Karen Olness

Health, Neurologic, and Cognitive Status of HIV-Infected, Long-Surviving, and Antiretroviral-Naive Ugandan Children

OBJECTIVE. The purpose of this study was to assess the health status and school-age neurodevelopmental progress of antiretroviral treatment (ARVT)–naive, HIV-infected Ugandan children who had been followed as part of cohorts of children born to HIV-infected and -noninfected mothers between 1989 and 1993. METHODS. Twenty-eight children, aged 6 to 12 years, vertically infected with HIV-1 and never treated with ARVT were evaluated in terms of health status, neurologic, and psychometric testing. A randomly selected group of 42 seroreverters and 37 HIV-1 negative children who were age- and gender-matched and who had been followed in the same cohorts were evaluated also. The families studied were homogenous in their socioeconomic status. None of the mothers or children had received ARVT or been exposed to illicit drugs. RESULTS. The HIV-infected children showed significantly more evidence of acute malnutrition. They also had more illness, especially parotitis, otitis media, upper respiratory infections, and lymphadenopathy. However, they did not differ significantly in neurologic and cognitive assessments when compared with age- and gender-matched seroreverter and HIV-negative children. They were in the normal range with respect to neurologic and psychometric development measures. CONCLUSIONS.These children seem to represent a significant subgroup of HIV-infected child survivors for whom the progress of the disease is less aggressive throughout early life. Given the fact that many infants, especially in developing countries, continue to be born without the benefit of perinatal ARVT, there will likely continue to be many older HIV-infected children in the same situation as those described in this follow-up study. They will not have been recognized as being HIV-infected. It is important that such children be identified and offered access to ARVT and other appropriate support services.

The pediatrician and disaster preparedness

For decades, emergency planning for natural disasters, public health emergencies, workplace accidents, and other calamities has been the responsibility of government agencies on all levels and certain nongovernment organizations such as the American Red Cross. In the case of terrorism, however, entirely new approaches to emergency planning are under development for a variety of reasons. Terrorism preparedness is a highly specific component of general emergency preparedness. In addition to the unique pediatric issues involved in general emergency preparedness, terrorism preparedness must consider several additional issues, including the unique vulnerabilities of children to various agents as well as the limited availability of age- and weight-appropriate antidotes and treatments. Although children may respond more rapidly to therapeutic intervention, they are at the same time more susceptible to various agents and conditions and more likely to deteriorate if they are not monitored carefully. This article is designed to provide an overview of key issues for the pediatrician with respect to disaster, terrorism, and public health emergency preparedness. It is not intended to be a complete compendium of didactic content but rather offers an approach to what pediatricians need to know and how pediatricians must lend their expertise to enhance preparedness in every community. To become fully and optimally prepared, pediatricians need to become familiar with these key areas of emergency preparedness: unique aspects of children related to terrorism and other disasters; terrorism preparedness; mental health vulnerabilities and development of resiliency; managing family concerns about terrorism and disaster preparedness; office-based preparedness; hospital preparedness; community, government, and public health preparedness; and advocating for children and families in preparedness planning.

Effects on brain development leading to cognitive impairment: A worldwide epidemic

ABSTRACT. This article reviews causes of cognitive impairment in children with a focus on those in developing countries. The number of children with cognitive limitations is increasing, and for the majority there is little access to professional expertise. Causes include malnutrition, genetic diseases, infectious diseases such as meningitis, parasites, and cerebral malaria, in utero drug and alcohol exposure, newborn asphyxia, low birth weight, head injuries, and endocrine disorders. Many of these are preventable; however, resources for prevention are limited in most developing areas of the world. The challenge for this century is to encourage community leaders and government officials to take on the prevention of cognitive impairment as the highest priority for society. This article proposes that specialists in child behavior and development work with United Nations agencies to develop a “world cognitive impairment watch” to assess and assist each country annually in terms of risk factors, prevention programs, and early intervention programs.

The Use of Relaxation-mental Imagery (self-hypnosis) in the Management of 505 Pediatric Behavioral Encounters

This report assessed outcomes of hypnotherapeutic interventions for 505 children and adolescents seen by four pediatricians over a period of one year and followed from four months to two years. Presenting problems included enuresis, acute pain, chronic pain, asthma, habit disorders, obesity, encopresis, and anxiety. Using strict criteria for determination of problem resolution (e.g., all beds dry) and recognizing that some conditions were intrinsically chronic, the authors found that 51% of these children and adolescents achieved complete resolution of the presenting problem; an additional 32% achieved significant improvement, 9% showed initial or some improvement; and 7% demonstrated no apparent change or improvement. Children as young as three years of age effectively applied self-hypnosis techniques. In general, facility in self-hypnosis increased with age. There was an inverse correlation (p < 0.001) between clinical success and number of visits, suggesting that prediction of responsivity is possible after four visits or less.

Effects of self-induced mental imagery on autonomic reactivity in children

The purposes of this research study were: (1) to determine whether changes in cardiac rate, skin temperature, and/or electrodermal activity occur as children change mental imagery and (2) to determine whether such changes are related to age, sex, or other variables. Children who were evaluated in this study had no previous experience with hypnosis or biofeedback training and were in good health with no learning disabilities. Thirty-eight boys and 38 girls ranging in age from 5 to 15 years were studied in a comfortable setting with a constant room temperature and biofeedback equipment. A Procomp 5DX computer software unit was used to measure autonomic reactivity during baseline and mental processing periods. After baseline monitoring indicated stabilization of autonomic measures, each child was asked to think about being in a quiet, pleasant place for 120 seconds. Pulse rate, skin temperature, and electrodermal activity were recorded. A resting period followed, and each child was then asked to think about an exciting activity, such as a preferred sports activity, for another 120 seconds. At the end of this monitoring, each child was asked to describe what had been his/her mental imagery during the two monitoring periods. Data analysis used paired t tests and repeated measures analysis of variance. For all children, the pulse rates showed significant decreases (p<.001) during quiet and relaxing imagery and significant increases (p<.001) during active imagery. Skin temperatures increased significantly (p<.001) during quiet imagery and active imagery, whereas electrodermal activity decreased (p<.001) during active imagery. Observed changes did not relate to age or sex. The results confirm our clinical observations that deliberate changing of mental imagery by children results in immediate autonomic changes. Questions evolving from this study and similar studies done in adults are: (1) Do average-thinking processes impact on autonomic changes over long periods of time and (2) do these changes ultimately impact on health, such as cardiovascular status?

Self-hypnosis and biofeedback in the management of juvenile migraine

ABSTRACTSelf-hypnosis with and without biofeedback of peripheral temperature was used successfully in treating migraine headaches of 15 children who had not responded well to previous pharmacologic management. Case histories of 3 of these children are presented. Prospective research is needed to det

Chronic constipation in children: can it be managed by diet alone?

Chronic constipation is a common childhood problem. In a study of 60 children aged 2 to 12 years, a special diet that involved daily intake of raw bran and high-fiber foods and exclusion of milk and other constipating foods was found to be successful. Within six weeks, the problem resolved in all 60 patients. Milk and other restricted foods were returned slowly to the diet if they were found not to be a contributing factor to constipation. We believe our clinical observations support the prescription of a special diet for childhood constipation. For patients in whom specified organic causes have been excluded, we recommend a trial of this diet before other, more complex therapeutic efforts are undertaken. Implementation of the diet necessitates careful explanation to the child and family, as well as long-term follow-up.

Hypnotherapy in children: New approach to solving common pediatric problems

Physicians have long used the power of suggestion informally in their practice as a means of motivating patients and boosting compliance. Recent research shows that formal use of hypnosis can be a valuable primary or adjunctive therapy, especially in children. Children are more in touch with innate imagery processes than adults and consequently can learn and use self-hypnosis easily, particularly to control autonomic responses. Hypnotherapy has proven useful in habit and behavior disorders, psychophysiologic disorders, pain control, anxiety control, cellular growth, and chronic conditions. The cases reported here illustrate the effectiveness of this process in children. Before hypnotherapy can be used clinically, the physician should become certified by an association approved by the American Medical Association and know when hypnotherapy is indicated and how long it should be continued.

The effects of a stress management intervention in elementary school children.

Objective: This preliminary study tests the effectiveness of an elementary school-based stress management technique on anxiety symptoms and heart rate variability (HRV) in children. Methods: In this controlled prospective longitudinal study, children in third-grade classroom participated in a teacher-led daily 10-minute stress management intervention for 4 months. The control class teacher read from a childrens book for 10 minutes daily. A standardized anxiety scale and HRV (using computer biofeedback program) were measured before the 4-month intervention, immediately after, and 1 year later. Results: The intervention class showed significant improvement from baseline to the immediate postintervention period in total anxiety (N = 14, F = 12.95, p = .002), with 1-year follow-up scores maintaining improvement (N = 13, F = 5.88, p = .025). The intervention class had small improvement in HRV using the biofeedback program in the immediate postintervention period, with significant improvement at 1-year follow-up (N = 13, F = 10.61, p = .005). The control class showed no improvements. Qualitatively, children reported that the intervention was helpful during stressful times at school and at home, even after the study period. Conclusion: An elementary school-based short daily stress management intervention can decrease symptoms of anxiety, and improve HRV, a measure of relaxation. Ultimately, these children found this skill continued to help them cope better with everyday stressors.

State-of-the-Art Pediatric Hypnosis Training: Remodeling Curriculum and Refining Faculty Development

Training in pediatric hypnosis has been part of clinical hypnosis education in the United States since 1976. Workshops expanded over time and are now taught by highly experienced pediatric clinicians across the globe. In 1987, a small vanguard of North American faculty, academic pediatricians, and pediatric psychologists taught a 3-day pediatric hypnosis workshop at the national meeting of the Society for Developmental and Behavioral Pediatrics (SDBP). This model of annual tri-level concurrent workshops (introductory, intermediate, and advanced) was sponsored by the SDBP for 24 years. In 2009, the National Pediatric Hypnosis Training Institute (NPHTI) assembled, and in 2010, offered its first annual workshops. This article documents this history of pediatric hypnosis education and describes NPHTI’s remodeling and ongoing refinement toward a state-of-the-art curriculum with innovative methodology based upon (1) current research about adult experiential and small group learning; (2) design principles for presentations that maximize adult learning and memory; and (3) evaluations by participants and faculty. These underpinnings—including clinical training videos, individualized learning choices, emphasis on personalized, goal-oriented sessions, and advances in faculty selection, and ongoing development—are applicable to adult training models. Integration of developmental and self-regulation strategies may be more unique to pediatric hypnosis skills training programs. The conclusion proposes expansion of pediatric hypnosis education and elimination of related barriers toward goals that all children learn self-hypnosis (SH) for mind–body health.