bluuebunny/crossref_metadata_2025 huggingface dataset:
JOHN LOCKE (1632-1704) ON THE CHILD'S BED
Authors: C. T. E.
Published: December 2021

In his Thoughts concerning Education, John Locke, the philosopher-physician, gave a Mr. Edward Clarke of Chipley, near Taunton, England, detailed rules for bringing up his son. Locke's advice about Mr. Clarke's son's bed follows:

Let his Bed be hard, and rather Quilts than Feathers. Hard Lodging strengthens the Parts; whereas being buried every Night in Feathers, melts and dissolves the Body, is often the Cause of Weakness, and the Fore-runner of an early Grave. And, besides the Stone, which has often its Rise from this warm Wrapping of the Reins; several other Indispositions, and that which is the Root of them all, a tender weakly Constitution, is very much owing to Downe-Beds. Besides, He that is used to hard Lodging at Home, will not miss his Sleep (where he has most need of it) in his Travels abroad, for want of his soft Bed, and his Pillows laid in order. And therefore, I think it would not be amiss, to make his Bed after different Fashions, sometimes lay his Head higher, sometimes lower, that he may not feel every little Change he must be sure to meet with, who is not design'd to lie always in my young Master's Bed at home, and to have his Maid lay all Things in print, and tuck him in warm. The great Cordial of Nature is Sleep. He that misses that, will suffer by it: And he is very fortunate, who can take his Cordial only in his Mother's fine Gilt Cup, and not in a Wooden Dish.
THE SMALL-FOR-DATE INFANT. II. NEUROLOGICAL AND INTELLECTUAL SEQUELAE
Authors: Fitzhardinge P. M. , Steven E. M.
Published: December 2021

A prospective study has been done on 96 full term small-for-date infants to determine the incidence and type of neurological and intellectual sequelae. Major neurological defects were uncommon with an incidence of 1% for cerebral palsy and 6% for convulsions. Minimal cerebral dysfunction characterized by hyperactivity, a short attention span, learning difficulties, poor fine coordination and hyper-reflexia was diagnosed in 25%. EEG abnormalities predominantly of a diffuse mild nature were seen in 59% of the boys and 69% of the girls (similar EEC tracings are reported in 27% of apparently normal children). Speech defects featuring immaturity of reception and expression were present in 33% of the boys and 26% of the girls. Hearing and vision were not appreciably affected.

The average IQ was 95 (boys) and 101 (girls). However 50% of the boys and 36% of the girls had a poor school performance.
THE PUZZLE OF PERIODICITY
Authors: Hornbein Thomas F.
Published: December 2021

While the last gasp enjoys rather catholic cognizance, the first seems to be primarily the domain of a breed of physiologically curious pediatricians concerned with the respiratory health of newborns. In this issue Drs. Henrique Rigatto and June P. Brady,1,2 present studies attempting to unravel the mechanisms underlying the periodic breathing seen at times in otherwise "healthy" preterm infants. As is often the case, their efforts provoke more questions than they answer.

Periodic breathing is considerably more common than its adult counterpart, Cheyne-Stokes ventilation, occurring in 30% to 40% of premature infants. The ventilatory pattern consists of a series of breaths interspersed with 3- to 15-second periods of apnea.
PERIODIC BREATHING AND APNEA IN PRETERM INFANTS. II. HYPOXIA AS A PRIMARY EVENT
Authors: Rigatto Henrique , Brady June P.
Published: December 2021

We studied nine healthy preterm infants during the first 35 days of life to define the relationship between periodic breathing, apnea, and hypoxia. For this purpose we compared ventilation/apnea (V/A), minute ventilation, and alveolar and capillary blood gases during periodic breathing induced by hypoxia and during spontancous periodic breathing in room air. We induced periodic breathing by giving the baby in sequence 21, 19, 17, and 15% O2 to breathe for 5 minutes each, and also by giving 21, 15, and 21% O2. We measured ventilation with a nosepiece and a screen flowmeter. With a decrease in arterial oxygen tension, preterm infants (1) hypoventilated, (2) breathed periodically more frequently, and (3) showed a decrease in V/A due to an increase in the apneic interval. In one baby this led to apnea lasting 30 seconds.

These findings support our hypothesis that preterm infants breathing periodically hypoventilate and suggest that hypoxia may be a primary event leading to periodic breathing and apnea.
WHAT A HEALTHY TWO- OR THREE-YEAR-OLD CHILD WAS FED IN 1839
Authors: C. T. E.
Published: December 2021

Compared with the varied diet of today's 2- or 3-year-old child, that advised by Dr. Caleb Ticknor in 1839, and given below, will strike us as being rather unappetizing.

A healthy child, of 2 or 3 years old, commonly awakes, hungry and thirsty, at five or six o'clock in the morning; sometimes even earlier. Immediately after awaking, a little bread and sweet milk should be given to it (sic), or (when the child is too young to eat bread), a little bread pap. The latter should be warm; but in the former case, the bread may be eaten from the hand, and the milk allowed to he drunk cold, as it is as well, at this meal, to furnish no inducement for eating, beyond that of hunger. After eating, the child will generally sleep again for an hour or two; and about nine o'clock, it should get its second meal, of bread softened in hot water, which latter is to be drained off, and fresh milk, and a little sugar, added to the bread. Between one and two, the child may have dinner, consisting, at the younger ages, of beef, mutton, or chicken broth, (deprived of all fat), and bread. When a sufficient number of teeth are developed to admit of chewing being performed, a little animal food, as chicken, roast or boiled mutton, or beef, not too much dressed, should be allowed, with a potato or bread, and some fresh, well-dressed vegetable, as turnips or cauliflower. After dinner, some drink will be requisite; and a healthy child requires, or indeed wishes for, nothing but water.
How Much Medical Evaluation for Reading Disability?
Authors: Snyder Russell D.
Published: December 2021

After several years of extensive experience in evaluating children with reading problems, I agree with Kenny et al. that medical and neurological evaluations of these children have only a minimal role. Previously unrecognized poor vision, previously unrecognized epilepsy, and previously unrecognized mental retardation are just not found. Also, any teacher or parent can recognize clinically significant hyperactivity.

However, the authors have overlooked a very important function of the physician's evaluation. In many parts of this country the children with reading problems are left to the whims of aggressive school districts and rigid programs of remediation.
Letter to the Editor
Authors: Kenny Thomas J. , Clemmens Raymond L.
Published: December 2021

We agree with Dr. Snyder on the role of the pediatrician as a "child advocate" and so stated in our article. However, we feel strongly that there is need for definition of professional roles in an area which is so laden with confusion and emotionality. It is our experience that referring agents expect neurological examinations and electroencephalograms, procedures which we find of limited value. By all means defend the child against questionable school practices, but be equally vigorous against unnecessary medical investigations.
Otitis Media, Milk Allergy, and Folk Medicine
Authors: Phillips Barry L.
Published: December 2021

In his recent article, "Otitis Media in the First Six Weeks of Life." Dr. Bland suggested that middle ear infection occurred predominately in bottle-fed babies because breast-fed babies perhaps enjoyed the advantage of IgA in breast milk.

An alternative explanation would be an allergy to cow's milk with resultant inflammation and blockage of the eustachian tubes leading to middle ear infection.

I would suggest that a baby with a history of recurrent otitis media in the first year of life be given a three-month trial on a strict cow's milk elimination diet.
PRODUCTION AND EXCRETION OF UREA BY THE FETAL LAMB
Authors: Gresham Edwin L. , James Elizabeth J. , Raye John R. , Battaglia Frederick C. , Makowski Edgar L. , Meschia Giacomo
Published: December 2021

The urea production rate of the fetal lamb has been measured in 10 pregnant ewes studied who were free of operative stress. The measurement of the fetal urea production rate was made by utilizing an independent measurement of placental urea clearance by the infusion of urea tagged with radioactive carbon (14C) into the fetal circulation and the endogenous concentration difference for urea between umbilical arterial blood and maternal arterial blood. It was shown that the concentration difference of urea between umbilical arterial and maternal arterial blood is significantly elevated during the first four days of recovery from surgery, with a mean value of 0.06 mg/ml plasma water on the first day. By the fifth postoperative day this concentration difference has decreased to a mean value of 0.034, which does not change from the fifth to the twelfth postoperative days. This study demonstrates that urea is excreted across the placenta at a rate of approximately 0.54 mg/min/kg fetal weight. By comparison with the urea excretion rate of adult sheep, this is a high rate of fetal urea excretion. It was demonstrated that the urea excretion rate across the placenta could be increased threefold by an infusion of ammonium lactate into the fetus. Thus, the endogenous urea excretion rate of 0.54 mg/min/kg fetal weight does not represent the maximum rate of urea production for the fetus. The finding of a high urea production rate in fetal life is new and contrary to the common belief that nitrogen catabolism plays a minor role in fetal life. These studies demonstrate that as much as 25% of the fetal oxygen consumption could be accounted for by the catabolism of amino acids.
FOLLOW-UP: THE BACTERIAL ETIOLOGY AND ANTIBIOTIC MANAGEMENT OF SEPTIC ARTHRITIS IN INFANTS AND CHILDREN
Authors: Nelson John D.
Published: December 2021

In 1966 we published our experience with 117 cases of septic arthritis seen on the pediatric services of Parkland Memorial Hospital and Children's Medical Center in Dallas. That review brought to attention the hitherto unrecognized frequency of Hemophilus influenzae in this disease and, by emphasizing the wide variety of bacteria involved, tried to make the point that precise bacteriological diagnosis was essential to optimal therapy.

This follow-up report of 221 patients adds the 104 patients treated from 1966 through 1970 to the previous series. The tabular material is arranged in the same manner as in the report covering the years 1955 through 1965 for easy comparison. (Tables I to IV) This analysis excludes patients with joint involvement secondary to osteomyelitis except for the unique situation of septic hip in which it is difficult to determine whether joint infection or bone infection is the primary event.

The average number of cases per year has steadily risen but this appears to reflect mainly the even-enlarging medical population served rather than a real increase in frequency of septic arthritis. For example, total pediatric admissions rose by 32% from 1960 to 1970 while septic arthritis cases increased 46%.

1955-59: 6.4 cases per year

1960-65: 14.2 cases per year

1966-70: 20.8 cases per year

A bacteriological diagnosis was established in 66.5% of cases overall (Table I) but the figure is higher during the past decade when the quality of diagnostic bacteriology was improved.

1955-59: 34%

1960-65: 71%

1966-77: 73%

Part of the improved percentage of bacteriological diagnosis stems from better use of blood cultures.
WEIGHT AT MENARCHE: SIMILARITY FOR WELL-NOURISHED AND UNDERNOURISHED GIRLS AT DIFFERING AGES, AND EVIDENCE FOR HISTORICAL CONSTANCY
Authors: Frisch Rose E.
Published: December 2021

The mean weight at menarche of 30 undernourished Alabama girls did not differ from that of 30 well-nourished controls, although the undernourished girls attained menarche two years later than controls and at a significantly greater height. This supports the hypothesis that a critical weight triggers menarche. The weight-dependency of menarche, irrespective of a causal relationship, reduces variation in body size at sexual maturity by delaying or advancing the age of sexual maturation as a compensation for environmental or genetic variation. Recent and historical evidence indicates that the mean weight at menarche of Caucasian girls has been about 46 kg. for over a century.
Utilization Review
Authors: Rako Jules
Published: December 2021

The article by Duff et al. regarding inpatient care is a very important article because it focuses on the many unnecessary hospital admissions at community hospitals. My own personal experience coincides with their figures.

Why are there so many unnecessary hospitalizations? I am sure that pediatrics is not the only field that has many unnecessary hospitalizations, but community hospitals are very ill equipped for intensive pediatric care, unless the hospital has a sound university affiliation.
Accidents and Automobiles
Authors: Mofenson Howard C.
Published: December 2021

The article in Pediatrics by Pless et al. brought several very important issues in Accident Prevention to the attention of the pediatrician. The most important were:

1. Almost half of the deaths in children from 1 to 14 years of age are the result of accidents, not diseases that take up most of the time in pediatric training.

2. Nearly half of the accidental deaths involved motor vehicles.

3. Pediatric departments and pediatricians, in general, are not interested in this facet of pediatrics.
Letter to the Editor
Authors: Eisner Victor
Published: December 2021

Dr. Gilbert has pointed to the outstanding considerations in health care for migrants, although we must disagree with his interpretation of our report. We did not say or imply that "there is no serious health problem among migrant children" and we do not believe that services for this group are adequate. Our point, which I welcome the chance to reemphasize, is simply that concentration on case-finding doesn't cure anyone unless it is linked to adequate follow-up.
Diseases of the Newborn, ed. 3, by Alexander J. Schaffer, M.D., and Mary Ellen Avery, M.D. Philadelphia/London/Toronto: W. B. Saunders, 1971, 919 pp., $22.00
Authors: Vulliamy David
Published: December 2021

Six years after publication of the second edition, Dr. Schaffer has produced a third revised version of his well-known book, this time in collaboration with Dr. Mary Ellen Avery. Dr. Milton Markowitz has contributed by writing the cardiological section and Dr. Laurence Finberg that on fluid and electrolyte therapy.

The book remains essentially a comprehensive practical clinical guide to the subject of neonatal disease, intended primarily for "the medical student, the resident, the pediatrician and the general practitioner," but surely most medical students would be daunted by its size and the wealth of detail therein.
HISTOPATHOLOGIC CHANGES IN AIRWAY MUCOSA OF INFANTS AFTER ENDOTRACHEAL INTUBATION
Authors: Rasche Rodolfo F. H. , Kuhns Lawrence R.
Published: December 2021

To assess the pathologic changes in the airways of infants after endotracheal intubation, we examined histological sections of the airways of 19 infants who had been intubated for periods of time ranging from 15 minutes to 9 weeks and of 12 infants who had not been intubated. Fourteen of the 19 intubated infants had epithelial necrosis of the airway which none of the controls developed. Two kinds of mucosal necrosis were observed following intubation: focal necrosis in the larynx and extensive necrosis in the trachea. Anatomical differences between the trachea and the larynx may explain why necrosis is more extensive in the trachea and why complications occur most frequently in the subglottic area. The duration of the intubation was the most important single clinical factor related to damage of the airway when a properly fitted tube was used.
PROLONGED APNEA AND THE SUDDEN INFANT DEATH SYNDROME: CLINICAL AND LABORATORY OBSERVATIONS
Authors: Steinschneider Alfred
Published: December 2021

Little is known of the final physiologic mechanism(s) resulting in SIDS. Five infants participated in this study, three of whom were referred at about 1 month of age because of cyanotic episodes of undetermined etiology. Respirations and eye movements were recorded during several sleep sessions on each patient. In addition, patients were observed on an apnea monitor and a record was kept of the incidence of prolonged apneic episodes (≥ 15 seconds).

The laboratory sleep studies revealed frequent periods of apnea (≥ 2 seconds) which (1) decreased in amount after a certain age and (2) were most frequent during REM sleep. All infants had a number of prolonged apneic and cyanotic episodes during sleep, some requiring vigorous resuscitative efforts. Prolonged apnea most often occurred in conjunction with an upper-respiratory tract infection or when frequent apnea was noted in the laboratory. Two of the infants subsequently died of SIDS.

These data support the hypothesis that prolonged apnea, a physiological component of sleep, is part of the final pathway resulting in sudden death. It is suggested also, that infants at risk might be identified prior to the final tragic event.
PEDIATRICIANS' ATTITUDES CONCERNING INFANTS' SHOES
Authors: Dyment Paul G. , Bogan Paul M.
Published: December 2021

A questionnaire concerning attitudes towards the necessity of specially constructed baby shoes for the development of normal feet was sent to 500 pediatricians. Of the 279 responding, three quarters of them thought that tennis shoes were adequate. This view was not influenced by the pediatricians' age nor academic status. It would appear that the widespread belief among American and Canadian parents in the importance of baby shoes is not widely shared by the pediatric profession.
Vaccinia Virus and Tuberculin Reactivity
Authors: Smithwick Elizabeth M. , Steiner Morris , Quick Jacquelin D.
Published: December 2021

In the January issue of Pediatrics (p. 118), Drs. Cooper and Martin described a child with probable scotochromogen (M. scrofulaceum) infection, whose signs and symptoms became evident after a primary smallpox vaccination. We studied the tuberculin skin test and the in vitro lymphocyte response in two children vaccinated during therapy for primary tuberculosis, with results which may be of interest to the authors and to other readers.

All skin tests were done with freshly prepared PPD-S; the induration was recorded after 48 hours.
Poliomyelitis: Do We Need to Immunize the Newborn?
Authors: Katz Michael , Brown Roy E. , Plotkin Stanley A.
Published: December 2021

In their article Miller et al. propose administration of oral polio vaccine to newborn infants. This, they suggest, would obviate the difficulty of reaching these children later, when their voluntary return to a health facility cannot be assured. We agree there is merit in the idea that type 1 vaccine should be given as early as possible in areas where infection with wild poliovirus is frequent. In formulating such a program, however, one must consider factors that might interfere with its success.
Letter to the Editor
Authors: Diamond Eugene F.
Published: December 2021

There would seem to be an honest difference of opinion among orthopedists on the hazards of epiphyseal injury related to Little League pitching, especially the throwing of curve balls. Where such disagreement exists, the time-honored principle of primum non nocere would suggest following the more conservative opinion in developing policies. The Joint Committee on Physical Fitness, Recreation, and Sports has been gratified by the willingness of officials of national organizations such as Little League Baseball and Pop Warner Boys Football to seek out and accept medical consultation in such areas as precompetition physical examination, protective equipment, and injury control.
Letter to the Editor
Authors: Hathaway William E.
Published: December 2021

In a tiny premature infant the presence of a large thrombotic lesion of the type described by Neal et al. could produce thrombocytopenia without evidence of disseminated intravascular coagulation. In the case of Nachman et al. the causal relationship of the catheter to the thrombocytopenia is intriguing but not proven (no evidence for a thrombus was presented). Nevertheless, based on the data shown, it is a reasonable possibility and could be a cause of many cases of unexplained thrombocytopenia in sick infants with indwelling catheters.
TO THEIR MUTUAL ADVANTAGE
Authors: Solnit Albert J.
Published: December 2021

At opposite ends of the life line, children and grandparents have clear over- lapping interests. They should be interested in and involved with each other, not only for sentimental reasons, but also for crucial mutual developmental needs. An example of how this works appeared in a recent issue of Pediatrics.1 The comfort of a generation gap between a grandparent and children the ages of his grandchildren enables children entering adolescence to be more comfortable in learning about the origins and development of the human child. As Helene Deutsch2 has also demonstrated, closeness to the next generation may interfere with the ability of adolescents to bring their problems, worries, and troubles to their parents, or even to parental figures; but they often can relate to adults older than their parents with greater ease.
PATIENT CARE AND STUDENT LEARNING IN A PEDIATRIC CLINIC
Authors: Haggerty Robert J.
Published: December 2021

Every pediatrician who has taught or worked in university pediatric outpatient departments recognizes the syndrome presented by Duff et al. in this issue of Pediatrics. The diagnosis is clear: effective student teaching is not occurring. The etiology of this problem is complex and not so clear. Some of the causes are inappropriate patient selection for beginning students, lack of effective administrative organization to achieve even limited teaching objectives, and lack of appropriate techniques to diagnose and manage the complex sociomedical problems presented. As a result, student, faculty, and patient dissatisfaction is very high. Effective management of the syndrome is even less clear.

As with most complex problems, a clearer definition of the goals is the first step to a solution. What do we want the student to learn?

How to gather information from families with such complex social and medical difficulties? Skills in diagnosis and management of common or rare health problems? Change of attitudes? Until each ambulatory program defines its teaching objectives more clearly in behaviorally measurable terms, effective management of the disease "poor patient care and teaching" will continue to elude us. I would, however, suggest the following considerations:

1. The first direct patient experiences which students have in ambulatory settings should be with patients who present considerably less complex problems than those available in most of our outpatient departments, and there should be a wider social class selection for the student's initial experience. To achieve this will require either a different patient recruitment procedure or the use of different settings for such education.
LATE ADOLESCENT GROWTH IN STATURE
Authors: Roche Alex F. , Davila Gail H.
Published: December 2021

Information is lacking concerning the ages at which children cease to grow in stature and the increment in stature after particular chronological ages or maturational events. This information would assist the management of children receiving therapy that may alter potentials for growth in stature and would be useful in developing new methods for estimating adult stature from childhood parameters.

The data were obtained from 194 children measured serially from birth to at least 22 years of age. Piecewise regressions provided estimates of the ages at which adult statures were reached and of adult stature levels. Growth in stature ceased at median ages of 21.2 years (boys) and 17.3 years (girls). The median stature increments, from 18 years to the cessation of growth in stature, were very small in the girls but were about 1.0 cm in the boys. The median stature increments after the femur or the tibia became mature, until growth in stature ceased, were close to 1.0 cm in each sex.

These results demonstrate the variability of growth in children. Some retain considerable potentials for growth in stature after 18 years of age, after the femur or tibia has become mature or after intervals of one or two years during which stature increments are small.
PROLACTIN ACTIVITY IN JUVENILE HYPOTHYROIDISM AND PRECOCIOUS PUBERTY
Authors: Costin Gertrude , Kershnar Ann K. , Kogut Maurice D. , Turkington Roger W.
Published: December 2021

Two 8-year-old girls, one of whom had Down's syndrome, presented with myxedema and precocious sexual development. Elevated circulating thyrotrophin (TSH), luteinizing hormone (LH), follicle-stimulating hormone (FSH) levels, and prolactin activities were documented. Following treatment with thyroid extract, the abnormal clinical findings and the elevated levels of pituitary hormones returned to normal. The results of studies in our patients suggest a derangement in hypothalamic pituitary regulatory mechanisms.

It is postulated that low circulating thyroxine may increase the hypothalamic content of thyroid-releasing hormone (TRH) and the sensitivity of the pituitary to TRH stimulation resulting in increased release of TSH and prolactin. The elevated plasma gonadotrophins may result from a nonspecific stimulation of the hypothalamic gonadotrophin-releasing hormone (LH-FSH-RH) or from a direct stimulation by prolactin of the LH-FSH-RH.
THE ROLE OF THE PEDIATRICIAN AS OMBUDSMAN IN THE HEALTH CARE OF THE YOUNG HANDICAPPED CHILD
Authors: Battle Constance U.
Published: December 2021

Using the care of children with craniofacial malformations as an illustrative example, it is the purpose of this paper to suggest that the pediatrician is the logical person to serve as ombudsman for the handicapped child. The organization of treatment, and indeed, of daily life, for such a child and his family has such numerous and such complex ramifications that it demands the direction of the one individual with knowledge and interest in the overall problems of the child as a person and his family. The child's medical care, and ultimately the child himself, becomes fragmented and lost among the various specialties evaluating and treating him unless the pediatrician is diagnosing, organizing, selecting, interpreting, integrating, and implementing the total care. By accepting this responsibility, the pediatrician rightfully assumes a primary position rather than the secondary or even forgotten one he has sometimes unfortunately occupied.
Letter to the Editor
Authors: Kenny Thomas J. , Clemmens Raymond L.
Published: December 2021

Dr. Svoboda's comments are circuitous regarding the central issue of the paper, namely the striking dearth of relevant, useful information forthcoming from medical evaluation of children with reading problems. The purpose of the report was to "assess the efficiency and utility of the diagnostic procedures recommended for children who are referred for a medical evaluation because of reading problems." The population was defined and selected to represent the children usually referred for evaluation i.e., school problems centering on reading.
Letter to the Editor
Authors: Harley J. D. , Gillespie Ailsa M.
Published: December 2021

We appreciate the opportunity to make several points in response to the letter from Dr. Koplan and his colleagues. First, having stressed the mildness of the lesions in our patient with congenital vaccinia, we would be dismayed if the report were used in favor of abortion of a pregnant vaccinee. Second, we readily concede and in fact wish to emphasize that the similarities between the hypoplastic bone changes in our patient and those observed by Edwards in the offspring of overheated guinea pigs provide quite strong support for our suggestion that these changes may have resulted from the maternal pyrexia which followed vaccination.
THE CHILD HEALTH ASSOCIATE: A NEW HEALTH PROFESSIONAL TO PROVIDE COMPREHENSIVE HEALTH CARE TO CHILDREN
Authors: Silver Henry K. , Ott John E.
Published: December 2021

The child health associate is a new category of allied health professional capable of providing a wide range of diagnostic, preventive, and therapeutic services to children. Working principally in ambulatory settings as colleagues and associates of physicians, child health associates have the knowledge and the skill to care for a large percentage of the patients seen in a typical pediatric practice. Child health associates and similar health workers in other branches of the health professions have the potential to be major providers of primary health care in the future. Evaluation of the pediatric knowledge and the diagnostic ability of child health associates students and interns indicates that they compare favorably with medical students and approach pediatricians in these areas.
THE GENETICS OF THANATOPHORIC DWARFISM
Authors: Pena Sergio Danilo Junho , Goodman Harold O.
Published: December 2021

Two cases of thanatophoric dwarfism are presented with guidelines for diagnosis. A review of the literature is made, and from that, a discussion of possible genetic mechanisms is made. Although data favor a polygenic mechanism at the present time, it is possible that some cases are due to autosomal recessive inheritance. An empiric recurrence risk of 1:50 is suggested by cases published to date. This is in marked contrast to the small recurrence risk for sporadic cases of classical achondroplasia and the importance of differentiation between these two entities cannot be overemphasized.
Intracranial Hemorrhage and Subsequent Communicating Hydrocephalus in a Neonate With Classical Hemophilia
Authors: McCarthy James W. , Coble Larry L.
Published: December 2021

Quick1 states that spontaneous intracranial hemorrhage is less common in hemophilia than in other clotting disorders, though others2-3 have shown it to occur in as high as 10% to 13% of all cases of hemophilia. However, intracranial hemorrhage is an exceedingly rare occurrence in the neonate with hemophilia.4-5 Silverstein's review of 31 reported cases of proven hemophilia with intracranial hemorrhages revealed only one case in the neonatal period. The advent of readily available and definitive laboratory procedures for the prompt diagnosis of hemophilia coupled with the development of factor VIII concentrates allows for the aggressive treatment of intracranial hemorrhages and their complications.
Warning: The Use of Lomotil in Children
Authors: Rosenstein Gladys , Freeman Martha , Standard Anna L. , Weston Nathan
Published: December 2021

Recently a father wrote the Food and Drug Administration (FDA) concerning the death of his child from accidental ingestion of Lomotil tablets. He bore the blame for leaving the "pills" where the child had been able to reach them. He had thought they were a harmless medication for diarrhea.

On December 3, 1969, the New York Times1 carried a column entitled "Children Periled by an Adult Drug," commenting on a paper delivered at the American Medical Association's clinical session. The article stated that "children who accidentally swallow a few tablets of a commonly prescribed antidiarrheal drug can get severe breathing difficulty, lose consciousness and sometimes die. . ."
RADIATION PROTECTION IN DIAGNOSTIC RADIOGRAPHY OF CHILDREN
Authors: Grossman Herman , Altman Donald H. , Baker David H. , Gwinn John L. , Kirkpatrick John A. , Shopfner Charles E. , Swischuck Leonard , Tefft Mekvin , White Harvey , Wilkinson Robert H.
Published: December 2021

As is readily apparent, the problem of reducing radiation exposure to the pediatric patient encompasses many areas. In the past, more attention has been devoted to the concrete aspects such as refined radiographic equipment and gonadal shielding. Less attention has been devoted to the abstract aspects which involve the general philosophy and disposition of the referring physician and his radiologic consultant. In this regard, it cannot be overstated that close communication with the radiologist is mandatory. The (pediatric) radiologist is constantly aware of the aspects of radiation safety and utilizes this information when he obtains radiographic examinations.

There is a tendency to treat radiographic examinations in the same context as clinical and chemical laboratory investigations. Perhaps this attitude stems from the fact that radiographs are often ordered at the same time as these laboratory tests. Such an orientation is dangerous, and it behooves the referring physician and the radiologist to work in cooperation to remedy this situation. Indeed, it is simple to improve radiographic equipment and not too difficult to shield the child; but, it is difficult to formulate a proper attitude regarding radiographic examinations and their potential hazard to the pediatric population.

The Committee on Radiology plans to prepare additional recommendations on radiographic examinations to provide more detailed and technical information which should be helpful to pediatricians and other physicians providing care for children.
Medical Evaluation for Reading Disability— Last Time Around
Authors: Gregory Warren C.
Published: December 2021

I agree with Kenny et al.1 on only one thing: the history, neurologic exam, and electroencephalogram have little to contribute to the evaluation of dyslexia.

Medical evaluation is all important in early identification of dyslexic children, and the unmasking of school failures who come to their physician with psychosomatic, physical, or emotional complaints, or as school failures. The physician who handles such a problem should not only have expert knowledge of the reasons for school failure but he should have an approach to the evaluation that will identify the strengths and weaknesses of the visual and auditory systems as relate to language functioning.
REVERSAL OF SELECTIVE IgA DEFICIENCY IN A CHILD WITH JUVENILE RHEUMATOID ARTHRITIS AFTER PLASMA TRANSFUSIONS
Authors: Petty Ross E. , Cassidy James T. , Sullivan Donita B.
Published: December 2021

A 10-year-old girl with selective IgA deficiency, recurrent sinusitis, otitis media, and juvenile rheumatoid arthritis was given plasma for replacement of IgA. These treatments were followed by improvement in inflammatory joint disease and resolution of upper-respiratory tract infections. IgA was detected in her serum, parotid saliva, and tears 11 months after these transfusions. In addition, transformation of peripheral blood lymphocytes in response to phytohemagglutinin returned to normal levels.
UTILIZATION OF CHILD HEALTH ASSOCIATES BY A PRACTICING PEDIATRICIAN
Authors: Greeb Charles A.
Published: December 2021

In the preceding article, Drs. Silver and Ott have described the program for the new child health associate. However, the success or failure of any such program lies with its practical application. How does the child health associate perform in a clinical setting? How does he or she perform when dealing with private patients in a busy office?

I am a solo pediatrician in Lamar, a community of approximately 8,000 people in southeast Colorado. My practice is probably no different from that of most pediatricians except that I am the only one within a radius of at least 125 miles. On a typical office day, I see 25 to 40 patients depending on the time of year and the particular epidemic making the rounds of the community. I also serve as consultant to the local Migrant Council Health Program set up to deliver health care during the harvest season to migrant laborers and their families. It was through the Migrant Council Health Program that I had my first contact with a child health associate.

A child health associate student who had finished the first year of the course of study in Denver was sent to Lamar during the summer of 1971 to work under my supervision in delivering health care to migrant children. Initially, she spent approximately three weeks with me in my office developing greater skill in performing a physical examination and managing the more common pediatric conditions which she would be seeing in the migrant workers setting. She then took over the first-line health care at the migrant center and the day care center which was providing supervision for the children of families working in the fields.
Removal of Coins From the Esophagus: Nothing New Under the Sun
Authors: Chang Jack H. T. , Burrington John D.
Published: December 2021

In the recent literature there appears to be a revival of interest in the use of Foley catheters in removing foreign objects from both orifices of the alimentary canal.1-3

During the peak of the Byzantine period, foreign bodies were extracted from the esophagus by having the patient swallow a small, dry sponge on a string, allowing it to expand in the stomach and then withdrawing the sponge. Paulus Aegineta (seventh century) wrote in Book Six of his Epitome of Medicine:
Potential Danger of Catheter Removal of Foreign Body
Authors: Stool Sylvan E. , Deitch Mark
Published: December 2021

As frequently happens the day after an issue of Pediatrics arrived we admitted a patient with a problem that had been presented in the journal. This 7-month-old infant had been referred to the department of radiology for a skull series because of a lump on the skull–an incidental finding was the presence of coins in the esophagus. He had no swallowing difficulty but did cough in the prone position. In view of Pediatrics, 50:475, we considered use of the method, but elected to do it under direct vision as we did not know the duration of the ingestion.
The Rising Cost of Hospital Care, by Martin S. Feldstein. Washington: Information Resources Press, 1971, 88 pp., $4.25
Authors: Cronkite Leonard W.
Published: December 2021

Dr. Feldstein has produced an essay of extraordinary clarity for the lay reader. He bravely tackles the incredibly complex issue of hospital economics. He analyzes the course of hospital cost inflation during the past 20 years and attempts to define the underlying causes. Unlike many economists he does not fall into the trap of comparing hospitals with other industries nor does he try to apply the simplistic laws of supply and demand as they apply to the manufacturer of goods.
PEDIATRICS AND THE ADOLESCENT
Authors: Gallagher J. Roswell
Published: December 2021

Thank you, Dr. Janeway; and thank you Dr. Work. And thank you all, very much. Deserving or not, it is very pleasant to know that you feel that I should have this award. However, I want to be sure that you all know that a large share of the award belongs to the trustees and the staff of the Children's Hospital. They wanted to establish a medical service for adolescents, and they supported it enthusiastically. My debt is very great to the late James Wells Farley, then President of the Board of Trustees, and to Dr. Janeway and others on the Senior Staff.

By nature, I have followed Satchel Paige's sage advice: "Never look back– something might be gaining on you." But today it is more appropriate to remember Jung's suggestion that the first part of life should be concerned with doing, and then the later years be given over to examining what had been done, and why. So I have chosen to review some of my thoughts about general, medical programs for adolescents.

Today, on all sides there is concern about providing health care. Surely this is long overdue; but there is so much that needs to be done, and done now, for adolescents, that I hope that the major share of effort will go into providing service, teaching, and research in these young people's behalf, and only a minor share diverted into discussing who is to do it and how it is to be done. When those important questions are tackled, I trust all will keep in mind the fundamental reasons these general programs–these clinics or units, call them what you will-began to develop here and abroad in the 1950s.
PROTEIN CALORIE MALNUTRITION AND INFECTION WITH HEPATITIS-ASSOCIATED ANTIGEN
Authors: Suskind Robert M. , Olson Lloyd C. , Olson Robert E.
Published: December 2021

The incidence of hepatitis-associated antigen (HAA) in normal Thai adults is approximately 10%. When Thai children were studied for the age-specific prevalence of serum hepatitis-associated antigen it was found that the adult frequency is reached at about the age of 5 years. Children below this age showed a lower prevalence, with serum hepatitis-associated antigen being significantly more common in boys. In young children with severe protein-calorie malnutrition, however, serum HAA was found in 29% of 48 patients during their eight-week hospitalization, with no sex-difference in the incidence of antigenemia. In three of the four patients who were antigenemic throughout the period of observation the titer of serum hepatitis-associated antigen declined significantly as the patients' nutritional status improved. It is suggested that undernutrition and its associated defects in host defense mechanisms contributes to an increased susceptibility to infection with hepatitis-associated antigen. This may in part help to explain the relatively high prevalence of hepatitis-associated antigen infection as found in tropical countries.
PEDIATRIC PERCEPTIONS
Authors: Goldring David
Published: December 2021

William Withering, an English physician, learned of a secret recipe for the treatment of dropsy from a woman of Shropshire in 1775. The medication was a concoction of more than 20 herbs, but Withering, who was a competent botanist, as well as an excellent physician, determined that it was the foxglove which contained See Table in the PDF file the active ingredient, digitalis, and he decided to use the leaves of the plant, not the whole recipe, on his patients.1 After ten years of clinical trials, he published his classical book, "An Account of the Foxglove and Some of its Medical Uses; With Practical Remarks on Dropsy and Other Diseases."2

Withering, however, was not the first physician to use and write about digitalis. The drug is mentioned by medical writers as being used for various diseases such as epilepsy, anasarca, wounds and ulcers, and was taken both internally and applied externably, during the 13th through the 15th centuries. Gerrarde (1597) and Parkinson (1640) mention the drug being used as an expectorant and emetic.3 Although it is highly probable that children, as well as adults, were treated in those times, it was Withering who first recorded the use of digitalis in children.

Withering reported the use of digitalis in 12 children with a variety of diseases, and the results are abstracted in Table I. His comments are noted as quotations to retain the flavor of his original accounts. There is also a general statement about the drug's use in children at the end of the table, and this, too, is reproduced in its original language.
Excerpt IX: The Hermit
Authors: Cone Thomas E.
Published: December 2021

The moral of the fable below1–if accepted–must have been a source of strength to children of a bygone age when misfortune struck.

The moral was reinforced by this stanza written by John Milton and found in the same book as the fable:

Let us with a gladsome mind Praise the Lord, for he is kind, For his mercies ay endure, Ever faithful, ever sure.
THOMAS JEFFERSON WRITES TO HIS 11-YEAR OLD DAUGHTER
Authors: C. T. E.
Published: December 2021

In the British Royal Family's collection of holograph letters, that of Thomas Jefferson's dated November 28, 1783, to his daughter, Martha, (Patsy as he called her), shows Jefferson to be as dedicated a father as he was a statesman.

After telling Patsy of the sorrow he felt in seeing her leave for school, Jefferson wrote as follows:

The acquirements which I hope you will make under the tuition I have provided for you will render you more worthy of my love, and if they cannot increase it, they will prevent its diminution.

With respect to the distribution of your time, the following is what I would approve:

From 8 to 10 practice music.

From 10 to 1 dance one day and draw another.

From 1 to 2 draw on the day you dance and write a letter next day.

From 3 to 4 read French.

From 4 to 5 exercise yourself in music.

From then till bedtime read English, write, etc.

Take care that you never spell a word wrong. Always before you write a word consider how it is spelled, and if you do not remember it turn to the dictionary. It produces great praise to a lady to spell well.

If ever you are about to say anything amiss or do anything wrong, consider beforehand and you will feel something within you which will tell you it is wrong and ought not to be said or done. This is your conscience and be sure and obey it. Our Maker has given us this faithful internal monitor, and if you always obey it, you will always be prepared for the end of the world....
Letters to the Editor
Authors: Slater Philip
Published: December 2021

We rarely receive correspondence about what is known in the trade as a "white-space filler," though these are selected with considerable care. We so heartily agree with Dr. Gruenwald's thoughtful comment that we repeat the paragraph from Philip Slater's book below. Some readers of Dr. Gruenwald's letter may have missed either the book or page 701 of the December Pediatrics.

We behave toward our cities like an irascible farmer who never feeds his cow and then kicks hen when she fails to give enough milk.
Increased Intracranial Pressure in Children (vol. VIII in the series, Major Problems in Clinical Pediatrics), by William E. Bell, M.D., and William F. McCormick, M.D. Philadelphia/London/Toronto: W. B. Saunders, 1972, 260 pp
Authors: Welch Keasley
Published: December 2021

Dr. Bell, a pediatric neurologist, and Dr. McCormick, a neuropathologist, have combined their talents in writing an account of increased intracranial pressure from the points of view of their disciplines. They have organized the work into three parts: increased intracranial pressure in childhood, its causes, and intracranial tumors, the latter making up some 40% of the whole.

In the first and more general part there are five chapters including a long one on headache in children and one which describes the essential features of tentorial and foraminal herniation.
A PRACTICAL APPROACH TO THE PROTECTION OF THE ABUSED CHILD AND REHABILITATION OF THE ABUSING PARENT
Authors: Kempe C. Henry
Published: December 2021

Many judges and social workers feel that anyone can turn on to mothering. The fact is that some parents frankly do not like their children. They hate them. We don't find it socially acceptable to let them say so. It is tragic that we don't.

We have faced the problem of parents not getting along and we call that divorce.

We must acknowledge as a socially acceptable situation that a parent can admit she cannot mother her child for one reason or another. Allowing a mother or father to say in a socially acceptable way that try as they may, they cannot tolerate this child, will help us on the way to giving protection to all children.

I would like to now propose the thought that the quality of mothering is a continuum of from none of it to a lot of it. By mothering, I mean not only the female term but a quality of caring for a defenseless young child, giving without limit if you please, to a tiny child, which fathers have in great abundance as well. This quality saves many lives and can be had by maiden aunts and spinsters and people who have never had a baby. For practical purposes we have to face the fact that very few of us, fathers or mothers, have it in us to be "that kind of a mother" 24 hours a day, seven days a week, all year long.

If we have money we can arrange to supplement mothering for pay.