Psychosocial adjustment and physical health of children living with maternal chronic pain

AIM: There is limited research examining the functioning of children living with parental chronic pain and illness. The aim of this study was to examine the psychosocial adjustment and physical health of children living with a mother experiencing chronic pain. METHODS: One-hundred and three children aged 6-12 years served as participants, with approximately equal numbers of children in maternal chronic pain (n=55) and control groups (n=48). Children completed self-reports about their internalising behaviour, health and attachment security. Mothers, fathers and teachers completed questionnaires relating to children's internalising and externalising behaviour, social behaviour and physical health. RESULTS: Reports from children, mothers and fathers indicated significantly more internalising, externalising, insecure attachment and social and health problems for children in the maternal chronic pain group compared with control children. Teachers reported decreased social skills and increased pain complaints for children in the maternal chronic pain group. Boys in the maternal chronic pain group appear to be affected more than girls. Boys reported more anxiety and insecure attachment, while mothers reported greater social problems and increased illness behaviour for boys. Characteristics of the mother's pain condition, such as, severity, length and frequency were generally unrelated to child functioning. CONCLUSIONS: The study demonstrates the importance of maternal and family variables to child outcomes. The results are discussed in terms of maternal chronic pain comprising a considerable, yet rarely studied, influence in the lives of young children.     

Mental Health and Psychosocial Functioning in Children with Recent Onset of Rheumatic Disease

Mental health was evaluated early in the course of juvenile rheumatic disease; 106 parents of children (aged 1-17 yrs) were interviewed and 98 of the children were assessed when the child was hospitalized. Instruments included the Child Assessment Schedule (CAS), the Children's Global Assessment Scale (CGAS) and the Child Behavior Checklist (CBCL). Half the patients received a psychiatric diagnosis; psychosocial dysfunction of at least mild severity was found in 64% of the patients. In the polyarthritic group there was a negative correlation between CGAS and severity of disease. CBCL behaviour scores did not differentiate between patients and siblings when corrected for somatic components.     

Prevalence of recurrent complaints of pain among Greek schoolchildren and associated factors: a population-based study

AIM: To determine the prevalence of recurrent complaints of pain (RCP) in Greek children, and to examine associations with socio-demographic characteristics and psychosocial factors. METHODS: Cross-sectional study comprising a nationally representative population of 8130 7-y-old Greek schoolchildren. Data were collected by mailed questionnaires (response rate 89%). RCP was defined as present if at least one of the complaints of headache, abdominal pain or limb pain occurred at least once a week. RESULTS: The RCP prevalence rate was 7.2%, with significant gender differences (8.8% of girls, 5.7% of boys; p<0.001). RCP was significantly positively associated with a chronic health problem among the children, frequent change of residence, poor school performance, often watching TV and rarely playing with other children. There were no statistically significant associations of RCP with family structure and socio-economic status. CONCLUSION: The results are indicative of the prevalence of RCP in Greek schoolchildren. This study enlightens the psychosocial component of RCP and emphasizes the importance of gathering information on children's social background in medical settings.     

Female adolescent rheumatological presentations: The importance of chronic pain syndromes

Abstract The clinical features of 60 female adolescents (mean age 15 ± 0.3 years) presenting consecutively to a rheumatologist are reviewed. Thirty-five per cent met criteria for well-defined chronic pain syndromes, 19 having fibrositis syndrome and two having a reflex sympathetic dystrophy syndrome. Other diagnoses were inflammatory arthritis (30%), anterior knee pain syndromes (13.3%), tendinitis (8.3%) and miscellaneous conditions (13.3%). The high prevalence of chronic pain syndromes in this patient group is highlighted and an approach to management is suggested.     

US findings of metacarpophalangeal joints in children with idiopathic juvenile arthritis

Background Juvenile idiopathic arthritis (JIA) is the most common cause of chronic arthritis in children, with frequent involvement of the metacarpophalangeal joints (MCPJ). Objective To compare US findings with those of radiography and clinical examination. Materials and methods All MCPJs in 20 children with JIA (17 females, median age 9.7 years, range 3.6 to 16.8 years) were evaluated clinically and imaged with gray-scale and color Doppler US, and 90 MCPJs were also imaged radiographically. Each MCPJ was graded on physical examination from 0 (normal) to 4 (severe) by the patient’s rheumatologist. Results US demonstrated abnormalities in 64 of 200 MCPJs (32.0%), including pannus vascularity and/or tenosynovitis in 55 joints (27.5%) (pannus vascularity in 43, tenosynovitis in 40) and bone destruction in 25 joints (12.5%). Overall, US abnormalities and physical examination scores were significantly associated (P < 0.001). However, interobserver agreement between US and clinical evaluation was poor (kappa 0.1) and between US and radiography was only fair (kappa 0.4). Conclusion US of the MCPJ in children with JIA can demonstrate cartilage thinning, bone erosions, and pannus vascularity. Abnormal US findings are significantly correlated with severity of disease as evaluated clinically.     

Motilin in children with recurrent abdominal pain: a controlled study

Fjord Christensen M. Motilin in children with recurrent abdominal pain: a controlled study. Aeta Pædiatr 1994;83:542–4. Stockholm. ISSN 0803–5253
The aim of this study was to compare serum motilin levels in children with and without recurrent abdominal pain, based on the assumption that recurrent abdominal pain in children is a gut motility disorder. In this controlled study, 19 children between 6 and 15 years or age with recurrent non-organic abdominal pain and 20 control children between 6 and 15 years of age without abdominal pain or other functional somatic complaints were evaluated. No slatistical significant difference was found in serum motilin levels between children with and without abdominal pain. Median difference between the groups was II pmol/1 (95% confidence limits of median difference -9 to +33). This investigation could not support the assumption that motilin might be a pathogenic factor in children with recurrent abdominal pain. It is suggested, however, that future research should compare serum motilin levels during and between attacks of pain.     

Knee pain in children

Knee pain is common in children, particular during adolescence. A detailed history and clinical examination often will identify the likely cause. Health care professionals looking after children and young people should be aware of the common causes of knee pain and red flags which are a feature of more sinister causes. Common causes of knee pain include patellofemoral problems, apophysitis such as Osgood Schlatter's disease and Sinding-Larsen-Johansson Syndrome, osteochondritis dissecans, trauma, rheumatological causes such as juvenile idiopathic arthritis, and infective causes as such septic arthritis and osteomyelitis. Malignancy must be excluded when there are red flag signs. Non-accidental injury and referred pain from the hip if not considered, can be easily missed. This review offers practical advice regarding the assessment of knee pain.     

Upper endoscopic findings in children with active juvenile chronic arthritis

Aim: To investigate the association between gastroduodenal mucosal damage and symptoms of the digestive tract in children with juvenile chronic arthritis (JCA) Methods: This was a prospective, open, non-randomized study. Gastroscopy was performed on 45 children with active JCA in 1996-2000. Gastrointestinal symptoms before and during the treatment were noted, as was the length of antirheumatic medication, for which the data were retrospectively assessed. Plasma haemoglobin (Hb) and mean corpuscular volume (MCV) levels and erythrocyte sedimentation rate (ESR) were analysed. Mucosal biopsies were obtained for histology and Helicobacter pylori culture. All patients were taking non-steroidal anti-inflammatory drugs (NSAIDs) and 11 (24.4%) were on peroral steroids; 16 (35.6%) were receiving hydorxychloroquine, 9 salazopyrine, 5 myocrisine and 14 methotrexate. Results: Seven children (15.6%) were found to have active inflammation in their gastric and/or duodenal mucosa, two having ulcers and two being infected with H. pylori. Abnormal endoscopic findings were more common in symptomatic children (n = 24) than in children without symptoms (n = 21) (75% vs 38%, p = 0.017). There was no clear association between the Hb or MCV level and the degree of gastroduodenal inflammation (p = 0.98 and 0.7, respectively). Significantly more children (66.6% vs 33.3%) experienced abdominal pain after beginning medical therapy than before therapy (p = 0.02).

Conclusion: Endoscopic evaluation of patients with JCA and receiving NSAIDs should be considered at least in symptomatic cases.     

Severe mental retardation in 2 to 24-month-old children in Lahore, Pakistan: a prospective cohort study

Severe mental retardation (developmental quotient (DQ) < 50) was investigated in 1303 children from 2 to 24 months of age, born during 1984-87 in four population groups representing different socioeconomic levels in and around Lahore, Pakistan. The incidence per 1000 live births was 22 in the periurban slum, 9 in the urban slum, 7 in the village and 4 in the upper middle class group. The aetiology was prenatal in 79%, perinatal in 14% and untraceable in 7% of cases. Down's syndrome was the most common cause of severe mental retardation (36%). Impairments were studied at 2 years of age. Impairment of language was present in all, while locomotor dysfunction was seen in 89% of cases. Epilepsy and cerebral palsy were each present in 22% of cases. Mortality among these severely mentally retarded children was 36%.     

幼年特发性关节炎患儿肾脏受累的观察

目的 观察幼年特发性关节炎(JIA)患儿肾脏受累的特点以及与临床分型、病程、用药之间的关系.方法 回顾性分析60例JIA患儿的临床表现,并进行血沉、C反应蛋白、类风湿因子、血生化、免疫球蛋白、补体、抗核抗体、尿常规、尿系列蛋白等辅助检查.其中2例患儿接受肾穿刺活检.结果 17例(28.3%)患儿出现尿常规异常,依次为全身型7例(7/18,占38.9%)、多关节型6例(6/22,占27.3%)、少关节型4例(4/20,占20.0%).表现为孤立性血尿和(或)蛋白尿,其中1例全身型患儿合并肾小管损害,另有5例(8.3%)伴血清尿素氮增高.肾脏受累的JIA患儿中病程<1个月者12例(70.6%),初发未用药和短期(<2周)口服非甾体抗炎药者10例(58.8%).结论 血尿、蛋白尿是JIA患儿肾脏累及最常见的临床表现,以全身型较多见,其中原发疾病所致肾损害可能性较大.随访尿常规和肾功能,积极治疗原发病,将有助于减少肾脏病变的发生.     

Macrophage activation syndrome in 13 children with systemic-onset juvenile idiopathic arthritis

Background  Macrophage activation syndrome (MAS) is a severe, potentially life-threatening condition induced by chronic rheumatic diseases, especially systemic-onset juvenile idiopathic arthritis (SoJIA) in childhood. This study aimed to analyze the clinical and laboratory characteristics of systemic-onset juvenile idiopathic arthritis (SoJIA) with macrophage activation syndrome (MAS) in 13 patients. Methods  Clinical and laboratory data of 13 SoJIA patients with MAS treated in our hospital from January 2003 to October 2007 were analyzed. Results  In the 13 patients, 9 were boys and 4 girls aged from 5 months to 12 years. Clinical manifestations were of no typical characteristics including persistent fever, anemia, arthritis, hepatosplenomegaly, lymph-adenopathy, dysfunction of the liver, abnormal fat metabolism, and hemophagocytic cells in the bone marrow. Two patients experienced acute respiratory distress syndrome, two had mutiorgan failure, and three died. The perforin A91V (NCBI:SNP rs35947132) gene in 6 patients was normal. Glucocorticoid and immunoimpressive therapy were effective in all patients and plasmapheresis used in one severe patient was also effective. Conclusions  MAS is a serious complication of JIA, especially systemic-onset juvenile idiopathic arthritis. It is essentially important to recognize and treat MAS earlier in order to lower the mortality.     

磁共振成像对初诊为幼年特发性关节炎的急性淋巴细胞白血病的诊断价值

目的 探讨磁共振成像(MRI)对临床初诊为幼年特发性关节炎(JIA)的急性淋巴细胞白血病(ALL)患儿的诊断价值.方法 回顾性分析2018年1月—2020年12月以下肢疼痛为首发症状且临床初诊为JIA,但最终经骨髓检查确诊为ALL患儿(病例组)的临床资料.将同时期确诊的JIA患儿作为对照组.所有患儿均在就诊初期(未进行...     

新发活动期全身型幼年特发性关节炎血清细胞因子水平分析

目的 分析新发活动期全身型幼年特发性关节炎(SJIA)患儿血清细胞因子水平,探讨细胞因子在其发生发展中的作用.方法 采用流式细胞术检测2010年1月至2013年12月新发活动期74例SJIA患儿血清白介素(IL)-2、-4、-6、-10、肿瘤坏死因子(TNF)和γ-干扰素(IFN-γ)水平,202例健康体检儿童为对照组;并同时检测患儿白细胞、中性粒细胞、血红蛋白、血小板、超敏C反应蛋白和血沉等常规实验室指标.结果 74例SJIA患儿的白细胞、中性粒细胞比例、超敏C反应蛋白和血沉等均明显高于正常范围,血小板在正常范围,血红蛋白水平低于正常范围.与健康对照相比,SJIA组患儿血清IL-6明显升高(PPP>0.05).SJIA患儿IL-6水平明显升高,血红蛋白明显降低,两者呈负相关(r=-0.244,P结论 SJIA患儿血清IL-6水平明显升高,且与贫血呈负相关.     

CPIPS: musculoskeletal and hip surveillance for children with cerebral palsy

CPIPS (Cerebral Palsy Integrated Pathway Scotland) provides access for all children with cerebral palsy (CP) aged between 2 and 16 years in Scotland for a standardized musculoskeletal examination of the spine and lower limbs by paediatric physiotherapists. Children with more severe CP are at risk of developing a displaced hip joint which can become painful and interfere with seating and daily activities. Therefore all children also receive regular X-rays of their hips based on their age and severity of CP. CPIPS has been universally accepted and approved by the children, parents, carers and clinicians alike. It provides useful data on epidemiology, hip subluxation, physiotherapy participation and orthotic use as well as much more. It is already producing a significant improvement in hip displacement rates in Scotland. CPIPS has also greatly improved communication between community based care and hospital services. It is now fully embedded in the day to day care of these vulnerable children in Scotland and is now deemed essential in improving and maintaining their musculoskeletal health.     

Japanese clinical guidelines for chronic pain in children and adolescents

Chronic pain is a common problem in pediatric practice. The prevalence of chronic pain in children is >30%. Because pain indicates emotional expression as well as the physiological reaction toward infection, injury, and inflammation, both physiological and psychological assessments are essential to determine primary interventions for chronic pain. The Japanese Society of Psychosomatic Pediatrics Task Force of clinical practice guidelines for chronic pain in children and adolescents compiled clinical evidence and opinions of specialists associated with the primary care of pediatric chronic pain in the Japanese ‘clinical guidelines for chronic pain in children and adolescents’ in 2009, which are presented herein. The guidelines consist of three domains: general introduction to chronic pain; chronic abdominal pain; and chronic headache. Each section contains information on the physiological mechanism, psychological aspects, assessment methods, and primary interventions for pediatric chronic pain. These guidelines are expected to help disseminate knowledge on primary interventions for chronic pain in children and adolescents.     

Chest pain in children referred to a cardiology clinic

One hundred consecutive patients (54 girls, 46 boys) referred to a pediatric cardiology department with the primary complaint of chest pain were evaluated. The age distribution was 2.5–16.0 years (mean 11.3 years for girls and 9.9 years for boys). The history showed 17% of patients with chest pain, 22% with heart disease, and 19% with recent death in the family. The time course of the pain was longer than 1 week in 92 patients. Localization was on the left precordium in 60 patients, and there was no radiation from the original site in 66 cases. Ninety-two percent of cases were idiopathic in origin. Of the 74 patients who had a psychiatric interview, 55 (74%) had psychiatric symptoms and 5 required psychiatric care. Anxiety, conversion disorder, and depression were the main psychiatric symptoms.