The effect of baby walker on child development: a systematic review

Abstract:Baby walkers are used all around the world as a fun equipment without any dangers. In contrast with public beliefs, some researchers have claimed they can cause developmental delay. We aimed to investigate their effect on child development through a systematic review. We searched Pubmed, Google Scholar, Embase, and Scopus for related articles in English and included all study designs. Of 315 articles found in Pubmed, 1630 citations in Google Scholar, 18 articles in Embase, and 38 papers in Scopus, only 9 articles fulfilled the inclusion criteria. Among them, only a cohort and a cross-sectional study reported developmental delay caused by baby walker use. Based on the current data, evidence against baby walker is not enough regarding its negative effect on child development. This subject needs to be addressed more, considering the large number of baby walker users worldwide

Intermittent Clonazepam in The Prevention of Recurrent Febrile Seizures

ObjectiveTo evaluate the efficacy and common side effects of intermittent clonazepam in febrile  seizures.Materials & MethodsThis study was an experimental trial designed to determine the efficacy of intermittent clonazepam in febrile seizures .Thirty patients with an age range of 6 months to 5 years (60% male, 40% female) were studied. Children with a history of psychomotor delay, abnormal  neurological examination, a history of antiepileptic drug consumption, and afebrile seizures were excluded from the study. Patients received a single dose of prophylactic Clonazepam (0.05 mg/kg/ day) on the first day of febrile illness and twice daily during the course of fever.An antipyretic medication (Acetaminophen) was advised if fever exceeded 38oC. Patients were followed up for one year after the study inclusion date.ResultsThree patients were excluded from study since they didnot follow the tritment and three patients experienced afebrile seizures. Twenty four patients had 162 febrile episodes during the course of the study and all patients were seizure-free after 1 year.ConclusionClonazepam was 100% effective but lethargy and ataxia were common side effects in patients. Fortunately, their parents continued treatment because they had prior awareness of the  possible side effects of clonazepam. Clonazepam is efficacious as an intermittent therapy for febrile seizures if parents are informed of its side effects.

Effect of baby walker use on developmental status based on Ages and Stages questionnaire score

 AbstractObjectiveBaby walker is a popular device which parents use for entertainment, keeping infants safe and walking promotion. Some studies showed developmental delay in baby walker users though others reported no significant effect on development in this group. We designed this study to determine whether baby walker usage has any effect on development by using Ages and Stages Questionnaire (ASQ).  Materials & MethodsWe evaluated 107 one-year-old infants in each baby walker user group and non-users (total number of 214 participants) by using ASQ test of 12-month. We re-evaluated 168 infants at age 18-month by using ASQ test of 18-month. The data of these groups was compared.  ResultsGirls use baby walker more frequently (p=0.02). Baby walker usage was not significantly associated with parent’s educational state, mother employment, birth rank of infant and delivery method. The starting age of baby walker use was 6.61 ± 1.46 months. ASQ results in area of gross movement and fine movement were not significantly different in users and non- users at age 12 and 18 month.  ConclusionMost parents believe baby walker can promote earlier walking, but based on current evidences this belief might not be true. Although most studies showed no developmental delay in baby walker users, parents should become aware about their possible negative effects and hazards

L-carnitine versus Propranolol for pediatric migraine prophylaxis

  Objective Carnitine plays a significant role in fatty acid transportation in mitochondria and has been shown to have a prophylactic effect on adult migraine. The aim of this randomized controlled trial was to compare and evaluate the effects of L-carnitine supplementation versus propranolol in the prevention of pediatric migraine. Materials & Methods A total of 60 pediatric patients with episodic migraine were randomly allocated to 2 independent groups to receive either 50 mg/kg/day L-carnitine or 1 mg/kg/day propranolol as a prophylactic drug. Frequency, severity, and duration of migraine attacks and headache disability based on the Pediatric Migraine Disability Assessment Score (PedMIDAS) were studied at the baseline and after 2, 4, and 12 weeks. Results A total of 56 patients were evaluated in the study: 23 girls (41%) and 33 boys (59%) with a mean age of 9.7 ± 2.1 years. Frequency of migraine headaches per month reduced from 11.4 ± 7.1 to 5.34 ± 2.4 in the L-carnitine group and from 10.7 ± 6.2 to 4.96 ± 3.9 in the propranolol group by the end of the study. Headache severity score was also reduced from 19.38 ± 14 to 2.88 ± 7.4 and from 12.92 ± 13 to 0.82 ± 1.3 in the L-carnitine and propranolol groups, respectively. We found a significant decrease in frequency, severity, and duration of headache attacks in both groups (P < 0.01). No significant difference was observed between the efficacies of the 2 drugs. Conclusion This study concluded that L-carnitine supplementation can play a prophylactic role in the management of pediatric migraine

Clinical features and outcome of Guillain-Barré syndrome in children

 Background: Considering the fact that there are no reports about the clinical presentations and outcome of Guillain-Barré syndrome (GBS) in our region, we aimed to report some mentioned findings in children diagnosed with GBS in Isfahan, Iran. Materials and Methods: In this retrospective study, pediatric patients diagnosed with GBS were enrolled.The following information were extracted from the medical files of patients; age, gender, early signs and symptoms of GBS, neurological features, sensory and motor and autonomic involvements, sphincter dysfunction, bulbar muscle involvement, respiratory failure, cranial nerve paralysis, delay time from onset to definite diagnosis and management of GBS and the outcome. Results: During this study, 57 children with GBS aged 1-13 years were evaluated. Frequency of GBS was significantly higher in boys than in girls (38.6% vs. 61.4%, P=0.01, OR=0.39). The most common clinical presentations were distal lower limb weakness (92.11%), reduced deep tendon reflex (DTR ) (82.46%) and neuropathic pain (75.44%). 92.9% of patients had complete recovery. Conclusion: The findings of this study indicated that distal lower limb weakness, reduced deep tendon reflex and neuropathic pain are the main clinical presentation in children with GBS but in some patients DTR may be normal or even exaggerated in early stage of disease. This finding suggests that revising the diagnostic criteria for GBS may be necessary. Most of our patients had complete recovery. The only death was due to autonomic involvement

Comparison of the efficacy of amitriptyline and topiramate in prophylaxis of cyclic vomiting syndrome

Objectives: Cyclic vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder with no certain treatment. We aimed to compare the efficacy of amitriptyline and topiramate on prophylactic therapy of CVS.Materials and Methods: This is a randomized clinical trial conducted during 2016 in Isfahan, Iran. The inclusion criteria were CVS patients (based on Rome III) aging 3-15 years with normal physical examination, no metabolic disorder, and no gastrointestinal obstruction or renal impairment. Recruited patients were divided into two groups of amitriptyline (1 mg/kg/daily) and topiramate (1-2mg/kg/daily) and were followed 3-months. The outcome was evaluated by comparing severity of attacks (monthly frequency and duration of attacks) before and after intervention.Results: Thirty-six children entered each group and two patients left the amitriptyline group. Patients and disease characteristics were similar between groups before intervention (P-value>0.05). The frequency of attacks (standard deviation) after intervention in amitriptyline and topiramate group were 0.91 (0.40) and 1.07 (0.55), respectively (P-value=0.368) and the duration of attacks (SD) after intervention were 3.43 (2.46) and 4.90 (3.03), respectively (P-value=0.017). Twenty-three patients (68%) in amitriptyline group and 14 patients (39%) in topiramate group stopped having attacks after intervention (P-value=0.016).Conclusion: Amitriptyline can be considered as the better choice for CVS therapy compared to topiramate considering the high response rate of patients to this drug

Clinical feature and Genetics in Rett syndrome; A report on Iranian patients

Background: Rett Syndrome is characterized by normal development for the first 6–18 months of life followed by the loss of fine and gross motor skills and the ability to engage in social interaction. Mutations methyl CpG-binding protein 2 gene (MECP2) have been found in the majority of patients. This study was performed to investigate the relation of Rett clinical diagnosis and its relation with mutations in MECP2. Materials and Methods: children suspected to Rett syndrome were invited to take part in this study. Those who had met classic Rett syndrome diagnostic criteria were enrolled. Severity of symptoms was assessed for all patients. Of peripheral blood samples collected in EDTA tubes, the genomic DNA was extracted by standard salting out method. MEPC2 gene mutation was studied by DNA sequencing method. Results and conclusion: 23 patients accepted to participate in the study. 11(47.8%) patients had MECP2 gene mutation meanwhile 12 ones (52.2%) had no mutation. change in genetics was in association with phenotypical manifestations. The most prevalent mutation was p.v288 which is mostly in association with partially or uncontrolled seizures. This was the first time that Rett syndrome patients were studied in both clinical manifestations and genetic changes in Iran

Short-term side effects of low dose valproate monotherapy in epileptic children: a prospective study

Objectives: Considering the common use of valproate among children, we investigated short-term side-effects of low dose valproate monotherapy in epileptic children.Materials and Methods: In this prospective study, 209 epileptic children (48.3% male, mean age: 7.02 ± 3.13 years) on low therapeutic dose of valproate monotherapy (20-30 mg/Kg/daily) were enrolled and side-effects were evaluated through frequent clinical visits and laboratory tests during 6 months.Results: Weight gain was reported in 53.1% of patients. Decreased appetite was seen in 11% of patients, more frequent in younger cases (P=0.006). Abdominal pain, nausea/vomiting, diarrhea, and constipation were reported in 16.3%, 2.4%, 1.4%, and 1% of patients, respectively. Headache, tremor, dizziness, abnormal color vision, myoclonus, and bruxism were seen in 5.7%, 1.4%, 1%, 1%, 1%, and 0.5% of patients, respectively. Enuresis, hair loss, and skin rash were reported in 8.1%, 6.7%, and 0.5% of patients, respectively. Thrombocytopenia, impaired liver function tests, and leukopenia occurred in 1%, 1%, and 0.5% of patients, respectively.Conclusions: low dose valproate monotherapy may cause numerous side-effects, mostly not life-threatening and requiring no action. Besides more reported complications, we observed decreased appetite (among younger patients), enuresis, and abnormal color vision which have been briefly discussed in the literature and need to be addressed more

Evaluation of Developmental Delay in Infants Who Came in for 6th Month Vaccination in Isfahan City Health Centers

How to Cite this Article: Yaghini O, Danesh F, Mahmoudian T, Beigi B. Evaluation of Developmental Delay in Infants Who Came in for 6th Month Vaccination in Isfahan City Health Centers. Iran J Child Neurol 2012;6(2): 29-32. Objective Developmental delay is one of the most common causes of conferring the pediatric neurologist. The main part of neurological growth and development occur in the first two years especially in the first 6 months of life. Metabolic or skeletal diseases are important causes of developmental delay. Early diagnosis of deviance from the normal diagram of development in lower ages is important. Materials & Methods Specific ages and stages questionnaires (ASQ) for 6 months was completed in the health centers for 800 infants conferring for their vaccination in Isfahan and the retest was performed at 24 months of age by ASQ and then these two questionnaires were compared. Results 10.5% of the infants were delayed in at least one domain. At 24 months, 38.4% of them remained delayed; 21.1% in one domain, 9.6% in two domains, 3.8% in four domains and 3.8% in five domains. Of the children who had problem in communication, 20%; in gross motor, 25%; in fine motor, 20%; and in problem solving, 30% remained delayed. In the personal social domain, none of the delayed children at 6 months remained delayed at 24 months. Conclusion ASQ is feasible, inexpensive, easy to use and was appreciated by the parents. It can be used as a screening test for detection of developmental delay in lower ages, but its results must be followed by other standard tests or diagnostic tools.References Lewis R, Palfreg GS. The infant or young child with developmental delay. The New England J Med 1994;330:478-83.Cleary MA, Green A. Developmental Delay: when to suspect and how to investigate for an inborn error of metabolism. Arch Dis Child2005;90(11):1128-32.Schendel DE, Stockbauer JW, Hoffman HJ, Herman AA, Berg CJ, Schrann WF. Relation between very low birth weight and developmental delay among preschool children without disabilities. Am J Epidemiol 1997;146(9):740-9.Zimmer MH, Panko LM. Developmental status and service use among children in the child welfare system. Arch Pediatr Adolesc Med 2006;160(2):183-8.Michael V. Johston, Encephalopathy in Nelson text book of pediatrics 181 E . 2007.Platt, MJ, Cans C, Johnson A, Surman G, Topp M, et al. Trends in cerebral palsy among infants of very low birth weight (<1500 g) or born prematurely (<32 weeks) in 16 European centres: a database study. Lancet 2007; 369(9555):43-50.Robertson CM, Watt MJ, Yasui Y. Changes in the prevalence of cerebral palsy for children born very prematurely within a population-based program over 30 years. JAMA. 2007;297(24):2733-40.Lindsay NM, Healy GN, Colditz PB, Lingwood BE. Use of the Ages and Stages Questionnaire to predict outcome after hypoxic–ischemic encephalopathy in the neonate. J Pediatr Child Health 2008; 44(10):590-5.Yu LM, Hey E, Doyle LW, Farrell B, Spark P, Altman DG et al. Evaluation of the Ages and Stages Questionnaires in identifying children with neurosensory disability in the Magpie Trial follow-up study. Acta Paediatr 2007;96(12):1803-8. 10.  Squires J, Bricker D, Potter L. Revision of a parent completed development screening tool: Ages and Stages Questionnaires. J Pediatr Psychol. 1997;22(3):313-28. 11.  Glascoe FP. Screening for developmental and behavioral problems. Ment Retard Dev Disabil Res Rev 2005;11(3):173-9. 12.  Richter J, Janson H. A validation study of the Norwegian version of the Ages and Stages Questionnaires. Acta Paediatr 2007;96(5):748-52. 13.  Shashani S, Vameghi R, Azari N, Sajedi F, Kazemnejad A. Comparing the results of developmental screening of 4-60 months old children in Tehran using ASQ & PDQ. Iran Rehabil J 2011;11(14):3-7. 14.  Shashani S, Vameghi R, Azari N, Sajedi F, Kazemnejad A. Validity and reliability determination of Denver developmental screening test- II in 0-6 years old in Tehran. Iran J Pediatr. 2010;20(3):313-22. 15.  Jorina E, Andrew M, Elaine M, Faitb G. The Age and Stage Questionnaires: feasibility of use as a screening tool for children in Canada. Can Rural Med. 2008; 13(1):9-14. 16.  Gollenberg AI, Lynch CD, Jackson LW, Guinness BM, Msall ME. Concurrent validity of the parent-completed Ages and Stages Questionnaires, 2nd Ed. with the Bayley Scales of Infant Development IIin a low risk sample.Child Care Health Dev 2010;36(4):485-90.

Comprehensive Assessment of The Relative Frequency of Sleep Disorders in Migraine and Non Migraine in 6- To 14-Year-Old Children

ObjectiveHeadaches are common during childhood. In addition, sleep disorders are common problems in children, too. Although it is commonly thought thatheadache and sleep problems are related, there is not enough evidence to confirm this relationship. Finding evident relations between these problemswould help practitioners a lot to make earlier diagnosis and plan treatment modalities for both problems as soon as possible. This study aimed to assess the relative frequency of sleep disorders in migraine and non migraine children.Material & MethodsIn a cross sectional study, 148 children were enrolled in migraine (60) and non migraine (88) groups. They were aged 6 to 14 years. Migraine group consistedof patients who had definite migraine according to IHS (International Headache Society) criteria. Ten sleep problems (snoring, nightmares, sleep walking, sleeptalking, bedtime struggle, bruxism, sweating during sleep, excessive daytime sleepiness, insomnia in early or mid night and sleep apnea) were comparedbetween 2 groups. Fisher exact and chi square tests were used for making comparisons.ResultsWe found relationships between night sleep and daytime headaches. Some of these relationships were easy to explain but for some others, finding complicated explanations are necessary.Our findings showed that bruxism, sleep walking, early and midnight insomnia was significantly higher in migraine children. There was a common etiology forheadache and sleep disorders. Also, parents and migraine children were well familiar with the effect of relaxation on decreasing migraine episodes .Theyprovided appropriate facilities for night sleep for this reason.Conclusionwe found relationships between night sleep and daytime headaches. Some of these relationships were easy to explain but for some others, finding complicated explanations are necessary