bluuebunny/crossref_metadata_2025 huggingface dataset:
Oral Manifestations of Pediatric Human Immunodeficiency Virus Infection: A Review of the Literature
Authors: Kline Mark W.
Published: December 2021

Oral lesions are the source of substantial HIV-associated morbidity in both adults and children. In addition, certain oral lesions are markers for progressive immunologic dysfunction and HIV disease progression. For these reasons, careful and continuous assessment of oral health is an integral part of comprehensive HIV disease treatment.

Available information suggests that HIV-infected children have many of the same oral manifestations observed in HIV-infected adults, but distinguishing features have been noted. Prospective pediatric studies are needed to determine the prevalence and natural history of oral lesions, to examine the relationships between immunologic and virologic markers of HIV disease status and the occurrence of oral manifestations, to evaluate changes in the oral microbial flora of HIV-infected children over time, and to assess the causative nature of oral lesions comprehensively.
A Single-sample, Subcutaneous Gonadotropin-releasing Hormone Test for Central Precocious Puberty
Authors: Eckert Kathryn L. , Wilson Darrell M. , Bachrach Laura K. , Anhalt Henry , Habiby Reema L. , Olney Robert C. , Hintz Raymond L. , Neely E. Kirk
Published: December 2021

Objective. We compared a rapid, subcutaneous (SQ), single-sample gonadotropin-releasing hormone (GnRH) stimulation test with the standard multiple-sample, intravenous (IV) GnRH stimulation test used in the evaluation of central precocious puberty (CPP).

Methods. We evaluated 22 patients presenting with evidence of precocious puberty. GnRH (100 µg) was administered subcutaneously in the clinic setting with single serum luteinizing hormone (LH) measured 40 minutes after injection. A standard IV GnRH stimulation test was performed within 2 weeks, with serum LH obtained at 0, 20, 40, and 60 minutes. LH was assayed by immunochemiluminometric assay.

Results. The mean peak LH levels after IV and SQ testing were identical. A significant correlation (r = .88) was found between the LH determined by SQ stimulation and the peak LH determined by IV GnRH testing. CPP was diagnosed (LH, ≥8 IU/L) by both SQ and IV testing in 7 of 22 patients and was excluded by both tests in 14 of 22 patients. A diagnostic discrepancy between peak IV and SQ results was seen in 1 patient.

Conclusions. We conclude that mean GnRH-stimulated LH levels from rapid SQ and standard IV testing are indistinguishable and that individual LH levels by each method are strongly correlated. A rapid SQ GnRH test is a valid tool for laboratory confirmation of CPP.
CHILDREN OF THE ATOMIC BOMB: AN AMERICAN PHYSICIAN'S MEMOIR OF NAGASAKI, HIROSHIMA, AND THE MARSHALL ISLANDS
Authors: Yamazaki J. N.
Published: December 2021

This book was written especially for all those concerned for the welfare of children, but it also serves as a compendium for pediatricians to the hazards of atomic radiation and other effects of the bomb. In a sense the text may be considered a continuation of the Academy's endeavor to communicate related information to its membership in which I have participated in the past.

This effort began in 1957 when the Academy created a Committee of Radiation Hazard and Epidemiology of Malformations that subsequently became the Committee on Environmental Hazards. My assignments included updating the information on the ongoing studies of the children in Hiroshima, Nagasaki, and the Marshall Islands and related studies, which the Committee reported in Pediatrics.

It has been my privilege to serve on the Committee especially with Drs Robert Aldrich, Lee Farr, Fred Silverman, and Paul Wehrle, most of whom successively chaired the Committee. They have encouraged the writing of the narrative and have reviewed the manuscript.
Facilitated Communication
Authors: Hostler Sharon L.
Published: December 2021

The optimistic side of FC, that nonspeaking children could miraculously become competent communicators, is unfortunately a myth. The dark side of the phenomenon of FC includes false hope, false communication, family disruption, losses of job and reputation, and inappropriate use of scarce resources.14 Unwitting pediatricians have accepted transcripts of FC that described sexual abuse by family members. The result was removal of the child from the family and prosecution of the alleged perpetrator even though the evidence suggested that the communication came from the facilitator and not from the child.16

As more families seek alternative health care for themselves29 and for their children,30 we pediatricians have the following responsibilities: 1) to become informed about our own community's offerings; 2) to develop a framework for our own evaluation (What is the theory or proposed mechanism? What is the research evidence? What is the cost in money and time? What is the potential harm?);)31 3) to support parents as they evaluate the risks and benefits of nontraditional interventions for their children;32 4) to advocate strongly for controlled evaluations of alternative therapies;33 and 5) to remember the unfortunate consequences of therapies such as facilitated communication when inclined to dismiss a nontraditional treatment as "not doing any harm."
Apnea as a Presenting Sign of Hydrocephalus
Authors: Nitahara Jim , Dozor Allen J. , Schroeder Scott A. , Rifkinson-Mann Stephanie
Published: December 2021

The differential diagnosis for apnea in newborns and infants is extensive and includes, but is not limited to, central nervous, gastrointestinal, metabolic, and respiratory system disorders.1 Frequently no cause is found for the apnea. We present a case in which an unusual cause was found and only after many months.

CASE REPORT

S. K. was a healthy infant with a normal birth history and no significant problems until the age of 13 months when, while playing with his mother, he suddenly collapsed, becoming apneic and cyanotic. Cardiopulmonary resuscitation was administered for 10 minutes before the child began to breathe spontaneously.
Letter To The Editor
Authors: Goldstein Ricki F.
Published: December 2021

The purpose of this study1 was not to identify any single variable that, by itself, could predict neurologic or developmental outcome in premature infants. Rather, it was to further investigate the previously published finding that acidosis was one of the factors in the newborn period that was influential in predicting poor motor performance and neurologic outcome at 2 years in very low birth weight infants.2 As stated in the introduction, we sought to determine whether it was the metabolic or respiratory component of acidosis that was associated with poor outcome.
Letter To The Editor
Authors: Kimbrough Renate D. , LeVois Maurice , Webb David R.
Published: December 2021

Dr Landrigan oversimplifies the results of our study. Although distance was negatively correlated with blood lead levels, it was not as important a factor as other variables. In contrast to the earlier studies Dr Landrigan is referring to in his letter, the lead smelter in the community we studied had been closed for 8 years at the time we conducted our survey. Dr Landrigan's and the other studies cited were, for the most part, conducted around active smelters where airborne lead from the smelters may have contributed to the exposure of the children.
Pertussis Deaths: Report of 23 Cases in the United States, 1992 and 1993
Authors: Wortis Naomi , Strebel Peter M. , Wharton Melinda , Bardenheier Barbara , Hardy Iain R. B.
Published: December 2021

Objective. To characterize pertussis deaths and to identify possible risk factors and prevention strategies.

Methods. A retrospective review of all deaths attributed to pertussis with disease onset during 1992 and 1993 reported to the Centers for Disease Control and Prevention. Hospital discharge summaries and autopsy reports were reviewed, and additional clinical information was provided by physicians involved in the care of the children.

Results. During 1992 and 1993, 23 deaths attributed to pertussis were reported to the Centers for Disease Control and Prevention. Cultures for Bordetella pertussis were positive in 18 (90%) of the 20 cases in which it was performed. Twenty (87%) of the 23 children who died were younger than 1 year of age, and 18 (78%) of the children had received no doses of pertussis vaccine. Among 20 children for whom gestational ages were known, 12 (60%) were born at 36 weeks' gestation or earlier; in contrast, 10.7% of live births in the United States in 1992 were at 36 weeks' gestation or earlier. The median age of mothers whose children had fatal pertussis was 20 (range, 14 to 37) years in the 15 cases in which ages were known, compared with the national median age of 26.3 years in 1992. Pneumonia was a complication in all but 1 (96%) of the cases. Seizures occurred in 4 cases (17%), and acute encephalopathy occurred in 3 cases (13%).

Conclusions. Pertussis continues to cause serious illness and death in the United States, particularly among infants who are not vaccinated. Preterm delivery and young maternal age may place infants at increased risk of death because of pertussis. Under the current pertussis vaccination schedule, three fourths of the infants who died were too young to have received three doses of pertussis vaccine, the minimum number of doses considered necessary for adequate protection against clinical pertussis. Additional strategies to prevent deaths caused by pertussis in young infants, such as starting infant vaccination at an earlier age and booster doses to adolescents and adults, need to be evaluated.
Pediatric Care for Children Whose Parents Are Gay or Lesbian
Authors: Perrin Ellen C. , Kulkin Heidi
Published: December 2021

Background. A growing number of children have at least one parent who is gay or lesbian. There is no evidence that these children experience any particular difficulties as a result of their parents' sexual orientation. Considerable evidence suggests that the provision of health care may not address the special needs and concerns of gay men and lesbians adequately. No research has been done regarding the pediatric care of children whose parents are gay or lesbian. It is likely that there are predictable challenges and developmental transitions for these children and parents for which pediatricians and other health care providers might be helpful advisers.

Objective. This exploratory project sought to describe the experiences that lesbian and gay parents and their children have had with the pediatric health care system. We were interested in describing experiences that had been especially affirming and others that had been troublesome and in gathering suggestions regarding changes in the structure and process of care.

Methodology. Two hundred fifty-five parents completed an open-ended questionnaire. Responses were coded and tabulated.

Results. Most parents described considerable success in obtaining pediatric care that was affirming, supportive, and satisfactory. On the other hand, many parents noted deficiencies in pediatric offices, clinics, emergency departments, and hospitals, many of which could be corrected easily.

Conclusions. We have summarized the accumulated advice to pediatric health care providers and have described some of the developmental transitions that are potentially appropriate opportunities for pediatric intervention.
Henna: A Potential Cause of Oxidative Hemolysis and Neonatal Hyperbilirubinemia
Authors: Zinkham William H. , Oski Frank A.
Published: December 2021

Objective. To evaluate the in vitro oxidative potential of lawsone (2-hydroxy-1,4 naphthoquinone). Lawsone is a chemical present in henna, the crushed leaves of which are used worldwide as a cosmetic agent to stain the hair, skin, and nails.

Methodology. Venous blood from glucose-6-phosphate dehydrogenase (G6PD)-normal and G6PD A- subjects were incubated with various amounts of lawsone for 2 hours at 37°C. Reduced glutathione and methemoglobin (MHb) levels were measured before and after incubation.

Results. Final molar concentrations of lawsone in normal blood of 1.4, 2.8, 5.7, and 8.6 x 10-3 mol/L increased MHb percentages from 0.5% to 2.2%, 8.3%, 9.5%, and 12.5%, respectively. In a G6PD A- blood, MHb percentages were 19.8%, 32.2%, 44.9%, and 53.9%. At a lawsone concentration of 2.8 x 10-3 mol/L, blood from 15 healthy adults formed MHb percentages of 7.4% ± 3.3% (±1 SD); in blood from 4 G6PD A- adults, percentages were 44.5%, 40.6%, 41.3%, and 42.8%. Simultaneous measurements of reduced glutathione revealed preincubation values of greater than 40 mg/100 mL of red cells in blood of healthy and G6PD A- subjects. Postincubation values were greater than 40 in blood of healthy subjects and less than 40 in blood of G6PD A- subjects.

Conclusions. These in vitro observations indicate that lawsone is an agent capable of causing oxidative hemolysis. In regions of the world where there is a high incidence of G6PD deficiency and unexplained hyperbilirubinemia, oxidative hemolysis secondary to the cutaneous application of henna could be the initiating event.
Nebulized Budesonide Is as Effective as Nebulized Adrenaline in Moderately Severe Croup
Authors: Fitzgerald Dominic , Mellis Craig , Johnson Mark , Allen Hugh , Cooper Peter , Van Asperen Peter
Published: December 2021

Objective. Nebulized budesonide and nebulized adrenaline have been shown to be effective in the treatment of moderately severe croup. However, there has been no direct comparison of these therapies. We undertook a multicenter, randomized, double-blind, parallel group study in 66 hospitalized children with viral or spasmodic croup.

Methods. Children 0.5 to 6 years of age were assessed using a validated croup symptom score (stridor, 0 through 4; cough, 0 through 3; retractions, 0 through 3; dyspnea, 0 through 3; and color, 0 through 4) at 0.5, 1, 1.5, 2, 12, and 24 hours after nebulization. Patients received either budesonide (2 mg/4 mL) or L-adrenaline (4 mg/4 mL) via nebulization. The primary outcome measure was change in the total croup symptom score.

Results. Thirty-five children received budesonide and 31 received adrenaline. There was no significant difference in baseline features, including croup score (mean [95% confidence interval]: budesonide, 7.1 [6.7- 7.5]; adrenaline, 7.7 [7.3-8.1]). All patients had significant improvement from baseline, and there was no significant difference between the two treatments, as measured by change in croup scores, change in oxygen saturation, duration of hospitalization, number of subsequent treatments with systemic steroids or adrenaline, and adverse events. No child required intubation.

Conclusion. This study does not show any difference in efficacy and safety between nebulized budesonide and nebulized adrenaline in the treatment of acute upper airway obstruction in patients with moderately severe croup.
GAG CLAUSES IN DOCTOR CONTRACTS
Authors: L. J. F.
Published: December 2021

U. S. Healthcare, Inc. said it removed controversial provisions from its physician contracts that have prompted doctors to complain that they are hampered in treating patients.

Called "gag clauses" by critics, they are common in contracts of many managedcare companies. Doctors charge that such clauses prevent them from giving patients complete information about treatment options, for instance, or that they are forbidden from telling patients that health maintenance organization (HMO) financial arrangements may penalize doctors for making referrals to specialists.

HMOs counter that some doctors have waged campaigns against managed care with their patients, and that such clauses are intended to prevent such campaigns and any anxiety among patients about their care that may result.
The Adolescent's Right to Confidential Care When Considering Abortion
Authors:   Committee on Adolescence
Published: December 2021

In this statement, the American Academy of Pediatrics (AAP) reaffirms its position that the rights of adolescents to confidential care when considering abortion should be protected. The AAP supports the recommendations presented in the report on mandatory parental consent to abortion by the Council on Ethical and Judicial Affairs of the American Medical Association. Adolescents should be strongly encouraged to involve their parents and other trusted adults in decisions regarding pregnancy termination, and the majority of them voluntarily do so. Legislation mandating parental involvement does not achieve the intended benefit of promoting family communication, but it does increase the risk of harm to the adolescent by delaying access to appropriate medical care. The statement presents a summary of pertinent current information related to the benefits and risks of legislation requiring mandatory parental involvement in an adolescent's decision to obtain an abortion. The AAP acknowledges and respects the diversity of beliefs about abortion and affirms the value of voluntary parental involvement in decision making by adolescents.
Efforts to Reduce the Toll of Injuries in Childhood Require Expanded Research
Authors:   Committee on Injury and Poison Prevention
Published: December 2021

Efforts to control injury, like those to control disease, are based on epidemiologic evidence that most occurrences are both predictable and preventable. Effective injury control programs depend heavily on evidence generated as a result of a strong research agenda. This policy statement outlines the magnitude of the injury toll and the prevention efforts that have expanded during the past decade. Even with this expansion, the level of federal commitment to research aimed at reducing the toll of injury does not match the magnitude of the injury problem. Much research remains to be done, and the AAP recommends a multilevel and multifaceted approach to prevention and treatment, based on injury morbidity and mortality data. As injury control methods of proven efficacy continue to be developed, pediatricians can apply them to their patients, and thereby reduce the toll of childhood injury.
Technical Report Summary: The Neurodiagnostic Evaluation of the Child With a First Simple Febrile Seizure
Authors: Baumann Robert J. , D'Angelo Sandra L.
Published: December 2021

Febrile seizures are a common problem in clinical practice, occurring in 2.7% of children in the British Birth Cohort Study.1 The subcommittee's efforts were focused on the large subgroup of children (88%)1 who have simple febrile seizures, because in the view of most clinicians and on the basis of the epidemiologic evidence, this is a relatively homogeneous clinical grouping2 in terms of age, clinical presentation, course, and outcome.1-3

DEFINITION OF THE PROBLEM

Children younger than 5 years who have their first seizure in association with a fever are commonly divided into three groups. Children with simple febrile seizures make up the largest group. The second group includes children whose seizures are secondary to central nervous system (CNS) infection (symptomatic febrile seizures). In the third group, children whose seizures are neither simple nor secondary to CNS infection are classified as having complex febrile seizures.

The definition of a simple febrile seizure in this practice parameter corresponds to that in usual clinical practice and is also supported by the analysis of data from the Collaborative Perinatal Project of the National Institute of Neurological and Communicative Disorders and Stroke.4 In that project, Nelson and Ellenberg4 analyzed the data of 1706 children 7 years of age who had had one or more febrile seizures. The risk of epilepsy (afebrile seizures) was significantly higher for children whose neurological development was not normal before the seizures, whose seizures occurred before 6 months of age, whose seizure lasted longer than 15 minutes, or who had more than one febrile seizure per day.
Homeopathic Treatment of Childhood Diarrhea
Authors: Fisher Peter , Dantas Flavio , Reilly David
Published: December 2021

Sampson and London's critique1 of Jacobs et al's2 double-blind, placebo-controlled clinical trial of homeopathic treatment of childhood diarrhea in Nicaragua misrepresents the scientific evidence.

Sampson and London place great emphasis on possible contamination of the homeopathic medicines, citing three references. Of these three references, two do not, in fact, involve contamination or adulteration. The first (which is incorrectly quoted) reports a case of pancreatitis that followed a proprietary homeopathic preparation, but no contamination was demonstrated and no causal relationship proved.3
Isoniazid Neurotoxicity
Authors: Lewin Peter K.
Published: December 2021

I read with great interest the article entitled "Acute Isoniazid Neurotoxicity in an Urban Hospital" in the May 1995 issue of Pediatrics.1

As noted by the authors, there has been a resurgence of tuberculosis in North America that is affecting increasing numbers of children and adolescents. Isoniazid (INH) is still the medication of choice in the management of early primary tuberculosis. However, because INH therapy interferes with pyridoxine metabolism, chronic INH neurotoxicity is also becoming much more prevalent.
Combination Therapy With Stavudine and Didanosine in Children With Advanced Human Immunodeficiency Virus Infection: Pharmacokinetic Properties, Safety, and Immunologic and Virologic Effects
Authors: Kline Mark W. , Fletcher Courtney V. , Federici Marianne E. , Harris Alice T. , Evans Kim D. , Rutkiewicz Victoria L. , Shearer William T. , Dunkle Lisa M.
Published: December 2021

Objectives. To obtain preliminary information on the pharmacokinetic properties, tolerance, safety, and antiviral activity of combination therapy with stavudine and didanosine in children with advanced human immunodeficiency virus (HIV) infection.

Methods. Eight children (median age, 6.6 years; range, 2.8 to 12 years) with advanced HIV disease (median CD4+ lymphocyte count at baseline, 42 cells/µL; range, 8 to 553 cells/µL) were treated with stavudine (2 mg/kg per day in two divided doses) and didanosine (180 mg/m2 per day in two divided doses) for 24 weeks. Seven children had histories of prior zidovudine therapy. All children had received stavudine alone for 19 to 33 months before the addition of didanosine to the treatment regimen. Children were assessed clinically and with laboratory studies at baseline, weekly through week 4 of combination therapy, and every 4 weeks thereafter.

Results. Analysis of stavudine and didanosine plasma half-life values, clearances, and area under the plasma concentration-versus-time curves revealed no obvious clinical pharmacokinetic interaction between the drugs through study week 12. Combination therapy was well tolerated, and there were no drug-associated clinical or laboratory adverse events. Signs and symptoms of peripheral neuropathy were not observed. All three children with baseline CD4+ lymphocyte counts greater than 50 cells/µL had greater than 20% increases in their counts within the first 12 weeks of therapy; CD4+ lymphocyte count increases were not observed in the other children. Plasma HIV RNA concentrations showed median declines of 0.88 log10 (range, -3.41 log10 to 0.31 log10) and 0.30 log10 (range, -0.63 log10 to 0.89 log10) at study weeks 12 and 24, respectively.

Conclusions. Combination therapy with stavudine and didanosine was well tolerated and safe in this small group of children with advanced HIV disease. Plasma HIV RNA concentration declines suggest a favorable effect of therapy on virus load. These findings should be confirmed, and the regimen's clinical efficacy should be examined, in controlled studies of HIV-infected children with less-advanced disease.
On Listening to Parents: The Sudden Infant Death Syndrome Over 25 Years
Authors: Tonkin Shirley
Published: December 2021

I have been watching the sudden infant death syndrome (SIDS) epidemic in New Zealand over 25 years. I've seen it both coming and going.

As a medical officer with the government Department of Health, I had access to official statistics from 1960. New Zealand has a small, circumscribed, stable population, a good universal public health system, a good standard of infant health, and almost full employment. However, in 1970, because New Zealand had a high postneonatal infant mortality rate in comparison with other countries such as the United States, I decided to home visit each family in Auckland (population 500 000) where an infant's death had occurred. I expected to learn of such deaths from hospital records, and although I had learned that there were approximately 80 such deaths in Auckland annually, the hospital could supply me with the names of only 10. This lack of deaths occurring in hospital explains why pediatricians were unaware of the situation. "The coroner may know of some deaths that have happened in people's homes," I was told. The coroner gave me a long list. In that year over 70 babies had died unexpectedly in their own homes, unattended by any medical practitioner. I checked the death certificates. Twenty of these home deaths were inevitable from severe congenital defects, 25 had died of unrecognized infections, but the other 25 had not been sick. They had been well cared for. They had simply been found dead after having been put down for sleep in the usual manner.
Lead in Breast Milk
Authors: Baum Carl R. , Shannon Michael W.
Published: December 2021

Continued efforts are needed to identify all environmental sources of lead, a potent neurotoxin. In recent decades, lead has been removed from gasoline and from food containers, resulting in dramatic falls in the blood lead of American children. Although this has left paint and lead dust as primary sources of lead, it also elevates the importance of identifying other potential sources (eg, soil, water).1,2

Questions have arisen in the past regarding the excretion of maternal lead into breast milk.
A Cohort Study on Childhood Asthma Admissions and Readmissions
Authors: To Teresa , Dick Paul , Feldman William , Hernandez Rod
Published: December 2021

Background. Admissions to hospitals for childhood asthma seem to be increasing, even though admissions for other childhood conditions are decreasing. We studied admissions and readmissions for childhood asthma in Ontario in an attempt to uncover factors relating to the admission patterns.

Methods. Using the hospital discharge data from the Canadian Institute for Health Information, 28 646 children with diagnoses of asthma were identified from April 1, 1989, to March 31, 1992.

Results. The admission rates for asthma among children in Ontario showed a 14.8% decrease from 1987 to 1992. This decline was observed primarily in 5- to 17-year-olds. Younger children had a fourfold risk of hospital admission for asthma. In the 4 years studied, 10 427 children (36.4%) were readmitted at least once, representing 22 114 readmissions, 16 196 (73.2%) of which were for asthma. The 6-month probabilities of readmission for asthma were 20.0% (0- to 4-year-olds) and 11.7% (5- to 17-year-olds). The estimated relative risks (RRs) indicated that younger children had a significantly higher risk of readmission for asthma (RR, 1.38;95% confidence interval, 1.30 to 1.46) or asthma-related causes (RR, 5.02; 95% confidence interval, 4.16 to 6.05).

Conclusions. The observed increasing trend in admissions for asthma among children in the 1970s and 1980s leveled off in the early 1990s. The declining admission rates were largely caused by the lower admission rates among school-aged children from 5 to 17 years. The relatively high admission and readmission rates of preschool children are still a concern. Further research is necessary to examine factors that influence admissions for asthma among young children.
Male Adolescents Involved in Pregnancy: Associated Health Risk and Problem Behaviors
Authors: Spingarn Roger W. , DuRant Robert H.
Published: December 2021

Objective. Little is known about male high school students who have been involved in a pregnancy. This study was undertaken to determine whether male involvement with a pregnancy during adolescence is associated with other risk and problem behaviors.

Methods. The 1993 Massachusetts Youth Risk Behavior Survey was conducted on a random sample of 3054 9th- through 12th-grade students. The use of tobacco, alcohol, and other drugs, early and multiple sexual experiences, fighting resulting in injury, and demographic variables were compared between sexually active young men who reported being involved in pregnancy (n = 82) and their counterparts who reported not ever causing a pregnancy (n = 537). Associations were measured using x2 analyses and Kruskal-Wallis analysis of variance. Stepwise logistic regression was used to further analyze those variables significantly associated with involvement with a pregnancy.

Results. Based on logistic regression, older age and earlier ages of onset of cocaine use, initial sexual intercourse, and regular use of cigarettes were associated with being involved with a pregnancy. An increased lifetime frequency of cocaine use, lifetime frequency of alcohol use, and an increased number of lifetime sexual partners were also associated with having caused a pregnancy. Those who reported involvement with a pregnancy reported a higher frequency of being injured in a fight during the past year, drinking while driving, and having multiple sexual partners during the previous 30 days than those who had not gotten someone pregnant.

Conclusions. A history of being involved with a pregnancy clustered with other health risk and problem behaviors to form a "risk behavior syndrome." These findings suggest that when risk behaviors are encountered during the routine comprehensive screening of male adolescents, strategies for pregnancy prevention among young men should also be emphasized.
POINT/COUNTERPOINT: ON VALUES
Authors: Charney E.
Published: December 2021

"It doesn't count unless you can count it."

Favorite saying of Leonard Abramson, Chairman, USHealthcare. (Made $492 million on sale of his company to Aetna Life, and Casualty, quoted in the New York Times)

"Not everything that counts can be counted."

Albert Einstein
Gastric Fluid Analysis for Determining Gestational Cocaine Exposure
Authors: Garcia Daisy C. , Romero Al , Garcia Gerardo C. , Ostrea Enrique M.
Published: December 2021

Concerns for the acute and long-term complications associated with substance abuse during pregnancy have led to various ways of detecting gestational drug exposure in newborn infants. These have ranged from maternal history to the toxicologic analysis of biological samples. Maternal history is often unreliable because of maternal denial of drug use.1 Drug analysis of biological samples have included the analysis of hair, urine, amniotic fluid, and meconium. Hair analysis can provide information on the time and amount of drug use; however, technical problems inherent to the test have limited its use in the newborn period.2 Urine is often tested, but the incidence of false-negative tests is high.3
Medication for Children With Attentional Disorders
Authors:   Committee on Children,   Disabilities and Committee on Drugs
Published: December 2021

Increasing numbers of children with attentional difficulties have been treated with medication, especially during the last 25 years, and now adolescents and adults are also being recognized with attentional difficulties. This policy statement provides information on the role and the pharmacology of medications used to treat children with attention deficit disorders. Indications and use of medications are discussed and recommended drugs and dose levels are outlined. Information on adverse effects and common side effects is presented.
Pinhole Occluder
Authors: Risser William L.
Published: December 2021

This issue of Pediatrics includes an American Academy of Pediatrics policy statement titled "Protective Eyewear for Young Athletes." I have begun using these guidelines and have found that one of the requirements-that athletes obtain an eye evaluation before clearance for participation in sports if their visual acuity is worse than 20/40 in either eye-often results in indigent athletes not playing sports because they cannot afford these services.

After the policy statement was approved for publication, too late to alter it, the AAP Committee on Sports Medicine and Fitness became aware of a device called a pinhole occluder.
Need for Bedtime Dose of Ritalin
Authors: Rogers William B.
Published: December 2021

Congratulations to Dr Jeffrey D. Kent and co-workers for their article on methylphenidate dosing in the late afternoon (Pediatrics. 1995;96;320-325). They deserve extra praise for publicizing that many children with attention deficit disorder with hyperactivity (ADDH) need more than an AM and noon dose of that psychoenergizer.

As a full-time, private practicing pediatrician for 47 years, and one who has, in the past decade, developed a special interest in treating ADDH, I can heartily support their findings.
SUBSEQUENT INSECT STINGS IN CHILDREN WITH HYPERSENSITIVITY TO HYMENOPTERA
Authors: James John M.
Published: December 2021

The authors concluded that the dual sting challenge scheme appears to be the best predictor of reactions to subsequent insect stings. The procedure did not significantly increase the individual patient's sensitivity to future stings, and the data demonstrated a lower frequency of subsequent systemic reactions than expected on the basis of history or predicted by in vitro sensitization markers, or both. They also stated that this scheme should be useful in select patients with an uncertain sensitization status for purposes of beginning or discontinuing venom immunotherapy.
ALLERGIC REACTIONS ASSOCIATED WITH AIRBORNE FISH PARTICLES IN IMMUNOGLOBULIN E (IgE)-MEDIATED FISH HYPERSENSITIVE PATIENTS
Authors: Zeiger Robert S.
Published: December 2021

Fish allergens carried by fumes, water vapor, and airborne particulates cause respiratory and dermal reactions, occasionally severe, in up to 11% of IgE-mediated fish-allergic children.
MANAGEMENT OF SINUSITIS IN CYSTIC FIBROSIS BY ENDOSCOPIC SURGERY AND SERIAL ANTIMICROBIAL LAVAGE
Authors: Kosko James R. , Tunkel David E.
Published: December 2021

The ESSAL is a successful approach to treatment of sinusitis in cystic fibrosis that reduces recurrent symptoms requiring revision sinus surgery.
QUALITY OF CARE FOR PRESCHOOL CHILDREN WITH ASTHMA: THE ROLE OF SOCIAL FACTORS AND PRACTICE SETTING
Authors: Tracy James M. , Koabayshi Roger H.
Published: December 2021

Racial minorities admitted for asthma were less likely to have received maximally effective preventive therapy. Marked differences in the quality of care planned after hospital discharge differed significantly when comparing white patients with black and Hispanic patients. In an era of health care reform, attention should focus on the area of high quality care for underserved children who are already at high-risk for asthma-related morbidity.

[See table in the PDF file]
POSTNATAL MATERNAL SMOKING INCREASES THE PREVALENCE OF ASTHMA BUT NOT OF BRONCHIAL HYPERRESPONSIVENESS OR ATOPY IN THEIR CHILDREN
Authors: Bollinger Mary E. , Wood Robert A.
Published: December 2021

The authors concluded that postnatal maternal smoking increases the prevalence of asthma in the offspring without inducing BHR or enhancing sensitization to allergens.
LACK OF EFFECTIVENESS OF MAGNESIUM IN CHRONIC, STABLE ASTHMA: A PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND, PLACEBOCONTROLLED, CROSSOVER TRIAL IN NORMAL SUBJECTS AND IN PATIENTS WITH CHRONIC, STABLE ASTHMA
Authors: Adinoff Allen
Published: December 2021

Magnesium sulfate had no bronchodilator effect in chronic, stable asthmatics or normal nonasthmatic adults.
EVIDENCE FOR SUPERANTIGEN INVOLVEMENT IN CARDIOVASCULAR INJURY DUE TO KAWASAKI SYNDROME
Authors: Hopp Russell
Published: December 2021

Coupled with the observation that a novel toxic shock toxin-producing S aureus can be cultured in KS, is the finding from this study that a superantigen of that type could be responsible for the selective expansion of the Vβ2+ T cells.
The Impact of Physical Activity on Lipids, Lipoproteins, and Blood Pressure in Preadolescent Girls
Authors: Craig Suzanne B. , Bandini Linda G. , Lichtenstein Alice H. , Schaefer Ernst J. , Dietz William H.
Published: December 2021

Objective. Inconsistent findings reported for the effect of physical activity on lipids, lipoproteins, and blood pressure in children may be due to errors inherent in the methods used to measure physical activity, lack of control for other cardiovascular risk factors, or both. The purpose of this study was to evaluate the association between physical activity assessed using direct measures of energy expenditure and cardiovascular risk factors, controlling for dietary intake and percent body fat.

Methods. Nonresting energy expenditure was determined in 49 8- to 11-year-old girls from measurements of daily energy expenditure (using doubly-labeled water, 2H218O) and resting metabolic rate (using indirect calorimetry). Self-reported recall of the hours of participation in physical activities of at least moderate intensity (energy expenditure at least four times the resting metabolic rate, METS ≥4) during the previous year was also obtained. Percent body fat was estimated from the measurement of total body water with H218O. Concentrations of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (apo B), apo A-I, lipoprotein (a), insulin, and estradiol, as well as the waist-to-hip ratio, systolic blood pressure, diastolic blood pressure, and dietary intake from 7-day food records were measured Data were analyzed using Pearson product-moment correlation and stepwise multiple regression.

Results. Self-reported hours of participation in activities with METS (metabolic equivalents) of 4 or greater significantly predicted LDL-C and apo B concentrations, even after adjustment for percent body fat and percentage of dietary energy from saturated fat. Nonresting energy expenditure adjusted for weight, a measure of the energy spent on physical activity, did not predict LDL-C or high-density lipoprotein cholesterol concentrations. Body mass index and insulin concentration predicted systolic and diastolic blood pressure, respectively.

Conclusions. These findings suggest that the intensity of physical activity may be a more important determinant of LDL-C in children than the energy spent on physical activity.
Triathlon Participation by Children and Adolescents
Authors:   Committee on Sports Medicine and Fitness
Published: December 2021

This Policy Statement was retired May 2004.

Triathlon is a sport combining swimming, cycling, and running in one continuous event. It is a relatively new sport for children and adolescents, and participation is growing rapidly. The purpose of this statement is to provide pediatricians and others with information on the participation in triathlons by young athletes. A list of triathlon events is given in the "Resources" section at the end of this statement.
Intervening to Reduce Environmental Tobacco Smoke Exposure in Infants
Authors: Haddow James E. , Palomaki Glenn E. , Knight George J. , Williams Josephine , Chilmonczyk Barbara A.
Published: December 2021

The literature search performed by Wall and his associates in conjunction with their study1 failed to identify a randomized intervention trial carried out by our group several years ago, aimed at reducing infant exposure to environmental tobacco smoke(ETS).2 In common with Wall's study, our trial was carried out in primary care offices and used a low-impact intervention strategy. Our study was different, however, in that the infants' interpreted urine cotinine measurements were incorporated into the intervention and were also used to assess ETS exposure in the cases and controls.
Esophageal pH Monitoring in Infants and Children
Authors: Colletti Richard B.
Published: December 2021

The North American Society for Pediatric Gastroenterology and Nutrition recently published a medical position statement on the indications for esophageal pH monitoring in infants and children.1 The statement includes a discussion, with 126 references, of clinical situations in which esophageal pH monitoring is generally useful, generally not useful, or conditional. The statement, which also includes summary recommendations, was prepared to promote optimal patient care, to foster learning, and to guide practitioners, as well as to facilitate peer and other review of clinical practices.
Parental Leave: Pediatric Faculty
Authors: Hayden William R.
Published: December 2021

An AAP committee has wisely dealt with the touchy issue of parental leave for residents and fellows. It is my impression that the same issues are just as important and bothersome for the faculty. This document outlines the principles well enough that the words housestaff and resident could be changed to faculty and attending physician. I believe all pediatric faculties should seriously begin open debate on this issue and develop principles that each faculty can live with.
Maternal Postpartum Cognitive Deficits and Early Discharge of Infants
Authors: Eidelman Arthur I. , Kaitz Marsha
Published: December 2021

In the ongoing debate regarding the appropriate time postparturn to discharge the mother-infant dyad from the hospital,1,2 the focus has rightfully been on the health status of the infant and the need for supervised postdischarge medical services. Less discussion, let alone objective data, has been presented as to maternal factors in the decision for or against early discharge.

Thus, we wish to bring to the attention of the readers of Pediatrics our recent study3 that documented significant cognitive deficits in women on the first postpartum day.
Health Needs of Homeless Children and Families
Authors:   Committee on Community Health Services
Published: December 2021

The intent of this statement is to substantiate the existence of homelessness in virtually every community, illustrate the pervasive health and psychosocial problems facing the growing population of children who are homeless, and encourage practitioners to include homeless children in their health care delivery practices, social services, and advocacy efforts. The recommendations will guide practitioners in taking actions to diminish the severe negative impact that living in temporary shelters has on the health and well-being of developing children. In this statement the American Academy of Pediatrics reaffirms its stance that homeless children need permanent dwellings in order to thrive.
The New Immunization Debate
Authors: Terry William F.
Published: December 2021

Polio is a disease that has not occurred in the United States in its wild form in the last 17 years and which is likely to be eradicated worldwide in the next decade. Given these facts, it seems excessive to formulate a policy that attempts to achieve high-titer lifelong immunity in 100% of the pediatric population in this country.

Dr Katz's excellent summary1 mentions that the Institute of Medicine and the Centers for Disease Control and Prevention considered five options involving either four doses of polio vaccine in various combinations or no immunization at all.
Letter To The Editor
Authors: Adler Philip
Published: December 2021

In his argument supporting the Advisory Committee on Immunization Practices-recommended switch to a sequential inactivated polio vaccine/oral polio vaccine (IPV/OPV) immunization schedule (Pediatrics. 1996;98:116-117), Dr Samuel Katz fails to address the enormity of the threat that an untested immunization practice poses to an unprepared public.

Dr Katz theorizes that the proposed sequential schedule may reduce the six to eight cases of vaccine-associated paralytic polio that occur each year. Yet no solid proof exists to support this claim.
Unintended Consequences of Punishment
Authors: McCord Joan
Published: December 2021

Because punishments are intended to control children's behavior, many people assume that the major—and perhaps the sole—consequence of punishment is teaching children to behave as they ought. Yet the use of punishment is (I will argue) counterproductive. Furthermore, the use of punishment has additional unintended consequences. I will attempt to demonstrate how children perceive punishments and what those unanticipated consequences are. These illustrations rest on the nature of reasoning itself, although they are bolstered by empirical evidence.

Although this conference is about the use of corporal punishment, most of what I have to say applies to using any type of punishment—including, of course, physical punishment.

First, punishments give pain and therefore teach children that at least under some conditions, it is all right to give pain to others.

The law of excluded middle asserts that things must be either of one class or not of that class. I believe this law is fundamental to rational thought. Even very young children come to understand it and can therefore reason that parents are either good or not good when they punish.

Let me begin with the assumption that children believe their parents are good. If good people do good things, then if they punish, it must be good to give pain. If good people do bad things, then even if giving pain is bad, it is all right to do some bad things. That is, if a parent uses punishments, then either the parent is doing something right and it is right to give pain or the parent is doing something wrong and it is all right to do something wrong.
How Can Generative Theories of the Effects of Punishment be Tested?
Authors: Cohen Patricia
Published: December 2021

For a number of us at this conference who have concluded on the basis of the substantial literature1-17 and their own empirical data18,19 that punishment is a serious risk for poor child and adult outcome, the relative sparsity of studies that provide unambiguous evidence of negative effects of spanking specifically, and corporal punishment as compared with noncorporal punishment,20 comes as a shock. (By unambiguous evidence we require longitudinal investigation with appropriate controls for potential confounding variables, particularly the child's behavioral elicitation of the punishment). Dr McCord has provided a series of theoretically coherent reasons why we would expect such negative outcomes. I would like to focus on some of the reasons why research is still needed on this topic.

It is hard, possibly even impossible, to study spanking or corporal punishment without contamination from the other variables with which it is moderately to strongly correlated, particularly the tendency to use punishment more frequently, and to use a greater variety of punishment methods. Current advocates of spanking propose considerable restrictions as to the age of the child and the circumstances, methods, and frequency of use that can be endorsed. Is it likely ever to be possible to determine whether punishment has positive or negative effects when used within these restrictions? It is useful to consider this question within current paradigms for determining the effects of any treatment on a particular problem.

EFFICACY RESEARCH

When determining the efficacy of a given medical, surgical, or other treatment on a disease or other problem, the preferred model is the randomized trial.