bluuebunny/crossref_metadata_2025 huggingface dataset:
Letters to the Editor
Authors: Barness Lewis A.
Published: December 2021

Dr Houck is quite right in stating that there is little information on the actual vitamin requirements for low birth weight infants with a few exceptions.

One liter of most infant formulas contains somewhat more than the recommended daily allowances for a young term infant in the first few months of life. An infant taking one tenth this volume would, of course, receive very small amounts of vitamins; however, vitamins are necessary for growth and, in rapidly growing infants, the vitamin requirement would be expected to be increased.
Benefits of Breast Milk
Authors: Magnus Peter D.
Published: December 2021

I was delighted to read of Dr Weichert's results in her article "Lactational reflex recovery in breast-feeding failure."1 All four infants would have been labeled "failure to thrive" in most pediatric centers with possible interruption of the precious lactation bond by formula supplements,2 as recent articles in the English literature have suggested.3,4

The Lact-Aid supplementer, utilized with all four mother-infant dyads, helped correct the problems of breast milk insufficiency and poor infant weight gain. The Lact-Aid is used not only to correct insufficiency and restore confidence, but also to alter sucking defects in babies who have not been acclimated to a constant pattern of good sucking.
What Is Proper Food for Human Infants?
Authors: Mittleman Richard S.
Published: December 2021

This letter is in response to the article by Pisacana et al (Pediatrics 61:360, 1978) concerning the prevention of obesity in infancy.

I take issue with a number of statements, implications, and the general tone of this article. The authors seem to be suggesting that starting infants on solid food at 2 months of age and cow's milk at 3 months of age is a good thing to do because it may result in infants who weigh less (weigh less than whom or what?).
Use of Primary Care Facilities by Patients Attending Specialty Clinics
Authors: Palfrey Judith S. , Levy Janice C. , Gilbert Kim L.
Published: December 2021

The health care patterns of 158 children attending a medical specialty clinic at least twice a year were studied. The families were interviewed about (1) use of a primary care source, (2) continued contact with the referring physician, and (3) perceived health needs. For almost one third of the children, no source of primary care was reported. This group contained a higher percentage of older children and children from the urban center than did the group as a whole. No differences were attributable to insurance coverage. Of patients referred by a primary care provider, 62% were still in contact with that provider, whereas only 20% referred from another hospital-based program were still in touch with that program. Of the children attending specialty clinics 60% had other perceived health needs. Thirty-eight percent of the families reported health problems that they had never discussed with any medical provider. This study indicates that a large proportion of children with frequent attendance at specialty clinics perceive the hospital as the source of all their care. Health planners and providers need to take this patient perception into account as they design and manage programs for chronically ill children.
Maternal Responsiveness of Primiparous Mothers During the Postpartum Period: Age Differences
Authors: Jones Freda A. , Green Vicki , Krauss David R.
Published: December 2021

Variables influencing maternal responsiveness of primiparous mothers in the postpartum period were explored. Forty mothers, aged 17 to 24, were randomly assigned to either a control group, or to a group with one of two experimental conditions: additional information given mothers about the sensory capacity of neonates, or additional postpartum contact with their infants. Age differences in maternal responsiveness were also examined. Fourteen dependent measures of maternal behavior were obtained from video-taped sessions of mothers watching their infants. In addition, lateral preference of mothers for their infant following midline presentation was also noted. At the time of hospital discharge (a mean time of 3.5 days following birth) no differences were found on the dependent measures for either experimental condition. The age of the mother was isolated as a variable influencing maternal readiness. Mothers were divided into three age groups: low (17 and 18 years, N = 17), middle (19 and 20 years, N = 10), and high (21 to 23 years, N = 13). Age effects upon the 15 measures were assessed. The results suggest that there is a "critical" age when a mother may develop maternal readiness. Mothers 19 years of age and older demonstrated significantly more maternal responsiveness toward their infants than did mothers 18 years and younger.
Simultaneous Screening for Child Health and Development: A Study of Visual/Developmental Screening of Preschool Children
Authors: Sturner Raymond A. , Funk Sandra G. , Barton Joanne , Sparrow Sara , Frothingham Thomas E.
Published: December 2021

This study was designed to explore the feasibility of using observations made during pediatric health examinations to obtain clinically useful developmental information without prolonging the health procedure itself. Standard preschool vision-screening procedures were modified so that adjustments in approach could be made for developmental capability as it unfolded and so that behavioral responses could be systematically recorded and quantified. There were 440 children (aged 52 to 64 months) screened by trained lay people who demonstrated high inter-tester reliability (95% agreement; r = .99). The average time required to complete each screening was eight minutes. In order to estimate the clinical efficiency of the developmental aspects of the experimental observation system, a stratified sample of 129 of these children was administered the McCarthy Scale for Infants and Children. Utilizing a weighted function of the sample to approximate the population distribution, the sum of the experimental vision/development test items was found to correlate .71 with the General Cognitive Index (GCI) score of the McCarthy test. A multiple correlation of .84 was obtained between items of the experimental test and the GCI scores. Discriminant analyses revealed that the overall agreement between the experimental test and the McCarthy criterion test was 93.3%, with a 5.4% over-referral rate and a 1.4% underreferral rate. Co-positivity was .84; co-negativity was .94. These results are comparable or better than results reported by others comparing extensive and time-consuming developmental tests with the McCarthy test.
The School Nurse Practitioner
Authors: Silver Henry K.
Published: December 2021

The report of the American Academy of Pediatrics' Committee on School Health on the school nurse practitioner which appears in this issue of Pediatrics (p 665) recognizes the innovative approach that school nurse practitioners are making to the problem of delivery of medical services to children in underserved areas and stresses that school nurse practitioners, with supervision, can be used appropriately and effectively in providing improved health care to these children. The Committee notes that utilization of school nurse practitioners has been associated with improved immunization referrals and a decrease in emergency room use by participating children, and indicates that the presence of school nurse practitioners in school settings permits some children to obtain care who previously were not receiving adequate care and services.
Medroxyprogesterone Acetate (Depo-Provera)
Authors: Segal Sydney , Anyan Walter R. , Cohen Sanford N. , Freeman John , Hill Reba M. , Kauffman Ralph E. , Mofenson Howard C. , Pruitt Albert W. , Shinefield Henry R.
Published: December 2021

Members of the American Academy of Pediatrics have asked the Committee on Drugs to comment on the efficacy and the indications for use of the injectable progestin, medroxyprogesterone acetate (Depo-Provera), in adolescents. The Committee has reviewed the available data about the drug and assembled several possible indications for its use in adolescents. The Committee has found no conclusive evidence that Depo-Provera is harmful to humans, and it acknowledges that there is controversy about the potential, undesirable, long-term effects of the use of Depo-Provera that cannot be resolved by the extant data. The Committee also wishes to state that the lack of availability of Depo-Provera as an approved contraceptive agent hinders the provision of care needed by some adolescents in the United States.

The Committee believes that Depo-Provera—or a similar, long-acting contraceptive agent—can be invaluable to a small, well defined group of adolescents who need effective contraception and are unable to benefit from other methods. They may be at risk of participating in sexual activity unknowingly or unwillingly, or may be sexually active by choice. Some of these adolescents are intellectually impaired and pregnancy is especially unwanted. Conventional oral contraception may be difficult for retarded teen-agers. If there is no adult who will be responsible for administering oral contraceptives or protecting the vulnerable adolescent from sexual advances or from her own inability to estimate the consequences of unprotected sexual intercourse, the use of Depo-Provera is warranted. Menstrual flow creates a major emotional disturbance or hygienic problem for a small number of intellectually impaired adolescents (or for their caretakers), and the cessation of menstrual function—so often resulting from the continued use of Depo-Provera—may be a desirable side effect.
Letters to the Editor
Authors: Holtzman Neil A.
Published: December 2021

Let me first repeat what I said about children with a family history of premature cardiovascular disease:

By restricting cholesterol testing to those with positive family histories, fewer children will be unnecessarily treated, but whether those at risk will benefit from learning of the high probability that they will develop coronary disease or from diet modification is still unknown.

I agree with Dr Freis on the need for more information. Until that information is forthcoming I cannot agree that proper patient management involves labeling children at risk, selectively modifying their diets, or treating them with cholesterol-lowering drugs.
Prevalence of Lactose Intolerance in Children with Recurrent Abdominal Pain
Authors: Christensen M. Fjord
Published: December 2021

Dr W. M. Liebman has reported an interesting study on lactose intolerance in children with recurrent abdominal pain (Pediatrics 64:43, 1979). His data suggest that lactose intolerance plays a contributory role in recurrent abdominal pain in children.

Recently I have performed an almost identical study on Danish children with recurrent abdominal pain with quite another result.1

Tolerance tests after oral lactose (2 gm/kg of body weight) were performed with parental consent on 50 children (22 girls and 28 boys, mean age 9.5 years) with recurrent abdominal pain and on 40 children (17 girls and 23 boys, mean age 9.6 years) without such pain.
Lack of Protective Effect of Breast-feeding in Congenital Hypothyroidism: Report of 12 Cases
Authors: Letarte Jacques , Guyda Harvey , Dussault Jean H. , Glorieux Jacqueline
Published: December 2021

Hypothyroid babies being breast-fed (12 cases) or bottle-fed (33 cases) have been compared. Anthropometric measurements at referral as well as biochemical values including plasma T4, T3, and thyroid-stimulating hormone were not significantly different. Bone maturation expressed as number of ossification centers or their surface were identical. Babies from both groups had similar psychologic performance at their first anniversary. It is concluded that breast-feeding does not protect against the deleterious effects of congenital hypothyroidism.
Apnea and Sleep State in Infants with Nasopharyngitis
Authors: Gould Jeffrey B. , Lee Austin F. S. , Cook Peter , Morelock Suzette
Published: December 2021

Having a mild upper respiratory tract infection does not change the sleep state proportions or total sleep time of an infant. However, infants with colds exhibit some sleep state specific alterations in sleep apnea. At 40, 44, and 48 weeks postconception, the number of respiratory pauses of 2 to 4.9 seconds and of 5 to 9.9 seconds duration per 100 minutes of state, during rapid eye movement, and indeterminate sleep are decreased in infants with colds. The absence of this phenomenon at 52 weeks suggests that it is modified by maturation. We hypothesize that the reduction in rapid eye movement and indeterminate sleep apnea is a manifestation of an adaptive response in normal infants, but for infants at risk for the sudden infant death syndrome, this response may be overwhelmed, resulting in increased apnea and, in some instances, sudden infant death.
A Randomized Controlled Trial of Prenatal Nutritional Supplementation
Authors: Jacobson Howard N.
Published: December 2021

This report is the long-awaited presentation of the results of the major study on the use of nutritional supplementation to improve the outcomes of pregnancy. In this study, a nutritional supplement refers to the provision of specified amounts of nutrients in a formula made up as a beverage. The formula would be used to aid in the quantification of the dietary intake of nutrients under study, in this case calories and protein. The expectation was that the supplements would be consumed in addition to the diet normally consumed and that they would not displace foods normally eaten.

The study design was initially presented at a workshop on nutritional supplementation and the outcome of pregnancy and sponsored by the Committee on Maternal Nutrition, National Research Council, in November 1971.1
Haemophilus influenzae Type b in a Day Care Center: Relationship of Nasopharyngeal Carriage to Development of Anticapsular Antibody
Authors: Granoff Dan M. , Gilsdorf Janet , Gessert Charles E. , Lowe Lawrence
Published: December 2021

In the article "Haemophilus influenzae Type b in a Day Care Center: Relationship of Nasopharyngeal Carriage to Development of Anticapsular Antibody" by Granoff et al (Pediatrics 65:65-68, 1980), on p 66 in Table 2 the geometric mean antibody level for adult blood bank donors should read 698 not 459.
Letters to the Editor
Authors: Nelson John D. , Laird W. Pennock
Published: December 2021

We did not state and we certainly did not mean to imply that patients with purulent pericarditis should be treated only with antibiotics. We agree with Drs Bass and Kaplan that surgery is an essential part of therapy; in fact, one of the references they cite supporting the need for surgical drainage is from this department.

We only speculated that, if the small effusions detected by our survey were infectious in origin, they must have been incipient infections aborted by antibiotic therapy since no patient progressed to symptomatic purulent pericarditis.
Letters to the Editor
Authors: Kanof Abram
Published: December 2021

With regard to the article by Cleary and Kohl (Pediatrics 64:301, 1979), is there a literature on such infection following circumcision by a licensed mohel, ritual circumcisor. In 45 years of pediatric practice in a largely Jewish area, I have never seen any occurrence. The only infection I have seen is minor oozing, easily controlled.

Perhaps the seventh day is the best time for the procedure, and the use of the Gomco clamp is the simplest and least traumatic.
Letters to the Editor
Authors: Cleary Thomas G. , Kohl Steve
Published: December 2021

We appreciate the interest in our report. We generally agree with the comments of Dr Woodside, although we are uncertain of the exact role surgery should play. Clearly if there is an abscess, necrotic gangrenous tissue, or subcutaneous crepitance surgery is crucial. For the infant who has cellulitis without these features a less aggressive approach seems reasonable.

In reference to the comments of Dr Kanof, the largest series evaluating the complications of ritual circumcision performed on day 8 by skilled mohelim comes from Jerusalem.
Styrofoam Aspiration
Authors: Sessa Edward M.
Published: December 2021

Some years ago Dr Reuben Reiman, in a letter to Pediatrics,1 discussed the case of an 8-month-old infant who died subsequent to aspiration of a particle from a styrofoam cup. A recent case in my practice is reminiscent of his, and again points out the potential hazard from aspiration of a material that is widespread in distribution, eg, cups and packing material, easy to break apart, and lightweight enough to be inhaled from the oropharynx into the bronchial tubes.
History and Observation Variables in Assessing Febrile Children
Authors: McCarthy Paul L. , Jekel James F. , Stashwick Carole A. , Spiesel Sydney Z. , Dolan Thomas F.
Published: December 2021

Attending pediatricians listed five history and eight observation variables on which they base their "instinctive" judgment (prior to performing a physical examination) of overall degree of illness of febrile children. Attending pediatricians and house staff observer pairs independently scored these variables in an overall assessment on 219 young, febrile children. The observation variable playfulness had the strongest correlation with overall assessment. Observer agreement in scoring the variables and overall assessment, while statistically significant, was only fair. When an attending pediatrician judged a child as moderately or severly ill on overall assessment, serious illnesses were four times as likely as when such a judgment was not made. When a house officer judged a child as moderately or severely ill, serious illnesses were less than twice as likely as when such a judgment was not made. However, only 57% of children with serious illnesses were judged by the attending pediatrician as moderately or severely ill on overall assessment. These data demonstrate the importance and limitations of "instinctive" clinical judgments about young, febrile children; the association between observation of complex behavioral patterns, especially playfulness, and overall assessment; and the need for further study of these complex behavioral patterns in order to define a reliable clinical approach to febrile children.
Countercurrent Immunoelectrophoresis in the Evaluation of Infants with Group B Streptococcal Disease
Authors: Baker Carol J. , Webb Bette J. , Jackson Claudia V. , Edwards Morven S.
Published: December 2021

Admission specimens of CSF, serum, and urine from 67 patients with proved group B streptococcal (GBS) bacteremia and/or meningitis were evaluated by countercurrent immunoelectrophoresis (CIE). Group B and type-specific antigens were detected in 81% of CSF, 63% of serum, and 96% of concentrated urine specimens by CIE. Each of 26 infants with meningitis from whom all three body fluids were available and ten with bacteremia from whom both serum and urine were collected at admission had GBS antigens detected by CIE in at least one specimen. No false positive reactions were observed. Among patients with type III, GBS meningeal infection, fatal outcome or neurologic sequelae were significantly correlated with concentration of type III antigen in admission CSF and duration of antigenuria when compared to normal survivors (P = < .05, Mann-Whitney U tests). CIE appears to be a useful diagnostic and prognostic tool for infants with GBS infection if admission specimens from more than one source are examined and appropriately high-titered antisera are employed for testing.
On Replacing the Surfactant
Authors: Avery Mary Ellen
Published: December 2021

Ever since it was realized that hyaline membrane disease was the consequence of surfactant deficiency, replacing the missing surface-active alveolar lining layer has been a tantalizing prospect. The report of Fujiwara et al1 is the first demonstration in the human of consistent and dramatic success after a single instillation of an artificial surfactant by way of an endotracheal tube. The prompt restoration of a stable alveolar lining layer and the impressive improvement in blood gases are well documented. The problem of the widely patent ductus producing difficulties in the subsequent days is expected and of course could be approached by other interventions.
Ascorbic Acid, Dietary Restriction, and Upper Respiratory Tract Infection
Authors: Holborow P. L.
Published: December 2021

The manipulation of diet to control hyperactive behavior in children has become popular, although not adequately proven.1-3 The use of vitamin C to control infections is in a similar state. A survey of children taking both a "low-salicylate" diet and vitamin C supplements has shown seemingly paradoxical changes in the incidence of sore throats and other upper respiratory illnesses.

Questionnaires were mailed to parents of children who had been maintained on a "low-salicylate" diet for at least six months, because of perceived hyperactivity.
Letters to the Editor
Authors: Barness Lewis A.
Published: December 2021

I must say that I think the author has carefully couched his findings; therefore, I believe it is safe to publish even though I am sure people will draw conclusions from the letter which are not satisfactory and not born out by facts. I do believe that his statement about vitamin C certainly deserves publication.
Letters to the Editor
Authors: Gorlick Gary M.
Published: December 2021

Regarding "Pregnancy and Abortion Counseling" (Pediatrics 63:920, 1979) I wish to inquire:

1. On page 920, "Information may not be offered to anyone, including the patient's parents, without the patient's permission." I have long wondered: At what age does this apply? What is the legality (answer) to this question for California? Does it vary from state to state?

2. On page 921, "Both premature parenthood and abortion during the formative adolescent years may have serious and long-term consequences."
Letters to the Editor
Authors: Harfi Harb
Published: December 2021

We would like to point out that the children we studied were known asthmatics whose symptoms had been controlled with oral theophyllin with, or without beta II agonists. All these patients had received either epinephrine parenterally or isoproterenal with IPPB before their admission, indicating the failure of these agents to control their asthma attacks.

The dosage of aminophyllin was relatively low (4 mg/kg) and none of the patients had toxic symptoms. Changing the aminophyllin dosage based on measurement of serum theophyllin could have added another variable which is not our purpose from the study, ie, the effect of high doses versus conventional doses of corticosteroids.
Ventilator-Induced Pneumoperitoneum—A Rapid Diagnosis
Authors: Chang Jack H. T. , Hernandez Jacinto
Published: December 2021

Pneumoperitoneum found on abdominal roentgenography in the newborn usually indicates intestinal perforation. With the increased use of high pressure ventilation, pneumoperitoneum secondary to air dissecting transdiaphragmatically is being encountered with greater frequency.1-3 Accurate differentiation between respirator-associated pneumoperitoneum and perforated viscus can save the neonate a needless surgical exploration at a time when an operation is least able to be tolerated.

This report reviews our recent experience with six neonates and suggests a rapid method to differentiate a surgical from a nonsurgical cause of pneumoperitoneum.

CLINICAL DATA

Six neonates with positive pressure ventilationinduced pneumoperitoneum were encountered at The Children's Hospital, Denver, between 1976 and 1979.
Vincristine Poisoning
Authors: Barna Peter
Published: December 2021

Vincristine is an effective and potent antileukemic agent. Its FDA-approved labeling, ie, its package insert, does not contain directions for treatment of overdose. Several recent communications1-7 report accidental overdoses whose outcome was often fatal (Table).

Although treatment is thougth to be symptomatic and supportive only,1 folinic acid (leucovorin calcium, citrovorum factor), a well-known methotrexate antidote, was used successfully by Grush and Morgan5 and Wakem and Bennett7 on overdosed patients. The treatment, on the part of Grush and Morgan, was based on a brief description of folinic acid rescue of vincristine-poisoned mice.8
Is the Study Flawed?
Authors: Forsyth Brian
Published: December 2021

I commend Cohen and colleagues1 for taking another look at the practice of managing patients with chronic nonspecific diarrhea (CNSD) with elimination diets. However, their report proposes yet another abnormal diet for this condition and I feel that we should be sure that this treatment is truly efficacious before it is used as widely as the dietary practices which it is intended to replace.

For this reason, I wish to point out some possible serious flaws in the study presented.
Letters to the Editor
Authors: Ginsburg Charles M. , Nelson John D.
Published: December 2021

We do not disagree with the recommendations of Drs Fischer, Bass, and Arthur for treating hospitalized patients with pneumonia. They might have mentioned, additionally, the possible utility of cefamandole as an alternative to a penicillinase-resistant penicillin plus chloramphenicol for hospitalized infants with presumed bacterial pneumonia. We are currently evaluating cefuroxime, which has a similar in vitro spectrum, and are finding it effective in patients with pneumonia due to Haemophilus influenzae type b, pneumococci and Staphylococcus aureus.
Letters to the Editor
Authors: Shull Margaret W. , Dwyer Johanna T.
Published: December 2021

Dr Dillard has interpreted our results as an attempt to show adverse effects of prolonged breast-feeding. In studying the less than 2-year-old vegetarians we found it necessary to note the effects of breast-feeding. The breastfed infants had reduced weight, but not length velocities. These velocities were compared to Harvard growth norms and a reduced weight velocity does not necessarily imply a health hazard.

What appears to be unique among this group is the extended breast-feeding and reduced weight gain velocity up to 2 years of age.
Neonatal Death
Authors: Bergman Abraham B.
Published: December 2021

The eloquent articles on neonatal death by Elliott and Hem (Pediatrics July 1978) raise several questions. (1) How many practicing pediatricians, let alone academicians, provide routine follow-up care to the families of their patients that die? (2) Can more compelling testimony exist than these two pieces, in favor of establishing this practice as a standard in pediatrics? (3) Might the day ever come when the various groups responsible for training, review of standards, and assessing competency, allow points for a pediatrician's ability to provide comfort?
Letters to the Editor
Authors: Tinanoff Norman
Published: December 2021

There is presently some difficulty with fluoride supplementation for a child in the first year of life. The American Academy of Pediatrics regimen for supplemental fluorides produced mild fluorosis in some subjects (Aasenden R, Peebles IC: Arch Oral Biol 19:321-326, 1974), and infant formulas may presently have variable amounts of fluorides.

See Table in the PDF File

This regimen is needed only in areas that do not have optimally fluoridated water, and when infants are ingesting commercial infant formula, no supplementation may be necessary.
Noninvasive Transcutaneous Oxygen Pressure Diagnosis of Reversed Ductal Shunts in Cyanotic Heart Disease
Authors: Tateishi Kazuma , Yamanouchi Itsuro
Published: December 2021

Double-site transcutaneous oxygen pressure (tcPo2) monitoring was carried out in 24 infants with cyanotic heart disease and in 12 acyanotic "control" infants. The tcPo2 values were recorded continuously as ambient forced inspiratory oxygen (FIO2) was varied from 0.21 to almost 1.0. The recordings obtained in the cyanotic infants could be grouped in one of four patterns, each of which correlated closely with the altered hemodynamic characteristics of heart disease. These data confirm the value of this noninvasive technique for hemodynamic and anatomic diagnosis of cyanotic heart disease, especially in cases with aortic arch anomalies with reversed ductal shunts.
The Early Window: Effect of TV on Children and Youth by Robert M. Liebert, John M. Neale, and Emily S. Davidson. New York, Pergamon Press, 1973, $9.50, 193 pp
Authors: H. R. J.
Published: December 2021

"...a child born today will, by the age of 18, have spent more time watching television than in any other single activity but sleep." The question is, of course, what are the effects of this "treatment?" These authors review the relevant data, especially of the effects of TV violence on children. It is a gross oversimplification to say that violence on TV does increase children's violent behavior, for there are many caveats required. But the power of TV to do ill to some children is made clear in this book.
Laparoscopy in Children
Authors: Leape Lucian L. , Ramenofsky Max L.
Published: December 2021

Laparoscopy has been performed in 120 infants and children for a variety of indications including chronic abdominal pain, debatable appendicitis, liver biopsy, biliary atresia, and abdominal trauma. A specific diagnosis was made in 71% of patients and 59% were spared laparotomy. There were one complication and four errors in interpretation (3.3%). Laparoscopy represents a considerable advantage over laparotomy in the diagnosis and management of a number of pediatric disorders and deserves wider application.
Letters to the Editor
Authors: Kendig Edwin L.
Published: December 2021

Dr Farer and I have agreed on our mutual commitment to the eradication of tuberculosis in children. However, it is important that all avenues be utilized toward elimination of tuberculosis in the United States and two current actions of the United States Public Health Service have unintentionally served to minimize the seriousness of the problem. These actions are: (1) recommendation that routine use of the tuberculin test be discontinued and (2) official statistical counting methods that in large measure exclude the reporting of children with primary tuberculosis (III. Tuberculosis: Infected, with disease, lymphatic).
Children's Blood Pressure in the United States
Authors: Blumenthal Sidney , Smith W. McFate , Tarazi Robert C. , Lauer Ronald , Jesse Mary Jane
Published: December 2021

We have read Dr Forrest Adams' note entitled "Blood Pressure of Children in the United States" (Pediatrics

See Table in the PDF File

61:931, 1978) in which he comments on specific sections of a report of a Task Force on Blood Pressure Control in Children. Knowledge concerning the relationship between blood pressure in children and subsequent health in adult life should be of continuous interest to all pediatricians.

Dr Adams states that it is misleading to present percentile graphs of US children's blood pressures for reference because US children's blood pressures increase with age while other cultures fail to show an increase from infancy to 50 years.
Doing Better by Doing Less
Authors: Cohen Daniel L.
Published: December 2021

This letter has been prompted by a recent editorial in the Archives of Diseases of Childhood written by Professor Ronald Illingworth,1 a physician of international reputation whose contributions toward an understanding of normal and abnormal development in pediatrics are noteworthy. The essence of the editorial is that Professor Illingworth feels physicians don't know when to leave well enough alone and that normal children are often better off before they see a physician than afterward. He lambasts our archaic notions on the need for circumcisions (the cost of which in the United States approaches $59,000,000 per year!!),2 clipping of frenula, double diapers for "hip clicks," correction surgery or shoes for "toeing in," etc.
On Death, Dying, and Decisions
Authors: Freeman John M. , Rogers Mark C.
Published: December 2021

Brain death is a concept of recent concern. Formerly, death was validated when the heart stopped beating. With modern technology, such as pacemakers, ventilators, and cardiopulmonary machines able to sustain the heart, physicians and the public have become concerned about prolonging existence after massive brain destruction. Out of this concern came the concept of "death with dignity" and the "right to die."

Since cardiac transplantation required a viable heart, and since the brain was found to be the key to "meaningful existence," a new definition of death was derived. That definition included "sufficient damage to the brain that it would not recover."
Letters to Editor
Authors: Greydanus Donald E. , McAnarney Elizabeth R.
Published: December 2021

We thank Dr Emans for her comments and compliment. We shall address the two issues raised: oligomerorrhea and sickle cell trait.

Many relative and absolute contraindications to oral contraceptives were listed in our review of contraception.1 Certainly each of these difficulties deserves a careful evaluation, whether the physician is dealing with severe headaches, collagen vascular disorders, epilepsy, diabetes mellitus, or others. Irregular menstruation can be a complex process, requiring a thorough diagnostic assessment before a prescription of oral contraceptives is given.
Blood Pressure of Children in the United States
Authors: Walker Alexander R. P. , Walker B. Faith
Published: December 2021

Professor F. A. Adams1 has criticized data published by the Task Force of the National Heart, Blood and Lung Institute,2 averring that the cross-sectional data used to produce the blood pressure standards for children "cannot define the optimal or medically normal; they only describe the status of the population at that moment in time." Adams believes that, ideally, "beyond infancy the normal aging process is unaccompanied by an increase in blood pressure."

There are many populations living primitively to whom this applies, although our experience of blacks living in very remote parts of Southern Africa is that it is only beyond adolescence, not infancy, that blood pressure does not rise significantly.
Letters to the Editor
Authors: Sassaman Edward , Mulick James A.
Published: December 2021

The article by Vining and Freeman (Pediatrics 62:850, 1978) regarding sterilization of retarded females is a thoughtful consideration of a difficult subject. Unfortunately, we feel that the authors have oversimplified several issues and thereby created more confusion among practicing pediatricians.

First, it is a debatable value judgment to say that sexuality and menstruation in a retarded female is undesirable or abnormal. Normalization is what we in developmental pediatrics want for our patients. It is contradictory, therefore, to maintain that routine physiologic functions are abnormal.
Letters to Editor
Authors: Freeman John M. , Vining Eileen P. G.
Published: December 2021

We are delighted to respond to the letter concerning "Sterilization and the Retarded Female" (Pediatrics 62: 850, 1978). If we provoke thoughtful debate we will have partially accomplished our purpose.

Several points from our commentary require emphasis, because they have been misunderstood by the correspondents.

1. It is imperative that the "retarded" not be lumped, but must be evaluated individually on the basis of functional skills, IQ, and total environment. What is appropriate for those with higher levels of function may not be appropriate for those with very low function.
Be Fair to Snakes
Authors: Gibson Lewis E.
Published: December 2021

I began to suspect that Mandell et al1 were a bit weak in their herpetology when they left out the water moccasin or cottonmouth from their list of poisonous snakes in the United States. However, when they suggest that the 14.5% of venomous snakebites in Florida which could not be identified as crotalid or elapid bites might be caused by rear fanged colubrid envenomation, they are in real difficulty. According to Ditmars2(p125) the only species of rear fanged snake in Florida is the black-headed snake (Tantilla coronata coronata).
More on Snakebites
Authors: Janchar Leonard J.
Published: December 2021

The recent article by Mandell et at "Major Coagulopathy and ‘Nonpoisonous’Snake Bites" (Pediatrics 65: 314, 1980), brings to light several problems in regard to the treatment of snake bites. While it can be said that bites of venomous snakes are of major concern, the bites of so-called nonvenomous snakes also likewise are of some concern. The authors raised the point concerning the colubrids and venomous members of their family. It must be stated that approximately 78% of the species of snakes of the entire world belong to this family. Here in the United States this figure rises to approximately 84% of the species found.
Is the Fluorometric Method for Blood Bilirubin Accurate?
Authors: Cembrowski George , Garber Carl C.
Published: December 2021

The article by Brown et al1 interested us greatly. Direct fluorometric measurement of whole blood bilirubin, if accurate and precise, will help in the care of the jaundiced neonate. The accuracy and precision of this technique, however, cannot be readily assessed from the authors' data.

Consider the comparison of the fluorometric method to the Jendrassik-Grof method for total bilirubin. To assess accuracy, the authors use the correlation coefficient, r, and the slope of the linear regression line through the method comparison data. There are two problems with this data analysis.
CHARLES DICKENS DESCRIBES THE FEELINGS OF THE MOTHER OF A MENTALLY RETARDED CHILD
Authors: C. T. E.
Published: December 2021

Disease played a considerable part in the novels of Dickens. He looked on disease with the observing eye of the astute clinician, and recorded faithfully what he saw and what was told to him.1

A strikingly sensitive passage in Dickens' Barnaby Rudge is the following description of the feelings of Mrs Rudge toward her mentally retarded son.2

Two-and-twenty-years. Her boy's whole life and history. The last time she looked back upon those roofs among the trees, she carried him in her arms, an infant. How often since that time had she sat beside him night and day, watching for the dawn of mind that never came; how had she feared, and doubted, and yet hoped, long after conviction forced itself upon her!...

His older childhood, too; the strange imaginings he had; his terror of certain senseless things—familiar objects he endowed with life; the slow and gradual breaking out of that one horror, in which, before his birth, his darkened intellect began; how, in the midst of all, she had found some hope and comfort in his being unlike another child, and had gone on almost believing in the slow development of his mind until he grew a man, and then his childhood was complete and lasting...
Pre-participation Sports Assessment—An Objective Evaluation
Authors: Goldberg Barry , Saraniti Anthony , Witman Philip , Gavin Michael , Nicholas James A.
Published: December 2021

The yield from a pre-participation sports examination consisting of a review of the medical history, routine physical examination, musculoskeletal examination, laboratory screening and an assessment of fitness by evaluation of body composition, flexibility, and muscular strength testing was studied. There were 701 students evaluated. Two students (0.3%) were excluded from participation because of medical problems and seven (1%) because of orthopedic problems. Sixty students (8.6%) were referred for additional medical evaluation. Thirty-five students (5.0%) required further orthopedic evaluation. All of the students who required additional evaluations were eventually granted permission to participate. The review of the medical history was positive in seven of the restricted students and 40 of the referred students. The routine physical examination was normal in the two restricted students and abnormal in 14 of the referred students. The musculoskeletal examination was abnormal in all of the students restricted or referred for orthopedic problems. The assessment of physical fitness revealed that 32% of the students had excessive body fat, 10% to 15% of both boys and girls had excessive muscle tightness in either the upper or lower body and approximately 5% of the students had weakness in hip abductors or flexors. Significant unilateral strength deficits were also found. When performed for the purpose of restricting participation or referring students for additional evaluation, the medical history and musculoskeletal examination are the components of the pre-participation sports examination with the highest yield. Additionally, the aspects of the examination which related to fitness revealed a significant number of abnormalities.
Getting the Most Out of the Periodic "Checkup"—The View from Canada
Authors: Goldbloom Richard B.
Published: December 2021

How often should noncomplainant, ostensibly healthy North Americans of all ages be medically examined? By whom? What procedures should the examination include? Does the yield of improved health justify the cost and effort, and does each maneuver included in the examination result in more good than harm?

The questions are not new. Many of the answers have been suggested previously, and some are mindlessly presumed. However, a task force commissioned by Canada's Department of Health and Welfare has recently taken a long, hard look at these questions. The published report of their findings and recommendations1 is important because it reflects a new and useful approach to providing rational, appropriately qualified answers that serve the best interests of everyone's health.
Confessions of a Manuscript Reviewer
Authors: Bergman Abraham B.
Published: December 2021

Stop the presses! Reviewer A, that nameless, faceless, and heartless cad who pierces one's most treasured literary prose with cynical barbs, is finally emerging from the closet. The umpire is doffing his mask and chest protector to tell the pitchers how to hit the strike zone. The curricula vitae of aspiring academicians are about to be fattened. The occasion? I'm leaving the editorial board of Pediatrics. Unfortunately, it's not because I'm being lured away by the big bucks of a competitor journal. I'd jump at the chance. In order to infuse fresh blood into the ranks, six consecutive years is as long as anyone can serve on committees of the American Academy of Pediatrics, including the editorial board of Pediatrics.
The Taboo Zone
Authors: Jelliffe Derrick B. , Jelliffe E. F. Patrice
Published: December 2021

The recent letter by "Perplexed Observer" (Pediatrics 65:369, 1980) opens up the taboo zone that exists in pediatrics—or, indeed, in any other aspect of medicine. Discussion of the ethics of the interaction between the infant food1 (or pharmaceutical) industries2,3 and the health profession is not considered "nice"—nevertheless, it exists.

Pediatricians in the United States will react strongly and negatively to the suggestion that they have been "bought off" by the infant food and pharmaceutical industries. Yet how mant of us at various stages of our careers have been subtly "influenced off" or "muted off"—very often without being aware of it—by means of various forms of "manipulation by assistance," leading to "endorsement by association."4,5
You Should Demand Scientific Proof
Authors: Marino Joseph T.
Published: December 2021

Dr Crook's comments1 on scientific proof and its application to documenting the clinical spectrum of allergic reactions to foods touched upon many issues; but it left me with the uncomfortable feeling that he did not see the need for scientific proof in certain areas of medicine because "scientific proof" is difficult to define. Admittedly, it is a difficult concept to define as is any other abstract concept (truth, justice, etc). However, our inability to define these terms does not prevent us from distinguishing the true from the false, the just from the unjust, or the proven from the unproven.
Letters to the Editor
Authors: Crook William G.
Published: December 2021

I appreciate the comments of Dr Marino and Dr Altenburger; and I agree with Dr Marmno that a significant part of the advances in medicine ("from the realm of magic to that of science") have taken place because accepted scientific methods, including double-blind studies, have been carried out which have confirmed (or rejected) impressions gained from anecdotal data.

I can also understand how Dr Altenburger would be "disappointed" that the editors of the official publication of the American Academy of Pediatrics would choose to publish what he feels to be an "unscientific" commentary.
Proof, Science, and the Practice of Medicine
Authors: Kramer Michael S. , Pless I. B.
Published: December 2021

We read with surprise and considerable alarm Dr Crook's editorial concerning the role of scientific proof in medical practice. Unfortunately, he appears to confound the admittedly problematic philosophical construct of "proof" with the basic tenets of the scientific method. It is one thing to argue that scientific proof is difficult to define, but quite another to then conclude that opinion, even enlightened and informed opinion, is preferable to hard evidence as the principal criterion for assessing the efficacy of medical treatment.
Wild Animal Milks
Authors: Gerrard John W.
Published: December 2021

The Nutrition Committee of the Canadian Paediatric Society and the Committee on Nutrition of the American Academy of Pediatrics are to be highly commended for their commentary on breast-feeding. One recommendation made to encourage breast-feeding is to feed on demand. An all-too-common reason put forward by mothers for giving up breast-feeding is that the baby is always hungry, implying that breast milk does not satisfy him. An alternative inference, and often the correct one, is that he likes his milk so much that no sooner has he had one feed than he demands another.
The Child Psychologist and the Pediatric Residency Program
Authors: Pierog Sophie , Hill Austin C.
Published: December 2021

Anders,1 noted that pediatrics and child psychiatry have, in the past, shown little ability to collaborate. The unfortunate effects of this lack of collaboration have been brought into focus in the report of the Task Force on Pediatric Education,2 which notes that "about half of young pediatricians rated their residency as providing insufficient experience with psychosocial and behavioral problems," and indicated a need for information about normal and abnormal growth and development patterns, psychological testing, psychotherapy, psychopharmacology, parenting and behavioral change.
ON THE IMPORTANCE OF LANCING THE TEETHING INFANT'S GUMS, AS VIEWED IN 1857
Authors: C. T. E.
Published: December 2021

John Arbuthnot (1667-1735),1 physician to Queen Anne, claimed that "above a tenth part of Infants die in Teething by Symptoms proceeding from the irritation of the tender parts of the Jaws." He, along with many others, including Ambroise Paré (1510-1590),2 recommended lancing the gums in difficult cases.

The same recommendation was found in many American medical journals well into the nineteenth century, as is evident in this quotation published in 1857.3

The principal thing in the treatment of these cases, is to lance the gums freely. A superficial incision will be of no avail; the gums must be cut down until the lancet impinges on the approaching tooth. The only caution required, is that the incision be inclined outwards, in order to avoid the tissues which connect the permanent and temporary teeth. . . . The operation requires considerable skill and caution to ensure its safe and effectual performance. The terrors of the mother and the restlessness of the infant, frequently render it by no means an easy operation; and the careless operator is apt to wound either the cheeks or tongue, to make the incisions too superficially to be of the slightest use.

The prejudices of former writers against this invaluable operation scarcely require comment; but as we still find a few, and we are happy to say a very few individuals, who retain a bigoted faith in the absurd dogmata of their forefathers, we will briefly refer to the objections which have been urged against the utility of lancing the gums.