bluuebunny/crossref_metadata_2025 huggingface dataset:
Pharyngitis—Principles of Judicious Use of Antimicrobial Agents
Authors: Schwartz Benjamin , Marcy S. Michael , Phillips William R. , Gerber Michael A. , Dowell Scott F.
Published: December 2021

Accurate diagnosis of group A streptococcal pharyngitis and appropriate antimicrobial therapy are important, particularly to prevent nonsuppurative sequelae such as rheumatic fever. Most episodes of sore throat, however, are caused by viral agents. Clinical findings cannot reliably differentiate streptococcal from viral pharyngitis and most physicians tend to overestimate the probability of a streptococcal infection based on history and physical examination alone. Therefore, diagnosis should be based on results of a throat culture or an antigen-detection test with throat culture backup. Presumptively starting therapy pending results of a culture is discouraged because treatment often continues despite a negative test result. Other bacterial causes of pharyngitis are uncommon and often can be diagnosed based on nonpharyngeal findings. Penicillin remains the drug of choice for streptococcal pharyngitis because of its effectiveness, relatively narrow spectrum, and low cost. No group A streptococci are resistant to β-lactam antibiotics. High rates of resistance to macrolides has been documented in several areas; in Finland, decreased national rates of macrolide use led to a decline in the proportion of macrolide-resistant group A streptococci.
Cough Illness/Bronchitis—Principles of Judicious Use of Antimicrobial Agents
Authors: O'Brien Katherine L. , Dowell Scott F. , Schwartz Benjamin , Marcy S. Michael , Phillips William R. , Gerber Michael A.
Published: December 2021

Millions of courses of antibiotics are prescribed for children with acute cough illness each year, despite evidence from randomized, placebo-controlled trials that such treatment is not effective. Evidence that children with cough for ≤10 days should not be treated with antimicrobial agents is presented. Older children with prolonged cough or those with underlying lung disease may benefit from antimicrobial treatment directed specifically at B pertussis, M pneumoniae, C pneumoniae, P aeruginosa, or other specific infections. None of the routinely prescribed cephalosporin or amino penicillin antimicrobials would be effective for these organisms. Noninfectious diagnosis should be sought in children with markedly prolonged cough.
Antenatal Detection of Hereditary Disorders, by Henry L. Nadler, MD,Pediatrics, 1968;42:912–918
Authors: Hoyme H. Eugene
Published: December 2021

Amniotic fluid cells obtained by transabdominal amniocentesis at various stages of pregnancy were cultivated successfully. The intrauterine detection of Down syndrome, galactosemia, and mucopolysaccharidosis was established using the cultivated amniotic fluid cells. The use of this procedure increases the precision of genetic counseling and should stimulate the development of new approaches for the intrauterine management of genetic defects. However, until considerably more experience is gained with these techniques, the procedures should be considered experimental.
The Role of Auxologic and Growth Factor Measurements in the Diagnosis of Growth Hormone Deficiency
Authors: Hintz Raymond L.
Published: December 2021

The use of auxologic measurements in the diagnosis of short stature in children has a long history in pediatric endocrinology, and they have even been used as the primary criteria in selecting children for growth hormone (GH) therapy. Certainly, an abnormality in the control of growth is more likely in short children than in children of normal stature. However, most studies have shown little or no value of auxologic criteria in differentiating short children who have classic growth hormone deficiency (GHD) from short children who do not. In National Cooperative Growth Study Substudy VI, in more than 6000 children being assessed for short stature, the overall mean height SD score was −2.5 ± 1.1 and the body mass index standard deviation score was −0.5 ± 1.4. However, there were no significant differences in these measures between the patients who were found subsequently to have GHD and those who were not. There also was no consistent difference in the growth rates between the patients with classic GHD and those short children without a diagnosis of GHD. This probably reflects the fact that we are dealing with a selected population of children who were referred for short stature and are further selecting those who are the shortest for additional investigation.

Growth factor measurements have been somewhat more useful in selecting patients with GHD and have been proposed as primary diagnostic criteria. However, in National Cooperative Growth Study Substudy VI, only small differences in the levels of insulin-like growth factor I and insulin-like growth factor binding protein 3 were seen between the patients who were selected for GH treatment and those who were not. Many studies indicate that the primary value of growth factor measurements is to exclude patients who are unlikely to have GHD or to identify those patients in whom an expedited work-up should be performed. The diagnosis of GHD remains difficult and must be based on all of the data possible and the best judgment of an experienced clinician. Even under ideal circumstances, errors of both overdiagnosis and underdiagnosis of GHD still are likely.
Early Emotional Development: New Modes of Thinking for Research and Intervention
Authors: Emde Robert N.
Published: December 2021

Recent thinking about early emotional development in a context useful for pediatricians and other clinicians is reviewed in this chapter. Important functions of emotions are that they help define individuality, motivate approach or withdrawal from a situation, and communicate with caregivers. Emotional development in the first years of life may be seen as a series of predictable stepwise transitions when changes are pervasive and involve major reorientation for children and families.
Mother and Infant: Early Emotional Ties
Authors: Klaus Marshall
Published: December 2021

Recent behavioral and physiologic observations of infants and mothers have shown them ready to begin interacting in the first minutes of life. Included among these findings are the newborn infant's ability to crawl toward the breast to initiate suckling and mother–infant thermoregulation. The attachment felt between mother and infant may be biochemically modulated through oxytocin; encouraging attachment through early contact, suckling, and rooming-in has been shown to reduce abandonment.
Environmental Risk Factors in Infancy
Authors: Sameroff Arnold J.
Published: December 2021

Environment plays an important role in shaping development from the newborn period through adolescence. Many individual environmental risk factors may impinge on development (poverty, mental illness, minority status, and many others), but the most detrimental effects are caused when multiple risk factors act on a single infant. These effects were revealed by the Rochester Longitudinal Study, an ongoing comprehensive investigation of environmental risk factors, summa rized in this article.
Behavioral Outcomes in Low Birth Weight Infants
Authors: McCarton Cecelia
Published: December 2021

Low birth weight infants are at increased risk for behavioral and emotional problems. The Infant Health and Development Program was designed to evaluate the efficacy of intense pediatric and family support on reducing developmental and behavioral problems in low birth weight, premature infants. The major findings of this and other studies are presented in this article.
Holistic Pediatrics: A Research Agenda
Authors: Kemper Kathi J. , Cassileth Barrie , Ferris Timothy
Published: December 2021

Increasing numbers of American families seek complementary and alternative medical care (CAM) for their children; at the same time health care organization and financing are undergoing radical changes. The combination of these factors provides a powerful incentive for research on the effectiveness and safety of CAM therapies and their role in treating children. This article describes a rationale, spectrum, priorities, and methodologies for a research agenda in holistic pediatrics. The top priorities are clinical research projects addressing the safety and effectiveness of alternative therapies used for vulnerable children suffering from serious illnesses. Additionally, major research questions involve the impact of the various definitions such as “alternative,” “complementary,” “folk,” “integrative,” and “holistic” medicine on perceptions of health care, professional education, and funding of products and services. Research efforts in alternative therapies need to address explicitly the tremendous heterogeneity between and among the practices, beliefs, and providers of professional and lay services. Qualitative ethnographic research is needed to understand the consequences of diverse explanatory models and meanings of health and illness for patient-provider communication, adherence with professional recommendations, and satisfaction with care. Health services researchers need to address questions related to the epidemiology of CAM practices, health manpower issues, practice characteristics and the process and content of health care and how discoveries about CAM care may enhance the quality of mainstream health services. A rationale is provided for prioritizing certain conditions and therapies within these efforts.
Outcome Measures of Interventions in the Study of Children of Substance-abusing Parents
Authors: Kumpfer Karol L.
Published: December 2021

Children of substance-abusing parents, including children of alcoholics (COAs), are one of the highest risk groups of youth for substance-abuse problems. For both genetic and family environmental reasons, COAs and children of drug abusers are very vulnerable to becoming alcohol or other drug abusers.1,2 With drug use rates increasing in the past 7 years,3 prevention practitioners must work harder to identify and evaluate effective ways to prevent future substance abuse in these at-risk children. Most prevention programs designed specifically for COAs or children of drug abusers have struggled with identifying, attracting, maintaining, and measuring outcomes.

This article focuses on general and unique measurement methods and instrument problems in prevention interventions for children of substance-abusing parents. Part I covers the need for improved measurement in research and practice with children of substance-abusing parents and recommended measures for different hypothesized outcome variables. Part II covers considerations in selecting measures, and Part III covers how to select measures. This article concludes with recommendations to improve measurement in research and practice.
State Health Agencies and Quality Improvement in Perinatal Care
Authors: Johnson Kay A. , Little George A.
Published: December 2021

The origin of the federal-state partnership in Maternal and Child Health (MCH) can be traced from the Children's Bureau grants of 1912, through the Sheppard-Towner Act, to the creation of Title V and other programs of today that mandate planning, accountability, and systems development. In the past decade with the transformation of the health care system and the emergence of managed care, there has been a resurgence of interest in public, professional, and governmental interest in quality measurement and accountability. Regional perinatal systems have been implemented in all states with varying levels of involvement by state health agencies and the public sector. This historical framework discusses two primary themes: the decades of evolution in the federal-state partnership, and the emergence in the last three decades of perinatal regional system policy, and suggests that the structure of the federal-state partnership has encouraged state variation.

A survey of state MCH programs was undertaken to clarify their operational and perceived role in promoting quality improvement in perinatal care. Data and information from the survey, along with five illustrative state case studies, demonstrate great variation in how individual state agencies function. State efforts in quality improvement, a process to make things better, have four arenas of activity: policy development and implementation, definition and measurement of quality, data collection and analysis, and communication to affect change. Few state health agencies (through their MCH programs and perinatal staff) are taking action in all four arenas. This analysis concludes that there are improvements MCH programs could implement without significant expansion in their authority or resources and points out that there is an opportunity for states to be more proactive as they have the legal authority and responsibility for assuring MCH outcomes.
Lack of Pediatric Drug Formulations
Authors: Nahata Milap C.
Published: December 2021

Many drugs frequently used in infants and young children are not available in suitable dosage forms. Liquid dosage forms must be prepared extemporaneously, while using appropriate excipients. However, it is critical to determine the stability of various drugs at clinically important concentrations and practical storage conditions. It is of concern that few funding agencies are willing to support research on the development of stable liquid dosage forms for pediatric patients. The need for such data will continue, because it is unlikely that all drugs approved for adults will also be labeled simultaneously for potential use in infants and children. Presentations and publications on stable drug formulations will offer the opportunities for pediatric patients to receive the desired drugs and doses most effectively and safely.
Primary Care Role in the Management of Childhood Depression: A Comparison of Pediatricians and Family Physicians
Authors: Rushton Jerry L. , Clark Sarah J. , Freed Gary L.
Published: December 2021

Objective.

To provide a self-described assessment of pediatricians' and family physicians' management of childhood depression.

Design.

Mail survey of 595 general pediatricians and 557 family physicians in North Carolina.

Results.

The response rate was 66%. Most primary care physicians used referral (65%) and counseling (61%) for management of childhood depression. Family physicians used medications more commonly (18% vs 9%), and pediatricians referred patients more commonly (77% vs 48%). In logistic regression analysis, physicians comfortable with management of depression (odds ratio [OR], 4.8: 2.7–8.4), physicians who believed that antidepressants are more effective than counseling (OR, 2.6: 1.4–4.8), and family physicians (OR, 2.2: 1.9–4.1) were more likely to have used medications for childhood depression.

Conclusions.

Most primary care physicians refer pediatric patients with depression; however, practice patterns vary by specialty and other factors. Future studies must consider the role of primary care and evaluate how interspecialty variations affect costs and outcomes of childhood depression.
Measuring Consumer Experiences With Primary Care
Authors: Cassady Charlyn E. , Starfield Barbara , Hurtado Margarita P. , Berk Ronald A. , Nanda Joy P. , Friedenberg Lori A.
Published: December 2021

Objective.

To assess the adequacy of the Primary Care Assessment Tool-Child Edition (PCAT-CE) for evaluating the attainment of the key characteristics of primary care services for children and youth.

Design.

Community-based telephone survey.

Setting.

Specific political subdivision in Washington, DC.

Participants.

Four hundred fifty parents/guardians of offspring 18 years of age or less.

Measures.

Reliability, validity and principal component analysis of 5 scales representing key aspects of the 4 cardinal domains of primary care included in the PCAT-CE. In addition, 2 subdomains (first contact use and extent of affiliation with a primary care source) were included as indices to describe overall patterns of use and affiliation with the particular source of care.

Results.

Most scales had adequate internal consistency, test-retest reliability, and construct validity. The principal components factor analysis yielded 5 separate factors. These corresponded to the subdomains of first contact accessibility; coordination of care; characteristics of the professional-patient relationship over-time; and comprehensiveness (both services available and indicated services received).

Conclusions.

Psychometric assessment supported the integrity and general adequacy of the PCAT-CE for assessing the characteristics and quality of primary care for children and youth. Testing of revised versions in a variety of different settings is underway. A major component of this testing is to explore the possibility of reducing the number of items while retaining sufficient detail about each component of primary care to make judgements about people's experiences with that care.
Final Report of the FOPE II Pediatric Subspecialists of the Future Workgroup
Authors: Gruskin Alan , Williams Roberta G. , McCabe Edward R. B. , Stein Fernando , Strickler Jeffrey , Chesney Russell W. , Mulvey Holly J. , Simon Jimmy L. , Alden Errol R.
Published: December 2021

The report of the Pediatric Subspecialists of the Future Workgroup of the Second Task Force on Pediatric Education reviews the critical changes of the past 2 decades that have affected the provision of pediatric subspecialty services, education of pediatric health care providers, and the acquisition and application of new knowledge. The report considers the future needs that will determine the ability of pediatric subspecialists to meet identified goals. Recommendations for change in the education, role, and financing of the pediatric subspecialist are reported together with those of other workgroups. Pediatrics2000;106(suppl):1224–1244; pediatric subspecialist, pediatric subspecialist workforce, education pediatric subspecialist, research pediatric subspecialist.
Final Report of the FOPE II Pediatric Workforce Workgroup
Authors: DeAngelis Catherine , Feigin Ralph , DeWitt Thomas , First Lewis R. , Jewett Ethan A. , Kelch Robert , Chesney Russell W. , Mulvey Holly J. , Simon Jimmy L. , Alden Errol R. ,   The FOPE II Workforce Workgroup
Published: December 2021

From the inception of the Future of Pediatric Education II (FOPE II) Project, it was acknowledged that any discussion of pediatric education would need to encompass a review of the pediatric workforce. This report looks at the current trends in pediatric workforce and draws some conclusions regarding future growth and composition. In addition to looking at demographic trends, ranging from geography to gender, the report explores influences including managed care, telemedicine, and others. Models for determining workforce needs are described and scenarios and projections are discussed. Pediatrics 2000;106(suppl):1245–1255;pediatric workforce.
Round Table Discussion
Authors: LANGFORD WILLIAM S. , JENSEN REYNOLD A. , GRENNBERG MILTON M. , LYNCH HAROLD D.
Published: December 2021

Chairman Langford: In the personality and physical growth of the individual there are some periods when the task of adjustment is a little more difficult than others. We see it at weaning, when the child starts school, at adolescence, on his first job, later when he gets married and—one of the most severe trials of all—when the individual becomes a parent. About 90% could be called normal disturbances in this area of adolescence and psychologic disturbances.

Dr. Cornelia M. Carithers, Jacksonville, Fla.: When you see a marked problem such as rivalry between children, how do you convince the parent it is a real problem?

Chairman Langford: One of the more common instances is the jealousy of the younger child for the older child. This may enter the picture with the obese child. Often it is the younger child who will become obese for the satisfaction he gets out of the tremendous body size. The problem of obesity may be of particular significance in the adolescent period. It may be a phase that many children go through as part of this gradual growth process but it also may be related to other factors; this suggests that when dealing with a child who is heavier than he or she should be, one ought to individualize each child who presents the problem. Therefore, it is necessary for those of us who deal with these children to determine what is a normal gain in weight for a period of time and what is outside the range of normal.
Symposium
Authors: RATNER BRET , GRUNBERG EMANUEL , BURKE J. C.
Published: December 2021

The discovery of streptomycin has shown the way by which therapeutic activity against the causative agent of tuberculosis can be found and evaluated in the laboratory prior to its administration in patients. A great number of substances synthesized by the chemist in his laboratory or isolated from natural sources have been found to exert activity against the bacillus of tuberculosis. Many of these show this effect only in the test tube and prove without effectiveness if studied in experimental animals infected with tuberculosis.

The new antituberculous agent, isonicotinic acid hydrazide (rimifon®), is a rather simple synthetic compound which was found to be superior to known antituberculous drugs during early stages of the laboratory investigation. Rimifon® possesses not only a remarkably high growth inhibiting effect against the tubercle bacillus in the test tube but also unusual features if studied in infected animals. Most of the fundamental work which has been confirmed in laboratories all over the world was done in mice which were infected with high and fatal doses of human tubercle bacilli. In this infection rimifon® showed 4 characteristic properties which had not been observed with any of the known drugs: (1) the drug protected heavily infected mice after administration of very small doses, (2) the drug successfully prevented the multiplication of the tubercle bacilli in the infected tissues of the animal and therefore (3) produced a lasting protection after discontinuance of therapy, and (4) if given therapeutically in animals in which the disease had already produced its characteristic lesions the drug tended to stop further development of the disease and to prepare the ground for the final cure.

In sharp contrast to the broad spectrum antibiotics acting on a multitude of pathogenic bacteria and even viruses, rimifon® is a specific drug in the strict sense of Ehrlich's concept of chemotherapy in that it exerts its activity only against the group of mycobacteria of which the most important representatives are the tubercle bacillus and bacillus of Hansen's disease (bacillus leprae).
TRANSIENT DIABETES IN INFANCY
Authors: AREY STUART LANE
Published: December 2021

An example of a transient diabetic state in infancy is reported, together with a review of four others and a discussion of possible etiologic factors.
SPECIAL ARTICLE
Authors: LANGFORD WILLIAM S. , GILDER RODMAN , WILKING VIRGINIA N. , GENN MINNIE MARDER , SHERRILL HELEN H.
Published: December 2021

A major problem of child health today is the prevention of accidents. Part of the answer to this problem lies in the answer to the question of why some children have more than their share of accidents. Although there is an extensive literature on the accident-susceptible or accident-prone adult, there has been but little written on this aspect of the accident-prone child. Much remains to be done in order to identify the respects in which children who have repeated accidents differ from their fellows. In spite of the lack of reported studies of children there has been a tendency to talk about the accident-prone child and to attribute to him the personality characteristics and motivations seen in the adult accident repeater. It was with a desire to do something about it, and not merely to talk about it, that the study, of which this paper is a preliminary report, was begun at the Babies Hospital of the Columbia-Presbyterian Medical Center, New York, in the fall of 1951.

The purpose of this investigation was to explore methods for identifying and determining the significance, in relation to the incidence of accidents in children, of parental attitudes, parent-child relationships, environmental accident hazards, personality characteristics and functioning of the child, physical coordination and physical disabilities as these are reflected in the experience of the accident repeater. It was planned to do this through the study of a relatively small number of children of school age and their environment, both personal and physical, comparing a group who have had repeated accidents with a group who have no accident history. Even though the number of children studied would be small some questions might be answered. In addition, leads for further investigations with a larger number of children might emerge. In any event, it would be discovered whether the proposed approach in the study would bring out meaningful information.

The plan was to select for investigation 10 or 12 children of average intelligence who had been brought to the Emergency Clinic of the Columbia-Presbyterian Medical Center for treatment of accidental injuries at least 3 times during the 18 month period prior to the outset of the study. Children whose only accidents had been traffic or who had had severe or repeated head injuries were to be included.
IMMUNOFLUORESCENT AND HISTOLOGIC FINDINGS IN THE HEMOLYTIC UREMIC SYNDROME
Authors: Gervais Marc , Richardson John B. , Chiu Jane , Drummond Keith N.
Published: December 2021

Pathologic and immunopathologic studies were done in four patients with the hemolytic uremic syndrome. The principal lesions involved the endothelial and subendothelial regions of the renal arterioles and of the glomerular capillaries. The endothelial cells were swollen and, in the case of the glomerular capillary loops, separated from the basement membrane by an accumulation of material in the subendothelial space. In contrast to the glomerular capillaries, the endothelial changes in the renal arterioles were associated with a striking deposition of fibrinogen or its derivatives. No evidence for the operation of immune mechanisms of the type known to be associated with the development of vascular pathology was found to account for the microangiopathy.
THE USE OF BUFFERED L-ARGININE IN THE TREATMENT OF CYSTIC FIBROSIS
Authors: Solomons Clive C. , Cotton Ernest K. , Dubois Reuben , Pinney Margo
Published: December 2021

Buffered L-arginine was administered to 22 patients with cystic fibrosis in an attempt to improve pulmonary function and fat absorption. Arginine was selected because of its low toxicity, ability to break hydrogen bonds, bind metal ions, and act as a detergent.

When arginine was administered by inhalation as an ultrasonicated mist to eight patients with chronic lung diseases, improvements occurred in vital capacity, thoracic gas volume, specific conductance, and arterial Po2. Oral administration of arginine to patients with predominantly gastrointestinal symptomatology resulted in rapid relief of abdominal pain, weight gain in all the patients treated in this fashion, and improved fat absorption in 11 out of 14 patients. There were no important side effects attributable to the inhalation or oral administration of buffered arginine.
Formula Fatality
Authors: Coodin Fischel J. , Gabrielson Ira W. , Addiego Joseph E.
Published: December 2021

Most American mothers have come to consider cow's milk, particularly when modified and marketed as a proprietary formula, as the ideal replacement for breast milk as an infant food. The preparation of the baby's "bottle" has been simplified to a degree unknown even a generation ago. This simplification carries with it inherent dangers, as illustrated in the case described.

This 3-week-old Caucasian female infant was spontaneously delivered at term of a 15-year-old Spanish-speaking unmarried primigravid mother on June 22, 1969. There were no ante- or postnatal complications. Birth weight was 8 lb 6 oz. Mother and infant (weighing 8 lb 8 oz) were discharged from hospital on the third day.
A Committee on Long-Range Planning for Pediatrics?
Authors: Schulman Jerome L.
Published: December 2021

We are in an era of great sociological unrest and change. This has affected medicine considerably, but as yet in a miniscule fashion compared to what is in store in the relatively near future. Medicine has the opportunity of being the trail-blazer, the innovator or it can take the opposite tack and, when compelled, take a few reluctant steps at a time, trying to catch up with things fashioned by others.

The Academy of Pediatrics was founded as a progressive and forward looking group and dared to challenge tradition.
Letters to the Editor
Authors: Shwachman Harry
Published: December 2021

In reply to the letter of Dr. Phillip A. Cohen I should like to point out that the article referred to was designed primarily to present the advantages accrued from establishing a diagnosis of cystic fibrosis early in life and instituting a therapeutic program. To outline this therapeutic program in detail was not the purpose of the paper. The opening statement in the paragraph discussing treatment refers to Shirkey's Pediatric Therapy and I should like to quote from this chapter, second edition (1966-1967), page 536:
Letters to the Editor
Authors: Leonard Martha F. , Solnit Albert J.
Published: December 2021

In the recent article by our townsman, Dr. Hans H. Neumann, "Pica–Symptom or Vestigial Instinct?" (Pediatrics, 46:441) the concept of vestigial instinct is used as part of the basis for discounting emotional deprivation as one of the most significant factors leading to pica in this country. Dr. Neumann's otherwise fascinating report does not define adequately what he means by instinct, nor does he use the word pica in its usual sense. He admirably describes how a mother in West Africa introduces her infant to a piece of wood for chewing.
Letters to the Editor
Authors: Gutelius Margaret F.
Published: December 2021

I read with pleasure Dr. Hans Neumann's refreshing article on pica (Pediatrics, 46: 441). We should be grateful to him for adding spice to the pica problem. Any discussion which stimulates a reappraisal of one's prejudices is well worth reading.

It is easy for me to accept that chewing on hard substances throughout life promotes dental health. I am all for it, but I don't expect this habit to be generally accepted except by those types who become early morning joggers.
Familial Uremic Medullary Cystic Disease or Nephronophthisis?
Authors: Srivastava R. N.
Published: December 2021

Drs. Alexander and Campbell (Pediatrics, 45: 1024) rightly mention the similarity between Medullary Cystic disease and familial juvenile nephronophthisis. It is now clear that the separation of these disorders on the basis of familial occurrence, age of onset, and presence of medullary cysts is not possible.

I, however, disagree with these authors' recommendation to refer to these conditions as "Familial Uremic Medullary Cystic disease." The disorder is not always familial and the cystic changes are not confined to renal medulla.
Letters to the Editor
Authors: Alexander F.
Published: December 2021

Dr. Snivastava suggests the use of the term "nephronophthisis" for these conditions. Does this term mean anything to most people, and if it does, how is it appropriate here? Is Familial Uraemic Medullary Cystic disease really a wasting away of the nephron, i.e., the tubular apparatus from Bowman's capsule to the collecting ducts, as the name nephronophthisis suggests? Surely it is time we stopped using Greek terms which to most are meaningless and generally wrongly applied, as would seem to be the case here.
QUILLET TELLS PROSPECTIVE MOTHERS HOW THEY MAY GIVE BIRTH TO A SON
Authors: C. T. E.
Published: December 2021

Claude Quillet (1602-1680), a French abbot and physician-a protégé of Cardinal Mazarin-published a didactic poem in 1655 of about 2,000 Latin hexameters titled Callipaedia, or The Art of Getting Beautiful Children. Surprisingly enough, medical poems as a method of instruction–even those written in Latin hexameters–were once well received and actually read. Quillet's was so popular that none less than the English Poet Laureate, Nicholas Rowe (1674-1718), translated the Latin hexameters into English rhyming heroics in 1712. This translation in English verse passed through at least four other editions (1715, 1733, 1761, 1771).1

Quillet's erroneous advice to mothers anxious for a son was held to be irrefragable by many of the greatest physicians of ancient Greece and Rome. Even Avicenna (980-1037), the greatest of the early Arabian physicians, in his Canon, which many consider the most famous medical text ever written, writes emphatically that males are formed in the right chamber of the uterus and females in the left chamber.2

Here is Quillet's advice to prospective mothers:

. . . The morning for a male is best; The seed maturing in the Time of Rest, a firm and well-cemented Basis lays, From whence the lusty nervous Boy to raise.

Nor must thou only this thy Care believe, That the close womb the fruitful Seed receive:

But when the Stream of either Parent mix'd, Are in their proper Receptacle fix'd; Let the wife, mindful of the kind Design, Turn to the Right, and there at Ease recline: For in that Cell, the Seeds of Life begun, Will surest work the Fluid to a Son Who knows not that the Right the Left excels.
ALTERNATING HEMIPLEGIA IN CHILDHOOD: A REPORT OF EIGHT PATIENTS WITH COMPLICATED MIGRAINE BEGINNING IN INFANCY
Authors: Verret Simon , Steele John C.
Published: December 2021

In this report eight patients are described who suffer an unusual symptom complex of intermittent, alternating hemiplegia. Symptoms have begun in early childhood and in one child at age 3 months. Typically, there is a brief vasomotor prodrome and then the abrupt onset of hemiplegia. Contralateral headache tends to develop soon after the onset of neurological symptoms. Recovery is usual within several hours but may be prolonged over several days. Recurrence during early childhood is frequent.

Serial electroencephalograms have shown fluctuating and inconstant slow wave abnormalities as occur with cerebral ischaemia, but radiological investigations have failed to indicate structural or dynamic changes in cerebral blood vessels. The treatment of the disorder is symptomatic and antiserotonin compounds have not been found to be effective.

As these children have matured, attacks have become less frequent and in some a more characteristic picture of migraine has emerged. In several patients residual neurological signs including dementia and dyskinesia are now present.

Because convulsions occasionally occur with the hemiplegia, differentiation from a primary seizure disorder is often difficult. The profile and evolution of symptoms, however, suggests that these patients suffer a primary vascular disorder within the category of migraine, but they are unusual in the early onset of symptoms and the fixed neurological deficits that may ensue.
SYMPTOMATIC AUTISM IN CHILDHOOD AND ADOLESCENCE
Authors: Easson William M.
Published: December 2021

While crippling autism may be present in a range of illnesses with psychological and organic etiology, this symptom occurs most frequently when a child has been forced, from infancy or an early age, to live and to grow in his own private world due to a severe perceptual or intellectual handicap. If this symptomatic autism is anticipated, diagnosed, and treated early, the child may develop in a relatively healthy and productive way. Without appropriate treatment the symptomatic autistic child is liable to be increasingly handicapped; eventually such a child is almost indistinguishable from children who are autistic due to other causes. This paper highlights some of the most common causes leading to symptomatic autism.
LONG-TERM STEROID-IMMUNOSUPPRESSIVE TREATMENT OF THE CHILDHOOD NEPHROTIC SYNDROME
Authors: Pachioli R. , Genova R.
Published: December 2021

In the last 16 years at the Nephrotic Center of the Children's Clinic in Modena, 319 children have been subjected to treatment, 127 of which were subjected only to corticosteroid therapy, while 192 were subjected to corticosteroids associated with immunodepressive drugs, such as 6-mercaptopurine, azathioprine, cyclophosphamide.

The associated treatment has proved to be of great value chiefly in the cortico-resistant and cortico-dependent cases, allowing a complete and lasting normalization in children who had been treated for a long time with corticosteroids, without showing any conspicuous results, but relevant secondary symptoms.

Among the several immunosuppressive agents, cyclophosphamide turned out to be the most effective.
IRON-FORTIFIED FORMULAS
Authors: Filer L. J. , Barness Lewis A. , Goldbloom Richard B. , Holliday Malcolm A. , Miller Robert W. , O'Brien Donough , Pearson Howard A. , Scriver Charles R. , Weil William B. , Whitten Charles F. , Cravioto Joaquin , Kline O. L.
Published: December 2021

In its recent statement on iron,1 the Committee on Nutrition emphasized the value of iron-fortified, proprietary milk formulas for the prevention of iron-deficiency anemia of infancy. Despite this recommendation, the most recent marketing information available to the Committee shows that more than 70% of the proprietary formulas currently prescribed by physicians do not contain added iron.

The reasons for continuing routine use of formulas not fortified with iron are not entirely clear. One reason may be that some physicians still believe iron additives increase the incidence of feeding problems or gastrointestinal disturbances. There is no documented evidence that this is a significant problem.

The Committee strongly recommends when proprietary formulas are prescribed that iron-supplemented formulas be used routinely as the standard–that is, that this be the rule rather than the exception. There seems to be little justification for continued general use of proprietary formulas not fortified with iron. The Committee is fully aware that only a small percentage of American infants are fed proprietary formulas after 6 months of age. Fluid whole milk (available in bottle or carton ) or evaporated milk, both of which contain only trace amounts of iron, are substituted at the time of greatest iron need and highest prevalence of iron-deficiency anemia. The infant's diet is usually deficient in iron, unless other foods are carefully selected to insure adequate iron intake.

Since the major dietary component during infancy is milk, two courses of action should be taken:

(1) Pediatricians and other health professionals should engage in a program of public education to convince American mothers to provide their infants with a source of dietary iron.
Rubeola and Rubella
Authors: Ebbin Allan J.
Published: December 2021

I would like to respond to Dr. Lewak's letter1 concerning the "nibeola-rubella" confusion. This problem is not limited only to the layman. Dr. Miriam G. Wilson and I began a surveillance program of possible fetal sequelae after inadvertent rubella vaccine administration to women shortly before or early in pregnancy.* Our preliminary findings will be published soon (J.A.M.A., in press). A surprising finding among the first 29 mothers was that two of them, in fact, received rubeola vaccine early in pregnancy!
Recurrent Abdominal Pain
Authors: Hyde John S.
Published: December 2021

The omissions and emphases in discussing "irritable bowel syndrome" in Drs. Stone and Barbero's article on recurrent abdominal pain1 were criticized in the December issue of Pediatrics.2

The difficulties encountered in lumping children with abdominal pain into simple categories are part of daily clinical pediatrics. The most urgent decision is whether or not the problem is medical or surgical. The latter is of more immediate consequence, but one would like not to put under the same label all the medical problems which are limited to the abdomen and have few systemic counterparts.
The Infant "Collaborator" (Sudden Unexpected Death, and Nosogenic Prehension of Nasus)
Authors: Shaw Edward B.
Published: December 2021

Many infants with nasal obstruction will not reflexly or voluntarily establish oral respiration. This is observed in choanal atresia, and can be demonstrated by occluding the baby's nares. It has been proposed that in the sleeping infant nasal obstruction due to mild respiratory infection may be responsible for the sudden unexpected death syndrome (SUD), his determined effort to establish a nasal airway being responsible for spasm of the respiratory muscles, apnea, and respiratory arrest.1
URINARY CATECHOLAMINE EXCRETION AND PLASMA NEFA CONCENTRATION IN SMALL-FOR-DATE INFANTS
Authors: Anagnostakis D. E. , Lardinois R.
Published: December 2021

Urinary catecholamine excretion, blood glucose, and plasma nonesterified fatty acids (NEFA) concentration were studied in five full-term, seven premature, and 22 small-for-date (SFD) babies (16 at term and six prematurely born) during the first 8 to 10 days of life.

Episodes of hypoglycemia (arbitrarily designed as < 40 mg/100 ml for full term and < 30 mg/100 ml for premature infants) were observed between the second and fifth day of age in 12 SFD babies. During their low blood sugar period, these infants exhibited a significantly higher catecholamine excretion (three- to fourfold for norepinephrine and five- and sixfold for epinephrine) when compared to full term, premature, and "nonhypoglycemic" SFD babies.

All SFD babies during the first 2 days of life showed a significantly higher plasma NEFA concentration than the other groups of neonates; among the former, the hypoglycemic ones had a tendency to maintain for a longer period a higher NEFA concentration than the nonhypoglycemic ones.

These findings show that SFD babies are capable of reacting to an hypoglycemic stress by mobilizing their fat stores and by releasing catecholamine; therefore, adrenal medullary unresponsiveness cannot be considered as a cause of their transient neonatal hypoglycemia.
RECURRENT ABDOMINAL PAIN DUE TO MILK AND LACTOSE INTOLERANCE IN SCHOOL-AGED CHILDREN
Authors: Bayless Theodore M. , Huang Shi-Shung
Published: December 2021

Five otherwise healthy children, ages 6 to 13 years, with episodes of abdominal pain, experienced the same symptoms with a lactose tolerance test and became asymptomatic on a diet low in milk products. None complained of diarrhea and all had been able to drink milk as infants. The abdominal pain was related to milk and lactose intolerance.
Familial Occurrence of the Freeman-Sheldon Syndrome: Cranio-carpo-tarsal Dysplasia
Authors: Gross-Kieselstein Eva , Abrahamov Abraham , Ben-Hur Nahum
Published: December 2021

Freeman and Sheldon syndrome known as "cranio-carpo-tarsal displasia" or "Whistling face" deformity is described in a mother and daughter. The inheritance suggests an autosomal dominant trait.
OXYGEN THERAPY IN THE NEWBORN INFANT
Authors: Lucey Jerold F. , Cornblath Marvin , Graven Stanley N. , Korones Sheldon B. , James L. Stanley , Lubchenco Lula O. , Oliver Thomas K. , Schaffer Alexander J. , Segal Sydney , Shinefield Henry , Sutherland James M. , Tooley William H. , Washington Juan , Weintraub David , Hasselmeyer Eileen , Talner Norman L. , Carrington Elsie R.
Published: December 2021

The following recommendations will appear in the revision of the manual, Standards and Recommendations for Hospital Care of Newborn Infants, scheduled for publication early in 1971. Because the Committee felt a sense of urgency to provide these recommendations to pediatricians, family physicians, and other health professionals caring for newborn infants, they are being published prior to appearance of the manual. The statement has had extensive review by a large number of experts not on the Committee, and their comments and suggestions have been followed in the preparation of the final draft. It was also reviewed and approved by the Committee on Drugs of the Academy at their meeting in San Francisco October 24, 1970.

When a newborn infant needs extra oxygen, it must be administered with great care because there is a causal relationship between a higher than normal oxygen tension in arterial blood (60 to 100 mm Hg) and retrolental fibroplasia (retinopathy of prematurity). When the normal O2 tension is exceeded, there is an increased risk of retrolental fibroplasia. The upper limit of arterial oxygen tension and its duration which are safe for these infants is not known. It is probable that even concentrations of 40% of inspired oxygen (formerly considered safe) could be dangerous for some infants.

An inspired oxygen concentration of 40% may be insufficient for infants with cardiorespiratory disease to raise the oxygen tension of arterial blood to a normal level. In such instances, an inspired oxygen concentration of 60%, 80%, or higher may be necessary.
Health and the Developing World, by John Bryant, M.D. New York/London: Cornell University Press, 1969, 345 pp., $10.00
Authors: Yankauer Alfred
Published: December 2021

Here is a gracefully written, tastefully illustrative book which can be recommended to pediatricians as an introduction to the realities of clinical work in developing countries, and as a general guide to assessing their health problems and adapting their clinical services to needs. It does not deal in clinical detail, but presents a pragmatic approach to medical education and service and to the important interface between them.

The influence of American and Western European "physician models," systems of medical education, and hospital-centered delivery systems upon developing countries has been nothing short of disastrous, and children have been the greatest sufferers.
Human Growth and Development, by Robert W. McCammon, M.D. Springfield, Illinois: Charles C Thomas, 1970, 294 pp. $9.00
Authors: Falkner Frank
Published: December 2021

The disappointment felt at the conclusion of reading this book–with its misleading title–was alleviated by a whetting of the appetite and Hope. The Denver longitudinal study of human growth from birth to maturity, spread over 40 years of effort, is legendary. Here, Dr. McCammon and his colleagues summarize the formation of the samples, methodology, and data collection and its storage.

Then, the majority of the book consists of tables of measures presented cross sectionally against age.
RESTRAINT AND SPEECH
Authors: Sibinga Maarten S. , Friedman C. Jack
Published: December 2021

The incidence of delay in language development and difficulties in speech articulation was determined in 71 children selected because of a history of prior physical immobilization. Ten children were referred for psychological evaluation after contact with a speech department, 44 presented with a variety of learning and behavioral difficulties, and 17 children were known through social contacts. Nine children were clearly brain damaged while 13 showed questionable evidence of brain damage. Language delay and speech articulation problems occurred in at least 55% of the children in the various groups. Young age (4.7 months) at the time of the initial restraint experience, but not the duration of the initial restraint experience, was positively related to the presence of language delay and articulation problems. Interference with sensorimotor function not directly involved in receptive or expressive speech functions might well he implicated in language and speech disturbances.
Disseminated Coccidioidomycosis Associated with Immunosuppressive Therapy Following Renal Transplantation
Authors: Murphey Stephen M. , Drash Allan L. , Donnelly William H.
Published: December 2021

Renal homograft transplantation has become an accepted and relatively common therapeutic approach in chronic renal failure.1 This report is concerned with the development of disseminated coccidioidomycosis in a child receiving immunosuppressive therapy following renal homograft transplantation. It would appear that a subclinical, quiescent infection was activated by the administration of immunosuppressive agents.

Case Report

P.M., a Caucasian male, age 10 years at the time of his death, was first seen at the Children's Hospital of Pittsburgh at 6 years of age with evidence of advanced renal disease. A diagnosis of "chronic nephritis" had been made at age 2 years. Although a native of Pennsylvania, the child had resided in Phoenix, Arizona from his second through fifth year of life.