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Pediatric Dental Health
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Children With ADHD
Attention deficit hyperactivity disorder (ADHD) is the
most commonly diagnosed behavioral disorder of childhood, affecting 6 percent of
school-age children. The clinical hallmarks of this genetically influenced,
neuropsychiatric disorder are inattention, hyperactivity, and impulsivity. ADHD
is often accompanied by other disorders such as learning disability,
oppositional defiant disorder, anxiety, or depression. Children with ADHD
usually have difficulty functioning at home and at school, and with peers.
The symptoms of ADHD include inattention, hyperactivity, and impulsivity.
Inattentive children are disorganized and easily distracted. They have a hard
time keeping their mind on a task, and get bored quickly. Hyperactive children
are always in motion. They can't sit still, and they touch everything. Impulsive
children have difficulty waiting for things. They may grab a toy from another
child, or may hit another child when they are upset.
Although children can show signs of ADHD at an early age, a diagnosis is usually
not made until they start school. This is because the symptoms may be more
apparent in the classroom. The diagnosis of ADHD can be made by using
well-tested diagnostic interview methods. Diagnosis is based on history and
observable behaviors in the child's usual settings. There is no single test for
ADHD. The diagnostic evaluation starts when the child's pediatrician takes a
complete health history to rule out physical problems. The pediatrician will
also ask about the child's behavior at home and in school.
The most effective treatment for ADHD is a combination of medication,
behavior-changing therapy, and environmental modifications.
ADHD is one of the best researched disorders in medicine. Despite progress in
the assessment, diagnosis, and treatment of ADHD, the disorder and its treatment
have remained controversial. The main controversy continues to be the use of
psychostimulants for treatment. It may seem strange to give stimulants to a
child with hyperactivity, but these drugs actually reduce hyperactivity and
increase the attention span of the child. These medications do not cure the
disorder, but they do control the symptoms temporarily. For school-age children
with ADHD, the most common medication taken is Ritalin (methylphenidate
hydrochloride). This medication is not addictive, but may have side effects,
depending on the dose. The side effects associated with a moderate dose may
include decreased appetite, and insomnia. The usual dose of Ritalin is 5 to 20
MG, given two to three times per day. There is no conclusive evidence that
careful therapeutic use of Ritalin is harmful to a child with ADHD.
Behavior-changing therapy includes contingency management techniques. Examples
of contingency management in the classroom setting are the point/token reward,
time-out, and response cost techniques. A combined medication and behavioral
treatment protocol results in improved social skills. An important potential
advantage for including behavioral treatment is the possibility of improving
social function with a reduced dose of stimulants.
Environmental modifications in the classroom may include: posting clear rules
with rewards for appropriate behavior, providing a place to sit that has few
distractions, and providing an area where the child can move around and release
A recent study found a correlation between reduced activity in the basal ganglia
region of the brain, called the putamen, and ADHD hyperactivity. By using a new
diagnostic tool called T2 relaxometry, the blood flow to the basal ganglia can
be measured, and this may improve the diagnosis and treatment of ADHD.
Teicher MH, et al: Functional deficits in basal ganglia of children with
attention-deficit/hyperactivity disorder shown with functional magnetic
resonance imagery relaxometry. Nature Medicine. Vol 6 Number 4 pp 470-473. April
Teething In Babies
Teething has been the subject of myths and controversy for
centuries. In the 4th century B.C., Hippocrates said that "teething infants
suffer from itching of the gums, fever, convulsions, diarrhea, especially when
they cut their eye teeth." Up through the end of the nineteenth century,
teething was considered a leading cause of childhood death. During that century,
the "treatment" for teething included leeches, emetics, mercury-based
teething powders, and "lancing" of the gingiva. In many cases, deaths
of children were actually due to the remedy, and not to teething! As late as
1954, a theory of "reflex stimulation" was cited to explain the
prevailing dogma on teething.
Today, parents still attribute many infant symptoms to teething. They
incorrectly believe that teething causes fever, pain, irritability, sleep
disturbance, biting, drooling, rashes, ear pulling, feeding problems, runny
nose, loose stools, and infections. The truth is that many symptoms previously
thought to be associated with teething are simply coincidental findings!
The eruption of baby teeth begins when other changes in an infant's immune
system, growth, and development are also occurring. The eruption of the primary
teeth usually begins around 6 months of age. This is, coincidentally, when
infants have lost most of their maternally-derived antibody protection. By the
age of 6 months, the number of maternal antibodies has decreased to a very low
level, predisposing an infant to a variety of infections. Drooling in infants
reaches its maximum level just before tooth eruption. This is because in early
infancy, the ability to swallow all of the saliva is not yet well-developed.
Putting objects in the mouth, and biting them, also first occurs at the time of
teething. This newly-acquired ability to "mouth" objects is simply
part of the normal neurological development of a child.
Parents should always seek the advice of a physician when their child has an
illness which occurs simultaneously with teething. This will permit the
physician to rule out any serious medical problems. Parent should remember that
infants with oral Herpes Simplex Virus-1 may be misdiagnosed as having teething
What can be done about the pain associated with teething?