Self-inserted foreign body and attention-deficit/hyperactivity disorder: evaluated by the Conners' Parent Rating Scales-Revised

Aural and nasal foreign bodies in children - Epidemiology and correlation with hyperkinetic disorders, developmental disorders and congenital malformations

OBJECTIVES

Foreign body incorporation in children is often a serious situation. Attention deficit hyperactivity disorder (ADHD) could be a risk factor for self-insertion of foreign bodies. Large cohort analyses are missing.

METHODS

This was a retrospective analysis of patients' records from a health insurance company representing 2.19% of the German population and 1.75% of German children and adolescents. According to the International Classification of Diseases, children in the age range between 1 and 18 years have been screened for foreign bodies in ear, nasal sinus and nostrils as well as for hyperkinetic disorders (F90), disorders of psychological development (F80-F89), and congenital malformations, deformations and chromosomal abnormalities (Q00-Q99).

RESULTS

In total, 12887 children (6609 male; 6278 female) have been treated in 16929 cases. The majority (n = 10041 (77.9%)) presented with foreign body incorporation on a single occasion. On average, 1.31 cases of foreign body treatment were recorded per child; 14.1% of children with foreign body treatment (FBT) also had a record of hyperkinetic disorder, 52.7% had a disorder of psychological development, and 50.8% a congenital malformation. Mean occurrence of FBT was 174.8 days before the diagnosis of a hyperkinetic disorder but 517.2 days after the diagnosis of a psychological development disorder and 683.1 days after the diagnosis of a congenital malformation, deformation or chromosomal abnormality.

CONCLUSION

Patients with disorders of psychological development as well as children with congenital malformations are high-risk patients for nasal and aural foreign bodies. The prevalence of a hyperkinetic disorder in patients with FBT is much higher than in the normal population. ADHD is a risk factor for foreign bodies.

Prevalence of attention deficit hyperactivity disorder (ADHD) in children presenting with foreign body ingestion

BACKGROUND

Foreign body ingestion is a common condition in children. We aimed to compare the incidence of attention deficit hyperactivity disorder (ADHD) symptoms in children that ingested foreign bodies with healthy children.

METHODS

The study group consisted of 3- to 17-year-old pediatric patients admitted to the emergency department after foreign body ingestion, and the control group was formed with children having similar demographic and cultural characteristics that presented to the same department for non-traumatic causes. After initial intervention and stabilization, we administered the Conners' Parent Rating Scales-Revised (CPRS-R) to both groups.

RESULTS

The study group consisted of 53 patients with a mean age of 7.83 ± 4.36 and the control group comprised 47 children with a mean age of 7.72 ± 3.48 years. There were no statistically significant differences between the study and control groups in terms of age, gender, and parental education levels (p > 0.05 for each). The foreign objects most ingested by children were coins (32.1%), followed by needles (15.1%) and beads (9.4%), and all the patients recovered without complications and were discharged. All the CPRS-R subscale scores were significantly higher in the study group than in the control group (p < 0.001). The parental education levels of the study group were not significantly correlated with DSM-IV hyperactivity-impulsivity and DSM-IV total.

CONCLUSION

We found that the incidence of ADHD symptoms may be high in children referred to emergency services after accidentally ingesting foreign bodies.

Psychological status in children with ear and nose foreign body insertion

OBJECTIVE

Children with psychological disorders are prone to various unintentional injuries, one of the most common of which is foreign body inserting. In spite of the high incidence, the association is not studied yet.

METHODS

This is a case control study in otorhinolaryngology and psychology departments, at a tertiary referral teaching hospital. One hundred five children (2-12 years old) who were referred for removal of foreign bodies in their ear or nose over a period of one year were selected for the study. Also, 155 children were selected and matched from the same community as the controls. Parents were given the standard strengths and difficulty questionnaire (SDQ) for psychological evaluation of their child. The total score and also the subscales for emotional symptoms, hyperactivity disorders, conduct problems, peer-relationship problemsand prosocialbehaviors were recorded and statistical analysis was performed.

RESULTS

In the case group, 34 cases (%32.4) were suffering from foreign bodies in their ear, 70 cases (%66.7) in their nose, and just one case (%1) in both. Age and sex distributionin the two groups were comparable. There were significant differences of SDQ scores between the two groups in total score (p < 0.001), emotional symptoms (p < 0.001), hyperactivity disorders (p < 0.001), conduct problems (p < 0.001), and prosocial behaviors (p < 0.001). However peer-relationship problems showed no significant difference between the two groups (p = 0.161).

CONCLUSION

Psychological problems are more common in children with foreign bodies than the controls. Thus physicians are recommended to consider referring these patients to the pediatric psychologist.

Foreign body injuries in children: Are the younger siblings doomed?

Background and objectives

Foreign body injury (FBI) is a considerable public health issue for children. Although the relationships of FBI with age, gender, and objects of injury have been studied, the extent to which other demographic factors influence FBI is unclear. We hypothesized that the risk for FBI increases with the number of children in the household.

Design and settings

This was a retrospective analysis of 223 patients aged 2-10 years who presented to the emergency department of an inner-city pediatric hospital and who were found to have FBI.

Patients and methods

The guardians were contacted via phone to examine the associations of FBI with income, parental educational level, number of children in the household, and birth order while controlling with a matched population of 250 patients. Statistical analyses using frequencies and univariate and multivariate analyses were performed.

Results

For each increase in the number of children, the risk of FBI increased 1.44-fold (OR = 1.442). With each increase in the number of caregivers, the risk of a FBI decreased 33% (OR = 0.673). With each increase in income category, the risk of a FBI decreased 59% (OR = 0.413).

Conclusion

The results suggest that an increase in the number of children in a household is associated with a greater risk of FBI.

Cognitive and behavioral characteristics of children with caustic ingestion

BACKGROUND/AIM

Children with attention-deficit/hyperactivity disorder (AD/HD) have risk taking behavior and are more prone to sustaining injury. It is aimed to evaluate the cognitive and behavioral characteristics of children with caustic ingestion.

PATIENTS AND METHODS

Ninety two children with a history of nonsuicidal caustic ingestion (CI, n=46) and healthy subjects (HS, n=46) admitted to pediatric surgery department were enrolled into the study. Patients in groups were evaluated for age, sex, number of siblings and educational status of the parents. Before filling the questionnaires, the children were undergone flexible endoscopy and treated accordingly. Conners Parents Rating Scale-revised long form (CPRS-R:L), validated for Turkish Children, was used to evaluate the cognitive and behavioral characteristics of children. Parents rate their child's behavior with a four-point Likert scale. Subscales of CPRS-R:L including cognitive problems/inattention (CG/I), hyperactivity (H), attention deficit hyperactivity disorder index (AD/HD-I), Conners' Global Index-discomfort-impulsivity (CGI-DI), DSM-IV-symptom subscale-inattention (DSMIV, SS-I), DSM-IV-symptom subscale-hyperactivity-impulsivity (DSM-IV, SS-HI), DSMIV-symptom subscale-total score (DSM-IV SS-T) were used to determine the severity of the AD/HD symptom. Demographic features and cognitive/behavioral characteristics of children with caustic ingestion were compared with healthy subjects.

RESULTS

The median age of the patients was 4 (2-14 years) in both CI and HS groups. Female male ratio was 13:33 in CI and 12:34 in HS. Sixty seven percent of patients were preschool children (younger than 5 years of age) in both CI and HS groups. There was no difference between groups for number of siblings (p>0.05). Parents of HS group had higher educational status than parents in CI (p<0.05). When subscale scores of CPRS-R:L compared between CI and HS groups, CI group had higher CGI-DI scores than HS (p<0.05). Children younger than five years of age had higher scores of H, emotional instability and total CG/I in CI than HS group (p<0.05).

CONCLUSION

Children with caustic ingestion had impulsiveness behavior when compared to healthy children. In addition to impulsivity, hyperactivity can be also assessed as a risk factor for caustic ingestion in children younger than 5years of age. We suggest that association between AD/HD behavior and risk of sustaining injuries was also confirmed for caustic ingestion in children.