Some unresolved issues in paediatric rehabilitation.
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Australia↗
Biomedical subjects
R K Oates
Publications and source records attributed to R K Oates.
Congenital syphilis has not disappeared.
Thirty-three cases of congenital syphilis that were seen at The Children's Hospital, Camperdown, over a 34-year period were reviewed. Twenty-nine cases were examples of early congenital syphilis, as the patients developed clinical features in the first two years of life, and the other four cases were examples of late congenital syphilis, with the clinical features developing between two years and nine months of age and 10 years of age. Twenty-five patients were symptomatic at the time of admission to hospital. The most common clinical feature on the patient's presentation to hospital was a maculopapular or vesiculobullous skin eruption which occurred in 13 of the infants. Hepatic and splenic enlargement were present in 12 cases, and nine children had the "snuffles". Five of the children died. Patient follow-up occurred in fewer than 40% of cases and three of the children who were followed-up suffer from developmental delay. Congenital syphilis can occur in all social groups but is most common in infants who are premature or are small for gestational age and are born to young, unmarried mothers of low socioeconomic status. The treatment of congenital syphilis is simple and effective although the patients may need to be linked with community-health facilities to assist in their compliance with follow-up appointments.
Child↗
Infant feeding in Sydney: a survey of mothers who bottle feed.
Two hundred and seventy-four mothers who were bottle feeding their infants aged from 1 to 9 months, were interviewed. Particular attention was paid to mixing technique, storage of reconstituted formulae, the reasons for deciding to bottle feed and what influenced the choosing of a particular milk. Following the interview, a sample of milk from a previously prepared bottle was taken to measure osmolality and bacterial colony count. Eighty-two per cent of the mothers had initially attempted breast feeding. The commonest reason for changing to a bottle was that the mother felt she was not able to produce enough milk to satisfy the baby. Thirty per cent chose the milk they were using on the recommendation of the maternity hospital. Errors in reconstituting the formulae, compared with the manufacturer's instructions were made by 100 (30%) mothers. In 52 cases these were potentially serious errors, usually erring on the side of preparing an over-concentrated formula. This finding from the interviews was confirmed by osmolality analysis of milk samples. Twenty-two per cent of samples collected grew potential pathogens. There was no correlation between the presence of bacterial growth and the use of prewarmed formulae stored in insulated carriers. No correlation was found between triceps skinfold thickness, age of introduction of solids or method of reconstitution of formula.
Australia↗
Non organic failure to thrive.
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Affective Symptoms↗
The consequences of child sexual abuse: a review of recent research.
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Child↗
Professional knowledge of infant feeding techniques (or if you want to know how to feed a baby, ask a nurse).
Three hundred and forty-two health professionals who deal with children, including general practitioners, paediatric residents and paediatric nurses were asked questions about their knowledge of infant feeding, particularly how they would recommend mothers to reconstitute milk formulae. A proportion of errors was noted in all groups, with errors occurring more frequently in the medical groups. Mothers seeking feeding advice are most likely to obtain the correct answers from paediatrically trained nurses.
Bottle Feeding↗
Self-esteem of abused children.
Thirty-seven children admitted to hospital with a diagnosis of abuse at an average of 5.5 years previously were compared with 37 non-abused children matched for age, sex, ethnic group, school and social class. The mean age of the children with 8.9 years (range 4.6-14.0 years). Self-esteem in the children was assessed by means of a structured interview with the child and the Piers-Harris Self-Concept Scale. The abused children saw themselves as having significantly fewer friends than the comparison children and they played with friends less often. They were less ambitious than the non-abused children with regard to the sort of occupation they would like as adults and were significantly lower in self-concept on the Piers-Harris Self-Concept Scale. These results show that, as well as providing treatment for abusive parents, a long-term program which aims at improving interpersonal relationship skills and self-esteem is required for abused children.
Adolescent↗
Self-esteem and early background of abusive mothers.
Thirty-six mothers whose children had been abused were interviewed and compared with 36 mothers matched for social class and ethnic background. The abuse group mothers had lower self-esteem than the comparison mothers as judged by their desire that their children should not grow up to be like themselves or their partners. They were also less likely to discuss their problems with other people. They were less likely than the comparison mothers to have been brought up by their own parents. They had significantly more negative feelings than the comparison mothers towards their fathers when they were children and these negative feelings persisted into adult life. It is important that emphasis on treatment programs for these mothers should be placed on building up self-esteem and skills in interpersonal relationships.
Child↗
Mothers of abused children. A comparison study.
A group of 36 mothers whose children had suffered from child abuse at an average of 5 1/2 years previously was compared with a group of mothers of similar social class where there had been no reported instances of abuse of their children. There was no significant difference between the two groups with regard to marital, housing, or financial problems or in physical health. Statistically significant differences were found between the abuse and comparison group mothers in the following areas: the abuse group mothers (1) were less likely to have been brought up by their own parents; (2) had more negative feelings towards their fathers; (3) were more likely to have received help for an emotional disorder; (4) had higher expectations for their children; (5) perceived a greater number of personality problems in their children; and (6) were more likely to have assertive, demanding, and suspicious personality traits. It is possible that these maternal factors will influence the emotional development of their children.
Child↗
Long-term effects of nonorganic failure to thrive.
Fourteen children admitted to the hospital at an average age of 12.5 years previously were reviewed in comparison with a group of children matched for age, sex, social class, and ethnic group. The children in the study group were smaller in height and weight, than children in the comparison group. They had lower scores on the verbal intelligence scale of the Wechsler Intelligence Scale for Children--Revised, poorer language development, and less well-developed reading skills. They had lower social maturity and a higher incidence of behavioral disturbances. There were no differences between the study and comparison groups in family size, maternal age, family health, social isolation, and mothers' childhood experiences. The study group mothers had less knowledge about their children's education, were more anxious, and had a tendency toward concrete thinking. To prevent the long-term adverse effects of nonorganic failure to thrive, a more active, practical, and long-term program, begun at the time of presentation, is recommended.
Adolescent↗
Persisting characteristics of parents of battered children.
To study the personality of mothers whose children had suffered from child abuse in the past, a group of 36 such mothers was compared with a control group of mothers matched for social class. There was no difference between the two groups in pregnancy experience, in general health or in the number of family problems they had. The mothers from the study group had higher expectations for their children and perceived their children as having more personality problems than did the control mothers. The study-group mothers were less likely to have been brought up by their own parents, had more negative feelings towards their fathers, and were more likely to have received help for an emotional disorder than the control mothers. On formal testing, they were more likely to have suspicious, assertive, and demanding personality characteristics. As the majority of abused children remain in their natural families, these maternal factors are likely to influence the emotional development of their children. The children, as well as the parents, from families where child abuse has occurred should receive long-term supportive treatment to try to ameliorate some of the effects of these parental characteristics.
Adult↗
Development in children following abuse and nonorganic failure to thrive.
Thirty-nine children who had been abused an average of 5 1/2 years earlier and 14 children who had been admitted to the hospital with nonorganic failure to thrive (NOFTT) 13 years earlier were studied to look at similarities and differences in their development. Each group was studied in relation to a comparison group matched for age, sex, social class, and ethnic background. The abused children and those with NOFTT were similar in their language ability, and were significantly behind their comparison groups in language development, reading age, and verbal intelligence. The abused children, but not the group who had NOFTT, were significantly behind their comparison group in general intelligence, interpersonal relations, and self-concept, but in contrast to the children with NOFTT they were not delayed in social maturity. The long-term adverse sequelae of these two conditions emphasize the need for a long-term, child-centered approach.
Adolescent↗
Similarities and differences between nonorganic failure to thrive and deprivation dwarfism.
Although the terms, nonorganic failure to thrive and deprivation dwarfism, are sometimes used interchangeably, and while the family pathology is similar in both conditions, the clinical features differ. The majority of children with nonorganic failure to thrive are under 2 years and often 18 months of age. Weight loss is the most marked feature and they are often withdrawn and apathetic. In contrast, the documented ages of children with deprivation dwarfism range from 2 to 15 years although the history may reveal earlier feeding and behavior problems. Short stature is the most striking feature, their weight often being in proportion to their height. They may steal and hoard food and have bizarre eating habits. In some cases reversible hypopituitarism has been documented. It is suggested that deprivation dwarfism constitutes a subgroup within the nonorganic failure to thrive syndrome. Management in both conditions is similar. It should emphasize a practical, supportive approach and be on a long-term basis.
Adolescent↗
Non-organic failure to thrive.
Non-organic failure to thrive is a clinical diagnosis which should be considered in parallel with other causes of failure to thrive in infants. It has not been resolved as to whether the condition is due to a lack of stimulation or to deprivation of calories, although both these factors, as well as a contribution from the child in some cases, are likely to be responsible. There is no typical profile of the parent whose child develops non-organic failure to thrive. The condition can occur in all social classes but is more common in situations of poverty, poor marital relationships, chaotic family lifestyle and when there is a history of deprivation in the parents' own childhood. Although the majority of these children eventually show catch-up growth, long-term follow-up studies show a high incidence of emotional and cognitive problems. Treatment should go beyond nutritional rehabilitation in the hospital and should include practical, supportive help for the mother together with measures to improve the level of stimulation and the quality of interpersonal relationships for the child.
Affective Symptoms↗
Reliability of mothers' reports of birth data.
To determine the reliability of recall of birth and early childhood events, a group of 47 mothers was asked details of their child's birth and about any child-rearing problems at an average of 5-6 years after the birth. Thirty-four of these mothers were asked similar questions 3 years later. The information given by the mothers was compared with the information documented in the hospital records when the children were born. The mothers overestimated the length of pregnancy and overestimated the number of neonatal problems. Only half could recall the birth weight accurately. When asked the same questions 3 years later there was a tendency for memory to have mellowed with fewer pregnancy complications and child-rearing difficulties being recalled than on the previous interview. Information given by mothers about such objective data as length of gestation, birth weight and obstetric complications is not necessarily accurate. Less objective data may be recalled even less accurately.
Attitude↗
Parents who physically abuse their children.
Increased knowledge of child abuse has mad what was once an infrequently diagnosed condition become recognised as a major pediatric and social problem. While there is no typical profile of an abusive parent, characteristics that have been found more frequently include a history of having been deprived and possible abused in the parent's own childhood, low self-esteem in the mother and increased ill-health in the immediate family members. Personality testing shows that the parents relate poorly to their children and to other people and that they have immature and impetuous personalities. Predictive studies show that abuse is commoner in families where the above characteristics are found, where family supports are minimal and where there are complications in the pregnancy, birth and in the neonatal period. However it should be recognised that the majority of families with these characteristics do not abuse their children. There is evidence that supportive measures provided to families who have known risk factors for abuse can reduce the incidence of this problem.
Age Factors↗
The development of abused children.
Thirty-nine children were reviewed who had suffered child abuse at an average of 5 1/2 years earlier. In comparison with a group matched for socio-economic status, the abused children performed significantly lower on the Wechsler Intelligence Scale, and were more delayed in language development and reading ability. Their teachers' assessments of behaviour showed significantly more abnormal profiles than in the comparison group. These differences could not be accounted for by the small proportion of known head-injuries in the abused group. Child abuse has long-term effects, so it is necessary that these children are thoroughly assessed at first presentation, and that they are followed with a specific programme aimed at preventing these sequelae.
Adolescent↗
Personality development after physical abuse.
Personality development after child abuse was studied in 39 children who had, on average, been admitted to hospital five and a half years previously. In contrast to a control group, the abused children had fewer friends, lower ambitions, and lower self esteem. They were more serious, shy, and subdued on a personality assessment and were more likely than the control children to have behaviour disturbances recorded on a questionnaire for teachers. Their mothers also noted a higher incidence of behaviour disorders than mothers of control children. Child abuse has long term effects on the personality development of children. A long term, child centred approach is needed for abused children to try to prevent some of the sequelae.
Child↗