Thomas A. Roesler

Parental criticism and treatment outcome in adolescents hospitalized for severe, chronic asthma

This pilot study investigated the relationship between parental criticism and medical treatment outcome across an inpatient hospitalization in 19 adolescents with severe, chronic asthma. Parental criticism toward their asthmatic adolescent was assessed using the Five Minute Speech Sample technique (FMSS) at the beginning of the adolescents inpatient stay at a national asthma referral center. Those adolescents whose parents were rated as high in criticism on the FMSS were found to have greater improvement in their overall asthma severity, greater reduction in their steroid medication dose, and shorter lengths of stay in the hospital than those whose parents were rated as low in criticism. The adolescents whose parents were rated as high in criticism also showed lower compliance with their prescribed theophylline and oral steroid medication at admission than the low criticism group. These findings do not appear to be due to misdiagnosis secondary to the presence of vocal cord dysfunction or to the allergy status of the children. Clinical implications and possible causal mechanisms underlying these findings are discussed.

Posttraumatic distress in children and families after intubation

Background: Posttraumatic stress disorder symptoms are seen in children who have experienced significant trauma. Respiratory arrest with subsequent intubation can be associated with terror, helplessness, and the threat of death. Methods: Three case reports are presented where emergency intubation was followed by symptoms of psychologic distress in the intubated child and his or her family members. Results: Although the medical literature documents posttraumatic distress symptoms after other medical procedures, this is the first account of symptoms following intubation. Children and other family members were found to have symptoms of reexperiencing the traumatic event, avoidance of thoughts or feelings related to the intubation, and hyperarousal. Issues around diagnosis and treatment are discussed. Conclusions: Children with a history of emergency intubation should be evaluated for possible posttraumatic stress disorder symptoms.

Management of the Child Presenting With Allergy to Multiple Foods

dase in the biopsy tissue. Nevertheless, the child was placed on a 6-week trial of Vivonex (an elemental formula) , boiled potatoes, cranberry juice, and vegetable oil. No significant improvement was noted in his skin condition or gastrointestinal symptoms. The boy’s mother gave a history of restricting many foods from his diet. Specifically, she said he was allergic to eggs, milk, cheese, ice cream, chocolate, fish, yogurt, pea-