bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bronchiolitis
Authors: Welliver Josephine R. , Welliver Robert C. 
Published: December 2021

Bronchiolitis is an acute respiratory illness precipitated by a viral infection and resulting in obstruction of the small airways. While mortality due to bronchiolitis is low in developed countries, it remains an important illness because of the frequency with which infants require hospitalization and because of the potential association with asthma during later life.
Definition
An enduring definition of bronchiolitis has been the first episode during infancy of an illness beginning as an upper respiratory infection that progresses to the development of wheezing. This definition is inadequate for a number of reasons. First, infants who have obstructive airway disease do not always wheeze audibly. Second, many infants have two or more episodes of viral bronchiolitis within an interval of only a few months. The recurrent wheezing episodes are clinically quite similar to the first episode. Finally, some children may have their first episode of virus-induced wheezing during the second year of life, with the age of onset being the only feature that is different from a typical episode of bronchiolitis.
It has been suggested that clinicians use the response of the wheezing infant to a single subcutaneous dose of epinephrine to distinguish bronchiolitis from asthma. This is inappropriate because a small number of infants who have true bronchiolitis respond to the first course of beta-adrenergic agents while many patients with status asthmaticus do not.
INDEX OF SUSPICION
Authors: Bradford Bradley J. , Miller Harry S. , Gilbert Walter L. 
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 with discussions.
Case 1 Presentation
A 19-year-old girl comes to the university health service with complaints of difficulty swallowing and fever. The illness began 2 days ago with a minor sore throat. Although she has been able to take in sufficient fluids, she has had progressively more difficulty swallowing and has became febrile. There has been no known exposure to other illnesses, nor does she have any specific complaints of a chronic nature. Her last menstrual period was 3 weeks ago; she denies sexual activity.
Physical examination reveals a febrile young woman in no acute distress but complaining of throat discomfort. Pertinent findings include a markedly swollen oropharynx with erythema of the uvula and marked cervical adenopathy. The remainder of the examination is normal.
Then and Now
Authors: Menna Vincent J. 
Published: December 2021

Dr. Nick, a family practitioner, has been a resident of Heaven for about 20 years. Although content in most respects, he began to miss the practice of medicine. Dr. Nick approached St. Peter, the archetypical gatekeeper, about the possibility of getting a glimpse of medicine in the 1990s, and the following conversation ensued:
Dr. Nick: I miss my office. I was alone and king of my castle. I had no staff and my office was in my home. The expenses were negligible.
St. Peter: Today most doctors have offices away from their homes and practice in groups. Their office staffs resemble General Motors, and overhead approaches 50%.
INDEX OF SUSPICION
Authors: Nield Linda S. , Tejeda David M. , Garfunkel Lynn C. 
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 mother is concerned because her 2-year-old son is "not as sure on his feet as he used to be." In the past 2 weeks she has noticed that he seems clumsy and is falling more than usual when playing or walking. His babysitter also has noticed this change in abilities, heightening the mother's concern. No other neurologic impairment is noted, and his play does not seem disrupted.
The boy's medical history is unremarkable. Recently, he had a persistent middle ear infection that finally resolved after 1 month of treatment with three different antibiotics. He also has been having 6 to 12 loose stools a day. Clostridium difficile toxin has been isolated from his stool.
Juvenile Delinquency: Considerations for Pediatricians
Authors: Yancy W. Sam 
Published: December 2021

Society long has been concerned about the behavior of its youth. Today, because of the easy accessibility of more dangerous drugs, more lethal weapons, and automotive transportation, this concern is greater. In 1989 there were 1 744 818 arrests among those under 18 years and 585 521 arrests in the age group under 15 years. Although the overall arrest rate for males has increased only 5% over the past 10 years, violent crimes such as murder and rape have increased significantly (&gt;60% and &gt;27%, respectively). Further, motor vehicle thefts have increased even more (72%). The overall arrest rate for females under 18 years of age has increased 13%, with aggravated assault and motor vehicle theft (&gt;69% and 54%, respectively) chiefly responsible for the increase. These figures would be even more staggering if they included youth who commit delinquent acts but do not come into contact with legal authorities. Not only do pediatricians, because of their relationship with youth and their families, have an opportunity to affect those factors that may lead to delinquent behavior, but they have an obligation to provide for the medical and mental health needs of these youth.
Legal Considerations
Legally, a youth is considered a delinquent if he or she commits an act that violates the law and if the violation comes to the attention of the police or the court system.
Vesicoureteral Reflux
Authors: Sheldon Curtis A. , Wacksman Jeffrey 
Published: December 2021

Vesicoureteral reflux describes a pathologic event in which urine progresses in a retrograde fashion from the bladder to the ureter and in many cases into the intrarenal collecting system. This pathologic event cannot be treated successfully in isolation. Appropriate care requires meticulous attention to the treatment and prevention of urinary tract infection; correction of any associated voiding dysfunction; and careful attention to such adjuvant care as perineal hygiene, hydration, and treatment of defecation disorders.
Vesicoureteral reflux is classified according to the International grading system demonstrated in Figure 1. Grade I reflux represents retrograde flow into a nondilated ureter only. Grade II reflux refers to the filling of a nondilated ureter and a nondilated renal pelvis. With Grade III reflux, one begins to see a dilatation of the collecting system, but the fornices remain sharp. With Grade IV reflux, the fornices become blunted. Grade V reflux refers to associated massive dilatation and tortuosity of the collecting system.
It is very important to classify ureteral reflux as primary or secondary in its etiology. Primary vesicoureteral reflux refers to a congenital deficiency of the ureteral insertion that results in an ineffective valve mechanism. Secondary vesicoureteral reflux refers to reflux that is caused by either bladder dysfunction or previous surgical intervention.
Neck Injury
Authors: Avner Jeffrey R. 
Published: December 2021

Although rare in pediatrics, cervical spine injuries still are associated with serious morbidity, disability, and mortality. Many of these injuries are exacerbated by inadequate neck immobilization or improper manipulation. Thus, the physician should be aware of which children are at risk for cervical spine injury and how to assess these patients properly.
To find clinical markers that identify children who actually have cervical spine injuries, Rachesky et al reviewed 2133 cervical spine radiographs obtained in pediatric patients during a 7-year period. Of these children, 25 (1.2%) had abnormalities confirmed on radiographs. The incidence of injury increased with age; only four of the children who had cervical spine injuries were less than 8 years old.
Hirschsprung Disease
Authors: Rudolph Colin , Benaroch Lee 
Published: December 2021

In 1886, Harald Hirschsprung first described a disorder in newborns of severe constipation with dilatation and hypertrophy of the colon. No mechanical obstruction could be demonstrated, but there appeared to be an area of spasm that prevented the movement of lumen contents through the sigmoid or rectum. This disorder, termed Hirschsprung disease, later was recognized to be due to an absence of the intramural neural ganglia in the rectum, and provided the first example of an abnormality of intestinal innervation associated with a disorder of gastrointestinal movement. Recent insights into the development of the gastrointestinal neural plexus that provide new clues to the pathogenesis of Hirschsprung disease are discussed in the first section of this review.
Despite continued uncertainty about the pathogenesis of Hirschsprung disease, surgical treatment approaches have evolved over the past 50 years, and after removal of the abnormal bowel, most affected children lead normal, productive lives. Unfortunately, children who have Hirschsprung disease can develop life-threatening bowel obstruction with perforation or severe diarrhea and sepsis before surgery. Early diagnosis and surgical treatment are crucial to preventing these complications, which remain the major cause of serious morbidity and mortality. To assure early diagnosis, this article reviews the clinical presentations of Hirschsprung disease and provides an approach to the differential diagnosis of constipation among infants and children.
Diagnosis of Allergic Disorders
Authors: Fireman Philip 
Published: December 2021

Although some pediatricians may trivialize allergic illnesses as "just allergy," most clinicians now realize the significant impact that allergic diseases have on children's health and quality of life. Allergic diseases, including asthma, are among the major causes of chronic illnesses in the United States, affecting approximately 50 million patients or as many as one in five children. The economic impact is enormous; asthma alone is estimated to cost more than 6.2 billion dollars of health care expenditures annually. Of all the chronic illnesses, allergic respiratory problems, including allergic asthma, is the most common cause of school absenteeism. Even though allergic disease usually is not fatal, death can result as a consequence of allergic anaphylaxis related to medication, food, or insect venom allergy or from a complication of asthma. Therefore, the pediatrician must be capable of diagnosing allergic disease so as to institute appropriate management. This review will emphasize those clinical diagnostic features ascertained by history and physical examination as well as the appropriate laboratory studies useful in the diagnosis of respiratory (inhalant) and gastrointestinal (food) allergy.
General Features of Allergic Diseases
Allergic diseases are immunoglobulin E (IgE)-mediated immunologic illnesses that can affect any of the body's major organ systems either individually or collectively.
Management of Chronic Pain In Children
Authors: Kain Zeev N. , Rimar Stephen 
Published: December 2021

Pain relief has received considerable attention in recent years, but pain in neonates and children has been underreported, undertreated, and misunderstood. Several reviews have dealt with the recognition and treatment of acute pain, but much less has been written about chronic pain in children. Here we will address general considerations of pain management in children and specific chronic and recurrent pain syndromes of childhood.
Developmental Considerations
The perception of pain includes both a sensory component, involving neural pathway activation in response to noxious stimuli, and an affective/cognitive response, involving several behavioral aspects.
Cutaneous sensory perception has been reported in the perioral area of human fetuses as early as the seventh week of gestation and spreads to include cutaneous and mucosal surfaces by the twentieth week. Incomplete myelinization of nerve fibers and immature synaptic connections have been thought to indicate a lack of maturity in the neonatal nervous system, but this phenomenon merely implies a slower conduction velocity, with much shorter traveling distance in newborns.
Development of the fetal neocortex begins during the eighth week of gestation; by 20 weeks, each cortex has a full complement of neurons. Sensory pathways required for pain transmission can be traced from receptors in the skin to sensory areas in the cerebral cortex of infants. Functional development of the cerebral cortex is suggested by specific features of both the fetal and the neonatal electroencephalogram.
Pubertal and Psychosocial Development: Implications for Pediatricians
Authors: Litt Iris F. 
Published: December 2021

The endocrinology and somatic events of puberty have been well described, and their assessment is incorporated routinely into the evaluation of the adolescent patient. Because of the increasing collaboration between behavioral scientists and physicians who share an interest in the developing adolescent, understanding of the interactions between the physical, cognitive, and psychological experiences of this age group has grown. Examining the contextual and possible predictive implications of variations in pubertal events and their timing will help the pediatrician to guide and counsel adolescents and their parents.
Findings from recent research have highlighted the salience of gender differences in the experience of puberty and in the timing of its onset and tempo as well as the importance of being earlier in maturation rather than synchronous or later than one's peers. In this article, we will consider the findings in four major domains: 1) the effect of adolescent development on family homeostasis; 2) the implications for cognitive development; 3) the implications for personality (psychological) development; and 4) the recognition of risk factors or markers for problem behavior.
Pubertal Development and Family Homeostasis
One of the earliest tasks of adolescence is to separate from the family emotionally in preparation for developing independence.
For girls, pubertal development may be the signal to their fathers to be less physically affectionate.
Pinworms
Authors: Sonnenblick Howard 
Published: December 2021

Enterobius vermicularis, more commonly known as pinworm, is the most common intestinal nematode in the United States, affecting 5% to 15% of the population. Although infection may appear in all age groups and socioeconomic levels, it is most prevalent in preschool and school-age children.
Typically, embryonated eggs are ingested and migrate to the duodenum where they hatch and undergo sexual maturation before reaching the cecum. Adult pinworms reside in the cecum, emerge at night through the anus, and migrate to the perianal region where gravid females deposit their eggs and die. The eggs cause anal pruritis, which leads to scratching and accumulation under the fingernails, thereby promoting auto-infection and spread to close contacts.
Consultation with the Specialist
Authors: Strong William B. 
Published: December 2021

J.D. is a 3-year-old boy who has tetralogy of Fallot. His definitive correction has been deferred because of the parents' desire for bloodless surgery. Until 4 days prior to being seen in the office, he was in his usual state of health. He always has been reasonably active, and his oxygen saturation by transcutaneous pulsed oximetry has been in the mid-80% range. His last hemoglobin level, obtained 3 months ago, was 16.5 g/dL; his red blood cell indices were normal.
Four days prior to coming to the office he complained of a mild headache, and his mother thought he felt warm to the touch. He seemed to respond to acetaminophen therapy. Three days later, he again complained of headache, felt warm to the touch, and was not his usual active self. His mother stated that she thought he was coming down with the same virus from which his preschool brother had just recovered. He has not improved with acetaminophen, and he now appears more cyanotic and lethargic and complains of a severe left-sided headache.
Your examination reveals a sick-appearing child who is quite cyanotic and only moderately responsive to commands. His temperature is 38.8°C, pulse is 120 beats/min, respirations are 28/min and unlabored, and blood pressure is 96/58 mm Hg.
Control of Infections in Schools
Authors: McMillan Julia A. 
Published: December 2021

School staff members, public health officials, and parents often look to pediatricians to provide recommendations for dealing with exposure in school to a variety of infectious diseases (Table 1). It is extremely important to provide accurate, consistent, and sufficient information to allow parents to make individual decisions regarding their children without unnecessary fear. Schools should take appropriate precautions to assure that students are not put at unnecessary risk of serious infection, but they also have a responsibility to protect the privacy of any children whose infection poses little or no risk to their classmates.
In considering appropriate recommendations for exposures to specific infections in schools, it is important to review the available information about the mechanism(s) by which the infection is spread from person to person as well as the likelihood of spread. It also is important to recognize the extent to which contacts would be expected to be immune, either by virtue of previous infection or through immunization. The availability of methods for prevention of infection in susceptible contacts (passive or active immunization, antimicrobial therapy) should be reviewed, and recommendations for implementation made based on the risk of infection and the severity of the disease.
Varicella Exposure
Varicella generally is a mild illness of childhood; 90% of cases occur in children 14 years of age or younger, and most cases in the United States occur in children between the ages of 5 and 10 years (Table 2).
Hemophilia: An Updated Review
Authors: Bell Beverly , Canty David , Audet Michelle 
Published: December 2021

Introduction
Hemophilia is a genetic disorder that results in either an inactive or inadequate supply of a plasma protein needed for normal blood clotting. The two most common forms are hemophilia A and B, caused by a defect or deficiency in clotting factors VIII and IX, respectively. Both types are X-linked recessive disorders characterized by prolonged bleeding and hemorrhages, typically into joints and soft tissues. Hemophilia C is an autosomal recessive defect that results in a deficiency of factor XI. Marked by bleeding in mucous membranes, hemophilia C exhibits a somewhat different clinical pattern of hemorrhaging than hemophilia A or B but similar to that in von Willebrand disease. This review will focus on hemophilia A and B.
Hemophilia has served as a model for the treatment of chronic illness through the comprehensive approach to care. If a child who has hemophilia is managed appropriately with early factor replacement therapy and attempts to avoid the long-term consequences of bleeding, the prospects for a long, full, and healthy life are very good.
Epidemiology/Genetic Transmission
The incidence of hemophilia A and B is about 15 to 20 per 100 000 males born worldwide and occurs in all races and socioeconomic groups. Hemophilia A, also known as "classical hemophilia," accounts for about 80% of cases of hemophilia, occurs in one of 10 000 male births, and affects about 17 500 individuals in North America.
Divorce: Consequences for Children
Authors: Emery Robert E. , Coiro Mary Jo 
Published: December 2021

An extensive body of research exists on the consequences of divorce for children. The conclusions of this research are captured by the concept of resilience, children's ability to "bounce back" in the face of stress. Most children from divorced families cannot be distinguished from children from married families on objective measures of psychological functioning, including assessments of conduct, depression, anxiety, and school performance. Nevertheless, it is clear that divorce often creates many dramatic stressors for children, including involvement in their parents' conflicts, decreased contact with one parent, strained relationships with the other parent, and economic problems. Coping with these substantial changes can tax children's emotional resources and may leave them with lingering feelings of hurt, resentment, and longing for a parental reconciliation. The concept of resilience highlights both children's ability to cope with change and some of the painful consequences of coping with unwanted changes in family life.
Definition
Despite its familiarity, several considerations should be noted about the definition of divorce. First, divorce is a developmental process that unfolds over time. Changes in family life typically begin long before the physical separation and continue long after the legal divorce. Second, because divorce reaches into many areas of people's lives, theorists often talk about the "legal divorce," the "emotional divorce," the "emotional divorce," the "economic divorce," and the "social divorce."
Hemoptysis in Children
Authors: Pianosi Paul , Al-sadoon Hammad 
Published: December 2021

Definition
Hemoptysis is defined as coughing up of blood or the presence of blood in sputum. It is not a common symptom in children and although not usually life-threatening, it can become so. Massive hemoptysis is defined as bleeding that exceeds 8 mL/kg per 24 hours. Because children younger than 6 years of age tend to swallow their sputum, they rarely present with hemoptysis, unless the bleeding is substantial.
Epidemiology and Etiology
Causes of hemoptysis in children are listed in Table 1. Acute lower respiratory tract infection is the single most common cause, accounting for approximately 40% of cases. Hemoptysis that ranges from blood-tinged sputum to massive quantities of blood in the sputum is relatively common among those who have cystic fibrosis (CF). Massive hemoptysis is estimated to occur in 5% of CF patients, but approximately 1% will have mild hemoptysis every year, most commonly among those who are older than 18 years. In bronchiectasis due to causes other than CF, the incidence of hemoptysis is approximately 10% to 15%. Foreign body aspiration remains a leading cause of hemoptysis in children, with the majority of cases occurring in those younger than 4 years of age. Hemoptysis seldom is encountered in those who have primary pulmonary tuberculosis; it is estimated to occur in fewer than 1% of cases.