bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gifted and Talented Children: Issues for Pediatricians
Authors: Robinson Nancy M. , Olszewski-Kubilius Paula M. 
Published: December 2021

Giftedness is both similar to and different from other exceptionalities in its implications for the lives of children and families. Unlike other exceptionalities, the prognosis for giftedness is, of course, considerably more positive. Like the others, however, this kind of differentness makes demands on family and community resources and carries risks of psychosocial stress, social isolation, and nonfulfillment of potential. Given society's other pressing needs, those of this group often are brushed aside, even resented; both the life quality of the children and their families and the contribution the children might make in years to come, therefore, can be eroded. All children deserve to love school and to have the opportunity to make the best of their possibilities. Informed and sympathetic pediatricians who are sensitive to the issues involved can play critical roles in promoting healthy development.
Definitions and Prevalence
Reasoning from the apparent symmetry of the normal curve, professionals sometimes tend to regard giftedness as the mirror image of mental retardation, but this is not a useful model. There is much greater diversity among the highly capable than among the less capable. Indeed, advanced ability is neither restrictive nor defining; gifted children (and their families) are probably more diverse than any other group in our society.
Almost Extinct Diseases: Measles, Mumps, Rubella, and Pertussis
Authors: Gold Eli 
Published: December 2021

Introduction
The availability of effective vaccines led to a dramatic decrease in the number of cases of measles, mumps, rubella, and pertussis reported each year. However, several years after their introduction, small but significant outbreaks began to appear in urban settings among clusters of children, adolescents, and young adults. Some of those who became ill were members of families that did not accept vaccine for religious reasons or because of fear of adverse reactions. Others were "vaccine failures," the 5% to 10% who did not respond to injected antigens or responded with only transient low levels of protective antibody. However, the majority of children who are infected during community outbreaks of contagious disease are those younger than school age who never received the vaccine. The requirement for immunization before school attendance and the new practice of administering a second dose of measles, mumps, rubella (MMR) vaccine to children of school age has resulted in relatively good levels of immunity among those 5 years of age and older, but more vigorous efforts are needed to protect a higher proportion of those not yet in school. Estimates for the year 1993, based on the National Health Interview Survey (NHIS), revealed that 67.7% of children ages 19 to 35 months had received the series of vaccines recommended routinely: four doses of diphtheria and tetanus toxoids and whole-cell pertussis (DTP) vaccine, three doses of polio vaccine, and one dose of MMR.
Lipoprotein Disorders
Authors: Belamarich Peter F. 
Published: December 2021

Although symptomatic lipoproteinemias are rare in childhood, early detection often can prevent severe complications.
Abetalipoproteinemia is characterized by severe hypolipidemia, fat malabsorption, failure to thrive, unusual spiculated erythrocytes known as acanthocytes, and progressive neuromuscular and retinal pigmentary degeneration believed to be related to vitamin E deficiency. Plasma triglyceride concentrations are so low as to be frequently undetectable, and cholesterol concentrations typically are less than 50% of normal. This disorder results from an inability of both enterocytes and hepatocytes to secrete their apoprotein B-containing lipoproteins. Consequently, chylomicrons, very low-density lipoprotein are absent from plasma.
A related disorder, homozygous familial hypobetalipoproteinemia, mimics the signs and symptoms and the characteristic lipid levels of abetalipoproteinemia, but is believed to involve a different mutation.
Kawasaki Syndrome
Authors: Melish Marian E. 
Published: December 2021

Kawasaki syndrome (KS) is an acute, febrile, self-limited, multisystem vasculitis that almost exclusively affects young children. First described in 1967 by Dr. Tomisaku Kawasaki of Tokyo, Japan, it now has been recognized as occurring in all regions of the world among children of multiple and diverse ethnic groups. Its occurrence is common enough in all parts of North America that primary physicians should be familiar with its diagnosis and treatment. Originally thought to be a benign febrile exanthem, it soon was recognized that fever could be prolonged and that significant adverse cardiac effects were common, especially the development of coronary aneurysms that could lead to myocardial infarction and sudden death.
Fatal KS is a multisystem vasculitis indistinguishable from infantile periarteritis nodosa (IPN); until the discovery of KS, IPN had been a condition diagnosed only at autopsy. Dr. Kawasaki's enduring contribution is the recognition and description of the major clinical features of this unique disease, which only rarely causes death. The clinical criteria he described remain the basis of all clinical and epidemiologic descriptions in use today.
Although effective therapy has been discovered, the etiology of the disease remains unknown. The acute, febrile, self-limited nature of the disease and its clinical features of fever; rash; and menigeal, joint, hepatic, and mucous membrane inflammation strongly suggest that the etiologic agent is microbial.
Acute Otitis Media
Authors: Maxson Suzanne , Yamauchi Terry 
Published: December 2021

Definitions
Acute otitis media with effusion (AOME) is a clinically identifiable, suppurative infection of the middle ear. The infection has a relatively sudden onset and short duration. It denotes inflammation of the mucoperiosteal lining of the middle ear. The inflamed tympanic membrane (TM) is bulging, opacified, or both.
The condition chronic otitis media is poorly defined, but it may be categorized into two clinical entities for simplification: chronic otitis media with effusion (COME) and chronic suppurative otitis media (CSOM). COME, also known as serous or non-suppurative otitis media, is characterized by the presence of a middle ear effusion (MEE) behind an intact TM that persists for more than 2 to 3 months. It may be asymptomatic except for hearing loss. There generally are no acute clinical signs or symptoms, and the TM is not red or bulging. CSOM is characterized by chronic perforation of the TM, with purulent discharge, for a prolonged period of time, usually more than 6 weeks. There generally is an insidious clinical onset. Either COME or CSOM may follow AOME.
Epidemiology
Otitis media is one of the most frequent causes for physician visits by children. Approximately 25% of such visits during the first year of life are for middle ear disease; this increases to 40% for children 4 to 5 years of age.
INDEX OF SUSPICION
Authors: Nield Linda S. , Keri Jonette E. , Fisher Randall G. , Khanfar Nasha't M. 
Published: December 2021

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
A 10-year-old boy is brought to your office in late spring because of an erythematous rash on his arms and legs that has been present for 4 days and because he is having joint pains. The rash first appeared after the boy had been playing outdoors for several hours in the sun. He did have a new commercial sunblock lotion applied to his skin before going outdoors. His father is concerned because even though the rash is less pronounced, his son has been experiencing stiff and painful knees and ankles upon awakening for the past 2 days. The joint discomfort improves with movement during the day. The boy has had no other symptoms and has been free of fever.
Advances in the Management of Acute Asthma in Children
Authors: Murphy Shirley J. , Kelly H. William 
Published: December 2021

In 1991, the National Heart, Lung and Blood Institute's National Asthma Education Program (NAEP) published "Guidelines for the Diagnosis and Management of Asthma" recommended by an expert panel. This was followed in 1992 by the publication of the "Internal Consensus Report on Diagnosis and Management of Asthma" (ICR). These reports reviewed the current state of knowledge and established the goals of therapy for both chronic asthma and acute exacerbations. This article will provide an update on the research that has been published since those recommendations.
The first NAEP guidelines established three goals for the treatment of acute asthma: Rapid reversal of airflow obstruction, correction of significant hypoxemia, and reduction of the rate of recurrent severe asthma symptoms. The ICR added two additional goals: Restoration of lung function to normal as soon as possible and development of a written plan of action in case of a further exacerbation.
Both reports concluded that these goals could be accomplished best by aggressive use of inhaled selective beta2-agonists and early introduction of systemic corticosteroids (in certain patients at home). The liberal use of low-flow oxygen was considered safe; it often easily corrects the hypoxemia produced by the alveolar hypoventilation and the mismatch in ventilation/perfusion (V/Q) that frequently accompanies acute asthma exacerbations.
Pressures: Impact on Health of Adolescents
Authors: Neal Wendy , Alderman Elizabeth 
Published: December 2021

Adolescents experience a variety of daily pressures from various facets in their social environment. Their ability to deal with these pressures and the resulting stress depends on individual coping mechanisms. Stress that is induced by pressures can manifest itself as participation in risk-taking behaviors and development of poor self-concept, leading to an overall poor self-assessment of health and somatic complaints. Recent data evaluating the impact of stress on adolescents have focused on the influence of the adolescent's social environment, specifically peer and family relationships.
Metzler et al studied risky sexual behavior in a group of adolescents as a consequence of associations with peers engaging in risk-taking behaviors.
Developmental Learning Disorders: Clues to Their Diagnosis and Management
Authors: Capin Donna M. 
Published: December 2021

Introduction
The observant physician can make a truly life-enhancing difference with the timely diagnosis of a learning disorder. Approximately 6% to 7% of all school-aged children are identified as "learning disabled" and receive special educational services. In the 1992 to 1993 school year, 4,633,674 students ages 6 to 21 years received services under Federal formula grant programs. In medical settings, roughly twice as many boys as girls are diagnosed formally, a ratio that most likely is biased by the different phenotypes of learning problems among boys and girls. High-profile disorders that cause disruption in classroom and family functioning are the earliest to be identified and often are referred for help as early as the preschool years. More subtle or nearly "invisible" disorders (such as isolated attention deficit without hyperactivity) are masked by unexceptional or even "good" (passive) behavior and can persist undetected into adulthood, becoming symptomatic in college or graduate school. Long-term follow-up studies and evaluations of the parents of children who have learning disorders have taught two lessons: 1) learning disorders are not "outgrown" and 2) they can be extremely subtle and well hidden, especially among adolescents, who are more likely able to compensate (albeit at a price) through most of their formal schooling.
INDEX OF SUSPICION
Authors: Harris J. Peter , Buzzard Carol J. , Gutierrez Liliana D. , Babl Franz E. , Ratzan Susan K 
Published: December 2021

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
While driving to work, a 17-year-old female high school senior who has been in good health has an abrupt syncopal episode resulting in a headon collision at 40 miles per hour. She is alert and oriented right after the accident, but complains of sternal pain as well as pain in her left chest, left shoulder, and the right side of her jaw. Evaluation in the emergency department reveals slight tachypnea of 26 breaths/min, blood pressure of 90/60 mm Hg, a midsternal abrasion, a left pneumothorax, and nondisplaced fractures of the left clavicle and right mandible. Results of her neurologic examination, including mental status, are normal.
She denies the use of any medication, street drugs, or alcohol, but she does report a 9-month history of brief spells of lightheadedness, diaphoresis, nausea, and visual blackouts, with one previous episode proceeding to complete syncope.
Lifestyle and Practice Style: Making Choices
Authors: Haggerty Robert J. 
Published: December 2021

Although pediatricians are knowledgeable in many areas of the human condition, most will admit to an incomplete understanding of homosexuality, an aspect of life that is poorly understood by most of society. At the same time, the overwhelming majority of pediatricians are dedicated to providing each patient with complete and appropriate care, regardless of where that individual fits into the societal mosaic. Consequently, all of us are indebted to Perrin for providing a clear and useful guide to understanding gay and lesbian youth, many of whom currently are in our care, whether or not we know it.
Defining sexual orientation, gender identity, and gender role is the important first step that Perrin takes in educating the reader.
Pneumonia
Authors: Schidlow Daniel V. , Callahan Charles W. 
Published: December 2021

Introduction
One in three children can be anticipated to develop a lower respiratory tract infection (LRI) in the first year of life. Denny and Clyde reported 6000 cases of LRI in an outpatient practice in North Carolina. Of this group, 15% had croup, 34% had tracheobronchitis, 29% had bronchiolitis, and 29% had pneumonia. The overall attack rate for pneumonia in all ages was four to six cases per hundred children per year.
An LRI is defined as any respiratory tract infection involving the larynx or structures distal to it. Four clinical syndromes have been described: croup, tracheobronchitis, bronchiolitis, and pneumonia. Croup is characterized by hoarseness, cough with inspiratory stridor, and laryngeal obstruction. Tracheobronchitis leads to cough with rhonchi, but without laryngeal obstruction. Croup and acute tracheobronchitis primarily are the result of extension of viral upper respiratory infections. They generally are self-limited and require no more than symptomatic treatment. Neither will be discussed further.
Bronchiolitis is an acute infectious inflammation of the lower airways. The classic syndrome is defined as the first episode of wheezing in a child younger than 2 years of age. Viral infection of the airways, most often respiratory syncytial virus (RSV), is the most common etiology of bronchiolitis. However, other viral agents and chronic inflammatory diseases, including cystic fibrosis, ciliary dyskinesia, and recurrent aspiration, also can be associated with bronchiolitis.
Consultation with the Specialist
Authors: Leslie Laurel K. , Boyce W. Thomas 
Published: December 2021

Historical Perspective
In 1964, Green and Solnit first described a constellation of clinical features comprising a "vulnerable child syndrome" based on a cohort of 25 families. Each of the families had a child who had suffered a life-threatening illness in infancy. The authors observed that the parents, particularly the mothers, shared a continuing and unfounded anxiety concerning their children's health. Green and Solnit hypothesized that the parents persisted in fearing that their child was destined to die in childhood.
The parents' perception of their child as uniquely vulnerable led to myriad maladaptive behaviors and difficulties in parent-child interactions (Tables 1 and 2). The parents overprotected the child, were unable to set age-appropriate limits, and displayed excessive concerns in medical settings about their children's health. The children, responding to their parents' expectations of vulnerability, evidenced exaggerated separation anxiety, out-of-control behavior, school underachievement, and distorted perceptions of their own health. Interestingly, these behaviors were not noted in the parents' interaction with their other children.
As clinicians began to identify families that had this constellation of clinical features, additional details about the vulnerable child syndrome were elucidated. Parental perception of their child as medically vulnerable was not a universal legacy of severe illness in infancy, but more likely a reflection of how an individual family responded to an illness in their child.
Editorial: The First Birthday
Authors: H. R. J. 
Published: December 2021

With this issue of PEDIATRICS IN REVIEW we start our second year of publication. In the spirit of the second year theme of PREP, "Child Development," I feel that during this first year we have developed a considerable amount of trust and support from our readers' acceptance of the journal and, at times, from their stern guidance; we have also learned some things that should improve the Journal during the second year.
EDUCATIONAL OBJECTIVES
I had originally hoped to address, in the course of a year, the majority of the educational objectives developed by the two task forces, but the task force on Recent Advances produces some 150 objectives per year and the one on Topics produces 35.
Editorial: Feedback
Authors: H. R. J. 
Published: December 2021

During the 1980/81 year the self-assessment examinations at the end of each issue of PEDIATRICS IN REVIEW were dropped in response to the large number of criticisms of the questions. In their place the computer cards required readers to check whether the articles were relevant and accurate. In addition, we asked readers to add comments on the back of cards. The feedback has been very useful.
Dropping the self-assessment examinations has been overwhelmingly condemned. Many wrote that, while they had written protesting the quizzes last year, they now had changed their minds and wanted them back. The Chapter Chairmen, overwhelmingly, voted to have them reinstated.
Fetal Drug Syndromes
Authors: HILL REBA MICHELS , SMITH DAVID W. 
Published: December 2021

1. The antiepileptic drug syndrome does occur, but 80% to 90% of the babies born to mothers on antiepileptic drugs are normal.
2. The minor malformations are not physically handicapping to the child.
3. The majority of major anomalies are medically or surgically correctable. Some, such as the VSD, correct spontaneously.
4. Exposure of the fetus to phenobarbital alone may result in a similar yndrome, so the term "hydantion syndrome" is a misnomer.
5. Infants with lQ &gt;120 may be born to mothers on phenytoin or phenobarbital.
6. There appears to be an increased number of malformations and lowering of IQ from multiple drug exposure rather than single drug exposure.
7. The physical appearance of the child may be reasonable and not grotesque.
8. Infants exposed to alcohol, phenobarbital, or phenytoin have been reported to have malignancy, but the incidence must be compared to the general population to see whether it is significant.
9. Vitamin K3 must be given immediately after birth and a clotting profile checked to see whether additional vitamin K3 is needed, or whether frozen plasma is indicated, because hemorrhage may result in a 33% mortality.
10. Multiple deficiency states occur in patients on chronic drug therapy, and these deficiency states may contribute to the neurologic and physical disability. Vitamin supplements for pregnant epileptic patients may be indicated.
11. Seizures do not increase in the epileptic patients who are given supplementary folic acid as believed by neurologists.
12. A comparison was made between the morbidity in the infant of the epileptic and that of the infant of the diabetic. Since 1950, there have been no recommendations to abort diabetic patients. Their infants have morbidity similar to that of infants of epileptics. Physicians learned what contributed to the morbidity and treated it.
13. Physicians should not administer trimethadione or paramethadione to women of childbearing-age since by the time a pregnancy is diagnosed fetal injury may have already occurred.
Kawasaki Syndrome (Mucocutaneous Lymph Node Syndrome)
Authors: Melish Marian E. 
Published: December 2021

Kawasaki syndrome or the mucocutaneous lymph node syndrome (MCLS, MLNS) is an acute febrile exanthematous illness of children, first recognized in Japan by Kawasaki in 1967.1 In 1970, the Research Committee of MCLS, supported by the Ministry of Health and Welfare of the Japanese government, organized a case registry to elucidate the clinical, pathologic, epidemiologic, and etiologic features. By 1974, the committee had collected approximately 5,000 cases from all over Japan.1,2 The illness has continued to be recognized in Japan with more than 10,000 cases registered by 1979.
The disease was recognized independently in the United States by Melish et al with 12 cases encountered between 1971 and 1974.3,4 Although these American workers had no knowledge of the Japanese experience they independently identified the same diagnostic criteria. Later consultations with Japanese MCLS researchers have established that the cases in Hawaii and the cases in Japan were indistinguishable in their presenting manifestations and their clinical course.
Since 1974, Kawasaki syndrome has been recognized worldwide. Outside Japan, the illness appears to be most prevalent in Hawaii which has the largest published series3; the largest proportion of cases in the United States reported to the Center for Disease Control come from this state. The experience at the Kapiolani-Children's Medical Center now includes more than 100 cases from various parts of Hawaii.