bluuebunny/crossref_metadata_2025_split huggingface dataset:
Families on the Move and Children's Health Care
Authors: Fowler Mary Glenn , Simpson Gloria A. , Schoendorf Kenneth C. 
Published: December 2021

Objective. To evaluate the relationship of family moves to children's health care use.
Design. Analyses of data from the 1988 National Health Interview Survey of Child Health (NHIS-CH). This survey uses a multisite probability cluster technique to achieve nationally representative estimates of health and demographic characteristics of the US civilian population.
Participants. 17 110 US children and their families who took part in the 1988 NHIS-CH.
Measurements. The 1988 NHIS-CH collected health and demographic data including family mobility information on 17 110 US children and their families. This study analyzed the relationship of number of family moves to reporting a regular site for preventive pediatric health care services, a regular site for pediatric sick care, and routine use of emergency departments when a child was sick.
Results. Overall, 8% of US children were reported to lack a regular site for preventive care services, 7% a site for sick care, and 3% routinely used an emergency department for sick care. However, 14% of children who had moved three or more times lacked a regular site for preventive care and 10% lacked a regular site for sick care, compared to only 3% of children who had never moved. Children who had moved more than twice were three times as likely to lack a regular site for preventive or sick care and 1.6 times as likely to use an emergency department for sick care, as were children who had never moved.
Conclusions. Families with increased mobility are more likely to lack a regular site for both preventive and sick care and to use emergency departments when their children become ill.
Dietary Approaches for Reducing Fat Intake of Preschool-Age Children
Authors: Sigman-Grant Madeleine , Zimmerman Sally , Kris-Etherton P. M. 
Published: December 2021

Study objective. The present study was conducted to determine the effects of applying different fat reduction strategies to the overall nutrient profile of diets for preschool-age children.
Design. Computer modeling techniques were used to modify the diets of children (ages 2 through 3 and 4 through 5 years old) to meet contemporary dietary recommendations (&lt;30% of calories from total fat, &lt;10% from saturated fatty acids, and &lt;300 mg of cholesterol daily). Fat reduction strategies were applied to a 1-week menu that included preschoolers' favorite foods. Strategies applied were replacing high-fat meat exchanges with lean meat exchanges (± three high-fat meat exchanges per week), replacing higher fat milks with skim milk, replacing high-fat meat exchanges with medium-fat meat exchanges, using fat-modified products, using low-fat preparation techniques, and added fat. All diets were made isocaloric after modifications were applied.
Results. It is more difficult to meet all recommendations for the 2- and 3-year-old children. Use of skim milk is the simplest strategy to use for the 4- and 5-year-old children, although other single strategies are effective.
Conclusions. When multiple strategies are effected. some diets are very low in fat (&lt;20% of calories) and potentially inadequate in energy and nutrients. It is important that caregivers know the appropriate foods to choose when modifying fat in children's diets to ensure meeting energy and nutrient requirements.
INTRODUCTORY COMMENTS
Authors: DAVILA ROBERT R. 
Published: December 2021

This conference comes at an appropriate time in our nation's history. As we move toward the close of the 20th century the full participation of individuals with disabilities in all aspects of daily life is gaining in importance. Never before have the needs, capabilites, and potential of people with disabilities received so much attention at all levels of government and in the private sector.
This increase in awareness and activity has brought with it the recogintion that the disability community, like society in general, is a diverse community, made up of people from many different backgrounds and walks of life. The needs of this community are as complex as the community itself; they are influenced by such factors as age, gender, disability, and of course, cultural background.
If we are to reach our goal of full participation for individuals with disabilities, our first task is to try to understand the various forces that shape the lives of individuals with disabilities in our society.
The Office of Special Education and Rehabilitative services (OSERS) supports the goal of full community integration for all persons with disabilities and their families. In our efforts to pursue this goal, we must consider the strengths and needs of children and their families from a variety of backgrounds. We must be aware of the unique ethnic and cultural values of children with disabilities and their families. These values give meaning to a particular illness or disability and affect current functioning and future developmental outcomes.
It is especially important for policy-makers and service providers to understand the differences that exist among people in a culturally divergent society.
Monitoring Premature Infants in Car Seats: Implementing the American Academy of Pediatrics Policy in a Community Hospital
Authors: Bass Joel L. , Mehta Kishor A. , Camara Jeanne 
Published: December 2021

Objectives. In 1990, the American Academy of Pediatrics (AAP) Committeee on Injury and Poison Prevention issued a policy statement which recommended that all infants born at less than 37 weeks gestational age be monitored in their car seat before discharge to identify infants at risk for apnea associated with car seat use. The objective of this report is to summarize the experience of a community hospital in implementing this recommendation, including: education of health professionals about the problem and its management, development of an effective hospital policy and procedure for testing at-risk infants, overcoming logistical difficulties for nursing staff who implement the policy, overcoming liability concerns, and summarizing the clinical results which we observed during a 15-month period.
Methods. MetroWest Medical Center, Framingham Union Campus is a community hospital with a Level II Neonatal Unit with approximately 2200 deliveries annually. Hospital procedures and policies were developed to implement the AAP policy for safe transportation of premature infants. Consequently, infants less than 37 weeks gestation at birth were monitored for a 90-minute observation period for oxygen saturation, apnea, or bradycardia in the car seat that they would be going home in from the nursery.
Results. Policies and procedures for car seat monitoring were instituted successfully during 15-month period. Sixteen of 87 (18.4%) monitored infants 26 to 36 weeks gestation had abnormal results. In addition, one 37-week gestational newborn who was monitored because of duskiness during feeds also became apneic and bradycardic in the car seat.
Conclusions. A car seat monitoring program can be incorporated effectively into a Level II community hospital nursery discharge plan provided that appropriate medical staff policies, nursing procedures, and administrative support to deal with the logistics of the program is established. Our monitoring results are consistent with previous reports that premature infants are at risk of desaturation in a car seat. In addition, we have demonstrated that a full-term neonate may also be at risk if other evidence of desaturation (eg, duskiness during feedings) is observed.
Efficacy of Albumin and Diuretic Therapy in Children With Nephrotic Syndrome
Authors: Haws Robert M. , Baum Michel 
Published: December 2021

Objective. To examine the efficacy and complications of albumin and diuretic therapy in the treatment of edema due to the nephrotic syndrome.
Methods. The clinical and biochemical effects of 35 treatment courses of albumin and diuretics administered to 21 children with nephrotic syndrome were retrospectively examined. Treatment consisted of intravenous infusion of 25% albumin and furosemide. A second diuretic was administered in addition to furosemide during 10 treatment courses. There was an average of 5 infusions per hospitalization.
Results. Albumin and furosemide therapy resulted in a 1.2 ± 0.2% (SEM) body weight loss per infusion. The administration of albumin with two diuretics did not result in improved weight loss compared to albumin and furosemide alone. Patients whose nephrotic syndrome was in remission at the time of posthospitalization follow-up (n = 8) had a sustained weight loss both during and after albumin and diuretic treatment. Patients with persistent proteinuria (n = 27) transiently lost weight during therapy, but returned to a weight similar to their pretreatment weight at 2-week follow-up. Albumin infusion resulted in hypertension, requiring acute antihypertensive therapy in 16 treatment courses (46%) and increased maintenance antihypertensive therapy in 12 treatment courses (34%). In addition, hypokalemia, hypernatremia, and hyperbicarbonatemia developed in 40%, 17%, and 11% of treatment courses, respectively. Albumin and diuretic therapy resulted in the development of respiratory distress during four treatment courses, including one patient who developed respiratory failure and one patient who developed congestive heart failure.
Conclusions. Albumin and diuretic therapy results in fluid removal and weight loss in children with the nephrotic syndrome; however, this effect is transient unless remission of proteinuria occurs. While this is a retrospective study, the findings suggest that albumin and diuretic therapy can be associated with frequent and potentially serious complications.
Severe Reactions Associated With Diphtheria-Tetanus-Pertussis Vaccine: Detailed Study of Children With Seizures, Hypotonic-Hyporesponsive Episodes, High Fevers, and Persistent Crying
Authors: Blumberg Dean A. , Chatfield Patricia , Cherry James D. , Mink ChrisAnna M. , Lewis Karen , Christenson Peter D. 
Published: December 2021

Objective. The pathophysiology of severe reactions to diphtheria-tetanus-pertussis (DTP) vaccine is not well understood. Active pertussis toxin in DTP vaccine has been proposed to cause severe DTP vaccine reactions. Large doses of pertussis toxin cause hyperinsulinemia and hypoglycemia as well as leukocytosis with a predominant lymphocytosis in animal models. To learn more about the causes of and risk factors for severe DTP vaccine reactions, children experiencing severe DTP vaccine reactions were studied.
Design. Prospective, referral-based surveillance.
Setting. Los Angeles, CA.
Subjects. Children experiencing severe reactions within 48 hours of DTP immunization and evaluated within 24 hours of the reaction. Severe reactions included encephalopathy, persistent crying ≥3 hours, hypotonic-hyporesponsive episodes (collapse episodes), fever ≥40.5°C, or seizures. Some comparisons were made between children with DTP vaccine-associated seizures and a comparison group of children experiencing febrile seizures unrelated to immunization.
Outcome measures. A history and physical examination were performed. Follow-up examinations were performed 1 month later. Blood was collected for complete blood cell count with leukocyte differential count, serum chemistry measurements, and insulin and glucose values. Serum was assayed for active pertussis toxin, both in free and immune-complex masked states.
Results. Sixty children experienced severe reactions within 48 hours of DTP immunization: 32 children had seizures only, 14 subjects had hypotonic-hyporesponsive episodes, 2 subjects had fever ≥40.5°C only, 4 subjects had persistent crying ≥3 hours, 6 children had seizures and fever ≥40.5°C, and 2 children had persistent crying and seizures. The children with seizures had a high rate of personal and family histories of seizures, and 90% had documented fevers (≥38°C). Persistent crying was associated with painful local reactions. Effects that may have been due to vaccine pertussis toxin were not found. Lymphocytosis did not occur, nor did hypoglycemia. Some relatively elevated insulin values were noted; however, this finding was also noted in the comparison group of children experiencing febrile seizures unrelated to immunization. No biologically active pertussis toxin was found in the acute sera of children experiencing severe DTP vaccine reactions.
Conclusions. Seizures associated with DTP vaccine have similar clinical characteristics as febrile seizures, and persistent crying is initiated by painful local reactions. Vaccine endotoxin is a cause of febrile DTP vaccine reactions. We found no evidence that DTP vaccine pertussis toxin plays a role in severe DTP vaccine reactions.
Self-medication in Childhood: Observations at a Residential Summer Camp
Authors: Rudolf Mary C.J. , Alario Anthony J. , Youth Brian , Riggs Suzanne 
Published: December 2021

Since the 1930s our society has experienced a marked increase in the consumption of medicines. Expenditure for medications has amounted to 10% to 15% of health care costs in both the United States and Europe, equivalent to 1% of the American Gross National Product.1 Per capita drug consumption in the United States is among the highest in the Western World and twice that in the British Isles.1,2 A large proportion of drugs consumed are self-prescribed, nonprescription medications accounting for 40% of the national expenditure on medicines.1 Surveys of large populations confirm the high rate of drug consumption; 30% of people questioned have used one or more nonprescription medications in the previous 48 hours.2,3
The use of nonprescription medications is not limited to adults. In surveys of large populations it has been shown that 30% to 50% of children have received medicines during a 48-hour recall period,4,5 and 75% received medicines during a 4-week period.5-7 Furthermore, 50% of mothers stock seven or more medicines for home use, and 30% report giving their children seven or more types of medicines during the course of a year.6,7
In the face of this extensive consumption of medicines little is known about the age at which children are given or assume responsibility for taking medications. A review of medical history forms for enrollment at a summer camp in 1990 revealed that 30% of campers aged 9 to 16 years intended to bring their own nonprescription medications to camp.8 This led us to suspect that American children may be given responsibility for self-medicating at an early age.
Establishment of Primary Care Continuity Experiences in Community Pediatricians' Offices: Nuts and Bolts
Authors: Sargent Janice R. , Osborn Lucy M. , Roberts Kenneth B. , DeWitt Thomas G. 
Published: December 2021

During the past 30 years, there has been an increasing awareness of the importance of ambulatory care training in medical education. The discrepancy between education and practice was pointed out in the General Professional Education Panel report that indicated training was based largely in hospital settings even though the vast majority of doctor-patient encounters do not result in hospitalization.1 Perkoff,2 noting changes in hospital care such as shorter lengths of stay, increased outpatient care, and the need for well-trained primary care physicians, stated that programs need to make a major effort to emphasize clinical teaching in outpatient settings. Recognizing the need for these changes, the Accreditation Council on Graduate Medical Education (ACGME) has increased dramatically the requirement in primary care specialties for clinical ambulatory training.3 For pediatrics, these requirements have progressed from the suggestion that clinical training should be obtained in outpatient clinics (1961) to requiring clinical training in primary care clinics weekly for 3 years (1985).
The problems in providing good training in ambulatory settings have been well described.2-4 In comparison inpatient teaching, training students and residents in an outpatient clinic is inefficient and costly. One of the methods suggested to address these problems has been to move ambulatory training out of tertiary care centers to community sites.5-9 Many pediatric programs are now using community sites for at least a portion of resident education.10 Alpert et al10 and Greenberg et al,11 although encouraging the use of these sites to reduce the gap between pediatric education and the service delivery system, pointed out that there are no standards for use of community sites.
Blue Sclerae: A Sign of Iron Deficiency Anemia in Children?
Authors: BEGHETTI MAURICE , MERMILLOD BERNADETTE , HALPERIN DANIEL S. 
Published: December 2021

An association between blue sclerae and iron deficiency anemia (IDA) was described in 1908 by W. Osler1 and confirmed recently in adults.2 In these studies, blue sclerae appeared more sensitive and equally specific as an indicator of IDA than mucosal pallor.4 Because IDA is common in young children even in industrialized countries, and since infants with IDA may be at risk for long-lasting developmental impairment,9-11 we carried out a survey to verify the validity of this association and to assess the value of this clinical sign in a pediatric population.
SUBJECTS AND METHODS
One hundred hospitalized children (median age 3.3 years, range 2 months to 17 years) were prospectively studied in accordance with the ethics committee of our institution.
Self-regulation of Energy Intake in Children, Questioned
Authors: GOLDMAN HERBERT I. 
Published: December 2021

To the Editor.—
The paper by Shea et al1 is misleading. The observed coefficients of variability of the caloric intakes of children at individual meals and snacks were much larger than the variability of the total daily intakes, 46.5 to 165.8 vs 30.3. However, the main reason for this is statistical. The variability of the sum of a total of such items is less than that of the individual items. For example, if you time your daily mile run, the variability of each day's run will be substantially less than the variability of the total weekly times.
On the Association of Unilateral Thalamic Hemorrhage and Urinary Tract Infection
Authors: ROLAND ELKE H. , FLODMARK OLOF , HILL ALAN 
Published: December 2021

In Reply.—
Rooman et al report on an infant who developed thalamic hemorrhage associated with a urinary tract infection caused by Escherichia coli. They speculate that E coli endotoxin may enhance clotting potential via the extrinsic cascade and decrease endothelial thrombomodulin expression, thus shifting the hemostatic balance and increasing the risk of cerebral venous infarction.
In our article,1 we suggest that the most probable mechanism causing thalamic/intraventricular hemorrhage in the full-term newborn is thrombosis of the deep cerebral veins resulting in infarction and secondary hemorrhage in the thalamic region.
The Lead Debate Goes On
Authors: MARCUS STEVEN M. 
Published: December 2021

To the Editor.—
I had to pinch myself to realize that I was not dreaming after reading the Letters to the Editor in the January 1992 issue of Pediatrics. I thought this was 1993, and I thought that we were scientists and that we were adaptable to change. After reading the letters by Drs Banner et al and Ernhardt et al, I seriously question our stances. No other than Benjamin Franklin, in the late 1700s, commented on how long it is between the time that a certain thing is "known" and that we begin to act on it.
The Avianca Plane Crash: An Emergency Medical System's Response to Pediatric Survivors of the Disaster
Authors: van Amerongen Robert H. , Fine Jeffrey S. , Tunik Michael G. , Young Grace M. , Foltin George L. 
Published: December 2021

Objective. On January 25, 1990, a jetliner crashed on Long Island, New York. Twenty-two children survived the crash. The purpose of this study was to evaluate the emergency medical system's response to these pediatric survivors.
Methods. A questionnaire was sent to all local, acute care hospitals to determine their specific pediatric capabilities and to rank them as level I, II, or III pediatric centers; level I centers are tertiary care facilities. A second questionnaire was sent to all hospitals that received pediatric survivors to collect specific clinical information for each patient. Based on this clinical information a Pediatric Trauma Score (PTS) was assigned to each patient. Children with a PTS ≤8 are considered to be at increased risk of trauma-related mortality. The assigned PTS was compared to the level of the pediatric center to which each patient was transported.
Results. Of 25 children on board the plane, 22 (88%) survived the crash; of 135 adults on board, 70 (52%) survived (χ2 = 9.9, P = .002). Seven children had a PTS ≤8; only 1 of these high-risk patients was transported directly to a level I pediatric center, and only 2 of the 5 high-risk children initially transported to level III facilities were transferred to higher level pediatric centers.
Conclusions. Pediatric survivors were neither adequately triaged nor transported to appropriate facilities which could optimize their care. Possible explanations for this include (1) unique features of the rescue operation, (2) limited pediatric training of prehospital personnel, and (3) deficiencies of the regional disaster plan. Emergency medical services systems and disaster plans can be made more responsive to children's needs by (1) acknowledging that children have special needs requiring referral, (2) improving the training of prehospital personnel in pediatric emergency care, (3) classifying ill and injured children according to appropriate triage criteria, (4) recognizing existing tertiary care pediatric centers as the optimal location for the treatment of critically ill and injured children, and (5) designating these centers as the appropriate transport destination for critically ill and injured children.
Lead Poisoning: From Screening to Primary Prevention
Authors:   Committee on Environmental Health
Published: December 2021

Knowledge of the extent and seriousness of childhood lead poisoning has vastly expanded since the last statement regarding lead poisoning by the American Academy of Pediatrics in 1987.1 Blood lead levels once thought to be safe have been shown to be associated with IQ deficits, behavior disorders, slowed growth, and impaired hearing.2 In fact, lead poisoning is, according to the Department of Health and Human Services, "the most important environmental health problem for young children."3 The rapid development of the scientific database requires recognition by physicians of the significance of effects at lower levels and a change in clinical practice.
During the last 30 years the Centers for Disease Control and Prevention (CDC) has revised downward the definition of the blood level at which lead poisoning occurs from 60 µg/dL whole blood in the early 1960s, to 30 µg/dL in 1975, and 25 µg/dL in 1985. The 1991 CDC statement "Preventing Lead Poisoning in Young Children" recommended lowering the community intervention level to 10 µg/dL and setting several action levels (Table 1).2 In 1987 the American Academy of Pediatrics stated that lead levels greater than 25 µg/dL were unacceptable for children.1 The Academy now recognizes that impairment of cognitive function begins to occur at levels greater than 10 µg/dL, even though clinical symptoms are not seen. In the late 1970s, the average blood lead level for US children was 16 µg/dL.4 The mean blood lead level for US children has declined since 1976 due to the phaseout of lead in gasoline5 and the reduction of lead in food, and it is now between 4 and 6 µg/dL.6