bluuebunny/crossref_metadata_2025 huggingface dataset:
Food Insufficiency and American School-Aged Children's Cognitive, Academic, and Psychosocial Development
Authors: Alaimo Katherine , Olson Christine M. , Frongillo Edward A.
Published: December 2021

Objective.

This study investigates associations between food insufficiency and cognitive, academic, and psychosocial outcomes for US children and teenagers ages 6 to 11 and 12 to 16 years.

Methods.

Data from the Third National Health and Nutrition Examination Survey (NHANES III) were analyzed. Children were classified as food-insufficient if the family respondent reported that his or her family sometimes or often did not get enough food to eat. Regression analyses were conducted to test for associations between food insufficiency and cognitive, academic, and psychosocial measures in general and then within lower-risk and higher-risk groups. Regression coefficients and odds ratios for food insufficiency are reported, adjusted for poverty status and other potential confounding factors.

Results.

After adjusting for confounding variables, 6- to 11-year-old food-insufficient children had significantly lower arithmetic scores and were more likely to have repeated a grade, have seen a psychologist, and have had difficulty getting along with other children. Food-insufficient teenagers were more likely to have seen a psychologist, have been suspended from school, and have had difficulty getting along with other children. Further analyses divided children into lower-risk and higher-risk groups. The associations between food insufficiency and children's outcomes varied by level of risk.

Conclusions.

The results demonstrate that negative academic and psychosocial outcomes are associated with family-level food insufficiency and provide support for public health efforts to increase the food security of American families.
Implementing Potentially Better Practices to Reduce Lung Injury in Neonates
Authors: Burch Kelly , Rhine William , Baker Robin , Litman Fern , Kaempf Joseph W. , Schwarz Edward , Sun Shyan , Payne Nathaniel R. , Sharek Paul J.
Published: December 2021

Objective. Adherence to basic quality improvement principles enhances the implementation of potentially better practices (PBPs) and requires extensive planning and education. Even after PBPs have been identified and acknowledged as desirable, effective implementation of these practices does not occur easily. The objective of this study was to identify and assess implementation strategies that facilitate quality improvements in the respiratory care of extremely low birth weight infants.

Methods. The 9 members of the Neonatal Intensive Care Quality Improvement Collaborative Year 2000 Reducing Lung Injury focus group identified 9 PBPs in a evidence-based manner to decrease chronic lung disease in extremely low birth weight newborns. Each site implemented several or all PBPs based on a site-specific selection process. Each site was asked to submit 1 or more examples of experiences that highlighted effective implementation strategies. This article reports these examples and emphasizes the principles on which they are based.

Results. The 9 participating institutions implemented a total of 57 PBPs (range: 1–9; median: 5). Including previous implementation, the 9 participating institutions implemented a total of 70 of a possible 81 PBPs before or during the study period (range: 5–9; median: 8). We report 7 approaches that facilitated PBP implementation: information availability, feedback, perseverance, collaboration, imitation, recognition of implementation complexity, and tracking of process indicators.

Conclusions. Quality improvement efforts are enhanced by identifying and then implementing PBPs. In our experience, implementation of these PBPs can be difficult. Implementation strategies, such as those identified in this article, can improve the chances that quality improvement efforts will be effective.
Implementing Potentially Better Practices for Improving Family-Centered Care in Neonatal Intensive Care Units: Successes and Challenges
Authors: Moore Kimberly A. Cisneros , Coker Kara , DuBuisson Allison B. , Swett Betsy , Edwards William H.
Published: December 2021

Objective. Multidisciplinary teams from 11 medical center neonatal intensive care units collaborated in a quality improvement project with a focus on family-centered care.

Methods. Through a process of self-analysis, literature review, benchmarking site visits, and expert consultation, 10 potentially better practice (PBP) areas were defined. Improvement activities in 4 of the 10 areas are given as examples of successes and challenges that individual centers encountered. The 4 areas are vision and philosophy, unit culture, family participation in care, and families as advisors.

Results. Centers were at different places for all of the PBPs at the beginning and throughout the collaboration. Seven centers developed or revised their vision or philosophy of care statements about family-centered care. Incorporating the vision and philosophy of care into performance appraisals, hiring of new personnel, and changing unit culture to a more family-centered practice were more challenging than developing the statements. Full parent participation in care requires unrestricted access to the neonatal intensive care unit. The shift from considering parents to be “visitors” to being partners in caring for their child was more difficult for centers with restricted visitation policies. All centers developed, expanded, or started plans for establishing family advisory councils. The experience of 2 centers is described.

Conclusions. Family-centered care is more of a journey than a destination. Collaborating centers in this project found themselves at different places in that journey. Through perseverance in implementing the PBPs, all have moved further along the path.
Implementation of Evidence-Based Potentially Better Practices to Decrease Nosocomial Infections
Authors: Kilbride Howard W. , Wirtschafter David D. , Powers Richard J. , Sheehan Michael B.
Published: December 2021

Objective. Six neonatal intensive care units (NICUs) that are members of the Vermont Oxford National Evidence-Based Quality Improvement Collaborative for Neonatology collaborated to reduce infection rates. There were 7 centers in the original focus group, but 1 center left the collaborative after 1 year. Nosocomial infection is a significant area for improvement in most NICUs.

Methods. Six NICUs participating in the Vermont Oxford Network made clinical changes to address 3 areas of consensus: handwashing, line management, and accuracy of diagnosis. The summary statements were widely communicated. Review of the literature, internal assessments, and benchmarking visits all contributed to ideas for change.

Results. The principle outcome was the incidence of coagulase-negative staphylococcus bacteremia. There was an observed reduction from 24.6% in 1997 to 16.4% in 2000.

Conclusions. The collaborative process for clinical quality improvement can result in effective practice changes.
Environmental Causes of Central Nervous System Maldevelopment
Authors: Rodier Patricia M.
Published: December 2021

The central nervous system is the most vulnerable of all body systems to developmental injury. This review focuses on developmental processes by which the nervous system is formed and how those processes are known or suspected to be injured by toxic agents. The processes discussed are establishment of neuron numbers; migration of neurons; establishment of connections, neurotransmitter activity, and receptor numbers; deposition of myelin; and 2 processes that are prominent in postnatal development, trimming back of connections and postnatal neurogenesis. Our knowledge of the risks of exposure to environmental hazards in childhood and adolescence is minimal. Most of our information concerns the effects of neurotoxicants in prenatal and early postnatal life. More worrisome than our lack of data regarding later stages of development is the minimal effort that we have mounted to protect the public from known neurotoxic agents and that regulations for testing new drugs and chemicals still do not require any assessment of neuroteratologic effects.
A Clinic-Based, Comprehensive Care Model for Studying Late Effects in Long-Term Survivors of Pediatric Illnesses
Authors: Hinkle Andrea S. , Proukou Cindy , French Carol A. , Kozlowski Amy M. , Constine Louis S. , Lipsitz Stuart R. , Miller Tracie L. , Lipshultz Steve E.
Published: December 2021

Objective. Long-term survivors of several childhood illnesses are at risk for multiple late effects of their illness or therapy, and children with documented toxic exposures may also experience long-term health consequences. Clinical studies of these effects are difficult to conduct. The Cardiovascular Status in Childhood Cancer Survivors Study is an established study that highlights the ability to perform comprehensive clinical investigations when patients are cared for in a formal, long-term follow-up clinic. This clinic model facilitates long-term retention and recruitment of patients, allowing comprehensive clinical studies of late effects of illness or exposures, in this case, of cardiovascular complications of cancer treatment during childhood.

Methods. The study is funded through the National Institute of Health Office of Cancer Survivorship. Participants are recruited from the Long-Term Survivors Clinic at the University of Rochester. The clinic provides care for all survivors of childhood cancer in the region. The Long-Term Survivors Clinic provides medical care and psychosocial and educational support to patients and facilitates coordination of care. Patients remain in close contact with clinic staff for extended periods.

Results. We recruited a representative sample of this long-term survivor population, with a wide range of ages, diagnoses, and time since diagnosis. Longitudinal collection of detailed clinical data will enable us to conduct cohort studies of late effects as well as case-control studies of toxic exposures.

Conclusions. The success of this study shows the advantages of formal programs for continued care of patients with chronic illnesses or treatment or toxic exposures. The Long-Term Survivors Clinic provides an excellent model for clinical care and research that is applicable to multiple pediatric and young adult populations.
SPECIAL REVIEWS
Authors: WEDGWOOD RALPH J. P. , COOK CHARLES D. , COHEN JONATHAN
Published: December 2021

Twenty-six cases of dermatomyositis in children with follow-up studies ranging from one to 19 years are presented in order to indicate the natural history of this disease.

Of these 26 children, 10 are dead, 4 still have active disease, 4 have crippling contractures and 8 are able to lead an active normal life.

Thirteen of the children received endocrine therapy with adrenocorticotropic hormone, cortisone or testosterone. This appeared to produce at least symptomatic benefit in some cases, particularly early in the course of the active disease and, coordinated with symptomatic care, helped to tide the patients through the acute stages.

The most important treatment consists of persistent orthopedic measures and physiotherapy to minimize contractures.

Since death in this disease often results from palato-respiratory involvement, maintenance of an adequate airway and the use of a mechanical respirator may be life-saving.
INFANTILE RENAL ACIDOSIS
Authors: LIGHTWOOD R. , PAYNE W. W. , BLACK J. A.
Published: December 2021

Thirty-five cases of renal acidosis in infants are presented. Clinically there is failure to thrive with vomiting and obstinate constipation starting from the fourth to sixth month of life. Biochemically there is a hyperchloraemic acidosis with a neutral or alkaline urine. Radiological evidence of renal calcification was present in 13 of the 35 cases.

The treatment is to give sufficient alkali (as citrate, lactate or bicarbonate) to bring the alkali reserve up to the lower limit of normal. The prognosis is good, cure resulting in all cases.

The etiology and pathology has been considered; it is suggested that the cause lies in an imbalance in the normal postnatal development of renal function.
ABSENCE OF THE INFERIOR VENA CAVA
Authors: DOWNING DANIEL F.
Published: December 2021

Two patients with absence of the inferior vena cava are presented. Both were shown to have associated cardiovascular anomalies. A roentgen sign which may be of diagnostic aid is described.
STUDIES OF 17-HYDROXYCORTICOSTEROIDS
Authors: ELY ROBERT S. , RAILE RICHARD B. , BRAY PATRICK F. , KELLEY VINCENT C.
Published: December 2021

An ACTH-17-hydroxycorticosteroid response test is described as a measure of adrenal cortical function in which the change in plasma concentrations of 17-hydroxycorticosteroids in response to the intramuscular injection of 25 I.U. ACTH is determined.

The limitations of this test are discussed and it is compared with other tests of adrenal cortical function.

No correlation is seen between the magnitude of steroid elevation and of eosinopenia in response to ACTH. These data suggest that the ACTH-induced eosinopenia is not mediated by elevations in the circulating concentrations of 17-hydroxycorticosteroids.

Although this test might be improved by modifying the ACTH dose or route of ACTH administration, the direct measurement of alterations in circulating concentrations of 17-hydroxycorticosteroids probably represents the most practical approach to evaluation of adrenal cortical responsiveness.
VIRAL HEPATITIS IN EARLY INFANCY
Authors: SCOTT ROLAND B. , WILKINS WARREN , KESSLER ALTHEA
Published: December 2021

Three fatal cases of hepatitis with jaundice are reported in siblings with onset at ages of 4 weeks, 1 week, and 4 months, and death at 3 months, 4 months and 9 months, respectively.

Microscopic findings in postmortem sections of the liver were consistent with a diagnosis of viral hepatitis. From known data available it was probably of the homologous serum type.

The mother and two living siblings exhibited laboratory evidence of liver damage. Congenital viral hepatitis may simulate the clinical picture of biliary atresia.

Failure to include a consideration of viral hepatitis in the differential diagnosis of icterus in the very young infant may have serious consequences since these cases do not withstand surgical procedures, such as exploratory laparatomy, very well.
EDUCATION
Authors: KORSCH BARBARA M. , LEVINE S. Z.
Published: December 2021

A brief description is given of an outpatient fellowship program for pediatricians-in-training which has been in operation at The New York Hospital-Cornell Medical Center since 1942.

The reaction of the participating fellows, as obtained through the medium of questionnaires, is reported.
THE ATHETOID SYNDROME IN CEREBRAL PALSY
Authors: KOVEN LEO J. , LAMM STANLEY S.
Published: December 2021

We have attempted to illustrate some of the principal clinical aspects of the athetoid syndrome. The universal characteristics, clinical varieties and other clinical features, as well as the reflex, functional and orthopedic alterations of these patients, has been discussed.
CALCIFICATION OF THE ARTERIES IN INFANCY AND CHILDHOOD
Authors: COCHRANE W. A. , BOWDEN D. H.
Published: December 2021

Eight cases of calcification of the arteries have been described, six infants and two older children. The arterial lesions in all are similar, consisting of a deposit of calcium on the internal elastic lamina followed by more extensive calcification and fibrous thickening of the intima. The aetiology of the infantile condition is unknown. The lesions in the older children are probably secondary to renal disease.
A METHOD OF BLUNTING THE TIPS OF SMALL INDWELLING NASOGASTRIC POLYETHYLENE CATHETERS FOR FEEDING PREMATURE INFANTS
Authors: SILVERMAN WILLIAM A.
Published: December 2021

A simple method of blunting the tip of a minute polyethylene catheter has been described to make the tube suitable as an indwelling nasogastric tube for feeding premature infants.
COCCIDIOIDOMYCOSIS IN CHILDREN
Authors: DENNIS JAMES L. , HANSEN ARILD E.
Published: December 2021

1. The pediatric implications of coccidioidomycosis have been presented including the clinical features as well as the specific diagnostic procedures. 2. The in vitro response of coccidioides immites to ethyl vanillate, para-aminobenzoic acid and Thiocymetin have been reported. The direct observation of the effect of drugs upon spherules in living tissue cultures has been made with some degree of success. 3. Four children with disseminated coccidioidomycosis have been used to illustrate the clinical and serologic responses to various drugs. 4. At this time ethyl vanillate appears to be the best agent available. Although in selective cases actual cure seems possible, the occasional spontaneous regression of the disseminated disease demands caution in the evaluation of any chemotherapeutic agent.
SPECIAL ARTICLE
Authors: MCDANIEL WALTON B. , RADBILL SAMUEL X.
Published: December 2021

THE Philadelphia Pediatric Society has presented to the library of the College of Physicians of Philadelphia, an important work published in 1565 entitled: Five Books on the Feeding and Management of Children From Birth by Simon de Vallambert, thereby making an outstanding contribution to the historical and pediatric literary resources of Philadelphia, for the book is one of the earliest classics in the history of pediatrics, the first of its kind to be written in the French language, and one of the earliest in any modern language.

The medical care of children in the modern complete overall welfare sense is as old as archeological records go. One of the earliest records of mankind is a relatively short fragment of Egyptian papyrus written in the Sixteenth Century B.C., usually referred to as the Berlin Papyrus, For Mother and Child, which consists of a collection of incantations against two diseases of infants and various charms to facilitate childbirth, as well as prescriptions and incantations for the protection of infants. This fascinating text makes it possible for us to look into the Egyptian nursery. Just as a mother today knows lullabies with which she croons the crying baby to sleep, so the Egyptian mother was skillful in making amulets and using correct soothing words for the child who was sick, restless or threatened by evil.

Before the printing press was invented, literary efforts were transmitted in manuscript form. Through the centuries a number of such manuscripts have endured which pertain to matters of pediatric interest. Then came the printed book and, as soon as it did, pediatric printed works appeared.
NITROGEN BALANCES IN A PATIENT WITH FIBROCYSTIC DISEASE OF THE PANCREAS AND A PATIENT WITH THE CELIAC SYNDROME AND THE EFFECT OF AUREOMYCIN
Authors: Caughey Ronald H. , McCrory Wallace W. , Kaye Robert
Published: December 2021

1. Nitrogen and electrolyte balance studies were carried out in 1 infant with fibrocystic disease of the pancreas and 1 infant with the celiac syndrome.

2. The addition of Aureomycin® to the control regimen was not associated with any apparent beneficial effect on clinical status, weight gain or nitrogen and electrolyte balance in either subject.

3. Gelatin supplementation of a high protein diet did not enhance nitrogen retention in the celiac subject.

4. The subject with the celiac syndrome exhibited a fairly normal absorption of nitrogen which was offset by a large loss of nitrogen in the urine.

5. The infant with fibrocystic disease of the pancreas compensated to some extent for an impaired nitrogen absorption by an efficient utilization of the absorbed nitrogen.
INEFFECTIVENESS OF PYRIDOXINE (VITAMIN B6) IN THE TREATMENT OF EPILEPSY
Authors: Livingston Samuel , HSU Jeng Mein , Petersen Don C.
Published: December 2021

Pyridoxine proved of no value in the control of convulsions in 31 children with various types of cryptogenic and secondary epilepsy and who apparently had no deficiency of vitamin B6.
REVIEW ARTICLE
Authors: Scrimshaw Nevin S. , Behar Moisés , Pérez Carlos , Viteri Fernando
Published: December 2021

The principal nutritional problems of school children in Central America and Panama are those of a lack of sufficient protein of good quality, vitamin A, and riboflavin. Where tortillas prepared from lime-treated corn are not used, calcium deficiency is also evident. In many areas the high incidence of endemic goiter reflects an absolute or relative deficiency of iodine. Because supplementary feeding of nursing infants, and particularly the feeding of the child after weaning, are poorly carried out in the area, malnutrition is almost universal among children of these ages in low income and rural groups.

This is reflected in the tendency for growth and bone maturation, which parallels that for U. S. children during the first months after birth, to be severely retarded during the period from 1 to 4 years. During these ages either the cumulative effect of the poor diet or the poor diet plus some additional stress, results in the child developing Infantile Pluricarencial Syndrome (I.P.S.). Infectious diarrhea is a frequent precipitating cause. The I.P.S. of Central America, characterized by edema, skin and hair changes, retardation in growth and development, apathy, diarrhea and anorexia, is not essentially different from kwashiorkor.

The basically poor nutritional state of many pre-school children is defined and given the name incipient I.P.S. or prekwashiorkor. Nutritional surveys reveal physical signs compatible with a deficiency of vitamin A and sometimes also of riboflavin. In general deficiencies of niacin, ascorbic acid, vitamin D and thiamine are not recognized. Anemias are frequent and usually of a macrocytic type. In hookworm infested areas an appreciable amount of microcytic anemia may also be observed.

Investigations in progress by the Institute of Nutrition of Central America and Panama (INCAP) in the area include: continued nutritional and dietary surveys; studies of the effect of vitamin B12 and antibiotics on growth; studies of the physiopathology of I.P.S., and the development of vegetable mixtures and other dietary means of improving child feeding practices at low cost.
THE PEDIATRICIAN AND THE PUBLIC
Authors: Jelliffe D. B.
Published: December 2021

THE VAST majority of the global child population is located within what have been termed the technically developing subtropical and tropical regions of the world. In India, for example, there is a child population of approximately 150 million with an estimated infant mortality rate ranging in different parts from over 100 to much more than 200 per 1000 live births. Despite these enormous concentrations of population, problems of child health in these areas have been neglected to a large extent until very recently, while pediatric education has usually received but little emphasis.

PRESENT SITUATION

The concentration of trained pediatricians in most tropical regions is extremely low, sometimes literally only 1 or 2 may be practising in a whole country. This is, for the most part, a reflection of the general deficiency of all types of medical and nursing personnel. Of greater importance is the all too common inadequate knowledge of pediatrics possessed by those in general practice in many tropical countries, which is often primarily the result of defective emphasis given to this specialty during undergraduate training. In some regions, including much of South-East Asia and especially India, pediatrics still has the same status that it had in the United States and Britain over 30 years ago—that is as an insignificant fragment of the student's training, perfunctorily dealt with in a few didactic lectures and ward rounds. There is, therefore, great need in some tropical countries to educate those responsible for organising and planning medical education to the understanding that pediatrics is 1 of the 4 major components of the student's clinical curriculum.
Office Procedures
Authors: BELFORD WILLIAM W.
Published: December 2021

This is a very good reference book for all sorts of office procedures. The author is careful in his choice of methods. Likewise he sounds warnings of confusion that may follow some procedures such as the B.M.R. It appears the volume is designed for those in general practice. This reviewer enjoyed reading it.
ANTIBODY RESPONSES TO NATURALLY OCCURRING POLIOMYELITIS INFECTIONS
Authors: Miller C. Arden , Lenahan Margaret F.
Published: December 2021

The neutralizing antibody responses of 52 asymptomatic household contacts of patients with poliomyelitis were studied by the metabolic inhibition method. Half of these contacts were fecal carriers of poliomyelitis virus. For purposes of comparison the antibody responses of 25 patients with paralytic poliomyelitis, all fecal virus carriers, were studied. The errors of replication of the test procedure were determined by duplicate testing of 51 serums.

Duplicate testing of serum specimens indicated disagreement regarding the presence or absence of antibody in 6.0 to 8.0 per cent of the serums. The second test gave antibody titers which disagreed with those from the first test by a factor of fourfold or more 37.0 per cent of the time; errors occurred equally in either direction.

Half of all persons studied showed an increase of fourfold or more in the antibody titers of paired serums; this was 3 to 4 times as many as would be expected by chance. It was not possible to distinguish the antibody responses of paralyzed patients from asymptomatic household contacts; or the fecal virus carriers from the nonvirus carriers in the latter group.

Four virus carriers who did not have homologous antibody in convalescent serums were found. By repeat testing homologous antibody was found in all but one of these.

The limitations of the test procedure as a diagnostic tool are discussed.
GROWTH AND DEVELOPMENT OF PERUVIAN CHILDREN
Authors: Trulson M. F. , Collazos C. , Hegsted D. M.
Published: December 2021

One hundred nine school children from 2 rural areas in the coastal area of Peru were measured and weighed and roentgenograms of the hand and wrist were obtained.

Three-fourths of the children were below Stuart's tenth percentile in height. Roughly, a third of the children were below the tenth percentile in weight. Fifteen per cent of the girls and 30 per cent of the boys were above the fiftieth percentile in weight.

Forty to forty-five per cent of the children were in the stocky to obese channels of the Wetzel grid; 5 to 10 per cent would be classified as fair to poor, and roughly half would be considered average.

Developmental age (Wetzel) was 7.5 ± 15.6 months less than chronological age for boys, 10.5 ± 11.3 months less for girls. A third of the boys and 15 per cent of the girls were advanced in Wetzel developmental age. It was apparent that the heavier children were generally advanced in Wetzel developmental age.

Roentgenograms of the hand and wrist were assessed by comparing the films to the Greulich-Pyle Standards. Skeletal age was -11.3 ± 12.7 months for boys and -7.1 ± 9.8 for girls. Eighteen per cent of the population were advanced in skeletal age. Boys were more retarded than girls in skeletal age.

The correlation and partial correlation coefficients for all combinations of the 4 measurements (retardation in weight, retardation in height, retardation in skeletal age and retardation in developmental age) were calculated. The various pairs were all rather highly correlated, this being particularly true of weight and Wetzel developmental age. The partial correlation coefficients show, however, that skeletal age was not closely correlated with any of the other 3 measurements. Height and developmental age were negatively correlated to a significant degree, and developmental age and weight were so closely related that they appear to be measures of the same characteristic in this population.

Individual dietary histories are not available from these children, but it is known that the diets in the area are considerably below recommended levels in certain nutriients. Whether dietary deficiencies are factors in the apparently abnormal developmental patterns, or if the patterns are truly abnormal for the Peruvian child or indicate an adverse effect on health, remain to be shown.

It is pointed out that there are probably advantages in studies upon growth and development in different areas of the world where a variety of dietary or environmental factors may have specific effects.
MONGOLISM (MONGOLOID DEFICIENCY) DURING EARLY INFANCY—SOME NEWLY RECOGNIZED DIAGNOSTIC CHANGES IN THE PELVIC BONES
Authors: Caffey John , Ross Steven
Published: December 2021

IN MONGOLOID defectives, stigmas in the skeleton have been reported at several sites: hypoplasia of the base of the skull; hypoplasia of the nasal and other facial bones, and dysplasia and hypoplasia of metacarpals and phalanges. Undergrowth of the vertebral bodies and the tubular bones in the extremities is responsible for the dwarfism which is one of the most consistent components of this syndrome. Maturation of the skeleton varies greatly in different mongoloid infants; it may be advancecd, normal, or retarded. At birth practically all infants with mongolism show normal or advanced maturation, in our experience.

Spitzer and Robinson found the frontal sinuses to be absent in 26 out of 28 individuals with mongolism in contrast to an absence in 4 to 5 per 100 of the remainder of the general population. Only 2 of the 28 individuals with mongolism showed no dental aplasia. The erupted teeth were commonly stunted, eruption of the permanent teeth was often delayed, and there was a higher incidence of the dental anomalies found than in the general population. No pathognomonic lesions in the teeth were found. The partial anodontia, deformed teeth and delayed eruption resemble the changes found in ectodermal dysplasia and in cleidocranial dysostosis.

Smith and McKeown found the mean weights of newly born infants with mongolism to be 2860 gm. in contrast to 3220 gm. for normal newborns. the mean duration of gestation to he shorter for infants with mongolism than for normal newborns, 269 days and 278 days respectively.

So far as we have been able to ascertain, stigmas in the pelvic bones of infants with mongolism have not been reported in either anatomical or roentgenographic studies.
STUDIES OF DISTAL COLONIC MOTILITY IN CHILDREN
Authors: Davidson Murray , Sleisenger Marvin H. , Almy Thomas P. , Levine Samuel Z.
Published: December 2021

A characteristic propulsive wave, previously reported in adults with ulcerative colitis, has been found in infants with acute diarrhea but not in children with ulcerative colitis. The reasons for this are discussed. The induction of propulsive wave forms in normal individuals by administration of magnesium sulfate orally is described and attention is called to its application to therapeutic studies. The relation of this wave form to propulsion of fecal contents and defecation and its role in the production of abdominal discomfort are considered. Observed variations in the responses of individual children to subcutaneous injection of Mecholyl®, to oral administration of iced water, and to rectal distention may explain innate differences in susceptibility to the development of colonic symptoms in different children. A classification of wave forms from the distal colon based on current concepts of their probable physiologic significance is offered. A tracing from the distal colon in a child having a spontaneous bowel movement is presented and commented on.
Fractures in Children
Authors: LARSON CARROLL B.
Published: December 2021

The broad subject of Fractures in Children has been discussed in this book with such clarity and simplicity that the book is delightfully readible. A distinct note of authority in discussing each type of fracture that occurs in children is well justified, since Dr. Blount has had the benefit of a great volume of fractures carefully followed over a period of greater than 20 years at the Milwaukee Children's Hospital. This experience has allowed the author to set down principles of treatment which are justified on the basis of end results.
Disorders of Character
Authors: WORK H. H.
Published: December 2021

In a small but tightly packed volume, Dr. Michaels has compressed his medical career of research into the subject of persistent enuresis and has correlated this with a high incidence of the condition in juvenile delinquents, particularly those of a psychopathic type.

He has elaborated his findings into a triad of maleness, persistent enuresis, and juvenile delinquency. This he has fitted into a rather deeply rooted character structure which he terms as having "bio-psycho-social" connotations.
A SIMPLIFIED TECHNIQUE FOR THE SWEAT TEST IN THE DIAGNOSIS OF FIBROCYSTIC DISEASE OF THE PANCREAS
Authors: Barbero Giulio J. , Kim Ih Chin , McGavran Jean
Published: December 2021

A simplified technique for the collection of sweat is described. The body sweat from 21 patients with fibrocystic disease of the pancreas and 50 control subjects with a variety of other conditions was analysed for sodium and chloride content. A significant difference between the two groups in these examinations was demonstrated. This method was compared to a method of collection previously reported and found to be of equal value from the diagnostic standpoint. It is felt that this technique will make it easier for smaller institutions and pediatric services to use the sweat test as a diagnostic measure in fibrocystic disease of the pancreas.
THE ROLE OF GENETICS AND OTHER PRENATAL FACTORS IN DISORDERS OF CHILDHOOD
Authors: Warkany Josef , Fraser F. C.
Published: December 2021

THE PHYSICIAN interested in the etiology of a disease should always try to ascertain as many etiologic factors as possible, because the causal pathogenic web can often be disturbed from different angles. Although hereditary factors will be the main topic of this round table, we shall stress that they never act in a vacuum. The genes direct the development of the embryo and fetus, but the development depends also upon an environment limited by the mother's body and surroundings.

Certain terms are fundamental to an understanding of heredity:

Chromosomes. The nuclear carriers of the hereditary factors, the genes. Each nucleated somatic cell of a person's body has 24 pairs of chromosomes, each pair carrying hundreds of genes. One member of each pair is derived from the person's mother and one from the father. In the female there are 23 pairs of autosomes (non-sex chromosomes) and 1 pair of like sex chromosomes (X-chromosomes). In the male there are 23 pairs of autosomes and 1 pair of unlike sex chromosomes (one X and one Y-chromosome).

Gene. The particulate biochemical factor responsible for a particular hereditary characteristic. As the genes are carried on the chromosomes, they also occur in pairs. Each pair occupies a particular locus on the chromosomes. Genes located at the same locus are termed alleles. A child gets 1 member of each gene pair from each parent. Sometimes by the rare event of mutation, a gene becomes changed into one that may function abnormally—a "pathologic" gene.

Homozygote. An individual in whom the gene pair in question consists of 2 like genes.

Heterozygote. An individual in whom the gene pair in question consists of unlike genes.

Depending upon the type (dominant or recessive) and location (autosome or sex chromosome) of the gene, several types of inheritance patterns are possible.
FAMILIAL NONHEMOLYTIC JAUNDICE WITH KERNICTERUS
Authors: Childs Barton , Najjar Victor A.
Published: December 2021

Two cases of familial nonhemolytic jaundice have been described. Both patients, though severely jaundiced for periods of 5 and 2 years, have grown and developed normally and show no evidence of damage of the nervous system. This is in contradistinction to the six other patients, presented in the original report of this disease, who died after developing kernicterus. No reasons can be suggested for the escape of these two patients from kernicterus.

Some speculations concerning the nature of the genetically controlled aberration in this disease have been given.

It is suggested as a plausible hypothesis that the lesion consists of deficiency of an enzyme which controls the chelation of indirect-reacting bilirubin so as to form direct-reacting bilirubin. The enzyme, though deficient, is capable of adequate function if a sufficient load of bilirubin is presented to the liver. Under such circumstances bilirubin is excreted in normal amount, but only in the presence of a large accumulation of the pigment in the blood.
CONGESTIVE HEART FAILURE
Authors: Keith John D.
Published: December 2021

HEART failure is associated with an inability of the heart to empty itself adequately, with the result that there is a high venous filling pressure and a decrease in the effective work done by the heart muscle. There are several factors that, if sufficiently severe, will produce congestive heart failure in either infancy or childhood. These include valvular obstruction or insufficiency; mechanical obstruction of the heart as a whole, as in pericardial disease; the physical effects of large intracardiac shunts which increase the load on one or both ventricles; the presence of raised pressure in the pulmonary or systemic circulation; inflammatory reactions in the heart muscle or oxygen lack; and, finally, certain metabolic disturbances, such as hyperthyroidism or hypothyroidism.

One or more of these factors may be operating in the same child, as in rheumatic fever where myocarditis is associated with valvular insufficiency, or in congenital heart disease with pulmonary stenosis and patent foramen ovale, where the right ventricle has a high pressure to maintain and is at the same time being offered cyanotic blood from the coronaries.

PATIENT MATERIAL

In analyzing 1,580 cases of congenital heart disease at the Hospital for Sick Children, Toronto, 20 per cent were found to have had failure at some time. In 90 per cent of these failure occurred in the first year of life. A list of the various causes of heart failure in the pediatric age group in order of frequency follows. [see table in source pdf]

In certain types of heart defects failure develops in characteristic age groups. For example, during the first week of life the most common cause of heart failure is aortic atresia. From 1 week to 1 month, coarctation of the aorta leads. From 1 to 2 months, transposition of the great vessels predominates. From 2 to 3 months, endocardial fibroelastosis is the chief cause of heart failure, with transportation of the great vessels second to it.

The actual incidence of type of heart defect in relation to age at onset of heart failure is as follows.
DIGOXIN DOSAGE IN INFANTS
Authors: Sapin Samuel O. , Donoso Ephraim , Blumenthal Sidney
Published: December 2021

Digoxin is suggested as the drug of choice for digitalis therapy in infants and children, primarily because of its rapid dissipation.

The use of average dosage figures, while necessary in starting therapy, is often unsatisfactory and may be hazardous unless one appreciates the great range of sensitivity to digitalis amongst patients. The principle set forth by Withering and repeated by many since then that each patient treated with digitalis is a titration experiment, still holds.

Our studies and experience with digoxin in normal infants as well as in those with heart disease enable us to propose a digitalizing regimen which has proven effective and yet safe in most of the infants who can benefit from digitalis therapy.

We recommend an initial "digitalizing dose" of 75 µg/kg in 24 hours, orally or intramuscularly. One-half or one-third is given first and the remainder in equal portions every 6 to 8 hours. If the desired clinical effect is evident, a maintenance dose of 25 µg/kg once daily is administered. If, however, the desired clinical effect has not been achieved after the initial "digitalizing dose," 25 µg/kg should be given under careful clinical and electrocardiographic observation every 6, 8 or 12 hours (depending upon the severity of the failure) until either a satisfactory effect or toxic signs appear. The maintenance dose may then be proportionately larger. Changes in S-T segment and T wave in the electrocardiogram are not considered signs of toxicity. The development of vomiting or the appearance in the electrocardiogram of significant conduction defects, or arrhythmias are indications of digitalis toxicity.

Relatively large amounts of digoxin may be necessary in some infants both initially and for maintenance in order to obtain maximum benefit from the drug.
CONGENITAL ATRESIA OF THE EXTRAHEPATIC BILIARY TRACT
Authors: Myers Richard L. , Baggenstoss Archie H. , Logan George B. , Hallenbeck George A.
Published: December 2021

The records in 40 cases of congenital atresia of the extrahepatic biliary tract, proved at surgical exploration or necropsy or both, were studied at the Mayo Clinic with reference to clinical and pathologic aspects. Histologic examination of the liver was carried out in 21 of these cases; the muscular injections of vitamin K; each of these patients died during hospitalization.
SCHOOL AND THE ADOLESCENT
Authors: Farnsworth Dana L.
Published: December 2021

TO THE adolescent school is not only of great interest, it is his life, the activity that occupies the greater portion of his waking hours, the standard by which almost everything else is judged. If he does not like school, or does not do well in his studies, his future progress is almost always seriously impaired. Instances of aversion to school are numerous, so numerous in fact that it would not be possible to have all those older children who have a "school phobia," as it is sometimes called, treated by psychiatrists, desirable as that might be in theory. It is very much the business of the physician who sees young people to know some of the reasons why the adolescent and the school sometimes become at odds with one another.

It is a reasonable assumption that if the young boy or girl has a natural curiosity (and almost all do), and his interest in the things about him and in the written word have been encouraged by his parents, he will almost always enjoy school and be able to put up with influences which would be highly harmful to a less fortunate youngster. We seldom have to worry about the adolescent who comes from a home where cultural things are valued, providing he has good intelligence and the school keeps his mind stimulated up to its capacity. Unfortunately, the opportunities for something to go wrong are numerous.

The most important bit of good fortune a young person can have is to fall under the supervision of teachers who like children, who like books, are curious, secure within themselves, are able to maintain discipline by their manner and example rather than by authoritarian methods, and who think of their pupils as young, growing personalities to be given responsibility and helped into self control, rather than as wild animals to be kept caged and under control.
COLIC IN INFANTS
Authors: Glaser Jerome
Published: December 2021

This may well have been a historic occasion because so far as I have been able to ascertain, this was the first time that a symposium on the important subject of colic in infants had ever been presented at a national meeting of pediatricians. Due to the fact that little attention is paid to colic in institutions, this disorder has rarely received the attention of the full-time academic pediatrician (unless he has experienced it in his own family). For that reason interns and residents all too commonly encounter this frustrating problem only on starting private practice when it becomes a matter of great importance and concern.

Our fundamental knowledge of what is termed "colic" is so uncertain that it is appropriate in discussing this subject to quote a remark by Tenney, "And so it is with colic; maybe there is no such thing, but there is certainly something that makes perfectly healthy babies cry almost unbelievably loud and long without interfering with their perfect health." For the purposes of this discussion colic may be defined as a symptom complex of early infancy characterized by evidence of intermittent abdominal pain of varying degrees of severity for which no organic or obvious physiological cause can be regularly demonstrated.

For discussion of this subject pediatricians were selected who for the most part, because of part-time positions on the teaching staffs of medical schools, would be expected to have academic as well as practical interest in this problem and who, because of their varying interests, have considered the problem from different viewpoints. Attention is directed particularly to the fact that among the 8 papers presented at this symposium only 2 were by pediatric allergists, Dr. Fries' and Dr. Ratner's.
The Teacher and the Child
Authors: STROUD JAMES B.
Published: December 2021

This is a fine book. Basically it reports and interprets the experiences of 92 elementary and secondary school teachers as they attempted to practice certain principles of mental hygiene in school situations. It presents an account of teachers' own perceptions of the needs and feelings of pupils and the behavior of these teachers as they tried to effect wholesome interpersonal relationships.

The fact that it is teachers who did the things reported, rather than a worker in group therapy or interview therapy or some other specialist, should make the book appealing to the education worker.
A CASE OF CRYPTOCOCCUS NEOFORMANS MENINGOENCEPHALITIS COMPLICATING BOECK'S SARCOID
Authors: Lepow Harold , Rubenstein Leo , Chu Foo , Shandra Joseph
Published: December 2021

A case is presented of diffuse systemic sarcoidosis complicated by fatal meningoencephalitis caused by Cryptococcus neoformans in a 10-year-old child.

The frequency of coincidence of diseases of the reticulo-endothelial system and infections with cryptococcus neoformans, as well as possible causes for this relationship, are discussed.
TREMBLING OF THE CHIN—AN INHERITABLE DOMINANT CHARACTER
Authors: Grossman Burton J.
Published: December 2021

An unusual phenomenon, trembling of the chin, is reported in a family. The trait appears to be inherited as a simple dominant. Three other families with this trait, reported in the literature, are reviewed. Another dominant trait, otosclerosis, was found to be present in this family.
INTRODUCTION
Authors: Warkany Josef
Published: December 2021

Congenital Malformations, once considered as rare curiosities of medicine, have been recognized in recent years as an important source of human morbidity and mortality. Consequently, investigators in many medical fields have shown an increasing interest in questions concerned with the etiology and morphogenesis of congenital malformations. The science of teratology which had been neglected somewhat during the last few decades by the medical profession has been revived as a branch of medicine. Yet communications between teratologists working in the basic sciences and those interested in clinical problems of congenital malformations have not been good, and it appeared that a real need existed for a conference in which teratologists working in different branches of medicine could meet, establish contacts and exchange ideas. Such a conference took place on January 12 and 13, 1956, at the College of Medicine, University of Cincinnati. It was sponsored by the Human Embryology and Development Study Section, Division of Research Grants, National Institutes of Health, and by the Association for the Aid of Crippled Children, New York, New York. From the beginning it was decided to keep the group of participants small and the proceedings informal. Ten of the participants gave 20-minute papers designed to provoke debate. Neither the papers nor the excellent ensuing discussions were recorded, as no plans had been made for publication of the proceedings. However, as the conference progressed, there was an increasing demand for publication of the papers presented and Mr. L. W. Mayo, Doctors J. V. Neel, B. M. Patten, J. G. Wilson and I were charged with the task of exploring the possibilities of bringing the proceedings before a larger medical forum.