bluuebunny/crossref_metadata_2025 huggingface dataset:
SCIENTIFIC LITERATURE
Authors: Comroe J. H. , H. R. J.
Published: December 2021

Can the NIH use its funds to speed publication of articles that have been carefully reviewed and accepted by competent editorial boards? Some editors take the position that since the process of research and writing a manuscript may take a year or two, why fuss about speeding up the mechanical process of publication by from four to six months. But slow publication is an anachronism in the modern era of electronics and computers which have not only revolutionized the speed of making scientific measurements but also the process of printing and reproduction.

The author suggests that steps be taken to obtain rapid publication for a wide audience of the proceedings of small conferences that must be limited to a select few to make them profitable (now done effectively by some divisions of some institutes of the NIH).
Gonorrhea in Preadolescent Children: An Inquiry Into Source of Infection and Mode of Transmission
Authors: Folland David S. , Burke Ralph E. , Hinman Alan R. , Schaffner William
Published: December 2021

From November 1974 through December 1975 a study was made of all reported cases of gonorrhea in children under 10 years of age in Tennessee. Clinical manifestations of the 73 subjects identified included vaginal infection (48), urethritis (11), conjunctivitis (8), and ophthalmia neonatorum (6). A total of 203 relatives and associates of 54 subjects was cultured. Fifty-four (27%) had gonorrhea; 43 of these were relatives. A history of sexual contact was found in 18 children, including seven where the contact had a positive culture for Neisseria gonorrhoeae. Sexual transmission was common in children with vaginitis or urethritis. In nine cases, sexual abuse or child neglect was suspected. The recognition of a child with gonococcal infection identifies a cluster of family members and associates who are at increased risk of having gonorrhea.
Cultural Relativity of Toilet Training Readiness: A Perspective From East Africa
Authors: deVries Marten W. , deVries M. Rachel
Published: December 2021

Ideas about infant capabilities and toilet training practice have changed in the United States following cultural trends and the advice of child care experts. Anthropologists have shown that a society's specific infant training practices are adaptive to survival and cultural values. The different expectations of infant behavior of the East African Digo produces a markedly different toilet training approach than the current maturational readiness method recommended in America. The Digo believe that infants can learn soon after birth and begin motor and toilet training in the first weeks of life. With a nurturant conditioning approach, night and day dryness is accomplished by 5 or 6 months. The success of early Digo training suggests that sociocultural factors are more important determinants of toilet training readiness than is currently thought.
Pediatric Social Illness: Toward an Etiologic Classification
Authors: Newberger Eli H. , Reed Robert B. , Daniel Jessica H. , Hyde James N. , Kotelchuck Milton
Published: December 2021

The significance of ecological stress factors for understanding the etiology and interrelationships among the pediatric social illnesses was explored in a case-control study of 560 children under 4 years of age. Cases of child abuse and neglect, failure to thrive, accidents, and poisonings were matched on age, socioeconomic status, and ethnic group with children who had comparably acute medical conditions. Data were ascertained from the children's medical records and from an extensive maternal interview which probed historical and contemporary familial, environmental, and child developmental realities.

The findings support the basic hypothesis that the occurrence of pediatric social illness is associated with increased family stress. Child abuse is associated with more extreme stresses in all categories studied; failure to thrive with maternal historical stresses, perceived sickness of the index child, and contemporary social isolation; and accidents with contemporary household crises. An additive mode of pathogenesis of the more severe symptom manifestations is suggested by these data.

Specific at-risk items were also noted. Although child abuse separated sharply from the other entities in a discriminant function regression analysis of the data, the insufficient predictive power of the principal discrimination features suggests that proposed programs to screen for risk of child abuse are of questionable accuracy and social utility.
Effectiveness of Physician-Mother Interactions During Infancy
Authors: Liptak Gregory S. , Hulka Barbara S. , Cassel John C.
Published: December 2021

For the purpose of correlating elements of process in well-child care with outcomes, 479 normal infants from the practices of 42 physicians in a single community were evaluated. Data on maternal characteristics, physician awareness of maternal concerns, physician communication to the mother, and physician management were obtained from interview of mothers, questionnaires completed by physicians, and abstracting of medical records. Outcomes were evaluated prior to the child's 11th-month birthday by interviewing the mother. The outcomes selected were mother-child adaptation, bother experienced by the mother over common symptoms of infancy, and the mother's satisfaction with medical care.

All three outcomes were found to be associated with the mother's attitudes and concerns about her infant. Physician awareness of maternal concerns correlated positively with mother-child adaptation; both physician communication to mother and physician management were associated with maternal satisfaction with medical care. When controlling for maternal attitudes, the process measures of physician awareness of maternal concerns and physician communication to the mother was still found to be associated with mother-child adaptation and maternal satisfaction with medical care, respectively.
Pediatricians' Attitudes Affecting Decision-Making in Defective Newborns
Authors: Todres I. David , Krane Diane , Howell Mary C. , Shannon Daniel C.
Published: December 2021

A questionnaire designed to identify the factors that influence the resolution of ethical dilemmas was returned by 230 (57% of the total) Massachusetts pediatricians. The decision to recommend surgery for an infant with Down's syndrome with duodenal atresia when the parents had refused surgery was influenced by religious affiliation (P < .01), religious activity (P < .04), and sex (P = .05). Of those favoring surgery, 40.2% would pursue a court order. The decision to recommend surgery for an infant with severe meningomyelocele when the parents' position was not stated was influenced by age (P < .01), religious activity (P < .02), and specialization (P < .008). When the parents' wishes were expressed, the majority of the pediatricians modified their decision in accord with these wishes. In response to general ethical questions, 79.6% of all pediatricians thought that parents should have the right to withold consent for surgery. Equal numbers thought that psychosocial reasons justified withholding lifesaving procedures. Among a variety of factors, they thought that willingness of the parents to care for the child would influence the decision to take heroic measures. There were 90.4% who thought that ethics should be part of medical education; 55.7% indicated this need throughout their careers.
Clinical, Laboratory, and Epidemiologic Features of a Viral Gastroenteritis in Infants and Children
Authors: Tallett Susan , MacKenzie Carrie , Middleton Peter , Kerzner Benny , Hamilton Richard
Published: December 2021

We studied 27 infants admitted to the hospital with acute diarrhea caused by human rotavirus (HRV) and obtained additional data on fecal excretion from ten outpatients with the same infection. The disease was characterized by watery diarrhea with fever and vomiting at the onset, isotonic dehydration, compensated metabolic acidosis, and increased concentrations of sodium and chloride but low concentrations of sugar in stools. Diarrhea usually ceased in three to four days when oral feedings were reduced or stopped but recurred mildly in four patients. Of 57 household contacts, 12 were symptomatic, 6 had HRV in their stools, and 19 had significantly increased serum HRV antibody titers. These features of the disease accord with available information on the pathogenesis of HRV infection. Knowledge of the clinical pattern of this newly diagnosable infection should help physicians to recognize and treat quickly this highly infectious, potentially dangerous illness.
A Simple Device for Reducing Insensible Water Loss in Low-Birth-Weight Infants
Authors: Marks Keith H. , Friedman Zvi , Maisels M. Jeffrey
Published: December 2021

Insensible water loss (IWL) was measured in five premature infants, 1 to 4 days old, by multiple weighings on an electronic balance inside an incubator. The babies were studied naked before and after being covered with a transparent thermal blanket. The use of the thermal blanket produced a mean reduction of 70% in IWL and a net caloric saving of 27 kcal/kg/day. There was minimal interference with nursing care. The important caloric saving achieved from reduced vaporization of water and evaporative heat loss may be an important determinant of intact survival in the high-risk infant.
Polyarteritis Nodosa in Older Children
Authors: Blau Edward B. , Morris Rebecca F. , Yunis Eduardo J.
Published: December 2021

Polyarteritis in the older child is thought to be a rare disease. This study describes 11 children, 3 to 12 years of age, with polyarteritis seen over a five-year period. Fever, abdominal pain, hypertension, and leukocytosis were found in almost all. Renal disease occurred in eight. Examination of muscle, gut, or kidney tissue was an effective means of diagnosis. The pathological changes were the same as those seen in adults. There seemed to be an association between polyarteritis and group A streptococcal infection. Ten patients had a salutary response to high-dose prednisone administration.
HEALTH-CARE-DELIVERY-CENTER-JUNGLE
Authors: Bean William B. , H. R. J.
Published: December 2021

If only some wise person or group had established land grant medical schools as well as technical colleges, the gravitational tug of medical science into laboratories would have been balanced by the daily correctives which the practical art of caring for the ill and ailing brings. This might have avoided the dissociation and fragmentation which seem to follow so regularly when a medical school-hospital collaboration is transmogrified into a teeming unzoned megalopolis-the modern health-care-delivery-center-jungle.
A coming of age?
Authors: Keith Ronald Mac
Published: December 2021

The American Academy of Cerebral Palsy started in 1946. There had been a realization by some orthopedic surgeons and pediatricians that people with cerebral palsy had problems of a different character from the other children they saw, and these pioneers wanted to meet and exchange their ideas and experience. So Earl Carlson, M.D., a neurologist who had cerebral palsy, Bronson Crothers, M.D., a neurologist, George Dearer, M.D., physical medicine, Temple Fay, M.D., neurosurgeon, Meyer Perlstein, M.D., pediatrician, and Winthrop Phelps, M.D., orthopedic surgeon, met with mutual benefit. Dr. Phelps was the first president of the AACP from 1947 to 1949; in 1932 he had proposed the term "cerebral palsy."
Can ethics be taught in a hospital?
Authors: Singer Peter
Published: December 2021

No one now doubts that physicians frequently face difficult ethical questions in the course of medical practice. These questions are often of a kind that cannot simply be left to await a time when one has greater leisure. Physicians have to act and take responsibility for their decisions, whichever way they decide. Often the ethical decisions are as crucial as the medical ones. Yet most physicians have received no formal training in ethics and many of them have not thought, talked, or read much about the subject either. It is not uncommon for a physician to describe himself as purely a technician, a kind of advanced plumber who does nothing but respond to requests from people who come to have defective plumbing put right.
The pediatrician and children in foster care
Authors: Fanshel David
Published: December 2021

There are approximately 330,000 children living in foster care under the auspices of public and private social agencies in the United States. The vast majority-approximately 80%-have come into care because of severe personal and social problems that have afflicted their parents. More often than not, they come from households that are headed by women struggling to survive on public assistance budgets. Minority children are heavily overrepresented in their ranks.

Parental failure leading to breakup of families is usually related to such personal problems of adults as mental illness, poor physical health, mental retardation, drug addiction, alcoholism, arrest and imprisonment for deviant behavior, and marital discord. Sizable groups of children come into care because their parents have been judged in court actions to have been guilty of abuse or neglect.
UNTITLED
Authors: Willcox Darlene
Published: December 2021

I have such lovely big blue eyes . . . or so the dalies told me. But what are blue eyes anyway?? My Mama doesn't hold me.

Oh, my, you sing just like a lark!! My teacher's face is beaming. Who cares? My Daddy doesn't hear my aching heart screaming.

Again you're second in the class; you've won another prize, Dear. But I would rather be a dunce and have my brothers live here.

My heart, my head . . . all pulled apart . . . I know some think I'm plucky. And yet, without the ones I love, I don't feel very lucky.
Article Stimulates Review of Immunization Practices
Authors: Overend Don S.
Published: December 2021

The article by McDaniel et al. in the October 1975 issue of Pediatrics was surprising and somewhat appalling: surprising, perhaps, because more studies of this kind have not been done, and appalling because of the apparent poor record of practicing pediatricians in maintaining immunization rates. I am sure that many practicing pediatricians proceed smugly under the assumption that children under their care are adequately immunized.

The article served to prompt a quick and superficial review of immunization procedures within our pediatric group.
Steiner's Dismay
Authors: Steiner Michael L.
Published: December 2021

I read with dismay and a mounting sensation of frustration the letter by Davis entitled, "It's the Right Direction," which appeared in the November 1975 issue of Pediatrics (page 840). Our specialty seems to be suffering from an autoimmune disease within its ranks characterized by an everincreasing attempt by certain of those in academic pediatrics to relegate the private pediatric practitioner to hospital-based status. I for one believe that pediatricians should offer primary care to children and that they are not "overtrained for the delivery of well-child care."
Dr. Goetzman Replies
Authors: Goetzman Boyd W.
Published: December 2021

Dr. Jacobs is correct in pointing out that we did not compare thrombotic complications of umbilical arterial catheters with their tips placed above and below the origin of the renal and mesenteric arteries. He takes issue with a statement appearing in the discussion section that our results "support the opinion of others that positioning the catheter tip below the mesenteric and renal arteries may be safer for the patient." The statement is based on the theoretical damage that may occur to kidneys and gut should a thrombus such as shown in Figure 1 of our article involve or embolize the arterial supply of these vital organs.
Lipids in Schoolchildren 6 to 17 Years of Age: Upper Normal Limits
Authors: deGroot Ido , Morrison John A. , Kelly Kathe A. , Raugh Joseph L. , Mellies Margot J. , Edwards Brenda K. , Glueck Charles J.
Published: December 2021

As part of a multiclinic U.S. National Heart, Lung, and Blood Institute study of lipid levels of Americans, the University of Cincinnati studied a total school district's population. Out of a total of 8,906 eligible students from all grades, 6 to 17 years of age, 7,337 participated (82%). After fasting for 12 hours or more, plasma cholesterol and triglyceride levels were ascertained in 6,775 children. For white and black boys and girls, normal lipid values are given by age in both fasting and casual (nonfasting) states. This study group closely resembled a normal pediatric practice populalion, so that the values established may be used as baseline data for the practicing pediatrician. Since sex, race, and age are dominant sources for variations, care must be taken in the interpretation of minor changes that occur over time in a child.
Giardiasis in Day-Care Centers: Evidence of Person-to-Person Transmission
Authors: Black Robert E. , Dykes Aubert C. , Sinclair Susanne P. , Wells Joy G.
Published: December 2021

In August and September 1975, an outbreak of diarrhea occurred in children 1 to 3½ years old attending a day-care center. An investigation revealed overlapping epidemics of shigellosis and giardiasis, with 54% of the children infected with Giardia lamblia. At two other centers 29% and 38% of the children had G. lamblia infection, but none had Shigella. The prevalence of G. lamblia in the day-care children was significantly higher than the 2% prevalence in age-matched children not in day-care centers. Epidemiologic data suggested fecal-oral transmission of the parasite from child to child in the centers and from infected children to other family members.
Stimulant Drug Therapy in Hyperactive Children: Research and Clinical Implications
Authors: Wolraich Mark L.
Published: December 2021

In spite of 39 years of experience in stimulant drug use for children since it was first reported by Bradley,1 there is still some controversy over its effectiveness. During the past ten years stimulant therapy has gone through periods of great popularity and periods of disfavor. In an article in 1973 Wender described stimulant therapy as the “mainstay of treatment for children with minimal brain dysfunction”2 and Eisenberg in 1972 described it as the most effective and best documented available method.3 Meanwhile in 1976, Bax wrote that “in my own experience medication has little to offer in the way of help either to the children who present primarily as having learning difficulties or to those whose behavior is the outstanding problem. Virtually no children in normal schools should, I believe, be on treatment.”4

After all these years why is there still such difference of opinion? What valid data are available? Several articles review the research in this area.5-7 A recent article reviews the results of 110 studies but does not consider methodological criteria.8 It is helpful to look at the numerous research studies done with stimulant drugs in light of research criteria. There are two studies that discuss methodological criteria required for valid research on psychotropic medication.9,10 Sprague and Werry9 define six minimum requirements for valid drug studies. These are (1) placebo control, (2) random assignment of subjects, (3)double-blind method, (4) standardized dosage, (5) standardized evaluations,and (6) appropriate statistical analysis. Fish10 amplifies the problem of subject selection, stating
Transient Neonatal Hypothyroidism Detected by Newborn Screening Program
Authors: LAFRANCHI STEPHEN H. , BUIST NEIL R. M. , MURPHEY WILLIAM H. , LARSEN P. REED , FOLEY THOMAS P.
Published: December 2021

A screening program for the detection of neonatal hypothyroidism has been in effect in Oregon since May 1975. Blood samples are obtained from all newborn infants to test for phenylketonuria and other metabolic diseases. A second specimen is obtained from more than 90% of these infants who are retested at 4 to 6 weeks of age. These Guthrie filter paper blood samples are analyzed for thyroxine (T4), and all samples with a low T4 value are analyzed for thyroid stimulating hormone (TSH). At the outset of the program, it was speculated that the screening might detect infants who had reduced
Concerns About Screening Programs
Authors: KUHR MURRAY D.
Published: December 2021

To the Editor:

Clow and Scriver have advanced our knowledge of the psychosocial impact of genetic screening (Pediatrics 59:86, January 1977). More than half of the carriers were worried or depressed. Four of the 45 carriers had diminished self-image. Why the self-stigmatization? Stone, in describing the case of a psychotic adolescent who was a Tay-Sachs carrier cautions against screening in this age group.1 The evidence builds that genetic screening can be harmful to one's psychic
Dr. Powell Replies
Authors: POWELL GERALDINE K.
Published: December 2021

Our original design in planning this study was to assess three areas: (1)the efficacy of nasoduodenal tube feeding as a technique of providing adequate caloric intake to the very-low-birth-weight infant, (2) the efficiency of these calories in promoting weight gain, (3) the complication rate of this feeding method.

To answer our first two questions, we chose the most rigorous control available to us, which was nasogastric continuous drip feeding, rather than the standard gavage,
Dr. Tomlinson Replies
Authors: TOMLINSON WILLIAM A.
Published: December 2021

I appreciate Dr. Kash's comments regarding “Parents' Knowledge of Respiratory Disease.” The main point I was trying to make concerns the inattention of pediatric educators to methods of health education. The questionnaire study was really only a device by which I hoped to call attention to the above point. I think the need for making this point can just as well be shown by considering only the inner city group's scores, without comparing them with
Why Wasn't It Pink?
Authors: POSNER MARTIN
Published: December 2021

To the Editor:

I recently used a dosage of triple live vaccines (rubeola, rubella, and mumps), and on injecting the diluent into the vial withdrew a clear fluid. Past experience has always resulted in a pink to red color of the fluid on reconstitution.

The question of efficacy of the product was the basis of my making inquiry of the manufacturer. Attached is a letter explaining the variations in color. I believe that the main
The Answer
Authors: OLIVERO PETER A.
Published: December 2021

Since December 1974, when revised regulations concerning shipment of live virus vaccines issued by the Food and Drug Administration, Bureau of Biologics, went into effect, Merck Sharp & Dohme has transported all shipments of our vaccines and diluent syringes in containers with dry ice.

Previously, our live virus vaccines turned pink to red when reconstituted. This color is due to the addition of phenol red, which is a pH-sensitive indicator. Now, however, a few of
Simple Apnea Monitoring May Not Work
Authors: LEWAK NORMAN
Published: December 2021

To the Editor:

In August 1975 (Pediatrics 56:296, August 1975) I reported on an infant who died of sudden infant death syndrome (SIDS) despite apnea monitoring in an intensive care nursery. My communication was made to counter lay articles advocating use of apnea monitors to “prevent” SIDS. Similar responses to home apnea monitor advocates have been made in a Pediatrics commentary1 and an American Academy of Pediatrics committee statement.2

An article has since appeared that
It's Sometimes Useful
Authors: ESKES PHILIP W. H.
Published: December 2021

To the Editor:

I read the letters by Drs. Ivey and Kattwinkel and Drs. Soyka and Neese regarding codeine-containing cough mixtures (Pediatrics 57:164,January 1976). I certainly have no bone to pick with those letters as the mixture was used inappropriately. But before we all jump on the“ban”-wagon regarding use or nonuse of those mixtures, maybe the voice of a practicing pediatrician should be heard.

All of us are plagued at certain times of
Infants in a Public School System: The Indicators of Early Health and Educational Need
Authors: Levine Melvin D. , Palfrey Judith S. , Lamb George A. , Weisberg Herbert I. , Bryk Anthony S.
Published: December 2021

The Brookline Early Education Project (BEEP) is a demonstration model in which a public school system in collaboration with a pediatric center has extended teaching and diagnostic services to the earliest days of life. In most cases, enrollment and data collection began three months before the children were born. A comprehensive diagnostic component including health, neurologic, sensory, developmental, and psychological assessments was performed periodically. The present study, the first of several reports, is an analysis of positive indicators of health and developmental need during the first six months of life. At the time of initial surveillance, age 2 weeks, a high yield of physical and demographic findings, along with peninatal stresses, was observed. It was noted that demographic, neurologic, physical, and peninatal stress factors appeared as independent variables. At the three- and six-month checkpoints, there were more overlapping findings between the categories of physical assessment, developmental examination, and neurologic evaluation. Over the six-month period, there was a tendency toward instability of findings: The group of youngsters thought to have special needs at the age of 2 weeks, 3 months, and 6 months differed in composition from each other. Likewise, there was significant flux in membership between the three- and six-month groups with needs. The study may have public policy implications, insofar as early education services should not be constructed to admit only "high-risk newborns" since this would exclude many children whose needs would become manifest later and would take in a number of children falsely identified as in need but with the resiliency to overcome this. The BEEP program has relevance for pediatric practice in demonstrating a component of health care with greater diagnostic and therapeutic responsibility for educational competence in young children.
Ethical Issues in Pediatric Surgery: A National Survey of Pediatricians and Pediatric Surgeons
Authors: Shaw Anthony , Randolph Judson G. , Manard Barbara
Published: December 2021

The findings reported in this article are based on a nationwide survey of the attitudes and practices of pediatric surgeons and pediatricians with respect to some of the difficult ethical choices confronting them in medical practice.

Four hundred fifty-seven physicians completed a questionnaire in the spring of 1975 in which they reacted to a wide range of issues that have been of increasing concern to the public, as well as to the medical profession. The survey attempts to identify some areas of physician consensus as well as some of the factors, personal and professional, influencing physicians' attitudes.

The survey and its statistical analysis are intended to provide current sociological data and are not intended by the authors as an endorsement of any particular point of view or course of action.
Influence of Life Events and Family Routines on Childhood Respiratory Tract Illness
Authors: Boyce W. Thomas , Jensen Eric W. , Cassel John C. , Collier Albert M. , Smith Allan H. , Ramey Craig T.
Published: December 2021

Respiratory illnesses account for nearly two thirds of the total illness in a community,1 account for as much as 40% of the problems seen in a pediatric practice,2,3 and are responsible for over one third of school absences.4 Despite major advances in the microbiology of respiratory disease, why and how a child becomes ill remain poorly understood. In over half of respiratory illnesses, complete cultures fail to yield an etiologic agent.5 Conversely, 30% of a school-age population can harbor group A streptococci without developing symptoms,6 three quarters of preschool children infected with Mycoplasma pneumoniae remain asymptomatic,7 and as many as 42% of upper respiratory tract cultures from well children yield pneumococci.8 Furthermore, there is no satisfactory explanation for the observation that certain children are predisposed to more frequent or more severe respiratory illnesses.9

The limited ability of microbiologic data to account for clinical experience has increased interest in studying the influence of social factors upon childhood disease. The family is undoubtedly the most important social context in which illness occurs, and many studies have documented the link between pediatric disease and family dynamics.10-18 Meyer and Haggerty reported a strong relationship between patterns of streptococcal illness and the degree of chronic family stress.19 Another group of observers found an accumulation of major family life events in the year preceding general pediatric hospitalizations.20 Others have demonstrated the prevalence of psychosocial problems in the families of children with repeated accidents and ingestions of poisons.21,22 There has, however, been little study of the general relationship between social environment and respiratory illness in children.
Pediatricians and Parents: Remarks on Receiving the C. Anderson Aldrich Award
Authors: Gordon Harry H.
Published: December 2021

When John Bartram phoned to tell me of this greatly appreciated honor, he said I could speak to whatever topic I chose. Implicit in such trust was the assumption that I would be brief.

Dr. Aldrich played a major role in bringing the practice of infant feeding from an era of pseudo-scientific misapplication of metabolic data into a psychologic era.1 He recognized that feeding was the the most important early transaction between mother and infant and that appropriate pediatric advice could promote healthy personality development. His wisdom was derived from a large experience with mothers and babies, and a grounding in the philosophic concepts of Ralph Waldo Emerson: "Respect the child. Be not too much his parent. . . . Respect the child, respect him to the end, but also respect yourself."2 I propose to address briefly the lack of respect by some pediatricians for the felt needs of mothers.

Dr. Aldrich saw the mother and infant as a unit. He considered the term "self-demand" feeding too autocratic and substituted "self-regulation," recognizing that limits should be set which respected the mother and her other responsibilities as well as the infant. He preferred a schedule of feeding which was neither rigid, leading to anorexia, nor virtually nonexistent, leading to early obesity and what Spock termed chronic resistance to sleep, the latter a family affair with tensions for father as well as mother.

His conceptualization led us to summarize our own laboratory observations under the title, "A Metabolic Basis for the Individualized Feeding of Young Infants," and to a later study of self-regulation of intake of food by prematurely born infants, a step toward flexible, sound advice to anxious mothers on discharge of their infants.3
Multiple Metatarsal Fractures in Child Abuse
Authors: Jaffe Arthur C. , Lasser Daniel H.
Published: December 2021

Ever since Caffey's classic description of its clinical findings,1 physicians have been aware of the syndrome of child abuse and its skeletal pathology. Because of the emphasis placed on them by Caffey1 and others,2,3 it is now considered standard medical practice to obtain roentgenograms of the skull, ribs, and long bones as part of the routine evaluation of suspected child abuse.

We are reporting an abused infant with multiple metatarsal fractures, an apparently undescribed finding in maltreatment syndromes. We also raise the question of whether or not roentgenographic search for fractures of the small bones of the extremities should be routinely performed.
Failure of Pediatricians to Provide Automobile Restraint Information to Parents
Authors: Simons Paul S.
Published: December 2021

In the past decade, over 15,000 children under the age of 5 years were killed in highway crashes (1,988 fatalities in l973).1-3 Practicing physicians could well prevent many such tragic deaths by educating parents on the value of automobile seat restraints.4-5

This study was designed to investigate parental use of automobile child restraint devices in the St. Louis metropolitan area and to determine what influence physicians had on the use of these devices.

METHOD

Questionnaires were sent to the mothers of 559 newborn infants delivered at Barnes Hospital in St. Louis in September and October 1974 and to the mothers of 757 newborns delivered at St. John's Mercy Hospital in St. Louis County from December 15, 1974, through February 14, 1975.
Intellectual Assessment of 111 Four-Year-Old Children With Phenylketonuria
Authors: Dobson James C. , Williamson Malcolm L. , Azen Colleen , Koch Richard
Published: December 2021

Of the 216 children with phenylketonuria (PKU) who were initially enrolled in the Collaborative Study of Children Treated for Phenylketonuria, 203 were placed on dietary therapy between 3 and 92 days of age. Of these, 111 are now at least 4 years of age and constituted the sample for the present analysis. Their mean IQ on the Stanford Binet Intelligence Scale was 93 (1972 norms). The children assigned to two treatment groups based on "moderate" and "low" serum phenylalanine levels were comparable on their IQs at age 4, although many of the children could not be maintained in the specified categories. Females scored a significantly higher mean IQ than males (97 vs. 90). Those children for whom dietary treatment was initiated during the first month of life scored a mean IQ of 95, compared with 85 for those initially treated from 31 to 65 days. However, the interpretation of dietary inception data may have been contaminated by familial and psychosocial factors. The PKU Collaborative Study is still in progress in 15 clinics located in 11 states.
Reflex Sympathetic Dystrophy in Children
Authors: Fermaglich Daniel R.
Published: December 2021

Two pediatric patients had reflex sympathetic dystrophy, which has been well described in adults but is rarely recognized in children. The syndrome consists of continuous pain, hyperesthesia, and autonomic symptoms occurring in an extremity, usually following trauma. The various types of presentation, differential diagnosis, and modes of therapy are discussed.
Iron Absorption From Human Milk, Simulated Human Milk, and Proprietary Formulas
Authors: McMillan Julia A. , Oski Frank A. , Lourie Gerald , Tomarelli R. M. , Landaw Stephen A.
Published: December 2021

Studies from our laboratory have shown that iron is better absorbed from human milk than from cow milk and that human milk can provide sufficient iron for infants during their first year. We compared iron availability from human milk with that from other formulas and determined the factors responsible for its superiority. Adults were fed 100 ml of human milk, simulated human milk, simulated human milk containing added lactoferrin, two commercial formulas containing iron, 12 mg/qt, and human milk that had been boiled. The simulated human milk resembled human milk in concentration of protein, fat, carbohydrate, iron, total minerals, calcium, and phosphorus. Iron 59 was added to each feeding and iron incorporation into RBCs was determined 14 days after each feeding. Percent iron absorption was highest from human milk and lowest from the commercial formulas. The simulated human milk supported a 9.0% absorption; addition of lactoferrin reduced this to 4.7%. Net iron absorption was 0.12 mg/liter from human milk and 0.40 and 0.37 mg/liter from the iron-enriched commercial formulas. Absorption of iron from boiled human milk was the same as from the unboiled milk.

This study confirms the unique ability of human milk to promote iron absorption. Simple manipulation of the protein, fat, lactose, calcium, phosphorus, or lactoferrin content of proprietary milk did not reproduce the iron absorption demonstrated with human milk.
Respiratory Arrest in Infants Secondary to Gastroesophageal Reflux
Authors: Leape Lucian L. , Holder Thomas M. , Franklin John D. , Amoury Raymond A. , Ashcraft Keith W.
Published: December 2021

Gastroesophageal reflux is being recognized with increasing frequency in infancy and childhood. Once thought to be rare, or of no significance, it is now commonly recognized when sought for by proper radiologic techniques in suspected individuals. Its manifestations are protean. Although in most instances it is relatively harmless, gastroesophageal reflux in infancy may be responsible for failure to thrive, blood loss anemia resulting from peptic esophagitis, and recurrent aspiration pneumonia, The importance of the last has been well described by several authors.1-5

In recent years, we have treated ten children less than 6 months old for episodes of respiratory arrest which appeared to be due to gastroesophageal reflux (Table I).
Varicella vaccine at the crossroads
Authors: Kempe C. Henry , Gershon A. A.
Published: December 2021

Faithful readers of Pediatrics will be aware of the recent dialogues among investigators, commentators, and letter-writers concerning the development and use of a live attenuated varicella-zoster (V-Z) virus vaccine.1-3 As the situation now stands, Dr. M. Takahashi and associates have developed a V-Z vaccine that has produced at least temporary and possibly even lasting immunity to varicella.4-5 This vaccine has been associated during the two years in which it has been used with minimal side effects. In the current issue (p. 805), Izawa et al. describe a study in which 17 children with malignant disease who were highly susceptible to severe vanicella were given this vaccine.
More than a startle and a blink
Authors: Knauss Thomas A.
Published: December 2021

Audiometry in the neonate most often depends on behavioral or autonomic reactions to an acoustic stimulus.1 A more objective assessment of hearing in the neonate can be obtained using the following techniques: (1) tympanometry, which depends on the mobility of the tympanic membrane2; (2) stapedial reflexes, which require the integrity of the acoustic nerve and its bilateral reflex brainstem connections through the facial nerves to the stapedius muscles and their attachment to the head of the stapes3; and (3) cortical auditory evoked potentials.4 A combination of techniques is often required to adequately test the auditory system of the pediatric patient.5
Subacute necrotizing encephalomyelopathy (Leigh's disease)
Authors: McCandless David W. , Hodgkin William E.
Published: December 2021

Subacute necrotizing encephalomyelopathy (SNE) was first described in 1951 by Denis Leigh.1 Since then, well over 100 cases have been described, and probably as many as 100 more have been diagnosed (at postmortem examination) and not recorded. With an increased awareness of the clinical features of this disease comes an increase in early diagnosis. Such diagnosis is not easy, however, since there is a broad range of variability in symptoms and time of onset. Characteristically, most patients with SNE develop normally until about 1 year of age. the parents may note a gradual reduction in development. There is usually a loss of appetite with resultant weight loss.
Letter to the Editor
Authors: Williams Mary L.
Published: December 2021

In their article Hennekens et al. presented evidence indicating that the mean cholesterol level of children whose fathers had early-onset, overt coronary heart disease (CHD) was higher than that of children of healthy men. However, they apparently did not exclude kindreds with familial hypercholesterolemia, which is inherited as an autosomal dominant and is expressed in childhood. This condition is common and may have constituted a significant fraction of their study group, in which case it would not be surprising to find that the mean cholesterol level of this group would exceed that of the control group.
MORAL KINSHIP
Authors: Ryder Richard D. ,   Student
Published: December 2021

The idea that all sentients have rights is rapidly gaining ground in philosophical and theological circles and should make sense to scientists. If we accept the darwinian idea of biological kinship then what is the logical reason why there should not be moral kinship? On what grounds, other than sentimentality, do we discriminate so unfairly against other species?
HONESTY IS THE BEST ..
Authors: Claove C. ,   Student
Published: December 2021

What motivation should medical schools be looking for? A wish to cure people? Better become a faith healer. Want to be rich? Try organised crime. Daddy-is-a-doctor? Professional phenotypes are the result of environmental effects on the products of multiple genetic loci, not directly inherited. So why did I want to be a doctor? I think the answer that I would look for as dean is: "Please sir, I really don't know."
THE MESSAGE ON BREAST-FEEDING ISN'T NEW
Authors: L. J. F.
Published: December 2021

This poster was used in 1918 to educate parents on the value of breast-feeding. The title is "Value of Natural Feeding." The text explains that the mortality of bottle-fed babies (Flaschenkinder) is seven times higher than that of breast-fed babies (Brustkinder).

See image in the PDF file
Hepatic Injury in a Child Caused by Trimethoprim-Sulfamethoxazole
Authors: Stevenson David K. , Christie Dennis L. , Haas Joel E.
Published: December 2021

Trimethoprim-sulfamethoxazole was given to a 16-year-old boy as prophylaxis for a urinary tract infection. He developed severe cholestatic hepatitis 41 days after administration of the drug. A liver biopsy specimen showed a mixed inflammatory infiltrate in the portal triads and prominent bile stasis. The clinical course in this patient supports the concept of an indirect hypersensitivity reaction to sulfamethoxazole.
Management of Congenital Adrenal Hyperplasia Using Serum Dehydroepiandrosterone Sulfate and 17-Hydroxyprogesterone Concentrations
Authors: Golden Michael P. , Lippe Barbara M. , Kaplan Solomon A. , Lavin Norman , Slavin John
Published: December 2021

Simultaneous serum concentrations of dehydroepiandrosterone sulfate (DHEA-S) and 17-hydroxyprogesterone (17-OHP) were compared with urinary 17-ketosteroid (17-KS) and pregnanetriol (PT) excretion during therapy in 18 prepubertal patients with the 21-hydroxylase deficiency form of congenital adrenal hyperplasia (CAH). Patients were classified into those in good, poor, or questionable control on the basis of clinical examination, skeletal age, and 17-KS and PT excretion. During therapy, use of serum steroid concentrations was found to be nearly as accurate in judging adequacy of control as use of urine steroid concentrations. Of 34 evaluations, a definite assessment of adequacy of control could be arrived at 25 times using urinary values and 22 times using both serum DHEA-S and 17-OHP concentrations. DHEA-S concentration responded sluggishly when treatment was not adequate, being greater than 100 µg/dl only in patients significantly undertreated. It was never elevated in well-controlled patients. Mid-afternoon 17-OHP concentrations were less than 200 ng/dl in well-controlled patients but readily escaped suppression and could not be used to differentiate poor from borderline control or from temporary noncompliance. Therefore, an increased DHEA-S concentration indicated poor control and a suppressed 17-OHP concentration indicated good control. The combination of normal DHEA-S level with elevated 17-OHP level, however, did not permit exact evaluation of the degree of control. Of significance is that not all patients with CAH present with an elevated DHEA-S concentration, and only in those in whom an elevated level has been documented can DHEA-S level be used as an index of control during therapy.
Noncompliance in Children With Renal Transplants
Authors: Korsch Barbara M. , Fine Richard N. , Negrete Vida Francis
Published: December 2021

Fourteen patients (13 of them adolescents) interrupted immunosuppressive treatment following renal transplantation. Twelve were girls and two were boys. Six subsequently lost their allografts and eight had impaired renal function. Noncompliance was suspected when diminution in cushingoid features, unexplained weight loss, or changes in renal function occurred. Noncompliance was confirmed by interview with psychosocial staff.

Available psychosocial data from family interview and personality tests obtained earlier as part of systematic followup study were analyzed to explore the reasons for noncompliance. Noncompliant patient families had lower incomes, more fatherless households, and communication difficulties within the family and with the medical establishment. Using a stepwise discriminant analysis, a discriminant function was derived which selected 13 of 14 noncompliant patients.

Noncompliance may be a preventable cause of allograft failure. These data can aid in identifying high-risk patients and planning intervention programs.
Q-oTc Interval and Blood Calcium Levels in Newborn Infants
Authors: Giacoia George P. , Wagner Henry R.
Published: December 2021

The interval from the beginning of the Q wave to the origin of the T wave (Q-oTc interval) and total and ionized serum calcium levels were measured in 27 full-term and 77 premature infants. The correlation between Q-oTc and total and ionized calcium levels was significant in both full-term and normal premature infants. No correlation was found in a group of critically ill premature infants, most of whom had evidence of CNS involvement. Constant infusion of calcium gluconate in a number of infants belonging to the latter group produced a significant shortening of the Q-oTc interval. It is speculated that the lack of correlation of Q-oTc interval and total or ionized calcium levels in sick premature infants could be explained on the basis of a dysfunction in cardiac sympathetics or alternatively by marked variations in serum catecholamines.
Arrhythmias and Stokes-Adams Attacks in Acute Rheumatic Fever
Authors: Lenox Cora C. , Zuberbuhler James R. , Park Sang C. , Neches William H. , Mathews Robert A. , Zoltun Richard
Published: December 2021

In the same issue an error was made in the article "Arrhythmias and Stokes-Adams Attacks in Acute Rheumatic Fever" by Lenox et al. (Pediatrics 61:599, April 1978). In the Table on page 601, under "Comments & Treatment," the words "paced every. . ." should be replaced by "paced for. . . ."
PENNY GUM
Authors: Hitach Richard ,   Student
Published: December 2021

"Inflation was reported threatening the survival of the nation's penny gumball in 1974 and early '75. Manufacturers were exploring ways to hold the line by increasing the size of the gumball's hollow center. Some distributors were swinging to 2-cent and 5-cent gumballs. Uncertainty was shaking the industry.

The penny gumball lives, and one of its biggest manufacturers says it will survive into the ‘foreseeable future.’

That manufacturer, Leo Leary, president of the Ford Gum and Machine Company of Akron, N.Y., credits automation with slashing production costs and saving the day. Ford, which turns out a million colored gumballs a day, or six million pounds a year, offers a product that is ⅝ of an inch in diameter, with the hole in the middle ‘possibly ⅛ inch.’

‘It's still a value,’ Mr. Leary says, noting: ‘I've just invested a quarter of a million dollars in new equipment to further automate this plant, so I can see the 1-cent gumball in any part of the foreseeable future.

‘I get a new set of customers every seven years. They buy my gum from 3 years old until about 9 or 10 or 12, and then they go into stick gum and baseball gum.’"
Distal Digital Occlusion
Authors: Narkewicz Richard M.
Published: December 2021

Hair strangulation of an appendage has been reported by Alpert et al.1 Although this problem is probably seen by pediatricians and family physicians, the cause may not be appreciated and, therefore, treatment may be inadequate.

CASE REPORTS

Case 1

A 4-month-old boy was seen in the office with a swollen, red, warm middle toe. The toe was edematous and oozing purulent material near the attachment to the foot (Fig. 1). On close inspection, several small hairs were found encircling the toe. These were removed with a forceps and scalpel and the infant was treated with intravenous cloxacillin. The edema and redness promptly resolved.