Because of parental interference, some pediatricians prefer examining children without parents nearby. Can inanimate, noninterfering attachment agents placate children during medical evaluations? Accompanied through random assignment by their mother, blanket, mother plus blanket, or no supportive agent, 64 blanket-attached or blanket-nonattached 3-year-olds underwent 4 routine medical procedures. Behavioral and physiological measures showed that mothers and blankets (for children attached to them) equally mitigated distress compared with no supportive agents. However, simultaneously presenting 2 attachment agents did not produce additive soothing effects. For comforting blanket-attached children during moderately upsetting medical procedures, blankets can function as appropriate maternal substitutes. Distress evidenced by children with no attachment agent demonstrates the undesirability of conducting medical examinations without supportive agents.
A 6-month-old infant had bullous lesions on his posterior neck, upper trunk, and extremities for two months prior to admission for fever and shock. He had an elevated white blood cell count with left shift and normal platelet count, but abnormal coagulation studies. He was treated with intravenous antibiotics, crystalloids, fresh-frozen plasma, and pressor agents. A histamine H2 receptor antagonist was started for guaiac-positive nasogastric tube drainage. The patient recovered after four days of treatment. A skin biopsy confirmed mastocytosis. A week later the child passed grossly bloody stools with blood clots. No source of gastrointestinal bleeding was identified by extensive work-up. Blood histamine level measured one day before gastrointestinal bleeding was 16,400 pg/ml (normal 263 +/- 202 pg/ml). The bleeding resolved spontaneously. The patient was maintained on cimetidine. Results of a subsequent bone scan were normal. Shock or gastrointestinal bleeding associated with unusual skin lesions should alert the pediatrician to the possibility of mastocytosis.
239 many other genetic syndromes. Prenatal diagnosis of hydronephrosis can be made in approximately 95 percent of the cases after 20 postmenstrual weeks.' 1982;100(6):943-6. 4. Wallace ME, Spickett SG. Hydronephrosis in mouse, rat, and man. J Med Genet 1967;4:73-9. 5. Johnton JH, Evans JP, Glassberg KI. Pelvic hydronephrosis in children: a review of 219 personal cases.
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