The role of a saliva control clinic in the management of drooling

This paper describes a saliva control clinic which has been established at the Royal Children's Hospital, Melbourne. A team involving two speech pathologists, a paediatrician, a plastic surgeon and a dentist has assessed and managed 68 young people over a period of 2 years. Treatment options have included behavioural programmes, trial of oral appliances, medication and surgery. This multidisciplinary approach has been useful in developing assessment techniques and formulating recommendations.     

建立残疾儿童社区康复网络

由医疗单位为主体的残疾儿童社区网络,对智残及脑瘫患儿如何进行社区家庭康复训练受到各阶层人士的高度重视。自2003年6月起,我们在这方面进行了探索,现将有关资料总结如下。1对象与方法1.1对象所在地总共13个街道的122250名0～18岁户籍少年儿童。1.2方法由区卫生局直接领导,区所在地残联及区妇幼保健所组成残疾儿童网络领导层,并由其各自所辖的街道及地段医院组成网络成员,见表1。参加调查的相关人员先集中进行筛查和诊断方法的应用培训,然后于2003年6月1日～30日对13个街道户籍儿童逐一入户调查,调查表由残联和妇幼保健所统一制定。残疾的…     

Studies on nutrition in severely neurologically disabled children in an institution

Severe neurological handicaps in children are frequently accompanied by growth retardation. We have studied 13 severely neurologically impaired children in an institution to see if their poor growth was related to a low intake of energy and nutrients, if this was reflected in biochemical nutritional parameters, and to modify their diet according to the results. The investigation showed low dietary intakes of energy and of several of the nutrients, with corresponding low Hb values and serum values of ferritin, selenium and vitamins E and D in some of the children. All the children were initially light for age, with catch-up growth after intervention. We conclude that severely disabled children are at high risk for under- and malnutrition, and that this may partly explain the growth retardation in the study group. To avoid the potential detrimental effects of malnutrition, it is important to aim at providing an optimal diet.     

Dietary fibre intake and constipation in children with severe developmental disabilities

OBJECTIVE: Constipation is a common problem in children with severe developmental disabilities (DD). This study aimed to evaluate fibre intake of severe DD children living in a residential institution, and the possibility of reducing the use of laxatives by increasing their fibre intake. METHODOLOGY: A baseline study was performed to evaluate the fibre and macronutrient intake in a group of severe DD children. Nutrients including fibre for a standard serving in each meal were calculated and daily macronutrients and fibre intake were estimated. An intervention study was then carried out to evaluate whether increasing fibre intake could relieve constipation. A total of 20 children aged between 3 and 17 years were assessed over a 4-month period. In a residential unit for severe DD children, laxatives were routinely prescribed if there was no spontaneous bowel motion for two consecutive days. Fibre intake was increased in stages by adding All-Bran(R) (Kellogg Company, Battle Creek, MI, USA) and desserts. The mean number of laxative usage per week per child in the different stages were then compared. RESULTS: The baseline fibre intake was found to be approximately 2 g/day. The mean number of laxatives required per week per child decreased significantly from a baseline value of 1.22 (about 5 laxatives/month) (standard deviation (SD) = 0.36)) to 0.90 (about 3. 5 laxatives/month) (SD = 0.75) in the first stage, and 0.71 (about 3 laxatives/month) (SD = 0.40) in the second stage. Using paired t-test, the difference was statistically significant when compared with the baseline: P < 0.05 for the first, and P < 0.01 for the second stage of fibre supplementation. CONCLUSION: Very low daily intake of fibre of 2 g/day was documented. Relief of constipation and a significant reduction in the usage of laxatives was demonstrated by increasing fibre intake to 17 g/day (stage 1). Increasing fibre intake further to 21 g/day (stage 2), showed a further reduction in the use of laxatives. There was, however, no statistical significance between stage 1 and stage 2 of fibre supplementation. Alternative ways to further relieve constipation in severe DD children require further studies.     

儿童厌食和睡眠障碍共病的初步探讨

目的 了解儿童厌食和睡眠障碍的相关影响因素,为早期干预提供依据.方法 以兰州市二城区三所幼儿园和三所小学2～12岁儿童为调查对象,向家长发放调查问卷,内容包括母亲孕期、出生、喂养和睡眠情况及父母一般情况等,共发放问卷1 800份,收回有效问卷1 560份,回收率86.7%.结果 调查儿童中厌食375人,发生率为23.9%,其中48%同时合并睡眠障碍;睡眠障碍儿童330人,其中54.5%合并有厌食;厌食合并睡眠障碍儿童180人,发生率为11.5%.两者的发生主要与母亲孕期的睡眠、心情、饮食、生产情况,辅食的添加时间,饮食习惯等有密切关系.结论 厌食和睡眠障碍的发生密切相关,儿童期的厌食和睡眠障碍与母亲孕期、围生期因素及早期的喂养有关,提示早期干预的必要性.     

Feeding Problems, Height and Weight in Different Groups of Disabled Children

ABSTRACT. Two hundred and twenty-one disabled children from seven diagnostic groups have been examined with respect to height, weight and prevalence of four different feeding problems. Retarded growth and feeding problems were common in children with cerebral palsy, mental retardation, congenital heart disease and deaf-blindness, but rare in children with esophagus atresia, cystic fibrosis and epilepsy. Mean relative height and weight were significantly lower ( p ≪.01) in children with mechanical feeding problems, such as impairment of self-feeding skills and oral-motor dysfunction, than in children without these problems, regardless of diagnostic group. Mean relative weight was also significantly lower in children with poor appetite than in children with good appetite. Feeding problems contribute to short stature and underweight in severely disabled children.     

儿童真两性畸形诊断与治疗:附9例报告

目的 探讨儿童真两性畸形的诊断、合理的性别选择及恰当的治疗方式。方法 回顾性分析1994年至2002年9例儿童真两性畸性的临床资料。结果 社会性别：男6例,女3例;染色体组型：46XX4例,46XY1例,45XO1例,45XO／46XY嵌合型3例。性腺畸形为：双侧型2例,单侧型3例,片侧型4例。按男性抚育者,行卵巢组织及子宫附件切除,睾丸固定,同期或二期尿道下裂修复;按女性抚育者,切除睾丸组织或卵睾,同期行阴蒂会阴成形术。近期2例用腹腔镜行盆腔探查和性腺切除。5例获得6个月～3年的随访。结论 早期诊断、根据外生殖器及性腺优势作出合理的性别选择至关重要,儿童期应完成对与确定性别相抵触性腺的切除和外生殖器矫形,腹腔镜在诊断与治疗上有很好的价值。     

Treatment of sialorrhea with glycopyrrolate: A double-blind, dose-ranging study

OBJECTIVE: To determine the safety and efficacy of glycopyrrolate in the treatment of developmentally disabled children with sialorrhea. DESIGN: Placebo-controlled, double-blind, crossover dose-ranging study. SETTING: Outpatient facilities in 2 pediatric hospitals. PATIENTS: Thirty-nine children with both developmental disabilities and excessive and bothersome sialorrhea. MAIN OUTCOME MEASURES: Parent and investigator evaluation of change in sialorrhea and adverse effects. RESULTS: Glycopyrrolate in doses of 0.10 mg/kg per dose is effective at controlling sialorrhea. Even at low doses, 20% of children may exhibit adverse effects severe enough to require discontinuation. CONCLUSIONS: Glycopyrrolate is effective in the control of excessive sialorrhea in children with developmental disabilities. Approximately 20% of children given glycopyrrolate may experience substantial adverse effects, enough to require discontinuation of medication. Arch Pediatr Adolesc Med. 2000;154:1214-1218.     

小儿亲体部分肝移植治疗肝母细胞瘤(附1例报告)

目的探讨小儿部分亲体肝移植治疗肝母细胞瘤的临床经验。方法对1例患肝母细胞瘤的4岁男童实施母亲供肝,左外肝叶亲体部分肝移植。结果供体于术后7d痊愈出院,受体于术后22d出院,无并发症。随访24个月,小儿生长发育良好,正常上学,无特殊不适。结论实施小儿亲体部分肝移植扩大了供肝来源,临床疗效好,可作为治疗肝母细胞瘤等小儿终末期肝病的有效治疗方法。     

Pain management in the critically ill child

Children frequently received no treatment, or inadequate treatment, for pain and for painful procedures. The newborn and critically ill children are especially vulnerable to no treatment or under-treatment. Nerve pathways essential for the transmission and perception of pain are present and functioning by 24 weeks of gestation. The failure to provide analgesia for pain results in rewiring the nerve pathways responsible for pain transmission in the dorsal horn of the spinal cord and results in increased pain perception for future painful results. Many children would withdraw or deny their pain in an attempt to avoid yet another terrifying and painful experiences, such as the intramuscular injections. Societal fears of opioid addiction and lack of advocacy are also causal factors in the under-treatment of pediatric pain. False beliefs about addictions and proper use of acetaminophen and other analgesics resulted in the failure to provide analgesia to children. All children even the newborn and critically ill require analgesia for pain and painful procedures. Unbelieved pain interferes with sleep, leads to fatigue and a sense of helplessness, and may result in increased morbidity or mortality.     

儿童哮喘综合治疗管理与心理影响研究

对60例哮喘患儿采用WHO全球哮喘防治策略,使用持续倍氯米松加间断沙本胺醇吸入治疗、峰流速仪肺功能监测、检测及避免触发因素、社会教育管理、心理干预等综合疗法,跟踪观察1年。结果显示：总有效率为98.3%,住院率、急诊率,因病缺课率均下降,患儿和家长对治疗疾病信心增强,心理障碍改善。学习成绩进步,生活质量提高。     

Disclosure of developmental disability: a study of parent satisfaction and the determinants of satisfaction

OBJECTIVE: To investigate the level of parent satisfaction with the first communication of a diagnosis of developmental disability in their child ('disclosure') and the determinants of this satisfaction. METHODOLOGY: Interviews with parents of children with developmental disabilities regarding their experiences at the time of disclosure and their level of satisfaction with the process were carried out. RESULTS: Parent satisfaction with disclosure overall was found to be high (82.6%). Parents were more likely to be satisfied if they received a large amount of information. Parent satisfaction was found to be higher when the disclosing professional communicates well with the parents, has an understanding of parental concerns, and is direct in manner. Having both parents, the child or support people present were not found to have any significant relationship to parent satisfaction. CONCLUSIONS: The high level of satisfaction with disclosure in this study supports the claim made by earlier researchers that parental dissatisfaction with the disclosure process is not inevitable. The major determinants of parental satisfaction with disclosure are directness, understanding of parental concerns and good communication on the part of the disclosing professional, and receiving a large amount of information.     

Subureteric Polytef injection in the management of vesico-ureteric reflux in children

Subureteric Polytef injection is one of the alternatives now available for the management of vesico-ureteric reflux in children. The results of the treatment by one surgeon, over a 2 year period, were studied prospectively in 47 children (60 refluxing units). Following a single injection, reflux was abolished in 49 (82%) ureters and of the 11 failures, 10 ureters showed a reduction of the grade of reflux while one remained unchanged. A repeat injection was performed in nine of these ureters with success in five, persistence in two, and two children are awaiting a follow-up cystogram. The conservative success, with the addition of a second injection, was 90% (54/60). Of the four with unresolved reflux, two have low grade reflux and are free of infection, and two have had a ureteric reimplant, one of which was after a single injection, at the request of the parents. There were no instances of ureteric obstruction. These results show a viable, minimally invasive alternative to open ureteric reimplantation in the management of vesico-ureteric reflux in children.     

Guideline statements on the management of procedure-related pain in neonates, children and adolescents

This annotation discusses the process of writing guidelines on procedure-related pain management by a diverse group of paediatricians and a consumer. It examines possible reasons for the huge gap between evidence and clinical practice and recommends that all health professionals look at their own experiences of pain growing up.     

支气管镜在儿童气管食管瘘全程手术管理中的应用研究

目的 探讨支气管镜在儿童气管食管瘘术前、术中和术后的临床应用价值.方法 对14例疑似气管食管瘘患儿(其中1例支气管食管瘘)尝试应用支气管镜进行手术全程管理.结果 术前对4例患儿应用支气管镜检查明确诊断为气管食管瘘;运用相同方法确诊1例患儿为气管窦道,排除了气管食管瘘;利用支气管镜引导下气管插管技术,成功封堵1例因误食烧碱造成左主支气管-食管瘘.在术中应用"支气管镜透射照明"法和"导丝环"法精确定位3例气管食管瘘,减少了手术创伤和探查瘘管的时间.在术后应用支气管镜发现2例气管食管瘘复发和2例存在气管软化;支气管镜还充当了一次"超细胃镜",将导丝引入食道,然后进行食管狭窄的球囊扩张.结论 支气管镜在儿童气管食管瘘诊治中有很大的临床应用价值,可应用于气管食管瘘的全程管理.