---

This study has been carried out on the 491 local children whom have been selected on random sampling in 20 villages around Gorgan. The size of the height and weight of NCHS standard has been used for comparison. The results of this study shows that the height and weight of all the children in any age group is below NCHS standard. It take more time to reach to acceptable height than reaching to a standard growth and weight. Children in any age experience delay in height monotonously but it has been recorded than in initial years of life, children experience shorter delay in growth and weight but by increasing the age, the delay in the former indices increased as well. In the whole, the rate of the malnutrition will be worsen after the breast feeding period is stopped.

---

Intestinal parasites have worldwide prevalence and is considered to be as one of the most important hygienic problems in the world. As a whole, we can say there is no where in the world without parasites infestations. For the assessment of parasitic infestations of children under 2 years old in urban areas of Semnan, sample of stools for 3 consecutive days of 359 children under 2 years old, whom were accompanied by their mothers to the health center, were obtained. Samples were recognized by Formalin/ether and direct methods and thionin staining. From 359 children below 2 years old that their stools were examined, 14.2% of them had Protozoa infestation and Giardia Lamblia by 10% was the most common parasite. In these children, infestation by intestinal helminths was not seen and infestation by pathogen parasites was seen in 10.3%. There was significant association between the age and infestation by intestinal parasites (P=0.0000). There was not any significant association between the sexual, areas condition (Tropical/cold) by intestinal parasites. The most common parasite was Giardia. Therefore, educating mothers the principles of hygiene, can prevent infestation to parasites and the potential complications.

---

Enuresis is one of the most common and complex problems of childhood and it affects the relationships between children, parents and coevals. It negatively affects these relationships. Studies have shown that in comparison with normal children, Enuresis children have behavioral problems and suffer them. This survey was done with this aim to determined and compare enuresis and non-enuresis children’s behavioral adjustment in Hamadan primary schools. This study was conducted by case-control method and a total of 320 pupils were studied. These subjects were selected randomly by multi-phase sampling. The interview forms were the data collecting means. It was based on children’s behavioral checklist for the school-aged children which had been reported by Russel and Cassel. The survey results showed that there was a difference in scores obtained by enuresis and non-enuresis children from the view point of self, social, physical, home and school and general personality adjustment and high percentage enuresis children had behavioral problems and there was statistical meaningful difference between the scores obtained by two groups.

---

Diarrhea is one of the main reasons of mortality among children in the developed countries and half of all death is due to persisted diarrhea. This research is a cross-sectional and analytical study done on 708 children with acute diarrhea in village around Gorgan, to find out the effective factors on having persisted diarrhea in children under 5 years old. Face to face interview and determining the variable factors and examining health center records on children with acute diarrhea were the basis for filling the corresponding questionnaires. 14 days after the start of acute diarrhea, which was the second part of this research, the above questionnaires were fully completed by calling on the patient’s home. According to our investigation the risk factors related to the persisted diarrhea were as follow: Age, ethnicity, children length of breast feeding, chlorinated water, children consumed food at the time of acute diarrhea. The results from this investigation indicate that with 95% about probability 10.7%-11.3% of patients with acute diarrhea end-up with persisted diarrhea, which means diarrhea, was continued for more than 14 days. Therefore by controlling the above risk factors the mortality rate due to acute diarrhea could be reduced.

---

Background and Objective: Stress hyperglycemia (Transient rise of blood sugar during acute physiologic stress) has been reported in adults in conditions such as trauma, burns, stroke, myocardial infraction and patients admitted for any cause in intensive care unit. In pediatric age group stress hyperglycemia occurs in febrile illness and sever gastroenteritis. Prevalence and importance of stress hyperglycemia is not fully appreciated by physicians. This study was designed to find the frequency of stress hyperglycemia in children and infants admitted in Qaem Hospital and comparing it with other studies in Iran and other countries. Physicians’ knowledge about these phenomena prevents unnecessary and sometimes dangerous intervention. Patients with stress hyperglycemia due to acute clinical illness may be at risk of developing diabetes in future and their follow up is important matter. Materials and Methods: This descriptive cross-sectional study was conducted from March 2001 to May 201 on 334 patients admitted in Qaem Hospital who needed blood sampling for diagnostic tests. Known cases of diabetes mellitus and patients who received corticosteroids or beta-agonist agent and dextrose containing intravenous fluids were excluded from study. Blood sugar was determined by glucose oxidas method. On serum samples within 30 minute-1 hour after blood sampling. Hyperglycemia was defined in our study as blood sugar more than 150 mg/dl, fever as 37.5°C auxiliary temperature, and dehydration status defined as criteria of WHO. Results: 334 patients from age 2 days to 14 years had inclusion criteria, of these 59.5% were male and 40.4% were female. 26.3% of patients had variable degrees of dehydration. 23.7% of patients had auxiliary temperature?38.5°C to 40°C. blood sugar were in the range of 37 mg/dl-325 mg/dl and there was stress hyperglycemia in 17 patients (5.1%). Stress hyperglycemia was obviously more observed in patients with higher temperatures, more sever dehydration or clinical deterioration. There was no case of diabetes mellitus throughout 1-year follow up. Conclusion: Stress hyperglycemia is a relatively frequent clinical and laboratory finding in patients admitted in pediatrics and neonatal wards. There is no relation between the stress hyperglycemia and final diagnosis of patients, however the more serious the clinical condition, the higher the temperatures or more sever dehydration rises the likelihood of stress hyperglycemia.

---

Background & Objective: Approximately one-third of the world’s population is infected with Mycobacterium Tuberculosis (TB), which is a indicator of high distribution of these bacteria in our environment. The only vaccine currently available against TB is the attenuated Mycobacterium Bovis strain bacillus Calmette-Guerin (BCG), which used regularly for many years to prevent the Tuberculosis in Iran and many part of the world. The efficiency of this vaccine varies in different populations, and is a matter for discussion. On this basis, the present study has been set up to determine the level of Tuberculin reaction in 4.5 months and in 7 years old children that receive BCG vaccine at birth time, in Golestan province. Materials & Methods: 2700, 4.5 month infant and 2400, 7 years old children in Golestan province were chosen by cluster sampling after the proper permission from the parents, public health centers and educational authorities were taken. The presence of the BCG scar were assessed, and 0.1 ml of 5 tu Tuberculin were injected subcutaneously. The induration was measured 48-72 h after Tuberculin injection. The results were determined as present and compare with T-test. Results: In these study 2559 infants and 2193 child were taken part in the final evaluation. The BCG scar were present in 97.9% of infants and 87.8% of 7 years children, this difference was meaningful. The average induration in 4.5 months babies were 2.29 mm, and in 7 years child was 0.66 mm, this difference was significant (P<0.05). More than 44.7% of babies and 82% of 7 years children didn’t show any reaction after PPD test, this difference was also significant (P<0.05). Conclusion: The level of positive Tuberculin reaction in infants of this province in spite of vaccination was very low, and this level was reduced after 7 years time, this indicate that BCG vaccination at birth did not have any major role in positive Tuberculin reaction. Our results also indicate that the presence of scar can be a good indicator for previous vaccination. In regard to the negative Tuberculin reaction in majority of babies, it is suggested to evaluate the efficacy of BCG vaccine in preventing the TB disease itself, by other method such as studying the TB incidence among children in long term or by determination of cytokines level after Tuberculin injection.

---

Background & Objective: Giardiasis is one of the most prevalent human intestinal parasites, especially among children aged between 2 to 12 years old. In this study, the effects of Giardiasis on serological levels of Zinc and Iron elements were determined. Materials & Methods: A total of 100 children aged under 12 years who were admitted to the pediatric departments of hospitals affiliated to Mazandaran University with gastrointestinal complain, and diagnosed as having Giardiasis by stool examination (Direct and Formalin-ether technique and trichrome stain) in the parasitology department, were enrolled as the case group. The control group consisted of 100 age-matched healthy children. A questionnaire including age, physical growth status and clinical symptoms were completed. Serological levels of Zinc and Iron were measured by atomic absorption spectophotometer in all samples in Shilat of Mazandaran. Results: In this study, serum Iron levels were 67±25 µg/dl and 77±23 µg/dl and Zinc levels were 64±20 µg/dl and 96±23 µg/dl in case and control group, respectively. Statistical analysis showed significant differences between the serological levels of these elements, which was much higher in serum Iron levels (P<0.05). Conclusion: These results revealed those serological levels of Zinc and Iron decreased during Giardiasis due to malabsorption.

---

Background&Objective: Low back pain (LBP) is common in youth, although `associated with chronic pain in adults. The purpose of this study was to determine the prevalence and risk factors of LBP in school children age 11-14. Materials&Methods: A cross sectional study was carried out on school children aged 11-14 in north of Iran. Using random multistage sampling 5000 children were selected. Demographic, mechanical and lifestyle data as well as the prevalence and LBP characteristics were collected by a questionnaire. Data analysis was carried out using SPSS (version11) software. Results: Of the original sample, 4813 (96.2%) children returned the questionnaire. Point, last month, last 6 months and annual prevalence were 15%, 14.4%, 15.6%, and 17.4%, respectively. LBP was significantly correlated with age (p<0.05), lifting (p<0.05), position and duration of watching TV, doing homework and duration of exercise (p<0.05). Conclusion: The results indicated that the prevalence of LBP in school children is relatively high. Further studies evaluating the effect of different preventive strategies to reduce the prevalence of LBP in school children is strongly recommended.

---

Background & Objective: Examinations are among the most important stressors in schools and universities that result to psycho physiological outcomes but these effects on children has not been paid much attention. This study was done to determine the effect of stress of final examinations on the activation of hypothalamus-pituitary-adrenal axis (change of salivary cortisol) and autonomous nervous system (pulse rate) in children. Materials & Methods: A total of 100 children (50 boys, 50 girls) in 5th grade aged less than 12 years from two primary schools of five educational district in Tehran were chosen randomly. The subjects completed Adolescent’s Eysenck personality inventory. Physical and mental health was reviewed the medical history, clinical examinations and after controlling sleep, food, drug and sport variables, salivary samples and pulse rates were taken five times as follows: once a week before and then three times through mathematics, history and science exams and once a week after passing the exams at 9 to 10 am .Salivary cortisol samples were analysed by ELISA method. Results: Cortisol levels increased significantly during examinations in compare with cortisol levels before and after examinations. Depending to sex, psychoticism, neuroticism and extroversion –introversion variables, only the effect of psychoticism and extroversion –introversion are statistically significant (P<0.05). Also repeated analysis of variance for pulse rate indicated the increase rate of later factor (P<0.05). Conclusion: Final examinations as a stressor resource increase salivary cortisol and pulse rates of children. Personality factors can modulate the effect of examinations on salivary cortisol. Sex also modulates pulse rates increasing during academic examinations.

---

Background&Objective: Pediatric renal tumors represent approximately 7% of all childhood cancers and are completely different from those occurring in adults. The aim of this study was to make an analysis of clinical and pathological characteristics of these tumors. Materials&Methods: In this descriptive study all of the pediatric patients diagnosed as having renal neoplasm in departments of pathology of Dr Sheikh children hospital and Imam Reza hospital from 1991-2006 were evaluated. Results: 52 patients including 27 boys and 25 girls with mean age of 40.63 months were studied. Tumors involved each kidney in 24 (45.3%) and were bilateral in 5 (9.4%) patients. Abdominal mass was the commonest clinical symptom and sign. Congenital anomalies were presented in 6 (14.6%) patients. Histopathological examination showed Wilms tumor in 46 (86.8%), cystic partially differentiated nephroblastoma in 2 (3.8%), mesoblastic nephroma in 2 (3.8%) rhabdoid tumor of the kidney in 1 (1.9%), metanephric adenofiroma and low-grade tubulopapillary carcinoma in 1 (1.9%) and clear cell sarcoma of the kidney in 1 (1.9%) patient. 11 (20.8%) cases were in stage I, 16 (30.2%) stage II, 13 (24.5%) stage III, 8 (15.1%) stage IV and 5 (9.4%) stage V. Conclusion: Although Wilms tumor is the commonest renal neoplasm in childhood there are also recently described entities such as metanephirc tumors and juvenile renal carcinoma that must be considered in histopathological evaluation of a pediatric renal neoplasm. Role of molecular and cytogenetic methods is increasing for classification and treatment of childhood renal neoplasms.

---

Background & Objective: At least about 30 percentage of children hospitalize in hospital in their childhood. Hospitalization of children cause anxiety, due to separation from their parents ,fear of new environment, disabilities and continuation of life. This study was done to determine the effect of music on the rate of anxiety among 9-12 years old hospitalized children.

 

Materials & Methods: This semi experimental study was done on sixty 9-12 years old children who are confined to bed in Taleghani hospital in Gorgan north of Iran during 2002-3. 60 of children were divided to 2equal groups of intervention and control randomly. The tools of gathering data including information questionnaire, patients demographic, state – trait anxiety inventory for children Spillberger (STAIC), face anxiety children examined scale Piyeri (FACES) information was compared before and after the intervention the collect. For intervention group, 2 music therapies listening of music section, for the 2 continuous days and each section lasted for 20 minutes. The collected data before and after intervention were analyzed by using Kolmogrov-Smironov, c², independent-sample T test, Wilcoxon signed Ranks, Bartlet and Mann Whitney test.

 

Results: There was not any difference between the average of state anxiety and amount of face anxiety in both group before execution of music therapy but there was a significant difference for the intervention group after the music therapy (p<0.05). Also the decrease in the rate of anxiety in intervention group can related to the executing of music therapy.

 

Conclusion: Music therapy reduced the rate of anxiety among the 9-12 years hospitalized children.

---

Background & Objective: ADHD is the most common mental disorder in children. Awareness of students' mental health has an important role in programming for decrementing their disorders and, improving their mental health and also preventing the complications of their decreased mental health. The aim of this study was to determine the prevalence of ADHD and some of the affecting factors among school children in Nishaboor localed in the North – East of Iran. Materials & Methods: This descriptive study was done on school children in Nishaboor during 2006. Subjectes selected by stratified cluster sampling. Data collection was done using the Conner's Parent and Teacher Scale questionnaire, and each student's questionnaires were completed by both the teacher and the parents. Data analysis was performed regarding to the mean scores of teachers and parents. The score 15 was chosen as the probable indicator for ADHD. Results: 722 students (79.6%) were involved this study. Prevalence of ADHD was 12.5%, CI95%: 10–14.8%. There was no significant difference in gender distribution. The prevalence of ADHD had a significant rise with age (P<0.05). The highest prevalence was in spring born and the lowest was in the summer born school children (P<0.05). The prevalence of ADHD had a significant relationship with father's education and was lower in students whose father had higher educations (P<0.05). Variables such as type of delivery, pariety, mother's education had no significant relationship with the prevalence of ADHD. Conclusion: In this study the prevalence of ADHD is higher than similar studies. Risk groups to be followed up by the responsible organizations.

---

Background & Objective: Vaccination is one of the most effective ways in preventing the hepatitis B viruse. This study was done to evaluate the response rate to hepatitis B vaccine in under one-year children in Gorgan, Iran. Materials & Methods: This cross-sectional descriptive study was carried out on 215, children of 7-12 month of age (55.3% male, 44.7% female), in Gorgan, northern Iran during 2006. These subjects already had received the three-time vaccination against hepatitis B. Anti-HBs, Anti-HBc and HBsAg level of these children serum were determined, using ELISA technique. Results: In 30 (14%) subject's serum, there was not detected any antibodies against the viruses. Out of 185 children positive for HBS, 4 cases belong to HBC viruses. As a whole, 86% of the samples, had more than ten international unit of HBS. The meanSD of the titred antibodies in male and female were 158.8412 and 187.5513.83 respectively. The response not to three-times vaccination in male and female were 84% and 89.9% respectively. Conclusion: This study showed that in spit of vaccination, there are cases with virus-contamination. The reasons for absence of any response to the vaccination in some of this children can be due to deficiency in the immune system, improper genetic background which can not be stimulated by that vaccination, inadequate proper conditions for the preservation of vaccine, and the type vaccine used. Also the procedure of vaccine inoculation, the vaccine preservation condition and transportation should be taken into considertion.

---

Child abuse as an ominous and abnormal phenomenon was scold in every community. In attention to severity of non - accidental injuries that inflict by parents or guardian and chance of death is considerable, intervention is necessary for life saving at early stage. A large number of child abuse fatality occur in world wide, that usually does not recognize at routine visits. Therefore the need for a program to recognize and intervent is an inevitable task. This study consider child abuse case with fatal abdominal injury with subsequent death.

---

Background and Objective: Anthropometric indeces are the best methods for determining of malnutrition and obesity in children and young adulescent worldwide. This study was designed to compare the physical growth status between Turkman and non-Turkman in rural area in Gorgan in North of Iran. Materials and Methods: This cross – sectional descriptive was done on 551 children of 2-5 years of age, Turkman and 895 of non-Turkman in the rural area of Gorgan North of Iran during autumn 2005. Height, weight and personal identification recorded by questioners. BMI percentile and under -1sd ,-2sd and -3sd from NCHS used for comparison. Data were analyzed by using Chi-Square and T-student tests. Results: Mean±SD of height in female Turkman and non-Turkman were 95.3±8.1 and 90.5±8.4 cm respectivly means±SD of height were 96.0±7.6 and 90.9±8.6 cm in Turkman and non-Turkman, respectively. Male childrens mean±SD of weight in were 14.5±2.4 and 14.2±2.9 and in male Turkman and non-Turkman children respectively. Also means±SD of weight were 15.0±2.03 and 14.5±2.3 cm in Turkman and non-Turkman male children, respectively. Turkman children are about 426 gram heavier and 4.9 cm taller than non-Turkman in all of age groups (P<0.05). Stunting and underweight were observed in 13.2% and 1.9% in Turkman group less than non-Turkman respectively by -2sd criterion. There was a significant differences between two groups by stunting (P<0.05). Obesity and overweight exist in Turkman group 24.5% and 2.6% less than in non-Turkman respectively. The difference in obesity statistically was significant between two groups (P<0.05). Underweight was shown in female more than male (7.2% vs 4.2%) and obesity in female less than male (25.6% vs 28.9%). Conclusion: This study showed that secular growth in two groups is incompatible and it is better in Turkman group than non-Turkman group. Malnutrition in Turkmans was less than Non-Turkmans children.

---

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.

---

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.

---

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.

---

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.

---

Background and Objective: The prevalence of behavioral disorders in children with mentally ill parents are higher compared with children of healthy parents. This study was carried out to assess the behavioral disorders in children with major depressive mothers. Materials and Methods: This case – control study was done on 50 children (6-11 years) of mothers with major depressive as case group and 50 children of healthy mothers as controls in Bandar Abbas, Iran drung 2009. With psycological interview, DSM-4-R and Beck tests, deprsion in mother were confirmed. The psycological health of control mothers were confirmed using Minnesota multiphasic personality inventory (MMPI) and questionnaire health general (QHG). The behavior disorders of children in two groups were compared using Achenbach child behavior questionnaire. Data were analyzed using SPSS-17, Chi-Square and student’s t tests. Results: Somatic complains, anxiety and depression, social problems, thought problems, externalization, internalization and antisocial behavior scores, were significantly higher in cases compared to controls (P<0.05). No significant differences in isolation and attention behavior were noticed between cases and controls. Conclusion: Behavior disorders in children with depressive mothers are common.