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Infant crying: nature, physiologic consequences, and select interventions.

This article describes the nature of infant crying, the physiologic events and changes associated with it, and appropriate nursing interventions for infant crying. A cry is a series of four movements that basically resembles a Valsalva maneuver. Documented immediate and long-term sequelae of crying include increased heart rate and blood pressure, reduced oxygen level, elevated cerebral blood pressure, initiation of the stress response, depleted energy reserves and oxygen, interrupted mother-infant interaction, brain injury, and cardiac dysfunction. Caregivers are encouraged to answer infant cries swiftly, consistently, and comprehensively. Kangaroo care is an efficient method for preventing, minimizing, and halting crying. Other interventions for crying include swaddled holding, a pacifier, sugar water, a sweet-tasting nonsucrose solution, heartbeat sounds, distraction by lullabies or mother's voice, rhythmic movement, and reduction of external stimuli.

Crying↗

CT peritoneography in evaluation of pediatric dialysis complications.

Intraperitoneal contrast material with CT scanning was used to evaluate three children with multiple recurrences of peritonitis and no obvious source of infection while they were undergoing continuous-cycling peritoneal dialysis. In one child a loculus of uno-pacified dialysate was readily identified, confirming sonographic findings that suggested an inflammatory pseudocyst. In the other two children, contrast material dispersed throughout the peritoneal dialysate, suggesting that recurrent peritonitis occurred from extraperitoneal contamination. CT peritoneography is easily performed with contrast material instilled through the peritoneal dialysis catheter. Combining anatomic imaging with intraperitoneal-fluid dynamics, this technique should provide more complete evaluation of the peritoneal cavity than other imaging methods. While additional evaluation is necessary, our initial experience suggests the usefulness of CT peritoneography in excluding an intraperitoneal source of infection during long-term peritoneal dialysis.

Adolescent↗

[Breastfeeding indicators in the city of Feira de Santana, Bahia, Brazil]

OBJECTIVE: To evaluate breast-feeding indicators surveying current alimentary status of under- two-year-old children.METHODS: During Vaccinations day, on June 15th, 1996, 3,898 mothers were interviewed in urban areas of Feira de Santana, Bahia, Brazil. The methodology proposed at WHO/CED/SER 91.14 was used. Rates were calculated for the appropriate age groups: breast-feeding exclusive and predominant, persistence of breast-feeding one and two years, median duration of breast-feeding, timely complemented breast-feeding, bottle-feeding and pacifiers utilization.RESULTS: The main results were exclusive breastfeeding rate of 45.6%, in children from 0-3 months old; breastfeeding medium duration of 9 months; and persistence of 45.4% of breastfeeding in children from 12-15 months old. CONCLUSIONS: These results pointed that children in Feira de Santana are benefitting from breast-feeding more than in other areas of Bahia and other states of the Brazilian Northeast reflecting correct orientation. The methodology revealed ease to applicate providing significant and replicable samples. Wider utilization of standardized methodologies will contribute to improve monitoring of breast-feeding indicators in Brazil.

Journal Article↗

Damage of office supply, personal use items, and over-the-counter medical devices after sterilization by ethylene oxide gas, electron beam, and gamma radiation.

After letters containing Bacillus anthracis spores entered the U.S. mail in 2001, a problem emerged regarding how to decontaminate the letters, packages, and personal items in offices that received these letters. The effects of three sterilization methods (i.e. ethylene oxide gas [EO], electron beam [e-beam] radiation, and gamma radiation) were evaluated for a variety of office supply and equipment, personal use items, and over-the-counter medical devices. No single sterilization method was suitable for all items that could be mailed or found in an office. Damage or discoloration was evident for some items by each sterilization method. There were changes in the color of certain items, such as some of the packaging material, some pacifiers, some of the fabrics, and the nylon stockings after e-beam and gamma radiation. Both e-beam and gamma radiation damaged all film samples. Following EO sterilization and normal aeration, there were a number of samples with high (above 250 microg/g) levels of EO and samples with detectable ethylene chlorohydrin levels. The data would suggest that certain items exposed to EO sterilization must be further aerated prior to use, or discarded. Generic descriptions of products (such as plastics) or grouping of items (such as condoms) were not sufficient to predict what is safe in terms of EO residual levels remaining on an item. Successful decontamination of a wide variety of items will require careful selection of different sterilization methods.

Biosensing Techniques↗

Renewal of mural thrombus releases plasma markers and is involved in aortic abdominal aneurysm evolution.

Human abdominal aortic aneurysm (AAA) expansion has been linked to the presence of a mural thrombus. Here we explored the mechanism of the continual luminal renewal of this thrombus and its ability to release biological markers potentially detectable in plasma. We also explored the ability of platelet inhibition to pacify the thrombus and to limit aneurysm progression in an experimental model. Blood samples and mural thrombi were collected in 20 AAA patients. In parallel, segments of sodium dodecyl sulfate-decellularized guinea pig aorta were xenografted onto the abdominal aorta of 30 rats to induce aneurysms. Fifteen rats received abciximab treatment and fifteen received irrelevant immunoglobulins. Procoagulant activity and platelet activation markers (microparticles, sP-selectin, sGPV, sCD40L) were increased threefold to fivefold in eluates from the luminal thrombus layer compared to other layers. All these markers were increased twofold to fivefold in patients' plasma compared to matched controls (P < 0.005). In the rat model, abciximab reduced both thrombus area and aneurysmal enlargement (P < 0.05). Platelet aggregation is probably responsible for the renewal of the thrombus in AAA. The luminal thrombus released markers of platelet activation that could easily be detected in plasma. Platelet inhibition limited aortic aneurysm expansion in a rat model, providing new therapeutic perspectives in the prevention of AAA enlargement.

Abciximab↗

The Finnish Family Competence Study: the effects of living conditions on sucking habits in 3-year-old Finnish children and the association between these habits and dental occlusion.

Sucking habits and their connection with family background was investigated in 3-year-old Finnish children. The association between sucking habits and malocclusion was also studied. The study was based on a survey with stratified randomized cluster sampling, confidential questionnaires, and clinical dental examinations. Dummy (pacifier) use was often associated with a negligent attitude towards the child's toothbrushing. This may imply that these parents need more support, encouragement, and counseling from the well-baby clinic than others. Sucking habits were strongly associated with malocclusion.

Adolescent↗

The diagnosis of pancreatic and biliary malignancy by endoscopy and retrograde cholangiopancreatography. An analysis of 52 consecutive cases.

Fifty-two consecutive cases of verified pancreatic and biliary malignancies in patients who had been subjected to endoscopic retrograde cholangiopancreatography (ERCP) have been investigated. Twenty-seven patients were women and 25 men; mean age was 66.3 (+/- 9.4 S.D.) and 62.3 (+/- 9.6 S.D) years, respectively. The commonest indication for ERCP was icterus, 41 of 52 patients having jaundice. Ductal filling was obtained in 75% of the cases, unsuccessful ductal opacification being due mostly to carcinoma of the head of the papy, endoscopic evidence of the tumor was obtained 22 times. Malignancy was suggested in 46 of the 52 patients by ERCP; no false-negative interpretations of pacified duct occurred.

Adult↗

Assessment of a brief interviewing course using the Helping Relationship Inventory: an interviewing course assessment.

A brief second year interviewing course consisting of 9 hours of small group meetings was evaluated by administering the Helping Relationship Inventory (HRI). Other studies have used the HRI to assess longer interviewing courses that included both small groups and large class lectures. The purpose of this study was to use the HRI to see if objective improvement in communication skills could be found in this relatively brief interviewing course. One hundred and nine students, representing an 80% return rate, completed all questions on the HRI pre- and post-tests. Analysis of pre- and post-test data showed that students became significantly more understanding (p less than 0.0001) and significantly less 'supportive' or pacifying (p less than 0.0001) by the end of the course. There were no differences found on pre- and post-test HRI scores comparing males (n = 71) and females (n = 38). This study demonstrates that even brief small group interviewing courses can effect a positive change in students' communication skills.

Communication↗

[Contents of phthalate in polyvinyl chloride toys].

The presence of plasticizers in PVC toys obtained in October 1998 was investigated. Diisononyl phthalate (DINP), di-2-ethylhexyl phthalate (DEHP), di-n-butyl phthalate (DBP), dinonyl phthalate (DNP), diheptyl phthalate (DHP), and di-2-ethylhexyl adipate (DEHA) were detected. The phthalates were found in all of the 68 samples. The principal phthalate found in toys was DINP, which was present in 48 of 68 samples. The DINP content ranged from 15 mg/g to 580 mg/g, and mean content was 308 mg/g. The highest content was found in a pacifier toy. DEHP was present in 20 of 68 samples and the content ranged from 2.0 mg/g to 380 mg/g. The mean content was 162 mg/g. It was found in 60% of domestic toys.

Adipates↗

Dental experiences and parenting practices of Native American mothers and caretakers: what we can learn for the prevention of baby bottle tooth decay.

This study attempts to gather information concerning the dental experiences, beliefs, and parenting practices of Native Americans. Five Native American women were trained to conduct interviews in their own language. After pilot testing, seventeen questions were asked. Sixty-two interviews were taperecorded and transcribed. Content analysis was performed on the transcriptions. Results indicate maternal and caretaker upset and displeasure with the dental experiences of adults and children. Fear and pain were prominent. Parenting practices indicate children are expected to clean their own teeth at about a year of age and parental awareness of risks associated with sleeping with a bottle. About half of the mothers and caretakers who used a bottle as a pacifier report engaging in one or more protective activities such as removing the bottle when the child falls asleep. Mothers and caretakers with greater parenting experience are likelier to be aware of these protective activities. In conclusion, results of this study highlight the importance of providing positive dental experiences for mothers and caretakers and the need to be aware of actual parenting practices before making recommendations or counseling mothers or caretakers.

Adult↗

Promoting and supporting breast-feeding.

The family physician can significantly influence a mother's decision to breast-feed. Prenatal support, hospital management and subsequent pediatric and maternal visits are all-important components of breast-feeding promotion. Prenatal encouragement increases breast-feeding rates and identifies potential problem areas. Hospital practices should focus on rooming-in, early and frequent breast-feeding, skilled support and avoidance of artificial nipples, pacifiers and formula. Infant follow-up should be two to four days postdischarge, with liberal use of referral and support groups, including lactation consultants and peer counselors.

Breast Feeding↗

Non-nutritive sucking behaviors in preschool children: a longitudinal study.

PURPOSE: Prolonged duration of non-nutritive sucking behaviors may have consequences in regard to the developing orofacial structures and occlusion. Little is known as to why some children have prolonged sucking habits beyond the first 2 to 3 years of life. This paper reports on non-nutritive sucking patterns among a large cohort of healthy children from birth to 36 months of age and older, and identifies factors predictive of prolonged non-nutritive sucking habits. METHODS: Over 600 children were followed from birth to at least 36 months of age using mailed questionnaires sent when children reached the ages of 6 weeks, and 3, 6, 9, 12, 16, and 24 months, and then yearly thereafter. Parents answered questions concerning non-nutritive sucking behaviors including use of pacifier and digit sucking. The study categorized children who maintained habits to 36 months of age or older as having prolonged habits, and using multivariate analyses, compared them to children without prolonged habits on various sociodemographic variables. RESULTS: The study found that for over 20% of the children, a non-nutritive sucking habit was prolonged to 36 months of age or older. Factors associated with prolonged sucking habits included older maternal age, higher maternal education level, and having no older siblings. CONCLUSIONS: Identifying factors related to prolonged non-nutritive sucking habits may be important in developing and targeting recommendations regarding such behaviors in an effort to prevent malocclusions that result from prolonged sucking habits.

Chi-Square Distribution↗

Sleep disorders of early childhood: a review.

Night awakening and refusal to go to sleep are common problems during the first three years of life, comprising 6-30% of children in the general population. The organization and regulation of child sleep is thought to be closely related to his mode of attachment to his mother. Sleep aids (pacifier, teddy bear, etc.) during the night seem to reduce the occurrence of sleep disorders whereas prolonged breastfeeding and co-sleep with the parents interfere with the normal development of sleep. During the preschool years, the main issue affecting sleep is the ability of parents to set firm limits while respecting the sense of autonomy of the child. Sleep disorders are considered to be more common among physically and mentally handicapped children. Children with a difficult temperament sleep less than those with an easy one. A clear association is found between sleep patterns and psychopathology of the mother probably due to emotional unavailability and inappropriate behavior. Evaluation of the disorder should follow medical examination. It should take place in the presence of the child in order to view the real interaction as well as given information about the reported interaction between the child and his mother. Therapeutic interventions in cases of early childhood sleep disorders can be behavioral or psychodynamic and are advised to be focused and brief, unless there is psychopathology in the parents.

Child↗

Oral sucrose compares favourably with lidocaine-prilocaine cream for pain relief during venepuncture in neonates.

UNLABELLED: To compare the relative efficacy of oral sucrose versus EMLA cream for pain relief during venepuncture, 51 full-term newborns (38M, 13F; postnatal age <4 d) in a stable condition were randomly allocated to one of four treatment groups: placebo (2 ml spring water); 2 ml sucrose 24% w/v; 1 g lidocaine-prilocaine 5% cream (EMLA); or EMLA plus sucrose. Water or a single dose of sucrose solution was administered orally 2 min before venepuncture. EMLA cream was applied in the antecubital fossa 45-60 min before venepuncture and covered by a Tegaderm dressing. A pacifier was given before skin puncture, but it was not actively held or replaced during the procedure or observation periods. In total, 55 venepunctures were performed blindly, always for clinical reasons. As indicators of pain, the total crying time was recorded and heart rate, respiratory rate and arterial oxygen saturation were measured blindly at baseline, immediately post-venepuncture, and 2 and 4 min afterwards. The main effects observed were: (i) time spent crying decreased significantly in the sucrose alone (p = 0.001) and EMLA plus sucrose (p = 0.008) groups; (ii) the above treatments attenuated significantly (p < 0.05) the immediate heart rate response to pain; and (iii) the concomitant use of EMLA did not increase further the analgesic efficacy of sucrose. CONCLUSION: This study shows that a 24% oral sucrose solution compares favourably with EMLA cream as a safe and cheap analgesic procedure to decrease pain responses to venepuncture in newborns.

Administration, Oral↗

[Factors associated with exclusive breastfeeding of infants in Poland].

Factors associated with cessation of exclusive breastfeeding in Poland were studied in 10156 randomly selected infants aged 1-6 months. They were breastfed at the time of data collection. Among them, 4929 (48.5%) infants were exclusively breastfed. In multiple logistic regression analysis, the factors associated with cessation of exclusive breastfeeding were: use of a pacifier, short duration of total breastfeeding and exclusive breastfeeding accepted by mothers, first child in the family, primary education of parents, mother working in farming and non-employed father, maternal smoking and maternal age over 34 years.

Adult↗

Initial management of breastfeeding.

Breast milk is widely accepted as the ideal source of nutrition for infants. In order to ensure success in breastfeeding, it is important that it be initiated as early as possible during the neonatal period. This is facilitated by skin-to-skin contact between the mother and infant immediately following birth. When possible, the infant should be allowed to root and latch on spontaneously within the first hour of life. Many common nursery routines such as weighing the infant, administration of vitamin K and application of ocular antibiotics can be safely delayed until after the initial breastfeeding. Postpartum care practices that improve breastfeeding rates include rooming-in, anticipatory guidance about breastfeeding problems and the avoidance of formula supplementation and pacifiers.

Bottle Feeding↗

[Patient satisfaction and duration of breast feeding].

INTRODUCTION: Only two out of three Danish women follow the recommendations for duration of breast-feeding given by The Danish National Board of Health, which recommend it as the sole source of nutrition for at least the first four months of life. The present study was carried out to investigate the influence of patient satisfaction on the duration of breast-feeding. MATERIAL AND METHODS: Based on an earlier investigation into the satisfaction of primiparas with the public health service during pregnancy, delivery, and the puerperium, 145 women were interviewed by telephone about the period in which their child was fed solely by mother's milk. Mothers of twins and those who had had an elective caesarean or whose child had been transferred to the neonatal care unit were excluded. Data from the patient satisfaction study and data on the delivery retrieved from a local obstetric database were related to the duration of breast-feeding. RESULTS: The mean duration of breast-feeding only was four months with no association to the women's satisfaction with the public health service in general. There was, however, an association between the period of breast-feeding only and satisfaction with issues dealing specifically with breast-feeding. In women who had had an oxytocin infusion breast-feeding was more often well-established. No other event during labour related to the initiation or duration of breast-feeding. There was an insignificant trend towards more use of a pacifier or formula supplementation in the first days in women, who did not initiate breast-feeding. It is unknown whether this is a cause or a consequence. DISCUSSION: The initiation of breast-feeding is influenced by the woman's satisfaction with the public service in matters relating to breastfeeding. In other ways, it is a process that is difficult to disturb.

Breast Feeding↗

Breastfeeding is early functional jaw orthopedics (an introduction).

Breastfeeding places beneficial orthopedic forces on the jaws, similar to the forces of Functional Jaw Orthopedics--the newest form of orthodontics. To date most breastfeeding benefits have been attributed to the content of mother's milk. The true orthopedic benefits of breastfeeding, suckling, deserve more definitive attention and research. Breastfeeding is early preventive Functional Jaw Orthopedics because breastfeeding forces impact the jaws during a very rapid period of infant jaw growth. Breast suckling aids proper development of the jaws which form the gateway to the human airway. Bottle, pacifier and digit sucking deform jaws and airways. Forward forces of suckling clearly oppose the backward forces of sucking. Dentists who understand the positive impact of forward orthopedic forces on the jaws should support and advocate exclusive breastfeeding for about 6 months.

Biomechanical Phenomena↗