1/7. An opportunity for office-based research.Robert, a nearly 12-year-old boy, traveled an hour to see a new pediatrician. Robert's mom told the pediatrician that Robert had not been seen by a doctor for several years because "no one seems to be able to help him with his problem." Robert had been wetting the bed "ever since he was toilet-trained" at age 2 years. Robert wets the bed about 5 out of 7 nights. He never has daytime accidents. He did not have a history of urinary tract infection, dysuria, urgency, or increased frequency of urination. He has daily bowel movements and denied soiling or accidents. Robert's mom said he had "toilet-trained himself" at age 2 years. Both Robert's mom and maternal grandfather had nocturnal enuresis "into their teenage years." The pediatrician was surprised to learn that another physician had treated Robert with imipramine at age 5 years. The medication worked intermittently and Robert continued to take it for about a year. At age 6 years, Robert's parents saw an advertisement for a bed-wetting alarm. They purchased the alarm but found that Robert never woke up when the alarm sounded. At age 7 years, Robert saw a urologist who told him he would "outgrow the problem." A year later, the urologist prescribed desmopressin acetate (DDAVP) nasal spray, which Robert took on occasion during the next 2 years. Every time he stopped the DDAVP, he resumed wetting the bed. His parents never punished him for his accidents, but they did try restricting fluids after dinner and also woke Robert in the middle of the night and encouraged him to go to the bathroom. Neither of these strategies was successful. Robert said he was "frustrated" and wondered if "I would still be wetting the bed as a grown-up." The pediatrician explained the nature of enuresis to Robert and his mom, provided them with instructions and an order form for a bed-wetting alarm, and arranged a follow-up visit. The next day, during nursery rounds, he asked several of his colleagues about their approaches to the treatment of enuresis. A few used DDAVP, one found imipramine beneficial, and one preferred behavioral treatment with a bed-wetting alarm. The pediatrician became concerned that he had misread the literature on enuresis. He brought the question up at the next pediatric staff meeting at the local hospital. A lively discussion ensued as the physicians realized that they employed a variety of treatments for enuresis. Robert's pediatrician wondered why his colleagues were not using the alarm because the literature seemed to indicate it to be the preferred treatment for enuresis. He asked the group if they would be interested in talking about the issue further and perhaps trying to understand the reasons for their varied approaches to this problem.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. Enuresis following masturbation in a mentally retarded adolescent.An unusual presentation of enuresis is described. A mentally retarded adolescent male with normal bladder function wet his bed while awake following masturbation. Initially, this sequence was not apparent to the parents or physicians. A multidisciplinary approach to the symptom helped to define and focus on the circumstances of the symptom itself, allowing for successful intervention.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/7. Loss of bladder control in hyperthyroidism.Urinary urgency and frequency and even enuresis may be manifestations of augmented adrenergic activity in hyperthyroidism, as are sweating, tremor, and tachycardia. Because patients rarely volunteer problems with urgency, frequency, and enuresis, it is worthwhile for the physician to inquire about such symptoms in patients with moderate to severe hyperthyroidism. Symptoms generally cease after treatment of the hyperthyroidism.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/7. 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.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/7. Setting the referral process in motion: a case study with teaching objectives.Pediatric collaboration with mental health professionals is necessary due to the high prevalence of behavioral and emotional disorders in this population. Clinicians frequently encounter parental resistance to acceptance and follow-through on recommended mental health services. In addition, physicians may have difficulty recognizing and referring psychosocial problems due to inadequate training or experience. The case presented of a 10-year-old girl with enuresis illustrates the process of referring a patient with a behavioral problem from a general pediatrician to a mental health specialist. The behavioral pediatrician plays a critical role in providing linkage between medical and psychosocial care.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/7. Some guidelines for uses of hypnotherapy in pediatrics.Hypnotherapy has many uses in pediatrics, and its value, not only as a adjunct but also as a primary therapy for certain conditions, justifies its inclusion in pediatric training programs. suggestion and expectation have long been related to therapeutic outcomes in medicine, but not all physicians know how to apply them constructively and systematically in communication with patients. In pediatrics there is a tendency to overlook opportunities in which hypnosis might be the treatment of choice. Because children engage in imagination and fantasy easily without the cognitive inhibitions of adults, they are able to use hypnosis more readily than adults. More research into the imaginative skills of children may facilitate understanding of learning mechanisms and make it possible for professionals to prevent the loss of the natural imaginative capacities in children and, therefore, enhance the ability of mature members of society to use these skills. In addition to reduction of specific symptoms through hypnotherapy, children benefit by the sense of mastery which they acquire, a sense which is surely needed to overcome the feelings of hopelessness, loss of control, and depression induced by many diagnostic and therapeutic procedures in medicine.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/7. central nervous system ischemia after varicella infection and desmopressin therapy for enuresis.A 7-year-old boy had a left-sided cerebrovascular accident 48 hours after beginning intranasal desmopressin acetate (DDAVP) therapy for persistent secondary nocturnal enuresis and approximately 2 weeks after varicella infection. A possible connection between desmopressin therapy or varicella infection (or both) and the patients neurologic symptoms is discussed, as is the relationship of desmopressin with hypercoagulability, Suggestions for patient/parent education, medical history taking, and patient surveillance are offered to prescribing physicians.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |