Tag Archives: The University of Arizona Department of Pediatrics

Centers for Disease Control report: Nearly 8 in 10 children miss developmental screenings

17 Sep

The goal of this society should be to raise healthy and happy children who will grow into concerned and involved adults who care about their fellow citizens and environment. A physical examination is important for children to make sure that there are no health problems. The University of Arizona Department of Pediatrics has an excellent article which describes Pediatric History and Physical Examination http://www.peds.arizona.edu/medstudents/Physicalexamination.asp

Every child should receive a complete systematic examination at regular intervals. One should not restrict the examination to those portions of the body considered to be involved on the basis of the presenting complaint.
Approaching the Child
Adequate time should be spent in becoming acquainted with the child and allowing him/her to become acquainted with the examiner. The child should be treated as an individual whose feelings and sensibilities are well developed, and the examiner’s conduct should be appropriate to the age of the child. A friendly manner, quiet voice, and a slow and easy approach will help to facilitate the examination.
Observation of the Patient
Although the very young child may not be able to speak, one still may receive much information from him/her by being observant and receptive. The total evaluation of the child should include impressions obtained from the time the child first enters until s/he leaves; it should not be based solely on the period during which the patient is on the examining table. In general, more information is obtained by careful inspection than from any of the other methods of examination.
Sequence of Examination
Skill, tact and patience are required to gather an optimal amount of information when examining a child. There is no routine one can use and each examination should be individualized. Ham it up and regress. Get down to the child’s level and try to gain his trust. The order of the exam should conform to the age and temperament of the child. For example, many infants under 6 months are easily managed on the examining table, but from 8 months to 3 years you will usually have more success substituting the mother’s lap. Certain parts of the exam can sometimes be done more easily with the child in the prone position or held against the mother. After 4 years, they are often cooperative enough for you to perform the exam on the table again.
Wash your hands with warm water before the examination begins. You will impress your patient’s mother and not begin with an adverse reaction to cold hands in your patients. With the younger child, get to the heart, lungs and abdomen before crying starts. Save looking at the throat and ears for last. If part of the examination is uncomfortable or painful, tell the child in a warm, honest, but determined tone that this is necessary. Looking for animals in their ears or listening to birdies in their chests is often another useful approach to the younger child.
If your bag of tricks is empty and you’ve become hoarse from singing and your lips can no longer bring forth a whistle, you may have to turn to muscle. Various techniques are used to restrain children and experience will be your best ally in each type of situation.
Remember that you must respect modesty in your patients, especially as they approach pubescence. Some time during the examination, however, every part of the child must have been undressed. It usually works out best to start with those areas which would least likely make your patient anxious and interfere with his developing confidence in you.

The article goes on to describe how the physical examination is conducted and what observations and tests are part of the examination. The Cincinnati Children’s Hospital describes the Process of the Physical Examination http://www.cincinnatichildrens.org/health/p/exam/

Christina Samuels reported in the Education Week article, CDC: Nearly Eight in 10 Children Miss Developmental Screenings:

Only about 21 percent of parents in 2007 reported that they were asked to fill out a questionnaire from their health-care provider asking about their child’s developmental, communication, or social behaviors—an essential step in steering children to early-intervention services, according to the Centers for Diseases Control and Prevention in Atlanta.
The CDC released the information Sept. 10 as part of an analysis on the use of several preventive services for infants, children and adolescents. In general, children are not receiving enough preventive care, the agency concluded. CDC recommendations are that young children be screened for developmental delays at 9, 18, and either 24 or 30 months, and for autism spectrum disorder at 18 months and at either 24 or 30 months.
For its analysis, the CDC turned to the 2007 National Survey of Children’s Health and focused on children from 10 to 47 months olds. Children were not more or less likely to be screened based on gender, race or ethnicity, family structure, parental education, household income, or location. However, parents were the least likely to report an official screening if the child had not had insurance in the past year; only 9 percent of parents reported that request.
The study did note that a majority of parents, about 52 percent, reported that a health-care advisor asked them informally if they had any concerns about their child’s learning, development, or behavior. However, indications of a parental concern or risk for a developmental delay did not result in additional screening for those children, and informal inquiries are less likely to pick up on the children who need help, the report said. Health-care providers may be overrelying on their own judgment or distrustful of parent reports, the researchers hypothesized.
The CDC noted other gaps in the preventive screening that connect to potential disabilities. Using surveys collected in 2009 and 2010, the CDC found that 50 percent of infants who failed their hearing screening were not documented to have received testing needed to diagnose hearing loss.
Also, 67 percent of children ages 1 to 2 years were not tested for blood lead or results were not reported to CDC in 2010; lead exposure can lead to serious negative consequences for a child’s developing brain. http://blogs.edweek.org/edweek/early_years/2014/09/cdc_nearly_eight_in_10_children_miss_developmental

Here are the key findings from the CDC report:

Key Findings
Morbidity and Mortality Weekly Report published a supplement that examined the use of selected clinical preventive services among infants, children, and adolescents in the United States. This supplement indicates that millions of U.S. infants, children, and adolescents did not receive key clinical preventive services. Increased use of clinical preventive services could improve the health of infants, children, and adolescents and promote healthy lifestyles that will enable them to achieve their full potential.
Read the full article: Use of Selected Clinical Preventive Services to Improve Health of Infants, Children, and Adolescents¬¬ – United States, 1999-2011
Main Findings from this Report
Use of clinical preventive services among U.S. infants, children, and adolescents is not optimal. There are large disparities by demographics, geography, and healthcare coverage and access in the use of these services. This report provides a baseline snapshot of use of selected clinical preventive services for U.S. infants, children, and adolescents prior to 2012, before or shortly after implementation of the Affordable Care Act.
Report findings include:
• Breastfeeding: One in six (17%) pregnant women did not receive breastfeeding counseling during prenatal care visits in 2010.1
• Hearing: Half (50%) of infants who failed their hearing screening were not documented to have received testing needed to diagnose hearing loss during 2009–2010.2
• Child Development: In 2007, parents of almost eight in ten (79%) children aged 10–47 months were not asked by healthcare providers to complete a formal screen for developmental delays in the past year.3
• Lead Poisoning: Two-thirds (67%) of children aged 1–2 years were not tested for blood lead or results were not reported to CDC in 2010.4
• Vision: According to their parents, approximately one in five (22%) children aged 5 years never had their vision checked by a healthcare provider during 2009–2010. Approximately one in four children did not have their blood pressure measurement documented at clinic visits during 2009–2010.5
• Hypertension: Approximately one in four (24%) outpatient clinic visits for preventive care made by 3–17 year-olds during 2009–2010 had no documentation of blood pressure measurement.6
• Dental: In 2009, more than half (56%) of children and adolescents did not visit the dentist in the past year, and nearly nine of ten (86%) children and adolescents did not receive a dental sealant or a topical fluoride application in the past year.7
• Human Papillomavirus (HPV) Vaccination: Nearly half (47%) of female adolescents aged 13–17 years had not received their recommended first dose of HPV vaccine in 2011, and almost two-thirds (65%) had not received all three recommended vaccine doses.8
• Tobacco: Approximately one in three (31%) outpatient clinic visits made by 11–21 year-olds during 2004–2010 had no documentation of tobacco use status, and eight of ten (80%) of those who screened positive for tobacco use did not receive any cessation assistance.9
• Chlamydia: During 2006–2010, almost two-thirds (60%) of sexually active females aged 15–21 years did not receive chlamydia screening in the past year.10
• Reproductive Health: During 2006–2010, approximately one in four (24%) sexually experienced females aged 15–19 years and more than one in three (38%) sexually experienced males aged 15–19 years did not receive a reproductive health service from a healthcare provider in the past year.11
These findings come from the second of a series of periodic reports from CDC to monitor and report on progress made in increasing the use of clinical preventive services to improve population health. There are many important clinical preventive services for infants, children, and adolescents. Healthcare providers, parents, and guardians can find out more about the preventive care children need by visiting http://www.cdc.gov/prevention.
About this Study collapsed
Clinical Preventive Services collapsed
The Affordable Care Act collapsed
CDC’s Activities http://www.cdc.gov/childpreventiveservices/key-findings.html

See, Developmental Monitoring and Screening http://www.cdc.gov/ncbddd/childdevelopment/screening.html

The increased rate of poverty has profound implications if this society believes that ALL children have the right to a good basic education. Moi blogs about education issues so the reader could be perplexed sometimes because moi often writes about other things like nutrition, families, and personal responsibility issues. Why? The reader might ask? Because children will have the most success in school, if they are ready to learn. Ready to learn includes proper nutrition for a healthy body and the optimum situation for children is a healthy family. Many of societies’ problems would be lessened if the goal was a healthy child in a healthy family. There is a lot of economic stress in the country now because of unemployment and underemployment. Children feel the stress of their parents and they worry about how stable their family and living situation is.

A healthy child in a healthy family who attends a healthy school in a healthy neighborhood ©


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Study: When teachers overcompensate for prejudice

Location, location, location: Brookings study of education disparity based upon neighborhood https://drwilda.wordpress.com/2012/04/18/location-location-location-brookings-study-of-education-disparity-based-upon-neighborhood/

Jonathan Cohn’s ‘The Two Year Window’

Hard times are disrupting families https://drwilda.com/2011/12/11/hard-times-are-disrupting-families/

3rd world America: The link between poverty and education

3rd world America: Money changes everything https://drwilda.com/2012/02/11/3rd-world-america-money-changes-everything/

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Albert Einstein School of Medicine study: Abnormal breathing during sleep can lead to behavior problems in children

25 Mar

A physical examination is important for children to make sure that there are no health problems. The University of Arizona Department of Pediatrics has an excellent article which describes Pediatric History and Physical Examination  A physical examination is important to discover any problems which might affect a child’s ability to learn or which might affect the child’s future health.

Albert Einstein School of Medicine announced the study, “Sleep Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years.”

A study of more than 11,000 children followed for over six years has found that young children with sleep-disordered breathing are prone to developing behavioral difficulties such as hyperactivity and aggressiveness, as well as emotional symptoms and difficulty with peer relationships, according to researchers at Albert Einstein College of Medicine of Yeshiva University. Their study, the largest and most comprehensive of its kind, published online today

“This is the strongest evidence to date that snoring, mouth breathing, and apnea [abnormally long pauses in breathing during sleep] can have serious behavioral and social-emotional consequences for children,” said study leader Karen Bonuck, Ph.D., professor of family and social medicine and of obstetrics & gynecology and women’s health at Einstein. “Parents and pediatricians alike should be paying closer attention to sleep-disordered breathing in young children, perhaps as early as the first year of life.”

Sleep-disordered breathing (SDB) is a general term for breathing difficulties that occur during sleep. Its hallmarks are snoring (which is usually accompanied by mouth breathing) and sleep apnea. SDB reportedly peaks from two to six years of age, but also occurs in younger children. About 1 in 10 children snore regularly and 2 to 4 percent have sleep apnea, according to the American Academy of Otolaryngology–Health and Neck Surgery (AAO-HNS). Common causes of SDB are enlarged tonsils or adenoids.

“Until now, we really didn’t have strong evidence that SDB actually preceded problematic behavior such as hyperactivity,” said Ronald D. Chervin, M.D., M.S., a co-author of the study and professor of sleep medicine and of neurology at the University of Michigan. “Previous studies suggesting a possible connection between SDB symptoms and subsequent behavioral problems weren’t definitive, since they included only small numbers of patients, short follow-ups of a single SDB symptom, or limited control of variables such as low birth weight that could skew the results. But this study shows clearly that SDB symptoms do precede behavioral problems and strongly suggests that SDB symptoms are causing those problems.”

The new study analyzed the combined effects of snoring, apnea and mouth-breathing patterns on the behavior of children enrolled in the Avon Longitudinal Study of Parents and Children, a project based in the United Kingdom.

“We found that children with sleep-disordered breathing were from 40 to 100 percent more likely to develop neurobehavioral problems by age 7, compared with children without breathing problems….”

— Karen Bonuck, Ph.D.

“We found that children with sleep-disordered breathing were from 40 to 100 percent more likely to develop neurobehavioral problems by age 7, compared with children without breathing problems,” said Dr. Bonuck.  “The biggest increase was in hyperactivity, but we saw significant increases across all five behavioral measures.”

Children whose symptoms peaked early—at 6 or 18 months—were 40 percent and 50 percent more likely, respectively, to experience behavioral problems at age 7 compared with normally-breathing children. Children with the most serious behavioral problems were those with SDB symptoms that persisted throughout the evaluation period and became most severe at 30 months.

Researchers believe that SDB could cause behavioral problems by affecting the brain in several ways: decreasing oxygen levels and increasing carbon dioxide levels in the prefrontal cortex; interrupting the restorative processes of sleep; and disrupting the balance of various cellular and chemical. Behavioral problems resulting from these adverse effects on the brain include impairments in executive functioning (i.e., being able to to pay attention, plan ahead, and organize), the ability to suppress behavior, and the ability to self-regulate emotion and arousal.

“Although snoring and apnea are relatively common in children, pediatricians and family physicians do not routinely check for sleep-disordered breathing,” said Dr. Bonuck. “In many cases, the doctor will simply ask parents, ‘How is your child sleeping?’ Instead, physicians need to specifically ask parents whether their children are experiencing one or more of the symptoms—snoring, mouth breathing or apnea—of SDB.”

“As for parents,” said Dr. Bonuck, “if they suspect that their child is showing symptoms of SDB, they should ask their pediatrician or family physician if their child needs to be evaluated by an otolaryngologist (ear, nose and throat physician) or sleep specialist.”

According to the AAO-HNS, surgery is the first-line treatment for severe pediatric SDB in cases where the tonsils and adenoids are enlarged. Another option is weight loss for overweight or obese children.

Dr. Bonuck’s paper is titled “Sleep Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years.” In addition to Dr. Bonuck, other Einstein contributors were Katherine Freeman, Dr.P.H., and Linzhi Xu, Ph.D.

The study was supported by grants from the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.                                                 http://www.einstein.yu.edu/news/releases/771/kids-abnormal-breathing-during-sleep-linked-to-increased-risk-for-behavioral-difficulties/


Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at 4 and 7 Years


Karen Bonuck, PhDa, Katherine Freeman, DrPHb, Ronald D. Chervin, MD, MSc, and Linzhi Xu, PhDa

  1. 1.    Published online March 5, 2012(doi: 10.1542/peds.2011-1402)
  2. » AbstractFree
  3. Full Text (PDF)
  4. Supplemental Information

The Cincinnati Children’s Hospital describes the Process of the Physical Examination

Process of the Physical Exam

A thorough history often precedes the physical examination and allows the cardiology staff to determine the reason for referral, significant family and medical history, and symptomatic status with respect to the cardiovascular system.

The history also provides the first interaction of our staff with the patient’s family so that some familiarity can be achieved prior to the performance of the physical examination.

The history is likely to vary somewhat based not only on the age of the patient, but also on the reason for referral.

A detailed history also allows us to tailor the physical examination and, if needed, subsequent testing to deal precisely and thoroughly with the patient’s suspected problem.

The first portion of the physical examination is performed by the screening clinic nurse. Height, weight, blood pressure and oxygen saturation determinations are made in the clinic at the time of being checked into the examination room.

Although these tests are painless, on occasion smaller children are anxious at the performance of blood pressure and pulse oximetry.

Rarely, however, are these tests difficult to obtain. The physical examination performed by the physician can be broken down into three separate parts, all of which are important in the accurate assessment of the patient.

  • Observation: The simple act of observing a patient is often very revealing. Patients are observed for their general sense of distress / discomfort, possible associated abnormalities (for example, orthopedic deformities or Down syndrome) and for any more subtle abnormalities that might be a clue to more serious underlying heart disease, for example, cyanosis or chest asymmetry.
  • Palpation (examination by touching): Using the fingers and hands, the physician in the clinic can gain insight into peripheral circulation (arms and legs) as well as overall heart muscle performance. Signs of peripheral fluid buildup (edema) can also be noted.

The chest is often palpated to determine the location of the heart and its overall degree of activity.

Additionally, some murmurs often create a loud enough noise to be felt through the chest, and the location of these “thrills” can pinpoint a structural heart abnormality.

  • Auscultation (examination by listening): The final portion of the physical examination involves the use of the stethoscope to listen to various sounds that a heart makes.

During the auscultation process, valve closure and opening sounds are determined. We attempt to determine how many valve closure sounds there are, how loud they are, and where they are best heard.

Heart murmurs are characterized by timing in the heart cycle, loudness, pitch, and location. The entire chest and often the back are inspected with the stethoscope during this process.

In addition, extra sounds such as rubs, gallops and clicks are listened for. These, if present, can lead to a precise bedside diagnosis of a cardiac abnormality.

Finally, the lungs and abdomen are examined both by auscultation and palpation so as to determine position and size of abdominal organs, abnormal lung findings and possible murmurs in the abdomen or back.

During the course of the physical examination process, the pulse rate (heart rate) and respiratory rate are determined often by several observers.

The Albert Einstein study should be taken seriously because of the implications for future behavior issues of children. See, Babies’ snoring linked to later behavior problems . http://www.king5.com/health/childrens-healthlink/Babies-snoring-linked-to-later-behavior-problems–143398676.html

Our goal as a society should be:

A Healthy Child In A Healthy Family Who Attends A Healthy School In A Healthy Neighborhood. ©

Dr. Wilda says this about that ©