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Background Opioid use is a significant national crisis impacting individuals struggling with addiction and their families. The majority of individuals who abuse opioids are of child-rearing age, and critical knowledge gaps remain regarding how this abuse impacts their offspring. Fortunately, treatment for opioid use disorders is available. The primary goal of this study was to evaluate both physical and psychiatric diagnoses of children who have at least 1 parent participating in a buprenorphine-assisted treatment program. Methods This retrospective study is based on chart review (January 1, 2010, through June 30, 2018). Children with parents receiving care in a buprenorphine clinic were identified and matched on sex, race, and age in a ratio of 1:5 with controls from the general pediatric clinic population. Data related to health outcomes were extracted from the medical records. Results Compared to controls (n = 120), children of parents receiving buprenorphine-assisted treatment (n = 24) were more likely to have been born premature (odds ratio [OR] = 3.3, P = .035), had jaundice after birth (OR = 2.7, P = .034), had enuresis/encopresis (P < .001), and had been the victims of abuse or neglect (OR = 19.7, P = .0005). Children of parents with opioid use disorders were also more likely to utilize emergency services (ie, being seen in the emergency department for fussiness; OR = 4.0, P = .046) and were less likely to be covered by private insurance compared to state-funded insurance (OR = 0.2, P = .0013). Conclusions Parental opioid use disorder impacts children. More research is needed to better describe long-term effects of treatment of parental opioid use on their offspring and to help design addiction treatment programs to support whole family units.

AIM: Paediatric bladder dysfunction, including daytime urinary incontinence and enuresis, is a common and distressing condition. Unfortunately, children with these symptoms are often on waitlists for several months. This treatment delay may significantly impact upon the child and family unit. This study aimed to quantify waiting times for children who had attended hospital outpatient clinics for symptoms of wetting. METHODS: A retrospective review was undertaken for patients who had been referred to The Royal Children's Hospital, Melbourne outpatient clinics for symptoms of wetting (with/without bowel symptoms). Data regarding the referral and triage pathway, up to the time of the first clinic appointment, were collected. These data were compared to a previous audit conducted in the same setting. RESULTS: A total of 101 clinic attendances were included in this study. The overall waiting time, from receipt of referral to the patient's first clinic attendance, was a median of 181 days (n = 94 valid responses; range 7-695). Wait times for patients with isolated symptoms of wetting were similar to patients with mixed bowel and bladder dysfunction (187 and 171.5 days, respectively). Most patients were triaged to the continence clinic (n = 68), whilst smaller proportions of patients were seen in the encopresis (n = 14), urology (n = 13), general medicine (n = 2), gastroenterology (n = 1) and nurse-led enuresis clinic (n = 3). CONCLUSIONS: The waiting times for patients with wetting generally exceeded 5 months. Alternative pathways for triage need to be explored to manage demand and improve wait times.

Objective To evaluate the characteristics of patients with NE. Design It is a cross-sectional study. Setting During the physical examination, we sought signs and symptoms of voiding disorders and comorbidities with precise questions posed to the patients and their parents. Further, we assessed family history and behavioral characteristics of patients. Analyses were conducted using the Microsoft Excel 2016 program. We used descriptive statistics to describe patients’ information. Patients We recruited 403 children with Noctunal Enuresis (NE) at the Services of Pediatrics, Campus Bio-Medico University Hospital of Rome between June 2013 and July 2018. We rejected 2 children respectively with a renal agenesis and a chromosomopathy and we enrolled 401 patients, 101 girls (25.2%) and 300 boys (74.8%), aged 5–16 years; mean age at first visit 8.8±2.44 years. Of the 401 eligible patients, we counted 327 (81.5%) patients with monosymptomatic NE (MNE) and 74 (18.5%) patients with non-monosymptomatic MNE (N-MNE). In the group of MNE children, 242 (74%) children were boys with mean age at first examination 9.1 years and 85 (26%) were girls with mean age at first examination 7.8 years. In the group of N-MNE children, 58 (78.4%) children were boys with mean age at first examination 9 years and 16 (21.6%) were girls with mean age at first examination 8.4 years. Among the children with MNE, 322 (98.5%) had PMNE and 5 (1.5%) were diagnosed with SMNE. Interventions Not applicable Main outcome measures Signs and symptoms of voiding disorders, comorbidities, family history of NE, behavioral characteristics and school achievement. Results We noticed that heredity, parasomnias, urogenital abnormalities, constipation and innocence heart murmur are correlated to NE. Notably, 53.6% (67/125 children) had paternal heredity, 46.4% (58/125) had maternal heredity; 11.2% (14/125) had both paternal and maternal inheritance. 12/401 (3%) had sleep apnea, 95/401 (23.7%) had somniloquy and 59/401 (14.7%) had bruxism. Children suffered from headaches were 21/401 (5.2%): 112 (27.3%) had family history of headache. 47/300 boys (15.7%) had urogenital-abnormalities: 28/47 (59.6%) children had balanopreputial adhesions. Cutaneous manifestations of spinal dysraphism such as pilonidal dimple, single and deflected intergluteal cleft or double intergluteal cleft were found in 21/401 (5.2%) patients. Encopresis was found in 12/401 (3%) children and 58/401 (14.5%) suffered from constipation. Lastly, a significant percentage of children presented innocent heart murmur (86/401 – 21.4%). Conclusions Our experience demonstrate that there are many comorbidities that influence the prognosis and the response to the therapy in these children.

Objectives Functional constipation in children should be diagnosed in primary care, based on Rome criteria. Management in tertiary care is rarely needed. The aim of this study was to assess the frequency and structure of paediatric patients diagnosed with functional constipation in a tertiary hospital setting. Methods This study enrolled children referred to the paediatric gastroenterologist (PG) at the UHC Zagreb from January 1st 2017 to December 31st 2017 (N=1729). Data on patients was extracted retrospectively from clinical records. The subjects were classified in three age groups: infants and toddlers (0–3 years), children (4–10 years) and adolescents (11–18 years). Descriptive statistics and chi-square test were used, statistical significance was determined as p Results After appropriate evaluation, about 8% of all outpatients seen by the PG at the UHC Zagreb during year 2017 had functional constipation with or without encopresis (7.63% or 132 patients, boys: 56,1% vs girls: 43,9%). Half of the patients were in the age group of 4 to 10 years (66/132 or 50%), about 1/3 was 0 to 3 years old (41/132), and about 1/5 were adolescents (25/132). It was the most common functional gastrointestinal disorder (FGID) (132/328 or 40.24%), both in girls and boys. Also, it was the leading FGID in the infant/toddler (41/57) and the children group (66/124). Retentive encopresis was present in about 1/5 of children (29/132 or 21.9%) Accompanied encopresis was mainly observed in the age group of 4–10 years (22/66 or 33.3%, χ²=9.9431, p Discussion Frequency of functional constipation in paediatric patients in tertiary hospital setting, as well as sex and age distribution, is comparable to reported incidences in the population. The discordance of referral and final diagnosis shows that constipation is not adequately recognized in primary care, but when recognized, it is mostly diagnosed correctly. Conclusion Functional constipation is not recognized enough in primary care and more efforts are needed to assure a positive diagnosis of this disorder prior to the referral to tertiary care.

Aim This study aimed to explore referral and triage pathways for paediatric patients referred to an Australian hospital with bowel dysfunction (isolated or mixed bowel and bladder). Methods We conducted a retrospective audit of patients who attended their first clinic appointment during April to June 2014. Patients were included if they: (i) were a new patient referred for symptoms of constipation, soiling, daytime urinary incontinence or enuresis; and (ii) attended the encopresis, general medicine, continence, gastroenterology, paediatric surgery, urology, renal or Child and Adolescent Mental Health clinic. Patients with an organic cause (e.g. Hirschsprung disease) for their dysfunction were excluded. Results Of 1485 new patients seen at our targeted clinics, 281 (18.9%) had symptoms of bowel and/or bladder dysfunction. After excluding patients aged younger than 3 years (n = 43) and those with isolated bladder dysfunction (n = 130), 56 were referred for isolated bowel dysfunction and 52 for mixed bowel and bladder dysfunction. The median wait time from referral to first appointment was 3.8 months. Median wait times varied across symptom groups (isolated bowel, 4.6 months; mixed 3.4 months) and clinics (encopresis, 7.7 months; general medicine, 2.5 months). Over a 12-month period, patients attended an average of 3.5 appointments (isolated bowel, mean 3 appointments; mixed, mean 4 appointments). Conclusion Paediatric patients with symptoms of bowel and bladder dysfunction wait several months to be seen in a public tertiary referral hospital. Alternative pathways for care, such as community-based primary care, need to be explored to improve timely management.

Amaç: Tuvalet eğitimi, çocuk gelişiminde önemli bir kilometre taşıdır. Uygun olmayan zamanda, uygun olmayan şekilde verilen tuvalet eğitimi, işeme bozuklukları, enürezis, enkoprezis gibi istenmeyen durumlara yol açabilir. İşeme ve dışkılama bozuklukları yaşam süresini kısaltan durumlar olmamasına karşın yaşam kalitesini önemli ölçüde etkilemektedir. Bu çalışmada, Ankara Üniversitesi Tıp Fakültesi (AÜTF) Sosyal Pediatri Polikliniği'nde sağlıklı çocuk izlemi yapılan ve tuvalet eğitimini tamamlamış olan çocukların, tuvalet eğitim süreçlerinin çok yönlü olarak değerlendirilmesi, bu süreçte ve sonrasında karşılaştıkları işeme-dışkılama problemleri ile sürecin ilişkilendirilmesi ve bu etkenlerin yaşam kaliteleri üzerindeki etkilerinin değerlendirilmesi amaçlanmıştır.Gereç ve Yöntem: Araştırmaya 12 Haziran 2017 - 1 Eylül 2018 tarihleri arasında Sosyal Pediatri Polikliniği'ne başvuran ve araştırma kriterlerini sağlayan 178 çocuk ve anne-babası dahil edilmiştir. Sosyodemografik özellikler, tuvalet eğitim süreci, eğitimde karşılaşılan sorunlar, işeme ve dışkılama bozuklukları ile ilgili yakınmalar sorgulanmıştır. PedsQL ölçeği kullanılarak çocukların yaşam kaliteleri ölçülmüştür. Verilerin analizinde SPSS paket programı kullanılmıştır.Bulgular: Çocukların %85,3'ünde önerilen zamanda (18-36 ay arası) tuvalet eğitimine başlanmış ve %91'inde önerilen zamanda (18-48 ay arası) tümüyle tuvalet eğitimi tamamlanmıştır. Tuvalet eğitimine başlanmadan önce, `çocuğun tuvalet eğitimine hazır olduğuna dair fizyolojik ve gelişimsel göstergelerin varlığı (%58,4)` sıklıkla göz önünde bulundurulmuştur. Eğitimde en çok uygulanan yöntemlerin rehberlerce de önerilen yöntemler olduğu, uygun olmayan yöntemlerin daha az uygulandığı saptanmıştır. Çalışan annelerin tuvalet eğitimine daha geç yaşlarda başladıkları saptanmıştır (p=0,06). Anne ve babaların eğitim düzeyleri yükseldikçe, çocuklarında tuvalet eğitimine başlama yaşı da o kadar büyüktür (p=0,01 ve p=0,006). Aylık gelir düzeyi arttıkça tuvalet eğitimine başlama yaşı da artmıştır (p=0,02). Ödül yöntemini kullanan anneler, kullanmayan annelere göre daha gençtir (p=0,034). Anne-babaların %80,8'i tuvalet eğitimi verirken çocuklarını belli aralıklarla tuvalete götürdüklerini belirtmişlerdir. Anne ve baba eğitim durumu ne kadar iyiyse bu yöntemin kullanılma sıklığı da o kadar yüksek bulunmuştur (p=0,001 ve p=0,01). İlk çocuklarda bu yöntemin uygulanma oranı daha yüksek, ikinci ve sonraki çocuklarda daha düşüktür (p=0,001). Çocukların %15,3'ünde kabızlık, %41,2'sinde aciliyet, %20,9'unda oyun sırasında idrar tutma, %13,6'sında gece idrar kaçırma, %12,4'ünde tuvalete yetişemeden idrar kaçırma yakınması olduğu görülmüştür. Çocukların %41'inde hiçbir yakınma bulunmamaktadır. Tuvalet eğitimini tamamlama yaşı arttıkça tuvalet reddi görülme sıklığı da artmaktadır (p=0,02). Ödül yöntemi uygulanan çocuklarda uygulanmayanlara göre tuvalet reddi görülme sıklığı daha fazladır (p=0,001). Oyun sırasında dışkı tutma davranışı 18-36 ayda tuvalet eğitimine başlananlarda, daha erken veya geç başlananlara göre yüksektir (p=0,03). 25-36 ay arası tuvalet eğitimine başlanan çocuklarda oyun sırasında idrar tutma davranışı daha sık görülmektedir (p=0,003). Gece idrar kaçırma, tuvalet eğitimine 25-36 aylar arasında başlayanlarda daha sık görülmektedir (p=0,02). İşeme yakınması olan çocuklarda hem çocuk hem ana-baba ölçek toplam puanları(ÖTP), fiziksel sağlık toplam puanları (FSTP), psikososyal sağlık toplam puanları (PSTP) ile çocukların sosyal işlevsellik alt ölçek puanları (SİP) ve ana-babaların duygusal işlevsellik alt ölçek puanları (DİP) yakınması olmayanlardan düşüktür. Dışkılama yakınması olan çocukların ana-baba ve çocukların ÖTP, DİP ile çocukların FSTP, SİP, PSTP dışkılama yakınması olmayan çocuklardan daha düşüktür. Herhangi bir yakınması olmayan, işeme yakınması olan, dışkılama yakınması olan ve hem işeme hem dışkılama yakınması olan çocukların yaşam kalitesi puanları karşılaştırıldığında çocukların ÖTP, FSTP, SİP, PSTP ile ana-baba ve çocukların DİP arasındaki farklar istatistiksel olarak da anlamlı bulunmuştur. Sonuç: Bu sorunların çocukların yaşam kalitelerini ve psikososyal iyilik hallerini olumsuz yönde etkilemeleri nedeniyle çocuk sağlığı izlemlerinde daha çok üzerinde durulması gerekmektedir. 12. aydan itibaren tüm çocuk sağlığı izlemi vizitlerinde anne babalarla tuvalet eğitimi konusunun görüşülmeye başlanması önem taşımaktadır. Özellikle işeme ve dışkılama yakınmalarının en sık görüldüğü zaman olan, bağımsız tuvalet alışkanlığının kazanılmasından sonraki ilk birkaç yıl süresince; rutin kontrollerde idrar tutma, idrar kaçırma, gece işemeleri, barsak alışkanlıkları hekimler tarafından özellikle sorgulanmalıdır. Anahtar kelimeler: tuvalet eğitimi, işeme bozukluğu, kabızlık, enkoprezis, yaşam kalitesi, ÇİYKÖ Purpose: Toilet training is an important milestone for child development. Toilet training given in an inappropriate time and inappropriate way, may cause undesirable situations such as enuresis and encopresis. While, urination and defecation disorders are not the factors to shorten lifespan, they significantly affect human-life-quality. In this study, it is aimed to; make versatile assessments about the toilet training process of the children who are being observed in the well child follow-up and completed toilet training, associate the process to the urination-defecation problems within this process and afterwards and make assessments about the effects of this factors on human-life-quality. Material and Method: 178 children and parents who applied to Social Pediatrics Outpatient Clinic between 12th of June 2017-1st of September 2018 and who are complying with the research criteria, were involved in the research. Socio-demographic characteristics, toilet training process, problems encountered at the training, complaints about urination and defecation problems has been questioned. Children's life-quality has been measured via PedsQL scale. SPSS package program has been used for the analysis of the data.Findings: Toilet training for the %85,3 of children was started within the suggested time (between 18th-36th months) and it was totally completed for the %91of children within the suggested time (between 18th-48th months). Before starting toilet training, the existence of physiological and developmental indicators (%58,4) that were revealing the child is ready for toilet training, had been taken into consideration frequently. It has been determined that the most applied methods at the training were the same as the methods suggested by the advisers, and that inappropriate methods were applied less. It has been determined that the working mothers are starting toilet training in older ages (p=0,06). As the education level of the parents increases, toilet training starting age for the children gets higher as well (p=0,01 and p=0,006). As the monthly income level increases, toilet training starting age for the children gets higher as well (p=0,02). Mothers using reward method are younger than those doesn't use (p=0,034). %80,8 of the parents stated that they took their children to the toilet at regular intervals during the toilet training. It's found that the frequency of using this method is highly correlated with the education level of the parents (p=0,001 ve p=0,01). The rate of using this method is higher for the first children, on the other hand, it's lower for the second and latter ones (p=0,001). Complaints of children observed were; %15,3 constipation, %41,2 urgency, %20,9 retention of urine during the games, %13,6 enuresis at night, %12,4 urinary incontinence while rushing to the toilet. %41 of the children had no complaints at all. As the toilet training completion age increases, the frequency of toilet rejection incidences increase, as well (p=0,02). The frequency of toilet rejection incidences is higher for the reward method used children than the contrary (p=0,001). Retention of stool behavior during the game hours is seen more for the children who started toilet training between 18-36 months than that those started before or after 18-36 months (p=0,03). Continence behavior during the game hours is seen more for the children who started toilet training between 25-36 months (p=0,003). Enuresis at night is seen more for the children who started toilet training between 25-36 months (p=0,02). For the children with urination complaints; the total scale-points of both parents and children (ÖTP/TSP), physical health total points of both parents and children (FSTP/PHTP), physio-social health total points of both parents and children (PSTP/PHTP), social functioning sub-scale points of children (SİP/SFP) and the emotional functioning sub-scale points of the parents, are lower than the children with no urination complaints. For the children with defecation complaints; ÖTP, DİP of both parents and children and FSTP, SİP, PSTP of children are lower than the children with no defecation complaints. When the life-quality points of; the children with no complaints, the children with urination complaints, the children with defecation complaints and the children with both urination and defecation complaints compared; the difference between ÖTP, FSTP, SİP, PSTP of children and the difference between DİP of children and parents, statistically found reasonable. Result: Due to the fact that urination and defecation problems affect the life-quality and psycho-social wellness of children negatively, more attention should be paid to both these complaints and the toilet training issue at the well-child-follow-up program. Beginning with the 12th month, it is important to start talking about the toilet training with the parents during the well child follow-up visits. During the first several years in which particularly the urination and defecation complaints seen most, after acquiring independent toilet habits, especially; urine retention, enuresis, bedwetting at night and intestinal habits should be questioned by physicians at routine controls. Keywords: toilet training, urination disorder, constipation, encopresis, life quality, PedsQL 127

Elimination disorders are common childhood concerns that are often distressing for children and parents. These disorders occur at a higher rate in children with neurodevelopmental disorders including autism spectrum disorder (ASD) and can lead to significant functional impairment at home, school, and in the community. Enuresis, or developmentally inappropriate urination behaviors, can occur during the day, at night, or both. Encopresis, or fecal incontinence, is the passage of stool into inappropriate places such as one’s clothing or onto the floor. Biological and psychobehavioral underpinnings of elimination disorders will be addressed in this chapter. Gold standard interdisciplinary treatment of elimination disorders will be discussed and the evidence for this approach reviewed.

Encopresis or fecal incontinence is a common childhood concern in which a child over the developmental age of 4 years passes stool into an inappropriate place (e.g., underwear or onto the floor). Although this condition can be diagnosed in adulthood, it is often first diagnosed in childhood or early adolescence. Encopresis has both biologic and behavioral components, is often very distressing for the youth and their family, and can cause significant disruption in day-to-day functioning. This chapter addresses biological and behavioral factors and reviews the evidence-based cognitive behavioral interventions for encopresis. The most common biological contributor to fecal soiling is constipation, which should be medically managed at the outset and throughout the course of treatment for this condition. Behavioral contributors such as stool withholding, delayed defecation, and noncompliance with toileting routines may also need to be addressed in order to achieve full symptom remission. Cognitive factors such as incorrect assumptions about the reasons for soiling, learned helplessness, and fear of the toilet or stooling should also be assessed and intervened upon if present. A combined medical and behavioral/psychological treatment approach is recommended.

Managing colorectal surgery conditions in infants and children presents a highly detailed and technical challenge that, in many cases, requires formal training, experience, and expertise. In addition to the wide array of congenital anomalies that surgeons may encounter, this chapter will cover conditions that are also experienced in adults; however, the evaluation and management of these disease states needs to be tailored to the pediatric population.

CASE Sonia is a 7-year-old old girl who was referred to the Developmental-Behavioral Pediatrics Clinic by the Pediatric Urology Clinic because of persistent wetting and soiling behaviors. Since age 3 years, she has had a history of encopresis (and wetting) for which she has seen gastroenterology and urology specialists. The mother reports that Sonia has accidents almost daily, and she is not upset when sitting in her urine or feces. She dislikes going into the bathroom or sitting on the toilet by herself. She participated in a behavior modification program associated with the pediatric urology clinic, which helps children learn healthy voiding habits and achieve continence.Sonia also has anxious behaviors. She bites her nails and chews on her hair or shirt. She is afraid of small spaces such as those between the bed and the wall and needs to have stuffed animals cover them. Other instances that trigger her anxious behaviors include loud noises, having a substitute teacher, being separated from her mother, and going to certain bathrooms or new places. She also has severe tantrums, which involve throwing and breaking objects, kicking, and hitting her head against doors.A cognitive behavioral therapy program was recommended to target anxiety symptoms, in addition to timed toileting after meals and polyethylene glycol. At a clinic visit several months later, symptoms of anxiety, encopresis, and enuresis persisted. Cognitive behavior therapy was continued and sertraline 25 mg was prescribed for anxiety. In addition, she was referred to a pediatrician who specializes in relaxation techniques and hypnotherapy.Sonia showed modest improvement with these interventions. There were fewer episodes of angry outbursts and a decrease in soiling and wetting, but at times, but she continued to have intermittent periods of wetting and soiling and fear of going to the bathroom by herself persisted.(This Challenging Case extends observations reviewed in a previous Challenging Case: J Dev Behav Pediatr 2010;531:513-515; DOI: 10.1097/DBP.0b013e3181e5a464.).

Incontinence in childhood in either of its forms, enuresis and encopresis, is one of the most prevalent and distressing of all childhood problems. Due to widespread misunderstanding, incontinence is a significant precipitating factor in the mistreatment of afflicted children. Interpretations of and treatments for enuresis and encopresis have shifted in the past few decades from a mostly psychopathological perspective to a biobehavioral perspective. Although the primary clinical features of incontinence are medical/organic, environmental and psychosocial elements are factors, and the most empirically supported treatments have a significant behavioral dimension. This chapter reviews the literatures on enuresis and encopresis with attention focused on clinical description, causes and correlates, assessment, treatment, challenges, and implications for practice. Case examples are included to illustrate these features.

Severe constipation and encopresis are significant problems in the pediatric population. Medical management succeeds in 50–70%; however, surgical considerations are necessary for the remainder such as the antegrade continence enema (ACE). The purpose of this study is to assess the long-term outcomes following the ACE procedure. All patients undergoing an ACE over a 14-year period were included. Data on clinical conditions, treatments, and outcomes were collected. A successful outcome was defined as remaining clean with ≤ 1 accident per week. Comparative data were analyzed using the Fisher’s exact test, Mann–Whitney U test, or Student’s t test. There were 42 ACE patients, and overall, 79% had improvement in their bowel regimens. Encopresis rates decreased from 79 to 5% (P

Results of examination and treatment of 12 children, operated on in various clinics for Hirschprung’s disease, in whom chronic constipation and other signs of anorectal dysfunction have occurred, were analyzed. In 8 patients Duhamel-Bairov operation was conducted, in 2 – Soave-Lenyushkin operation, and in 2 – Soave-Boley operation. The main cause of postoperative chronic constipation occurrence after Duhamel operation is the colorectal septum preservation. The only one radical method of treatment of this complication is a transanal removal of colorectal septum. The cause of anastomotic narrowing after Soave-Boley operation was absence of myotomy intraoperatively and of bougienage – after it. Elimination of chronic constipation in such patients, using long-standing bougienage and complex conservative treatment. The main cause of chronic constipation and nocturnal encopresis after Soave-Lenyushkin operation was preservation of the tissue excess while doing resection of a large bowel stump and creation of the narrowed ring, looking like a pendent plica. Complete reconvalescence of such patients is possible in transanal method of excision of stenosing ring and conduction of complex treatment.

Diverse etiological factors and clinical manifestations of cognitive dysfunction in children with different functional and organic diseases of the central nervous system are described in the article. The feasibility of using GABAergic agent Cognum in this pathology is justified. Experience of using Cognum in the complex of rehabilitation treatment of children with attention deficit/hyperactivity disorder, psycho-verbal-motor delay, convulsive disorder, consequences of traumatic brain injuries and apallic syndrome, severe forms of enuresis and encopresis is described. Treatment efficacy was assessed using the Wechsler scale, VABS, HASS., В статье приведены разнообразные этиологические факторы и клинические проявления когнитивной дисфункции при различных функционально-органических заболеваниях центральной нервной системы у детей. Обоснована целесообразность применения ГАМКергического препарата Когнум при данной патологии. Описан опыт применения препарата Когнум в комплексе реабилитационного лечения детей с синдромом гиперактивности и дефицитом внимания, психоречемоторной задержкой, судорожным синдромом, последствиями черепно-мозговых травм и апаллического синдрома, тяжелыми формами энуреза и энкопреза. Эффективность лечения оценивалась при помощи шкал Векслера, VABS, HASS., У статті наведені різноманітні етіологічні фактори і клінічні прояви когнітивної дисфункції при різних функціонально-органічних захворюваннях центральної нервової системи в дітей. Обґрунтовано доцільність застосування ГАМКергічного препарату Когнум при даній патології. Описано досвід застосування препарату Когнум у комплексі реабілітаційного лікування дітей із синдромом гіперактивності та дефіцитом уваги, психомовномоторною затримкою, судорожним синдромом, наслідками черепно-мозкових травм і апалічного синдрому, важкими формами енурезу і енкопрезу. Ефективність лікування оцінювалася за допомогою шкал Векслера, VABS, HASS.

Background: Childhood constipation is a common ailment that in certain cases can lead to encopresis or fecal incontinence. The literature suggests that standard care varies in effectiveness, especially in the long term. Fecal incontinence can lead to frustration, guilt, and shame for both the child and family and has untold long-term psychological and physical consequences. Objective: To address alternative treatment options for pediatric constipation and encopresis by using acupuncture and Chinese medicine. Patient and Setting: This is a case study of a 6-year-old girl seen in a private practice acupuncture clinic in the northwestern United States. Intervention: Treatment involved acupuncture, massage, and Chinese herbal medicine. Results: The patient in this study began to have regular bowel movements on her own, from a type 5 on the modified Bristol Stool Form Scale for Children to a type 3, with no laxative use and few to no fecal accidents. Conclusions: Emotional stability and support seem t...

OBJECTIVE: Enuresis and encopresis, both conditions are very distressful to children and their family members and it is responsible for significant social and psychological consequences in children and adolescents. The present study aims to determine the rate of abusive maternal attitudes towards children and adolescents with elimination disorders (EDs) and to investigate the maternal psychological and socio-cultural factors associated with abusive parenting attitudes. METHOD: N = 180 children with ED were included in the study. Family Assessment Device (FAD), and Symptom Check List (SCL-90-R) were administered to mothers. RESULTS: Our results indicated that prevalence of abusive maternal attitudes in our sample was 73.8%. Children and adolescents with ED who live with low-educated parents (p = 0.008), low socio economic status (p = 0.014), and in cases with living in a large or divorced family (p = 0.014), disorganized or chaotic families can be considered a population at risk (p CONCLUSION: Present study showed high rates of abusive parenting attitudes in cases of EDs in a sample of Turkish children and adolescents. Further research on the etiological and therapeutic importance of the family in the case of ED referred to a psychiatry clinic should be carried out.Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved. Language: en

BACKGROUND: Fecal incontinence (FI) in children is frequently encountered in pediatric practice, and often occurs in combination with urinary incontinence. In most cases, FI is constipation-associated, but in 20% of children presenting with FI, no constipation or other underlying cause can be found - these children suffer from functional nonretentive fecal incontinence (FNRFI).OBJECTIVE: To summarize the evidence-based recommendations of the International Children's Continence Society for the evaluation and management of children with FNRFI.RECOMMENDATIONS: Functional nonretentive fecal incontinence is a clinical diagnosis based on medical history and physical examination. Except for determining colonic transit time, additional investigations are seldom indicated in the workup of FNRFI. Treatment should consist of education, a nonaccusatory approach, and a toileting program encompassing a daily bowel diary and a reward system. Special attention should be paid to psychosocial or behavioral problems, since these frequently occur in affected children. Functional nonretentive fecal incontinence is often difficult to treat, requiring prolonged therapies with incremental improvement on treatment and frequent relapses.

Objective: Evaluate clinical aspects associated with the presence of nocturnal enuresis (NE) in children with a diagnosis of overactive bladder (OAB). Material and Methods: A data base of 200 children who were evaluated by a structured questionnaire was analysed retrospectively . OAB was defined as the presence of urinary urgency (n=183 cases) and/or daytime urinary incontinence associated with holding maneuvers (n=168 cases). Inclusion criteria were a confirmed diagnosis of OAB, age 5-16 years, and no anatomical or neurological alterations of the urinary tract. Patients were divided into enuretics and non-enuretics. The two groups were compared with respect to sex, age, skin color, presence urinary infection, urgency, urge incontinence, non-urge incontinence, pollakiuria, urinary dysfunction, nocturia, holding maneuvers, number of episodes of enuresis and bowel alterations. In a univariate analysis, the chi-square test was used to compare proportions, with p-values

Chronic constipation is an extremely common and costly condition that can negatively impact the patient’s quality of life, resulting in a major economic and social burden. Most patients do not understand their situation and suffer from social isolation. The developmental particularities of the child cause the etiology and symptomatology of constipation to differ from those described by adults, which requires a specific management in terms of diagnosis and treatment. The specialty literature to date relies on fragmented studies focused on these particularities, as well as on the multitude of aspects of diagnostic and treatment related to chronic stool retention and bowel evacuation in children. The problem that is being studied is important not only from a medical and socioeconomic point of view, but also because some complications caused by chronic constipation (such as encopresis and enuresis) lead to the social isolation and physical and psycho-emotional impairment of these children.

The aim of the present study was to study the effect of octreotide on colonic motility in pediatric patients with recalcitrant chronic constipation/encopresis and other suspected colonic motility disorders.This was a nonrandomized, single-center, open-label, prospective study evaluating the effect of a single subcutaneous dose of octreotide on colonic motility.Thirteen patients (5 boys) were enrolled in the study. The age range was 4.6 to 16.2 years. Eleven patients (84%) had normal colonic manometry and 2 patients (16%) had colonic neuropathy. Motility Index (MI) (mmHg) for the 15 minutes before and after octreotide infusion was 6.03 ± 1.26 (95% confidence interval [CI] 5.35-6.72) and 5.32 ± 1.66 (95% CI 4.42-6.23), respectively, with P value of 0.08. MI for the 30 minutes before and after octreotide infusion was 6.89 ± 1.37 (95% CI 6.14-7.64) and 6.71 ± 1.47 (95% CI 5.91-7.52), respectively, with P value of 0.55. MI for the 45 minutes before and after octreotide infusion was 7.73 ± 1.32 (95% CI 7.01-8.45) and 7.53 ± 1.38 (95% CI 6.78-8.28), respectively, with P value of 0.8.Our study showed that the administration of octreotide resulted in no significant changes in colonic MI in pediatric patients with chronic recalcitrant constipation.