When a child with a chronic condition needs hospitalization

The hospitalization of a chronically ill child requires meticulous orchestration. Treatment recommendations must be transmitted to the family in a coherent and supportive fashion. Patient comfort and nutrition must be maintained, and psychological support provided. Discharge planning is often extensive. To promote continuity of care, appointment of a case manager is recommended.     

Parenting and child development in families with a child conceived through embryo donation.

Concerns have been raised regarding the potentially negative effects of conception using donated embryos on parenting and child development. Findings are presented of an exploratory study of families with a child conceived through embryo donation. Twenty-one embryo donation families were compared with 28 adoptive families and 30 in vitro fertilization families on standardized interview and questionnaire measures of the parents' marital and psychological state, the quality of parent-child relationships, and the child's development. In all 3 groups, the children were aged 2-5 years. The differences indicated higher emotional overinvolvement and defensive responding in the embryo donation families, along with greater secrecy about the child's origins. The children were not at increased risk of psychological problems. The study provides interesting but preliminary findings on parent-child relationships and child development in a new family form. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical and biochemical studies in an American child with sialuria

Sialuria is a rare inborn error of sialic acid (NeuAc) metabolism resulting from failure of CMP-NeuAc to adequately feedback inhibit the rate-limiting enzyme in sialic acid synthesis, UDP N-acetylglucosamine (UDP-GlcNAc) 2-epimerase. We describe the fourth reported sialuria patient, T.W., whose clinical features include developmental delay, coarse facies, and massive urinary excretion of sialic acid. Biochemical studies of T.W. fibroblasts revealed a 200-fold increase in free NeuAc content compared with normal. Bound NeuAc was only slightly elevated. The free NeuAc was predominantly in the cytosol fraction of fibroblasts after differential centrifugation, with only 4% of the free NeuAc content in other (nuclear, granular, and microsomal) cellular compartments. CMP-NeuAc inhibited UDP-GlcNAc 2-epimerase by 80% in normal fibroblasts but inhibited the epimerase of T.W. (sialuria) cells by only 13%. Cytidine feeding of sialuria fibroblasts decreased the intracellular free NeuAc content by 47%; this was accompanied by a fourfold increase in CMP-NeuAc, which may be sufficient to feedback inhibit the mutant epimerase and reduce free NeuAc production. Cytoplasmic pH was determined by the pH sensitive fluorescent indicator 2',7'-bis(carboxyethyl)-5(6)-carboxyfluorescein, pentaacetoxymethylester (BCECF/AM) using the H+ equilibration method. The intracellular pH of sialuria fibroblasts, 7.18 +/- 0.04, was not found to be significantly different from that of normal cells (7.19 +/- 0.08).     

The assessment of competence in families with a retarded child.

60 families with retarded children were divided into 3 groups, based on age of the retarded child (6–8, 12–24, and 18–21 yrs). The families were observed by trained raters and compared with nonclinical families without handicapped children. Family reports from 45-min interviews were collected regarding feelings about the family's adaptation to the child and available support systems. Results indicate that most families were functioning well overall, despite speculations in older clinical literature about chronic family dysfunction. The older the retarded child, the more competent the family pattern; families with retarded children aged 6–8 yrs (school-entry age) and male retarded children were more dysfunctional. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increased child abuse in families with twins

Close spacing of children may be a significant risk factor for subsequent abuse in some families. Twin births are an extreme example of close spacing. Therefore, the authors hypothesized that twin births may predispose to an increased incidence of child abuse. Thirty-eight families with twins were compared with 97 single birth families and matched for birthdate, maternal age, race, and socioeconomic status. Families with twins experienced a significantly higher incidence of child abuse and neglect than did those with single births (p less than .003). A written questionnaire designed to study mothers' feelings and perceptions of support systems showed a significant difference only in greater difficulty in feeding twins as compared with single infants (p less than .001). Mothers of abused children were more likely not to answer the questionnaire at all (p less than .005). Neither mothers of single births nor those of twins felt that health professionals provided adequate education or support following the birth of their infants.     

Stressors and child and adolescent psychopathology: Moving from markers to mechanisms of risk.

In the first half of this review, the authors critically evaluate existing research on the association between stressors and symptoms of psychopathology in children and adolescents. This analysis reveals (a) problems with conceptualizations of stress, (b) variability in measurement of stressors, and (c) lack of theory-driven research. To address these problems, the authors propose a general conceptual model of the relation between stressors and child and adolescent psychopathology. The authors examine basic tenets of this general model in the second half of this article by testing a specific model in which negative parenting mediates the relation between economic stressors and psychological symptoms in young people. Results generally provide support for the specific model as well as for the broader model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Monoarticular chronic synovitis in a child

Lipoma arborescens is a villous lipomatous proliferation of the synovial membrane characterized by chronic and painless synovial effusion. The aetiology is unknown. It has to be included in the differential diagnosis of chronic monoarticular disease in childhood. Magnetic resonance imaging provides a highly efficient tool for the diagnosis of this very rare condition. This is indeed the fourth paediatric case reported. Rather than resorting to the often inconvenient surgical synovectomy commonly recommended, we chose to treat the knee of this 13-yr-old boy with intra-articular osmic acid.     

Relations in families with a mentally retarded child from the perspective of the siblings

Five monoclonal antibodies (MoAbs) against Indian reference/vaccine strain of foot-and-mouth disease (FMD) virus subtype A22 (IND17/77) and a guinea pig antibody against a synthetic peptide representing amino acids (aa) 136-151 of VP1 polypeptide of A22 virus were used in the study. All the antibodies either failed to react or showed a reduced reactivity with trypsin-treated (TT)-146 S virus particles in enzyme-linked immunosorbent assay (ELISA), and could neutralize the infectivity of the reference virus. The antibodies were hence identified as specific to a trypsin-sensitive neutralizable antigenic site of the virus. Using the antibodies we isolated mutants which showed either no or reduced reactivity with the homologous as well as heterologous antibodies in ELISA. The mutants could not be neutralized with the respective antibodies but were efficiently neutralized with the serum from vaccinated cattle (BVS). These results indicated that the antibodies elicited in cattle following vaccination protected them adequately against the mutants selected and that the trypsin-sensitive neutralizable antigenic site of FMD A22 virus as identified by the MoAbs may not be dominant in eliciting a neutralizing antibody response in vaccinated cattle.     

Choosing reconstruction after mastectomy: a qualitative analysis

Recent epidemiological studies have identified plasma triglyceride as a risk factor for atherogenesis. We have generated a mouse transgenic line that carries a recessive mutation designated lpd (lipid defect). Homozygous lpd mice develop as runts and die by age 10-15 days with striking liver pathology characterized by the presence of numerous lipid-containing vacuoles and extensive accumulation of triglycerides. Cloning of the mutant insertion locus and the wild-type lpd locus have revealed a duplication of host genomic sequences at the site of integration. Mapping of the lpd locus with the Jackson Laboratory BSS interspecific backcross panel of (C57BL/6JEi x SPRET/Ei) F1 x SPRET/Ei placed the lpd locus to the distal part of chromosome 16. These observations suggest that the transgene disrupts a putative gene at the lpd locus and that lpd is a novel locus related to triglyceride metabolism. The lpd mutant mice may serve as models for human disorders of fatty livers or hypertriglyceridemia.     

Characterization of medical activities of urban families in raising a healthy child

Ten statistically significant factors of risk of frequent diseases of children have been distinguished; four of them directly reflect medical activity of parents: late application for medical care when a child falls ill, neglect of prophylactic visits to doctors, neglect of child's health fortification, and refusal to take a sick leave when the child is ill. Poor medical activity of families as far as it concerns the upbringing of a healthy child results in a higher insurance risk, which should be taken into consideration when developing legal and economic aspects of medical insurance.     

Social support in families of children with chronic conditions: supportive and nonsupportive behaviors

We questioned parents of 182 young children with a variety of chronic health conditions concerning the amount of emotional, informational, and tangible social support they received from the family, community, and service providers. We also asked parents to describe nonsupportive or hurtful behaviors received from family or community members. Both mothers and fathers reported that family members provided the most emotional and tangible social support and service providers the most informational support. The amount of perceived support from all sources increased over time, but 78% of mothers and 60% of fathers reported at least one instance of nonsupport from these same sources, primarily from extended family members and health professionals. We encourage health professionals to show respect and to provide timely, accurate information in a sensitive manner to parents whose child has a chronic health condition and to assist parents in handling nonsupportive behaviors from family and friends.     

Donor insemination: child development and family functioning in lesbian mother families

Findings are presented of a comparative study investigating the family relationships and the emotional and gender development of children raised in lesbian mother families. A total of 30 lesbian mother families with 4-8 year old children created as a result of donor insemination (DI) were compared with 38 heterosexual families with a DI child and with 30 heterosexual families who had a naturally conceived child. A variety of assessment measures, including a standardized interview and questionnaires from the parents and psychological testing of the child were used to collect the data. The quality of the couples' relationships and the quality of the mother-child interaction did not differ between lesbian mother families and either of the heterosexual family groups. The quality of the interaction between the social mother and the child in lesbian families was superior to that between the father and the child in both groups of heterosexual families. Childrens' own perception of their parents was similar in all family types; the social mother in lesbian families was regarded by the child to be as much a 'parent' as the father in both types of heterosexual families. With regard to their emotional/behavioural development, boys and girls raised in lesbian mother families were well adjusted and their gender role development did not differ from that of children raised in heterosexual families. These results indicate that child and family development in lesbian mother families is similar to that of heterosexual families.     

The spiritual work of the dying: a framework and case studies

This article describes a systematic approach to understanding the spiritual work of the dying. It begins by defining "spirituality," "spiritual care" and "spiritual work" in order to create a common vocabulary. The remainder of the article uses vignettes from clinical experience to create a framework for understanding not only the recurrent themes in the spiritual work being done by the terminally ill but the support and interventions of the spiritual counselor as well. These case experiences are clustered under four headings: "remembering," "reassessing," "reconciliation" and "reunion." The article gives serious attention to the "supernatural" experiences of the dying as experienced by the hospice team.     

Neighbourhood support to families with a disabled child: observations on a coping strategy of caregivers in a Jamaican community-based rehabilitation programme

In Jamaica, a low degree of practical helpfulness of neighbours of families with a disabled child has been described. This seems to cast doubt on the World Health Organization's concept of community-based rehabilitation which simply assumes that the community is a source of support. Our study tries to elucidate which reasons, in a Jamaican socio-cultural setting, make neighbours give support to or withhold it from disabled children and their caregivers. A concept of neighbourhood help is identified, according to which help is something to be asked for and provided under exceptional circumstances only. Caregivers claim to give and receive support in child rearing within the limits of this definition, generally irrespective of the presence of a disability. The impression that neighbours are unconcerned can arise when the support needed becomes too extensive to fit into the local definition of neighbourhood help--which is more likely in the case of disabled children.     

Verbal rehearsal and memory in children with closed head injury: a quantitative and qualitative analysis

Nine closed head injured (CRI) children (mean age = 11.4 years) with post-onset intervals of seven months to eight years were studied. The CRI children ranged from mild-moderate to severely impaired. Nine normally developing children (mean age = 10.9 years) served as controls. An overt rehearsal free recall task was used. Subjects were instructed to "think aloud" following presentation of each item to-be-recalled. Quantitative analyses suggested impaired verbal recall and inefficient, passive rehearsal strategy use in severely injured subjects. Mild-moderate subjects performed similarly to controls and exhibited active rehearsal strategy use. Qualitative analysis revealed differences between CRI subjects and controls' range of rehearsal strategies, monitoring and metamemory. Implications for clinical assessment and intervention with respect to use of rehearsal strategies are discussed.     

The prediction of child maltreatment in Greek families

OBJECTIVE: The study had two aims: First, to identify characteristics of physically maltreating families in the Attica region of Greece; and second, to produce a checklist of high risk predictors which may be used for screening, as an assessment, to enable secondary prevention of physical abuse and neglect. METHOD: A case control design was used with individual matching. The sample comprised 197 physically abused and neglected children and their families referred to a multidisciplinary team. These were compared with 163 control children and their families attending a community health center. RESULTS: The findings suggest that abusing families differ from controls on a number of variables related to child, parental, and family characteristics. The statistical analysis produced a checklist of 15 Predictors. Their classification into High, Medium, and Low Predictors pointed out that the most prominent characteristics were those associated with parents' own adverse life experiences, mental health problems, bad quality of relationship between spouses, and parental neglect of the child's hygiene. The predictive ability of the checklist produced a sensitivity of 92% and a specificity of 96% (logistic regression) and a sensitivity of 86.8% and a specificity of 96.3% (discriminant function). The use of this checklist for screening is discussed with emphasis on methodological and ethical issues. Special emphasis is given on the cultural relevance of such an application within the Greek cultural milieu. CONCLUSION: The findings indicate that secondary prevention of child maltreatment in Greece is feasible by using a checklist of risk factors as predictors. Such screening should be accompanied by clinical assessment based on qualitative aspects of mother-infant interaction. Special emphasis should be given to the cultural relevance of this approach while ethical issues should be considered.     

Conflict negotiation in child abusing and nonabusing families.

Examined patterns of interaction exhibited by 8 child-abusing families (AFs) and 8 demographically matched non-AFs in response to a 10-min conflict resolution task developed by E. Bermann (1983). Videotape analyses show that, compared with non-AFs, AFs exhibited less verbal interaction during the task, less participation in the conflict negotiation required by the task, fewer sustained sequences of task-focused behavior, and less dyadic interaction. Children in AFs were less likely to initiate task behavior. A 2nd study with 6 AFs replicated these findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)