• Clinical and Experimental Pediatrics
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• v.52 no.2
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• pp.159-166
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• 2009

Purpose : Iron deficiency anemia (IDA) is one of the most common nutritional deficiencies in children on a weaning diet. We investigated weaning practices in infants and children, as well as their mothers' knowledge about weaning. Methods : We investigated 129 children with IDA and 166 without IDA (aged 6-36 months) who had visited 10 university hospitals between March 2006 and July 2007. We investigated the hematologic values of both groups. A questionnaire on weaning was answered by the mothers of these children. Results : The hematologic values in the IDA group showed a significant difference from those in the comparison group (P<0.05). Children who were solely breastfed until 6 months of age were 85%, 34% (P<0.05), and weaning was started by 6.3, 6.4 months, respectively (P>0.05). Rice gruel, boiled rice, and fruit juice accounted for approximately 80% of the starting foods in both groups (P>0.05). Only 40% of the children in the IDA group had a balanced diet within a month, versus 38% in the comparison group. In response to questions about the necessity of iron-fortified foods for breast-fed infants, less than 50% of mothers in both groups answered correctly. In the IDA group, 42% showed serum ferritin less than 10 ng/mL, while 92% showed serum MCV less than 72 fL. Conclusion : In conclusion, collection of information on history should be thorough for feeding and selective examinations for IDA in high-risk groups. Considering the adaptation period, we suggest beginning children on a weaning diet at 45 months. In addition, we need to educate mothers on weaning practice, especially on the necessity of iron-fortified foods for breast-fed infants.

• Clinical and Experimental Pediatrics
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• v.45 no.9
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• pp.1126-1133
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• 2002

Purpose : Prader-Willi syndrome(PWS) is a complex disorder affecting multisystems with characteristic clinical features. Its genetic basis is an expression defect in the paternally derived chromosome 15q11-q13. We analyzed the clinical features and genetic basis of PWS patients for early detection and treatment. Methods : We retrospectively studied 24 patients with PWS in Department of Pediatrics, Samsung Medical Center, from September 1997 to September 2001. We performed cytogenetic and molecular genetic techniques using high resolution GTG banding techniques, fluorescent in situ hybridization and methylation-specific PCR for CpG island of SNRPN gene region. Results : The average birth weight of PWS patients was $2.67{\pm}0.47kg$ and median age at diagnosis was 1.3 years. The average height and weight of PWS patients under one year at diagnostic time were located in a 3-10 percentile relatively, and a rapid weight gain was seen between two and six years. Feeding problems in infancy and neonatal hypotonia were the two most consistently positive major criteria in over 95% of the patients. In 18 of the 24 cases(75%), deletion of chromosome 15q11-q13 was demonstrated and one case among 18 had an unbalanced 14;15 translocation. In four cases without any cytogenetic abnormality, it may be considered as maternal uniparental disomy and the rest showed another findings. Conclusion : We suggest diagnostic testing for PWS in all infants/neonates with unexplained feeding problems and hypotonia. It is necessary for clinically suspicious patients to undergo an early genetic test. As the genetic basis of PWS was heterogenous and complex, further study is required.

• Clinical and Experimental Pediatrics
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• v.46 no.11
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• pp.1061-1066
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• 2003

Purpose : The rising prevalence of childhood obesity may be due to an energy imbalance between food intake and energy expenditure. Recently, consumption of beverages in children has increased. The aim of this study is to provide useful information for the prevention and the control of childhood obesity by assessment of variable beverage consumption. Methods : Fight hundred seventy seven children(M : F=1 : 1.02, mean age; 9.7 years) from two primary schools in Seoul in May 2003 were enrolled. Body mass index(BMI) was calculated and the degree of obesity was classified into normal, overweight and obese groups by BMI percentile. Parental BMI, socio-economic factor, 3-day dietary intake, calory intake and beverage intake were examined by questionnaires. We researched beverages and classified them into six categories, milk, other milk products, soda, sports beverage, other beverage. Results : The prevalence of obesity was 7.2%. The parental BMI of the obese group were higher than those of the other groups. There was no significant difference in birth weight, or parents' intellectual and economic levels between the obese group and the other groups. There was no significant difference in daily total calory intake between the obese group and the other groups. The obese group of 7-9 year-old-males was higher than the other groups in sodas, and sports beverages intake. The obese group of 10-12 year-old-males was higher than the other groups in total beverage intake and other beverage intakes. The obese group of 10-12 year-old-females was higher than the other groups in other milk products. Conclusion : Excessive intake of beverages is associated with childhood obesity. Efforts to decrease intake of beverages may be important approaches to counter the rise in the prevalence of obesity.

• Clinical and Experimental Pediatrics
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• v.50 no.5
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• pp.436-442
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• 2007

Purpose : To promote awareness and efforts by pediatricians to identity and prevent child abuse by investigation of characteristics of victim and types of injury caused by abuse. Methods : A retrospective study was performed with 20 patients who had been diagnosed or suspected as child abuse at Hallym University Hospital from January 1999 to December 2005. The medical records, radiologic documents, and social worker's notes were reviewed to investigate age, sex, visiting time, form of abuse, perpetrator, risk factor, and type of injury. Results : The mean age of the subjects was 2.8 years. Fourteen patients were between 0-1 years old, 2 patients between 1-6 years old, 3 patients between 7-12 years old, and 1 case over 13 years old. The ratio of male to female was 1:1. The majority of these patients (70%) visited via emergency department. Eight five percent of these patients reported with physical abuse, 5% psychological abuse, 5% sexual abuse, and 5% neglect respectively. The suspected perpetrator was the biological father in six cases, the biological mother in three cases, the stepmother in two cases, caregiver in one case, relatives in one case and "unknown" in six cases. Bruise and hematoma (80%) were the most common physical findings. Skull fractures were diagnosed in six cases, long bone fractures in two cases, hemoperitoneum in two cases, subdural hemorrhage in 10 cases, epidural hemorrhages in two cases, subarachnoidal hemorrhages in two cases, and retinal hemorrhages in five cases respectively. Seventeen cases required hospitalization and surgical operations performed were in nine cases. Four patients died and three patients had sequalae such as developmental delay and quadriplegia. Conclusion : Child abuse results in high mortality and morbidity in victims. Therefore early recognition and prevention is very important. Pediatricians should always suspect the possibilities of abuse in cases of fracture, intracranial hemorrhage, abdominal injury, or even any injury to the body. We recommend that the clinical investigation of suspicious children should include a full multidisciplinary social assessment, a skeletal survey and CT or MRI.

• Clinical and Experimental Pediatrics
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• v.46 no.1
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• pp.11-16
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• 2003

Purpose : Iron deficiency is still the most common nutrient deficient disorder despite the improvement in general health and nutrition. This study is designed to evaluate the dietary history of infants and young children with iron deficiency anemia(IDA) and the effects of nutritional counseling. Methods : This study was conducted on 120 children from 6 to 36 months of age with IDA. Their parents completed a questionnaire and took counsel for nutrition. IDA was defined as Hb <11.0 g/dL, ferritin <10 ng.mL or transferrin saturation <15%, or Hb increase >1 g/dL after iron preparation. The questionnaire consisted of their feeding patterns, weaning time and kinds of food. Results : In the 120 infants and young children aged from 6 to 36 months, the parents of 82 cases was counseled about nutrition. Fifty six infants among 82 cases have started weaning and the main foods of weaning were rice and/or rice gruel. Nutritional problems in weaning were that some children over one year of age were using a bottle, and parents restricted weaning food at will because of allergic disease or chronic disease. Most parents were satisfied with the nutritional counseling given from a clinical dietitian and showed good compliance. Conclusion : Many infants and young children with IDA were provided with non iron-fortified foods and made an inadequate wean. Most parents were satisfied with the nutritional counseling and showed good compliance. The need of dietary counseling was required for prevention and treatment of iron deficiency anemia because of inadequate weaning.

• Clinical and Experimental Pediatrics
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• v.52 no.5
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• pp.576-580
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• 2009

Purpose : Growth-promoting attempts are widespread in Korea, but little is known about their prevalence or associated factors. This study was designed to assess the prevalence of growth-promoting attempts among children visiting a university growth clinic. Methods : A questionnaire-based survey was carried out with 823 children (416 boys, 407 girls) who visited the growth clinic at Paik Hospital. Results : The mean age of the subjects was $10.4{\pm}2.6$ yr, and the height z-score was $-1.58{\pm}0.91$. Approximately 33.4% of the children had tried growth promotion. Among the height-gain methods, herbal medicine was the most frequently used (37.8%), followed by health-promoting supplements (37.1%), exercise or machine (3.0%), and growth hormone treatment (2.9 %). The mean age at which the parents began to worry about their children's height was 7.7 yr. The mean age at which they started height-gain methods was 8.9 yr for herbal medicine, 9.1 yr for health-promoting supplements, 9.4 yr for exercise or machine, and 9.9 yr for growth hormone treatment. Motivating factors included advice from relatives or friends (36.0%), advertisements in the Internet or newspaper (28.4%), advice from pharmacist (16.8%), and advice from their medical doctor (5.5%). The degree of satisfaction from the height-gain methods was 29.1% with growth hormone treatment, 6.6% with exercise or machine, 6.4% with herbal medicine, and 2.8% with growth-promoting supplements. Conclusion : Approximately one third of the children reported use of growth-promoting methods, but the satisfaction rate was not high. The benefits of growth-promoting methods should be carefully weighed against their costs and side effects.

• Clinical and Experimental Pediatrics
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• v.48 no.2
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• pp.191-196
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• 2005

Purpose : Short stature is one of the characteristic features of Turner syndrome. We investigated the factors affecting final adult height(FAH) in patients with Turner syndrome. Methods : The study group was comprised of 60 patients who were diagnosed with Turner syndrome by chromosomal study and clinical phenotypes and attained FAH. Data were obtained from retrospective review of the medical records. We analyzed the factors influencing FAH in growth hormone(GH) treated and GH untreated groups. Results : Sixty patients were enrolled; 48 patients received GH treatment, and 12 patients did not. Mean duration of GH treatment was 35.8 months(range 4 to 120 months), and mean dosage of GH was $0.8{\pm}0.2IU/kg/wk$ in GH treated group. Mean growth velocity was $5.6{\pm}2.0cm/yr$, which was significantly higher than that during pretreatment period. In the GH treated group, mean chronological age, bone age, mean height, and height standard deviation(SD) score at GH treatment were $12.2{\pm}2.7yr$ $10.3{\pm}2.5yr$ $127.5{\pm}10.1cm$ and $-3.1{\pm}1.1$, respectively. In the GH treated group, the mean FAH and SD score of FAH were $146.9{\pm}5.8cm$ and $-2.7{\pm}1.2$, respectively, which showed significant differences compared with those of the GH untreated group. Analyzing the factors affecting FAH in GH-treated patients, only the SD score of height at the time of treatment was significantly related to FAH. Conclusion : GH treatment leads to an increment in FAH in patients with Turner syndrome. Average FAH gain was as much as 5.8 cm. SD score of height at the time of GH treatment was the only factor influencing FAH.

• Clinical and Experimental Pediatrics
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• v.45 no.11
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• pp.1340-1345
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• 2002

Purpose : We studied the prevalence of snoring and its association with diseases, obesity and environmental factors, as well as sleep disturbance arising from snoring, in school-aged children. Methods : The survey was performed by a special questionnaire on 1,707 children at elementary schools from 1 to 30 July 2001 in Gwangju City. The prevalence of snoring, associated factors, and sleep disturbance were evaluated. Results : 266(16.5%) of the children snored at least once a week. 73(4.3%) of the children snored almost every day. Regarding the associated factors of snoring : There was a statistically significant difference between snoring and nonsnoring groups due to gender, obesity, sinusitis, tonsillar hypertrophy, bronchial asthma and allergic rhinitis. Of them, male gender, tonsillar hypertrophy, and obesity were significant risk factors for development of snoring. Especially, the odds ratio increased to 1.048(CI, 1.004-1.659), 1.748(CI, 1.175-2.599), and 2.266(CI, 1.300-3.950) in children with an obesity index of 20-29%, 30-49%, ${\geq}50%$, respectively. There was a statistically significant association of snoring with decreased sleep duration, sleep talking, and drowsiness during the day as a result of sleep disturbance. Conclusion : 16.5% of school-aged children snored at least once a week. The association of snoring with tonsillar hypertrophy, obesity and gender as risk factors was demonstrated in this study.

• Clinical and Experimental Pediatrics
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• v.50 no.2
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• pp.138-142
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• 2007

Purpose : The purpose of this study is to find out the changing pattern of drug or foreign body ingestion between 1990s and 2000s in Wonju Christian Hospital, which is located in one of the most rapidly urbanizing cities in Korea. Methods : We retrospectively reviewed the medical records of patients with acute drug intoxication and foreign body ingestion from January 1991 to December 1994 and from January 2001 to December 2004. We performed clinical analysis and compared the results of the 1990s and 2000s. Results : There were 43 cases of acute drug intoxication in the 1990s, and 35 cases in the 2000s. Foreign body ingestion was 47 cases in the 1990s and 22 cases in the 2000s. The ingested foreign bodies were chiefly coins (46.8 percent), Weiqi chips (14.9 percent), plastic toys (6.4 percent) and others (31.9 percent) in the 1990s. In the 2000s, others (58.2 percent) were the most commonly ingested foreign body with mercury batteries (23.8 percent), nails (9 percent), pins (9 percent) following. The most common cause of drug intoxication was medical drugs (37.2 percent) others (23.2 percent), agricultural agents (13.9 percent), carbon monoxide (11.6 percent), rodenticide (9.3 percent), insecticide (9.3 percent) in the 1990s. In the 2000s the most common causes were others (34.3 percent), medical drug (31.4 percent), agriculture agents (20 percent), detergent (11.4 percent), insecticide (2.9 percent) and carbon monoxide (2.9 percent). The highest incidence age group was the 1-3 year old group, both in acute drug intoxication and foreign body ingestion. There were no changes in the incidence age group between the 1990s and the 2000s. Conclusion : There were some significant changes in the cause of acute drug intoxication and foreign body ingestion between the 1990s and 2000s. New education programs for preventing acute drug intoxication and foreign body ingestion are important and necessary.

• Clinical and Experimental Pediatrics
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• v.45 no.10
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• pp.1234-1240
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• 2002

Purpose : This study was carried out to obtain the vaccination rate and age appropriateness of vaccination in children under five years of age in Jeonbuk province. Methods : Eight hundred and fifty infants and children were enrolled in this study. Vaccination rate(Number of vaccinees/Number of subjects), places of vaccination, age appropriateness of vacination were examined by either vaccine record review or interview with parents or guardians. Results : The salient features of the findings were as follows : All subjects were aged under five and mostly under two years of age(68.8%). Places of vaccination were health centers or subcenters( 50.4%), private clinics(44.3%), and general hospitals(5.3%). Routine vaccinations such as BCG, hepatitis B vaccine(HBV), diphtheria, tetanus, acellular pertussis(DTaP) and Trivalent Oral Polio Vaccine(TOPV), measles, mumps, rubella(MMR), and Japaneses B encephalitis(JBE) were vaccinated mostly in health centers or subcenters, while chickenpox(CHP) and haemophilus influenzae vaccines(Hib), which are not routine in Korea, were vaccinated in private clinics. The vaccination rates of BCG(99.2%), HBV(93.5%) and DTaP(96.1%) were very high. But those of MMR(83.7%), CHP(72.5%), JBE(50.2%), and Hib(15.8%) were lower than expected. Considering the age appropriateness of vaccination, some infants and children were not appropriately vaccinated(vaccination rate/age appropriateness of vaccine; HBV, 93.5%/88.4% : DTaP, 94.6%/73.1% : JBE, 50.2%/ 18.5%). Conclusion : The vaccination rate of BCG, HBV, DTaP and TOPV was very high, but MMR, CHP, JBE, and Hib vaccination rate was not high enough to be able to protect against epidemic. We should pay more attention to vaccinating children, and there is a need for a program that will enhance coverage for vaccines.