bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric Farm-related Injuries: A Series of 96 Hospitalized Patients
Authors: Smith Gary A. , Scherzer Daniel J. , Buckley Jeremy W. , Haley Kathryn J. , Shields Brenda J.
Published: March 2006

Ninety-six children were admitted during a 9-year period to a pediatric level 1 trauma center for treatment of farm-related injuries. The age range was from 6 weeks to 17 years (median, 7.5 years; mean, 7.6 years; standard deviation, 4.4). Thirty-nine patients (40.6%) had an animal-related injury, including 36 children (37.5%) who had an injury associated with a horse. Amish children had an increased risk of horse-related injury when compared with non-Amish children (p=0.04; RR=2.09, 95% CI: 1.18<RR<3.70). Thirty-seven patients (38.5%) had farm machinery-related injuries, including 14 children (14.6%) with an injury associated with a tractor. Falls from buildings or haylofts accounted for injuries to 12 patients (12.5%). Head trauma accounted for 35 cases (36.4%), with skull fractures in 23 cases (24.0%). Animal-related injuries were significantly associated with head/maxillofacial trauma (p = 0.001; RR = 2.15, 95% CI: 1.35 <RR<3.41). Five children (5.2%) died, and one child with a severe brain injury was discharged to a long-term rehabilitation facility. Animals, especially horses, accounted for a large percentage of farm-related injuries in this population.
Parental Perceptions of the Therapeutic Effect from Osteopathic Manipulation or Acupuncture in Children with Spastic Cerebral Palsy
Authors: Duncan B. , Barton L. , Edmonds D. , Blashill B. M.
Published: March 2006

Fifty children were involved in a randomized, controlled trial to evaluate the effectiveness of either osteopathic manipulation or acupuncture as a 6-month therapeutic adjunct for children with spastic cerebral palsy. Exit interviews were used to obtain parental perceptions and form the basis of this report. Only 2 of 17 parents reported positive gains while their child was in a wait-list control period but all 17 reported gains while in the treatment phase of the study. Ninety-six percent (48 of 50) of the parents reported some improvement while their child was receiving treatments but the gains varied from child to child. The most frequent gains were seen in improvement in the use of arms or legs (61% and 68%) and more restful sleep (39% and 68%) in the osteopathic and the acupuncture groups, respectively. Improvement in mood and improved bowel function were also very common benefits noted by the parents in both groups.
Parent-Pediatrician Communication about Complementary and Alternative Medicine Use for Children
Authors: Sibinga Erica M. S. , Ottolini Mary C. , Duggan Anne K. , Wilson Modena H.
Published: March 2006

Anonymous self-report surveys of a convenience sample of caregivers accompanying children to the pediatrician for acute or well visits at 4 pediatric practices in the Washington, DC area from July through November 1998 were evaluated. Three hundred seventy-eight (85%) of 443 caregivers approached participated. The 348 surveys completed by parents (92%) were analyzed. As previously reported, in this sample 21% of parents used complementary and alternative medicine (CAM) for their child. Overall, 53% of parents expressed the desire to discuss CAM with their pediatrician, increasing to 75% (p<0.001) among those who used CAM themselves and 81% (p<0.01) among those who used CAM for their child. Among parents who used CAM for their child, 36% had discussed it with their pediatrician. Factors associated with increased disclosure to the pediatrician were CAM use in children younger than 6 years (p<0.05), “bioenergetic” CAM use (p<0.02), and parent CAM non-use (p<0.05). Despite parents’ significant interest in discussion about CAM, few factors were associated with adequate parent-pediatrician communication.
Are Pediatric Offices “Supportive” of Breastfeeding? Discrepancies between Mothers’ and Healthcare Professionals’ Reports
Authors: Dillaway Heather E. , Douma Mari E.
Published: March 2006

According to previous research, pediatricians describe themselves as being “supportive” of breastfeeding, yet demonstrate suboptimal knowledge and skills when evaluated. Mothers also report dissatisfaction with receiving poor information and support from healthcare professionals (HCPs). To understand the depth of breastfeeding support problems within pediatric clinics, focus groups with mothers and individual interviews with HCPs were completed in 2000 to 2001 at a pediatric practice in a Midwest state. Results from interviews suggest that HCPs and mothers have different perceptions of “support.” Existing literature hypothesizes that improvements in support provision could increase breastfeeding durations; this will ultimately involve reconciling mothers’ and HCPs’ definitions of breastfeeding “support.”
How Do I Judge the “Medical Homeness” of My Practice?
Authors: Schulz Eldon G. , Buchanan Gil , Ochoa Eduardo
Published: March 2006

A Medical Home provides care to infants, children, and adolescents that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. These desirable characteristics are often difficult to assess in a practice. A recent policy statement from the American Academy of Pediatrics provides clarification and functional definitions of these characteristics. Tools and resources are available to aid physicians, clinic administrators and client-families in assessing their clinic’s compliance with Medical Home characteristics, as part of a long-term quality improvement program for their practice.
Discontinuation of Risperidone and Reversibility of Weight Gain in Children with Disruptive Behavior Disorders
Authors: Lindsay Ronald L. , Leone Sarah , Aman Michael G.
Published: March 2006

Although atypical antipsychotics generally have a good side effect profile and are clinically very effective, weight gain and associated problems accompany their use. The authors followed up 14 subjects who were in studies of risperidone for management of disruptive behavior disorders. The subjects exited after a mean exposure of 8.9 months because of excessive weight gain, or excessive appetite, or insufficient clinical response. Weight was monitored for the full cohort before risperidone treatment, at termination, and (for various subgroups) at 3, 9-12, and 24 months after termination. Analysis of standardized weight scores in relation to standardized BMI scores suggested marked similarity between them at all time points. Comparison of standardized weights at time of drug termination with 3, 9-12, and 24 months after termination indicated that weight gain during risperidone treatment is reversible (i.e., significantly less weight after risperidone was discontinued) at all time points after termination. Furthermore, standardized weight at 12 and 24 months after discontinuation of risperidone was not distinguishable from standardized weight before risperidone. The prospect of reversibility may provide some comfort for clinicians and parents alike, but far more data are needed before an assumption can be made that this is the case for all children. The authors provide several recommendations for clinicians and researchers working with atypical antipsychotics.
What Are Providers’ Reporting Requirements for Children Who Witness Domestic Violence?
Authors: Zink Therese , Kamine Darlene , Musk Lauren , Sill Morgan , Field Valerie , Putnam Frank
Published: March 2006

Each year, 3.3 to 10 million children are exposed to domestic violence/abuse (DV). Providers’ reporting obligations for these children are unclear. The child maltreatment statutes available on state’s web sites (through August 2003) were reviewed. Only Alaska defines DV in the presence of a child as child abuse within its juvenile code. Within their child abuse definition and reporting statutes, many states include language such as “substantial risk” or “imminent danger” of “physical harm” or “mental injury.” Although knowledge of the state law is an important first step, abiding by it may be challenging because most statutes are open to wide interpretation. As a result, providers are encouraged to seek advice from local child maltreatment specialists who understand the local legal interpretations and resources.
Recurrent Vomiting and Persistent Gastroesophageal Reflux Caused by Unrecognized Constipation
Authors: Borowitz Stephen M. , Sutphen James L.
Published: March 2006

Over a 2-year period, 34 children were referred to the division of pediatric gastroenterology at the University of Virginia with chronic upper gastrointestinal symptoms whose symptoms rapidly and completely resolved when their unrecognized constipation was treated. The average age at presentation was 8.24 (SD 0.78) years and average duration of upper intestinal symptoms was 15.6 (SD 3.5) months. Twenty-six of 34 had experienced recurrent vomiting, 6 complained of chronic nausea, 17 had chronic symptoms of gastroesophageal reflux, and 20 complained of chronic or recurrent abdominal pain, most often in the epigastric region. Smaller numbers had experienced early satiety, choking, gagging, dysphagia, or intermittent diarrhea. Given the prevalence of constipation in childhood, it seems likely that many children who experience chronic upper intestinal symptoms may be suffering from chronic unrecognized constipation as the cause of their upper intestinal symptoms.
Peer Victimization and Psychosocial Adjustment in Children with Type 1 Diabetes
Authors: Storch Eric A. , Lewin Adam , Silverstein Janet H. , Heidgerken Amanda D. , Strawser Melissa S. , Baumeister Audrey , Geffken Gary R.
Published: March 2006

This study investigated the frequency and psychosocial correlates of peer victimization in a sample of youths with diabetes. The Social Experience Questionnaire, Children’s Depression Inventory, Social Anxiety Scale for Children—Revised, and Asher Loneliness Scale were administered to 32 children diagnosed with type 1 diabetes and 32 control children without a medical diagnosis who were matched for age and gender. Results indicated that children with diabetes reported higher rates of relational victimization and lower levels of prosocial peer support than youths without diabetes. In addition, relational victimization was positively associated with depression, social anxiety, and loneliness for diabetic children. Implications of these findings for clinicians working with this population are discussed.
The Effect of Montelukast Sodium on the Duration of Effusion of Otitis Media
Authors: Combs Jerome T.
Published: March 2006

This study tests the hypothesis that montelukast sodium, a selective leukotriene receptor antagonist, will decrease the duration of the effusion of otitis media. Tympanometry and spectral gradient acoustic reflectometry were used to confirm the effusion of otitis media in patients between 2 and 12 years of age. Patients were treated with amoxicillin for 10 days and montelukast sodium or placebo for 30 days in a random, double-blind manner. Sixty patients completed the study: 31 received placebo and 29 received montelukast sodium. At a 4-week follow-up visit, 5 ears (16%) were free of effusion in the placebo group and 17 (58%) in the montelukast sodium group. The difference was significant. The efficacy of montelukast sodium in clearing the effusion was 49%.
Is Late Bottle-Weaning Associated with Overweight in Young Children? Analysis of NHANES III Data
Authors: Bonuck Karen , Kahn Richard , Schechter Clyde
Published: March 2006

To determine whether age of bottle-weaning is associated with overweight in young children, National Health and Nutrition Examination Survey III data for 3027 children aged 3-5 years were analyzed. The main outcome measure, the child’s body mass index (BMI), was measured as: <85%, 85-95%, >95%. Mean bottle-weaning age was 18.78 months. After adjustment for potential confounders, each additional month of bottle use corresponded to a 3% increase in the odds of being in a higher BMI category (95% CI 0.0099-0.0535). Prolonged bottle use in young children is associated with increased risk of overweight. From a preventive medicine standpoint, decreasing exposure to this potential risk for childhood overweight is indicated.
Parental Beliefs and Practices Regarding Early Introduction of Solid Foods to Their Children
Authors: Crocetti Michael , Dudas Robert , Krugman Scott
Published: March 2006

This study was a cross-sectional survey of primary female caregivers during their childs 4-month well-child visit. Our objectives were to document current caregiver awareness of infant feeding guidelines, and calculate the frequency of and reasons for early introduction of solid foods. Questionnaires were completed for 102 children. Forty-five respondents (44%) introduced solids at less than 4 months of age. Hispanic caregivers, OR 0.2 (0.07-0.9), and those who breastfed (partial or exclusive), OR 0.4 (0.2-0.9), were less likely to introduce cereal at less than 4 months of age. Among caregivers who introduced solids at less than 4 months, 36 (80%) stated that the child was not satisfied with formula or breast milk alone and 24 (53%) stated that solids helped the child sleep better at night. Thirty-four caregivers (76%) who started solids at less than 4 months were aware of guidelines regarding proper infant feeding practices. Despite knowledge of infant feeding guidelines, female caregivers frequently introduce solids at less than 4 months of age. Early targeted anticipatory guidance is needed to address the most common reasons caregivers begin solid foods before the recommended age.
Retrospective Assessment of Subacute or Chronic Osteomyelitis in Children and Young Adults
Authors: Auh Jane S. , Binns Helen J. , Katz Ben Z.
Published: March 2006

To identify factors associated with and to describe treatment outcomes of pediatric subacute or chronic osteomyelitis (S/CO), we retrospectively identified 52 patients with S/CO from January 1994 to November 1999 seen at a large pediatric hospital infectious disease clinic. S/CO was defined by the following: >10 days of clinical symptoms; radiographic, surgical, or pathologic changes consistent with S/CO; or relapse of prior osteomyelitis. Of these patients 63% were male, median age 9 years. Bones involved included vertebra (19% of subjects), femur (17%), finger (12%), humerus (10%), and tibia (8%). Sixty-five percent had at least 1 risk factor (most commonly hardware, neurologic disease or preceding trauma, sepsis, or surgery). Blood, bone, or wound aspirate cultures were positive in 67%, most commonly for Staphylococcus aureus. Erythrocyte sedimentation rate (ESR) was elevated in 88% of 41 patients at the time of diagnosis. Intravenous antibiotics were given for a median of 6 weeks and oral antibiotics for a median of 4.5 months. One child had a complication. In conclusion, consideration of S/CO should be high when predisposing factors are present. ESR may be useful for determining effectiveness and duration of therapy. With prolonged antibiotic therapy nearly all patients demonstrated resolution of disease.
Seizure Disorder as a Risk Factor for Gastroesophageal Reflux in Children with Neurodevelopmental Disabilities
Authors: Harrington John W. , Brand Donald A. , Edwards Karen S.
Published: March 2006

The proportion of children with severe neurodevelopmental disabilities, in whom symptoms of gastroesophageal reflux develop after gastrostomy placement, has not been well studied. The medical records of children who received a gastrostomy tube (with or without a simultaneous antireflux procedure) at our institution between 1987 and 1997 were reviewed to identify neurologically related diagnoses at the time of the gastrostomy, diagnostic tests ordered to detect reflux, and dates and reasons for re-admissions within 2 years of discharge. Of 102 patients studied, 37 received a gastrostomy tube alone. Complete follow-up data were available for 30 of these patients, 7 of whom (23%) required subsequent antireflux surgery within 2 years. Patients with a seizure disorder had greater than a 4-fold risk of re-admission for this operation compared with other patients (57% [4/7] vs. 13% [3/23]; P=0.03). In a child with severe neurodevelopmental disability, the existence of a seizure disorder at the time of a gastrostomy operation increases the risk of subsequently requiring an antireflux procedure by a factor of 4.
No Evidence of Sleep Apnea in Children with Attention Deficit Hyperactivity Disorder
Authors: Cooper Jacky , Tyler Louise , Wallace I. , Burgess Keith R.
Published: March 2006

Children with attention deficit hyperactivity disorder (ADHD) may have a component of sleep apnea causing arousal and contributing to ADHD behavior during the day. Twenty non-ADHD children between 4 and 16 years of age were compared with 18 children with ADHD with use of nocturnal polysomnography (PSG) and psychometric tests. The psychometric testing confirmed that the control group were normal and that the ADHD children fulfilled the diagnostic criteria for ADHD. The PSG showed normal arousal indexes for the ADHD group (9.8 ± 3.9/hr) and controls (10.2 ± 3.1/hr), and normal apnea/hypnea indexes for the ADHD group (1.0 ± 2.4/hr) and controls (0.6 ± 0.9/hr). The sleep architecture was not significantly different between groups. There were no sleep abnormalities in the ADHD children that could be responsible for, or contributing to, the disorder.
Inner-City Availability of Preservative-Containing Albuterol
Authors: Reznik Marina , Sharif Iman , Ozuah Philip O.
Published: March 2006

Benzalkonium chloride (BAC) added to nebulized albuterol may induce bronchospasm. The objective of this study was to determine the availability of BAC-containing nebulized albuterol in the Bronx, New York pharmacies. A cross-sectional telephone survey of pharmacies was conducted. Overall, 158 (80%) pharmacies participated in the survey; 133 (84%) carried BAC-containing albuterol; 25 (16%) dispensed BAC-containing albuterol solution when presented with a prescription written for generic albuterol. Only 14 (9%) pharmacists had seen a prescription for nebulized albuterol where a physician specified “without BAC.” Despite availability of BAC-free albuterol, pharmacies in the Bronx still carried and dispensed BAC-containing product.
Prevalence of Vesicoureteral Reflux in Neonatal Urinary Tract Infection
Authors: Cleper Roxana , Krause Irit , Eisenstein Bella , Davidovits Miriam
Published: March 2006

Vesicoureteral reflux (VUR) after a first episode of urinary tract infection (UTI) is apparently diagnosed much more frequently (25%-40%) in children than in neonates. The aims of the study were to determine the actual rate of VUR in neonates with UTI and to define the clinical clues to its diagnosis. The study sample included term infants with a diagnosis of UTI during their first month of life who were seen in this hospital between January 1997 and May 1999. All infants underwent complete diagnostic work-up (renal ultrasound and voiding cystourethrography [VCUG]). The medical files were reviewed for patient sex, age at UTI diagnosis, laboratory findings (including causative pathogen), and ultrasonographic findings. These parameters were correlated with the finding of VUR on VCUG. Sixty-four neonates (55 males, 9 females) with UTI were included in this study. UTI was 6 times more common in males than females, although the incidence of VUR was equal between the sexes (about 20%). The presence of VUR was associated with a significantly younger age at presentation of UTI (11.4±4 vs 16.9±6.6 days, p<0.01). VUR was diagnosed at a fourfold higher rate in neonates with Klebsiella-induced UTI compared to those with E. Coli-UTI. In 80% of those with significantly abnormal ultrasonographic findings VUR was found on VCUG. Jaundice was noted at UTI diagnosis 3 times more often in infants with VUR, and elevated creatinine level, 2.5 times more often.
Thrombocytosis in Pediatric HIV Infection
Authors: Ellaurie Maadhava
Published: March 2006

Thrombocytopenia has been extensively reported in association with HIV infection. Twenty-four children (6%) from a cohort of 400 children with platelet counts >500,000/mm3 were reviewed. All had symptomatic disease and 10 (42%) patients died. In 4 children the platelet count exceeded 700,000/mm3 and in 1 patient the platelet count was 1.5 million/mm3. There were no thrombotic complications, and no specific therapy was required for the thrombocytosis. Thus HIV-1 infection, a chronic viral infection, is another etiologic agent for thrombocytosis and is associated with severe disease.
The Relationship of Breastfeeding to Antimicrobial Exposure in the First Year of Life
Authors: Flores Major Michelle S. , Fairchok Mary P.
Published: March 2006

We assessed the relationship between breastfeeding and antimicrobial use in the first year of life in healthy infants by surveying a military population of healthy term infants with questionnaires obtained at the 6-month and 12-month well-baby visits. Breastfed (BF) babies spent 48% as much time receiving antimicrobials by 6 months of age and 47.4% by 12 months of age as compared to formula-fed peers. Breastfed babies also showed significant differences in use of second-line agents at both 6 months (BF=5.5%, Non-BF=19%) and 12 months (19% BF, nonBF=36.9%). These results suggest that breastfeeding decreases exposure of infants to antimicrobials throughout the first year of life and also decreases use of second-line antibiotics in the first year of life.
Parenting Book Recommendations for Commonly Encountered Pediatric Issues
Authors: Mau Monica K. , Holland Paul R. , Yamamoto Loren G.
Published: March 2006

Parenting books offer a variety of information and advice for parents on subjects they frequently encounter; however, the recommendations of books are dependent on the author and different books offer conflicting advice on the same subjects. In addition, some of the information presented is not concordant with current American Academy of Pediatrics policy statements and recent medical literature. It is important for pediatricians to be aware of the information parents are obtaining from different sources so that they can address areas where erroneous advice is potentially being given. Pediatricians will then be able to discuss discrepancies with parents and give them recommendations based on current research and recommendations.
Survey of Internet Web Sites on Circumcision
Authors: Okino Blaine M. , Yamamoto Loren G.
Published: March 2006

Information on circumcision is available on the Internet, which is available for parents to review. The purpose of this study is to sample and summarize the Internet’s informational content on circumcision. One hundred web sites were identified using the Google search engine on February 15, 2003. The informational content of each site was reviewed and tabulated. Seventy-three of the 100 web sites were appropriate for review. Ten agreed with recommending circumcision, 4 agreed under limited circumstances, 37 recommended against circumcision, and 4 recommended against circumcision under limited circumstances. Eighteen did not take a stance for or against. Thirteen agreed that circumcision reduces the risk of urinary tract infection, and 16 disagreed with this. Fifteen agreed that circumcision reduces the risk of penile cancer and 14 disagreed with this. Fifty-one percent of web sites surveyed were against circumcision, 14% of the web sites surveyed recommended circumcision, and 25% of surveyed web sites had no opinion.
Hyperammonemia, Bane of the Brain
Authors: Cohn Robert M. , Roth Karl S.
Published: March 2006

Ammonia, normally produced from catabolism of amino acids, is a deadly neurotoxin. As such, the concentration of free ammonia in the blood is very tightly regulated and is exceeded by two orders of magnitude by its physiologic derivative, urea. The normal capacity for urea production far exceeds the rate of free ammonia production by protein catabolism under normal circumstances, such that any increase in free blood ammonia concentration is a reflection of either biochemical or pharmacologic impairment of urea cycle function or fairly extensive hepatic damage. Clinical signs of hyperammonemia occur at concentrations > 60 µmol/L and include anorexia, irritability, lethargy, vomiting, somnolence, disorientation, asterixis, cerebral edema, coma, and death; appearance of these findings is generally proportional to free ammonia concentration, is progressive, and is independent of the primary etiology. Causes of hyperammonemia include genetic defects in the urea cycle (“primary”) or organic acidemias (“secondary”), as well as genetic or acquired disorders resulting in significant hepatic dysfunction. Thus, because of the neurotoxic implications of hyperammonemia and the typical absence of other specific laboratory abnormalities, appearance of the clinical signs should trigger an emergent search for elevated blood ammonia concentration.
Idiopathic Thrombocytopenic Purpura: A 10-Year Natural History Study at the Childrens Hospital of Alabama
Authors: Watts Raymond G.
Published: March 2006

Childhood idiopathic thrombocytopenic purpura (ITP) is a common disorder. However, single-institution, long-term, natural history data are limited. The objective of this paper is to review presenting features, response to therapy, and natural history of ITP treated at a single pediatric academic medical center. A retrospective chart review was made for all children (ages birth-18 years) diagnosed with ITP (ICD 287.3) and treated at the Childrens Hospital of Alabama/University of Alabama at Birmingham between 1993 and 2003. Four hundred nine patients were identified (49% male, 51% female; mean age: 5.85 years; range: 1 month-17 years). There was no seasonal variation of presentation. The mean platelet count was 19k (0-120k). Bone marrow aspiration (BMA) was performed in 72% but altered the diagnosis or therapy in no patient. Treatment consisted of corticosteroids in 256 (92% response), intravenous immunoglobulin (IVIG) in 125 (87% response), Win-Rho D in 58 (91% response), and no therapy in 71(100% response). Response was defined as increase in platelet count to > 50k. There was no difference in response to any therapy. No patients died. One patient presented with a CNS hemorrhage at presentation, responded to therapy, and survived. Twenty-three of 409 patients (6%) experienced clinical bleeding requiring hospitalization or blood transfusion. Chronic ITP (persistence > 6 months) was noted in 99 patients (24%). Chronic patients presented at an older age (7.8 vs 5.2 years for acute only, p<0.001), and with higher platelet counts (27k vs 17k, p<0.001). The risk of chronic ITP was partially predicted by presenting platelet count > 50k and age > 10 years, or both; 50% of patients presenting with these features developed chronic ITP vs 24% overall rate. Splenectomy was curative in 30/31 (97%) patients. There was no postsplenectomy sepsis. Of 99 patients with chronic ITP, 25 responded to splenectomy, 37 resolved at a mean of 20.3 months after diagnosis (7-96 months), 36 had persistent mild thrombocytopenia (50k-125k), and 1 failed to respond to any treatment including splenectomy. Overall, 91% of cases resolved with therapy or observation. ITP is a common pediatric disease presenting at any age with low morbidity and mortality. Most cases can be managed by pediatricians without hematology referral. Several equally successful therapeutic options exist. Chronic cases present at an older age with higher platelet counts. Up to 50% of cases of chronic ITP will resolve with ongoing follow-up. The overall prognosis in childhood ITP is excellent.
Factors Associated with Preventive Asthma Care in Inner-City Children
Authors: Butz Arlene M. , Riekert Kristin A. , Eggleston Peyton , Winkelstein Marilyn , Thompson Richard E. , Rand Cynthia
Published: March 2006

The goal of this cross-sectional study was to determine if the caregiver’s quality of life was associated with the child receiving appropriate preventive asthma care (2 or more preventive asthma care visits per year) in a sample of inner-city children with moderate to severe persistent asthma. Our findings confirm that children with moderate to severe persistent asthma are not receiving adequate preventive asthma care despite experiencing frequent asthma symptoms. Having a recent emergency department (ED) visit and increased number of school absences due to asthma were the strongest factors associated with these children receiving guideline-based preventive asthma care. However, for a subgroup of children without recent ED care, we found that low caregiver education level, increased school absences, and decreased caregiver’s quality of life, albeit a trend, were associated with the child’s receiving adequate preventive asthma care. This suggests that in a subgroup of children receiving adequate preventive care, other issues beyond basic asthma management may need to be addressed.
Student Evaluation Practices in Pediatric Clerkships: A Survey of the Medical Schools in the United States and Canada
Authors: Kumar Ashir , Gera Renuka , Shah Gaurang , Godambe Sonia , Kallen David J.
Published: March 2006

Despite the curriculum changes during the past decade, there is paucity of information regarding the structure and evaluation processes in pediatric clerkships. Information regarding the educational components of the pediatric clerkship and student evaluation practices was obtained from the pediatric clerkship directors via a paper/electronic survey. Completed surveys were received from 97 US and Canadian medical schools and were analyzed. The average length of a clerkship was 7 weeks. Most clerkships required a 4-week ward, a 1-week newborn rotation, and a 2-week ambulatory rotation. Students were evaluated on each component of the clerkship in 93.5% of the programs. All programs evaluated student’s clinical performance and fund of knowledge; 85.6% evaluated student’s written record. Student’s clinical performance was evaluated by direct observation in 57% of the programs. Penalties for failing in clinical performance were harsher. In 56% of programs, a student failing in clinical performance failed the entire clerkship in contrast to 21.8% or 7% of the programs where a student failed the entire clerkship if they failed in the examination for the fund of knowledge or written record evaluation, respectively. The survey demonstrated a fair amount of consistency in clerkships across programs when compared with data obtained in 1981 and 1986. There was a noticeable increase in the well-baby nursery rotation; however, there was a decline in direct observation to assess physical examination or clinical performance.
Physicians’ Attitude Toward Identification and Management of Childhood Obesity in Israel
Authors: Goldman Ran D. , Modan-Moses Dalit , Bujanover Yoram , Glasser Saralee , Meyerovitch Joseph
Published: March 2006

Obesity is a serious health problem, and is becoming increasingly common in affluent societies. In 1998, an Expert Committee published guidelines regarding obesity evaluation and treatment. The purpose of this study was to assess the attitude of primary care physicians in Israel toward diagnosis and treatment of childhood obesity, as related to the recommended guidelines. Primary physicians caring for children and adolescents were asked to complete an anonymous questionnaire including personal and professional details, methods of diagnosis, documentation and treatment of childhood obesity, and familiarity with and implemention of the Expert Committee recommendations. One hundred forty-four physicians, treating approximately 100,000 children monthly, completed the questionnaire. Ninety-four percent were considered to have diagnosed obesity properly. Furthermore, only 19% reported weighing all children examined, while 99% of the physicians suggested some treatment for obesity. The most frequent recommendations for managing obesity were referral to a dietitian (92%), physical exercise (85%), and group treatment (27%). The majority of physicians (78%) were not familiar with the new Expert Committee recommendations regarding obesity treatment. This study suggests that the majority of primary physicians diagnose obesity properly and recommend accepted modalities to manage obesity. A comprehensive program to prevent and treat obesity is recommended to improve the health status of the population.
Factors Affecting Missed Appointment Rates for Pediatric Patients Insured by Medicaid in a Traditional Hospital-Based Resident Clinic and Hospital-Owned Practice Settings
Authors: Specht Elizabeth M. , Powell Keith R. , Dormo Cynthia A.
Published: March 2006

Missed appointment rates (MAR) of pediatric patients insured by Medicaid and seen in a traditional hospital-based continuity (teaching) clinic were compared to the rates for the same patients after their care had been transitioned to a community practice. The hypothesis is that when rewarded with shorter waiting times, a less chaotic environment, and more pediatrician continuity, the MAR for patients insured by Medicaid would be lower in the practice setting than it had been in continuity clinic. The MAR decreased from 33% in the continuity clinic in 1999 to 18% in the community practice in 2001 (p<0.01). It was also hypothesized that the MAR for patients insured by Medicaid would be higher in practices with a higher percentage of Medicaid appointments. Among 15 hospital-owned pediatric practices, the MAR for patients insured by Medicaid was positively correlated with the percentage of total appointments that were made by patients insured by Medicaid (correlation coefficient 0.706 [p<0.01]).
Influence of Breast-feeding and Parental Intelligence on Cognitive Development in the 24-Month-Old Child
Authors: Gómez-Sanchiz Manuela , Cañete Ramón , Rodero Inmaculada , Baeza J. Enrique , González J. Antonio
Published: March 2006

This study was designed to analyze the relationship between breast-feeding and mental development at 24 months of age, independently of the influence of other factors. A total of 238 babies born between October 1995 and February 1998 were enrolled in an observational prospective cohort study. Cognitive development was assessed using the Bayley Infant Development Scale. The results of multiple linear regression analysis showed that infants breast-fed for longer than 4 months scored 4.3 points higher on the mental development scale than those breast-fed for less time. No differences were found in psychomotor development as a function of feeding regimen or duration. The positive linear correlation observed between parental IQ and mental development scores at 24 months was also statistically significant (mother: r = 0.39; p < 0.001; father: r = 0.43; p < 0.001). It may be concluded that breast-feeding for longer than 4 months has a positive effect on the child’s mental development at 24 months of age. Parental intelligence also appears to influence cognitive development.
Changes in Newborn Bathing Practices May Increase the Risk for Omphalitis
Authors: Simon Neal P. , Simon Michael W.
Published: March 2006

Aseptic cord care, in conjunction with antibacterial skin care, has reduced the incidence of omphalitis specifically caused by Staphylococcus aureus. However, this practice has resulted in the emergence of resistant organisms that may pose a greater risk for newborn infections. Subsequently, many institutions have changed to dry cord care and nonantiseptic whole-body baths, a practice that has not been adequately studied to determine potential infectious risks. Three cases of omphalitis occurring after an institutional change to nonantiseptic whole-body baths are presented. Clinical diagnosis and treatment of omphalitis are reviewed. Recommendations for surveillance of omphalitis are offered.
Peer Victimization and Psychosocial Adjustment in Children: Current Knowledge and Future Directions
Authors: Storch Eric A. , Ledley Deborah Roth
Published: March 2006

Childhood peer victimization is the experience of being a target of peers’ aggressive behavior. Peer victimization is a common occurrence and has been concurrently and prospectively linked to significant psychological distress. This paper provides a review of the extant literature on the relationship between peer victimization and psychosocial adjustment in nonclinical and pediatric populations. Clinical applications of this literature, as well as directions for future study, are presented.
Trisomy 21 and Congenital Heart Disease: Effect of Timing of Initial Echocardiogram
Authors: Ghaffar Sadia , Lemler Matthew S. , Fixler David E. , Ramaciotti Claudio
Published: March 2006

Current recommendations for infants with trisomy 21 include an echocardiogram in the first month of life. The purposes of this study were to determine whether outcome and presence of transient shunting differed between infants with echocardiograms in the first month (Group I) and those performed later (Group II). Transient patent ductus arteriosus was more commonly seen in Group I. Presence of a patent foramen ovale, failure to return for follow-up, and surgical mortality rate did not differ between the 2 groups. A more selective policy related to timing of the initial echocardiogram in asymptomatic infants with trisomy 21 appears to be warranted.
Role of Routine Urinalysis in Asymptomatic Pediatric Patients
Authors: Chandar Jayanthi , Gómez-Marín Orlando , del Pozo Rolando , Sanders Lee , Montane Brenda , Abitbol Carolyn , Strauss José , Zilleruelo Gastón
Published: March 2006

This study was done to evaluate the spectrum of diagnoses and identify risk factors for significant kidney disease in asymptomatic children with proteinuria and/or microhematuria detected by routine urinalysis. Clinical and laboratory data were obtained by retrospective chart review of 239 patients referred to a tertiary care center. The predominant diagnosis in children with isolated microhematuria was hypercalciuria and with isolated proteinuria, orthostatic proteinuria. When microhematuria and proteinuria were present in combination, kidney disease was the predominant diagnosis. Urinalysis is a valuable tool to identify patients with kidney disease. The combination of microhematuria and proteinuria increases the risk of having significant kidney disease.
Estimates of the Validity and Utility of Unstructured Clinical Observations of Children in the Assessment of ADHD
Authors: Edwards Mark C. , Schulz Eldon G. , Chelonis John , Gardner Eunice , Philyaw Amanda , Young Jonathan
Published: March 2006

The purpose of this prospective study was to examine the validity and diagnostic utility of unstructured clinic observations of attention deficit hyperactivity disorder (ADHD) behaviors in children. Results showed observations to be related to behavioral ratings of parents but not of teachers. The relationship between observations and parent ratings was stronger for hyperactive-impulsive than inattentive behaviors. The level of agreement between observations and classification of ADHD significantly exceeded chance levels only for parent measures of hyperactivity-impulsivity. Only parent measures predicted a diagnosis of ADHD at a rate that was significantly better than chance. Clinic observations were found to have consistently higher positive predictive power than negative predictive power. Clinical implications are discussed.
Refracture of the Clavicle in an Infant: Case Report and Review of Clavicle Fractures in Children
Authors: Nield Linda S. , Kamat Deepak
Published: March 2006

Perinatal clavicle fractures typically heal without complication, and subsequent refracture of the same clavicle during infancy or toddlerhood has not been reported. This is a case report of a fracture of the clavicle in a 9-month-old child who had previously suffered a fracture of the same clavicle at birth. A review of the evaluation and management of neonatal and post-neonatal clavicle fractures is also presented.
Neonatal Asymmetric Crying Facies: A New Look at an Old Problem
Authors: Sapin Samuel O. , Miller Alvin A. , Bass Harold N.
Published: March 2006

Neonatal asymmetric crying facies, described 75 years ago, is a clinical phenotype resembling unilateral partial peripheral facial nerve paralysis, with an incidence of approximately 1 per 160 live births. The cause is either facial nerve compression or faulty facial muscle and/or nerve development. Spontaneous resolution is expected with the former, but not necessarily with the latter etiology. Approximately 10% of the developmental cases have associated major malformations. Mandibular asymmetry and maxillary-mandibular asynclitism (non-parallelism of the gums) are frequently overlooked visual clues to nerve compression. Ultrasound imaging of facial muscles and electrodiagnostic testing may be useful for differential diagnosis and management.
Undetected Hepatomegaly in Obese Children by Primary Care Physicians: A Pitfall in the Diagnosis of Pediatric Nonalcoholic Fatty Liver Disease
Authors: Fishbein Mark , Mogren Jennifer , Mogren Chris , Cox Sibyl , Jennings Ryan
Published: March 2006

The diagnostic evaluation of nonalcoholic fatty liver disease (NAFLD) relies on the initial detection of hepatomegaly or elevated serum aminotransferases by the primary care provider. In this investigation, the aptitude of the primary care provider to identify children with hepatomegaly and initiate an evaluation for NAFLD is determined. The physical examination findings and requests for diagnostic testing of 18 primary care physicians (and pediatric gastroenterologists) on 11 obese school-aged children, including a subset of children with hepatomegaly and NAFLD, were analyzed. In children with NAFLD, clinicians detected hepatomegaly in 1.4% of encounters and requested serum liver chemistries in 12.5% of encounters. Hepatomegaly is detected poorly in obese children by primary care physicians and thereby increases the likelihood of a delayed or omitted evaluation for NAFLD.
Adolescent and Adult Issues in Charge Syndrome
Authors: Blake Kim D. , Salem-Hartshorne Nancy , Daoud Marie Abi , Gradstein Janneke
Published: March 2006

Very little information has been published about adolescents and older individuals with Coloboma, Heart defects, Atresia choanae, Retarded growth and development, Genital hypoplasia, Ear anomalies and deafness (CHARGE) syndrome. This paper describes the results of a study that identifies the unique issues faced by adolescents and adults with CHARGE. Descriptive information was gathered from parents of patients with CHARGE, and/or the patients themselves, about their developmental, medical, educational, and social history. The resulting body of information provides important insights into the prognosis and special needs of individuals with CHARGE, as well as further research questions.
Mothers’ Help-Seeking for Pediatric Psychosocial Problems
Authors: Barlow Meghan , Wildman Beth , Stancin Terry
Published: March 2006

Pediatricians have been criticized for failing to identify psychosocial problems in their pediatric patients. Maternal disclosure is important for identification; however, many mothers fail to discuss their concerns with the pediatrician. The present study explored the hypothesis that mothers are seeking and receiving help from sources other than the pediatrician. Participants were 50 mothers who brought their 4-13-year-old child for a routine health supervision visit at a county-funded hospital serving primarily low-income families. Results indicated that mothers actively seek help from multiple sources and find the help they receive useful. Clinical implications of these findings are discussed.
Congenital and Infantile Nephrotic Syndrome in Thai Infants
Authors: Vachvanichsanong Prayong , Mitarnun Winyou , Tungsinmunkong Kobkul , Dissaneewate Pornsak
Published: March 2006

Congenital and infantile nephrotic syndrome reported from the Eastern world is rare and might be a different entity from that in the West. In a retrospective review of 10 nephrotic syndrome in Thai infants (5 girls and 5 boys), 7 were diagnosed with congenital nephrotic syndrome and 3 with infantile nephrotic syndrome. Two had congenital nephrotic syndrome secondary to congenital syphilis. All had edema, ascites, and failure to thrive. Of the 3 patients tested for thyroid function, all showed hypothyroidism. Two patients developed renal failure. Renal tissue was examined from 4 patients from 3 biopsies and 2 autopsies; only 1 patient showed tubular microcysts. Symptomatic therapy was performed concurrently with penicillin therapy in 2 patients having congenital syphilis. Prednisolone, cyclophosphamide, captopril, and enalapril were tried in some patients, with little effect. Five patients died from respiratory failure complicated by later infection, 1 patient died from renal failure, and 4 patients were lost to follow-up. Nephrotic syndrome in the first year of life in the Eastern world is rare. Prognosis of nephrotic syndrome in Thai infants at this time is still poor.
Clinical Utility of the Bispectral Index Score When Compared to the University of Michigan Sedation Scale in Assessing the Depth of Outpatient Pediatric Sedation
Authors: Shields Cynthia H. , Styadi-Park Grace , McCown Michael Y. , Creamer Kevin M.
Published: March 2006

This single blinded observational study compared the bispectral index (BIS) monitor with a validated pediatric sedation scale, the University of Michigan Sedation Scale (UMSS), to evaluate whether the BIS score can be used to judge the depth of sedation in pediatric outpatients. Thirty-eight children, with a mean age of 5.8 years, undergoing routine sedation for both noninvasive and gastrointestinal procedures, had simultaneous BIS and UMSS scores recorded. Sedation categories were defined as light, moderate, and deep for both UMSS and BIS. There was a moderate correlation between BIS and the UMSS, Spearman’s r <- 0.499. The correlation was poor for children receiving chloral hydrate, r < -0.213. The BIS score was not predictive of any specific UMSS score. The UMSS and BIS categories of sedation matched only 36% of the time. BIS underestimated the clinical level of sedation.
Factitious Disorder and Malingering in Adolescent Girls: Case Series and Literature Review
Authors: Peebles Rebecka , Sabella Camille , Franco Kathleen , Goldfarb Johanna
Published: March 2006

Six cases of factitious disease and malingering in pediatric patients referred to an infectious diseases practice in a tertiary care children’s hospital are described, and implications for general clinical practice are reviewed. All patients were girls aged 9-15 years. Two patients were malingering with the secondary gain of avoiding attendance at school. The other 4 patients presented with factitious illness without clear link to secondary gain, but rather for a psychological purpose. Three of the subjects admitted to self-induced or feigned illness. The 2 patients diagnosed with malingering did very well with early parental support, psychotherapy, and attention paid to school difficulties. The outcomes of the others with underlying psychological conflicts were less resolved. Factitious disorders and malingering occur in the pediatric population. A high index of suspicion is needed for prompt diagnosis and care.
Treatment of Labial Fusion with Topical Estrogen Therapy
Authors: Leung Alexander K. C. , Robson W. Lane M. , Kao C. Pion , Liu Edmond K. H. , Fong Justine H. S.
Published: March 2006

Twenty girls with labial fusion that covered at least 50% of the vaginal opening were treated with a topical estrogen cream. The cream was precisely applied to the fused area twice a day until the adhesions were totally lysed. After separation of the adhesions, a petroleum ointment (Vaseline®) was applied twice a day to the labia minora for at least 1 month. The introital area was carefully rinsed twice each day before application of either the estrogen cream or the petroleum ointment. The mean age of the studied population was 13.2 months (range, 2 to 38 months). The mean duration of estrogen treatment was 2.4 months (range, 1 to 3.5 months). All patients were successfully treated. Five patients developed vulval pigmentation, which lasted for a mean of 1.5 months. One patient developed breast enlargement, which lasted for 1 month. The mean duration of follow-up was 3.1 months, and there was no recurrence of labial fusion during the period of follow-up. We conclude that treatment of labial fusion with topical estrogen therapy is safe and effective.