bluuebunny/crossref_metadata_2025 huggingface dataset:
Pertussis Immunization
Authors: EMERSON BRIAN P.
Published: December 2021

The Task Force on Pertussis and Pertussis Immunization should be congratulated for a timely and thorough review of some difficult issues. Although the authors have done a commendable job in objectively presenting the controversial areas, they have unfortunately not maintained a clear distinction between protection from clinical disease (that which is recognized and notified) and protection from infection (all pertussis caused illness, much of which is "mild, often unrecognized disease". That the vaccine likely protects much more against clinical disease than infection has been well discussed by Fine and Clarkson.

The Task Force did acknowledge this distinction ("Control v Eradication"; however, they subsequently ignored it when they suggested that an adult dose "would reduce transmission of B pertussis in adults and could help in the eradication of pertussis in our population."
The Anencephalic Controversy
Authors: COULTER DAVID L. , QUINN DIANA LIACOS
Published: December 2021

The Special Articles by Botkin and Landwirth concerning the use of infants with anencephaly as organ donors, and the accompanying Commentary by Milunsky, raise a number of important questions. All three authors make the same assumption, however, that readers share their understanding of what anencephaly is. This assumption may not be well-founded. We have known several instances in which "anencephaly" was the diagnosis in infants when in fact, they had hydranencephaly or severe hydrocephalus.
In Reply: The Anencephalic Controversy
Authors: BOTKIN JEFFREY R.
Published: December 2021

Dr Karrer provides several arguments in support of using anencephalic infants as organ donors. Although I believe this position was well represented in the August issue, his letter deserves comment on several points. First, Dr Karrer recognizes that a determination of death based on whole brain criteria has been well accepted by all concerned, yet he is prepared to dismiss these criteria with the claim that an anencephalic infant is not a "living person" and that to distinguish between life and death based on brainstem reflexes is "splitting hairs."
In Reply: Rape and AIDS
Authors: SCHONBERG S. KENNETH
Published: December 2021

Drs Mascola and Gellert are correct to alert pediatricians to the need to consider the issue of the possible transmission of human immunodeficiency virus (HIV) at the time of a sexual assault. The failure to address this issue within the recent position paper on Rape and the Adolescent represents an omission by the Committee on Adolescence which we hope will be in part corrected by their letter. However, the Committee would add the following points of clarification.
In Reply: Hemorrhage, Phenobarbital, and Fluctuating Cerebral Blood Flow
Authors: KUBAN KARL C. K. , LEVITON ALAN , SULLIVAN KATHLEEN F. , SKOUTELLI HELEN , PAGANO MARCELLO
Published: December 2021

We believe that our conclusions are justified based on the data presented, First, we grant that because it tends to smooth out the curves, the mean mode will give blunted and, therefore, somewhat lower values for coefficient of variation when compared to the systolic-diastolic mode. The values we obtained for mean mode in 17 babies paralleled the values obtained by the systolic-diastolic mode. Because we did not dichotomize between normal and abnormal at some value, such as 10, but rather looked for a significant association between the absolute coefficient of variation values and hemorrhage, lowering of values for all babies should not have resulted in bias.
Errors in Harriet Lane Handbook
Authors: CHORPENNING NANCY E.
Published: December 2021

In a recent issue of Pediatrics(1988;82:674-676), there was discussion about information concerning acetaminophen poisoning that appeared in the first two printings of The Harriet Lane Handbook, ed 11. We want your readers to be aware that replacements for pages 247 and 248 containing information about acetaminophen poisoning are available directly from Year Book Medical Publishers, Inc (write to 200 North LaSalle St, Chicago, IL 60601-1080 or phone, toll free, 800-622-5410). The replacement pages are printed on gummed labels that can be affixed directly to individual copies of the handbook.
Ethical Basis for Repealing Religious Exemptions From Child Abuse Statutes
Authors: JECKER NANCY S.
Published: December 2021

In a recent statement, the American Academy of peatrics' Committee on Bioethics maintained that "all child abuse, neglect, and medical neglect statutes should be applied without potential or actual exemption from religious beliefs." The AAP recommendation should be hailed. But sufficient attention should also be paid to the justification for it in philosophical and moral argument. This will ensure that the recommendation is followed in the long run, by providing physicians and others with a compelling reason to challenge present statutes that oppose it.
In Reply: Hearing Loss and Persistent Fetal Circulation
Authors: HENDRICKS-MUNOZ KAREN D. , WALTON JOSEPH P.
Published: December 2021

This was not a double-blinded study. This was initially a retrospective analysis of the incidence of hearing loss in infants with the diagnosis of persistent fetal circulation in our neonatal intensive care unit. When a high incidence of hearing loss was noted, all infants with the diagnosis of persistent fetal circulation were evaluated for hearing loss prospectively during the designated period. We assessed multiple perinatal and treatment variables to determine any differences that would suggest factors associated with the development of hearing loss in these infants.
Fictitious Crystalluria
Authors: ABU-ARAFEH I. A. , STUART C. , SMAlL P. J.
Published: December 2021

The use of disposable nappies with high absorptive power caused confusion in the past leading to the erroneous diagnosis of oligunea. We report crystalluria as another confusing condition in association with the use of a new brand of nappies, Ultra-Pampers.

A 13-month-old infant, receiving regular treatment with theophylline for recurrent wheezing, was admitted to the hospital because of a three-day history of passing crystals in his urine. Each time his diaper was changed, his mother noticed crystals and jelly-like particles about 5 to 10 mm in diameter in his wet nappies.
DOLLAR SCHOLARS
Authors: Student
Published: December 2021

Institutions openly applaud the magnitude of grants, and prospective faculty are wooed in anticipation of the dollars they may bring rather than by abstract criteria of new ideas and observations they may generate. One consequence is the favoring of expensive projects over cheaper ones, irrespective of other considerations. Dollars coming has replaced publications coming out.
Blood Pressure Fluctuation and Intraventricular Hemorrhage in the Preterm Infant of Less Than 31 Weeks' Gestation
Authors: Miall-Allen Vivienne M. , de Vries Linda S. , Dubowitz Lilly M. S. , Whitelaw Andrew G. L.
Published: December 2021

A total of 22 infants of less than 31 weeks' gestation who were mechanically ventilated for a minimum of 12 hours for respiratory distress syndrome were studied. The coefficient of variation of direct systolic pressure was measured each minute from six to 36 hours of age and averaged per hour after birth with a microcomputer-based system of data collection. At the start of recording, the ultrasound scan appeared normal in each infant, but intraventricular hemorrhage developed in ten infants less than 36 hours of age. Twelve infants remained free of intraventricular hemorrhages. BP fluctuation was greater for a longer proportion of measured time in infants in whom intraventricular hemorrhage did not develop compared with those in whom it did develop P < .05). These findings do not support a causal relationship between BP fluctuation and intraventricular hemorrhage within the range of coefficient of variation studied.
Long-Term Development of Children Monitored as Infants for an Apparent Life-Threatening Event During Sleep: A 10-Year Follow-up Study
Authors: Kahn A. , Sottiaux M. , Appelboom-Fondu J. , Blum D. , Rebuffat E. , Levitt J.
Published: December 2021

The outcomes of 26 children who had an apparent life-threatening event during sleep and who were monitored at home were evaluated. In a preliminary study that was first reported when the children had a mean age of 2.7 years, only minor behavioral difficulties were seen. The children of this earlier study were characterized by more aggressive behavior, which was tentatively related to parental anxiety. The same children were retested at a mean age of 7 years (range 6 to 10 years), together with sex-, age-, and social class-matched control children. No significant differences were found in their clinical daytime and nighttime behavior or in IQ tests, although in some of the psychodevelopmental tests minor signs of anxiety were revealed. In conclusion, infants with an apparent life-threatening event who underwent continued cardiopulmonary home monitoring develop normally during preadolescence. A prolonged follow-up of the children during adolescence is needed to evaluate later school performance.
Lack of Improved Growth Outcome Related to Nonnutritive Sucking in Very Low Birth Weight Premature Infants Fed a Controlled Nutrient Intake: A Randomized Prospective Study
Authors: Ernst Judith A. , Rickard Karyl A. , Neal Patricia R. , Yu Pao-Lo , Oei Tjien O. , Lemons James A.
Published: December 2021

The effect of nonnutritive sucking during gavage feeding on nutritional outcome and gastrointestinal transit time was evaluated in 18 premature appropriate for gestational age infants whose birth weights were \g=le\1,400 g and gestational ages were \g=le\30 weeks. Infants were randomized to a treatment (nonnutritive sucking infants received a pacifier for 30 minutes with each feeding, 12 times per day until they reached a weight of 1,500 g, eight times per day thereafter) or control (no pacifier) group. The nine nonnutritive sucking (five girls, four boys) and nine control (five girls, four boys) infants were treated for 14 days. Infants were without medical complications and were fed a single premature formula by intermittent gastric gavage at exactly 120 kcal/kg/d throughout the study period. Weight gain, linear growth, subscapular and triceps skinfold, and arm circumference accretions were assessed weekly. Serum proteins (albumin, prealbumin, retinol-binding protein, and transferrin) were measured weekly. Gastrointestinal transit times were measured weekly using carmine red markers. In contrast to previous studies, these data indicate no apparent effect of nonnutritive sucking on growth outcome, serum proteins, or gastrointestinal transit time in growing, very low birth weight infants when nutrient intake was controlled. In a subgroup of eight boys (four nonnutritive sucking, four control), energy and fat excretions were determined from 72-hour fecal collections and energy expenditure was estimated from six-hour cumulative heart rate measurements. Neither excretion of fat and calories nor estimated energy expenditure was affected significantly by nonnutritive sucking in this subgroup of baby boys. Fat excretion correlated well (r = .987) with energy excretion.
Mutant Fetal Hemoglobin Causing Cyanosis in a Newborn
Authors: Priest John R. , Watterson Jan , Jones Richard T. , Faassen Anne E. , Hedlund Bo E.
Published: December 2021

A well but cyanotic newborn was found to have a mutant γ-globin chain, leading to a functionally abnormal fetal hemoglobin. A single amino acid substitution was found in a site consistent with known adult M hemoglobins. This patient showed no clinical evidence of cyanosis at 5 weeks of age as γ-chain synthesis was replaced by β-chain synthesis. A sibling born 20 months later was also cyanotic and the same mutant hemoglobin was found.
Normal Neurodevelopment in Four Young Children Treated With Bone Marrow Transplantation for Acute Leukemia or Aplastic Anemia
Authors: Kaleita Thomas A. , Shields W. Donald , Tesler Alan , Feig Stephen A.
Published: December 2021

Longitudinal neurodevelopmental studies of four consecutive young children treated by bone marrow transplantation for acute leukemia or aplastic anemia are presented. The children, the only four children less than 2 years of age who have received bone marrow transplants for these diseases at UCLA Medical Center, ranged in age from 36 weeks to 24 months at the time of transplantation. Conditioning involved high-dose cyclophosphamide treatment; three also had total body irradiation prior to bone marrow transplantation. Their respective outcomes after follow-up times of 28 months to 71 months posttransplantation are remarkable for normal somatic growth and normal development of intelligence, language, perception, and motor coordination. These findings indicate that future therapeutic studies of infants and young children with acute leukemia or aplastic anemia using total body irradiation, cyclophosphamide, and bone marrow transplantation are not contraindicated by risks of debilitating neurodevelopmental sequelae.
Perceptions of Parenthood Among Adolescent Fathers
Authors: Elsters Arthur B. , Lamb Michael E. , Kimmerly Nancy
Published: December 2021

To investigate perceptions of parenthood among adolescent fathers, we studied three groups of first-time fathers: adolescent fathers with adolescent partners (n = 21), adult fathers with adolescent partners (n = 14), and adult fathers with adult partners (n = 55). Subjects were interviewed during the immediate postpartum period and then again 3 months later. Group differences were noted concerning items related to paternal involvement, sex stereotypic behaviors, and stress, but not concerning preparation for parenthood. Fathers' perceptions appeared to be influenced by both their ages and those of the mothers as well as an interaction between these two fathers (adult fathers with adolescent partners v adult fathers with adult partners). Our results suggest that fathers with adolescent partners may benefit from interventions designed to promote more active involvement in parenthood.
SI Unit Dangers
Authors: PERLMAN SHARON A.
Published: December 2021

The recent commentary concerning SI units by the American Academy of Pediatrics' Committee on Drugs (Pediatrics 1989;83:129-131) pointed out some of the difficulties associated with conversion of drug concentrations to SI units. As further evidence of the potential dangers inherent in changing to a system of molar units, I would like to point out two errors, presumably typographical, in that very report. First, the statement was made that "a 125-mg tablet of erythromycin would become a 0.1703-mg tablet"; I believe a 0.1703-mmol tablet was intended.
In Reply: Residency Training and Child Abuse
Authors: DUBOWITZ HOWARD
Published: December 2021

Dr Johnson provides interesting data indicating the need for improved training in child maltreatment for pediatric residents. I agree with most of his suggestions and would like to make several additional observations.

Even when pediatricians might see themselves in a screening role, it is apparent that a report of child abuse can have far-reaching ramifications, such as removal of the child from the family. Frequently, the state agencies involved in child protection give enormous weight to the medical opinion, perhaps too much at times, and so it becomes important that the initial report be reasonably justified.
In Reply: Late-Onset Hearing Loss
Authors: HENDRICKS-MUNOZ KAREN D. , WALTON JOSEPH P.
Published: December 2021

We concur with Nield et al who point out that progressive sensorineural hearing loss is not limited to infants with persistent fetal circulation. It was not the intent of the study to imply that delayed hearing loss was limited to infants with persistent fetal circulation. Our center routinely refers for serial audiologic testing all infants who meet the high-risk registry criteria for deafness (ASHA 1984;26:17-21). Unfortunately, many of the infants in the study did not meet criteria established by the registry and, therefore, were not referred for evaluation.
Techniques' Comparison and Report of the North Carolina Experience
Authors: Kinney Thomas R. , Sawtschenko Martha , Whorton Mary , Shearin Jean , Stine Christy , Hofman Lindsay , Safko Robbi , Vitaglione Thomas , Kaufman Russel E.
Published: December 2021

Controversy still exists as to the best laboratory method to use to screen newborns for sickle cell disease and other hemoglobinopathies. The proposed methods include hemoglobin electrophoresis, column chromatography, isoelectric focusing, and high performance liquid chromatography. There is also debate concerning the preferred method of sample collection. The proposed methods of sample collection include cord blood or blood obtained from the infant collected in a tube with anticoagulant or on filter paper.

We compared hemoglobin electrophoresis patterns from infant blood samples collected in heparinized capillary tubes and on filter paper. This comparison was performed because hemoglobin electrophoresis of dried blood samples collected on filter paper has been advocated as a practical, reliable, and inexpensive method for mass screening programs, although the limitations of this technique have not been explored fully. We also summarize data from the North Carolina Newborn Hemoglobinopathy Screening Program, which relates to the advantages and limitations of hemoglobin electrophoresis from filter paper blood specimens.

MATERIALS AND METHODS

Specimens

Four sets of specimens were used for this study: (1) specimens collected at Duke University Medical Center to compare hemoglobin electrophoresis patterns of hemolysates from filter paper and heparinized capillary tubes, (2) specimens collected by the North Carolina program for hemoglobinopathy screening, (3) specimens routinely collected at Duke University in heparinized capillary tubes for newborn hemoglobinopathy screening, and (4) samples for retesting to examine the error rate of the state program and to confirm screening results compatible with a hemoglobinopathy.

Samples for Direct Comparison Between Filter Paper and Heparinized Specimens
Hemoglobinopathy Screening During Early Pregnancy
Authors: Anyane-Yeboa Kwame
Published: December 2021

Screening during early pregnancy is desirable for monitoring the mothers' health and pregnancy. Newborn screening for hemoglobinopathy is desirable for early detection of infants with sickle cell disease and referral for care. Parents of infants with trait should also be tested and counseled. The resources required to set up a program that selectively screens babies of mothers with trait are enormous.
ISSUES TO BE CONSIDERED
Authors: Andrews Lori B.
Published: December 2021

The main purpose of screening is to identify infants with sickle cell anemia so that appropriate health care might be given to such infants. The following four types of legal issues will be considered: the extent to which existing state newborn screening laws can accommodate sickle cell anemia, the malpractice concerns related to sickle cell anemia screening, the need for protection of the confidentiality of the data collected by such testing, and the legal issues raised by discrimination against sickle cell carriers.

These legal issues cannot be considered in a vacuum, however. Attention must be given to the history of sickle cell screening laws in this country. When state laws mandating sickle cell anemia screening were passed in the early 1970s, they were aimed at giving people information that was helpful for making reproductive choices. Two carriers who were married, for example, had a 25% risk of giving birth to a child with sickle cell anemia. However, because there were no health care measures that could be taken to cure an affected fetus or even to safely diagnose the condition prenatally, the only potential effect of the law was to deter such couples from having children altogether, a tactic criticized as genocidal. Moreover, the early laws lacked provisions for counseling and, thus, fostered misunderstanding and anxiety. The information collected by screening programs apparently also served as a basis for discrimination against people with sickle cell trait.

The issues presented by sickle cell anemia screening of newborns are somewhat different because screening is not for the primary purpose of changing reproductive behavior but rather to identify infants who then can be treated.
AGE
Authors: Student
Published: December 2021

As one gets older, one makes all the old mistakes with ever increasing confidence.
ELECTRONIC FETAL MONITORING: WISHING AWAY TRUTH
Authors: Student
Published: December 2021

The act of throwing into stark relief the unreliability of intrapartum EFM as a predictor of long-term neurological outcome threatens two other much more important beliefs: that the use of EFM can prevent cerebral palsy and that intrapartum asphyxia is the cause of cerebral palsy. It is no wonder that there is resistance to collecting relevant evidence and giving it credence. "I had not properly realised, until this time, the power of wish to distort and deny—and its prevalence in this complex situation, where enthusiasm of doctors and the distress of patients, might lie in an unconscious collusion, equally concerned to wish away an unpalatable truth."
US WARNS DOCTORS AGAINST AGREEMENTS ON FIXING OF PRICES
Authors: L. J. F.
Published: December 2021

The Justice Department issued a stern warning to the nation's doctors today that they are under surveillance for evidence of price fixing and other violations of the antitrust laws.

Assistant Attorney General Charles R. Rule, head of the Justice Department's antitrust division, told members of the American Medical Association's House of Delegates that agreements by doctors to reduce medical competition and thus harm their patients' interest "can be hazardous to your personal freedom."

"You can go to jail," he said.

The Justice Department's enforcement policy "is necessary to insure that society's decision to rely on competition to hold down health care costs will not be frustrated by a handful of greedy individuals."

The assistant attorney general gave . . . advice to doctors: Do not make any agreement with any competing independent doctors on prices or fee schedules, on patients you will serve or locations from which you will draw patients or on joint refusal to offer services to alternative health delivery systems.
Severity of Disease Correlated With Fever Reduction in Febrile Infants
Authors: Baker Raymond C. , Tiller Tracy , Bausher Judith C. , Bellet Paul S. , Cotton William H. , Finley Alan H. , Lenane Ann M. , McHenry Christine , Perez Katherine K. , Shapiro Robert A. , Stephan Maria , Wason Suman
Published: December 2021

A prospective study of the effects of fever reduction on the clinical appearance of infants at risk for occult bacteremia was undertaken to study the hypothesis that infants with bacteremic illness fail to improve clinically following defervescence compared with infants with benign viral illness. A total of 154 children were enrolled in the study, including 19 with bacteremia: 13 with occult Streptococcus pneumoniae bacteremia, two with occult Haemophilus influenzae, type b bacteremia, and four with Haemophilus meningitis and bacteremia. There were no differences in degree of temperature reduction with acetaminophen between the bacteremic and nonbacteremic groups of infants. Among infants with bacteremia but without meningitis, differences from nonbacteremic children were detected in clinical appearance prior to fever reduction but not following defervescence. All patients with meningitis appeared seriously ill before and after defervescence. It was concluded that clinical improvement with defervescence is not a reliable indicator of the presence of occult bacteremia. Lack of clinical improvement with defervescence may be a reliable indicator for the presence of meningitis. Because there were differences in clinical appearance prior to fever reduction, routine administration of acetaminophen may interfere with the clinical evaluation by the physician.
INFANT SUFFOCATION IN LONDON (1879)
Authors: C. T. E.
Published: December 2021

The description below of infant suffocation in London, published in the Lancet a century ago, bears a striking similarity to current epidemiologic characteristics of SIDS.

The deaths of no less than 503 infants aged less than one year were referred to suffocation within registration London during last year [1878], equal to 3.9 per 1,000 children born. In the two preceding years [1876 and 1877] the deaths of infants from this cause were 488 and 486 respectively. Previous to 1876 the causes of death among infants aged less than one year were not separately distinguished in the Registrar-General's Weekly Return. The deaths from suffocation in London, at all ages have, however, shown a considerable increase in recent years, and, as during the three years 1876-7-8 no less than 88 per cent of the deaths from this cause were of infants under one year of age, it may be assumed that the increase has mainly occurred among infants. Of the 503 deaths of infants from suffocation in London last year, 140 occurred in the first, 147 in the second, 88 in the third, and 128 in the fourth quarters of the year. These infant deaths from suffocation are almost twice as numerous in cold winter weather as in summer; for instance the fatal cases in August did not exceed 24, whereas they were 43 in December.
GOOSE . . . FEATHERS?
Authors: M. R. J.
Published: December 2021

Renton, WA—A goose in every pot strikes Michael Hansford as quite a good idea. In his capacity as maintenance foreman at Coulon Beach Park here, Mr. Hansford has to tidy up after several hundred Canada geese that feed on the park's lakeside grasses and sleep on the water.

"Do I like `em? No!" says Mr. Hansford. "They look OK flying overhead, but try cleaning up after them once they hit the ground."

Canada's most contentious export (after hockey players) is out of hand. In the past several years, the black-billed, white-cheeked birds have been abandoning their migratory ways at a rising rate, settling down to year-round suburban life on lawns, fairways and shorelines from Seattle to Maine. The mess they make sets bird lovers against people rather more concerned about what is happening to choice metropolitan landscapes. . .

Increasingly, geese are besmirching parks, beaches, golf courses and other places people enjoy going. The daily output per goose, to two decimal places is 1.17 ounces, according to limnologist E.A. Manny, who has done a study. . .

"They're disgusting," says Billy Regan, co-captain and quarterback of the Belmont High School football team in Massachusetts. "Sometimes we have to do push-ups in their." . . .
USEFUL BOOKLETS
Authors: Centerwall Willard R.
Published: December 2021

Introduction to Your Child series of booklets. Willard R. Centerwall, MD, medical editor. Medic Publishing Co, PO Box 89, Redmond, WA 98073, 10-24 pages, $.75 to $.95 per single copy; quantity discounts to 50%.

This series of booklets covers the following topics:

Asthma Hydrocephalus Achondroplasia Hyperkinesis-Hyperactivity Autism Learning Disability Behavior Problem Leukemia Cerebral Palsy Low Birth Weight Cleft Lip &/or Palate Mental Retardation Club Foot Muscular Dystrophy Congenital Heart Disease Nephrosis Congenital Hip Dislocation Neurofibromatosis Cystic Fibrosis Partial Sight or Blindness Diabetes Phenylketonuria Down Syndrome Speech Disorder Epilepsy Spina Bifida Hearing Impairment Strabismus Help Through Play Turner Syndrome

These inexpensive booklets inform parents about their child's possibly handicapping condition. The style tends to be easier to read and less technical than in many patient booklets. Content is, nonetheless, rather comprehensive—more so than with most material. For many of the titles, all issues appear to be addressed in detail.

The text is arranged in a question-and-answer format. It reinforces the answers already given by the physician on such topics as etiology and heredity. It adds those questions and answers which may not have been discussed, such as on education and social aspects. The parent's responsibilities in treatment are stressed, making compliance more likely. The role of the physician is also described, and the importance of follow-up visits is emphasized. There are helpful illustrations, many of which can be used to aid the doctor's communication with the family.

The most recently expanded and revised editions include Asthma, Hearing Impairment, Low Birth Weight, and Hyperkinesis (ADHD). These and all the other titles are available from one source—a distinct advantage to the practicing physician.
REVIEWS OF LAY LITERATURE ON CHILD CARE: WHAT PARENTS ARE READING
Authors: Glascoe Frances P. , Moore William R. , Henderson James , Martin Elaine D.
Published: December 2021

Dreikurs R, Stoltz V. Children: The Challenge. 2nd ed. New York, NY: Dutton; 1987; list price $7.95 (#9 on the 1988 bestseller list of books on child care of the Ingram Book Co, distributors of trade books).

Dreikurs considers development based on the mutual regulation between parent and child. Addressing issues in discipline and behavior from infancy to early adolescence, he perceives the parents' role as model, nurturer, and instructor, although mothers are given more responsibility for child-care than fathers. Various methods are offered for resolving conflicts in a range of typical problem situations. Techniques involve active listening, use of natural consequences, limit setting, etc. From toilet training to sibling rivalry, children's motives for misbehavior are explained. The text illustrates both theory and practice in child-rearing so that the principles learned are not only corrective and instructive, but also preventive. The difficulties of parenthood, peer, media, and sibling pressures are addressed but not the needs of special children. There is some presumption that families are intact and that a homemaker is present. The book is well-organized and rated as easy to read. Fairly believable vignettes illustrate parents' and children's contributions to situations of conflict. A section at the end of the book gives parents an opportunity to practice and review newly learned skills and principles.
ALAS, POOR MELVIN
Authors: M. R. J.
Published: December 2021

Sausalito, CA—Come dinner time aboard his yacht Adequate Award, and Melvin Belli really knows how to put on the dog. Tonight, his dining-room table is set with bone china and sterling silver, and browsing among the tableware is one hungry Italian greyhound. I know the animal is hungry because he has walked across the table and taken a bite of my bread plate. . .

There are those who would have you believe that Mr. Belli, the King of Torts, has become so eccentric that more than dinner is becoming chaotic. . .

Since summer, the 81-year-old lawyer has been barred by court order from his 25-room San Francisco mansion. His wife got the order after filing a petition for legal separation. She complained at the time to reporters and police that Mr. Belli physically and verbally abused her and their teenage daughter. Even more bizarre, she claims that he falsely accused her of having sex with a number of family friends, including celebrities of both sexes. . .

Another shot fired across the bow: In a lawsuit pending in Tax Court, the Internal Revenue Service contends that Mr. Belli, in effect, back-dated documents to avoid paying gift taxes in a transaction involving his San Francisco law-office building. . .

His firm, Law Offices of Melvin Belli, Sr., is on trial, too, these days. Three years ago, Mr. Belli lost a malpractice case resulting in a $3.8 million judgement against him. Since then, six more malpractice suits have been filed against him in San Francisco Superior Court. . .
UPDATE ON THE WORLD'S CHILDREN
Authors: Student
Published: December 2021

Less than 5% of the poor world's children were being immunised at the start of the decade. Now the proportion is over 50%. The UN target is 85% vaccination coverage by the end of 1990. China is expected to achieve this by the end of this year, and India, with 20% of the world's infants, is now passing the 60% level. Immunisation saves lives and reduces morbidity—poliovaccination prevents 190 000 cases every year. But only 25% of pregnant women are vaccinated against tetanus, which kills 800 000 infants annually. Improvemments in transport and cool storage of vaccines have extended the reach of immunisation programmes. Almost half the developing world's children are not protected by immunisation—another 2-3 million lives could be saved and 240 000 cases of poliomyelitis could be prevented a year. Rapid spread of knowledge about family planning, especially birth spacing, is a major break-through. Births that are "too many or too close" or to mothers who are "too old or too young" cause up to a quarter of all maternal and infant deaths world wide. Sensible spacing of births could save the lives of 3 million children and 200 000 mothers every year. The use of oral rehydration therapy saves almost a million children annually and has been a success story. But another 1.6 million child deaths from diarrhoea could be saved if use of this simple and cheap technigue could be extended.
Behavioral Distress in Pediatric Patients With Cancer Receiving Chemotherapy
Authors: Dolgin Michael J. , Katz Ernest R. , Zeltzer Lonnie K. , Landsverk John
Published: December 2021

The purpose of this study was to assess prospectively the behavioral effects of chemotherapy in children and adolescents with cancer. A total of 94 patients, with a range of malignancies and chemotherapy protocols, were evaluated 1, 4, and 7 months after treatment initiation. Assessments focused on behavioral distress symptoms and nausea/vomiting experienced in anticipation of chemotherapy and following its administration. Significant disturbances were described in a variety of domains, with adolescents exhibiting consistently higher levels of behavioral symptoms and nausea/vomiting than younger children. Behavioral distress tended to decrease and stabilize throughout time for children and to increase throughout time for adolescents. Age differences in behavioral distress were independent of the emetogenicity of therapy given to younger and older patients. The interaction of biologic and psychosocial factors in determining treatment-related distress is discussed, along with implications for future predictive and intervention studies.
Pediatric Endocrinologic Recommendations, Pediatric Practice, and Current Pediatric Training Regarding Care of Children With Diabetes
Authors: Golden Michael P. , Hibbard Roberta Ann , Ingersoll Gary M. , Kronz Kathleen K. , Fineberg Naomi S. , Marrero David G.
Published: December 2021

Many pediatric diabetes patients are cared for by community-based pediatricians. Training for pediatricians in optimal diabetes care should be based on both the recommendations of pediatric endocrinologists regarding optimal care and the practices of general pediatricians. Pediatric endocrinologists, general pediatricians, and pediatric residency coordinators were surveyed to assess the consonance of current recommendations, practices, and training in pediatric diabetes care. Not surprisingly, pediatric endocrinologists recommended more subspecialty care than pediatricians reported practicing. A major difference between endocrinologists and pediatricians emerged in the area of psychosocial support. A total of 85% of endocrinologists answered that there should be a mental health diabetes team member, but only 37% of pediatricians reported often or sometimes working with one to develop care plans. Pediatricians who provide complete diabetes care for most of their patients measure frequent glycosylated hemoglobin levels, obtain yearly lipid measurements marginally less often, and use urinary glucose measurements more often than recommended by pediatric endocrinologists. According to the descriptions of most pediatric residency training programs, multidisciplinary teams include a pediatrician, an endocrinologist, and a dietician. However, 25% do not include a social worker or nurse and 70% do not include a psychologist. Although most training programs operate on the assumption that their trainees will ultimately share responsibility with a subspecialist for diabetes care, in 26% of programs residents saw no diabetics in their continuity clinics. Most residents do not participate in providing diabetes education. In summary, pediatricians provide a large amount of diabetes care nationwide. Their reported practices are, in general, consistent with those of pediatric endocrinologists but significant deficits appear to exist with reference to appropriate use of psychosocial support. The need exists for training programs in pediatrics to recognize the large amount of diabetic care actually provided by pediatricians when designing training for their residents. Programs should include longitudinal experience with diabetes patients, involve residents in patient education, and provide a model for multidisciplinary care that includes psychosocial support.
Prehospital Intraosseous Infusion by Emergency Medical Services Personnel: A Prospective Study
Authors: Seigler Robert S. , Tecklenburg Fred W. , Shealy Ralph
Published: December 2021

Intraosseous infusion technique by paramedics in the prehospital setting was prospectively evaluated. Intraosseous access was successfully established in 16 of 17 pediatric patients with cardiopulmonary arrest. There were 13 successful first attempts with intraosseous access established within 1 minute. No significant complications occurred. In this study, the ease of establishing intraosseous access by paramedics in the field is documented.
Combined Medicine/Pediatrics Training Programs
Authors: MIDDELKAMP J. NEAL
Published: December 2021

Ferrari and Shumway in their article in this issue of Pediatrics provide information concerning the combined medicine/pediatrics training programs. These programs were initiated in 1967 but attracted little attention until recent years, during which the rapid proliferation and the number of positions offered has reflected the increasing interest of housestaff applicants in such programs. In 1980, there were 4 programs (9 positions); in 1983, 13 programs (45 positions); in 1985, 56 programs (161 positions); in 1987, 70 programs (206 positions,); and in 1988, 76 programs (232 positions). By comparison, in pediatrics, there were 1808 positions in 1980 and 2009 positions in 1987, whereas in categorical internal medicine, there were 5078 positions in 1980 and 5341 positions in 1987.
OGDEN CODMAN ON NURSERIES
Authors: McNamara John J.
Published: December 2021

Ogden Codman, Jr. (1863-1951), America's first significant interior designer is the subject of a retrospective at the Boston Athenaeum in 1989. The last chapter of his book, The Decoration of Houses, is devoted to schoolrooms and nurseries. Codman's decorating sense was classic and in the grand manner, however nurseries were to be functionally simple but stimulating. The child's environment conditions asthetic growth.

"The esthetic sensibilities wake early in some children." However, "parents of such children often think that no special care need be spent on their surroundings, a curious misconception. "If art is really a factor in civilization it seems obvious that the feeling for beauty needs as careful cultivation as the other civic virtues." "Children are not reached by abstract ideas." "The child's mind must be prepared by daily lessons in beauty." "To sum up then . . . the child's visible surroundings form the basis of the best . . . cultivation: . . . the development of any artistic taste . . . indirectly broadens the whole view of life."

Would that it were so! According to the Select Panel for the Promotion of Child Health, United States Children live under the following circumstances. 0.9% in homes without piped in water, 21.8% water not obtained from a system, 34% not connected to a public sewer. 11.2% in run down housing, 8.2% in abandoned structures, 12.8% with leaky basements, 7.5% with leaky rooves, 7.3% with cracks in the walls and ceilings, 5.1% with peeling paint and plaster, 2.8% with holes in the floors.
Neurodevelopmental Progress of Young Children With Chronic Renal Disease
Authors: Geary Denis F. , Haka-Ikse Katerina
Published: December 2021

Neurodevelopmental progress was prospectively studied in 33 children with chronic renal disease during a mean of 1.68 years. The mean age of the children when first evaluated was 1.11 years. Children with all levels of renal dysfunction were included, although end stage renal disease developed in 17 at some time during the study. When last evaluated, 10 of the children were developmentally delayed, 8 mildly delayed, and 2 moderately delayed. The developmental level achieved was significantly related to the children's growth and to the severity of their renal impairment. Also found was a strong correlation between the developmental quotients at first and final evaluations. This finding suggests that improvement throughout time is unlikely and underlines the need for early diagnosis and treatment of such infants. These observations suggest that the neurodevelopmental outcome of infants with chronic renal disease is considerably better than previously reported.
Upper Airway Measurements During Inspiration and Expiration in Infants
Authors: Gunn Tania R. , Tonkin Shirley L.
Published: December 2021

Accurate measurements of the upper airway of the infant are important but are difficult to obtain reliably because of the normal variation that occurs during respiration. X-ray films of the lateral upper airway were obtained during inspiration and expiration in healthy infants, by using as a timing device a respiration monitor which was wired to the x-ray machine and was attached to the abdominal wall of the infant. Cephalometric measurements were made of 44 "normal" full-term neonates and 29 infants at 6 weeks of age. Despite significant differences in head circumference between the sexes, only the nasion to sella length was significantly longer in the boys (P < .01). The lateral upper airway measurements were independent of weight, head circumference, and sex in the neonates and infants at 6 weeks of age but were significantly smaller during inspiration than expiration (P < .01). The measurements progressively increased from the middle to the posterior airway space at both ages. The middle airway space behind the caudal end of the hard palate was smaller during inspiration at 6 weeks of age compared to the neonate (P < .01). During expiration, the posterior airway space was larger at 6 weeks compared to the neonate (P < .01). The method described in this report enables reliable roentgenographic measurements to be made of the upper airway of the infant; normal values for the changes during inspiration and expiration are provided. This may assist in the evaluation of infants with suspected upper airway obstruction.
HEALTH HAZARDS OF EXCESSIVE STUDY IN THE BOSTON PUBLIC SCHOOLS (1854)
Authors: C. T. E.
Published: December 2021

During the mid-nineteenth century American physicians were greatly troubled by what they thought were the evils of excessive academic demands placed on children in our public schools. The editorial below, published in 1854 in the Boston Medical and Surgical Journal, is typical of many of a similar nature.

Our city prides itself on the superiority of its public schools; and we think Boston is justly entitled to take the highest rank among the cities of the civilized world for the facilities afforded by its citizens for the education of youth. But notwithstanding the large expenditure of money for the erection of beautiful and commodious school-houses, for mathematical and other instruments, for teachers, &c., all which give a character to our Boston schools, there exists an evil in the present system of educating, which seriously demands attention, and, if possible, a remedy. It is the ambition of the teachers of our schools, to have their scholars thoroughly instructed, and that they may appear well before the committees at examinations; and for that purpose, lessons in great numbers and requiring toilsome study, are imposed upon them. No discrimination is made, as regards the mental or physical capacity of the individual members of the class, but all are required to be perfect in their answers, or else they lose their position in the class and school. Not one fifth of the time devoted to school hours is allowed for study, being occupied in recitations; and the severe tasks the poor children have in getting their lessons must be apparent, when it is known that so long a time is required in reciting them. The scholars of the second class, for instance, have to commit to memory from twelve to twenty-five pages of geography, three to six pages of arithmetic, the same of grammar, three pages in spelling, besides exercises in reading, writing, &c. Now these lessons must be studied out of school, at the time which should be devoted to exercise and recreation. The imposition of such severe tasks upon the young and growing children, must enfeeble their constutions, and often incapacitates them, if they arrive at maturity, for enjoying life. We have seen many children who were ambitious to accomplish all that was required of them by teachers; and to do so, the greatest portion of the twenty-four hours was necessarily devoted to their books, scarcely allowing any time for taking their meals. It must be obvious to every one, that such close application to study, produces, in their turn, a train of diseases which cannot always be eradicated. Aching heads, loss of appetite, sleepless nights, inflamed eyes, with other deviations from health, are the accompaniments and the consequences of excessive mental exertion.
General Pediatric Clinic Practice Management: Results of a Survey of Academic Departments
Authors: Berkelhamer Jay E.
Published: December 2021

The purpose of this survey is to provide an overview of hospital-based general pediatric clinics (GPCs) from the perspective of the practice manager. Academic pediatric departments located in the United States were surveyed to gather information regarding a number of issues relevant to the operation of their GPCs. These issues include educational efforts related to practice management, personnel allocation, financial performance, organizational formats, administrative arrangements, and access to primary care services for children of poor families. Of 131 surveys, 94 were returned (72% response rate). There were an average of 15 486 visits per year to GPCs, and the number of visits overall has increased by 11.9% during the past 5 years. Educational efforts related to practice management vary greatly within GPCs; less than half report any. The overall staff ratios per faculty physician are similar to those in nonteaching practices but differ in composition because of training activities inherent to GPCs. There is an average loss of $250 000 per clinic at GPCs. Organizational formats vary considerably; the majority of physician directors have no line-management authority for nursing and clerical staff. Survey results confirm that GPCs serve a large number of poor children with 41.3% funded by Medicaid and 16.0% unable to pay out-of-pocket expenses. GPCs are generally not used to teach practice management, tend to lose money, and have little faculty involvement in their management.