Pediatric clinics of North America
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Pediatr. Clin. North Am. · Feb 2004
ReviewNeurocognitive dysfunction and sleep in children: from human to rodent.
Sleep disturbance in children, whether because of poor sleep hygiene or sleep-related breathing disorders, is associated with significant behavioral and neurocognitive deficits. The mechanisms by which sleep disturbance contributes to the daytime manifestations are unclear, although it seems that sleep fragmentation and intermittent hypoxia are important. The long-term outcome for children with untreated diseases leading to sleep disruption is currently unknown. Increased awareness and early identification and treatment of conditions that lead to altered sleep should yield improved neurocognitive outcomes in affected children.
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Pediatr. Clin. North Am. · Oct 2003
ReviewAttention-deficit/hyperactivity disorder evaluation and diagnosis: a practical approach in office practice.
Attention-deficit/hyperactivity disorder is the most common neurobehavioral disorder of childhood, with most children maintaining symptoms of ADHD as adolescents and as adults. It is among the most common chronic conditions that primary care pediatricians see. Progress in brain imaging, genetics, neuropsychology, and molecular biology of ADHD reveals complex interactions between neurologic mechanisms, genetics, and environmental influences. ⋯ The complex nature of this disorder is indicated by the observation that children and adolescents with ADHD have associated conditions, such as learning disorders, anxiety, oppositional behaviors, and depression. The AAP practice guideline on the evaluation and diagnosis of school-aged children with ADHD provides primary care pediatricians with a scientific foundation for assessing children with behavior and learning problems. Attention to accurate documentation of behaviors, coexisting learning disorders and mental health conditions, and the development of office practices that support the diagnostic process will ensure that children receive an appropriate and comprehensive assessment.
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Trauma is prevalent in the lives of children. It derives from many sources, and, depending on its characteristics, can produce transient or enduring and devastating consequences. Early trauma, if left untreated, can set the stage for chronic deficits in the behavioral repertoires of affected children, and thus shape personality development. ⋯ Health care providers must anticipate potential strain upon family relationships and financial resources. Parent's posttraumatic stress symptoms may result in deterioration of their own ability to support their injured child. And finally, reassessment of patient and family members should occur within the first days, at 1 to 2 weeks, 6 months, and 1 year following injury to ensure proper recovery and optimization of psychosocial function.
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This article provided many situations in which the pediatrician may cross paths (if not swords) with members of the legal profession. It is extremely rare for the doctor to avoid some aspect of the law for an entire career. ⋯ They may look to pediatricians for guidance in difficult cases in which children must be protected. By comprehensively reviewing all documents provided, preparing well, and, most importantly, remaining scrupulously honest throughout the process, a pediatrician has the opportunity to serve the system well, assist children and their families, and even, perhaps, make the system a bit better.
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In the next decade, many of the methodologies and research reviewed in this article will become clinical practice, making the transfusion of blood products safer and more universally available than they are today. NAT will be standard and will surely be performed on each unit of product, PCR testing for pathogens will evolve, and the pathophysiology and immunology of transfusion-related events such as TRALI and immunomodulation will be elucidated. ⋯ Clinical vigilance at the bedside and in the blood bank will remain key areas for transfusion safety. As I have told many a resident and patient, blood is not saline; there are and will remain risks inherent in this commonly used medical therapy.