Pediatric clinics of North America
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Pediatr. Clin. North Am. · Feb 2001
ReviewThe role of polyunsaturated fatty acids in term and preterm infants and breastfeeding mothers.
DHA and AA, which are components of breast milk but not infant formulas marketed in the United States and some other countries, are important components of the brain, and DHA is a major component of the retina. Also, many studies have demonstrated advantages of breastfeeding versus formula-feeding on subsequent cognitive and visual function; however, available data are insufficient to justify the conclusion that the presence of DHA and AA in breast milk is partially or soley responsible for the apparent advantages of breastfeeding. On the other hand, many studies of DHA (and AA)-supplemented versus unsupplemented formulas have shown clear advantages of the supplemented formulas on visual acuity at 2 and 4 months of age or neurodevelopmental status at 12 to 18 months of age. ⋯ Also, no foolproof method exists to ensure an adequate but not excessive intake. Thus, because some evidence shows that dietary LC-PUFA (DHA, AA, or both) as components of breast milk or formula confers at least transient developmental benefits, supplementation of infant formulas with LC-PUFAs is supportable provided that the supplements used are safe. The safety of all available supplements is unknown; however, some trials reveal few reasons for major concerns about the safety of single-cell oils, low-EPA fish oil, or egg-yolk phospholipid or triglyceride fractions.
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Approximately half of children sustain some type of dental injury. Management of injuries to the anterior teeth of preschool children is directed toward minimizing potential damage to the developing permanent teeth; therefore, heroic measures to save primary teeth are not indicated. Crown fractures in the permanent dentition, even those exposing the dental pulp, can be successfully treated hours after an injury. ⋯ If that is impossible, the teeth should be placed in cold milk and the child referred for immediate treatment by a dentist. Mouthguards prevent dental injuries but are not widely used outside of a few organized sports. Efforts should continue to promote mouthguard use in all contact sports.
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Pediatr. Clin. North Am. · Oct 2000
ReviewPharmacologic behavior management for pediatric dental treatment.
Sedatives are an important and necessary management technique for some children during dental procedures. Sedation can be administered safely and efficiently by competent practitioners who have special training in the use of the technique in children and who adhere to sedation guidelines. ⋯ Sedation cannot always safely and adequately meet the needs of these children. In these cases, general anesthesia in a hospital, ambulatory care facility, or office is indicated and must be provided by an appropriately licensed and trained physician or dentist.
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The science of pain assessment for infants and children has grown substantially in the past several decades to the point that valid and reliable methods for pain assessment are available for use in clinical settings. Accurate pain assessment requires consideration of children's developmental level, type of pain experienced, history and context of pain, family influences, and interaction with the health care team. Research is needed to improve the sensitivity, specificity, and generalizability of pain-assessment tools and to more fully incorporate contextual factors into the objective assessment process. Finally, the improvement of pain assessment in the clinical setting can be viewed as a patient care quality issue, and continuous quality improvement methods can be used effectively to incorporate pain assessment as an integral component of every infant's and child's health care.
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The past decade has brought about an explosion of knowledge about the physiology of nociception and many new techniques for pain relief, new analgesic drugs, and new applications of old analgesic drugs. These techniques include methods of opioid administration by transdermal and transmucosal absorption and the use of neuraxial analgesia for the management of pain in children. ⋯ Given the unprecedented interest in pain management in adults and children, physicians can now look forward to the development of new methods of drug delivery and of receptor-specific drugs that divorce analgesia from the untoward side effects of existing analgesics. Improvement in the quality of life of hospitalized children also will occur.