Journal of developmental and behavioral pediatrics : JDBP
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Physicians' attitudes toward pain in children were assessed in an attempt to explain why adults are administered more analgesics than children while in the hospital. A survey was conducted of all pediatricians, family practitioners, and surgeons in Hartford. Fifty-seven percent of the sample responded (112/195). ⋯ Many other attitudinal differences were also related to specialty. Other demographic variables (age, sex, mode of practice, and personal experience with pain) had little effect on attitudes. These findings suggest possible explanations for the discrepancy between child and adult analgesic prescribing practices.
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Preliminary evidence suggests that fetal movement in response to vibrotactile stimulation "habituates" with repeated exposure. If demonstrated in fetuses, the habituation paradigm may be useful as a measure of fetal well-being or as a predictor of neonatal outcome. However, the ability of the fetal response decrement phenomenon to meet criteria for habituation which would distinguish it from simple receptor fatigue has not been evaluated. ⋯ Fetal movement was observed on an ultrasound monitor. An inverse relationship between the strength of the stimulus and rapidity of the response decrement was not observed. However, return of the response to presentation of a novel stimulus, response decrement to repetition of the second stimulus, and more rapid response decrement upon re-presentation of the original stimulus suggest that the fetal response decrement phenomenon is true habituation.
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The behavior of full-term neonates undergoing circumcision with and without local anesthesia was examined using the Brazelton Neonatal Assessment Scale (BNAS). Evaluations were done blindly pre-and postcircumcision and on the day following the procedure. Infants receiving lidocaine in a dorsal penile nerve block (DPNB) remained more attentive to animate and inanimate stimuli following circumcision and demonstrated a greater ability to quiet themselves when disturbed. ⋯ This report adds to the growing body of data that indicate that circumcision is a painful procedure that disrupts the course of behavioral recovery following birth. These disruptions can be lessened by the use of local anesthesia to relieve pain and stress during the procedure without any additional morbidity. These data support the use of DPNB during anesthesia for routine neonatal circumcisions still requested by the majority of parents in the country.
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J Dev Behav Pediatr · Dec 1983
Behavior-disordered and aggressive children: new advances in pharmacotherapy.
The status of children's psychopharmacology is reviewed in the context of differences from its adult counterpart. An overview is presented of recent psychopharmacological developments in the treatment of childhood behavioral disorders. The disorders are grouped according to the potential usefulness of medication. ⋯ The effect of psychoactive drugs on cognitive functions in the laboratory is referred to, as well as the value of determining drug levels in clinical practice. It is concluded that drug administration in isolation is not the treatment of choice. Drug therapy is a valuable adjunct, however, to psychosocial interventions.
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J Dev Behav Pediatr · Dec 1983
The very low birth weight infant: the broader spectrum of morbidity during infancy and early childhood.
Neonatal intensive care has improved very low birth weight (less than 1.5 kg) outcome. To evaluate the spectrum of morbidity related to this care, 505 survivors born between 1975 and 1979 were followed during the first three years of life. Transient neurological abnormalities of muscle tone which resolved by two years of age were seen in 40% of children. ⋯ Mean IQ was 92.0. In the total population 80.6% were considered normal, 1.7% had major congenital malformations, 10.1% had neurosensory abnormalities, and 7.6% had developmental delay (DQ or IQ less than 80). Close followup care is essential to ensure the eventual adaptation and functional normalization which occurs in the majority of these high-risk infants.