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Background and Objective: Opium usage for sedating/relieving from diarrhea or cough causes a public health problem. In the northeast of Iran (Golestan province), opium is used widely for symptomatic therapy of routine illnesses in young children. It may cause severe intoxication and even death. This study was done to determine the toxification with opium in five years old children in Golestan Privine in Iran. Materials and Methods: This cross-sectional study was performed in collaboration with “Adverse Drug Reaction (ADR) Committee” in Golestan University of Medical Sciences. All members of ADR committee in pediatric centers trained to complete a certain valid questionnaire in children under 5-years-old, which either referred or admitted for opium intoxication (September 2006 to February 2007). Data analyzed by Chi-square and Fisher exact tests. Results: In this survey, 67 opium-intoxicated children were recruited. Minimum age of the subjects was 6 days and maximum was 5-years-old. In 41.3% of subject. The opium was given by the mother with low awakness and 61.2% of in toxicated children reside with rural area. More that 80% of the parant had the educational level below. The highschool diploma in 63.6% of cases the pure form of opium were consumed, diarrehea anxiety, were the two main cause for consuming the opium. In this study four subjects decleard dead due to toxification of the opium. Conclusion: Opium intoxication has a high prevalence among children under 5-years-old in our area. Therefore it is suggested that the intoxicated children accompanied with parant ambigious explanation opium toxification should be taken seriously.

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Background and Objective: Patent ductus arteriosus (PDA) is a common problem in preterm infants which can result in serious hemodynamic changes causing respiratory and cardiac morbidities if not treated in the first week of life. The treatment options available are pharmacological treatment with cyclo-oxygenase (COX) inhibitors and surgical ligation. The cyclo-oxygenase inhibitors approved for use are indomethacin and ibuprofen which have been used with different routes of administration and dosages. This study was conducted to evalute the lower and standard dose of oral ibuprofen in patent ductus arteriosus closure in preterm infants. Materials and Methods: In this clinical trial study, 44 preterm infants (<35 weeks gestational age) were randomly assigned to receive either a low dose (0.2mg/kg/dose for 3 doses, 24 hours apart) ibuprofen or a standard dose (10mg/kg/dose for the first dose, followed if needed, at 24hours interval by one or two additional doses of 5mg/kg each). These premature neonates either had clinical signs of patent ductus arteriosus or were diagnosed by echocardiography before stabilization of clinical signs. Patent ductus arteriosus closure was confirmed by echocardiography. They were under observe for drug's side effects (oliguria/anuria, GI bleeding, serum creatinin, intraventricular hemorrhage) and their clinical course was recorded. Results: The patent ductus arteriosus closure rates were the same with both doses (74% in case group vs.76% in control), 5 infants in the case group (22%) and 3 infants in the control group (14%) did not respond to the first course of therapy and needed a new course. There was a significant more rate of reducing renal output with the standard dose 33% vs. 4% (P<0.05), but the serum creatinin level was not different between two groups. One infant (4%) in the case group and 3 infants (14%) in the control group had GI bleeding. There was not any difference in intraventricular hemorrhage grading between two groups. Conclusion: This study showed that inspit of lower renal side effect, the low dose oral ibuprofen in comparison to standard dosage did not have any meaningful difference in closure of PDA in preterm infant.

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Background and Objective: There are some factors including socio-demographic, maternal and nutritional variables reported to influence the growth of children in the first two years of life. The aim of this study was to determine some factors related to undesirable growth of 6 months–2years old children in Tabriz-Iran. Materials and Methods: In this case - control study 233 children with undesirable growth as cases, and 412 children with desirable growth as controls selected in five primary health care centers in Tabriz city in North-West of Iran during 2007. A questionnaire which included some questions regarding demographic characteristics, fertility history, and nutritional status was filled by using face -to - face interview with selected children’s mother. The influence of different factors on undesirable growth was evaluated with a logistic regression model by using SPSS-14 and EPI-2000 software. Results: Having any disease during two monitoring (OR=4.23, 95% CI: 2.95-6.07, P<0.001), type of pregnancy (unwanted) (OR=1.87, 95% CI: 1.20-2.93, P<0.006), gender (girl) (OR=1.51, 95%CI: 1.05-2.17, P<0.025), low birth weight (OR=1.0, 95% CI: 0.99-1.01, P<0.097) and having conflict in the family (OR=1.22, 95% CI: 1.01-1.47, P<0.045) associated with undesirable growth. Conclusion: This study determined having any disease, type of pregnancy, sex of child and low birth weight related with undesirable growth of 6 months –2years old children. Using safe family planning methods and help to reduce unwanted pregnancy, parental training about the nutritional requirements of children particularly during period of disease, is recommended in order to enhance the health of children.

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Background and Objective: Childhood obesity is a significant public health concern due to its impacts on childhood physical and psychological health with subsequent adulthood complication. The aim of this study was to determine some related factors of obesity and overweight in girls' secondary school. Materials and Methods: This cross-sectional study was performed in Gorgan Northern Iran, during 2005-06. The subjects selected by stratified random sampling. Age, height, weight, BMI, daily time of television watching, frequency of physical activity and snack consumption was recorded by parents in a questionnaire sheet during a week. Data were analyzed by using SPSS-11.5 software, chi-square and ANOVA tests. Results: In this study, 6.3% and 41.7% of subjects were obese and overweight, respectively. The mean of BMI of girls was 19.69±4.6 kg/m2. The prevalence of obesity and overweight in Fars ethnic group was more than others (P<0.05). Average spending time for television watching was 2.35±0.98 hours and the same index was higher among the obese and overweight girls but, this difference was not significant. Food consumption during watching television, frequency and duration of physical activity were significantly related with obesity and overweight (P<0.05). Conclusion: This study showed that low physical activity and imbalanced nutritional behavior are related to obesity and overweight among secondary school girls in Gorgan-Northern Iran.

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Background and Objective: Asthma is the most prevalent chronic disease during childhood and it is estimated that 4.8 million children involved in asthma all over the world and its prevalence and incidence is increasing. The aim of this study was to identify the peak-flow meter application on quality of life in asthmatic children. Materials and Methods: This clinical trial study was done on 80 asthmatic children between 7 to 15 years old which referred to Shahid Beheshti hospital clinic in Kashan, Iran during 2009. Susan Sylvia questionnaire included 3 parts, was filled for every child. The questions in any section had three options in which there were 5 items in activity limitation, 13 questions in symptoms and 6 questions in emotional functions. Every question had 1 to 3 points and whole questionnaire taken 23 to 69 points. The children were learnt to measure their PEFR (Peak Expiratory Flow Rate) 3 times a day using Peak flow meter device and upon the results, the management procedure was changed. After 3 months the outcome were evaluated and data analyzed by SPSS-15 and paired t-test. Results: Mean age of patients was 8.82±2.75 years old. Thirty three subjects (41.3%) were girl. The average score in emotional functions was 13.1±3.07 before and 14.35±3.7 after using peak-flow meter (P<0.05). The average score in activity limitation was 7.33±1.57 and 8.47±0.67 before and after using peak-flow meter, respectively (P<0.05). The average score in symptoms before and after pek-flow meter was 28.81±5.13 and 32.02±5.62, respectively (P<0.05). Finally total score of quality of life showed significant increase in children after using peak-flow meter (P<0.05). Conclusion: This study showed that the application of pek-flow meter increase emotional functions, decrease limitation of activity and symptoms in asthmatic children. Therefore, it is suggested pek-flow meter dievice taking into account in asthma management of asthmatic patients particularly in children.

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Background and Objective: The metabolic syndrome is a cluster of metabolic disorders that are associated with elevated risk of cardiovascular diseases and type-II diabetes. This study investigated the prevalence of metabolic syndrome among adolescents population in Gorgan, Northern Iran - 2009.

Materials and Methods: A cross-sectional survey was conducted involving 450 adolescents 15-17 years, selected through 2 stage cluster randomized sampling from high schools. Anthropometric measurements, blood pressure, fasting blood glucose and lipid profile were assessed. Metabolic syndrome was defined according to NHANES III criteria. Data was analyzed by SPSS-16 software, Chi-Square and logestic regration.

Results: The overall metabolic syndrome prevalence was 3.3% (CI 95%:1.8–5.4). More than half of cases (54.6%) had at least 1 or 2 components. High triglyceride level was the most common disorder in both genders (boys 27.6%, girls 52.4%) and then low HDL cholesterol level (17.3%) and central obesity (7.6%) were common among boys and girls respectively. Where as abdominal obesity in boys (0.9%) and hypertension in girls (3.1%) were less common.

Conclusion: This study showed that the rate of metabolic syndrome is slightly lower but the obsity in adolescents is higher than other parts of country.

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Background and Objective: Child obesity is increased in developing countries. This study assessed the prevalence of obesity on children which are exclusively on breast feeding and its duration among children aged 24-59 months in Bandar Turkmen district Northern, Iran.

Materials and Methods: In this descriptive- analytical study, 343 in children aged 24-59 months were selected with stratified random sampling. Obesity was defined as >+2SD NCHS (National Center for Health Surveys) reference. Data were collected by questionnaire, interview with mothers and were analyzed with Chi-Square and Fisher tests and multiple regression logistic models.

Results: In this study, 6.4% of children were obese. Prevalence of obesity was not significantly different between boys and girls (5.4% and 7.4% respectively). Breast feeding duration<18 months (P<0.005) and formula or cow’s milk plus breast feeding up to 6 months old (P<0.01) was significantly correlated with children’s obesity. Breast feeding duration more than 18 months reduced the obesity risk factor with 64%.

Conclusion: This study demonestrated that exclusively breast feeding in the first 6 months of life and breast feeding duration more than 18 months reduce the child obesity.

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Background and Objective: Considering the relatively wide application of ceftriaxone in pediatric infectious diseases and its side effects, this study was done to determine gallblader sonographic abnormality following ceftriaxone treatment in children.

Materials and Methods: This descriptive cross- sectional study was carried out on 60 patients age 1 month up to 12 years in Besat hospital, Hamadan, Iran during 2007. The sonographic abnormal finding of gallbladder before ceftriaxone therapy and 5 days after therapy were recorded. In case of any abnormality in gallblader sonography was repeated twice a week in the first two weeks and afterward once a week up to disappearance of abnormalities.

Results: Gallblader sonographic abnormality were observed in 10 cases (16.5%). Out of them, 8 and 2 patients had bile stone and bile sludge, respectivley. The patients did not show any clinical manifestations. There was no relation between age and sex with abnormal findings. Gallblader abnormality completely were disappeared in the worst cases by sixteen days.

Conclusion: This study showed that the incidence of either gallstone or biliary sludge after treatment with ceftriaxone was 16.5% which is relatively similar to other studies.

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Background and Objective: Regarding to probable high frequency of Glucose - 6 - phosphate dehydrogenase (G6PD) deficiency in Iran, screening of all neonates by cord blood is under consideration. This study was conducted to determine the prevalence of G6PD deficiency in newborns and the relation between gender, jaundice, hemolysis, anemia and the G6PD deficiency in neonated born in in Tehran, Iran.

Materials and Methods: In this descriptive study, cord blood of 450 neonates born in Akbarabady hospital in Tehran, Iran during 2008-09 were screened. Demographic information was recorded by questionnaires and the newborns were examined for detection of jaundice till discharge. G6PD level was determined by Fluorescent Spot Test (FST). G6PD deficient neonate were put under close observation for detection of jaundice. Enzyme activity was rechecked by spectrophotometry.

Results: Nine neonates out of 450 were G6PD deficient (8 boys and one girl). Prevalence of G6PD deficiency was 2% (3.3% for boys and 0.5% for girls). Six neonates of nine G6PD deficient neonates (66%) developed pathologic jaundice. Four neonates were managed by phototherapy and two by exchange transfusion.

Conclusion: This study showed that G6PD deficiency is more prevalate among male neonates, therefore, G6PD determination is recommended to prevent the possible neonatal jaundice.

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Background and Objective: Infection with HBV is the most common chronic viral infection and mortality in children. Prevention of this infection with vaccination is vital. This study was done to compare the antibody level in post hepatitis B vaccination in children with 12-15 and 21-24 months age. Materials and Methods:This descriptive study was carreid out on 186 children with 12-15 (group I) and 21-24 (group II) months age who had not infected with hepatitis B infection in, Bandarabbas Iran during 2009. The parents were HbsAg negative, without immunodeficiency diseases and did not receive hepatitis vaccination, blood or blood products transfusion. Age, gender, birth weight, breast feeding duration and gestational age were recorded for each child. Hepatitis B antibody level was measured with ELISA method. Data were analyzed using SPSS-16 and student t-test. Results: Antibody level in group I (231 mIU/ml) was significantly higher than group II (142.9 mIU/ml) (P<0.05). There was not significant differences between males and females. Antibody level was not significantly corrolated with body weight, gestational age and breast feeding duration. Antibody level lower than 10 mIU/ml were observed in 4.34% of group I and 20.8% of group II. This differnce was significant (P<0.05). Conclusion: This study showed that the protective effect of vaccination reduced after six months of final dosage.

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Background and Objective: The etiology of childhood leukemia as the most common childhood malignancy remains largely unknown. This study was done to ascess the risk factors in childhood lymphoblastic leukemia in Shiraz-Iran. Materials and Methods: This case-control study was done on 141 children younger than 18 years suffering from acute lymphoblastic leukemia (ALL) whome resided at Fars Province of Iran during 2009. Patients were individually matched with 141 controls in respect to age, sex and residential area. Variables included: maternal age, parental education, father occupation, child birth weight and birth order, number of siblings, history of pet ownership including cat or dog, history of child day care attendance, history of leukemia in relatives, and history of mother diagnostic radiography during pregnancy. In order to evaluate the relationships between each variable and the risk of leukemia, odds ratio (OR) and 95% confidence interval (CI) were estimated using conditional logistic regression. Data were analyzed using SPSS-16 and Chi-Square test. Results: The agricultural occupation fathers in case and control were 17% and 5.7%, respectivley (P<0.01). The association between risk of childhood lymphoblastic leukemia with birth order≥3 (OR=5.939, 95% CI: 2.646-13.331, P<0.01), pet ownership (dog or cat) (OR=2.582, 95% CI: 1.265-5.269, P<0.009) and history of leukemia in first and second degree relatives (OR=3.5, 95% CI: 1.252-10.633, P<0.027) was significant. No relationship was found between birth weight, day care attendance, history of miscarriage, number of siblings and history of mother diagnostic radiology tests with risk of acute lymphoblastic leukemia. Conclusion: This study showed that father occupation, birth order, pet and history of leukemia in relation are risk factors of childhood acute lymphoblastic leukemia.

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Background and Objective: Viral upper respiratory tract infection and cold drugs consumption is prevalent among children. These drugs have no effect on disease improvement, but it may also have accompanied with many side effects. This study was conducted to compare the effect of honey and diphehydramine on the alleviation of cough in 2-5-year-old children with viral upper respiratory tract infection. Materials and Methods: This double-blind clinical trial study was carried out on 170 children (60 boys and 66 girls) aged 2-5 years old with viral upper respiratory tract infection who were taken to the pediatric clinic of Shariatee hospital in Bandar Abbas, Iran during 2010. Children demographic charactrastics were including age, gender, period of illness, vaccination history, weight, growth, overall health, and cardiopulmonary examinations. Patients were randomly divided into two groups of 63 children receiving honey (three times a day and the last dose an hour before bed) and diphehydramine syrup (5mg/kg/BW). Two days later, subjects were examined again for the severity and frequency of coughs during day and night. Data were analyzed using SPSS-19, independent t-test and chi-square test. Results: Mean±SD of the age of children was 45.21±11.39 and 43.98±11.95 months in honey and diphenhydramine groups, respectively. The frequency and severity of night coughs was lower in the honey group (97.4%) as compared to the diphenhydramine group (58.7%) (P<0.02). The frequency and severity of daily coughs was lower in the honey group (84.1%) while it was lower in 58.7% of the diphenhydramine group (P<0.01). Conclusion: This study showed that honey is more effective than diphenhydramine in the alleviation of cough caused by viral URTI in 2-5-year-old children.

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Background and Objective: The incidence of neural tube defects (NTDs) is varied according to race, geographical situation and other predisposing factors. This study was carried out to determine the incidence rate of NTDs and its risk factors in Yasuj, Iran. Materials and Methods: This case - control study was done on live newborns in Imam Sajad hospital, Yasuj, Iran during 2000-10. 78 neonates with NTDs out of 36755 live newborns were considered as cases. The control group was also consisting of the same number of healthy neonates who born at the same period and in the same hospital. Data were collected by a check-list and analyzed using SPSS-19, Chi-Square, Logistic regression and odd’s ratio. Results: The incidence rate of NTDs was 2.12 per 1000 live births. Anencephaly and Spina Bifida was detected in 59 (75.6%) and 19 (24.3%) of affected newborns, respectively. The ratio of females to males was 1.5 times. 53.85% of mothers with affected newborns were grouped in 27-36 years age range. The mean number of pregnancies and abortion between two groups of mothers had no statistical significant differences. There is no significant relation between the mothers occupation and the incidence of NTDs. 10 (12.8%) of mothers from case group and 7 (8.97%) of mothers from control group have used tobacco. 52 (66.7%) of mothers of case group and 30 (38.5%) of controls did not consumed folic acid. The relation between non-user folic acid during pregnancy with NTDs was significant (95% CI: 1.4-6.15, OR=2.93, P<0.001). Conclusion: This study showed relatively high incidence of NTDs in Yasuj. Non-consuming folic acid increased the risk of NTD by 2.93 times.

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Background and Objective: Congenital malformations are among important causes of morbidity and mortality in newborns. This study was done to determine the prevalence and pattern of congenital malformations in newborn. Materials and Methods: This descriptive study was done on 6089 newborns in maternity center in Rafsanjan, Iran during 2007-08. The newborns were examined by pediatricians and based on clinical examination the type of obvious of either minor or major malformations were recorded. Results: The 179 cases had at least a major or minor malformations. Over all the prevalence of malformations was 2.93%. The highest prevalence of obvious malformations was seen in the musculo-skeletal (43.5%), followed by genitourinary (22.9%) and cardiovascular systems (15.08%). There was significant relation between congenital malformations, gestational age and medicine used by mothers (P<0.05). Conclusion: The highest prevalence of obvious malformations was seen in the musculo-skeletal system.

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Background and Objective: Children constipation is one of the common causes of abdominal pain. Cow´s milk in children diet is suggested to be one of the main cause of chronic constipation. This study was performed to determine the effect of cow´s milk elimination from children diet with chronic constipation. Methods: This quasi-experimental study, was performed on 80 children with chronic constipation. Rome-III criteria were considered for disease diagnosis. Cow’s milk was eliminated for three weeks from children’s diet and the clinical symptoms in children were surveyed, subsequently. Results: Constipation was cured in 33.8% of children as result of cow's milk free diet. The rate of treatment response in affecting children whom their disease in began under 2 years of age (52.6%) was significantly higher than others (16.6%) (P<0.05). Children treatment was not significantly related to child’s gender and amount of milk consumption. Conclusion: Eliminating of cow's milk from the diet improves the chronic constipation in children.

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Background and Objective: Hematuria is one of the common causes of pediatric nephrology and urology diseases and is reported in 0.5-2% of children. This study was performed to determine the causes of hematuria in infants and children. Methods: This descriptive study was done on 200 infants, children and adolescents in one month to 18 year old ages with chief complaint of hematuria in Hamadan, Iran. Patients were evaluated by urinalysis, urine culture, measurement of calcium, creatinine and uric acid in random urine sample and abdominal sonography. Results: Microscopic and gross hematuria was detected in 79.5% and 20.5% of patients, respectively. Hematuria was idiopathic in 74 (37%) of patients. Urinary tract stones (18%), urinary tract infections (15.5%), hypercalciuria (13%), hyperuricosuria (10%), urinary tract anomalies (5.5%) and glomerulonephritis (1%) were diagnosed as causes of hematuria. Conclusion: In 56% of patients, hematuria was caused by three common etiologies of stone, urinary tract infections and crystalluria.

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Background and Objective: Urinary tract infection is the second common bacterial infection in children. Constipation as a risk factor in urinary tract infection was reported by several studies. This study was carried out to evaluate the relationship between rectal diameter and constipation with urinary tract infections in children. Methods: This case – control study was performed on 40, 2-12 years old hospitalized children with urinary tract infections as cases and 40 healthy children with the same age as controls in Boali Hospital in Sari, Iran. Rectal diameter was measured by ultrasonography. Demographic characteristics, rectal diameter, during of infectious and disease clinical signs were recorded for each subject. Results: Constipation was observed in 62.5% and 17.5% of cases and controls, respectively (P<0.05). Rectal diameter was 47.64 mm and 26.48 mm in case and control groups, respectively (P<0.05). Conclusion: Regarding to increasing of rectal diameter in patients with urinary tract infections in comparison with healthy subjects, ultrasonography can be a reliable method either to confirm or reject the presence of constipation in urinary tract infections.

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Background and Objective: Cryptorchidism or undescending testis is a developmental defect and occurred in 2-4% of male newborns. This study was done to determine the pattern and risk factors of cryptorchidism in Gorgan, northern Iran. Methods: In this cohort study, 2851 male newborns were examined for cryptorchidism at the birth and follow up for one year after birth in Dezyani referral teaching hospital in Gorgan, northern Iran during April 2010 - December 2011. Mother ethnicity, working in farmland, addiction, consanguinity, age, infant maturity and birth weight were recorded for each subject. Results: The rate of cryptorchidism was 18.9 per 1000 live birth. Bilateral and unilateral cryptorchidism was 11.7 and 7.1 per 1000, respectively. The rate of cryptorchidism in preterm newborns (30 per 1000) was significantly higher than the term (20 per 1000) and post term (11.4 per 1000) newborns (P<0.05). The Mean±SD of newborns weight with unilateral cryptorchidism (3024±537grams) was significantly lower than the healthy newborns (3253±489 grams) (P<0.05). The rate of cryptorchidism in Turkmens (10 per 1000 births) was significantly lower than Fars (21 per 1000 births) and Sistani (23 per 1000 births) newborns (P<0.05). One year Follow up of newborns showed that 41 (77.3%) testes were descent to scrotum. Conclusion: Low births weight, prematurity and ethnicity are the main risk factors of cryptorchidism in northern Iran.

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Background and Objective: Imperforate anus is a common anorectal malformation, which is associated with other anomalies. This study was done to determine the associated malformations in newborns with imperforate anus in northern Iran. Methods: This descriptive study was carried out on 40 hospitalized newborns (24 boys and 16 girls) with imperforate anus in Taleghani teaching hospital in Gorgan, northern Iran during 2006-10. Results: From 40 newborns with imperforate anus, 23 newborns (57.5%) had associated anomalies. The commonest associated anomalies was genitourinary (65.2%) followed by heart (47.8%), gastrointestinal (13%) and musculoskeletal anomalies (8.7%). Conclusion: Associated anomalies in newborns with imperforate anus in northern Iran have a high prevalence in comparison with other reports.

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Background and Objective: Poisoning is a major public health problem and a serious form of the common causes of hospital emergency visits in many countries. Incidence of toxicity based on cultural and economic characteristics of communities are varied. This study was done to determine the pediatric poisoning factors in children.

Methods: This descriptive-cross sectional study was performed on 201 patients younger than 12 years old with posinnig symptoms whom referred to hospitals in Shahroud city of central part of Iran from April 2011 to March 2012. Demogaphic data, posinnig symptoms, posinnig agents, time of hospitalization and outcome of posinnig for each child were recored in quetionare.

Results: Opium was the most common consumed material with (51.2%) while metadon considered to be the major opium. 180 (89.6%) and 21 (10.4%) children were poisoned accidentaly by their parant respectively. The clinical manifestation of the affected children were 15 (7.5%), 11 (5.5%), 93 (46.3%), 26 (12.9%), 19 (2.5%) and 22 (10.9%) without any symptoms, neuro-respiratory, nervous, gastrointestinal, gastrointestinal-respriatory and weakness respectively. Two children were died in the course of this project. There was a significant statistical correlation between the reason for poisoning and age parant education level and type of poisoning. Also, there was a relation between the type of poisoning and place of residence (P<0.05).

Conclusion: This study shows that the most common cause of poisoning among children was opiums.