Journal of Pediatric Perspectives
Year:2018 | Volume:6 | Issue:3 (51)|Papers Count:16

A digital rectal examination is a highly important procedure carried out on infants and children during visits to the gastroenterology clinic, but is often accompanied with physiologic and psychologic trauma in patients, along with being diagnostically inaccurate in the results obtained from it. In order to avoid causing discomfort to the patients, and to improve the accuracy of the results obtained from a Digital Rectal Examination (DRE), we have articulated a much safer and more precise method of conducting the examination.The use of a 16 French Foley Catheter in the collection of stool samples during a DRE has proved to be an innovative technique, which eliminates discomfort in patients, provides a less stressful environment for both the physician and the family of the patient, along with providing unambiguous results for the Fecal Occult Blood Test (FOBT). The use of this technique will not only produce accurate results, but will also eliminate reasons to avoid such an important examination due to the uncomfortable situation a normal DRE would cause.

Dear Editor-in-Chief, Sleep disturbance is a very common finding in patients with persistent cough (1). This is especially apparent in infants with common cold or influenza and the continuous crying can lead to considerable distress for the parents. Cough syrups which are easily available as over the counter medications can induce sleep, and many parents turn to this medication when their infant is suffering from persistent cough.It has also come to attention that for many years, new mothers have been misusing cough syrup to put their hyperactive or complaining children to sleep. Since these drugs are available over the counter, parents feel complacent that these drugs have no side effects whatsoever and are safe to use in infants (2). However, numerous studies have reported infantile deaths due to cough syrup as a contributive cause as infants are more sensitive to such effects. A study conducted by Rimsza and Newberry identified ten cases of unexpected infant deaths wherein the toxicological evidence suggested recent administration of Over-the-counter (OTC) cough medication (3).The US Food and Drug Administration (FDA) does not recommend over the counter cough medications for children below the age of two years old. The side-effects of such drugs can be severely fatal in children younger than two. Pediatric experts say that cough syrup is usually given to provide temporary relief from parenting duties and feel that this practice should be considered a form of child abuse (4).Pediatricians should emphasize the dangers of cough syrup use below the age of two. Counseling regarding how to handle hyperactive children and safer alternatives to cough medicine should be suggested to solve this problem; and regarding a child’s cough a valuable and harmless alternative such as honey could be used (5).

Background: Dermatoglyphics could assist in the diagnosis of congenital abnormalities. The aim of this study was to identify the dermatoglyphic patterns (finger print pattern type, total ridge count of each finger, a-b ridge count, and articulotrochanteric distance [ATD angles]) in the parents of cystic fibrosis children.Materials and Methods: We recruited 75 parents of children with cystic fibrosis for the study group and 341 parents for the control group. We recorded finger print pattern type, total ridge count (TRC), a-b ridge count, and ATD angles of all participants. Then we identified any asymmetry between the right and left hands of each person and characteristics of parents in two genders. Chi-square analysis, Mann-Whitney U test, and Fisher's exact test were used for data analysis.Results: We observed significant differences in a-b ridge count on the right hand (P=0.02), and mean total ridge count on the right digit I (P=0.05), right digit IV (P=0.03), and right digit V in the fathers of children with cystic fibrosis compared to the control group (P=0.02).Conclusion: According to the results, we suggest that the dermatoglyphic traits of parents could be used as a simple, appropriate, and supplementary screening method in the diagnosis of children with CF. Nevertheless, we need lager studies to precisely confirm that dermatoglyphics is a reliable method in the diagnosis of CF.

Background: Considering the importance of learning health knowledge and the need to promote appropriate health attitudes, beliefs and behaviors regarding Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) among school-age people, the aim of this study was to investigate the effect of an educational program based on Health Belief Model (HBM) about HIV/AIDS.Materials and Methods: This quasi-experimental study was performed on 100 male high school students in Fasa, Iran. A sample size of 100 was determined based on the examination of similar literature with 95% confidence interval and 80% test capability. The subjects were divided into two groups of 50 subjects. After administering a pre-test to both groups, only the experimental group was trained based on the HBM constructs on the HIV/AIDS preventive behaviors. Then intervention was followed by group discussion (10-person groups) in 8 sessions each 55-60 minutes. In order to collect information based on Health Belief Model, a questionnaire consisting of 41 questions in three sections was used. Data were analyzed using SPSS version 22.0 software.Results: Educational intervention based on Health Belief Model resulted in meaningful enhancement of the subjects’ knowledge, perceived susceptibility, perceived severity, perceived benefits, and perceived self-efficacy (P<0.05). Furthermore, the students’ perceived barriers about beliefs related to HIV/AIDS preventive behaviors decreased significantly (P<0.05).Conclusion: According to the results, educational intervention has increased the HIV/AIDS prevention behavior based on Health Belief Model. Therefore, the results of this study can be used in the theory-based intervention strategies to create and modify health behaviors.

Dear Editor-in-Chief, Considerable numbers of pediatric trauma cases are referred to the emergency department following a traumatic event. The worried parents request for the most sensitive diagnostic test, so emergency physicians order for brain computed tomography (CT) scan (1, 2). The low threshold for decision making regarding the use of brain CT scan results in a huge number of normal imaging. On the other hand, radiation exposure of the child may be accompanied with numerous side effects in the future (3, 4). This calls for the question as to "how to reduce the number of unnecessary brain CT scans of traumatic pediatric patients? ". Researchers from all around the world are trying to implement different strategies to reduce the number of unnecessary brain CT scans in the pediatric population. Some surveys have been conducted focusing on better history taking, considering an observation period before decision making, and even measurement of serum biomarker levels. But it seems that implementation of validated clinical prediction rules could be very helpful in this regard. The derivation of clinical prediction rules and conducting related validation studies have been taken into account recently. In such surveys, following a prospective high power cohort study based on the clinical presentation and without any paraclinical testing, the low-risk patients were differentiated from the others. These patients were defined as those who could be omitted from further unnecessary brain CT scan. The National Institute of Clinical Excellence in 2004, the Royal College of Surgeons of England (RCS) in 2005, and the Children's Head Injury Algorithm for the Prediction of Important Clinical Events study group in 2006 formulated their guidelines in this regard so as to reduce the number of unnecessary brain CT scans in pediatric traumatic patients (5-7).However, the Pediatric Emergency Care Applied Research Network (PECAREN) study was one of the valuable studies which developed and validated two distinct clinical prediction rules for pediatric patients under and above 2 years of age in 2009. Based on the PECAREN study, "normal mental status, no scalp hematoma except frontal, no loss of consciousness or loss of consciousness for less than 5 seconds, non-severe injury mechanism, no palpable skull fracture, and acting normally according to the parents" with a negative predictive value (NPV) of 100% obviate the need for performing brain CT in children younger than 2 years. Also, "normal mental status, no loss of consciousness, no vomiting, non-severe injury mechanism, no signs of basilar skull fracture, and no severe headache" with NPV of 99.95% obviate the need for performing brain CT in children older than 2 years (8). Its validity has also been recently confirmed by Nakhjavan-Shahraki et al. (9). Osmond et al. in 2010 also derived Canadian Assessment of Tomography for Childhood Head Injury (CATCH). Based on CATCH, "failure to reach a score of 15 on the Glasgow coma scale within two hours, suspicion of open skull fracture, worsening headache and irritability" were considered as high-risk factors that have 100% sensitivity for expecting the necessity of further investigation. "Large, boggy scalp hematoma, signs of basal skull fracture, dangerous mechanism of injury" were consideredas medium-risk factors with 98.1% sensitivity for the prediction of traumatic brain injury by brain CT scan. Apparently, in the absence of these risk factors, the child can be considered as at low risk and does not require brain CT scan (10). More recently, Pediatric Traumatic Brain Injury (PTBI) Prognostic Rule has been proposed in this regard. The related investigators reported that PTBI has a sensitivity of 100% and specificity of 73% in terms of differentiating clinically important traumatic brain injury in pediatric patients with minor head trauma (11). It should be noted that the controversies regarding the most valuable clinical prediction rules are still present, and research on this topic is necessary.

Background Diagnosis of cancer in children has an adverse effect on the family. Resilience refers to the ability of humans to adapt to diseases, the pain and suffering caused by parental stresses and stressful factors in the life. The aim of this study was to investigate the effect of resilience training on the styles of coping status and parental stress of mothers whose children had leukemia.Materials and Methods At a case- control study, 60 mothers of children with leukemia were selected by available sampling method in Mohammad Kermanshahi Hospital in Kermanshah city, Iran. They were randomly assigned into two experimental groups (n=30), and control group (n=30). Connor-Davidson Resiliency Questionnaire, coping styles and parental stress form were used for data collection. The experimental group was trained nine sessions of resilience training weekly and the control group did not receive any training.Results The mean score of mothers' style of coping after the training intervention in the experimental were increased (101.93±31.42 versus 89.20+23.84), and this difference was statistically significant (P<0.05). Also the mean of parental stress score after the training intervention in the experimental group were decreased (37.41±13.12 versus 54.23+21.09), and this difference was statistically significant (p<0.05).Conclusion The results of this study showed that mothers who were trained under resilience skills, had significant progress in increasing the style of coping and reducing parental stress in comparison with mothers in control group.

Malaria is an infection sustained by three parasites namely: Plasmodium falciparum, Plasmodium vivax, and Plasmodium ovale. Plasmodium falciparum is the most common and virulent parasite. These parasites are present in different areas of the sub-Saharan African countries and Asia. In 2010, there were an estimated 219 million cases of malaria resulting in 660, 000 deaths and, approximately, two-thirds were children. In sub-Saharan African countries, maternal malaria is associated with up to 200, 000 estimated infant deaths yearly. Chloroquine was the world's widely used antimalarial drug, but Plasmodium falciparum is now increasingly resistant. However, Plasmodium ovale and Plasmodium vivax are sensitive to chloroquine. Pregnancy makes women vulnerable to malarial parasites and the risks of anemia, miscarriage, stillbirth and prematurity increase. Resistance to chloroquine is a major concern for treatment of malaria and alternative drugs are needed.Proguanil is safe, being very rarely associated with severe adverse reactions. Chloroquine, mefloquine, sulfadoxine-pyrimethamine, and amodiaquine have been found to be active against Plasmodium falciparum in-vitro. In the Cameroons, chloroquine was initially replaced by amodiaquine and artemisinin-lumefantrine was gradually introduced in 2004. Tanzania replaced chloroquine with sulphadoxine-pyrimethamine, and in 2006 artemisinin was introduced in the therapy. Pyrimethamine-sulfadoxine should be reserved as a second-line-treatment. Mefloquine may provoke severe neuropsychiatric reactions. In the treatment of Plasmodium malaria, which has a high mortality rate if untreated, a greater risk of adverse reactions to malarial drugs is acceptable. The aim of the present study is to review the published data on the treatment of malaria in infants and their mothers.

Background: We designed a cross-sectional study to determine electrocardiographic disorders in Down syndrome patients with congenitally normal hearts in a bid to predict fatal cardiac arrhythmia in the future.Materials and Methods: We investigated 60 children with DS without congenital abnormal hearts. Sixty healthy juveniles were also included in the study as a control group. Physical examination, electrocardiography, and echocardiography were performed in all subjects. Corrected QT interval (QTc) was measured according to Bazett’s formula.Results: Patients with DS consisted of 32 males (53.33%), and 28 females (46.66%), aged 6–13 (9.21 ± 6.24) years old. Healthy subjects comprised 31 males (51.66%), and 29 females (48.33%) with a mean age of 9.15 ± 5.01. The two groups were significantly different in terms of heart rate (P=0.006), maximum P-wave duration (P=0.001), and P-wave dispersion (PWd, P=0.0001). There was no statistically significant difference regarding minimum P-wave duration (P=0.176). The patients with DS had a greater maximum QTc interval, QT dispersion, and corrected QT interval dispersion (QTc-d) than the healthy control subjects (P=0.001). However, there was no difference in maximum QT interval and minimum QTc interval between the two groups (P=0.67 and P=0.553, respectively). A positive correlation was found between age, heart rate, and all electrocardiographic variables.Conclusion: All DS patients, even in the absence of concomitant congenital heart disease should be followed up carefully by electrocardiography, looking for increased PWd and QTc-d to detect predisposed cases to arrhythmia.

Background: The elimination of breakfast and the high consumption of low-value snacks are becoming more frequent and common among adolescents. Nutrition is a complex behavioral phenomenon that is associated with the specific cultural and environmental issues of each society as well as psychological features. This qualitative research was conducted to identify factors affecting breakfast consumption behavior in adolescents using the social marketing framework.Materials and Methods: A qualitative research based on the social marketing framework was conducted through directed content analysis in the high schools of Isfahan and Khorramabad, Iran, in 2016. Data were collected through seven focus group discussions and 33 in-depth, semi-structured; interviews conducted in person with both male and female students, the parents, and the teachers and were analyzed simultaneously in three phases, namely preparation, organization and reporting.Results: The results obtained in the present study within the social marketing framework were coded into the four categories of product, place, price and promotion. The product category had four subcategories, including favorite taste sought in breakfast, breakfast preparation, breakfast serving style, variety and the healthful features of breakfast. The price category had four subcategories, including time, psychological, social and financial prices. The promotion category had three subcategories, including official channels, unofficial channels, and educational materials and equipment. The place category had two subcategories, including having breakfast at school or having breakfast in an outdoor space.Conclusion: The promotion of healthy breakfast as a product, requires that first its important features be considered, including the favorite taste sought in breakfast, second that it be promoted through channels most popular with students, and most importantly, that its price be reduced by using incentives such as serving breakfast at school as an attractive place for students.

Dear Editor-in-Chief, The clinical presentation of appendicitis in the newborn is nonspecific (1). No age is free from the risk of appendicitis, and the most common findings are abdominal distension, tenderness, feeding intolerance, and fever (2). Neonates with perforated appendicitis are usually diagnosed intra-operatively (3). The diagnosis was always made after surgical exploration for acute abdominal findings mimicking necrotizing enterocolitis (4). We report the case of acute appendicitis in a newborn diagnosed intraoperatively after neonatal occlusion symptoms. We describe the case of a male born at 37 weeks of gestation by spontaneous vaginal delivery. On his 47th day of life he developed an abdominal distension and feed intolerance, after 6 hours bilious vomiting was installed with fever to 38.7 °C. Our examination showed his abdomen to be distended but soft with no signs of peritonitis. We did not find any hernias or abdominal masses. His C-reactive protein (CRP) was 56 mg/L and the white blood cell count was 7750 cells/mm3. Abdominal radio-graph demonstrated gaseous distension of bowel loops in the right lower and upper quadrants. The diagnosis of enterocolitis was suspected so he was made nil per oral, a nasogastric tube was placed, blood cultures were drawn, and he was started on intravenous triple antibiotic therapy. An ultrasound showed a medium intraperitoneal effusion with dilated bowel loops. After aggravation of the general condition and of the abdominal distension, the patient was emergently brought to the operating room for exploratory laparotomy. The exploration showed that the small and large bowel was healthy and normal in appearance. His appendix was acutely inflamed (Figure.1). An appendectomy was performed. Histology demonstrated a pathological appendix. He was discharged home at day 52 of life and was thriving at 1- year follow-up.Neonatal appendicitis is an extremely rare condition, with fewer than 50 cases reported in the last 30 years and just more than 100 over the last century (5). Approximately 50% of cases occur in premature neonates and a third of cases are initially diagnosed as an enterocolitis (2). As in our case the first diagnosis was an enterocolitis and the diagnosis of appendicitis was retained only after laparotomy. Acute appendicitis is rare in term neonates and his diagnosis continues to be a challenge witch need a high index of clinical suspicion.

Background: According to the World Health Organization (WHO), parents need to be informed about Early Childhood Development (ECD). Different methods of parents’ education include group-based, face-to-face, book, booklet, web-based, technology-based, and mobile learning using laptops, tablets, and cell phones. Paying attention to caregivers' attitudes is the first step to their education. The objectives of this study were to determine parental education requirements and the best approach towards promoting caregivers` knowledge about ECD, from the perspective of the Iranian main child caregivers.Materials and Methods: A qualitative approach with directional content analysis method was used. Participants were selected through purposive sampling. Thirty-one child-caregivers participated in 5 individual interviews and 5 focus group discussions (FGDs). Participants were parents and grandparents that had less than the 36-month child (grandchild), and kindergarten staffs. Four criteria namely: validity, transferability, reliability and verifiability were used to validate data.Results: According to the perspective of participants, two main themes were requirements for parent education (educators, educational content, time, place), and approach to educate child caregivers (mobile learning, group and face-to-face education, electronic learning, media, physical resources), totally 98 sub-themes. Finally the best approach to educate child caregivers was a multi-model approach includes group or face-to-face education with mobile learning.Conclusion: Participants suggested a multi-model approach based on traditional and modern technological methods, especially mobile learning (smartphone). They believed that the educational approach should be flexible and selectable, so caregivers can choose an appropriate individual method.

Background: Head louse (Pediculus humanus capitis) is one of the common health problems of the children in elementary schools. The aim of this study was to determine risk factors associated with head lice (Pediculosis) infestation among elementary school students in Meshkinshahr County, Northwestern Iran.Materials and Methods: This descriptive-analytic study is done over 1, 950 students (1, 055 girls and 895 boys) in Meshkinshahr County, North West of Iran that were selected two-stage cluster. Data collection was conducted using researcher-made questionnaire. In addition, the suspected cases were confirmed via physical examination for the presence of adult lice, and eggs. Head examinations were done by general physicians and medical entomologist experts. For data analysis, Chi-square and Regression Logistics tests were used.Results: In total, out of 1, 950 students of primary schools, 200 students (10.25%) were infested with pediculosis. A total of 131 (12.42%) of girls, and 69 (7.71%) of boys were head lice infested. Most of head lice infested students 145 (72.5%) were in the classrooms with capacity of more than 20 students. Also, one hundred sixty-one (80.5%) of the cases were in the schools with capacity of more than 100 students. This study revealed significant differences among student’s family size, students and their parents' history of infestation, type of bathrooms, history of use shared hygiene items and head lice infestation (P<0.05).Conclusion: The prevalence of head lice infestation in Meshkinshahr County was relatively high in comparison to other studied areas of Iran. It seems family size, students and their parents' history of infestation, type of bathrooms, and history of use shared hygiene items were probably risk factors associated with head lice infestation among students of primary schools.

Background: This study investigates the association of perceived weight status and health-related quality of life (HRQOL) in a representative sample of Iranian children and adolescents. Materials and Methods: In this study, 6-18-year-old students were selected from 30 provinces of Iran. Weight status and perceived weight status of students were determined by physical examination and using the validated questionnaire of the World Health Organization-Global school-based student health survey, respectively. The students’ HRQL was evaluated by the Persian version of the Pediatric Quality of Life inventory (PedsQLTM 4.0TM 4.0) Generic Core Scales.Results: The participants consisted of 23, 043 students with mean (standard deviation [SD]) age of 12.55 (3.31) years. Underweight was significantly less prevalent than perceived underweight (30.8%vs 10.0%, respectively, P<0.001), whereas normal weight was significantly more prevalent than perceived normal weight (70.8% vs.52.5%, respectively P<0.001). The mean total PedsQLTM score and its subscales in different categories of perceived weight did not have significant difference (P>0.05). After adjustment for age, gender, region, socio-economic status, physical activity, screen time, and body mass index (BMI), significant negative association was documented between perceived overweight and total score of HRQOL. School functioning was negatively associated with perceived overweight. Positive significant association existed between perceived overweight and psychosocial functioning.Conclusion: Our findings indicated that weight underestimation is the most common form of weight misperception in Iranian children and adolescents, which could be a cause of concern especially for obesity treatment and prevention programs. Furthermore, considering the negative association between weight overestimation and total HRQOL and school functioning, it is suggested that social standards and norms impacts on weight perception and consequently HRQOL in children and adolescents.

Background The popularity of probiotics is on the rise. Despite the beneficial effects of antibiotics, gastrointestinal health is at risk of diarrhea. This study aimed to investigate whether probiotic yogurt is of capability to prevent the incidence of diarrhea versus conventional yogurt.Materials and Methods This controlled, randomized, double-blind trial was designed to recruit 48 hospitalized children, whose treatments included different types of antibiotics. They were subsequently assigned into a 1: 1 ratio into groups A and B at random. The first group was instructed to consume probiotic yogurt (Bifidobacterium strains and Lactobacillus acidophilus), while the second were on conventional yogurt (placebo containing Streptococcus thermophiles and Lactobacillus bulgaricus) at least for 7 days. The incidence of diarrhea, its onset and duration were compared between the two groups.Results The findings indicated that there was no statistically significant difference between the experimental and control groups (p>0.05). No significant decrease was observed in the incidence of diarrhea between the groups following adjustment for negative C-reactive protein (CRP) (p>0.05).Conclusion According to the results, the consumption of yogurt, either probiotic or conventional, reduced the incidence, duration, and onset of antibiotic-associated diarrhea in pediatric population. This study showed no significantly better performance for probiotic yogurt than conventional yogurt.

Background: Postural structure abnormalities have been highly prevalent among children in primary school children. The present study aimed to assess the relationship between the backpacks weight and method of carrying with postural structure disturbances in primary school children.Materials and Methods: This cross-sectional study was performed on 472 primary school children in Karaj-Iran. Study investigators, assessed stature structure disturbances of head, neck, and spinal cord based on the New York scoring protocol. Ergonomic data of backpacks such as type of bag, weight of students' bags, the method of carrying bag, feeling pain when carrying the backpack, the mean time for carrying the backpack from school to home, was evaluated Results: In this study 97.2% of students carried backpacks as the school bags and only 1.9% carried their bags correctly. The mean time for carrying backpacks was associated with the increased risk for posture disorder including forward head (p<0.001), crookneck (p=0.006), scoliosis (p=0.006), lordosis (p=0.006), and kyphosis (p<0.001). Also, the risk for all disturbances was significantly higher in those students who carried their bags themselves than others used services. Kyphosis was significantly more prevalent in students having backpacks weighted higher than 10% of their body weight (odds ration [OR] =2.50, 95%confidence interval [CI]: 1.61-4.10, p<0.001).Conclusion: According to the results the postural structure disturbances was partially high among primary school children and were closely associated with some ergonomic parameters such as weight and type of backpack.

Background: Pleural empyema is a collection of purulent exudate between the lungs and the chest wall. Despite the importance of the disease in children, no study has investigated it in Mazandaran province, Iran. The aim of this study was to evaluate the prevalence, clinical manifestations, diagnosis, treatment and its outcome in children referring to hospitals of Mazandaran during 12 years.Materials and Methods: In this cross-sectional study, medical records of all children aged 0 to 18 years admitted to 5 educational hospitals of Mazandaran province, Iran, with Tenth Revision, Clinical Modification (ICD-10-CM) codes confirming pleural empyema or effusion from March 2004 to 2016 were identified retrospectively. The clinical records were reviewed for demographic information, hospitalization information, medications, symptoms; laboratory and medical imaging results and the patient's condition on discharge were recorded. Statistical analysis was performed by SPSS version 20.0 software.Results: Of 50 patients with the mean age of 7.08±5.6 years, 31 (62%) were boys and empyema incidence was higher (58%) in 5-18 year-old children. The mortality rate was 12% (6 patients). The most common microorganisms were Escherichia coli and Klebsiella (33.3%). In 17 (34%) patients, antipyretics were prescribed prior to admission and pre-admission treatment regimen included betalactams with or without macrolides. The most commonly prescribed drug regimens were vancomycin and beta-lactam (50%), and the most common drug resistance of microorganisms was to ampicillin, cephalexin and ceftazidime.Conclusion: Since most of the gram-negative organisms in Mazandaran hospitals were Extended-Spectrum Beta-Lactamases (ESBL) and all the microorganisms of this study were susceptible to gentamicin, it is suggested to consider it in empiric therapy of pediatric pleural empyema in Mazandaran province. Also, lower rate of surgical intervention in children who received preadmission antibiotics highlights the importance of antibiotic intervention before admission.