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Leung AKC, Wong AHC, Hon KL. Childhood Obesity: An Updated Review. Curr Pediatr Rev 2024; 20:2-26. [PMID: 35927921 DOI: 10.2174/1573396318666220801093225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/05/2022] [Accepted: 05/19/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Childhood obesity is an important and serious public health problem worldwide. OBJECTIVE This article aims to familiarize physicians with the evaluation, management, and prevention of childhood. METHODS A PubMed search was conducted in May, 2021, in Clinical Queries using the key terms "obesity" OR "obese". The search included clinical trials, randomized controlled trials, case-control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to English literature and children. The information retrieved from the above search was used in the compilation of the present article. RESULTS Most obese children have exogenous obesity characterized by a growth rate for height above the 50th percentile, normal intelligence, normal genitalia, and lack of historical or physical evidence of an endocrine abnormality or a congenital syndrome. Obese children are at risk for dyslipidemia, hypertension, diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, psychosocial disturbances, impaired quality of life, and shorter life expectancy. The multitude of serious comorbidities necessitates effective treatment modalities. Dietary modification, therapeutic exercise, and behavioral modification are the fundamentals of treatment. Pharmacotherapy and/or bariatric surgery should be considered for obese individuals who do not respond to the above measures and suffer from a serious comorbid condition. CONCLUSION Childhood obesity, once established, is often refractory to treatment. Most treatment programs lead to a brief period of weight loss, followed by rapid re-accumulation of the lost weight after the termination of therapy. As such, preventive activity is the key to solving the problem of childhood obesity. Childhood obesity can be prevented by promoting a healthy diet, regular physical activity, and lifestyle modification. Parents should be encouraged to get involved in school and community programs that improve their children's nutritional status and physical activity.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, China
- Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong, China
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Liu G, Lu W, Qiu J, Shi L. Identifying individuals with attention‐deficit/hyperactivity disorder based on multisite resting‐state functional magnetic resonance imaging: A radiomics analysis. Hum Brain Mapp 2023; 44:3433-3445. [PMID: 36971664 PMCID: PMC10171499 DOI: 10.1002/hbm.26290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/17/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders, characterized by symptoms of age-inappropriate inattention, hyperactivity, and impulsivity. Apart from behavioral symptoms investigated by psychiatric methods, there is no standard biological test to diagnose ADHD. This study aimed to explore whether the radiomics features based on resting-state functional magnetic resonance (rs-fMRI) have more discriminative power for the diagnosis of ADHD. The rs-fMRI of 187 subjects with ADHD and 187 healthy controls were collected from 5 sites of ADHD-200 Consortium. A total of four preprocessed rs-fMRI images including regional homogeneity (ReHo), amplitude of low-frequency fluctuation (ALFF), voxel-mirrored homotopic connectivity (VMHC) and network degree centrality (DC) were used in this study. From each of the four images, we extracted 93 radiomics features within each of 116 automated anatomical labeling brain areas, resulting in a total of 43,152 features for each subject. After dimension reduction and feature selection, 19 radiomics features were retained (5 from ALFF, 9 from ReHo, 3 from VMHC and 2 from DC). By training and optimizing a support vector machine model using the retained features of training dataset, we achieved the accuracy of 76.3% and 77.0% (areas under curve = 0.811 and 0.797) in the training and testing datasets, respectively. Our findings demonstrate that radiomics can be a novel strategy for fully utilizing rs-fMRI information to distinguish ADHD from healthy controls. The rs-fMRI-based radiomics features have the potential to be neuroimaging biomarkers for ADHD.
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Xiong Z, Yan J, Shi S. Val158Met polymorphisms of COMT gene and serum concentrations of catecholaminergic neurotransmitters of ADHD in Chinese children and adolescents. Medicine (Baltimore) 2021; 100:e27867. [PMID: 34889236 PMCID: PMC8663844 DOI: 10.1097/md.0000000000027867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/19/2021] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT This study analyzed the Val158Met polymorphisms of the catechol-O-methyltransferase (COMT) gene and serum concentrations of catecholaminergic neurotransmitters in attention deficit hyperactivity disorder (ADHD) children and adolescents.All the subjects (180 paired ADHD and non-ADHD children and adolescents) were genotyped for the Val158Met polymorphisms of the COMT gene, and determined by the difference of dopamine and noradrenalin from a 1:1 paired case-control study.The frequencies of methionine (A)/A, valine (G)/A, and G/G were 51.67%, 41.11%, and 7.22% in the case group, and 62.22%, 31.11%, and 6.67% in the control group. There was a significant difference in the distribution of all genotypes of the COMT gene between the 2 groups (odds ratio = 1.85, 95% confidence interval: 1.62-2.08; χ2 = 7.80, P < .05). The serum concentrations of dopamine and noradrenalin were 1.42 ± 0.34 ng/mL and 177.70 ± 37.92 pg/mL in the case group, and 1.94 ± 0.42 ng/mL and 206.20 ± 42.45 pg/mL in the control group. There were the significant differences in the levels of dopamine and noradrenalin between the 2 groups (dopamine: t = 4.30, P < .01; noradrenalin: t = 2.24, P < .05).Our study suggested that the Val158Met polymorphisms of the COMT gene and serum concentrations of catecholaminergic neurotransmitters were associated with ADHD children and adolescents.
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Affiliation(s)
- Zhonggui Xiong
- Department of Child Health, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Jiong Yan
- Department of Child Health, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Shuhua Shi
- Department of Maternal and Child Health, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Treatment with Methylphenidate for Attention Deficit Hyperactivity Disorder (ADHD) and the Risk of All-Cause Poisoning in Children and Adolescents: A Self-Controlled Case Series Study. CNS Drugs 2021; 35:769-779. [PMID: 34283391 PMCID: PMC8310501 DOI: 10.1007/s40263-021-00824-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 10/26/2022]
Abstract
BACKGROUND Children and adolescents with attention deficit hyperactivity disorder (ADHD) are at higher risk of all-cause poisoning by drugs and chemicals (intentional or accidental). Currently, there is limited data on whether medication treatment for ADHD can reduce the risk of all-cause poisoning. METHODS Patients aged 5-18 years with a methylphenidate (MPH) prescription and an incident poisoning diagnosis between January 2001 and June 2020 were identified from the Hong Kong Clinical Data Analysis and Reporting System. A self-controlled case series study design was used to compare the incidence rate ratios (IRRs) of all-cause poisoning during different risk windows (30 days before the first MPH prescription, exposure periods within 30 days of the first prescription, and periods of subsequent exposure) compared with the reference window (other non-exposure periods). RESULTS 42,203 patients were prescribed ADHD medication in Hong Kong during the study period. Of these, 417 patients who had both an MPH prescription and poisoning incident recorded were included in the main analysis. Compared with other non-exposed periods, a higher risk of poisoning was found in the 30 days before the first prescription (IRR 2.64, 95% confidence interval [CI] 1.33-5.22) and exposure periods within 30 days of the first prescription (IRR 2.18, 95% CI 1.06-4.48), but not during prolonged exposure. However, compared with 30 days before the first prescription as well as exposure periods within 30 days of the first prescription, there was a lower risk during the subsequent exposure (IRRs 0.49 and 0.60, respectively). Similar results to the main analysis were also found in the subgroup analysis of intentional poisoning and females, but not in that of accidental poisoning and males. CONCLUSIONS The risk of all-cause poisoning was higher shortly before and after the first MPH prescription and became lower during the subsequent prescription period. Our results do not support an association between the use of MPH and an increased risk of all-cause poisoning in children and adolescents and, in fact, suggest that longer-term use of MPH may be associated with a lower risk of all-cause poisoning, although this latter finding requires further study.
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Zamorano F, Kausel L, Albornoz C, Lavin C, Figueroa-Vargas A, Stecher X, Aragón-Caqueo D, Carrasco X, Aboitiz F, Billeke P. Lateral Prefrontal Theta Oscillations Reflect Proactive Cognitive Control Impairment in Males With Attention Deficit Hyperactivity Disorder. Front Syst Neurosci 2020; 14:37. [PMID: 32625068 PMCID: PMC7314966 DOI: 10.3389/fnsys.2020.00037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/22/2020] [Indexed: 12/11/2022] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is a common neuropsychiatric disorder in which children present prefrontal cortex (PFC) related functions deficit. Proactive cognitive control is a process that anticipates the requirement of cognitive control and crucially depends on the maturity of the PFC. Since this process is important to ADHD symptomatology, we here test the hypothesis that children with ADHD have proactive cognitive control impairments and that these impairments are reflected in the PFC oscillatory activity. We recorded EEG signals from 29 male children with ADHD and 25 typically developing (TD) male children while they performed a Go-Nogo task, where the likelihood of a Nogo stimulus increased while a sequence of consecutive Go stimuli elapsed. TD children showed proactive cognitive control by increasing their reaction time (RT) concerning the number of preceding Go stimuli, whereas children with ADHD did not. This adaptation was related to modulations in both P3a potential and lateral prefrontal theta oscillation for TD children. Children with ADHD as a group did not demonstrate either P3a or theta modulation. But, individual variation in theta activity was correlated with the ADHD symptomatology. The results depict a neurobiological mechanism of proactive cognitive control impairments in children with ADHD.
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Affiliation(s)
- Francisco Zamorano
- Laboratorio de Neurociencia Social y Neuromodulación, Centro de Investigación en Complejidad Social (neuroCICS), Universidad del Desarrollo, Santiago, Chile.,Unidad de Imágenes Cuantitativas Avanzadas, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.,Departamento de Imágenes, Clínica Alemana, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Leonie Kausel
- Centro Interdisciplinario de Neurociencias, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Albornoz
- Facultad de Economía y Negocios, Universidad del Desarrollo, Santiago, Chile
| | - Claudio Lavin
- Centro Interdisciplinario de Neurociencias, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Figueroa-Vargas
- Laboratorio de Neurociencia Social y Neuromodulación, Centro de Investigación en Complejidad Social (neuroCICS), Universidad del Desarrollo, Santiago, Chile
| | - Ximena Stecher
- Unidad de Imágenes Cuantitativas Avanzadas, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile.,Departamento de Imágenes, Clínica Alemana, Facultad de Medicina, Universidad del Desarrollo, Santiago, Chile
| | | | - Ximena Carrasco
- Laboratorio de Neurociencias Cognitivas, Departamento de Psiquiatría, Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Aboitiz
- Centro Interdisciplinario de Neurociencias, Pontificia Universidad Católica de Chile, Santiago, Chile.,Laboratorio de Neurociencias Cognitivas, Departamento de Psiquiatría, Centro Interdisciplinario de Neurociencia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Billeke
- Laboratorio de Neurociencia Social y Neuromodulación, Centro de Investigación en Complejidad Social (neuroCICS), Universidad del Desarrollo, Santiago, Chile
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Leung AKC, Leung AAM, Wong AHC, Hon KL. Sleep Terrors: An Updated Review. Curr Pediatr Rev 2020; 16:176-182. [PMID: 31612833 PMCID: PMC8193803 DOI: 10.2174/1573396315666191014152136] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/12/2019] [Accepted: 09/21/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Sleep terrors are common, frightening, but fortunately benign events. Familiarity with this condition is important so that an accurate diagnosis can be made. OBJECTIVE To familiarize physicians with the clinical manifestations, diagnosis, and management of children with sleep terrors. METHODS A PubMed search was completed in Clinical Queries using the key terms "sleep terrors" OR "night terrors". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS It is estimated that sleep terrors occur in 1 to 6.5% of children 1 to 12 years of age. Sleep terrors typically occur in children between 4 and 12 years of age, with a peak between 5 and 7 years of age. The exact etiology is not known. Developmental, environmental, organic, psychological, and genetic factors have been identified as a potential cause of sleep terrors. Sleep terrors tend to occur within the first three hours of the major sleep episode, during arousal from stage three or four non-rapid eye movement (NREM) sleep. In a typical attack, the child awakens abruptly from sleep, sits upright in bed or jumps out of bed, screams in terror and intense fear, is panicky, and has a frightened expression. The child is confused and incoherent: verbalization is generally present but disorganized. Autonomic hyperactivity is manifested by tachycardia, tachypnea, diaphoresis, flushed face, dilated pupils, agitation, tremulousness, and increased muscle tone. The child is difficult to arouse and console and may express feelings of anxiety or doom. In the majority of cases, the patient does not awaken fully and settles back to quiet and deep sleep. There is retrograde amnesia for the attack the following morning. Attempts to interrupt a sleep terror episode should be avoided. As sleep deprivation can predispose to sleep terrors, it is important that the child has good sleep hygiene and an appropriate sleeping environment. Medical intervention is usually not necessary, but clonazepam may be considered on a short-term basis at bedtime if sleep terrors are frequent and severe or are associated with functional impairment, such as fatigue, daytime sleepiness, and distress. Anticipatory awakening, performed approximately half an hour before the child is most likely to experience a sleep terror episode, is often effective for the treatment of frequently occurring sleep terrors. CONCLUSION Most children outgrow the disorder by late adolescence. In the majority of cases, there is no specific treatment other than reassurance and parental education. Underlying conditions, however, should be treated if possible and precipitating factors should be avoided.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary and The Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Amy A M Leung
- Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong,Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong
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Altered microRNA 5692b and microRNA let-7d expression levels in children and adolescents with attention deficit hyperactivity disorder. J Psychiatr Res 2019; 115:158-164. [PMID: 31146084 DOI: 10.1016/j.jpsychires.2019.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/19/2019] [Accepted: 05/20/2019] [Indexed: 11/22/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder. Its etiology is not clearly understood yet, but neurobiological, genetic and environmental factors are shown to play a role. The relationship between ADHD and miRNAs has been studied quite recently, and few studies have been conducted up to now. In this study, peripheral blood expression levels of miR-5692b, miR-let-7d, miR-124-3p, miR-4447 and miR-107 of 30 children and adolescents with combined type ADHD were compared to 30 healthy controls to understand the roles of these miRNAs in the ADHD etiopathogenesis. Compared to controls, levels of miR-5692b (p = 0.006) were found higher and levels of miR-let-7d (p = 0.017) were found lower in the ADHD group. There was no significant difference in terms of miR-124-3p, miR-4447, and miR-107 levels between the groups. In conclusion, our findings support other studies suggesting the importance of miRNAs in the pathogenesis of ADHD. Regarding the regulatory role of miRNAs in gene regulation, their contribution to etiopathogenesis and heterogeneity of ADHD should be investigated further.
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Zhao Y, Cui D, Lu W, Li H, Zhang H, Qiu J. Aberrant gray matter volumes and functional connectivity in adolescent patients with ADHD. J Magn Reson Imaging 2019; 51:719-726. [DOI: 10.1002/jmri.26854] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Yue Zhao
- The Shandong University of Science and Technology Qingdao China
- Medical Engineering and Technology Research CenterShandong First Medical University (Shandong Academy of Medical Sciences) Taian China
| | - Dong Cui
- Institute of Biomedical EngineeringChinese Academy of Medical Sciences & Peking Union Medical College Tianjin China
| | - Weizhao Lu
- Medical Engineering and Technology Research CenterShandong First Medical University (Shandong Academy of Medical Sciences) Taian China
- Radiology DepartmentShandong First Medical University (Shandong Academy of Medical Sciences) Taian China
| | - Hongyu Li
- The Shandong University of Science and Technology Qingdao China
| | - Huayu Zhang
- The Shandong University of Science and Technology Qingdao China
| | - Jianfeng Qiu
- Medical Engineering and Technology Research CenterShandong First Medical University (Shandong Academy of Medical Sciences) Taian China
- Radiology DepartmentShandong First Medical University (Shandong Academy of Medical Sciences) Taian China
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Abstract
Concussion, also referred to as mild traumatic brain injury (MTBI), is a common pediatric condition. This article reviews global perspectives on the epidemiology, treatment, and prognosis of concussion in children. A Pubmed search was conducted using Clinical Queries with the key terms "concussion" and "mild traumatic brain injury," and the search was limited to "children." The search strategy included meta-analyses, randomized controlled trials, clinical trials, and reviews. The majority of publications were from Canada and the United States. Prevalence estimates vary widely according to case definition and studied population. Due to under-reporting and to the widely varying definitions of concussion, it is difficult to estimate how common the condition is. Common causes of concussions include sports injuries, motor vehicle collisions, bicycle accidents, falls, and assaults. Diagnosis is mainly clinical. Because concussion results from a disturbance in brain function rather than structural injury, neuroimaging studies, such as computed tomography and magnetic resonance imaging, are not routinely recommended. Treatment generally involves physical and cognitive rest, with a gradual return to activities, whereas prolonged rest may actually worsen outcomes. Helmets when bicycling, skiing, snowboarding, motor biking, placing age limits on certain types of contact sports, and encouragement of fair play are recommended to decrease the impact of head injuries but they do not prevent concussions. Overall outcomes are generally favorable. The symptoms and signs of concussion usually resolve within 10 days; most patients recover in 48-72 hours. Global perspectives on management and prognosis are lacking. Concussions or MTBIs are common childhood injuries and the prognosis is good but information is predominantly from Canada and the USA. Research in other countries in particular low and middle income countries is vital to have a global perspective on MTBI.
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Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong; PICU, The Hong Kong Children's Hospital, Hong Kong.
| | - Alexander K C Leung
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Alcy R Torres
- Department of Pediatrics, Division of Child Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA
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Professionals' Perceptions: "Why is Lead Poisoning Prevalent in Lancaster County?". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16132281. [PMID: 31252687 PMCID: PMC6651429 DOI: 10.3390/ijerph16132281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/23/2019] [Accepted: 06/26/2019] [Indexed: 11/16/2022]
Abstract
Background: The prevalence of lead poisoning in children under the age of six years living in Lancaster County, Pennsylvania continues to be greater than the state-wide prevalence for this age group. This study aims to determine the factors that contribute to the high lead poisoning rates. Methods: For this qualitative study, the researchers recruited a convenience sample of professionals providing healthcare and social welfare services in the county. Researchers conducted in-depth interviews with participants. The research team audio recorded, transcribed verbatim, and analyzed each interview using NVivo 12 software. Results: The 16 interviewed participants identified factors that contribute to high lead poisoning rates including knowledge levels, housing status, and competing interests. Specifically, low knowledge levels, renting as opposed to home ownership, and having competing interests seemed to minimize the attention directed towards preventing lead poisoning. The experts offered recommendations to address the high lead poisoning rates including increasing lead knowledge levels of both community members and landlords, through creating and distributing health promotion material, enacting policies to empower renters, and systematically collaborating to streamline lead poisoning related information and services. Conclusions: Findings provide insights to factors that Lancaster can address to achieve a decrease in lead poisoning rates. This study provides information that can be utilized by public health professionals to develop appropriate interventions.
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Leung AKC, Hon KL. Pica: A Common Condition that is Commonly Missed - An Update Review. Curr Pediatr Rev 2019; 15:164-169. [PMID: 30868957 DOI: 10.2174/1573396315666190313163530] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/22/2019] [Accepted: 03/06/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pica is a common condition in childhood that is commonly missed. OBJECTIVE To familiarize physicians with the clinical evaluation and management of children with pica. METHODS A PubMed search was completed in Clinical Queries using the key term "pica" OR "dirteating". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS Pica refers to the persistent, compulsive craving for and the ingestion of substances usually considered inedible and the behavior is discordant with cultural practices and continues beyond the normal developmental phase of occasional indiscriminate and experimental mouthing and swallowing over a period of at least one month. The condition is more common among children in lower socioeconomic classes and those who are mentally handicapped or emotionally deprived. Pica is a significant cause of anemia and lead poisoning. Pica generally resolves in children of normal intelligence after they have been trained to discriminate between edible and inedible items and proper supervision is provided. While relief of family economic and housing difficulties is an adjunct, attention to the individual's emotional needs and stresses is of paramount importance. Children with iron deficiency anemia should be treated with iron replacement therapy. Complications such as gastrointestinal obstruction and lead poisoning should be promptly recognized and treated. CONCLUSION Pica is often an overlooked phenomenon and its association with iron deficiency and lead poisoning has been known for centuries. The underlying cause and complications should be treated if possible. Primary care physicians should be aware of pica and proactively seek information about pica in patients that belong to the high-risk groups.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, AB, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong
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