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Biomedical subjects

W G Bithoney

Publications and source records attributed to W G Bithoney.

16 recordsLinked to original sources
PubMed1995

Fathers of children born to adolescent mothers. Predictors of contact with their children at 2 years.

OBJECTIVE: To examine factors associated with long-term involvement of the fathers of children born to adolescent mothers receiving health care in a teen-tot clinic. DESIGN: Ninety-three first-time adolescent mothers younger than 18 years receiving care in a hospital-based teen-tot clinic participated in standardized structured interviews at 2 weeks and 24 months post partum. Data were obtained on demographic factors, the father's prenatal and delivery involvement, frequency of the father's contact with his child, and his participation in child care and financial support of the child. RESULTS: Factors associated with at least monthly contact between father and child during the first 24 months of the child's life were attending at least one prenatal visit, seeing the newborn in the hospital, and a reported supportive relationship between the young mother's family and the father at the 2-week interview. Age of the father and his education, work, or living arrangement did not predict involvement at 24 months. CONCLUSIONS: Our study suggests an association between a father's active participation in both the prenatal and neonatal periods and later contacts between children of adolescent mothers and their fathers. Since other studies indicate that paternal involvement results in more effective maternal parenting and satisfaction, interventions that encourage fathers' participation in both prenatal and intrapartum care should be developed and rigorously evaluated.

Adolescent↗
PubMed1995

Parental stress and growth outcome in growth-deficient children.

OBJECTIVE: In order to examine the relationship between parental stress, child psychosocial factors, anemia, lead poisoning, and growth deficiency (GD), 48 children attending a GD referral program were recruited consecutively and matched with 50 comparison subjects from a primary care program. METHOD: Parents completed the Parenting Stress Index (PSI) with subscales and provided demographic data. Children received developmental screening, hemoglobin levels, Pb levels, and growth evaluation. They also received medical evaluation for GD. T tests were used to evaluate group differences. Spearman Rho correlation analyses were computed between group coefficients and PSI scales, Pb, and hemoglobin levels. RESULTS: No differences were found on the PSI with regard to overall parental stress. GD parents perceived themselves as less competent (P < .001), and their children as less adaptable (P < .006). They also reported more social isolation (P < .05). The GD group had more anemia and Pb poisoning (P < .002 and P < .001, respectively); however, these variables were not related to differences in child adaptability or growth outcome. A high sense of parental competence and high child adaptability were associated with improved growth outcomes (P < .001 and P < .02, respectively). CONCLUSIONS: We conclude that parents of GD children seen in an outpatient referral setting show no difference in overall perceived stress levels versus comparison subjects. Increased parental competence and child adaptability are strongly associated with improved growth outcome. Decreased child adaptability may contribute to GD pathology. These findings challenge the traditional view of GD etiology.

Adaptation, Psychological↗
PubMed1993

Elevated lead levels in reportedly abused children.

Children suspected of having been physically abused had significantly higher venous blood lead levels than a comparison group (p < 0.0001). Abused children were 27-fold more likely to have lead levels > 0.965 mumol/L (20 micrograms/dl) (odds ratio = 26.7). We recommend that abused children be monitored for lead intoxication more frequently than other children.

Case-Control Studies↗
PubMed1992

Decreased serum bicarbonate as a manifestation of undernutrition secondary to nonorganic failure-to-thrive.

Eight of 101 children (8%) seen serially in consultation in an outpatient failure-to-thrive (FTT) clinic had isolated serum bicarbonate (TCO2) levels between 16 and 20 MEQ/dL (normal 22 to 30 MEQ/dL). None of these eight patients had signs or symptoms of renal disease, and all had nonorganic etiologic factors associated with their malnutrition. At the time of this review, follow-up TCO2 measurements were available for seven of the eight children who had attained normal weight (wt/age greater than fifth percentile on National Center for Health Statistics (NCHS) growth chart). All these children had normal TCO2 levels and no evidence of renal disease on follow-up more than 12 months later. Clinicians treating undernourished children who have low TCO2 measurements and have no signs or symptoms of renal disease and identified nonorganic factors, should consider a trial of therapies directed at nonorganic factors. Clinicians should be aware that a high percentage of undernourished children without other medical disease may have abnormal TCO2 measurements that correct after the institution of adequate caloric intake.

Acidosis, Renal Tubular↗
PubMed1991

The effect of a multidisciplinary team approach on weight gain in nonorganic failure-to-thrive children.

Failure-to-thrive (FTT) is a chronic symptom accounting for 1% of all patients admitted to pediatric hospitals. FTT, which is traditionally attributed to organic (OFTT) and/or nonorganic (NFTT) causes, results in undernutrition. Undernutrition has potentially serious effects on child development, behavior, and cognitive skills. We undertook a study of children with FTT to determine whether multidisciplinary team treatment resulted in improved weight gain compared with children treated in a primary care setting. Fifty-three children with NFTT referred to our outpatient FTT consultative clinic and 107 children with NFTT identified as comparison subjects from our primary care clinic (PCC) were enrolled in the study. Growth outcomes over a 6-month follow-up were analyzed using growth quotient (GQ) analysis. Children followed in the multidisciplinary team clinic grew better (GQ = 1.75 +/- 0.39 SD) than did children in the PCC (GQ = 1.18 +/- 0.42 SD, p less than .001). The use of a multidisciplinary team offers special advantages in the rapid correction of undernutrition in children with NFTT.

Child, Preschool↗
PubMed1990

Bacteremia in an ambulatory setting. Improved outcome in children treated with antibiotics.

We undertook a study of 414 bacteremic patients (167 with Haemophilus influenzae and 247 with Streptococcus pneumoniae bacteremia) to evaluate their clinical presentation, laboratory and clinical results, and subsequent outcomes. Patients with H influenzae bacteremia were more likely to have soft-tissue foci, poorer clinical appearance at presentation, and be at higher risk for subsequent serious focal infections, persistent bacteremia, and subsequent hospital admissions than patients with S pneumoniae. Patients with H influenzae bacteremia had a 21.1-fold increase in risk of meningitis (95% confidence interval [CI] of 3.8 to 78.0) compared with those with S pneumoniae. The odds ratio for initial lumbar puncture was 5.25 (95% CI [1.1-23.6]). Ambulatory patients treated with antibiotics at presentation were less likely to develop new serious soft-tissue infections, persistent bacteremia, or to require subsequent hospital admissions than untreated patients. The effect of treatment was greater for patients with S pneumoniae than those with H influenzae. Careful follow-up and reevaluation of patients with presumptive bacteremia is essential because treated and untreated patients can still develop serious soft-tissue infections.

Adolescent↗
PubMed1989

Child abuse and failure to thrive: individual, familial, and environmental characteristics.

Similar theories of etiology have been postulated for child abuse and nonorganic failure to thrive (FTT). This study compared individual, familial, and environmental conditions in cases of child abuse to cases of FTT. Assessment of the mother's childhood home, supports, current living situation, attitudes toward her child, and child characteristics (such as temperament, social maturity, and complicating medical conditons) showed the groups to be remarkably alike. The major significant difference was that although both groups were poor, the abuse group was even more impoverished and lived in more crowded conditions than the families with a child with FTT. These data suggest a common etiologic context for different pediatric social illnesses and the need for a broad collaborative approach by pediatricians and colleagues in related disciplines.

Child Abuse↗
PubMed1989

Prospective evaluation of weight gain in both nonorganic and organic failure-to-thrive children: an outpatient trial of a multidisciplinary team intervention strategy.

Failure-to-thrive (FTT) is categorized as organic (OFTT) or nonorganic (NFTT). Traditionally, it has been taught that children with OFTT are unable to grow well in spite of adequate care (calories, nurturance, medical supervision), whereas NFTT children will grow well when given adequate care. We undertook this study to determine whether NFTT and OFTT children could grow at similar rates when treated by a specialized multidisciplinary team that provided concrete, individualized therapies including psychosocial support, medical care, and hypercaloric diets. Eighty-six children were enrolled on referral to our outpatient FTT consultative clinic; 64 had NFTT and 22 had OFTT. Growth quotient analysis was used to determine growth outcomes over a 6-month follow-up period. Growth at a rate paralleling the growth curve produces a GQ equal to 1. Growth 2 times as rapid as expected gives a GQ = 2. Children in both groups grew extremely well. For NFTT, GQ = 1.67 +/- 0.56 (SD); for OFTT, GQ = 1.81 +/- 0.37 (SD), p = NS. OFTT children grew just as well as NFTT children when given adequate calories for catch-up growth. Our data indicate that weight gain alone cannot reliably differentiate OFTT from NFTT, as has been traditionally taught. They suggest that we make every attempt to maximize caloric intake in FTT children. They also suggest that a multidisciplinary team consisting of a pediatrician, child psychiatrist, nutritionist, nurse clinician, and social worker may be successful in managing FTT children.

Behavior Therapy↗
PubMed1987

High sodium rehydration solutions in well-nourished outpatients.

We studied the safety and efficacy of high-sodium oral rehydration solution in the out-patient management of children with diarrhea, with or without dehydration. We studied 68 outpatients with acute diarrhea; 32% had mild-to-moderate dehydration; the rest were not dehydrated. They were treated at home for 24 h with either high-sodium (90 mmol/l) or low-sodium (30 mmol/l) solution. None of the patients given high-sodium solution became hypernatremic. Of those patients who were dehydrated, 55% did not take enough fluid at home to repair their dehydration. We conclude that patients must be closely supervised for the initial rehydration period, but that high-sodium rehydration solutions can be safely given to outpatients for up to 24 hours.

Acute Disease↗
PubMed1987

Child and family attributes of failure-to-thrive.

Forty-one Boston children hospitalized with non-organic failure-to-thrive (FTT) were matched with 41 control subjects on age, socioeconomic status (SES), sex, and race. A precoded maternal interview was used to evaluate family stress, isolation, infant health, and the temperament and social maturity of the child. A regression analysis was performed with 27 variables thought to be potentially associated with the FTT diagnosis. Ten variables explained 81% of the between group variance on F-tests. The most significant distinctions were poor child health (p less than 0.001), high reactivity to visual and auditory stimuli (p less than 0.001), and disordered feeding interaction (p less than 0.005). Other case-comparison differences included social isolation, few maternal opportunities to escape caregiving, the presence of a male adult in the family, fewer available extended family, fewer violent disagreements between parents, greater number of maternal unmarried years. Children with FTT appeared to have developmental idiosyncrasies. These conspire with social and familial factors to yield the current profile of non-organic FTT. This study questions whether such findings are the cause of FTT or are better understood as a result.

Child Abuse↗
PubMed1986

Elevated lead levels in children with nonorganic failure to thrive.

Every child with failure to thrive has at least one organic medical disease: malnutrition. It is well documented that lead and other heavy metals are absorbed more readily in the presence of both malnutrition and iron deficiency anemia. Malnutrition and lead exposure tend to be found in the same population groups. Furthermore, lead poisoning is correlated with many of the identical intellectual and behavioral deficits demonstrated in children suffering from nonorganic failure to thrive. Because of these facts, whole blood lead levels were determined for 45 children with nonorganic failure to thrive and 45 age-, race-, and socioeconomically matched comparison subjects. Children with failure to thrive had a lead level of 22.67 +/- 10.29 (micrograms/dL (mean +/- SD); for control children, it was 14.33 +/- 5.42 (P less than .001). Children with failure to thrive were more frequently anemic (P less than .0001), a possible lead effect, and had higher free erythrocyte protoporphyrin levels. Children with failure to thrive were developmentally delayed on the Denver Developmental Screening Test (unblinded observation) with high failure rates in both language (P less than .001) and gross motor skills (P less than .02). Although failure on the Denver Developmental Screening Test within the failure to thrive group was not linearly correlated with lead level, any such effects may have been masked by the effects of malnutrition and failure to thrive per se. A number of authors have suggested that lead levels formerly thought to be inconsequential are clinically toxic.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Weight↗
PubMed1985

Childhood ingestions as symptoms of family distress.

Familial, child developmental, and demographic concomitants of serious ingestions in preschool children were measured in 23 hospitalized children and controls matched on age, race, and socioeconomic status. A precoded maternal interview focused on family stress, parental discipline, parental emotional history, as well as childhood temperament and social maturity. A regression analysis was performed on variables that discriminated between ingestion cases and controls. Sixteen variables from the regression equation were entered into a stepwise discriminant function analysis. Significant descriptors of ingestion victims included the following: lack of extended family low Vineland Social Maturity quotient, few maternal opportunities to escape caregiving, good health, a high frequency of physical punishment in the mother's childhood, and increased current advocacy needs. Using these six variables as a screening device, the discriminant function correctly classified 87% of the subjects as either cases or controls. These data suggest that ingestions are symptoms of familial and, especially of maternal, distress. These healthy, active, but delayed children appear to overwhelm their caregivers.

Child Abuse↗
PubMed1985

Breaker's back.

Explore the source record for details and available documents.

Adolescent↗
PubMed1984

Munchausen's syndrome by proxy (child abuse) presenting as apparent autoerythrocyte sensitization syndrome: an unusual presentation of Polle syndrome.

Munchausen's syndrome was initially described in 1951. It has become increasingly recognized since that time. Recently, Munchausen's syndrome by proxy or Polle syndrome has been described. In this disease entity, a parent causes a factitious disease in a child. The disease may require extensive medical testing and the result may even be death. A wide variety of presentations of Polle syndrome have been reported including cardiac arrest, recurrent sepsis, and factitious bleeding. Autoerythrocyte sensitization, a syndrome of spontaneous purpura, was initially described in 1955. The diagnostic test described is intradermal injection of autologous blood which produces an area of painful purpura. The syndrome is therefore postulated to be due to hypersensitivity in the patient's own RBCs. The majority of patients with autoerythrocyte sensitization have had psychiatric disorders and the symptoms have improved only with psychotherapy. An infant who had a clinical picture of autoerythrocyte sensitization and who was later found to be a victim of Polle syndrome is reported.

Autoimmune Diseases↗