bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship Between Age at Initiation of Toilet Training and Duration of Training: A Prospective Study
Authors: Blum Nathan J. , Taubman Bruce , Nemeth Nicole
Published: August 2004

Objective. To study the relationship between age at initiation of toilet training, age at completion of toilet training, and the duration of toilet training.

Methods. A total of 406 children seen at a suburban private pediatric practice were enrolled in a study of toilet training between 17 and 19 months of age, and 378 (93%) were followed by telephone interviews with the parents every 2 to 3 months until the child completed daytime toilet training. Information obtained at follow-up interviews included how often parents were asking their child to sit on the toilet or potty and where the child urinated and defecated. Parents were considered to have initiated toilet training when they first took out a potty chair and discussed some aspect of training with the child. Intensive toilet training was defined as asking the child to use the toilet or potty >3 times per day.

Results. Age of initiation of toilet training correlated with age of completion of training (r = 0.275). The correlation between age at initiation of intensive training and age at completion was even stronger (r = 0.459). Younger age at initiation of intensive toilet training was not associated with constipation, stool withholding, or stool toileting refusal. However, age at initiation of intensive toilet training was negatively correlated with duration of toilet training (r = −0.481), indicating that initiation of training at younger ages was associated with a longer duration of training. In addition, the correlation between age at initiation of intensive toilet training and age at completion of training was not significant for those who began intensive training before 27 months of age (r = 0.107).

Conclusions. Early initiation of intensive toilet training correlates with an earlier age at completion of toilet training but also a longer duration of toilet training. Although earlier toilet training is not associated with constipation, stool withholding, or stool toileting refusal, initiation of intensive training before 27 months does not correlate with earlier completion of toilet training, suggesting little benefit in beginning intensive training before 27 months of age in most children.
Predictors of Low Back Pain in British Schoolchildren: A Population-Based Prospective Cohort Study
Authors: Jones Gareth T. , Watson Kath D. , Silman Alan J. , Symmons Deborah P.M. , Macfarlane Gary J.
Published: August 2004

Objective. To determine the onset of low back pain (LBP) in schoolchildren and to investigate the role of mechanical and psychosocial factors as risk factors for its onset.

Methods. A prospective population-based cohort study was conducted of 1046 schoolchildren, aged 11 to 14 years at baseline, identified as being free of LBP, from 39 secondary schools in Northwest England. New onset of LBP at 1-year follow-up was measured.

Results. Children who reported high levels of psychosocial difficulties were more likely to develop LBP than their peers (relative risk: 1.6; 95% confidence interval: 1.1–2.3). An excess risk was, in particular, associated with conduct problems (2.5; 1.7–3.7). Similarly, children who reported high numbers of somatic symptoms at baseline were at greater risk of developing LBP: abdominal pain (1.8; 1.1–3.0), headaches (1.6; 0.97–2.8), and sore throats (1.5; 0.8–2.6). In contrast, we have been unable to demonstrate a strong association between daily mechanical load (schoolbag weight) and the short-term risk of new-onset LBP (highest versus lowest quintile: 1.2; 0.7–2.1).

Conclusions. In children who were initially free of LBP, adverse psychosocial factors and the presence of other preexisting somatic pain symptoms were predictive of future LBP, reflecting findings in adults. In contrast, there was little evidence of an increase in short-term risk associated with mechanical load across the range of weights commonly carried by children to school.
Food Protein-Induced Enterocolitis Syndrome Caused by Solid Food Proteins
Authors: Nowak-Wegrzyn Anna , Sampson Hugh A. , Wood Robert A. , Sicherer Scott H.
Published: August 2004

Background. Infantile food protein-induced enterocolitis syndrome (FPIES) is a severe, cell-mediated gastrointestinal food hypersensitivity typically provoked by cow’s milk or soy. Solid foods are rarely considered a cause.

Objective. To describe the clinical characteristics and natural history of FPIES provoked by solid foods.

Methods. Patients with FPIES induced by solid foods were identified and their clinical course compared with a control group with FPIES caused by cow’s milk and/or soy evaluated over the same time period.

Results. Fourteen infants with FPIES caused by grains (rice, oat, and barley), vegetables (sweet potato, squash, string beans, peas), or poultry (chicken and turkey) were identified. Symptoms were typical of classical FPIES with delayed (median: 2 hours) onset of vomiting, diarrhea, and lethargy/dehydration. Eleven infants (78%) reacted to >1 food protein, including 7 (50%) that reacted to >1 grain. Nine (64%) of all patients with solid food–FPIES also had cow’s milk and/or soy-FPIES. Initial presentation was severe in 79% of the patients, prompting sepsis evaluations (57%) and hospitalization (64%) for dehydration or shock. The diagnosis of FPIES was delayed, after a median of 2 reactions (range: 2–5). Thirty patients with typical cow’s milk- and/or soy-FPIES were identified for comparison. Overall, 48% of the 44 infants with FPIES were reactive to >1 food protein, and the risk for multiple food hypersensitivity approached 80% in the infants with solid food or soy-induced FPIES. None of the patients developed FPIES to maternally ingested foods while breastfeeding unless the causal food was fed directly to the infant.

Conclusions. Cereals, vegetables, and poultry meats, typically regarded as of low allergenic potential, must be considered in the evaluation of FPIES, particularly in infants previously diagnosed with FPIES to cow’s milk or soy, and as an initial cause in patients who have been exclusively breastfed. Infants with FPIES are at risk for multiple dietary protein hypersensitivities during an apparent period of immunologic susceptibility. Pediatricians should consider FPIES in the differential diagnosis of shock and sepsis.
One-Year Changes in Activity and in Inactivity Among 10- to 15-Year-Old Boys and Girls: Relationship to Change in Body Mass Index
Authors: Berkey Catherine S. , Rockett Helaine R. H. , Gillman Matthew W. , Colditz Graham A.
Published: August 2004

Objective. Cross-sectional studies have suggested that children who were less physically active and children who watched more television (TV) had more excess body weight, but no large nationwide longitudinal studies have addressed whether children who change their personal levels of activity or inactivity, from one year to the next, experience changes in adiposity. Our objective is to study the association between change in body mass index (BMI) over 1 year and same year change in recreational physical activity and change in recreational inactivity (TV/videos/video games).

Design. Cohort study using data from 2 mailed questionnaires, 1 year apart.

Participants. A total of 11 887 boys and girls, aged 10 to 15, who returned questionnaires in both 1997 and 1998 as part of the Growing Up Today Study.

Outcome Measure. Change in BMI from 1997–1998, accounting for increases in BMI associated with growth and development.

Results. An increase in physical activity from 1997–1998 was associated with decreasing relative BMI in girls (−0.06 kg/m2 per hour increase in daily activity; 95% confidence interval [CI]: −0.11, −0.01) and in overweight boys (−0.22 kg/m2; CI: −0.33, −0.10). An increase in inactivity was associated with increasing BMI in girls (+0.05 kg/m2 per hour increase in daily TV/videos/video games; CI: +0.02, +0.08). Effects were generally stronger among overweight children. Increasing time doing aerobics/dancing and walking were associated with BMI declines for some groups of children.

Conclusions. Many children may benefit by increasing their physical activity and by reducing time watching TV or videos and playing video games. In particular, 2 activities accessible to most children, aerobics/dancing and walking, also appeared beneficial.
Relative Weight and Race Influence Average Age at Menarche: Results From Two Nationally Representative Surveys of US Girls Studied 25 Years Apart
Authors: Anderson Sarah E. , Dallal Gerard E. , Must Aviva
Published: August 2004

Objectives. 1) To establish with nationally representative US data whether menarche occurred earlier in the 1990s than it had 25 years before. 2) To assess whether the occurrence of menarche in relation to weight status and race had changed over this time period.

Methods. Relative weight, race, and menarcheal status of girls in the National Health Examination Survey cycles II and III (1963–1970) were compared with results from the Third National Health and Nutrition Examination Survey (1988–1994). Probit analysis was used to determine the average age at menarche during the 2 survey periods. Logistic regression was used to assess the association of relative weight to likelihood of having reached menarche.

Results. The average age at menarche dropped from 12.75 to 12.54 years, and the percentage of girls between 10 and 15 years old who were above the 85th percentile for body mass index increased from 16% to 27% over the 25 years between the 2 surveys. Higher relative weight was strongly associated with increased likelihood of having reached menarche after controlling for age and race. Black girls had a lower average age at menarche than did white girls, which was independent of the effect of relative weight.

Conclusions. These analyses from 2 nationally representative samples of US girls suggest a drop of about 2½ months in the average age of menarche during the time period between 1963–1970 and 1988–1994. This was paralleled by a concurrent shift in the population distribution of body mass index z-score toward higher relative weights.
Obesity and Psychiatric Disorder: Developmental Trajectories
Authors: Mustillo Sarah , Worthman Carol , Erkanli Alaattin , Keeler Gordon , Angold Adrian , Costello E. Jane
Published: August 2004

Objectives. To identify age-related trajectories of obesity from childhood into adolescence, and to test the association of these trajectories with the development of psychiatric disorders (conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder, substance abuse, depression, and anxiety).

Methods. White children (N = 991) 9 to 16 years old from the Great Smoky Mountains Study, a representative sample of rural youth, were evaluated annually over an 8-year period for height, weight, psychiatric disorder, and vulnerabilities for psychiatric disorder. Longitudinal analyses on the repeated measures data were conducted using developmental trajectory models and generalized estimating equation models.

Results. Obesity was 3 to 4 times more common than expected from national rates using Centers for Disease Control and Prevention 2000 criteria. Four developmental trajectories of obesity were found: no obesity (73%), chronic obesity (15%), childhood obesity (5%), and adolescent obesity (7%). Only chronic obesity was associated with psychiatric disorder: oppositional defiant disorder in boys and girls and depressive disorders in boys.

Conclusions. In a general population sample studied longitudinally, chronic obesity was associated with psychopathology.
Prevention of Rickets and Vitamin D Deficiency: New Guidelines for Vitamin D Intake
Authors: Gartner Lawrence M. , Greer Frank R. ,   Section on Breastfeeding,   Committee on Nutrition
Published: August 2004

Rickets in infants attributable to inadequate vitamin D intake and decreased exposure to sunlight continues to be reported in the United States. It is recommended that all infants, including those who are exclusively breastfed, have a minimum intake of 200 IU of vitamin D per day beginning during the first 2 months of life. In addition, it is recommended that an intake of 200 IU of vitamin D per day be continued throughout childhood and adolescence, because adequate sunlight exposure is not easily determined for a given individual. These new vitamin D intake guidelines for healthy infants and children are based on the recommendations of the National Academy of Sciences.
Selecting Appropriate Toys for Young Children: The Pediatrician’s Role
Authors: Glassy Danette , Romano Judith ,   Committee on Early Childhood, Adoption, and Dependent Care
Published: August 2004

Play is essential for learning in children. Toys are the tools of play. Which play materials are provided and how they are used are equally important. Adults caring for children can be reminded that toys facilitate but do not substitute for the most important aspect of nurture—warm, loving, dependable relationships. Toys should be safe, affordable, and developmentally appropriate. Children do not need expensive toys. Toys should be appealing to engage the child over a period of time. Information and resources are provided in this report so pediatricians can give parents advice about selecting toys.
Apnea, Sudden Infant Death Syndrome, and Home Monitoring
Authors:   Committee on Fetus and Newborn
Published: August 2004

This Policy Statement was retired May 2012.

More than 25 years have elapsed since continuous cardiorespiratory monitoring at home was suggested to decrease the risk of sudden infant death syndrome (SIDS). In the ensuing interval, multiple studies have been unable to establish the alleged efficacy of its use. In this statement, the most recent research information concerning extreme limits for a prolonged course of apnea of prematurity is reviewed. Recommendations regarding the appropriate use of home cardiorespiratory monitoring after hospital discharge emphasize limiting use to specific clinical indications for a predetermined period, using only monitors equipped with an event recorder, and counseling parents that monitor use does not prevent sudden, unexpected death in all circumstances. The continued implementation of proven SIDS prevention measures is encouraged.
Hearing Deficits in Young Adults Who Had a History of Otitis Media in Childhood: Use of Personal Stereos Had No Effect on Hearing
Authors: de Beer Brechtje A. , Graamans Kees , Snik Ad F. M. , Ingels Koen , Zielhuis Gerhard A.
Published: August 2004

Objective. To test the hypothesis proposed in a recent French study that a history of recurrent otitis media (OM) in childhood increases susceptibility to hearing loss from frequent exposure to a personal stereo (PS) during development to early adulthood.

Methods. A subcohort of 358 young adults selected from a historic cohort study, all 18 years old and with a well-documented OM history (secretory and acute), provided data on the sound level and length of exposure to PSs. Four contrasting groups were formed: those with the highest or lowest PS exposure combined with a positive or negative history of OM (n = 238). The main outcome measure was hearing thresholds from pure-tone audiometry (0.5–8 kHz).

Results. Young adults with a history of recurrent OM in childhood did not show greater susceptibility to hearing loss from PS use than their peers without a history of OM. However, a history of recurrent OM was associated with significant mean air-conduction hearing loss of 4 dB and a mean bone-conduction hearing loss of 2 dB compared with the participants without a history of OM (Fig 1).

Conclusions. Recurrent OM in childhood may have an irreversible effect on the middle ear and the cochlea and may lead to hearing deficits in later life. No interaction with PS exposure is seen.
Tuberculin Testing and Risk of Tuberculosis Infection Among New York City Schoolchildren
Authors: Gounder Celine R. , Driver Cynthia R. , Scholten Jerod N. , Shen Huimin , Munsiff Sonal S.
Published: August 2004

Objectives. To assess adherence to a 1996 health policy change, which discontinued mandatory tuberculin skin testing (TST) of new entrants to NYC primary schools and continued mandatory testing of new entrants to secondary schools.

Methods. The proportion tested before (1991–1995) and after (1996–1998) the change in health policy was determined. Factors associated with TST positivity and the cost of continued testing were assessed.

Results. A total of 76.6% of 551 636 new entrants to primary schools were tested in 1991–1995; slightly fewer, 71.1% of 339 958, were tested in 1996- 1998. Among new entrants to secondary schools, 31.0% of 106 463 were tested in 1991–1995 and 51.4% of 53 762 were tested in 1996–1998. The proportion who were TST-positive continued to decrease after 1996 to 1.2% among primary and 9.7% among secondary schoolchildren in 1998. Older age and birth outside the United States were associated with TST positivity. The estimated minimum cost of continued testing in primary schools was $123 152 per tuberculosis case prevented.

Conclusion. An approach aimed at reducing testing of children at low risk for latent tuberculosis infection did not decrease testing of younger children. More important, older children who were more likely to be born in countries of high tuberculosis incidence were not tested. Additional efforts are needed to increase awareness among medical and school personnel to decrease testing among children who do not have risk factors for latent tuberculosis infection and to increase tuberculin testing of children who are entering school for the first time at the secondary level and do have risk factors for tuberculosis infection.
Postpartum Length of Stay and Newborn Health: A Cost-Effectiveness Analysis
Authors: Malkin Jesse D. , Keeler Emmett , Broder Michael S. , Garber Steven
Published: August 2004

Objective. To evaluate the cost-effectiveness of increasing lengths of brief postpartum hospitalizations.

Methods. A cost-effectiveness model extrapolating from secondary data was used. Social costs in 2000 US dollars were estimated using several sources, including a randomized controlled trial, a retrospective study, and survey data. Life-years saved from reduced infant mortality were estimated from administrative data from Washington State. A total of 113 147 singleton newborns who were born in nonmilitary hospitals in Washington State in 1989 or 1990 and had postpartum stays short enough to be affected by length of stay legislation were studied. The cost-effectiveness of increases in postpartum lengths of stay similar to those that would occur if all mothers and singleton newborns used at least the time allotted to them under the federal length of stay legislation was measured.

Results. Estimated lower-bound cost per newborn life-year saved was $19 800 (95% confidence interval: $11 600–$61 300) when only neonatal deaths were considered. The corresponding upper-bound estimate was $94 800 (95% confidence interval: $55 200–$286 800). The results were very sensitive to assumptions about the discount rate for future life-years and the time from birth during which averted deaths are considered (neonatal deaths, postneonatal infant deaths, or all infant deaths).

Conclusions. At hospitals that do not experience additional capacity costs as a result of increased lengths of stay, lengthening short postpartum stays seems to be more cost-effective than many common health interventions and well below cost-effectiveness thresholds suggested by the literature. Even at hospitals that experience additional capacity costs, the cost-effectiveness of lengthening short postpartum stays seems to be roughly equal to the benchmark of $100 000 per quality-adjusted life-year suggested by the literature.
Too Small for a Seatbelt: Predictors of Booster Seat Use by Child Passengers
Authors: Ebel Beth E. , Koepsell Thomas D. , Bennett Elizabeth E. , Rivara Frederick P.
Published: August 2004

Objectives. Motor vehicle injury is the leading cause of injury death for children 4 to 8 years of age. Although booster seat use in this age group substantially reduces the risk of injury, most children are currently restrained by seatbelts designed for adults. The objective of this study was to measure booster seat use directly, determine factors predictive of proper child restraint, and assess parental reasons for booster use and nonuse.

Methods. We conducted a cross-sectional, observational study in Seattle, Washington, Spokane, Washington, and Portland, Oregon, from February to April 2000. Drivers were surveyed in their vehicles after picking up children from schools and child care centers. Trained observers recorded child age, weight, and height and directly observed restraint use. Observed restraint use was compared with the recommended restraint method based on the child’s weight and age. Data were analyzed using multivariate logistic regression, adjusted for clustering by car and site.

Results. We observed 2880 children traveling in cars, 1539 of whom were eligible for booster seat use. Eighty-eight percent of drivers agreed to respond to our survey. Only 16.5% of children for whom a booster seat was recommended were properly restrained, compared with 80% of younger children for whom a child safety seat was recommended and 55% of children for whom an adult seatbelt was recommended. Relative to a 4-year-old booster-eligible child, a 6-year-old was only half as likely to use a booster seat (odds ratio [OR]: 0.47; 95% confidence interval [CI]: 0.31–0.71) and an 8-year-old almost never used a booster seat (OR: 0.04; 95% CI: 0.01–0.19). Booster use was more common when the driver wore a seatbelt (OR: 3.1; 95% CI: 1.8–5.4). Parents whose children were using booster seat cited “safety” (61%) and “child comfort and visibility” (12%) as their primary concerns. When a child was not using a booster seat, parents most often believed that their child was “too big for a car seat” (56%), reported that the seat was in another vehicle (9%), or stated that they “had not heard” of booster seats (8%).

Conclusions. Many parents still incorrectly believe that children are safe in a seatbelt and have outgrown the need for a car seat. These results demonstrate the need for public education campaigns to educate parents about booster seat use.
Occurrence and Mechanisms of Sudden Oxygen Desaturation in Infants Who Sleep Face Down
Authors: Patel Aloka L. , Paluszynska Dorota , Harris Kathleen A. , Thach Bradley T.
Published: August 2004

Objective. Infants who sleep prone and face down on soft bedding are particularly vulnerable for sudden infant death syndrome. It has been suggested that 1 mechanism of death in this situation involves rebreathing of expired air. Many infants tolerate rebreathing while lying prone face down for long periods with stable saturations. Others occasionally have rapid desaturations and may require intervention to terminate rebreathing. The present study had 3 objectives: 1) to determine the frequency of rapid desaturations in a large group of healthy infants, 2) to elucidate the mechanism of these desaturations, and 3) to determine the timing of these events during periods of rebreathing.

Methods. We studied respiratory tracings and videotapes of 56 healthy 1- to 6-month-old infants who were sleeping face down and rebreathing on soft bedding in our laboratory. We compared the frequency of desaturations during rebreathing and nonrebreathing periods. We measured respiratory frequency and apnea occurrence before desaturation and nonrebreathing control episodes. We also measured minute ventilation during steady state before desaturation and just before desaturation.

Results. There were 25 desaturation episodes in infants while rebreathing, occurring in 11 (19.6%) of the 56 infants. Episodes were significantly more frequent during rebreathing than during nonrebreathing periods. Three desaturation episodes reached <85%; 2 required intervention to terminate rebreathing. The respiratory frequency was not different between nonrebreathing control and desaturation episodes. Brief apneas were significantly more frequent preceding desaturation than control episodes (44% vs 4%). Just before episodes, there was a transient decrease in minute volume despite increasing inspired carbon dioxide in 3 episodes. There was evidence of partial or complete pharyngeal airway obstruction in 3 episodes. Thirty-six percent of all episodes were immediately preceded by behavioral arousal.

Conclusions. Rebreathing in prone sleeping infants is associated with an increased frequency of episodic desaturations. Desaturation may result from respiratory pattern changes such as brief apneas often associated with evidence of behavioral arousal or failure to increase ventilation in the face of rising inspired carbon dioxide, also associated with behavioral arousal.
Median Household Income and Mortality Rate in Cystic Fibrosis
Authors: O’Connor Gerald T. , Quinton Hebe B. , Kneeland Terry , Kahn Richard , Lever Thomas , Maddock Joanne , Robichaud Priscilla , Detzer Mark , Swartz Donald R.
Published: August 2004

Context. Poverty has been shown to be a determinant of health outcomes in many epidemiologic studies.

Objective. The goal of this study was to assess the association between household income and the mortality rate in cystic fibrosis (CF) patients.

Design, Setting, and Patients. We selected white patients diagnosed before 18 years old and having 1 or more records in the Cystic Fibrosis Foundation Patient Registry since 1991. These 23 817 patients were linked to the 1990 US Census by their zip code of residence. The median household income was adjusted for state level differences in cost of living using the 1998 Consumer Price Index.

Interventions. None.

Main Outcome Measures. We examined the association between categories of the median household income and the mortality rate. We examined the association between income categories and age-related changes in pulmonary function and body weight as well as specific nutritional and pulmonary therapies.

Results. We found a strong monotonic association between the median household income and the mortality rate. The test of trend was significant, and this effect was maintained after adjustment for a variety of patient and disease characteristics. When the lowest income category (<$20 000) is compared with the highest (≥$50 000), the adjusted incidence rates were 90.3 and 62.6 per 10 000 person years, respectively; this represents a 44% increased risk of death in the lowest income category. Patients living in areas with lower median household income also had consistently lower pulmonary function and body weight than did those living in higher income areas. The differences in weight percentiles and forced expiratory volume in 1 second are substantial in magnitude, they appear at an early age, and they persist into adulthood for these CF patients. Prescribed nutritional treatments and screening for CF-related diabetes were significantly higher among patients living in areas with lower median household income. Prescription of deoxyribonuclease and inhaled tobramycin was not significantly associated with median household income.

Conclusion. There was a strong association between lower household income and increased mortality rate among CF patients. Additional understanding of this effect will require more complete and direct measurement of socioeconomic status and a better understanding of treatment adherence, local environmental conditions, and especially the care of CF patients during the early years of life.
Effects of Thickened Feeding on Gastroesophageal Reflux in Infants: A Placebo-Controlled Crossover Study Using Intraluminal Impedance
Authors: Wenzl Tobias G. , Schneider Sabine , Scheele Frank , Silny Jiri , Heimann Gerhard , Skopnik Heino
Published: August 2004

Objective. Thickening of formula feedings is part of the therapeutic approach for gastroesophageal reflux (GER) in infants. However, its mechanism of action, especially regarding the occurrence of nonacid (pH >4) GER, has not yet been clearly described. The aim of this randomized, placebo-controlled crossover study was to examine the influence of formula thickened with carob (St. John’s bread) bean gum on acid and nonacid GER.

Methods. Infants with recurrent regurgitation and without other symptoms were fed alternately (A-B-A-B-A-B) with thickened (A) and nonthickened (B) but otherwise identical formula. Documentation of GER episodes during the study was performed by simultaneous intraesophageal impedance measurement (intraluminal electrical impedance; IMP) and pH monitoring. The IMP technique is able to detect bolus movements inside a luminal organ. The use of multiple measuring segments on a single catheter allowed the analysis of direction, height, and duration of the bolus transport. Continuous videorecording and visual surveillance of regurgitation frequency and amount resulted in a severity score.

Results. Fourteen infants (42 ± 32 days old) were examined during 6 feeding intervals each for a total measuring time of 342 hours. A total of 1183 GER episodes and 83 episodes of regurgitation were registered. Regurgitation frequency (15 vs 68 episodes) and amount (severity score 0.6 vs 1.8) were significantly lower after feedings with thickened formula. The difference regarding the occurrence of GER documented by IMP was also pronounced (536 vs 647 episodes). Although not statistically significant, maximal height reached by the refluxate in the esophagus was decreased after thickened feedings. Mean GER duration and the frequency of acid (pH <4) GER were not altered.

Conclusions. Thickened feeding has a significant effect on the reduction of regurgitation frequency and amount in otherwise healthy infants. This effect is caused by a reduction in the number of nonacid (pH >4) GER episodes, but also because of a decrease of mean reflux height reached in the esophagus. However, the occurrence of acid GER is not reduced. The combination of IMP and pH monitoring allows the complete registration and description of these GER episodes. Thickening of formula feedings with carob bean gum is an efficient therapy for uncomplicated GER in infants.
Injuries Experienced by Infant Children: A Population-Based Epidemiological Analysis
Authors: Pickett William , Streight Susan , Simpson Kelly , Brison Robert J.
Published: August 2004

Objective. Injuries to infant children are an important health concern, yet there are few population-based analyses from which to develop prevention initiatives. This study describes the external causes, natures, and disposition from an emergency department of infants with injuries for a geographically distinct population in Eastern Ontario.

Methods. Epidemiologic analysis of emergency-based surveillance data (1994–2000) for infants (<12 months old) from the Kingston sites of the Canadian Hospitals Injury Reporting and Prevention Program.

Results. A total of 990 cases of injury to infants were identified, of which 217 (21.9%) required significant medical intervention. Leading causes of injury were falls (605/990; 61.1%), ingestion injuries (65/990; 6.6%), and burns (56/990; 5.7%). Common types of falls experienced were: from furniture (229/605; 37.9%), being dropped (92/605; 15.2%), in car seats (73/605; 12.1%), down stairs (63/605; 10.4%), or in a child walker (42/605; 6.9%). The observed patterns of injury changed according to the ages of the children. Vignettes are used to illustrate recurrent injury patterns (falls, physical vulnerability, burns and ingestions, equipment injuries).

Conclusion. The results indicate the relative importance of several external causes of injury and how these vary by age group. This population-based information is also useful in establishing rational priorities for prevention, and the targeting of interventions toward responsible authorities.
Health Care Utilization and Expenditures Associated With Child Care Attendance: A Nationally Representative Sample
Authors: Silverstein Michael , Sales Anne E. , Koepsell Thomas D.
Published: August 2004

Objective. Participation in center-based child care among preschool-aged children is associated with an increased incidence of communicable illness. Although estimates of health care utilization and costs associated with child care attendance exist in other countries with different health care systems, nationally representative data for the United States are lacking. The objective of this study was to determine the patterns of health care utilization and costs associated with attendance at different types of child care, among a nationally representative sample of preschool-aged children.

Methods. A nationally representative sample of children aged 0 to 5 years enrolled in the Medical Expenditure Panel Survey, 1997 Cohort were studied. Data were analyzed by cross-sectional analysis within a single calendar year. The Rand Health Insurance experiment 2-part multivariate regression model was used to accommodate skewed expenditure data.

Results. A total of 871 children were included in the study. A total of 484 (56%) attended no child care provided by anyone other than their primary caregiver; 134 (15%) attended center-based child care; 76 (9%) attended friend or neighbor care; and 170 (20%) attended in-home or relative care. In a weighted multivariate model, children in center-based child care were more likely than those not in child care to have attended at least 1 office-based visit (adjusted odds ratio [aOR]: 2.8; 95% confidence interval [CI]: 1.0–7.9) and emergency department visit (aOR: 2.0; 95% CI: 1.1–3.6) and to have received a medication prescription (aOR: 2.8; 95% CI: 1.2–6.1). The adjusted 2-part model predicted total health care expenditures for those not attending child care to be $642 (95% CI: 508–813), versus $985 (95% CI: 714-1336) for a similar population in center-based child care. Expenditure data for office-based visits and medication prescriptions mirrored these trends.

Conclusion. In the immediate term, children in center-based child care tend to use more health care services. This increased utilization translates into modest per-child differences in health care expenditures. We hypothesize that this pattern of utilization and expenditure is attributable primarily to a higher incidence of minor, self-limited, communicable illness among children in center-based child care.
Comparative Study of Anxiety, Depression, Somatization, Functional Disability, and Illness Attribution in Adolescents With Chronic Fatigue or Migraine
Authors: Smith Mark S. , Martin-Herz Susanne P. , Womack William M. , Marsigan Julie L.
Published: August 2004

Objective. To compare adolescents with migraine, unexplained profound chronic fatigue of >6 months duration, and normal school controls on measures of anxiety, depression, somatization, functional disability, and illness attribution.

Methods. Adolescents referred to Children’s Hospital and Regional Medical Center for behavioral treatment of migraine (n = 179) or evaluation of chronic fatigue (n = 97) were compared with a group of healthy controls of similar age and sex from a middle school (n = 32). Subjects completed the Spielberger State-Trait Anxiety Inventory-Trait Form, the Children’s Depression Inventory, the Childhood Somatization Inventory, and estimated the number of school days missed in the past 6 months because of illness. Migraine and fatigued subjects completed an illness attribution questionnaire.

Results. Subjects in the 3 groups were 56% to 70% female and ranged from 11 years old to 18 years old with a mean age of 14.0 ± 2.0. Forty-six of the 97 chronically fatigued adolescents met 1994 Centers for Disease Control and Prevention (CDC) criteria for chronic fatigue syndrome (CDC-CFS), while 51 had idiopathic chronic fatigue syndrome (I-CFS) that did not meet full CDC criteria. Adolescents with migraine had significantly higher anxiety scores than those with I-CFS or controls and higher somatization scores than controls. Adolescents with CDC-CFS had significantly higher anxiety scores than those with I-CFS or controls, and higher depression and somatization scores than all other groups. There were significant differences between all groups for school days missed with CDC-CFS more than I-CFS more than migraine more than controls. Parents of adolescents with unexplained I-CFS had significantly lower attribution scores relating illness to possible psychological or stress factors than parents of adolescents with CDC-CFS or migraine.

Conclusions. Adolescents referred to an academic center for evaluation of unexplained chronic fatigue had greater rates of school absenteeism than adolescents with migraine or healthy controls. Those meeting CDC-CFS criteria had higher anxiety scores than controls and higher depression and somatization scores than migraineurs or controls. Parents of adolescents with I-CFS were less likely to endorse psychological factors as possibly contributing to their symptoms than parents of adolescents with CDC-CFS or migraine.
Receipt of Psychological or Emotional Counseling by Suicidal Adolescents
Authors: Pirkis Jane E. , Irwin Charles E. , Brindis Claire D. , Sawyer Michael G. , Friestad Christine , Biehl Michael , Patton George C.
Published: August 2004

Objective. This study examined utilization of psychological or emotional counseling by suicidal adolescents to answer questions about the extent to which health services can contribute to the prevention of adolescent suicide.

Method. The study used data from Wave 1 of the National Longitudinal Study of Adolescent Health, which involved a household-based interview with a nationally representative sample of 15 483 adolescents from grades 7 to 12. Of these, 2482 adolescents were classified as suicidal, as indicated by an affirmative response to the question “During the past 12 months, did you ever seriously think about committing suicide?” For this group, the study asked the following questions: 1) What proportion receives psychological or emotional counseling? 2) What are the sources of this counseling? 3) What factors are associated with receipt of such counseling?

Results. Less than one third (28%) of suicidal adolescents received psychological or emotional counseling. The most common sources of care were private doctors’ offices (37%) and schools (34%). Factors associated with receipt of counseling in the past 12 months included age, race, degree of suicidality, depression status, and having had a physical examination during the same period.

Conclusions. Only one third of those who report suicidal ideation and behavior receive psychological or emotional counseling. Although not all of these young people may identify a need for counseling, this finding still suggests that many of those at risk of harming themselves do not receive professional help. However, on the positive side, those who do use counseling services tend to do so on the basis of their being in the greatest need, rather than their parents’ capacity to pay for services. Counseling services have an important role to play in suicide prevention, and a variety of sources of care need to be available. Although counseling services are vital, a range of other strategies is necessary to reduce the youth suicide rate.
The Effect of Zinc Supplementation on Linear Growth, Body Composition, and Growth Factors in Preterm Infants
Authors: Díaz-Gómez N. Marta , Doménech Eduardo , Barroso Flora , Castells Silvia , Cortabarria Carmen , Jiménez Alejandro
Published: August 2004

Objective. The aim of our study was to evaluate the effect of zinc supplementation on linear growth, body composition, and growth factors in premature infants.

Design. Thirty-six preterm infants (gestational age: 32.0 ± 2.1 weeks, birth weight: 1704 ± 364 g) participated in a longitudinal double-blind, randomized clinical trial. They were randomly allocated either to the supplemental (S) group fed with a standard term formula supplemented with zinc (final content 10 mg/L) and a small quantity of copper (final content 0.6 mg/L), or to the placebo group fed with the same formula without supplementation (final content of zinc: 5 mg/L and copper: 0.4 mg/L), from 36 weeks postconceptional age until 6 months corrected postnatal age. At each evaluation, anthropometric variables and bioelectrical impedance were measured, a 3-day dietary record was collected, and a blood sample was taken. We analyzed serum levels of total alkaline phosphatase, skeletal alkaline phosphatase (sALP), insulin growth factor (IGF)-I, IGF binding protein-3, IGF binding protein-1, zinc and copper, and the concentrations of zinc in erythrocytes.

Results. The S group had significantly higher zinc levels in serum and erythrocytes and lower serum copper levels with respect to the placebo group. We found that the S group had a greater linear growth (from baseline to 3 months corrected age: Δ score deviation standard length: 1.32 ± .8 vs .38 ± .8). The increase in total body water and in serum levels of sALP was also significantly higher in the S group (total body water: 3 months; corrected age: 3.8 ± .5 vs 3.5 ± .4 kg, 6 months; corrected age: 4.5 ± .5 vs 4.2 ± .4 kg; sALP: 3 months; corrected age: 140.2 ± 28.7 vs 118.7 ± 18.8 μg/L).

Conclusions. Zinc supplementation has a positive effect on linear growth in premature infants.
Reduced Bone Mineralization in Infants Fed Palm Olein-Containing Formula: A Randomized, Double-Blinded, Prospective Trial
Authors: Koo Winston W. K. , Hammami Mouhanad , Margeson Dean P. , Nwaesei Chuks , Montalto Michael B. , Lasekan John B.
Published: August 2004

Objective. Palm and palm olein (PO) oils are used in some infant formula fat blends to match the fatty acid profile of human milk, but their presence has been shown to lower calcium and fat absorption. We aimed to determine if the reported differences in calcium absorption could affect skeletal development by comparing bone mineral accretion in healthy term infants fed a milk-based formula with (PMF) or without PO.

Methods. Whole body bone mineralization was evaluated in healthy term infants fed 1 of 2 coded, commercially available, ready-to-feed infant formulas in a randomized, double-blind, parallel study. Subjects were fed either 1) PMF formula (Enfamil with iron; Mead Johnson Division of Bristol Myers, Evansville, IN; N = 63) containing PO/coconut/soy/high-oleic sunflower oils (45/20/20/15% oil); or 2) milk-based formula without PO (Similac with iron; Ross Products Division Abbott Laboratories, Columbus, OH; N = 65), containing high-oleic safflower/coconut/soy oils (40/30/30% oil) from enrollment by 2 weeks after birth until 6 months. Anthropometrics and formula intake were determined monthly; total body bone mineral content (BMC) and bone mineral density (BMD) were measured at baseline, 3, and 6 months of age using dual energy x-ray absorptiometry.

Results. Intent-to-treat analyses indicated no significant differences between feeding groups in weight, length, head circumference, or formula intake throughout the study. BMC and BMD were not different at baseline but repeated measures analyses show that infants fed PMF had significantly lower BMC and BMD at 3 and 6 months.

Conclusions. Healthy term infants fed a formula containing PO as the predominant oil in the fat blend had significantly lower BMC and BMD than those fed a formula without PO. The inclusion of PO in infant formula at levels needed to provide a fatty acid profile similar to that of human milk leads to lower bone mineralization.
The Ecology of Medical Care for Children in the United States
Authors: Dovey Susan , Weitzman Michael , Fryer George , Green Larry , Yawn Barbara , Lanier David , Phillips Robert
Published: August 2004

Background. Medical care ecology has previously been investigated for adults, but no similar exploration has been made specifically for children.

Objective. To describe proportions of children receiving care in 6 types of health care setting on a monthly basis and to identify characteristics associated with receipt of care in these settings.

Methods. Nationally representative data from the 1996 Medical Expenditure Panel Survey were used to estimate the number of children per 1000 per month who received care at least once in each type of setting. Multivariate analyses assessed associations between receiving care in various settings and children’s sociodemographic factors (age, sex, ethnicity, poverty, parent’s education, urban or rural residence, insurance status, and whether or not the child had a usual source of care).

Results. Of 1000 children aged 0 to 17 years, on average each month 167 visited a physician’s office, 82 a dentist’s office, 13 an emergency department, and 8 a hospital-based outpatient clinic. Three were hospitalized and 2 received professional health care in their home. Younger age was associated with increased proportions of children receiving care in all health care settings except dentists’ clinics. Poverty, lack of health insurance, black race, and Hispanic ethnicity were associated with decreased receipt of care in physicians’ and dentists’ offices. Only age (<2 years and 13–17 years) and poverty status were associated with hospitalization (P < .05 for each). Rural residence was not associated with any significant variation in proportions of children receiving care in any setting. Having a usual source of care was associated with increased receipt of care in all settings except hospitals.

Conclusions. The ecology of children’s medical care is similar to that of adults in the United States in that a substantial proportion of children receive health care each month, mostly in community-based, outpatient settings. In all settings except emergency departments, receipt of care varies significantly by children’s age, race, ethnicity, income, health insurance status, and whether they have a usual source of care.
Height and Weight Development During Four Years of Therapy With Cyclical Intravenous Pamidronate in Children and Adolescents With Osteogenesis Imperfecta Types I, III, and IV
Authors: Zeitlin Leonid , Rauch Frank , Plotkin Horacio , Glorieux Francis H.
Published: August 2004

Objectives. Treatment with pamidronate improves the clinical course in children with osteogenesis imperfecta (OI), but theoretically might affect longitudinal growth. In this study we analyzed growth during cyclical intravenous pamidronate treatment in children and adolescents (age .04–15.6 years at baseline) with moderate to severe forms of OI types I, III, and IV.

Methods. The effect of 1 year of pamidronate treatment on height and weight was analyzed in 116 patients (OI-I, N = 29; OI-III, N = 42; OI-IV, N = 45). The results of 4 years of therapy were evaluated in 41 children (OI-I, N = 12; OI-III, N = 14; OI-IV, N = 15).

Results. Baseline height was low for age in all OI types. After 1 year of pamidronate therapy, height z scores had increased significantly in OI-III (by 0.3 ± 0.8, mean ± standard deviation; P = .04) and did not change in OI-I and OI-IV. Weight z scores increased significantly in OI-I (by 0.2 ± 0.4, P = .01). After 4 years of pamidronate therapy, mean height z scores increased significantly in OI-IV (by 0.41 ± 0.71, P = .04), whereas nonsignificant trends to increase were found for OI-I and OI-III. When height was expressed as a percentage of the result expected for untreated patients with the same OI type, long-term pamidronate therapy was associated with a significant height gain in all 3 OI types (P < .001). Eight patients who reached final height after 3.0 ± 1.0 years of treatment were taller on average than expected for untreated patients (P = .04).

Conclusions. Four years of cyclical intravenous pamidronate treatment led to a significant height gain in moderately to severely affected OI patients.