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1. MakaleBaşlık : A group treatment approach to failure to toilet train: the case of Max. Yazarlar : Stadtler AC, Burke P Adres : Children's Hospital, Medical Diagnostic Clinics, Boston, MA 02115, USA. Kaynak : Clin Excell Nurse Pract. 1998 Mar;2(2):83-7. Özet : Toilet training is a major developmental milestone for children and parents. Accurate statistics on the prevalence of toilet-training failure do not exist; however, it is estimated that approximately 4% of 4-year-olds are not bowel trained. A number of biopsychosocial and developmental factors can interfere with toilet training. Frequently, a cycle of withholding and constipation with painful bowel movements and/or overflow incontinence ensues. A case study of a 4-year-old boy with encopresis and pervasive developmental disorder will highlight an interdisciplinary team's approach to helping children (4-6 years old) toilet train. Along with individual patient care management, parents and children attended (separately) a six-session medical and psychoeducational group called "Toilet School." This group model employs the principles of behavior modification, the concepts of children's preoperational thinking, and a philosophy of care that values collaborative relationships between caregivers and families.
2. MakaleBaşlık :Portable biofeedback apparatus for treatment of anal sphincter dystonia in childhood soiling and constipation. Yazarlar :Griffiths P, Dunn S, Evans A, Smith D, Bradnam M Adres :Department of Psychology, University of Stirling, Glasgow, UK. pvg1@stir.ac.uk Kaynak :J Med Eng Technol 1999 May-Jun;23(3):96-101 Özet : Biofeedback is an effective treatment for anal sphincter dysfunction in many cases of childhood constipation and soiling. Conventional methodologies centre on clinic-based manometric apparatus but are compromised by equipment being thinly available and practice sessions often infrequent. To counter these shortcomings, we have designed a portable anorectal biofeedback apparatus (the Easograph) for domiciliary use. It can be lent to families, enabling carers to mediate what is an intrinsically sensitive procedure. In this paper, we provide a technical description of the device which is based on an inexpensive pressure transducer. Casework experience suggests it is reliable in operation and readily understood by users. In a pilot study of eight patients treated with the apparatus, five achieved bowel continence after lifelong soiling in one to eight weeks of daily practice. We believe this is an innovative approach that has good potential for treating faecal retentive and expulsive disorders in childhood associated with poor anal sphincter control.
3.MakaleBaşlık : Encopresis in the child with a behavioral disorder: when the initial treatment does not work.Yazarlar : Buttross S Addres : Division of Child Development, University of Mississippi Medical Center, Jackson 39216, USA Kaynak : Pediatr Ann 1999 May;28(5):317-21Özet : Behavioral disorders occur more commonly in children who fail the initial standard treatment protocol of cathartics and designated toileting time. Whether such disorders are causally related or the result of encopresis, these children require a much more intensive, multimodal therapy. Treatment failures should have an in-depth history that reviews the potential developmental, emotional, behavioral, and psychosocial issues that may be causative. Use of the treatment protocols that have been outlined in this article can be time-consuming and will often require the help of a behavioral therapist. However, if they are successfully implemented, research shows that positive behavioral changes frequently occur in the child. The pediatrician can be instrumental in preventing long-term family, emotional, and social consequences by aggressively treating these difficult cases.
4.MakaleBaşlık : Constipation in school-aged children at public schools in Rio de Janeiro, Brazil.Yazarlar : de Araujo Sant'Anna AM, Calcado AC Addres : Faculty of Medicine, Department of Pediatrics, State University of Rio de Janeiro, Brazil. Kaynak :J Pediatr Gastroenterol Nutr 1999 Aug;29(2):190-3 Özet : BACKGROUND: Constipation in childhood is a significant problem worldwide; however, understanding of its epidemiology is limited. Some investigators in the United States have estimated the prevalence of constipation to be 1.2% to 8.0% in the general population. In Brazil, some have found a prevalence of up to 36%. METHODS: This cross-sectional, descriptive, observational prevalence study included 391 pupils (age range, 8-10 years) who were attending three public education centers in Rio de Janeiro. The prevalence of constipation, associated symptoms, and dietary fiber intake were evaluated by questionnaire. A child was considered to be constipated when he or she reported difficulty in defecating two or more times per week. The children were divided into constipated and nonconstipated groups, and the presence of fecal soiling, blood in the feces, and shape of the feces were assessed. RESULTS: Twenty-eight percent of the children were constipated. There was no significant difference between the sexes. Blood in the stools was significantly more frequently reported by the constipated children (p < 0.01). There was no significant difference in the prevalence and frequency of fecal soiling or in the stool shape between the constipated and nonconstipated children (p > 0.1). Fiber content in the diet ranged from 3.4 to 4.8 g per day, which is below the range recommended. CONCLUSIONS: The prevalence of constipation in Rio de Janeiro is similar to the rates reported in all of Brazil and in a recent study from the United Kingdom but is much higher than that in the United States. In addition, the school menu was found to contain inadequate dietary fiber content.
5. MakaleBaşlık : Measurement of low dietary fiber intake as a risk factor for chronic constipation in children. Address : Morais MB, Vitolo MR, Aguirre AN, Fagundes-Neto U. Kaynak :J Pediatr Gastroenterol Nutr 1999 Aug;29(2):132-5 Özet : BACKGROUND: Scarce information exists regarding dietary fiber intake in children with chronic constipation. The objective of this case-control study was to evaluate the intake of fiber as a risk factor for chronic constipation. METHODS: Fifty-two children with a mean age of 6.8+/-3.2 years who had chronic constipation were age and gender matched with 52 children with normal intestinal habits. The fiber content of the diet was evaluated with a 24-hour dietary recall. Two tables of fiber composition in foods were used: a Brazilian table, and a table based on the method of the Association of Official Agricultural Chemists (AOAC). RESULTS: According to the Brazilian table, the median intake of fiber (in grams per day) by the constipated and the control groups was 13.8 and 17.3, respectively, for total fiber (p = 0.020), 6.8 and 9.7 for insoluble fiber (p = 0.004), and 6.5 and 7.6 for soluble fiber (p = 0.104). According to the AOAC table, the constipation group (9.7 g/day) also had lower (p = 0.0022) intake of total fiber than the control group (12.6 g/day). The coefficient of correlation between the two tables on fiber content of food was +0.82 (p < 0.001) in the constipation group and +0.86 (p < 0.001) in the control group. The intake of fiber was less than the minimum recommendation (age + 5 g) and statistically associated (p = 0.001) with the constipation group (75.0%) in comparison with the controls (42.5%). The odds ratio was 4.1 (95% confidence limits, 1.64-10.32). CONCLUSION: Intake of fiber below the minimum recommendation is a risk factor for chronic constipation in children.
6. MakaleBaşlık : To do or not to do? That is the question. Pediatric constipation. Yazarlar : Parker PH Address : Division of Pediatric Gastroenterology, University of Mississippi Medical Center, Jackson 39216, USA Kaynak :Pediatr Ann 1999 May;28(5):283-90
7. MakaleBaşlık : Rectal biopsy in the investigation of constipation. Yazarlar : Wilschanski M, Faber J, Goldberg M, Branski D Kaynak :Arch Dis Child 1999 Aug;81(2):189