Capillary refilling (skin turgor) in the assessment of dehydration
Fluid balance is easily disturbed in young children. Dehydration is often detected by pediatricians by observing decreased skin elasticity and diminished skin turgor (increased time to refill capillaries, the smallest blood vessels), indicated by slow return of color after application of pressure. Although these signs are commonly used, no studies have evaluated or standardized the technique. Two studies were conducted to correlate hydration status with capillary refilling in infants. In the first study, the effects of light or moderate pressure were evaluated at two sites in three healthy infants. Light pressure on the thumb nail bed provided the least variability. Using this technique, the conditions of 30 healthy infants were assessed, as were 32 patients with diarrhea. The average filling time in the healthy infants was 0.8 seconds, while almost all patients with diarrhea had refilling times greater than 1.0 second. Those with serious dehydration had filling times over 2 seconds. The amount of refilling time correlated significantly with the extent of dehydration. A filling time of 2 to 3 seconds signaled a 50 to 100 milliliter per kilogram body weight (mL/kg) deficit of fluid, while 3 to 4 seconds indicated a 100 to 120 mL/kg deficit, and over 4 seconds signaled a dangerous deficit greater than 150 mL/kg. The study provides a standard by which capillary refilling time may be related to the extent of dehydration, although the relationship may vary in the presence of certain metabolic or disease states. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Diseases of Children
Medical Evaluation of Sexual Abuse in Children Without Disclosed or Witnessed Abuse
Many doctors need training in the detection of child sexual abuse. In a study of 393 children referred to a sexual abuse evaluation clinic, those with no history of sexual abuse were usually referred because of physical symptoms. However, only 2 of these children had physical symptoms that suggested sexual abuse and none had definite symptoms of sexual abuse. The results of a physical examination were normal in over 80% of the children, regardless of whether they had a history of sexual abuse or not.
Publication Name: Archives of Pediatrics & Adolescent Medicine
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