurrences frequently are children--be they siblings or direct descendants. In childhood sibling loss, the effects of the loss are mediated through different members of the family. The acute stressors can give rise to later adversity unless it is recognized that there is a social context in which life and death events occur. Recognizing these individual responses in the family can lead to interventions that may prevent later difficulty. Understanding the meaning of the events to the child, appreciating the fact that events are not just single occurrences, but interact with what existed before as well as with other concomitant events, helps in our therapeutic recommendations and interventions. Sibling loss, though initially related to the death of a sibling, can now be expanded to include the loss of a sibling through chronic illness (emotional, medical, surgical, long-term hospitalization), birth injuries, disabled children (accidents or illness with body changes), chronic illness with visible as well as non-visible changes that require special parental and nursing care, medication on an ongoing basis, and restrictions in diet and activities. The impacts of these losses without death can have devastating effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic chest pain in children and adolescents.

Abstract: Chest pain is a common symptom of older children and adolescents. The majority of the conditions causing it are benign and self-limiting. Almost all diagnoses can be made with a thorough history and physical examination. Most important, the patient and parents need to be assured that there is no heart defect and that there is no imminent danger of dying.

Abnormal vaginal bleeding in adolescents.

Abstract: The evaluation and management of abnormal vaginal bleeding should be tailored to the individual case. Pediatricians caring for adolescents need to be skilled in the evaluation and management of this common adolescent problem. Physicians who do not feel comfortable with their skills in the performance of a pelvic exam should obtain consultation from an adolescent specialist or a gynecologist who has experience with adolescents.

Early neuromotor reflexes in infancy.

Abstract: While motor milestones--the neurodevelopmental functional end point of the transitioning of the immature and mature primitive reflexes into volitional activity--have been highlighted in predicting future motor function, the primitive reflexes represent the earliest neurodevelopmental markers available for study. By pediatricians becoming familiar with their quantitative and qualitative aspects coupled with the time of their appearance and suppression, they will have this neuromotor tool available for the early detection of a significant motor handicap. Primitive reflexes II have been highlighted since they are available at birth to be clinically evaluated and followed during sequential office visits during the first 6 months of life, the time during which infants are more closely followed at office visits. Delay or deviancy (nonsequential appearance) of motor milestones are preceded by an exaggeration or delayed suppression of the primitive reflexes. It is anticipated that the study and standardization of an intrauterine primitive reflex profile will eventually lead to the identification of a high-risk fetus. This endeavor will be fostered by the further development and refinement of non-invasive roentgenographic techniques.

Vulvovaginitis in the preadolescent girl.

Abstract: Vaginal discharges in prepubertal girls can be categorized under two broad headings--those with specific microbiological causes and, in the absence of such, those that are nonspecific in origin. For specific vulvovaginitis, treatment should be tailored to the findings on cultures, wet mounts, KOH, or other slide preparations. For the sexually transmissible organisms resulting in a vaginal discharge, thorough social service investigation should be undertaken in addition to appropriate antibiotic therapy. When a microbiological cause cannot be found and a foreign body has been ruled out, one is left with a diagnosis of nonspecific vulvovaginitis; treatment goals should be aimed at reassuring and re-educating the patient and parents in good hygienic practices as well as the elimination of potential irritants.

Acute and long-term consequences of adolescents who choose abortions.

Abstract: An estimated 40% of US females now 14 years of age can be expected to experience pregnancy by age 19 years and the majority of these pregnancies will be unintended In 1981 there were 1343200 pregnancies among US females under 20 years of age and 448570 abortions in this same age group The abortion ratio is highest for adolescents under 15 years of age (1379 abortions/1000 live births) while the abortion rate is highest for 18-19 year olds (618/1000) When compared to adult women adolescents obtain abortions at a later gestational age--a factor that increases both the psychological and medical risks of the procedure Adolescents are also more likely than adults to base their decision regarding the pregnancy on the opinions of significant others Comparative studies have shown teenagers who continue a pregnancy to have underdeveloped conceptualizations of the future high levels of anxiety and an external locus of control Adolescents at greatest risk of psychological sequelae of abortion are those with pre-existing mental illness strong religious beliefs limited coping skills a narrow support network and abortion at later gestational stages If the teenager feels pressured by her family to terminate the pregnancy she is also at high risk for adverse psychological sequelae and a repeat pregnancy soon after abortion Thus counselors should maintain a neutral position while helping teens to examine the positive and negative aspects of their options In terms of medical effects teenagers have been shown to have the lowest risk of all age groups for abortion-related mortality However because of the later gestational age at which adolescents seek abortion there is a higher risk of complications such as endometritis Emphasis should be placed on expediting the abortion decision making process among adolescents to reduce delays and the potential risks

Psychological evaluation and support in the pediatric intensive care unit.

Abstract: This article has discussed the role of the psychological consultant in the PICU. New advances in critical care treatment have created the need for a greater awareness of psychological issues that affect the medical management of children, and the emotional impact on their families. Psychological consultation can assist in clarifying and addressing these issues by identifying and evaluating the stressors impinging on the patient, and implementing or directing appropriate interventions. This intervention may also entail assistance to the family and care providers in coping with intense and emotionally sensitive issues.