bluuebunny/crossref_metadata_2025 huggingface dataset:
Perspective on the Role of the Pediatrician in the Management of Adolescent Drug Use
Authors: Schonberg S. Kenneth
Published: December 2021

Coincident with the incorporation of adolescent care into pediatric practice has been the emergence and appreciation of new health concerns regarding these children as they move toward adult life. Issues of depression and suicide, developing sexuality, and substance abuse are recent additions to the knowledge expected of the pediatrician. These issues are all characterized by an inherent relationship between behavior and health, where the demarcation between normative development and dysfunction is often ill-defined and confounded by legal and moral concerns. Therefore, the practitioner is required to develop not only interviewing and counseling skills appropriate to a teenage population, but also that combination of knowledge and judgment that allows for a personalized definition of normal v abnormal behavior.
Stuttering and Stammering
Authors: Guitar Barry E.
Published: December 2021

Stuttering is a disorder characterized by intermittent difficulty in producing a smooth flow of speech. Stutterers may repeat or prolong sounds or may sometimes be unable to utter any sound without a great deal of effort. The disorder usually begins a year or two after the child has first learned to speak. The earliest symptoms are usually repetitions of parts of words. Signs of the problem may gradually progress, in a matter of months or during a period of several years, from these minor repetitions to prolongations of sounds, longer hesitations, and complete blockings of speech. Accessory signs and symptoms such as facial squeezing, tremors of the speech musculature, and eye blinks, as well as fear and avoidance of particular words and situations, often occur in more severe cases. At times stuttering may be "internal," ie, apparent only to the child involved, or manifested only by pauses in speech.

TERMINOLOGY

Stuttering v Stammering

"Stammering" is a term no longer in common usage in the United States. It is still used in Europe, as it was once used here, to denote tense blockages of speech, as opposed to "stuttering," which was applied to the repetition of sounds and syllables. Current usage in this country favors the term "stuttering" for all forms of the disorder.
Cytomegaloviral Infections: Epidemiology, Therapy, and Prevention
Authors: Nankervis George A.
Published: December 2021

The role of cytomegalovirus in human disease is a still-evolving story. Hanshaw presented an excellent review article on the subject in 1981 in this publication; this current review is an update, with particular emphasis on new concepts in the epidemiology and prevention of cytomegaloviral infection and disease.

Historically, evidence of infection with cytomegalovirus was first reported by pathologists in many parts of the world. They noted the presence of giant cells with intranuclear inclusions while examining a diversity of organs microscopically. Isolation of the virus and development of serologic techniques eventually enabled a definitive study of the agent, its pathogenesis and epidemiology. Biologically, it is one of the herpesviruses and, as such, is a DNA virus. Other members of the group include varicella-zoster, herpes simplex, and Epstein-Barr virus. Several different strains of cytomegalovirus exist, and they have specific characteristics which are of interest. The virus is cell associated and tends to be very labile; it has a tendency to become latent and may possibly have malignant potential.

EPIDEMIOLOGY

Prevalence

Infection with cytomegalovirus is found throughout the world. Studies of prevalence in a number of diverse populations have indicated that cytomegaloviral infection is ubiquitous. The major differences in prevalence between populations are related to the speed of acquisition of infection in various geographic and socioeconomic settings.
Allergy to Cow Milk-1985
Authors: Lee Eui Jung , Heiner Douglas C.
Published: December 2021

Cow milk became the most popular nutrient for infant feeding in much of the world near the beginning of the 20th century. It remains so today, especially in industrialized countries, but this widespread dependence on cow milk is not without problems. Physicians who care for infants and children know that intolerance to cow milk is not uncommon. Cow milk allergy can be defined as an adverse immunologic reaction to cow milk protein, seen only rarely in those who ingest ordinary amounts of milk. The term is often mistakenly applied to other causes of milk intolerance, such as lactase deficiency and galactosemia, which must be differentiated and excluded.

Reports of the incidence of cow milk allergy in infancy have ranged from 1.9% to 7.5%. The incidence is lower in older children and adults, but precise data are not available for these ages either. The reported incidences vary with the manner of selection of patients and with differing diagnostic criteria. Moreover, there are few reliable laboratory tests available to the clinician who wishes to confirm the diagnosis. Many instances of intolerance to cow milk are mild or transient, and after milk is eliminated from the diet for a few months or years, the symptoms disappear. Only a small percentage (probably 0.1% to 1%) of the population has severe or lifelong cow milk allergy.
Differential Diagnosis of Seborrheic Dermatitis
Authors: Williams Mary L.
Published: December 2021

Seborrheic dermatitis is a common skin condition of infancy of unknown etiology. The disorder is usually mild and responsive to therapy. In severe or atypical cases, a variety of other entities should be considered in the differential diagnosis. Atopic dermatitis, psoriasis, psoriasiform-id reaction, fungal infections, and irritant contact dermatitis can be differentiated on clinical grounds. Less common but more serious disorders, such as histiocytosis X, immunodeficiency disorders, and nutritional and metabolic diseases, may be considered in the child whose disease does not spontaneously resolve or respond satisfactorily to local therapy. Laboratory studies including skin biopsy may be helfpul in these cases. Seborrheic dermatitis is uncommon in children after infancy and before puberty. In this age group, scalp scaling is likely to be due to other causes, such as tinea capitis, atopic dermatitis, or psoriasis.
Understanding Allergic Rhinitis: Differential Diagnosis and Management
Authors: Shapiro Gail G.
Published: December 2021

Chronic rhinitis is a common condition responsible for a substantial morbidity. Allergic rhinitis is the most frequent reason for chronic rhinitis in children. The physician must begin any evaluation with a thorough history and physical examination. Specific questions concerning the environment will be important if allergy is a possible diagnosis. The microscopic examination of nasal secretions may be helpful in corroborating evidence.

Treatment of allergic rhinitis should include a serious attempt to avoid exacerbating factors that have been identified from the history. Pharmacologic intervention with antihistamines, decongestants, and topical use of cromolyn or corticosteroids may be highly successful.

If such therapy must be constant to achieve an adequate therapeutic response or if the response is suboptimal, an evaluation for specific allergies, including skin testing to identify pertinent allergens, should be considered.
Bronchiolitis
Authors: Wright Peter F.
Published: December 2021

Bronchiolitis is an acute respiratory disease of early childhood characterized clinically by upper respiratory tract signs of rhinitis and congestion and by lower respiratory tract signs of tachypnea, retractions, wheezing, and rales. The presence of wheezing differentiates bronchiolitis from many of the other entities to be considered in the child with respiratory distress. Fever and other systemic signs are not prominent components of bronchiolitis. Radiographically, there is evidence of hyperexpansion of the chest, thickening of the bronchial walls, and areas of atelectasis or interstitial pneumonia. Physiologically, there is evidence of hypoxia and hypercarbia with disequilibrium of perfuson-ventilation. Pathologically, there is evidence of damage to the mucosal epithelium with loss of ciliary function. There is an increased production of mucus, with a proliferation of goblet cells. Submucosal edema and lymphocytic infiltration are common. These changes are seen throughout the respiratory tract but are particularly prominent in the cells and submucosal lining of the bronchioles, with resultant obstruction of the small airways (Fig 1).

The pathologic events are obviously central to the whole process of the illness. An understanding of the mechanisms by which the pathologic changes in bronchiolitis evolve, and their implications for diagnosis, therapy, prognosis, and, ultimately, prevention, will be the focus of this review.
Prevention and Management of Infectious Diseases in Day Care
Authors: Aronson Susan S. , Gilsdorf Janet R.
Published: December 2021

HOW MODERN PARENTS CARE FOR THEIR CHILDREN

Almost one third of American children are in day care, a term used to describe care provided to children by individuals other than their parents for fewer than 24 hours per day. Day care for children has been a part of American culture since the Civil War, when women began to enter the labor force. Today, 60.5% of mothers of children younger than 18 years of age are working (Table 1).

In the past decade, the proportion of mothers who are working outside the home has increased by about 20% among both mothers of pre-school children and mothers of school-aged children. More than 9 million children younger than the age of 6 years have mothers who work outside the home, and the majority are working full time. Even mothers of infants are working outside of the home in record numbers. As of March 1984, almost half (46.8%) of married mothers of children younger than 1 year of age were working outside the home. The trend is expected to continue; by 1990 the population of children requiring care while their parents work will reach 10.4 million. Although we tend to concentrate on child care arrangements for the youngest children, an even larger proportion of parents of school-aged children are working in the labor force.
Phenylketonuria—1986
Authors: Levy Harvey L.
Published: December 2021

Phenylketonuria (PKU) has been aptly described as the "epitome of human biochemical genetics." In so distinguishing PKU among the many metabolic disorders now known, Scriver and Clow identified several categories in which this inborn error of metabolism is singularly prominent. First and foremost, PKU represents a fusion of effort between public health and genetics. It is the major genetic disorder in which treatment can prevent the clinical expression of disease and for which routine biochemical screening of newborn infants was developed. It remains the model for such screening. Second, PKU is the prime example of the importance of understanding as completely as possible the biochemical basis of a metabolic disorder. The detailed understanding of phenylalanine metabolism that arose from studies spawned by PKU led to the recognition of "new" metabolic disorders that relate to PKU in their capacity to increase the phenylalanine level but that involve a different category of metabolism and require very different treatment. Third, PKU represents an important link between obstetrics and pediatrics. The threat to the fetus from PKU in the pregnant woman (maternal PKU) must be met by special dietary care throughout the pregnancy. This is, perhaps, only the first of other maternal inborn errors that will require similar intervention during pregnancy.
Adverse Effects of Overdosage of Vitamins and Minerals
Authors: Barness Lewis A.
Published: December 2021

Throughout almost three centuries, knowledge of the uses, needs, and metabolism of trace nutrients, vitamins and minerals, has been acquired. This knowledge can be divided into five phases.

The first phase occurred during a period of about 200 years and was one mainly of discovery. Animals and/or humans were noted to have diseases that were related to deficiencies. Thus, in 1753 a Scottish surgeon in the British navy showed that citrus fruit could prevent or cure scurvy, and about 200 years later ascorbic acid was isolated, synthesized, and used. Many of the trace elements were determined either to correct deficiencies or to be growth factors for animals. Discovery of knowledge continues but at a less rapid rate.

The second phase, which considerably overlaps with the first, is related to determination of the mechanism of action. This required, first, study of animals, then, tissues, and, now, cells and cell components. Many biochemical pathways have been determined, and many vitamins and minerals have been identified as part of enzyme systems. Still others are to be explored and determined.

The last three phases appeared irregularly but periodically, two with scientific input and one by hope, prayer, and deductin.1

The third phase was one of the determination of recommended daily requirements and allowances (RDA).
The Pediatrician as a Member of The Community
Authors: Mclnerny Thomas K.
Published: December 2021

This simple statement by Dr. Haggerty, with its profound implications, has influenced my "extracurricular" activities significantly. It was delivered at a Grand Rounds shortly after I joined a pediatric practice in suburban Rochester, NY, while I was still impressionable and relatively uncommitted. At the same time. I became aware through firsthand experience of the very large role that school plays in determining the course of children's lives.

Our practice style is one of concern for the complete development of the child, not only physically, but also intellectually and emotionally. Thus, during the annual physical examinations, we inquire about progress in school and learn how children's natural intellectual curiosity can be encouraged or discouraged by different school environments.

There seemed to be little that I could do about the school's influence on children's development until some friends suggested that I consider joining the school board. My first response was to avoid this time-consuming, political, often "no-win" position of responsibility like the plague. However, Dr Haggerty's words kept coming back to me, piquing my conscience. After much deliberation, I decided to run and, with a great deal of help, was elected.
Acute Ataxia
Authors: Stumpf David A.
Published: December 2021

Ataxia is a vague term. Disease processes from the cerebral cortex down to the muscle can produce ataxia. Thus, it is not a localizable symptom, and other aspects of the clinical state are necessary to clarify the localization of the disorder. The neurologic history and examination will clarify the nature of acute ataxia.

The development of acute ataxia in a child is a dramatic event for both families and physicians. The physician evaluating the ataxic patient should be thinking foremost about common, treatable causes. Generally, this includes infectious and metabolic causes. As in most neurologic disorders, the history and physical examination provide important and critical information. A wide differential diagnosis must be entertained (Table 1).

CLINICAL HISTORY

The history of the onset and nature of the ataxia can provide valuable clues to the diagnosis. Specific information should be sought concerning the exact nature of the ataxia; does it involve just the limbs, or are truncal, postural, or eye movements also affected? The presence of associated neurologic symptoms such as weakness, headache, head tilt, or lethargy may provide direction to the differential diagnostic thinking. Systemic symptoms such as fever or concomitant or antecedent illness are also important. Preceding viral infections should be carefully reported. Viral diseases such as varicella, mononucleosis, influenza, or mycoplasma infectoins are particularly likely to produce a postinfectious ataxia. A history of drugs or poisons that may have been accessible to the child should be sought.
Commentary on The Difficult Child
Authors: Chess Stella
Published: December 2021

Dr William Carey has earned a well-deserved reputation as an important figure in the field of behavioral pediatrics. His studies and writings have enhanced our understanding of a number of behavioral issues that concern both pediatricians and mental health professionals. His major contributions have been in the field of temperament studies. Here, he has been a clinician-researcher who has made valuable theoretical, clinical, and methodologic contributions to the conceptualization of temperament, its systematic measurement, and its practical applications by the practicing clinician.

His present review of "The Difficult Child" gives us an authoritative and scholarly survey of one of the complex theoretical and practical issues of temperamental individuality in children. On the one hand, the review summarizes the pertinent research literature briefly but cogently. At the same time, Dr Carey's judgments and advice are not based on any academic approach but, on the contrary, reflect his own rich clinical and research experience in the field of temperament. My own comments will focus mainly on expanding Dr Carey's discussion of the basis for the concept of the temperamentally difficult child and his comments on practical management.

Our definition of difficult temperament grew out of two separate lines of investigation. First and foremost was the vivid impressions gained by Dr Alexander Thomas and myself as we interviewed the parents in our New York Longitudinal Study(NYLS), which we initiatead in 1956.
Evaluation of Chest Pain in Children
Authors: Selbst Steven M.
Published: December 2021

Childhood chest pain is a common complaint and often a recurrent, chronic symptom. A detailed history and complete physical examination are the most important aspects of evaluating a child with chest pain. Childhood chest pain has a good prognosis. Laboratory tests should only be ordered if they are indicated on the basis of history and physical examination findings.
Giving to Our Patients—Should We Draw the Line?
Authors: Nazarian Lawrence F.
Published: December 2021

"We've got a cut finger here. Can we meet you at the office right away?" The mother's voice on the phone was calm but insistent.

"Which child is this?" I asked.

" Well, actually, it's me. My doctor doesn't do suturing and I don't feel like waiting around the emergency room."

I had no problem telling her politely that I would call the hospital to let them know she was coming. Clearly, this was an inappropriate request to make of a pediatrician covering a large practice on a weekend, especially when other help was available.

But what about the parent who calls after hours regarding a diaper rash? How about the father who insists that you put a diagnosis other than "well child" on the charge slip, so his insurance will cover the routine examination? Does it change your mind when he points out that you discussed the child's headaches during the visit? How about the mother who wants erythromycin for her child "because it's the only thing that clears up his ears?"

Our orientation is to give our patients what they need. We are there to help and to give. Rightly so. And most of the time it is appropriate to give what is requested.
Counseling Families With Twins: Birth to 3 Years of Age
Authors: Becker Patricia Gallagher
Published: December 2021

The difficulties and demands facing parents of twins or other multiple births are significantly greater than those facing parents of children born singly. Even routinely day-to-day care is sometimes different from that of a singleton. With the added stress in the home, parents will benefit from the pediatrician's advice on caring for their twins. Physicians need to be emotionally supportive and to offer suggestions such as changing breast-feeding technique, getting the father or other support person involved, and even linking these mothers with other mothers of twins. Discussion of feelings of inadequacy should be addressed during office visits.

This study suggests a need for more physician education concerning management of multiple-birth infants. Providing health care alone is not sufficient in the management of twins. Attention to and guidance in a wide variety of twin care measures is important if the pediatrician is to provide optimal care for the children and families involved in multiple births.
Intrauterine Growth Retardation
Authors: Warshaw Joseph B.
Published: December 2021

Intrauterine growth retardation can result from a variety of environmental and genetic influences on fetal growth. The sequelae of intrauterine growth retardation resulting from impairment of nutrient flow include low birth weight with sparing of brain growth, polycythemia, and hypoglycemia resulting from decreased storage fuels and defective gluconeogenesis. Available data suggest that the vast majority of nutritionally growthretarded infants have normal postnatal development without significant difference in IQ or neurologic scores from normal infants. The outcome of infants in whom there is decreased growth potential relates to the condition underlying growth retardation and may, of course, result in later severe handicap.

Infants with nutritional intrauterine growth retardation may exhibit decreased fetal size and sparing of brain growth as an adaptive stage in the presence of lower oxygen and substrate availability. Under such conditions, a smaller size may decrease substrate and oxygen needs and improve outcome. All infants with intrauterine growth retardation, however, require follow-up and careful developmental evaluation.
Fetal Alcohol Syndrome
Authors: Jones Kenneth L.
Published: December 2021

The fetal alcohol syndrome is the third most common recognizable cause of mental retardation in the United States. Many of the features of the fetal alcohol syndrome are secondary to the effect of alcohol on brain development. These include microcephaly, short palpebral fissures, the long smooth philtrum and thin vermilion of the upper lip, joint anomalies, altered palmar crease pattern, and mental retardation. Approximately 40% of babies born to alcoholic women and 11% of babies born to nonalcoholic moderately drinking women have evidence of the prenatal effect of alcohol. Alcohol, like other teratogens, causes a spectrum of defects. Thus, affected children may show great variability from the fullblown fetal alcohol syndrome to much milder effects of alcohol, some of which may not be obvious until school age. A "safe" amount of alcohol probably does not exist for the pregnant woman. Depending on unknown factors, what may be a "safe" amount for some women, may be devastating to the unborn baby of another. Two factors, the severity of the maternal alcoholism and the extent and severity of the pattern of malformation, seem to be most predictive of the ultimate prognosis for children with the fetal alcohol syndrome. Any decision to file child abuse changes against a mother whose baby was prenatally exposed to alcohol should be based on the parents ability to provide a stable home environment and not on whether the baby has features of the fetal alcohol syndrome. The fetal alcohol syndrome, the third most common recognizable cause of mental retardation, is completely preventable. All attempts must be made to educate people regarding the deleterious effect of alcohol.
School Refusal
Authors: Schmitt Barton D.
Published: December 2021

School refusal is one of the major school problems with which health professionals need to become involved. In general, parents will only accept this diagnosis from a physician they consider an expert in physical disease. Often this disorder is not included among the differential diagnoses of physical symptoms. We should ask about school attendance whenever we evaluate a child for a vague chief complaint. Once considered, this diagnosis is easy to confirm. Intervention is also straight forward. The physician should be decisive about physical health, insist on an immediate return to school, and monitor the patient's progress.
Behavioral and Developmental Components of Child Health Promotion: How Can They Be Accomplished?
Authors: Green Morris
Published: December 2021

Child health supervision has been a service highly valued both by the consumer and by pediatricians. In addition to improved public health practices, nutrition, housing, and other environmental factors, pediatric health promotion has made a major contribution to the improved health status of children which has occurred in recent decades in the United States. Although the current preoccupation with cost containment might suggest otherwise, the present question is not how we can do less in health promotion but how we can do more, and with better effectiveness, especially in relation to behavior and development. The potential for child and family health promotion in these areas remains largely unrealized.

We live in a society characterized by rapid change. By 1 990, one fourth of the children in the United States will spend part or all of their lives in one-parent families. Today, most mothers work outside the home. Parental divorce, separation, and remarriage are events now frequently experienced by children. Many upwardly mobile families are postponing parenthood and having few children or none. In our highly migratory society, grandparents and other relatives are less available to provide emotional and other support, especially for young parents and children.

NEED FOR NEW MODELS

In view of all this, the model of pediatric practice that has gradually envolved over the decades to provide care, in the beginning for infants with nutritional and acute infectious disorders, requires constant reevaluation and renewal if it is to remain responsive to emerging health promotion needs, particularly in relation to behaviour and development.
Child Survival and Development Revolution
Authors: Grant James P.
Published: December 2021

As many pediatricians are aware (indeed, many of you are responsible!), the lives of significantly more than a million young children were saved last year as a direct result of specific primary health care measures singled out as the Child Survival and Development Revolution (CSDR). If fully applied on a worldwide scale, the CSDR has the potential to cut in half the toll of 40, 000 young lives lost each day to the most mundane and preventable of causes, and it could likewise halve the even larger number of youths who grow into adulthood bearing the crippling disabilities of childhood diseases.
The Pediatrician, the Disabled Child, and the Family: A Special Relationship
Authors: Miller Robert L.
Published: December 2021

Sooner or later, every practicing pediatrician will be asked to care for a baby who will be permanently disabled, such as a child with Down syndrome. To some, the request will be an unwelcome burden, to be dealt with as quickly as possible. To others, however, a new baby with a disability challenges the pediatrician to use all of his or her skills over a long period of time, receiving unexpected rewards in the process.

The first opportunity to establish a sound relationship comes when the pediatrician must inform the new parents about the diagnosis. The response to such unexpected news is always shock, denial, and guilt, with a healthy dose of anger. The pediatrician, who by nature is sensitive to the special needs of children and their parents, is in an ideal position to deal with the normal grief reaction.
Progressive Weakness in Infancy and Childhood
Authors: Lewis Donald W. , Berman Peter H.
Published: December 2021

The child with progressive weakness may have a disorder at one of many possible levels within the nervous system. By establishing the pace and character of the weakness and by localizing the anatomic site of the pathologic condition to either the upper or the lower motor neuron unit, a scheme for systematic evaluation can be developed.
Office Measurement of Serum Theophylline
Authors: Oliver W. , Chapman D.
Published: December 2021

Maintenance of serum theophylline concentrations within the therapeutic range is important in the treatment of asthmatic patients. Levels that are too high are associated with toxicity, whereas concentrations that are too low are ineffective. Commercial kits recently marketed permit measurement of serum concentrations of theophylline in the physician's office in as few as 15 minutes.
Developmental Assessment and Early Intervention Programs for Young Children: Lessons Learned From Longitudinal Research
Authors: Chamberlin Robert W.
Published: December 2021

We have good evidence that quality early intervention programs can be of considerable benefit to many children with established handicaps and their families and to children and families exposed to environments that severely restrict their opportunities to participate in development-promoting activities (Table). However, because a child's developmental status at any one time is the result of a complex interaction between the biologic characteristics of the child and his or her social environment and because development appears to progress over time through a series of mutually influencing "transactions" between the child and his or her caretakers rather than as a straight line from one point

[See table in the PDF file]

to another, we cannot accurately predict in which children problems will develop in the future. We do know that some children with mild and even moderate signs of neuromotor dysfunction "outgrow" them or at least compensate for them adequately without treatment, provided they are being reared in a development-promoting and emotionally supportive environment. We have also learned from studies of classroom settings and from our own clinical programs that monitor at-risk children for long periods of time that we can negatively influence a parent or child's perception of his or her normality and create a self-fulfilling prophecy.

Our proposal for handling this dilemma is to put more emphasis on prevention by seeing that every family in a community has access to the basic parent education and support services that can prevent many of these problems from occurring in the first place and/or can help those with mild to moderate signs of dysfunction effectively compensate for them. Therapy-oriented specialists can provide consultation to these programs to help children with special needs. Finally, to ensure that families in need actually connect with these preventive and/or treatment programs, the primary care providers, school personnel, and community health nurses need to work together in a communitywide screening/monitoring/referral System.
School Placement
Authors: Palfrey Judith S. , Rappaport Leonard A.
Published: December 2021

As part of the current emphasis on health rather than disease, strength rather than weakness, many pediatricians are orienting their practices to explore and support optimum childhood functioning. This orientation is totally in concert with the declaration of the special education movement that professionals can no longer exclude children from school but must do everything they can to include even the most severely disabled child in the life of the community.

Pediatricians have a unique opportunity and responsibility with regard to school placement. Aware of the child's history and medical background, pediatricians can work creatively with schools and other agencies to design placements that will allow the child the greatest room for growth. Moreover, pediatricians can help establish intervention programs as soon as a child's disability is determined. As pediatricians take the opportunity to interact with other child development specialists and service agencies, there will be a common growth of knowledge about children, their needs, and the best services to meet these needs.
Oral Rehydration Therapy
Authors: Finberg Laurence
Published: December 2021

The Committee on Nutrition of the American Academy of Pediatrics strongly supports the concept of the use of the oral route for rehydration and maintenance hydration of infants with enteritis as reviewed in this issue by Santosham et al. We place emphasis more forcefully on distinguishing the different stages of physiologic disturbance in such infants which, therefore, slightly changes our emphasis in the recommendations for therapy.

Even for mild dehydration, three stages are recognized: a state of clinical dehydration requiring rehydration, a maintenance fluid stage after hydration is achieved, and an early refeeding stage in which nutrition is restored.

These stages may merge into one another quickly, and in some patientsthe rehydration period may not ever present.
Mental Retardation
Authors: Healy Alfred
Published: December 2021

Rapid and significant changes in appropriate evaluation and care of infants and young children with mental retardation and other disabilities are substantively influencing the pediatrician's role. Pediatricians trained in models of development that emphasized biologic influences are now understanding the powerful influence of environmental forces on infant development and are beginning to recognize the landmarks of infant temperamental, emotional, and mental health development. Changes in the traditional American family and the resources available to the family are also exerting major influences on the developmental outcome of infants and children with and without disabilities. Pediatricians are becoming more aware of the value of joining in active interdisciplinary partnerships with parents and well-trained professionals as they evaluate, provide health care, and participate with others in coordinating services for infants with mental retardation.
Pediatric Preventive Cardiology: Atherosclerosis and Coronary Heart Disease
Authors: Strong William B. , Dennison Barbara A.
Published: December 2021

Pediatric preventive cardiology has as one of its goals, the reduction in incidence and severity of cardiovascular disease in adults by the promotion of prudent life-styles in children and adolescents. Few would find fault with this goal, yet the "best" approach and strategy to reduce atherosclerosis and coronary heart disease has been the source of controversy.1-4 The recently published National Institutes of Health Consensus Conference Statement on lowering blood cholesterol to prevent heart disease has summarized the literature relating blood cholesterol and heart disease.5 The strategies recommended include: (1) dietary changes to reduce total dietary fat, saturated fat, and dietary cholesterol consumption in everyone older than 2 years of age, (2) universal blood cholesterol screening for all adults older than 18 years of age, (3) more intensive diet therapy for those with a blood cholesterol level ≥75th percentile, (4) possible addition of drug therapy for individuals whose blood cholesterol levels remain ≥75th percentile despite diet therapy, and (5) in individuals with elevated blood cholesterol levels, emphasis on management of other coronary heart disease risk factors: hypertension, cigarette smoking, diabetes and physical inactivity.

The European Atherosclerosis Society has also recently advocated screening the population to find those at high risk (eg, those with an elevated blood cholesterol level in conjunction with population strategies to improve nutrition, eradicate smoking, control hypertension, and promote suitable physical activity.6
TECHNICAL TIP: Transillumination for Localization of Arteries and Veins in Young Infants
Authors: Chapman D. D. , Oliver W. J.
Published: December 2021

It is often necessary to puncture or cannulate arteries and/or veins of young infants for sampling or for injection purposes. Transillumination, using a fiberoptic light source, provides light intensity that greatly enhances identification of these vessels and the likelihood of successful cannulation. Use of a fiberoptic light source allows tiny blood vessels, both arteries and veins of Ithe newborn infant, premature or full term, to be accurately identified and punctured or cannulated.
Assessment of Renal Function in Newborn Infants
Authors: Springate James E. , Fildes Robert D. , Feld Leonard G.
Published: December 2021

Proper interpretation of renal function tests in newborn infants requires knowledge of conceptual age. A plasma creatinine concentration of 1.2 mg/dL, serum bicarbonate concentration of 16 mEq/L, and a fractional excretion of sodium of 5% is normal in a 2-week-old infant born at 28 weeks's gestational age but markedly abnormal in a 2-week-old baby born at term.

Newborn infants with urinary tract infections need radiologic evaluation for vesicoureteral reflux and urinary tract obstruction using voiding cystourethrogram and renal sonography or radionuclide scanning. Intravenous pyebography is not the test of choice for this evaluation.

If severe hypertension develops in a 1-week-old infant, seriously ill with respiratory distress syndrome, evaluation should include determination of the use of umbilical artery catheters and investigation for renal artery thrombosis with sonography and radionuclide scanning because renovascular disease is the major cause of hypertension in newborn infants.
Sleeplessness, Night Awakening, and Night Crying in the Infant and Toddler
Authors: Ferber Richard
Published: December 2021

1. Although nighttime awakenings are common in the second half year and beyond, this is not a developmental necessity; rather, most normal infants gain the capacity to "sleep through the night" by 6 months of age.

2. There is not a single cause of (or a single treatment for) nighttime awakenings and crying; many factors may be responsible, and these must be identified and individually treated if there is to be resolution.

3. What are often perceived as abnormal awakenings are really only the normal awakenings associated with normal sleep stage cycling, and, parents' "treatment" of these awakenings with interventions, such as rocking or feeding, only make it more difficult for the child to go back to sleep without them after subsequent awakenings.

4. No evaluation of a sleepless child is complete without a thorough understanding of the child's daily schedule. The child's sleep schedule may be consistent and his sleep normal, and only the timing may be shifted from that desired by the parents. The bedtime difficulties or early morning awakenings generated in this setting may be handled inappropriately by the family, creating even more complicated problems. Or, the schedule may be irregular, sleep/wake rhythms may not adjust, and any of a variety of apparent sleep disorders may appear.
Ethical Issues in the Care of Newborn Infants
Authors: Weil William B.
Published: December 2021

Some of the difficulties of obtaining surrogate decisions that are in the children's best interests, the extension of this problem to the newborn period, and the political and social derivatives of these difficulties have been reviewed. The 1984 child abuse and neglect amendments have been summarized and their impact on the care of newborns has been discussed. The outcomes of this entire process have been described and the potential extension of these issues to the prenatal period has been mentioned.

Although not everything that has transpired or will transpire as the result of the Baby Doe issue is salutary, it seems likely that the care of newborn infants has changed and will continue to change, and these changes will ultimately impact on medical care for everyone.
Cardiac Causes of Syncope
Authors: Ruckman Roger N.
Published: December 2021

Syncope in children and adolescents is a common problem which almost always has a definable etiology. A search for the underlying diagnosis is important because of the risk of injury or sudden death. Such a search should include history, examination, laboratory screening, and ECG as a primary workup protocol. Such an evaluation can be done at relatively low cost and will establish the diagnosis in most cases. The most frequent cause in childhood is vasovagal syncope or other reflex mechanisms that usually require no ongoing care. If, however, a cardiac cause is found, the potential for an untoward outcome is greater, and, accordingly, diagnostic and treatment steps need to be thorough and comprehensive. If no etiology is found, particularly if the episodes are recurrent, extensive cardiac studies may be required, including inpatient electrophysiologic testing. A small percentage of children with heart block or intractable symptoms may ultimately require a pacemaker.
Diagnosis of Deafness in Infancy
Authors: Ruben Robert J.
Published: December 2021

In the past 20 years, the prospects for hearing-impaired infants have improved significantly. It is now possible to diagnose deafness even in neonates and premature infants and to provide care that can prevent or ameliorate some of the most devastating effects of hearing loss. There have been steady advances in surgical and other medical procedures and in habilitation techniques. The value of many forms of therapy, however, depends greatly on how early intervention occurs.

Approximately one in 1,000, or 0.1%, of all infants are severely to profoundly deaf; their problems are permanent and pervasive. An estimated four to ten times as many infants suffer from hearing loss that is either unilateral or less than profound.

Hearing deficits affect language acquisition and consequently cognitive, social, and emotional growth. Behavioral and biologic evidence points to a critical time for linguistic development. Children normally master the language they hear around them by the age of 4 or 5 years, when they become competent to comprehend and produce all the variations of sentence construction found in adult speech. In this same period, deaf children can be taught sign language. The aptitude and flexibility for language acquisition diminishs with age. Early language deprivation results in permanent impairment.

Infants suspected of having hearing loss can be evaluated by means of auditory-evoked potentials, recently developed technology available at audiologic facilities throughout the country.
Preparticipation Evaluation for Athletics
Authors: Hulse Eddie , Strong William B.
Published: December 2021

Increasing participation in physical activities and sports has been noted in all age groups. The increase is encouraging from a health promotion, disease prevention, and sociologic perspective. As a result of the increased participation, sports-related medical problems are being recognized with increasing frequency. Injuries and sudden unexpected deaths resulting from physical activity are being described with increasing frequency. Injuries are especially likely to occur as previous nonathletes begin involvement without adequate preparation.

The increased interest in exercise, sports, and health-related activities involves children as well as adults. Organized sports for preschool children now exist in most communities. Estimates suggest that more than 20 million children are involved in community-based sports programs. High school sports are no longer restricted to a relatively few male-predominated sports. More than 30 sports are now approved for male participation and 27 for female participation. The concept of the female athlete continues to change as each new accomplishment plateau is achieved and increasing numbers of young women become involved.

Pediatricians are now faced with questions and issues that have only recently surfaced as pediatric problems. Young children are involved in "adult" sports (ie, marathons, adolescent olympic-level gymnastics) in which overuse injuries are likely to occur. These injuries may interfere with a child's ability to enjoy sports later in life.
Respiratory Syncytial Virus Infections in Infants and Children: Diagnosis and Treatment
Authors: McIntosh Kenneth
Published: December 2021

Respiratory syncytial virus is the most important cause of acute viral pneumonia and bronchiolitis in infants and children. Recent advances in diagnostic methods have put precise and rapid identification of cases within the capability of many hospital laboratories. Aerosolized ribavirin is now available for treatment of respiratory syncytial virus infections, and it should be used in selected instances, principally with the intent of preventing the necessity for intubation and ventilation. The criteria we use for selection of those patients include infants with underlying cardiopulmonary disease who are at high risk for severe disease, although normal infants occasionally deteriorate and should be considered candidates. With judicious use of laboratory techniques to make an accurate diagnosis and ribavirin treatment, the overall morbidity of respiratory syncytial virus infections should be significantly lessened.
Kawasaki Disease: Cardiac Problems and Management
Authors: Kato Hirohisa , Inoue Osamu , Akagi Teiji
Published: December 2021

Kawasaki disease or mucocutaneous lymph node syndrome is an acute febrile illness recognized most often in children younger than 4 years of age. It is characterized by mucosal inflammation, indurative edema of the hands and feet, skin rash, and cervical lymphadenopathy. The diagnostic criteria prepared by the Kawasaki disease research committee supported by the Ministry of Health and Welfare of the Japanese government are shown in Table 1. These criteria make up the characteristic symptoms and laboratory findings of the disease. It was first described as a clinical entity in Japan in 1967, by Dr Tomisaku Kawasaki (Fig 1). Kawasaki disease has been most prevalent in Japan; however, it has now been recognized in the United States and other countries. Kawasaki disease has aroused intense interest because of the catastrophic sequelae: coronary arteritis accompanied by coronary aneurysms and thrombotic occlusion which may lead to sudden death or ischemic heart disease.

In the early days, the prognosis for individuals with Kawasaki disease was considered to be good. However, the first nationwide survey in Japan in 1971 clarified that 1.7% of the patients had died from acute heart failure or myocardial infarction, and all autopsies had shown coronary arteritis accompanied by aneurysms and thrombotic occlusion.
Necrotizing Enterocolitis: A Practitioner's Perspective
Authors: Walsh Michele C. , Kliegman Robert M. , Fanaroff Avroy A.
Published: December 2021

Neonatal necrotizing enterocolitis is a multifactorial disorder. Factors previously thought to place patients at risk for necrotizing enterocolitis have been found to be identical among neonates with the disease and other neonates who do have it and, thus, are not true risk factors. The mainstays of therapy for necrotizing enterocolitis include bowel decompression, bowel rest, and broadspectrum intravenous antibiotics. The only absolute indication for surgical intervention is perforation of the bowel. Survivors of necrotizing enterocolitis are susceptible to stricture formation which usually occurs 2 to 8 weeks after the acute onset of necrotizing enterocolitis. Common signs include obstipation, vomiting, abdominal distention, and hematochezia.