bluuebunny/crossref_metadata_2025 huggingface dataset:
The Convention on the Rights of the Child: It's Time for the United States to Ratify
Authors: Haggerty Robert J.
Published: December 2021

On November 20, 1989, in an historic action, the General Assembly of the United Nations adopted a treaty statement labeled "The Convention on the Rights of the Child." It was ratified within 4 months by the required 20 countries to give it treaty status. The American Academy of Pediatrics endorsed it promptly, but it has yet to be ratified by the appropriate governmental body in the United States—the Senate. The United States (US) is the only Western democracy not to have signed; to date over 157 countries worldwide have adopted the Convention—only 30 have not. To understand the reasons why the US has abstained requires outlining some of the major points of the treaty, particularly those that have been the basis for the US inaction.
Managing Otitis Media With Effusion in Young Children
Authors:   The Otitis Media Guideline Panel
Published: December 2021

This reference guide contains highlights from the Clinical Practice Guideline, Otitis Media with Effusion in Young Children. The Otitis Media Guideline Panel, a private-sector panel of health care providers, developed the Guideline after comprehensively analyzing the research literature and current scientific knowledge of the development, diagnosis, and treatment of otitis media with effusion in young children.

Specific recommendations are given for the management of otitis media with effusion in young children age 1 through 3 years with no craniofacial or neurologic abnormalities or sensory deficits. The natural history of otitis media with effusion, the functional impairments that may result from otitis media with effusion, and the difficulty of measuring the effects of medical and surgical interventions on long-term outcomes are included. The medical interventions studied involve antibiotic, steroid, and antihistamine/decongestant therapies. The surgical interventions studied involve myringotomy with insertion of tympanostomy tubes, adenoidectomy, and tonsillectomy. Short-term outcomes addressed are resolution of effusion and restoration of hearing.
Stool Survey of Asymptomatic Diapered Children in Day Care
Authors: Ginsberg Michele M. , Keenan Kathleen , Thompson Muriel , Anders Bronwen
Published: December 2021

A survey of diaper-wearing children in community-day-care centers was conducted by the San Diego Department of Health Services during the period February-April 1986 to determine the presence of enteric pathogens in asymptomatic children. Written consent to collect stool samples from diapers was obtained from parents of children at four preschools. No reportable enteric diseases or outbreaks had occurred at the schools in the preceding year. For each child, the preschool teachers maintained a record of symptoms (eg, diarrhea, fever) during the week of stool collection. Stool specimens were collected from 63 diapered children. The samples were examined for parasites and cultured for bacteria and viruses. Giardia lamblia was identified in 18% to 32% of stool samples collected from children at three of the four centers. Prevalence of Giardia varied with the age of the child (0% age <12 months to 33% age <23 months). Microscopic examinations for Cryptosporidium and pathogenic amoeba were negative. Stool cultures were negative for Salmonella, Shigella, and Campylobacter. The prevalence of adenoviruses identified by viral cultures ranged from 32% to 80% at four sites. Echovirus was isolated from 36% of samples at one center. All stools were negative for rotavirus. Giardia was identified in the stools of 22% of children in day care in the absence of diarrhea or of concurrent illness. These findings indicate that asymptomatic infection with Giardia occurs commonly among children attending day-care centers. The lack of any documented outbreak or symptoms of enteric disease among attendees suggests that these asymptomatic children with Giardia need not be excluded from day care.
Children's Deaths at Day-Care Facilities
Authors: Good Susan E. E. , Parrish R. Gibson , Ing Roy T.
Published: December 2021

In the US, there is no mechanism readily available to identify children who die while attending day care. The National Center for Health Statistics (NCHS) uses the International Classification of Diseases 9th Edition (ICD-9) to categorize US mortality data; however, the International Classification of Diseases does not contain a category for "day care" as the place of death. Thus, researchers using NCHS mortality data are unable to count day-care deaths on a national basis. To identify children who died while in day care, it is necessary to review the records of those who investigated the deaths. In most counties and states, medical examiners or coroners (ME/C) are responsible for investigating unusual and sudden deaths. Their records often contain detailed information on the place and circumstances of death.

The Medical Examiners and Coroners Information Sharing Programs (MECISP) at the Centers for Disease Control and Prevention (CDC) works with state and local medical examiners and coroners to improve the availability of data on deaths that they investigate. Computerized data are gathered on all deaths investigated by participating ME/C offices; data are obtained from six state and seven county jurisdictions. These jurisdictions have a combined population of 37 million people and record 56 000 deaths per year. Of these jurisdictions, one state and three county offices have text within their computerized data that describes the circumstances, place, and cause of each death.

The objective of our study was to demonstrate the usefulness of ME/C death-investigation records as a means of identifying and characterizing the types of deaths that occur among children while attending day care facilities.
The Potential Health Benefits of Child Day Care
Authors: Randolph Linda A.
Published: December 2021

Child day-care programs are a part of an ecologic formulation of the contribution of family and the community to improved children's health. How does the promise of the possible become a reality?

Head Start may provide some clues. As a large-scale national child-development program with integrated health, education, social services, and parent involvement components, Head Start assumes a responsibility for assuring access to needed health knowledge, health maintenance skills, and health services. It has standards for each component, a training and technical assistance capacity, and funding through bipartisan political support. It is not perfect; quality is uneven and it evolves as health standards are revised on the basis of new scientific information. Head Start places emphasis on community health advocacy.

The needs of children and families will largely determine the combination of functions child care might assume. Until this nation recognizes that access to primary health care for all its citizens, especially its children, is non-negotiable, all child-care programs including Head Start are still at a significant disadvantage in realizing their potential.16 As the nation embraces the Education 2000 goal of all children being ready to learn when they enter school, child-care programs can play a significant role in helping children attain the health benefits that will foster that success in school.17 This cannot be accomplished by the programs alone, however. Health professionals must form partnerships with child-care providers to assist them in using their considerable expertise to promote the health and well-being of families who use their services.
A Public Health Perspective on Child Care
Authors: Gensheimer Kathleen F.
Published: December 2021

A child care provider is the mother of young life.

She nourishes the children, brings them up—gives them energy, her resources, her nerve and all the possibilities to come true—when needed or ready.

To not pay her a decent wage is undervaluing the care.

To over-regulate her can decrease the supply and raise the cost.

To under-regulate her can harm the quality.

To zone her out of residential neighborhoods does not fit in a society that "values" children.

And yet, all these misdeeds are committed state-wide.

Nobody is made really and effectively responsible.

Yet we all are!

That's why the misdeeds can go on and even increase.

Collective responsibility is hidden by our ignorance and greed.

At present we live in a world out of balance.

We work with no support for family and child care needs.

We live lives of turmoil because of a system unable to care.

We live lives that call for another way of living.

Can biotechnologists build a child who requires less nurturing, less loving? or

Can we foster conditions that help, rather than hurt, families using child care?

It will oblige all of us to assign a new value to families, children and child care.

It will oblige us to establish a strong public policy so that children and child care are valued as more than a mere "life style" option.1

On a personal level, as a mother of four young children and as a consumer of child-care services, I can well relate to the issue of child care.
MARKET PLACE VALUES ARE DESTROYING US
Authors: L. J. F.
Published: December 2021

"Our institutions and values are in jeopardy as the mores of the market pervade all social life in this country. Loyalty, honesty, courage, discipline, patriotism, and commitment to family are being crowded out by the goals and rules of economic rationality. The confusion and dissatisfaction experienced by even those who have made it, are caused by a growing rot at the core of our society."
Mortality and Growth of Low Birth Weight Infants on the Kangaroo Mother Program in Bogota, Colombia
Authors: Whitelaw Andrew , Liestøl Knut
Published: December 2021

The kangaroo mother program was started by Drs Rey and Martinez at the Instituto Materno Infantile in Bogota, Colombia in 1978. Mortality was high among low birth weight infants when hospital care was attempted. Neonatal intensive care was virtually nonexistent, and nosocomial infection was common.

The essentials of the kangaroo mother program were: (a) educating and motivating the mother as the baby's main resource; b) discharge home regardless of weight as early as possible to minimize nosocomial infection; c) exclusive breast-feeding; d) encouraging bonding and keeping the baby warm by skin-to-skin contact inside the mother's clothes; and e) vertical position between the mother's breasts to minimize reflux and aspiration.
Letter to the Editor
Authors: Robinette Martin S.
Published: December 2021

The importance of early identification of hearing loss is summarized in the report issued by the United States (US) Department of Health and Human Services,1 entitled "Healthy People 2000." The goal is to reduce the average age at which children with significant hearing impairment are identified to no more than 12 months. The report states:

The future of a child born with significant hearing impairment depends to a very large degree on early identification (ie, audiological diagnosis before 12 months of age) followed by immediate and appropriate intervention.
Letter to the Editor
Authors: Dennis J. Michael , Hall James W. , Jacobson John T. , Kileny Paul R. , Ruth Roger A.
Published: December 2021

In their recent Pediatrics commentary entitled "Universal Screening for Infant Hearing Impairment: Not Simple, Not Risk-Free, Not Necessarily Beneficial, and Not Presently Justified," Bess and Paradise argue that "universal screening is ill-considered and at this time ill-advised." Bess and Paradise state their general objections to the National Institutes of Health (NIH) Consensus Statement on Early Identification of Hearing Impairment, and then express their concerns about the rationale for early intervention for infant hearing impairment and about current infant screening tests.
Letter to the Editor
Authors: Bess Fred H. , Paradise Jack L.
Published: December 2021

We are pleased that our challenge1 of the National Institutes of Health Consensus Conference recommendation2 that all infants be screened for hearing impairment within the first 3 months of life, and preferably before discharge from the newborn nursery, has generated so much response. We thank Dr Miller for his approving comments and particularly for his suggestions concerning screening-related research. We also welcome the provocative rejoinders from the proposed screening program's advocates, first, because in answering their various criticisms we hope to shed further light on key component issues, and second, because heightened attention in these pages to the problem of hearing loss in young infants can only lead to heightened general vigilance and therefore earlier case detection.
Letter to the Editor
Authors: Kerr Harry D.
Published: December 2021

Jacobs and associates1 describe the use of a variety of homeopathic substances in treating young children with diarrhea. If such toxic substances as arsenic, podophyllin, or strychnine were introduced today as therapeutics, the public would have to be informed of the risks involved with their use. Although the 30°C concentrations utilized in the Jacobs study very likely did dilute the constituents to an infinitessimal degree and, therefore, probably posed no toxic risk to the study subjects, no data was presented to support that probability.
Inappropriate Discharge Instructions for Youth Athletes Hospitalized for Concussion
Authors: Genuardi Frank J. , King William D.
Published: December 2021

Objective. To evaluate the medical care, especially the discharge instructions regarding return to participation, received by youth athletes hospitalized for a closed head injury.

Methods. We examined the records of all patients admitted over a 5-year period (1987 through 1991) to The Children's Hospital of Alabama for a sports-related closed head injury. Descriptive information was recorded and discharge instructions reviewed. Injury severity was graded according to guidelines current during the study period, as well as those outlined most recently by the Colorado Medical Society, which have been endorsed by a number of organizations including the American Academy of Pediatrics. Discharge instructions recorded for each patient were then compared with those recommended in the guidelines.

Results. We identified 33 patients with sports-related closed head injuries. Grade 1 concussions (least severe) occurred in 8 patients (24.2%), grade 2 in 10 (30.3%), and grade 3 (most severe) in 15 (45.4%). Overall, discharge instructions were appropriate for only 10 patients (30.3%), including all with grade 1 concussions, but only 2 with a grade 2 (20.0%) and none with a grade 3 concussion.

Conclusion. All who care for youth athletes must become familiar with the guidelines for management of concussion to provide appropriate care and counseling and to avoid a tragic outcome.
Abusive Head Trauma: The Relationship of Perpetrators to Their Victims
Authors: Starling Suzanne P. , Holden James R. , Jenny Carole
Published: December 2021

Objective. Abusive head trauma is the most common cause of morbidity and mortality in physically abused infants. Effective prevention requires the identification of potential perpetrators. No study has specifically addressed the relationship of the perpetrators of abusive head trauma ("shaken baby syndrome") to their victims. The objectives of this study were to identify the abusers and their relationship to victims in these cases.

Methods. We reviewed the medical charts of 151 infants who suffered abusive head trauma to determine the perpetrator of the abuse. Caretakers were classified by level of certainty: confession to the crime, legal actions taken, or strong suspicion by the staff. The relationship of abusers to victims was analyzed.

Results. Male victims accounted for 60.3% of the cases. Twenty-three percent of the children died, although death rates for boys and girls did not vary significantly. Male perpetrators outnumbered females 2.2:1, with fathers, step-fathers, and mothers' boyfriends committing over 60% of the crimes. Fathers accounted for 37% of the abusers, followed by boyfriends at 20.5%. Female baby-sitters, at 17.3%, were a large, previously unrecognized group of perpetrators. Mothers were responsible for only 12.6% of our cases. All but one of the confessed abusers were with the child at the time of onset of symptoms.

Conclusions. Our data suggest male caretakers are at greater risk to abuse infants. Baby-sitters are a concerning risk group, because they represent a significant proportion of abusers, and they more easily escape prosecution. In addition, no prevention efforts have been directed at baby-sitters. These statistics could help change the focus of efforts to prevent abusive head trauma.
Vaccine Information Pamphlets: More Information Than Parents Want?
Authors: Fitzgerald Thomas M. , Glotzer Deborah E.
Published: December 2021

Objective. To assess the information needs of parents regarding childhood immunizations, and their satisfaction with the Vaccine Information Pamphlets (VIPs).

Research design. Verbally administered, forced-choice survey of a representative sample.

Setting. Urban teaching hospital-primary care center (N = 73), neighborhood health center (N = 75), and a suburban private practice (N = 75).

Participants. Parents or guardians of children scheduled for routine checkups, aged 1 month to 18 years, presenting for routine health care maintenance visits.

Results. Of 227 parents, 223 completed the survey. Almost all (98%) had prior experience with their children's immunizations, and 7% reported a history of a "bad" experience. Most parents stated that it was "very important" to receive information about immunizations regarding: diseases prevented by the immunizations (89%); common side effects (91%); serious side effects (89%); contraindications (91%). Eighty percent of parents indicated they wanted immunization information discussed with each vaccination. Forty-three percent of the parents were familiar with the VIPs; of these, 88% reported that the amount of information was "just right," and 94% thought the VIPs were helpful. However, 29% thought the VIPs were either too long, or somewhat too long.

Conclusions. Parents indicate that they want information about many aspects of immunizations, and those familiar with the VIPs report high levels of satisfaction with the pamphlets.
Supplementary Carrying Compared With Advice to Increase Responsive Parenting as Interventions to Prevent Persistent Infant Crying
Authors: St. James-Roberts Ian , Hurry Jane , Bowyer Josephine , Barr Ronald G.
Published: December 2021

Objective. To compare two interventions (supplementary carrying, increased parental responsiveness) introduced from birth for their effectiveness in reducing the amounts of crying in general community infants at 2, 6, and 12 weeks age.

Design and participants. Mothers and infants in newborn wards of maternity hospitals were assigned to carrying intervention, responsiveness intervention, or control groups. Follow-up measures were used to confirm that the interventions were implemented and to determine their effects on infant crying.

Setting and measurements. Diary measurements completed in the home were employed to measure the aspects of parental behavior targeted by the interventions. Audio recordings, diaries, and questionnaires assessed the amounts the infants cried and the impact of the crying on their mothers and the health services. Sample sizes at 6 weeks of age were 59 (carrying intervention), 57 (responsiveness intervention), and 94 infants (control group).

Results. The carrying intervention successfully increased the amounts the infants were carried, particularly while settled, to the target levels. The responsiveness intervention led to more limited increases in carrying and to a modest increase in feeding frequency, but did not affect measures of parental interactiveness and play. No differences in amounts of crying and fussing were found between the three groups of infants on any of the measures. Subsidiary analyses confirmed that the dependent variable (infant fuss\crying) and main independent variable (carrying while settled) were not significantly correlated.

Conclusions. It is not, at present, possible to recommend either supplementery carrying or increased parental responsiveness as primary, preventative interventions to reduce infant crying.
The Small for Gestational Age Infant: Accelerated or Delayed Pulmonary Maturation? Increased or Decreased Survival?
Authors: Tyson Jon E. , Kennedy Kathleen , Broyles Sue , Rosenfeld Charles R.
Published: December 2021

Objective. Small for gestational age (SGA) neonates have been considered to have accelerated pulmonary maturation and thus a lower risk for respiratory distress syndrome (RDS) than appropriate for gestational age (AGA) neonates. This, however, has not been thoroughly examined. Therefore, we compared SGA infants with AGA infants of the same gestational age (GA) with respect to risk of RDS, respiratory failure, or death.

Population. An indigent population born in a large county hospital.

Methods. Multivariate analyses were performed controlling for GA alone or for GA, race, sex, and congenital anomalies. Because the proper method to identify SGA infants is unclear, we performed separate analyses using different GA estimates (obstetric or pediatric) and intrauterine growth grids (hospital-specific grids or grids for a healthy, geographically-defined population).

Results. SGA infants did not fare better than AGA infants in any analysis. SGA infants had significantly increased risk in some analyses of RDS and in almost all analyses of respiratory failure or death. The risk associated with being SGA was generally comparable to that associated with male sex or White race.

Conclusion. The concept that intrauterine growth retardation accelerates lung maturation and improves outcome is not supported in comparisons of SGA and AGA infants of the same GA, sex, and race. This widely accepted concept deserves critical re-evaluation.
Information Update on Achondroplasia
Authors: Hall Judith G.
Published: December 2021

Last month guidelines for the care of children with Achondroplasia were published in Pediatrics (1995;95:443-451). They represent three years of work by the American Academy of Pediatrics (AAP) Committee on Genetics. They are already out of date!!

The field of molecular genetics is moving at an amazing pace. While the guidelines were being developed, the gene for Achondroplasia was mapped and sequenced and the specific defect identified. Because the mutation is very specific and very consistent in Achondroplasia [most diseases have many different mutations in the responsible gene(s)], it has been possible to develop an exquisitely precise diagnostic test very rapidly.
Adolescent Immunization: The Access and Anchor for Health Services?
Authors: Hall Caroline Breese
Published: December 2021

Concern is escalating for the medical and social health of our adolescents under the current discouraging avalanche of statistics. The need for comprehensive health care visits for teens and pre-teens has been highlighted as a national health objective for the year 2000,1 and emphasized by the recent goals and guidelines of the American Academy of Pediatrics2-4 and the American Medical Association.5 The frequency of pregnancies in early adolescence and the steep rise of sexually transmitted diseases, hepatitis B infections, drug abuse, and smoking in teens have been documented.6 Adolescence, if not the age of reason, is the age of risk.
A Single Shot at Salmonella typhi: A New Typhoid Vaccine With Pediatric Advantages
Authors: Hall Breese
Published: December 2021

A new typhoid vaccine has just been licensed, which is the third typhoid vaccine available in the United States.1,2 Since publication of the 1994 Red Book occurred before licensure, this new vaccine is not included. The recommendations concerning the two previously licensed typhoid vaccines in the 1994 Red Book remain unchanged.3

The new vaccine, Typhoid Vi, is manufactured by Pasteur Mérieux (Marnes-La-Coquette, France). This parenteral vaccine is composed of the purified Vi (virulence) antigen, which is the capsular polysaccharide (ViCPS) of Salmonella typhi. The two previously licensed typhoid vaccines are an oral live-attenuated vaccine, the Ty21a vaccine, manufactured by the Swiss Serum and Vaccine Institute, and the parenteral heat-phenol-inactivated vaccine (Berne, Switzerland), manufactured by Wyeth-Ayerst, which has been available for many years.
REDUCING HOSPITAL ADMISSION THROUGH COMPUTER SUPPORTED EDUCATION FOR ASTHMA PATIENTS
Authors: Bell Thomas
Published: December 2021

The authors felt that the use of the computer to integrate education material with personal management plans was important to the success of the program.
Phenylketonuria Screening: Effect of Early Newborn Discharge
Authors: Sinai Laura N. , Kim Susan C. , Casey Rosemary , Pinto-Martin Jennifer A.
Published: December 2021

Objective. To determine the percentage of term newborns discharged by 24 hours of life and the actions taken by physicians and institutions to avoid false-negative phenylketonuria (PKU) screens in these infants.

Design. Descriptive cross-sectional survey.

Participants. One hundred forty term nurseries and 157 pediatricians.

Selection Procedure. Stratified sampling techniques were used to sample nurseries from the 1992 American Hospital Association guide to provide equal representation systematically sampled from a national list of practicing pediatricians supplied by Ross Laboratories to provide equal sampling from each state.

Results. The response rates were 95% (n = 133) for term nurseries and 83% (n = 131) for pediatricians. Twenty-four percent of healthy newborns are discharged by 24 hours of life. Ninety-three percent of nurseries screen all infants for PKU before discharge. In states without laws mandating rescreening, only 48% of institutions that discharge the majority of their infants (>50%) by 24 hours of life rescreen. Also, in states without rescreening laws, 64% of pediatricians rescreen. The timing of this repeat screen ranges from less than 72 hours of life to 4 weeks. Determining which infants to rescreen varies by practitioner; some rescreen all infants, whereas others rescreen those discharged early. Just more than half of all pediatricians, whether practicing in a state requiring repeat PKU screening, claim to be familiar with the American Academy of Pediatrics recommendations regarding repeated PKU screening of infants discharged by 24 hours of life.

Conclusion. Twenty-four percent of term newborns in the United States are discharged by 24 hours of life. Most hospitals screen all infants for PKU before discharge regardless of age. The majority of states do not mandate rescreening; rescreening policies among pediatricians and institutions in those states vary widely. A significant number of infants do not receive repeated screening and are therefore at risk for delayed or missed diagnosis of PKU because of insensitive initial screens. Pediatrician awareness of the need to perform repeated PKU screens on infants discharged by 24 hours is poor.
Short-Term Efficacy of Oral Dimercaptosuccinic Acid in Children With Low to Moderate Lead Intoxication
Authors: Besunder James B. , Anderson Roberta L. , Super Dennis M.
Published: December 2021

Objective. To determine the short-term efficacy of meso-2,3-dimercaptosuccinic acid (DMSA) in mild to moderately lead poisoned children.

Methods. Medical records of all pediatric patients receiving 19 days of DMSA between June 1991 and May 1993 were reviewed retrospectively. Patients were included if their pretreatment blood lead concentration (BPb) was 1.21 to 2.36 µmol/L (25 to 49 µg/dL) and excluded if they: received DMSA through participation in a pharmaceutical company-sponsored drug study; underwent chelation therapy in the previous 28 days; or received another chelating agent concomitantly with DMSA; or if noncompliance was documented. Homes were inspected and abated of major hazards before chelation therapy. BPb and blood zinc protoporphyrin concentration (ZnP) were obtained at baseline. DMSA was administered in a dose approximating 10 mg/kg per dose every 8 hours for 5 days, followed by 10 mg/kg per dose every 12 hours for 14 days. Baseline laboratory studies were repeated weekly while the patients were receiving therapy and for 2 weeks after therapy, then monthly unless chelated again.

Results. Of the 46 children who were treated with DMSA, 18 were excluded from the analysis. In the remaining 28 children, the mean ± SD pretreatment BPb and ZnP were 1.79 ± 0.33 µmol/L (37 ± 6.9 µg/dL) and 1.26 ± 0.64 µmol/L (71 ± 36.1 µg/dL), respectively. The percent reduction (mean ± SD) in BPb compared with baseline was -43% ± 20.8%, -26% ± 16.9%, and -31% ± 20.2% on mean days 18, 30, and 80, respectively, whereas the changes in ZnP were -12% ± 21.7%, -20% ± 18.1%, and -32% ± 21.9%, respectively. Eighty percent of patients had 20% or more reduction in their pretreatment BPb and/or ZnP after completion of DMSA therapy (95% confidence interval, 61, 92%). No significant adverse effects were observed except for neutropenia (absolute neutrophil count of 0.752 x 109/L) in one patient.

Conclusion. Our findings support the short-term efficacy of DMSA in children with BPb of 2.36 µmol/L (49 µg/dL) or less.
Iodine-Induced Hyperthyroidism in a Newborn
Authors: Bryant William P. , Zimmerman Donald
Published: December 2021

In the article entitled Iodine-Induced Hyperthyroidism in a Newborn that appeared in the March 1995 issue of Pediatrics, the iodine content of povidone-iodine is estimated at 10 mg/mL rather than the estimate that we employed which was 10% or 10 g/dL. Thus, we are in agreement that the neonate in our report received 2.88 g rather than 28.8 g, which we reported.

Donald Zimmerman, MD

Mayo Clinic & Mayo Foundation

Pediatric Endocrinology

Rochester, MN 55905
The Role of Fiber in the Treatment of Hypercholesterolemia in Children and Adolescents
Authors: Kwiterovich Peter O.
Published: December 2021

The effect of adding water-soluble fiber to a diet low in total fat, saturated fat, and cholesterol to treat hypercholesterolemic children and adolescents with elevated plasma low-density lipoprotein (LDL) cholesterol levels was assessed. In more than a half-dozen studies, the effect of water-soluble fiber on the LDL cholesterol level ranged from no change to as high as a 23% decrease using oat bran, psyllium, or locust bean gum. The wide range of effects in these studies may be related to the quality of the dietary intervention or to different methods of randomization, blinding, dietary assessment, and laboratory measurement. For example, the addition of supplemented soluble fiber (psyllium) to a step 1 diet may provide additional lowering of LDL cholesterol of 10% to 15%. However, in children consuming the more stringent step 2 diet, the addition of water-soluble fiber may have less additional effects on LDL cholesterol. As recommended by the National Cholesterol Education Program Expert Panel on Blood Cholesterol Levels in Children and Adolescents, dietary therapy, that is, a diet low in total fat, saturated fat, and cholesterol, remains the cornerstone of treatment for children and adolescents with elevated LDL cholesterol levels. The use of foods high in water-soluble fiber that contain no cholesterol and are low in saturated fat remains a good choice in children following a step 1 or step 2 diet. Additional clinical trials in larger numbers of well-defined subjects will be needed to assess further the utility of adding water-soluble fiber supplements to the National Cholesterol Education Program step 1 or step 2 diets. The addition of drug therapy in children with elevated LDL cholesterol levels should be undertaken only in those with more marked elevations in the LDL cholesterol levels, particularly in those with positive family histories of premature coronary artery disease and the presence of two or more other coronary artery disease risk factors.
Psychological Changes in Parents Eight Months After the Loss of an Infant From Stillbirth, Neonatal Death, or Sudden Infant Death Syndrome—A Longitudinal Study
Authors: Vance J. C. , Najman J. M. , Thearle M. J. , Embelton G. , Foster W. J. , Boyle F. M.
Published: December 2021

Objective. We proposed to measure part of the natural history of grief by determining the changes in the psychological symptoms experienced by bereaved parents over the 8 months after the loss of an infant from sudden infant death syndrome (SIDS), neonatal death (NND), or stillbirth (SB). Parents were interviewed twice, at 2 and 8 months after the loss.

Methodology. A total of 220 bereaved families (45 SIDS, 93 NND, and 82 SB) were compared with 226 control families who had a live born child. Comparison was based on responses to a standardized measure of anxiety and depression (Delusions-Symptoms-States Inventory).

Results. For separate cross-sectional comparison at both 2 and 8 months, significant differences were noted in the frequency of maternal symptoms of anxiety and depression between bereaved and control groups (P < .001). Such differences were present for paternal anxiety and depression at 2 months, but not 8 months.

A second series of analysis examined longitudinal changes in symptom frequency between 2 and 8 months for each bereaved group. For mothers, the changes were significant for anxiety and depression: SIDS and NND (P < .001), SB (P < .01). For fathers, the changes for anxiety and depression in SIDS were P < .01; NND, P < .05 for anxiety and P < .01 per depression; changes were not significant for SB.

At 2 months, relative risks for symptoms of maternal anxiety were significant for all three bereaved groups: SIDS, 22.4; NND, 5.4; and SB, 5.1. Comparable significant figures at 8 months were: SIDS, 5.5; NND, 3.9; and SB, 3.0, respectively. For depression the results for 2 months were: SIDS, 8.6; NND, 5.9; and SB, 6.7 (all significant) while at 8 months the results were: SIDS, 5.1; NND, 3.8; and SB, 2.4 (SB group not significant). For fathers the relevant risks were generally lower. At 2 months, anxiety levels were higher than controls in all three groups, and for depression in the SIDS and SB groups. At 8 months, significant results persisted only in the SB group.

Conclusion. These data indicate that bereaved parents have a marked reduction in the symptoms of mental illness over the first 8 months after the loss. Although the changes over time are significant for both mothers and fathers, mothers at 8 months still demonstrated higher levels of anxiety and depression when compared with controls. These levels of symptoms are far less evident for fathers at 8 months.
Children's Medicaid Entitlement: What Have We Got to Lose?
Authors: Flint Samuel S. , Yudkowsky Beth K. , Tang Suk-fong S.
Published: December 2021

Medicaid's efficacy as a safety net for children has been lost in the heated health policy debates of the last 2 years. The second year of the last Congress was dominated by competing proposals that would have cast aside Medicaid and assured universal coverage through comprehensive private health insurance plans. The first year of the current Congress has been spent debating legislation designed to reduce the federal government's role in the provision of health care services through constrained funding, regulatory rollback, and broadened latitude for state programs dependent on federal dollars, (eg, Medicaid).

Over the past 2 years, taking the position that the Medicaid program should be exempt from proposed changes (at least with respect to children) has not been in vogue.
Parents' Recollection of the Initial Communication of the Diagnosis of Cystic Fibrosis
Authors: Jedlicka-Köhler Ilse , Götz Manfred , Eichler Irmgard
Published: December 2021

Background. The diagnosis of a chronic disease in children challenges parents' emotional coping abilities and cognitive capacities.

Objective. To study parents' emotional and cognitive reactions to the diagnosis of cystic fibrosis (CF) in their children.

Methods. Postal survey by means of a written questionnaire.

Participants. Forty-six parents of 29 children with a median age of 2 months at diagnosis.

Results. Most parents initially lacked knowledge of CF (76%) and were provided only oral information (96%). Parental estimates of how much of the information given they had understood and retained were 77% and 76%, respectively, with 15 parents (33%) having understood and remembered less than 50% of what the physicians had told them. The most frequent stressing feelings were fear (83%) and despair (56%). Fifty-four percent of parents had initial shocklike reactions. In this group, a significant decrease in the understanding and recall of information was noted compared with parents who had less-emotional responses.

Conclusions. Parents learning the diagnosis are, in effect, receiving a kind of lecture, which contains more information than they can possibly assimilate. Because of the incompatibility of emotional distress and optimum learning, impairment of early comprehension and retention of information about CF is unavoidable. Repeated interviews with both parents and the provision of written and audiovisual materials should be mandatory.
IMPACT OF NEONATAL INTENSIVE CARE
Authors: Student
Published: December 2021

Neonates who weighed > 1.5 kg at birth were the major contributors to the overall reduction in the neonatal mortality rate (NMR); approximately two thirds of total reduction in the NMR between 1960 and 1980 and 52.6% of the total reduction between 1980 and 1986 occurred in the > 1.5-kg birth weight groups.
Sexuality Education of Children and Adolescents With Developmental Disabilities
Authors:   COMMITTEE ON CHILDREN WITH DISABILITIES
Published: December 2021

Sexuality education challenges many parents of children with developmental disabilities because they deny the child's sexuality, fear sexual exploitation or pregnancy, and have difficulty deciding what and how to tell the child. Pediatricians should incorporate guidance on sexuality education, socially appropriate behavior, and sexual abuse prevention into the clinical supervision of children with disabilities, as for all other children. Pediatricians have extended involvement with both families and children. They can fill the important role of guiding parents from the time the children are young to instill the attitudes and teach the behaviors and information that are most likely to help children with developmental disabilities achieve personal satisfaction, behave in ways that are socially appropriate, and protect themselves from exploitation.
"DOCTORS SAY HMOs RESTRICT OPEN DISCUSSION OF PATIENT CARE AND PAYMENT POLICIES" "DOCTORS SAY HMOs LIMIT WHAT THEY CAN TELL PATIENTS"
Authors: L. J. F.
Published: December 2021

Doctors across the country say that health maintenance organizations (HMOs) routinely limit their ability to talk freely with patients about treatment options and HMO payment policies, including financial bonuses for doctors who save money by withholding care.

In interviews over the last 3 weeks, many doctors said such restrictions interfered with their ethical and legal duty to provide patients with information about the benefits, risks, and costs of various treatments.

Ill feeling over the restrictions is growing as more and more Americans join HMOs and employers encourage their use to control costs.

The doctors' complaints illustrate the tension between them and HMOs as health plans try to monitor and regulate the doctors' behavior.

Dr Daniel A Gregorie, president of Choice Care in Cincinnati, defended the confidentiality clause as a way to prevent doctors from sharing their frustrations with patients.

"Physicians are angry, frustrated and, to some extent, depressed because the world as they've known it is changing rapidly and radically," Dr Gregorie said.

"But physicians should not take out that frustration in a nonconstructive way by sharing it with patients. That does not help the patients. It just makes them more anxious about the care they are receiving."
STUDY COMPARES DOCTORS' EFFICACY IN HEART ATTACKS
Authors: L. J. F.
Published: December 2021

A new study raised questions about the trend of managed-care plans to rely on family doctors as the first physicians to treat heart attack victims.

Researchers at Duke University found that elderly heart attack patients who were immediately treated by a cardiologist were 15% less likely to die within a year than those who were treated by a family doctor. When general internists, who undergo more training than family doctors, were considered, the reduction in mortality for patients treated by a cardiologist was 5%.

The findings come as managed-care organizations, in an effort to control medical costs, increasingly ask primary care physicians to limit referrals to specialists and shoulder more responsibility for specialty care. In a hospital, this can influence whether a patient complaining of chest pain is seen by a generalist or admitted to a unit that specializes in coronary care.
High-dose Corticotropin (ACTH) Versus Prednisone for Infantile Spasms: A Prospective, Randomized, Blinded Study
Authors: Baram Tallie Z. , Mitchell Wendy C. , Tournay Anne , Snead O. Carter , Hanson Rebecca A. , Horton E. J.
Published: December 2021

Objective. To compare the efficacy of corticotropin (ACTH) (150 U/m2/day) and prednisone (2 mg/kg/day), given for 2 weeks, in suppressing clinical spasms and hypsarrhythmic electroencephalogram (EEG) in infantile spasms (IS). ACTH and prednisone are standard treatments for IS. ACTH at high doses causes severe dose- and duration-dependent side effects, but may be superior to prednisone, based on retrospective or uncontrolled studies. Blinded prospective studies have shown equal efficacy of prednisone and low-dose ACTH, and low versus high-dose ACTH.

Design. A prospective, randomized, single-blinded study.

Subjects and Methods. Patient population consisted of consecutive infants fulfilling entry criteria, including the presence of clinical spasms, hypsarrhythmia (or variants) during a full sleep cycle video-EEG, and no prior steroid/ACTH treatment. Response required both cessation of spasms and elimination of hypsarrhythmia by the end of the 2-week treatment period, as determined by an investigator "blinded" to treatment. Treatment of responders was tapered off over 12 days; those failing one hormone were crossed-over to the other.

Results. Of 34 eligible infants, 29 were enrolled. Median age of patients was 6 months. Twenty-two infants were "symptomatic" with known or suspected cause, and seven were cryptogenic (two normal). Of 15 infants randomized to ACTH, 13 responded by both EEG and clinical criteria (86.6%); seizures stopped in an additional infant, but EEG remained hypsarrhythmic (considered a failure). Four of 14 patients given prednisone responded (28.6%, with complete clinical-EEG correlation), significantly less than with ACTH, (x2 test).

Conclusions. Using a prospective, randomized approach, a 2-week course of high-dose ACTH is superior to 2 weeks of prednisone for treatment of IS, as assessed by both clinical and EEG criteria.
Meningococcal Disease Prevention and Control Strategies for Practice-based Physicians
Authors:   COMMITTEE ON INFECTIOUS DISEASES,   INFECTIOUS DISEASES AND IMMUNIZATION COMMITTEE
Published: December 2021

Localized outbreaks of meningococcal disease in the United States and Canada continue to cause serious alarm within communities as a result of the fulminating pattern of the disease, high mortality rate, and high incidence among adolescents. The increasing number of outbreaks since 1991 has raised questions about the management and prevention of further cases during an outbreak. The purpose of this statement is to guide primary-care physicians in their role in infection control and prevention of both sporadic cases and outbreaks of invasive meningococcal disease. This statement provides information on the epidemiology of meningococcal disease, including definitions of sporadic, secondary, and coprimary cases, clusters of cases, and outbreaks. Data are presented on identification of cases, disease risk of contacts, and agents for chemoprophylaxis, and recommendations are given for: (1) risk assessment of contacts, (2) administration of chemoprophylaxis, (3) appropriate use of meningococcal vaccine, (4) appropriate use of the microbiology laboratory, (5) the necessity for timely and appropriate reporting of invasive meningococcal disease to local public health authorities, and (6) information on counseling and public education that may be helpful during an outbreak to minimize public anxiety. An additional section, "Information for Sharing," which uses a question-and-answer format and which may be helpful to parents and community and health care workers during an outbreak, is also provided.
Technical Report Abstract: The Management of Acute Gastroenteritis in Children—Technical Report for the American Academy of Pediatrics Practice Parameter
Authors: BROWN GAIL R. , MARGOLIS PETER
Published: December 2021

This technical report describes the process followed in the development of the AAP practice parameter on acute gastroenteritis, as well as the evidence used to formulate the final recommendations.

An evidence model that defined acute gastroenteritis and identified diagnostic tests and interventions used in its management and outcomes of importance was used to identify topics to include in the guideline. The three topics selected were: (1) methods of rehydration, (2) refeeding after rehydration, and (3) the use of antidiarrheal agents. Primary outcomes of interest were duration of disease, complications of therapy, parental satisfaction, and cost.

Multiple bibliographic sources were searched to identify articles related to these areas; the sources included MEDLINE, reports on gastroenteritis from the Centers for Disease Control and Prevention and the World Health Organization, the Federal Register, a report to the Food and Drug Administration, and files of the expert panel. More than 4000 articles were initially reviewed, of which 230 were identified as being potentially related to the three topics. Qualitative aspects of the literature reviewed were summarized in evidence tables. Sufficient data for quantitative summary were available only for refeeding after rehydration. In this analysis, the weighted difference across studies between treatment and control groups in the mean duration of diarrhea was used as the measure of the relative benefit of one form of therapy over another.

Methods of Rehydration

Evidence comparing oral rehydration and intravenous therapy was limited to five reports of randomized trials conducted in developed countries. It was not possible to perform a quantitative synthesis of this information because of a lack of similar outcomes.
Making Sense of State v Messenger
Authors: Clark Frank I.
Published: December 2021

On April 30, 1994, Gregory Messenger was charged with manslaughter for physically disconnecting his premature son from a ventilator.1 He was acquitted of these charges on February 2, 1995. Although appellate courts have dealt with various aspects of withdrawing life-sustaining medical treatment (LSMT) in infants,2 State v Messenger raised the issues involved when this support is not desired by the parents at the time of birth. This case sets no precedent for future cases on this point. There is no appeal of a criminal case when the defendant prevails; therefore, for lawyers and judges it will remain just another trial court loss for a prosecutor.
Letter To The Editor
Authors: Sampson Wallace , London William
Published: December 2021

The disputed references illustrate the fact that homeopathic preparations can be dangerous and unreliable for a variety of reasons, which were grouped as adulteration—Fisher et al are correct to point this out. The first, pancreatitis following a homeopathic preparation, illustrates problems associated with taking unmonitored preparations (the reference was correct in our submitted draft.) The offending material is often not identified, looked for, or suspected. The second exemplifies the fact that some materials such as mercury, in lesser diluted amounts, can be toxic.