Listening and talking to patients. V: Communicating with children.
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Biomedical subjects
Publications and source records attributed to J Apley.
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Psychosomatic disorders are likely to be due to an interplay between biological predisposition and psychosocial stress. They are among the commonest chronic or recurrent disorders of childhood. Who gets PSD? It is commonly a family disorder, with a background of disturbed personal relationships. When? A chronology of PSD (age and disease) should be studied further. Many children do not "grow out of it". How? A biological abnormality (eg. autonomic) may underlie PSD, but pscychosocial factors are undeniably important.
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The diets of 36 children below the third centile for height but with no organic disease were compared with the diets of a control group. In most cases retarded growth was associated with a long-continued deficiency in calorie intake. When the diets were reassessed about a year later the shortfall in calorie intake was significantly reduced. This improvement, which tended to be followed by an increase in the rate of growth in height, might have been due to alteration in the child's circumstances or improvement in the family attitudes and feeding habits or both. Advice given at the clinic is thought to have played a part in bringing these changes about.
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The urinary total hydroxyproline:creatinine ratio was measured on samples collected from 18 boys and 11 girls referred to a children's hospital because of small stature. Any serious degree of growth hormone deficiency was excluded and each child's growth and development was recorded over the following year. The hypothesis that the average hydroxyproline:creatinine ratio on random urine samples may be used to predict height velocity was examined. Such a prediction would have been incorrect on 35% of occasions, and it is concluded that this investigation cannot be used reliability to predict growth in height; it is probably only useful with sequential studies of an individual child over short periods while monitoring therapy.
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The results of treatment by reassurance and explanation of 30 children with recurrent abdominal pain have been compared with those in a group of 30 children seen earlier and given no such treatment. Most of the 19 treated children who responded to treatment did so more quickly than the untreated ones, and relapse did not occur in the treated group.
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