bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of the Pediatrician in Abolishing Corporal Punishment in Schools
Authors: Poole Steven R. , Ushkow Martin C. , Nader Philip R. , Bradford Bradley J. , Asbury John R. , Worthington Daniel C. , Sanabria Kathleen E. , Carruth Thea
Published: December 2021

Corporal punishment in school is allowed in 30 states in the United States. The American Academy of Pediatrics, together with numerous other childadvocacy groups, has reaffirmed its position that corporal punishment in schools should be prohibited by state statute in all states.1,2 This article provides background information and recommendations regarding the potential role for pediatricians in attaining this goal.
Treatment of Lyme Borreliosis
Authors:   Committee on Infectious Diseases
Published: December 2021

The increasing number of cases of Lyme disease has resulted in frequent questions about the prevention, diagnosis, and treatment of this disease. The following information and guidelines may be helpful.

EPIDEMIOLOGIC CONSIDERATIONS

Lyme disease is caused by infection with the spirochete Borrelia burgdorferi. The organism is carried by a small tick, usually nymphal Ixodes dammini on the East Coast and Ixodes pacificus in the West. The disease is clustered in specific areas, with most cases reported in the Northeast, Wisconsin, Minnesota, and California. For patients who do not live in or have not traveled in those areas, the chances of acquiring Lyme disease are very small. However, at least some endemic cases have been reported from 46 states and Canada. Dogs can be infected with this spirochete and can develop symptoms of arthritis.

PREVENTION

Tick bites can be decreased by wearing clothing with long sleeves and long pants. Permethrin sprayed on clothing is effective in decreasing tick attachment. Tick repellents such as DEET are effective, but they require repeated application every 1 to 2 hours,1 and they have some negative side effects. For example, seizures have been reported coincidently with the application of DEET.2 If used, DEET should be applied sparingly only to exposed skin and should not be used on children's faces or hands. It should not be applied to irritated or abraded skin and should be washed off after coming indoors.

Daily inspection and prompt removal of ticks should help prevent infection because prolonged attachment appears to be required for an infected tick to transmit spirochetes.
Questioning Asthma Treatment Study
Authors: TAL ASHER , LEVY NISSIM , Bearman Jacob E.
Published: December 2021

In Reply.—

We thank Drs McJunkin and Stallo for their interest in our paper. Their suggestion of using objective lung function measurements in young children and infants with acute asthma in the emergency department is impractical. The pulmonary index score we used includes at least one important lung function measure, namely, respiratory rate; this score also has been shown to be very reliable in children.1 Although we routinely use the peak expiratory flow rate in children in the emergency department, most of our patients were younger than 3 years of age and could not cooperate with this objective measurement.
The Future of Primary Care
Authors: LOBECK CHARLES C.
Published: December 2021

To the Editor.—

As a pediatrician who has been a medical school administrator for almost 17 years, I am troubled by the lack of pediatric leadership in the primary care movement. Joel Alpert1 calls attention to the failure of the discipline to respond within itself to the need for change in pediatric education. I am concerned about a larger issue.

At the time of the Millis Commission report in 1966, pediatrics was the only clinical discipline active in primary care.
Teen Suicide
Authors: SAHLER OLLE JANE Z.
Published: December 2021

To the Editor.—

Congratulations to Drs Adler and Jellinek for their special article "After Teen Suicide: Issues for Pediatricians Who Are Asked to Consult to Schools."1 As someone who does such consultations, I appreciate their suggestions and have sent copies of the article to the superintendent of my school district for his use and distribution; I urge others to do the same for their districts.

There are three points I would like to discuss. The first is that a suicide is often a district-wide event.
The BPD Problem
Authors: SINKIN ROBERT A. , COX CHRISTOPHER , PHELPS DALE L.
Published: December 2021

In Reply.—

The above letter by Merritt et al gives us the opportunity to emphasize the goals of our report. Our model was not meant to be applied to individual neonates for prognostic reasons but only to select the most appropriate neonates for enrollment in clinical trials testing therapy for the prevention or treatment of "BPD." In this way, neonates with a low risk for BPD would be ineligible, enriching the frequency of BPD in the study population.
Is Childhood Sexual Abuse Really Increasing in Prevalence? An Analysis of the Evidence
Authors: Feldman William , Feldman Eva , Goodman John T. , McGrath Patrick J. , Pless Robert P. , Corsini Linda , Bennett Susan
Published: December 2021

One controversy regarding childhood sexual abuse is whether the increased rate of reported cases reflects a true increase in prevalence. In this report, data obtained in the 1970s and 1980s were compared with those of the 1940s. Using predetermined criteria for quality of information, commonality of definitions of childhood sexual abuse, and research design, the authors reviewed the Kinsey report published in 1953 and 19 prevalence studies reported in the last 10 years. Interrater reliability was .97 for each paper. In spite of differences in study designs and populations surveyed, where definitions of childhood sexual abuse were similar, the more recent studies with the strongest methodology reported prevalence figures similar to those of Kinsey in the 1940s, ie, 10% to 12% of girls younger than 14 years of age. Thus it would appear that increased reporting is due to changes in legislation and social climate rather than a true increase in prevalence. The absence of an increase in prevalence of childhood sexual abuse should not deter those interested in pursuing solid research in prevention and treatment because any childhood sexual abuse is too much.
Helmet Promotion in the Emergency Room Following a Bicycle Injury: A Randomized Trial
Authors: Cushman Robert , Down Jonathan , MacMillan Neale , Waclawik Helen
Published: December 2021

Head injury is the leading cause of serious morbidity and mortality in bicycle accidents. There is good evidence to recommend helmets, yet few children wear them. Following a survey of children presenting to the emergency room with a bicycle injury, helmet promotion was evaluated in a randomized trial. The intervention consisted of physician counseling and take-home pamphlets. The study involved 334 children: 161 in the intervention group and 173 in the control group. In a follow-up telephone call, 2 to 3 weeks later, only 9.3% of the intervention group had purchased helmets, compared with 8.0% of the control group. Families in the intervention group received further counseling during the telephone contact, resulting in one additional purchase at 6-week follow-up. Evidence that a bike injury motivates cyclists to purchase helmets, and the influence of the self-administered questionnaire most likely account for the high purchase rate in the control group. Surprisingly, the helmet promotion intervention, including follow-up phone counseling, made no further impact. The results probably are best explained by a "double threshold" effect. Certain families were easily encouraged to buy a helmet, whereas others were far from ready to adapt this fairly recent innovation as routine cycling equipment. The findings suggest that physicians interested in helmet promotion would do better to participate in the design and implementation of multidisciplinary community campaigns.
Comparison of Albuterol and Metaproterenol Syrup in the Treatment of Childhood Asthma
Authors: Wolfe James D. , Shapiro Gail G. , Ratner Paul H.
Published: December 2021

This study compared the acute and chronic effects of albuterol syrup (2 mg) and metaproterenol syrup (10 mg) three times a day over 28 days in 65 children, aged 6 to 9 years, with mild to moderate asthma. Wright peak flow, symptom scores, and rescue medication use were recorded twice daily during the 28 days; the acute cardiopulmonary effects of these syrups were compared over 8 hours on treatment days 1 and 28. Albuterol syrup produced a significantly greater peak magnitude of bronchodilation than metaproterenol, 29% vs 20% above baseline, respectively, on treatment day 1. Albuterol syrup had a duration of action of at least 8 hours and produced greater bronchodilation than metaproterenol syrup from 2 to 8 hours on both treatment days 1 and 28. The chronotropic effect of metaproterenol was greater than that of albuterol at 1 to 1½ hours postdose on treatment days 1 and 28. There was a trend toward higher morning and evening Wright peak flow measurements during 28 days of treatment in the albuterol group. Side effects of both drugs were comparable. These findings imply therapeutic advantages of albuterol syrup over metaproterenol syrup in currently recommended doses with respect to improvement in pulmonary function, chronotropic effects, and frequency of dosing required to maintain optimum bronchodilation over a 24-hour period.
The Weismann-Netter Syndrome: A Cause of Bowed Legs in Childhood
Authors: FRANCIS GARY L. , JELINEK JAMES J. , MCHALE KATHLEEN , ADAMSON MEGAN , LEVIN SONDRA W.
Published: December 2021

The Weismann-Netter syndrome is a rare, heritable skeletal dysplasia which often presents as asymptomatic bowing of the lower legs or short stature.1 Although more than 40 cases have been described, there is mention of only 8 cases in patients who were younger than 16 years of age.1-9 In retrospect, most of the affected adults reported symptoms during childhood. We recently had the opportunity to evaluate a 4-year-old boy, whom we believe to have the Weismann-Netter syndrome. This case served to heighten our awareness of this condition, which should be recognizable in the pediatric age range.

CASE REPORT

The proband (Fig 1), a four-year-old Arabic boy, was the product of a full-term, uncomplicated pregnancy.
Scoliosis in β Thalassemia
Authors: PAPAGEORGIOU OURANIA , PAPANASTASIOU DIMITRIS A. , BERATIS NICHOLAS G. , KOROVESSIS PANAGIOTIS , OIKONOMOPOULOS ALEKOS
Published: December 2021

Skeletal abnormalities in patients with homozygous β thalassemia have been noted as early as 1927 by Cooley et al1 and have been the subject of many reviews.2-5 Abnormalities have been observed in the entire skeletal system, especially the skull and the mandible, giving the patients a characteristic appearance. Bone changes cause mainly expansion of the medullary cavity, subperiosteal overgrowth of the bones of the skull, and cortical thinning with porous rarefaction of the long bones. Although most of the bone abnormalities in inadequately transfused thalassemic patients result from the overgrowth of the bone marrow, hypoparathyroidism and vitamin C deficiency occasionally occur and may cause bone deformities.6,7
Increasing Patient Knowledge, Satisfaction, and Involvement: Randomized Trial of a Communication Intervention
Authors: Lewis Catherine C. , Pantell Robert H. , Sharp Lee
Published: December 2021

A brief educational intervention to promote effective communication between physicians, children, and parents during pediatric office visits was designed and tested. A randomized clinical trial involving 141 children (5- to 15-year-olds) tested the effectiveness of the intervention to improve the process and outcome of medical care. The intervention was contained in three brief videotapes (one each for parents, physicians, and patients) and in accompanying written materials. Materials were designed to build skills and motivation for increased child competence and participation during pediatric medical visits. Control subjects saw health education videotapes and received materials comparable in length with those of experimental subjects. Postintervention medical visit process was analyzed using videotapes of visits. Visit outcomes, assessed with standardized instruments and interviews, included children's rapport with physicians, children's anxiety, children's preference for an active health role, children's recall of information, parents' satisfaction with the medical visit, and physician satisfaction. Results indicated that physicians in the intervention group, compared with their counterparts in the control group, more often included children in discussions of medical recommendations (50% vs 29%, t = 2.39, P < .05); that children in the intervention group, compared with control children, recalled more medication recommendations (77% vs 47%, P < .01) and reported greater satisfaction and preference for an active health role; and that the intervention and control groups did not differ in parent satisfaction, physician satisfaction, or child anxiety. The results suggest that a brief educational intervention administered during waiting room time can positively impact physician-child rapport and children's preference for an active role in health and their acquisition of medical information.
Remembering As We Look Ahead: The Three E's and Firearm Injuries
Authors: WIDOME MARK D.
Published: December 2021

There was a little man, and he had a little gun,

And his bullets were made of lead, lead, lead;

He went to the brook, and he saw a little duck,

And he shot it through the head, head, head.

—Mother Goose

Four decades ago, Harry Dietrich,1 a member of the American Academy of Pediatrics' newly established Accident Prevention Committee, described a developmentally based approach to the prevention of childhood injury. Dietrich stressed the great need for protection ("passive immunization") for the young child and for safety education ("active immunization") as the child matures. It was also in the early 1950s that George Wheatley, the first chairman of the Accident Prevention Committee, popularized the "three E's"2—education, enforcement, and engineering—as a framework for developing and categorizing strategies to prevent injuries.
Asthma and Food Sensitivity
Authors: CROOK WILLIAM G.
Published: December 2021

To the Editor.—

In their article in the January issue of Pediatrics, Hughes et al1 stated, "Asthma is the most common chronic medical condition affecting children .. Treatment of the asthmatic child is often crisis oriented, possibly at the expense of ongoing care and preventive measures."

Although these investigators stated that study subjects had significantly less school absenteeism than control subjects and spent fewer days in hospitals, I could find no mention of the role of food sensitivities in asthma in children.
Asthma and Food Sensitivity
Authors: HUGHES DANIEL M. , GOLDBLOOM RICHARD B.
Published: December 2021

In Reply.—

Dr Crook inquires about the role that food sensitivities might play in our study subjects with asthma. During the initial assessment visit, we reviewed the triggers of asthma, including allergens, in all subjects. Where specific foods were identified by the parent as triggering asthma symptoms—and this was a rare occurrence—the child was encouraged to continue to avoid the particular food. Recognizing the limitations of skin testing for foods, we did not undertake to carry out this procedure.
Do Postpartum Nursery Visits by the Primary Care Provider Make a Difference?
Authors: Serwint Janet R. , Wilson Modena H. , Duggan Anne K. , Mellits E. David , Baumgardner Rosemary A. , DeAngelis Catherine
Published: December 2021

A prospective, randomized, clinical trial was conducted to investigate whether a postpartum visit between a mother and her neonate's future primary care provider combined with telephone access would improve health care utilization, enhance identification of the provider as a source of advice, increase maternal knowledge of infant care, and decrease maternal anxiety and depression. Of 251 mother-neonate pairs, 122 were randomized to the control group and 129 to the intervention group. Outcome variables included health care utilization and results of maternal interviews. More mothers in the intervention group made a scheduled clinic visit in the first 30 days (P = .003), were more likely to seek some form of care at the clinic (P = .006), and tried to reach their physician by phone more often than the control group (P <.001). There were no differences between the groups' emergency room utilization, the percent who received immunizations by 90 days of age, maternal knowledge of infant care, maternal anxiety, or postpartum depression. The intervention succeeded in improving some measures of health care utilization and results suggest that the relationship between the mother and clinician was strengthened.
Six-Year Follow-up of Early Physiotherapy Intervention in Very Low Birth Weight Infants
Authors: Rothberg Alan D. , Goodman Muriel , Jacklin Loma A. , Cooper Peter A.
Published: December 2021

Eighty very low birth weight infants assigned to neurologically normal or at-risk groups on the basis of a neurodevelopmental score were previously described. Infants were assigned to physiotherapy or control groups, and the effect of physiotherapy was assessed at 1 year. At-risk infants had a significantly lower developmental quotient than the normal group and no beneficial effect of physiotherapy was shown. Of the original 80 subjects, 49 were reassessed at a mean age of 74.7 months. As observed previously, physiotherapy until 1 year did not influence subsequent outcome in either normal or at risk children. At-risk and normal children had similar mean developmental quotients at 6 years, but the loco-motor score of at-risk children was significantly below that of normal children. Cerebral palsy occurred in 6 of 24 at-risk vs 0 of 25 normal subjects (P <.01) and remedial therapy was recommended in 17 of 24 at-risk subjects vs 6 of 25 normal subjects (P <.001). These results confirm that the neurodevelopmental score predicts a risk for either cerebral palsy or soft neurological problems, and early physiotherapy is of questionable benefit in preventing such problems.
Factors Influencing the Epidemiology of Helicobacter pylori Infection in Children
Authors: Fiedorek Stephen C. , Malaty Hoda M. , Evans Dolores L. , Pumphrey Cindy L. , Casteel Helen B. , Evans Doyle J. , Graham David Y.
Published: December 2021

The epidemiology of Helicobacter pylori infection was studied in 245 healthy children (between 3 and 20 years of age) who presented for day surgery at Arkansas Children's Hospital. H pylori infection was identified serologically using an enzyme-linked immunosorbent assay to detect the presence of IgG against the high molecular weight, cell-associated antigens of H pylori. Demographic information collected included age, gender, race, family income, type of housing, location of housing, water supply, health status, upper gastrointestinal symptoms, and keeping pets. One hundred eighty-nine white children and 56 black children were studied; 139 were boys and 106 were girls. The data were analyzed by logistic regression analysis. H pylori infection increased significantly with age (P <.05). The frequency of H pylori infection was higher in blacks than whites (P <.01), and this difference remained after adjusting for age, gender, and family income. Family income was used as a measure of socioeconomic class and was an important factor related to infection; the rate of acquisition of H pylori in those children with family income <$5000/year was twice that of those with incomes >$75 000/year (P <.001). There were no significant differences in H pylori infection related to gender, type of housing, location of housing, or source of water supply. It is concluded that the rate of acquisition of H pylori infection increases with age, is higher in blacks than whites, and is inversely related to socioeconomic class.
Sticks and Stones May Break My Bones . . . Reasoning About Illness Causality and Body Functioning in Children Who Have a Chronic Illness
Authors: Perrin Ellen C. , Sayer Aline G. , Willett John B.
Published: December 2021

Children's concepts about illness causality and bodily functioning change in a predictable way with advancing age. Differences in the understanding of these concepts in healthy children vs children with a chronic illness have not been clearly delineated. This study included 49 children with a seizure disorder, 47 children with an orthopaedic condition, and 96 healthy children, all with normal intelligence and ranging in age from 5 to 16 years. It demonstrates systematic differences in children's general reasoning skills and in their understanding of concepts about illness causality and bodily functioning, as a function of their age and experience of illness. At all ages, children who had a condition with orthopaedic involvement reported less sophisticated general reasoning and concepts about illness than did healthy children; children with a seizure disorder reported similar general reasoning skills to those of healthy children, but considerably less sophisticated concepts about illness. children's concepts about body functioning did not differ as a function of the presence of a chronic illness. When their different levels of general cognitive reasoning were statistically controlled, children with a chronic illness had somewhat more sophisticated concepts about bodily functioning than did healthy children. Differences in conceptual development among children with different types of illnesses lead to interesting speculations with regard to the effects of particular illness characteristics on children's cognitive development.
Ancient Technique of Olive Detection
Authors: GELLIS SYDNEY S.
Published: December 2021

In the February issue of Pediatrics, Dr A. L. Senquiz describes a "new" method for detecting the "olive" of congenital hypertrophic pyloric stenosis. The infant is placed on his abdomen. Sliding his fingers under the abdomen, the examiner palpates upward and gently in the right epigastrium. I agree that the method is more sensitive than palpation of the abdomen with the infant lying on his back. But the method is not new—I described it in an editorial comment in the 1953 to 1954 Yearbook of Pediatrics,p 185. Dr Senquiz hardly could have known this; no one in his right mind would be reading the 1953 to 1954 Yearbook! Furthermore, the method was not original with me; it must have been taught to me by one of the surgeons in my early days.
In Reply: HIV Screening in Pregnancy
Authors: PLOTKIN STANLEY A.
Published: December 2021

Parker and Traverse raise the question of universal screening of newborns. The AIDS Task Force recently has completed statements on HIV testing of mothers and newborns and on ethical issues relating to pediatric AIDS. The subject is far too complicated to summarize in a letter. Suffice it to say that the Task Force believes that involuntary testing of newborns is not yet justified by either the risk of breast-feeding or the proven therapeutic options available for the child when one considers the negative effects of involuntary testing.
WOMEN'S COLLEGE RESCINDS ITS DECISION TO ADMIT MEN
Authors: L. J. F.
Published: December 2021

OAKLAND, May 18—Bowing to pressure from a student strike supported by faculty and alumnae, the trustees of Mills College voted today to rescind their decision to admit men to the 138-year-old women's college.
Perceptions of Vulnerability 3½ Years After Problems of Feeding and Crying Behavior in Early Infancy
Authors: Forsyth Brian W.C. , Canny Priscilla F.
Published: December 2021

The long-term consequences for infants with problems of feeding and crying behavior remain unknown. The purpose of this research was to determine whether such children are later perceived by their parents as vulnerable and more often have behavior problems and have different personalities than children without problems in infancy. The implications of managing such problems by changing milk formulas is explored. Mothers of 379 infants were enrolled in the postpartum period. Information about problems of feeding and crying behavior was obtained at 4 months. Thirty-six percent of the infants had problems and the formula had been changed for 17%. At 3½ years, 320 (84%) mothers completed a questionnaire. Children who had had problems were more often perceived as vulnerable (relative risk [RR] 1.86; 95% confidence interval [CI] 1.09, 3.19) and more often had behavior problems (RR 1.78; 95% CI 1.03, 3.07). There were no differences in personality. Children whose problems had been managed by changing milk formulas were more often perceived as vulnerable (RR 2.18; 95% CI 1.05, 4.53). Although allergies were reported significantly more often for those children who had had problems, there were no differences in the prevalence of asthma or eczema. Problems of feeding and crying behavior in early infancy and the way they are managed may have long-term implications for the child.
Starvation Ketosis After Rehydration With Diet Soda
Authors: LEWIS PAUL
Published: December 2021

Pediatricians often tell parents to give their children clear liquids for hydration during acute gastroenteritis. Since the release of aspartame (Nutrasweet) in 1981, the composition of some clear liquids for hydration of children has changed. Although 12 ounces of sucrose-sweetened carbonated beverage contains about 100 calories, the same volume of aspartame-sweetened beverage contains about one calorie. Therefore, using aspartame-sweetened beverage to support hydration in children with diarrhea theoretically increases the potential for a starvation state to develop. A case of oral rehydration associated with starvation ketosis is described.

CASE HISTORY

In the 3 weeks preceding admission, a 5-year-old boy had been treated with oral cephalexin (Keflex) for a knee infection (septic arthritis vs cellulitis).
Persistent Eosinophilia in an Infant With Probable Intrauterine Exposure to l-Tryptophan-containing Supplements
Authors: HATCH DOUGLAS L. , GARONA JUAN E. , GOLDMAN LYNN R. , WALLER KIRSTEN O.
Published: December 2021

Eosinophilia-myalgia syndrome (EMS), a previously undescribed illness, occurs mainly in adults and is characterized by severe myalgias and an absolute eosinophil count (AEC) >1000 cells/mm3.1 This syndrome has been associated with the consumption of capsules and tablets containing 1-tryptophan (LT), an essential amino acid. As of August 1990, 1536 cases of EMS and at least 27 EMS-associated deaths have been reported in the United States, with most cases occurring among middleaged women.1,2 We report on an infant who had eosinophilia at birth, following maternal consumption of supplemental LT for insomnia and hyperemesis gravidarum during the fourth through ninth months of pregnancy.
Incidence of Intrauterine Cocaine Exposure in a Suburban Setting
Authors: Schutzman David L. , Frankenfield-Chernicoff Maria , Clatterbaugh Helen E. , Singer Jerome
Published: December 2021

This study endeavored to determine the incidence of intrauterine cocaine exposure in a socioeconomically mixed suburban setting. It also assessed the effectiveness of an anonymous questionnaire in eliciting information on maternal use of illicit drugs during pregnancy. Meconium was collected from 500 consecutively born infants and analyzed for the presence of cocaine and its metabolites. An anonymous two-page questionnaire also was distributed to all postpartum mothers. Of the infants' mothers, (73.2%) were covered by some form of insurance (private), whereas 26.8% either had no insurance or were covered by Medicaid (clinic). Fifty-nine (11.8%) babies tested positive for cocaine. The meconium of 6.3% of the babies whose mothers had private insurance tested positive, while the meconium of 26.9% of the babies whose mothers had Medicaid or no insurance tested positive. 316 (63.2%) of the mothers returned a questionnaire. 73% had private insurance and 27% were covered by Medicaid (clinic). Only five mothers with no insurance or covered by Medicaid admitted using cocaine. It appears that neonatal exposure to cocaine may be an even greater problem than previously imagined, particularly in the private population. In addition, anonymous maternal self-reporting forms probably will not be helpful in identifying infants at risk for illicit exposure to drugs.
Gastroesophageal Reflux, as Measured By 24-Hour pH Monitoring, in 509 Healthy Infants Screened for Risk of Sudden Infant Death Syndrome
Authors: Vandenplas Yvan , Goyvaerts Harry , Helven Rudy , Sacre Liliane
Published: December 2021

Continuous long-term esophageal pH monitoring has become the preferred test to quantify acid gastroesophageal reflux. Because reflux to a limited extent is physiologic, the determination of optimal thresholds to separate normal from abnormal reflux is mandatory. Esophageal pH was measured during 24 hours in 509 healthy thriving infants, aged 3 days to 1 year, using a glass microelectrode with an external reference electrode connected to a portable recorder.

Percentiles of the four parameters studied (reflux index or percent of the investigation time with a pH <4, number of episodes with a pH <4 during 24 hours, number of episodes lasting >5 minutes, the duration of the longest episode (in minutes)) are presented. A percentile curve of the reflux index regarding the age distribution shows that the normal range for the reflux index during the first 12 months of life is about 10% (95 percentile), decreasing from 13% at birth to 8% at 12 months. Application of an age-related percentile curve offers a close-to-reality possibility of data interpretation and illustrates that there is inevitably an overlap of data between normal and abnormal populations, because reflux is a phenomenon occurring to some extent in every human being.
Frogger
Authors: WIDOME MARK D.
Published: December 2021

"I see nobody on the road," said Alice.

"I only wish I had such eyes," the King remarked in a fretful tone. "To be able to see Nobody! And at that distance too!"

—Through the Looking-Glass

"Frogger," the video game, is now a classic. The game is played from the frog's point of view. Video frogs must cross the road, negotiating lanes of increasingly hostile traffic. Many frogs get squished. When you run out of frogs, you push the reset button and play again.

Rivara,1 in this issue of Pediatrics, reports on an ambitious effort to educate early elementary schoolage children on the rudiments of traffic safety.
What Happened to the Predicted Glut of Pediatricians?
Authors: EATON ANTOINETTE PARISI , FLINT SAMUEL S.
Published: December 2021

In 1986 the Council on Graduate Medical Education (COGME) was asked to advise the Congress of the supply and distribution of physicians in the United States, current and future shortages or excesses of physicians by specialty, issues relating to foreign medical graduates, and other matters relating to the financing and structure of undergraduate and graduate medical education. In 1988, the COGME Subcommittee on Physician Manpower stated to the Congress that "there appears to be an impending oversupply of pediatricians at present,"1 and the Subcommittee undertook—before making its final report to the Congress—its own independent study on manpower needs for pediatrics and six other specialties.
Decline in Breast-Feeding?
Authors: TOGNETTI JANET , HIRSCHMAN JAY D. , MCLAUGHLIN JOAN E.
Published: December 2021

To the Editor.—

The study "Recent Declines in Breast-Feeding in the United States, 1984-1989" by Ryan et al1 recently was brought to our attention because it reports a negative statistical association between participation in the United States Department of Agriculture's Special Supplemental Food Program for Women, Infants and Children (WIC) and the initiation and duration of breast-feeding.

WIC staff at all levels have been working actively to promote breast-feeding in the Program2-4 for many years, and they certainly would be concerned about a negative impact of the Program on breast-feeding.
Pedia-What!
Authors: FISCHER HOWARD
Published: December 2021

To the Editor.—

Several pharmaceuticals manufactured for children have the prefix "pedia-" in their names. These include Pedicare (a line of cold and allergy preparations, McNeil), Pedialyte (oral electrolyte maintenance solution, Ross), Pediacof (a codeine-containing cough preparation, Winthrop Pharmaceuticals), PediaSure (liquid nutrition for children, Ross), Pediaflor (fluoride drops, Ross), Pediapred (prednisolone sodium phosphate, Fisons), and PediaProfen (Ibuprofen, McNeil).

The first two on this list are sold without prescription. Although they are very different in appearance and therapeutic aim, I have seen some confusion among parents about these two preparations.
Arterial Catheters, Endothelin, and ROP
Authors: YAMANOUCHI ITSURO , IGARASHI IKUKO
Published: December 2021

To the Editor.—

During the 15 years from 1976 to 1990, a total of 615 cases of very low birth weight (VLBW) infants weighing between 500 and 1500 g were treated at the Okayama National Hospital Children's Medical Center. 497 of them survived. There were 121 cases of retinopathy of prematurity (ROP), 15 of which were treated with cryocoagulation. The Table shows the classification of the VLBW cases according to birth weight and International Classification of ROP.
Causes of Encopresis
Authors: PILAPIL VIRGILIO R.
Published: December 2021

In Reply.—

I appreciate Dr Weintraub's thoughtful comment regarding my reply on the report on encopresis by de Vos et al.1 In reality, the plan for the case I described2 was for the mother to familiarize the child with the nature of the toilet setting and to demonstrate casually the safety and harmlessness of sitting on the toilet but not necessarily at the time of the private function. However, that was the extent to which it was carried out by the mother, perhaps with the thought that it was a more realistic approach.
Sexually Transmitted Diseases in Childhood Sexual Abuse
Authors: HUSTON REBECCA , KELLOGG NANCY , PARRA JUAN M. , FOULDS D. MICHAEL
Published: December 2021

To the Editor.—

We read with interest the statement by the Committee on Child Abuse and Neglect, "Guidelines for the Evaluation of Sexual Abuse of Children."1 However, we are very concerned with the Committee's statement that routine cultures for sexually transmitted diseases are not necessary. There are several reasons for these concerns.

1. It has been our experience that even after a thorough interview, many children only reveal some details of their abuse. We have seen many children who initially report only fondling, then later report penetration.
Sexually Transmitted Diseases in Childhood Sexual Abuse
Authors: KRUGMAN RICHARD D.
Published: December 2021

In Reply.—

The authors, who are apparently seeing a referred population of children who are suspected or known to be sexually abused, have decided, based on their experience and the published data from other referral centers, to do cultures (presumably from at least two or three sites) for gonorrhea, chlamydia, as well as a serologic test for syphilis on all cases of suspected sexual abuse.

The American Academy of Pediatrics (AAP) guidelines are not written for referral centers, but instead they are an attempt to assist the primary care practitioner to know how to recognize and/or manage a case of suspected or known sexual abuse.
Dietary Management of Persistent Diarrhea: Comparison of a Traditional Rice-Lentil Based Diet with Soy Formula
Authors: Bhutta Z. A. , Molla A. M. , Issani Z. , Badruddin S. , Hendricks K. , Snyder J. D.
Published: December 2021

Recent studies have indicated that enteral diets can play an important role in the treatment of persistent diarrhea. Khitchri, a local weaning food in Pakistan, is composed of rice and lentils, which have previously been shown to be well tolerated in many children with acute diarrhea. The effectiveness of a khitchri and yogurt (KY) diet, which is inexpensive and widely available in Pakistan, was studied. One hundred two weaned boys (6 to 36 months old) with persistent diarrhea were randomly assigned to receive either soy formula (group A) or the KY diet (group B) for 14 days. Group A also received the KY diet in addition to formula for days 8 through 14. Twenty-nine children did not complete the study because of severe infection (13) or their family's decision to leave the study early (9 in group A and 7 in group B). Sixty-six children successfully completed the study protocol; there were five clinical failures in group A and two in group B. On a comparable caloric intake, there was a significantly lower stool volume (group B: 38 ± 16 [mean ± SD] vs group A: 64 ± 75 g/kg per day, P < .05) and frequency (B: 4.4 ± 2.0 vs. A: 6.6 ± 4.2 stools per day, P < .005) in children fed KY during the first week of therapy. Group B children also had a significantly greater weight gain than children in group A during the first week (B: 468 ± 373 g/wk vs A: 68 ± 286 g/wk, P < .005). The addition of KY to the diet of the soy-fed group in the second week of therapy resulted in a significantly greater weight gain compared with the first week (575 ± 408 g/wk, P < .005). These data indicate that a traditional rice-lentil and yogurt diet can be successfully used for the dietary management of persistent diarrhea in children.
Differences in Antibody Response to Whole-Cell Pertussis Vaccines
Authors: Edwards Kathryn M. , Decker Michael D. , Halsey Neal A. , Koblin Beryl A. , Townsend Timothy , Auerbach Barry , Karzon David T.
Published: December 2021

It has been assumed that whole-cell pertussis vaccines (WCVs) commercially distributed in the United States are of comparable immunogenicity, as all must comply with established standards for licensure. However, we have recently noted significant differences in antibody responses between groups of infants receiving the two WCVs commercially available in the United States. In separate studies performed concurrently under similar protocols at Vanderbilt and Johns Hopkins universities, infants were randomized to receive either an acellular pertussis vaccine or WCV. The acellular pertussis vaccine used at the two sites was identical, but the WCVs were from different manufacturers. Antibody responses to acellular pertussis vaccine did not differ between the two studies; responses to WCV differed dramatically, with infants receiving the Lederle WCV producing a 46-fold increase in antibody to pertussis toxin, compared with a 2.4-fold increase for infants receiving the Connaught WCV (P = .00003). Evaluation of other comparative data sets that were available provided further support for the conclusion that the two commercially available WCVs consistently differed in their ability to induce antibody to pertussis toxin. These findings have important implications for the design and interpretation of clinical trials comparing acellular and WCV products.
THE SCRABBLING FOR RECOGNITION RESULTS IN TOO MANY UNDERSIZED CLINICAL TRIALS
Authors: STUDENT
Published: December 2021

. . . medical journals are cluttered with inconclusive, contradictory trials of small size from which it is almost impossible to make generalisations for clinical practice.

Many important clinical questions would be answered quickly and efficiently if the junior doctors currently scrabbling for research publications could be allowed to turn their efforts to multicentre trials.
Measles Revaccination Response in a School-Age Population
Authors: Wittier Robert R. , Veit Bruce C. , McIntyre Susan , Schydlower Manuel
Published: December 2021

Due to the dramatic upsurge in the incidence of measles, the American Academy of Pediatrics and the Immunization Practices Advisory Committee of the Centers for Disease Control revised their measles immunization policies in 1989 to include a routine two-dose schedule. The objectives of this study were the following: (1) determine the prevalence of immunologically measles-susceptible subjects in a previously vaccinated, school-age, military dependent population; and (2) assess risk factors to identify immunologically measles-susceptible subjects. Serum was collected just prior to measles revaccination and again 2 weeks later. Measles-specific IgG and IgM titers were determined by enzyme-linked immunosorbent assay. Immunologically measles-susceptible subjects constituted 9.8% of the population. The interval since previous measles vaccination was significantly related to pre- and postrevaccination IgG titers in a repeated-measures analysis of variance model. The magnitude of increase in IgG titer following revaccination and analysis of trend for proportions of measles-susceptible subjects were significantly related to the age of initial vaccination. This study supports continued measles revaccination; in addition, revaccination appears to be of greater value at 11 to 12 years of age than at 4 to 6 years of age.
BREVITY TAKES TIME
Authors: DOW JEAN
Published: December 2021

A wise critic of science declared

That reports could be better prepared.

If more authors would think,

Use more care and less ink,

From poor writing we all would be spared.
Prenatal Origin of Hemiparetic Cerebral Palsy: How Often and Why?
Authors: NELSON KARIN B.
Published: December 2021

"Consider what must be accomplished during the course of fetal brain development. In effect, in a few months the entire work of hundreds of millions of years of evolution must be reachieved. . . . Tens of billions of neurons must be born. . . . These new cells must find their way to their anatomical destinations, sometimes moving over substantial distances in an embryo that is constantly changing in form. . . Once the cell is fixed in place, the axon must find its way to its own destination. . . . They must not only get where they are going and make a connection, but they must avoid making any number of other connections that they might wrongly make in places they pass. Each nerve cell must develop one or more of at least a dozen neurotransmitters. . . ." The product of that miracle is the most complicated object in the known universe, a human brain.

In this "Decade of the Brain," we can anticipate the emergence of a great deal more information about how the nervous system develops, prenatally and thereafter, and how and when that development can go awry. That information will come from laboratories, clinics, and nurseries. Neuroimaging of the infant brain, a subject now producing a rich harvest in journals of pediatrics, neurology, radiology, and obstetrics, will contribute important new information about the processes of brain development in our species, the timing of derailment from the normal course of brain development, and some aspects of pathogenesis. Neuropathology and the enormous flowering of new approaches in the basic and clinical neurosciences will help in explication of the mechanisms of maldevelopment and early injury. And we can hope that identification of mechanisms will allow us to develop strategies to prevent at least some of the problems leading to prenatal damage of the developing human brain.
Resident Related Liability in the Emergency Department
Authors: SIMON HAROLD K.
Published: December 2021

In a recent article in Pediatrics, "Professional Liability in a Pediatric Emergency Department" by Reynolds et al, one of the major conclusions is that a disproportionate number of claims occurs when an attending physician is not present in the emergency department. Their conclusions from the facts that 46% of the claims arise from midnight to 8:00 AM when an attending physician is not present, while approximately 8% of total visits occur during this period, are as follows: "It may be that parents had higher expectations at 3:00 AM compared with 10:00 AM or that parents perceived the physician to be less experienced and less self-confident.
In Reply: Boomerang Effect of Drug Education Programs
Authors: GOLDBERG LINN , ELLIOT DIANNE L. , BOSWORTH ERIC , BENTS ROBERT
Published: December 2021

The concern expressed by Dr Miele is not isolated to this study. As stated under "Discussion," drug education interventions "may even have a boomerang effect and actually encourage use." We previously have commented on this paradoxical effect and are critical of those who foster the notion that focusing on anabolic steroids' untoward effects would be an effective way of curbing abuse. Others have acknowledged the phenomenon of adolescents' increased desire to use illicit substances after interventions to prevent drug abuse.
Lead Exposure and Growth in the Early Preschool Child: A Follow-up Report from the Cincinnati Lead Study
Authors: Shukla Rakesh , Dietrich Kim N. , Bornschein Robert L , Berger Omer , Hammond Paul B.
Published: December 2021

This report is a follow-up of an earlier study of the effects of low to moderate prenatal and postnatal lead exposure on children's growth in stature. Two hundred thirty-five subjects were assessed every 3 months for lead exposure (blood lead level) and stature (recumbent length) up to 33 months of age. Fetal lead exposure was indexed by maternal blood lead level during pregnancy. The adverse effects of lead on growth during the first year of life were reported previously. This analysis covers essentially the second and third years of life. The results indicate that mean blood lead level during this period was negatively associated with attained height at 33 months of age (P = .002). This association was, however, evidenced only among those children who had mean blood lead levels greater than the cohort median (≥10.77 µg/dL) during the 3- to 15-month interval. The results also suggest that the effect of lead exposure (both in utero as well as during the first year of life) are transient provided that subsequent exposure to lead is not excessive. It appears that maintaining an average blood lead level of 25 µg/dL or more during the second and third year of life was detrimental to the child's attained stature at 33 months of age. Approximately 15% of this cohort experienced these levels of lead exposure. Continued follow-up of this cohort will reveal whether these lead-related deficits persist and whether they continue to be dependent on the level of exposure in an earlier period.
EDUCATIONAL TIDBITS
Authors: L. J. F.
Published: December 2021

In 1985, 5 percent of the United States population was enrolled in some form of higher education, at least twice the percent of any other industrialized nation except Canada.
RISKS IN EVERY DAY LIFE
Authors: STUDENT
Published: December 2021

[There is a need to create] awareness in both politicians and experts that while the statistical risk of death from a particular source is 0.1% overall, to the individual it strikes that risk will appear to be 100%. We assume, protectively, that we bear a charmed life when we drive or smoke cigarettes, until we draw the short straw.
Effects of Sugar on Aggressive and Inattentive Behavior in Children With Attention Deficit Disorder With Hyperactivity and Normal Children
Authors: Wender Esther H. , Solanto Mary V.
Published: December 2021

Foods high in refined sugar are claimed to exacerbate hyperactivity and increase aggressive behavior. Controlled studies have failed to confirm any effect on hyperactivity and effects on inattention have been equivocal. Possible effect on aggressive behavior has received little study. This study assessed cognitive attention and aggressive behavior immediately following an acute ingestion of sugar compared with saccharin and aspartame-sweetened placebos in 17 subjects with attention deficit disorder with hyperactivity compared with 9 age-matched control subjects. The sugar and placebo challenges were given with a breakfast high in carbohydrate. Although the children with attention deficit disorder with hyperactivity were significantly more aggressive than the control subjects, there were no significant effects of sugar or either placebo on the aggressive behavior of either group. However, inattention, as measured by a continuous performance task, increased only in the attention deficit disorder with hyperactivity group following sugar, but not saccharin or aspartame. This result is of questionable clinical significance inasmuch as aggressive behavior was unchanged. The finding may be due to the combination of the sugar challenge with a high-carbohydrate breakfast. These findings should be replicated and any possible clinical significance should be documented before any dietary recommendations can be made.