Symptoms and spontaneous passage of esophageal coins.
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Child, Preschool↗
Biomedical subjects
B D Schmitt
Publications and source records attributed to B D Schmitt.
Behavioral aspects of temperature-taking.
Ear thermometry addresses two basic psychological aspects of fevers. The first one is obvious: the battle of the rectal temperature can be eliminated by ear thermometry. The second one addresses the overtreatment of tactile fevers. Tactile temperature taken by feeling the forehead occurs in 50% to 90% of homes. Half of warm foreheads occur in afebrile children who are warm because they're releasing heat generated by a recent activity or bath. If an actual temperature were measured, these children wouldn't be mislabeled as having fever and unnecessarily treated.
Age Factors↗
Evaluating persistent sleeplessness in children.
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Animals↗
Nonorganic failure to thrive: an outpatient approach.
This article reviews our experience, as well as the medical literature, regarding the treatment of failure to thrive (FTT) on an outpatient basis. Nonorganic FTT can be accidental, neglectful, or deliberate. Accidental FTT occurs with errors in formula preparation, diet selection, or feeding technique. These errors can usually be corrected by education and demonstration. Deliberate underfeeding is rare, and these children usually require placement in foster care. Neglectful FTT usually occurs because the mother is overwhelmed or psychologically disturbed. Children with neglectful FTT do not automatically require hospitalization. If the degree of FTT is mild to moderate, the mother-child interaction is positive, the mother is not severely disturbed, and the baby has no inflicted injuries or deprivational behavior, the baby can be safely and more economically managed as an outpatient. Management includes new feeding instructions, a stimulation program, social work intervention, home visits by a public health nurse, and weekly weight checks. Most infants respond to this one-month therapeutic trial with an appropriate weight gain. Even after normal weight is attained, many of these families require long-term follow-up to help them deal with multiple psychosocial issues.
Ambulatory Care↗
Thumb sucking: pediatricians' guidelines.
Thumb sucking is a common, generally harmless child behavior whose persistent practice occasionally leads to dental, dermatological, orthopedic, and psychological problems. When to treat thumb sucking should be determined by risk potential. With a few rare exceptions (e.g., hair pulling), thumb sucking related problems do not occur until after the age of four years and therefore, treatment is rarely necessary before then. Even after this age, treatment is not recommended unless physical and/or emotional sequelae are imminent or a thumb sucking child requests help in quitting. Thus, in most cases parents should be instructed to ignore thumb sucking. When intervention is necessary, it should be preceded by a 1-month moratorium on parental attention. Treatment should include a combination of monitoring with charts, incentives for successful days and various external cues to remind the child who forgets.
Adolescent↗
Seven deadly sins of childhood: advising parents about difficult developmental phases.
Seven of the more difficult developmental phases for any parent to deal with are colic, awakening at night, separation anxiety, normal exploratory behavior, normal negativism, normal poor appetite, and toilet training resistance. For the child living in a high-risk family, these innocent acts can trigger dangerous or even deadly abuse. The two behaviors most commonly associated with fatal abuse are colic and toilet training. When we recognize a child who is going through a provocative phase, we should be prepared to advise the parents on some practical alternatives to a physical response. Such advice is welcomed by most types of families. Any treatment plan for an abusive family that fails to include this type of problem solving may be inadequate.
Anxiety, Separation↗
The prevention of sleep problems and colic.
The pediatrician can prevent or improve most sleep problems. Colicky babies need holding and cuddling. All babies should be placed in their cribs when sleepy but awake. Trained night feeding can be prevented by stretching out the daytime feeding intervals and making middle-of-the-night feedings "brief and boring." Trained night crying can be prevented by not providing any entertainment or lifting the infant out of the crib during the night. Fearful night crying can be prevented by eliminating the source of fears when possible and providing extra holding and reassurance during the day for fears.
Colic↗
Colic: excessive crying in newborns.
The pediatrician is commonly called upon to evaluate and manage the crying newborn. While most of these infants have colic, organic causes of crying must be carefully considered. The role of crying in precipitating child abuse also requires special vigilance on the physician's part. Colicky babies respond most effectively to physical contact and gentle motion. Other approaches, such as changing formulas or drugs, are unnecessary and potentially dangerous. Preventive measures for colic are addressed in steps one through four of the article "The Prevention of Sleep Problems" in this volume.
Child Abuse↗
The prevention of sleep problems.
The author offers guidelines that will help parents with the prevention of colic, trained night feeding, trained night crying, fearful night crying, bedtime temper tantrums, and bed-sharing. The information is presented chronologically by the visit at which it should be addressed.
Child, Preschool↗
Preschoolers who refuse to be examined. Fearful or spoiled?
Twenty-two children (aged 2 to 5 years) who cried excessively or resisted physical examination during routine office visits initially seemed to be afraid of physicians, but eight were afraid of medical procedures, five had prolonged separation anxiety, six were manipulative, and three were afraid of men because of previous physical abuse by their fathers. Management plans were initiated for each etiological subtype. Five of eight parents whose children were afraid of medical procedures and five of six parents whose children were manipulative returned for counseling. In these cases, 100% (8/8) and 80% (4/5) of the children, respectively, made major improvement. Abused children required referral to mental health centers. Most parents of children with prolonged separation anxiety (three of five) did not consider the overdependent behavior to be a problem and therefore did not comply with treatment recommendations.
Anxiety, Separation↗
Telephone encounters in a university pediatric group practice. A 2-year analysis of after-hour calls.
The records of off-hours calls received by the University of Colorado Pediatric Group Practice from 4:30 p.m. throughout 8:00 a.m. weekdays and all day Saturday, Sunday, and holidays were audited. An answering service and pageboy system ensured 24-hour, 7-day-a-week accessibility through a single telephone number. The four practices received 2386 after-hours calls from November 1978 to October 1980. An average of 104 calls per month were received with approximately four calls per day on weekday evenings and six calls per day on Saturday, Sunday, and holidays. Five concerns accounted for 49 percent of all after hours calls: fever, vomiting and/or diarrhea, upper respiratory infection (URI), earache, and rash. While 75 percent of families made fewer than four calls per year, 4 percent made at least 12 calls per year, accounting for 18 percent of all calls. Families calling three or more times a month were defined as "frequent users" and accounted for 22 percent of a given month's calls. Most calls from the same families (55%) occurred within a 24-hour period and dealt chiefly with parental concerns about fever, vomiting and diarrhea, URIs, ear infection, accident, and rashes. The additional responsibility that residents assume in taking calls for the Pediatric Group Practice while on other off-hour assignments was not excessively demanding, and cost of the answering service was easily absorbed by group practice revenues.
Colorado↗
Fever in childhood.
Fever is one of the commonest reasons for seeking pediatric care. Many parents have unrealistic fears regarding fever. Many physicians treat fevers vigorously to relieve these concerns. Parent education in the following areas may be helpful: a definition of fever, including diurnal variation; a demonstration of how to take axillary, rectal, and oral temperatures; guidelines for retaking the temperature in febrile children; a reminder that fevers can be helpful in fighting infections; clarification that fever by itself is rarely harmful below 41.7 degrees C; recommendations for when to use antipyretics, including clarification of appropriate dosages; recommendations for sponging; and guidelines for when to call the child's physician, with an emphasis on observation of the child rather than the level of fever. If parents are instructed about fever, inappropriate telephone calls, unnecessary office visits, and the giving of antipyretics to afebrile children can be reduced.
Anti-Inflammatory Agents, Non-Steroidal↗
Nocturnal enuresis.
The plethora of treatments for enuresis points to the shortcomings of each of them. While no single approach is consistently successful, some modalities are superior for particular age groups. This article compares the benefits and risks of motivational counseling, bladder exercises, self-awakening programs, enuresis alarms, and medications.
Adolescent↗
Encopresis.
Retentive (impacted) and nonretentive encopresis should be separated because the treatment for each type is radically different. The rectal examination is the definitive test. Children with retentive encopresis need enemas, stool softeners, and mandatory sitting on the toilet; children with nonretentive soiling usually respond to behavioral management.
Child↗
The family physician's role in school health.
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Affective Symptoms↗
Daytime wetting (diurnal enuresis).
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Child↗