bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Manpower Recommendations
Authors:   Committee on Pediatric Manpower
Published: December 2021

The quality of pediatric care available to children in the United States remains a source of concern. The cost and accessibility of care, the education and training of pediatricians, and the numbers of pediatricians and other health care professionals who serve children affect the quality of care significantly.
The GMENAC (Graduate Medical Education National Advisory Committee) Report1 strongly suggested a coming "glut" of physicians and recommended reductions in the numbers of students in medical schools in the United States, severe restriction on the number of graduates of foreign medical schools entering practice in the United States, and reevaluation of the need to train nonphysician health care providers at current levels. More recent information confirms the GMENAC projections of a serious physician surplus.
The GMENAC recommendations are sensitive issues which affect the lives of many deeply motivated men and women who are eager to serve as physicians. It is important to note that foreign medical graduates are included among leading pediatricians in our country. Their contributions are outstanding, and some provide care in underserved The diversity of this group has enriched not only medicine but our entire culture. Unhappily, severe restrictions on the ability of those educated in medical schools overseas to establish practices in the United States would tarnish the potential of the "American Dream." Nevertheless, with a limited demand for physicians, it is also clear that, in the future, for every foreign medical graduate whose dream of medical practice in the United States is fulfilled, there will ultimately be one highly qualified United States medical graduate for whom it is denied.
Hunger Debate
Authors: GRAHAM GEORGE G. 
Published: December 2021

In Reply.—
The letter from Meyers and Spivak is disheartening: its vituperative tone suggests that they really believe what they are saying. They question the author's right to criticize the Massachusetts Nutrition Survey because it is "unpublished in the medical literature and...inaccesible...." I would hate to have to hold my breath until it appeared in a serious peer-reviewed journal and I dare say that, having been released with great fanfare via press conference to the national media, many more pediatricians (and legislators and ordinary citizens) will have heard its claims than will ever read this correspondence.
Metolazone and Furosemide Therapy for Edema
Authors: GARIN EDUARDO H. , RICHARD GEORGE A. 
Published: December 2021

To the Editor.—
In his report, Dr Arnold1 concludes that the combination of furosemide and metolazone offers a useful and effective oral therapy in most children with edema resistant to furosemide. In our opinion, pitfalls in patient selection and methodology cast doubts on his conclusions.
Dr Arnold defines furosemide resistance as no clinical response after a dose of 2 to 4 mg/kg/d of furosemide. However, the inclusion of patients who did not respond to 2 mg/kg/d seems inappropriate because: (1) 2 mg/kg/d has been considered the initial dose to treat these types of patients2 and (2) some of these patients may have responded to higher doses of furosemide (3 or 4mg/kg/d).
Endotracheal Tube Placement in Infants
Authors: HELLER RICHARD M. , COTTON ROBERT B. 
Published: December 2021

In Reply.—
We agree with Dr Bloch that auscultation is a primary tool for determinig appropriate position of an endotracheal tube. However, experience in a busy neonatal intensive care unit has shown that, even with careful auscultation, endotracheal tubes still become inappropriately positioned, often with serious consequences. Our experience has been that the illuminated endotracheal tube provides a clear indication of depth of penetration when asymmetric lung disease may cause auscultatory findings to be equivocal.
Dr Goldenring raises the important point that the cost of the illuminated endotracheal tube is under evaluation at the present time, and as soon as information concerning pricing is available, I will make this information available to the readership of Pediatrics.
Zinc Deficiency and Edema
Authors: GOLDEN MICHAEL H. N. , GOLDEN BARBARA E. 
Published: December 2021

To the Editor.—
Kumar and Anday1 describe three premature infants presenting with edema and hypoproteinemia—the classical signs of kwashiorkor—between 5 and 9 weeks of age. Such cases are not uncommon in developing countries. Kumar and Anday's patients had low plasma zinc concentrations (43, 37, and 42 µg/dL). On this basis the authors claim that edema and hypoproteinemia is a clinical presentation of zinc deficiency not previously reported.
We reported2 a clear association between "nutritional" edema and a low plasma zinc concentration in 1979; our subsequent experience has confirmed that edema of this type is always associated with a low plasma zinc concentration, as indeed Kumar and Andays' cases demonstrate.
New Abuse of Ipecac
Authors: CZAJKA PETER A. , RUSSELL STEVEN L. 
Published: December 2021

In Reply.—
We agree with the statements of Drs Ente and Penzer on the chronic abuse of ipecac syrup, namely, that chronic ipecac syrup abuse may produce myocardial injury, that chronic ipecac syrup abuse by persons with anorexia nervosa should be more widely recognised, and that ipecac syrup should remain a nonprescription drug. These issues were beyond the scope of our article (Pediatrics 1985;75:1101-1104) that addressed the effects of single doses of ipecac syrup. Although Drs Ente and Penzer do not advocate restricting the sale of ipecac syrup to limit its abuse, others recently have promoted in news reports the reclassification of ipecac syrup so that a prescription is required for purchase.
Committee Statement on Nutrition Corrected
Authors: SILVERIO JOHN 
Published: December 2021

To the Editor.—
I have read with interest the statement of the Committee on Nutrition entitled "Nutritional Needs of Low-Birth-Weight Infants" (Pediatrics 1985;75:976-986).
In the section, "Commercial Formulas for LBW Infants," reference 65, which refers to a paper showing adequate growth and metabolic stability obtained with our Preemie SMA, is erroneously given as reference 45. The other two references that refer to competitive formulas are correct.
Unfortunately, this gives the wrong impression that Preemie SMA has not been shown to be associated with "adequate growth and metabolic stability."
American Academy of Pediatrics and Child Abuse
Authors:   EXECUTIVE COMMITTEE OF THE AMERICAN ACADEMY OF PEDIATRICS
Published: December 2021

The December issue of Pediatrics (1985;76:993-997) carried a commentary by Dr Ray Helfer relating to the 25th Anniversary of the recognition of child abuse as a specific and identifiable entity.
In one paragraph of this article (p 995) one would have to draw the conclusion that the subject of child abuse has been the object of an unfortunate neglect by the American Academy of Pediatrics. For the benefit of our membership and others who have reason to be concerned by this allegation, we feel the necessity to set the record straight.
Neurologic/Behavioral Syndrome Associated With Ingestion of Chloride-Deficient Infant Formula
Authors: KALEITA THOMAS A. 
Published: December 2021

To the Editor.—
Six consecutively examined children (five boys, one girl) exposed to Neo-Mull-Soy formula have demonstrated consistent symptomatology, suggesting the existence of a distinct neurologic/behavioral syndrome relating to its use. Two of these children were found to have hypochloremic metabolic alkalosis reported elsewhere.1 All six children had failure to thrive, including arrest of head circumference in four. The children were examined between 5 and 6 years of age, and four had been followed longitudinally for at least 2 years.
Changing Spectrum of Serious Child Abuse
Authors: HANSON KAREN J. 
Published: December 2021

To the Editor.—
Child abuse and neglect is receiving considerable attention in both the scholarly and popular press. The acknowledgment of this problem, however, represents an admission of social failure, and explanations frequently serve as displacement mechanisms, value justifications, or support for agendas unrelated to child abuse and neglect. In an area currently receiving widespread media attention, it is crucial that research used to justify policy recommendations be clearly conceptualized, well supported by the data, and rigorously critiqued, both inhouse and in the public arena.
Child Abuse
Authors: GOLDSON EDWARD 
Published: December 2021

To the Editor.—
As a member of the Child Advocacy Team at the Children's Hospital in Denver and one who also knew Henry, I was very pleased to read Dr Ray E. Helfer's commentary (Pediatrics 1985;76:993-997). I can say that I am in agreement with many of the issues raised and with the priorities established. Nevertheless, I feel a sense of concern in that I wonder whether several more basic and perhaps more difficult issues were omitted.
Substance Abuse by Teenagers
Authors: FELDMAN VIRGINIA 
Published: December 2021

To the Editor.—
Pediatrics is to be commended for its recent articles keeping the problem of teenage alcohol abuse before the pediatrician's eye.1,2 Schwartz et al1 concluded that "pediatricians should play an active role in educating patients and their parents about alcohol." Unfortunately, alcohol education by physicians is at the stage car safety education was ten years ago—we know the scope of the problem but have few studies to show us how to effectively guide or change behavior in our daily office practices.
Failure of Trimethoprim/Sulfamethoxazole As Prophylactic Therapy of Gram-Negative Sepsis in Pediatric Patients With Cancer
Authors: WALD ELLEN R. 
Published: December 2021

In Reply.—
Esquembre et al report an experience with the failure of trimethoprim/sulfamethoxazole (TMP/SMX) as prophylactic therapy in pediatric patients with cancer. This occurred during the second to third year after chemoprophylaxis was instituted as a routine method of therapy. Antimicrobial resistance to TMP/SMX has been reported previously in adults with malignancies who were receiving chemoprophylaxis1 and has likewise been noted among isolates of Escherichia coli in developing countries.2 However, resistance to TMP/SMX did not occur as a clinical problem either at Children's Hospital of Pittsburgh or at the National Cancer Institute during a similar time period.3,4
Circumcision Debate
Authors: WISWELL THOMAS E. 
Published: December 2021

In Reply.—
I wholeheartedly concur with the gist of Dr Cohen's letter. Circumcision, as performed in this country, is a painful, traumatic event. In his superb monograph, Wallerstein1(135-144) discusses the seemingly incongruous approach to newborn circumcision pain. Many believe that there is no pain felt by infants undergoing the procedure. As recently as 4 years ago, a neurosurgeon acquaintance of mine told me that he believed his own son would feel no pain while being circumcised—"he isn't myelinated yet."
Interaction of Dietary Pudding With Phenytoin
Authors: JANN MICHAEL W. , BEAN JOHNNIE , FIDONE GEORGE S. 
Published: December 2021

To the Editor.—
Patient compliance with use of anticonvulsant medication is necessary to achieve seizure control. In nonambulatory, mentally retarded epileptic patients, phenytoin tablets (Dilantin Infatabs, Parke Davis) are often crushed and mixed with various semisolid foods to mask their taste and to enhance compliance. At our facility, phenytoin tablets were customarily mixed with vanilla pudding prior to patient administration.
From our routine therapeutic drug-monitoring program, several patients were observed to have low therapeutic serum concentrations despite seemingly adequate phenytoin dosages.
Shigella and Child Abuse
Authors: SMITH RICHARD D. , MCNAMARA JOHN J. , LADD MARYANNE 
Published: December 2021

To the Editor.—
Chronic Shigella vulvovaginitis has occasionally been described in children.1-4 Although frequently asymptomatic, approximately 50% of patients have a sanguinous vaginal discharge that, at times, has been confused with gonorrhea. Most authors believe that the etiology of the infection is fecal contamination of the vagina from improper hygiene of the perineum. However, in a substantial percentage of culture-proven cases of Shigella vulvovaginitis, there have been no simultaneous or preceding gastrointestinal symptoms and cultures of the stool and/or rectum were negative.
Dyslipoproteinemia and Migraine
Authors: GLUECK CHARLES J. 
Published: December 2021

In Reply.—
Because the anatomic, biochemical, epidemiologic, nutritional, genetic, and clinical genesis of atherosclerosis is in childhood,1,2 it is important to consider models for sampling in childhood for the dyslipoproteinemias. At a minimum, I would recommend a family history-triggered high-risk strategy with sampling of all children whose parents had sustained premature (≤age 60 years) myocardial infarction, angina, cerebrovascular accident, or peripheral vascular disease.1,2 Second, all children with known parental dyslipoproteinemia should be sampled, as should all children with parental history of essential hypertension gout/hyperuricemia, and/or diabetes.
Familial Right Thoracic Stomach
Authors: HUBERT BRUCE C. , TOYAMA WILLIAM M. 
Published: December 2021

Hiatal hernia reportedly occurs in about one in 1,000 infants.1 Failure of fusion of the dorsal mesentery and the developing stomach probably accounts for the widened esophageal hiatus. A continuum then exists that ranges from a small loculus of gastric mucosa in the chest (partial thoracic stomach) to a complete herniation of the stomach into the thoracic cavity. This abnormality has rarely been reported in infancy and, almost always, the hernia has been reported in the left thoracic cavity.2-4 A familial occurrence in infants in successive generations has never been previously reported.
CASE REPORTS
K.C., a 2-month-old white boy, was admitted to the Marshfield Medical Center because of a progressive increase in postprandial vomiting.
Head Start: Making a Popular Program Work
Authors: BESHAROV DOUGLAS J. , HARTLE TERRY W. 
Published: December 2021

Head Start, the federal government's preschool program for low-income children, is one of the nation's most popular domestic initiatives. In 1980, President Carter praised it as "a program that works." President Reagan included Head Start in the "safety net" and has presided over a substantial funding increase.
Head Start began in 1965 as a 6-week summer experiment in using child development services to improve the future prospects of disadvantaged children. It quickly became a full year program. Now, 20 years old, it serves about 450,000 children, at an annual cost of more than $1 billion.
The program's popularity is based on the widespread impression that it lifts poor children out of poverty by improving their learning ability and school performance.
Tobacco Use by Children and Adolescents
Authors:   Committee on Adolescence
Published: December 2021

Cigarette smoking is the chief single avoidable cause of death in our society and the most important health issue of our time.1
Despite increased public awareness of the long-term morbidity associated with the initiation of cigarette smoking during childhood and adolescence, the 1979 US Surgeon General's report on the health consequences of smoking estimated that 6 million teenagers smoke, and there are another 100,000 youngsters less than 13 years of age who smoke.2 In 1979, the National Institute of Education reported a fivefold increase in the number of smokers between junior high school- and senior high school-aged students.3 In 1983, Johnston et al4 found that 21% of high school seniors were regular daily smokers. Although there has been a general decline of cigarette smoking among male adolescents, there has been no parallel decline in the rate of cigarette smoking among young women, particularly those 17 and 18 years of age (J. A. Califano, Jr, unpublished remarks, 1968, 1974, 1979). Young women who use oral contraceptives are at higher risk of cardiovascular complications if they smoke. Among women who smoke during pregnancy, there is increased risk of poor fetal growth, spontaneous abortion, fetal death, and neonatal death.5,6
In addition to the use of cigarettes, the use of "smokeless tobacco," eg, chewing tobacco and snuff, is becoming more common among young people, particularly rural youth. It is estimated that between 10% and 20% of high school students use smokeless tobacco.7 Its use has been associated with leukoplakia, oral cancer, tooth abrasion, and loss of teeth.8
Applesauce and Isoniazid
Authors: ABERNATHY ROSALIND S. 
Published: December 2021

To the Editor.—
Notterman et al (Pediatrics 1986;77:850-852) reported about an 8-month-old infant who absorbed crushed isoniazid in applesauce poorly both during treatment for tuberculous meningitis and later in pharmacokinetic studies. A second child exhibited a less severe malabsorption. The authors state that "Children should not be treated with untested ad hoc preparations of drugs. Common practice and textbook recommendations based on such practice may be seriously misleading."
I believe that is an unjustified condemnation of a longstanding practice.
Applesauce and Isoniazid
Authors: NOTTERMAN DANIEL A. 
Published: December 2021

In Reply.—
Abernathy indicates that she has achieved favorable results with chemotherapy of tuberculosis using a crushed isoniazid tablet admixed with a teaspoon of applesauce, jelly, or jam (flavor not specified). Citing historical controls, she also implies that the generally favorable response to antituberculous therapy in children supports the use of isoniazid preparations that have not undergone rigorous pharmaceutical scrutiny, including tests of gastrointestinal absorption.
In our study,1 the isoniazid was mixed with a tablespoon of applesauce rather than a teaspoon as used by Abernathy.
Thumb-Sucking Debate
Authors: MACKENZIE ELLEN P. 
Published: December 2021

To the Editor.—
I practiced pediatrics for 14 years before I switched specialties to psychiatry, which I have practiced (both adults and children) for the past 21 years. Therefore, I have double reason to be perturbed by the article on aversive taste treatment in Pediatrics (1986;78:174-176), which is apparently offered as the voice of "Experience and Reason." To contradict this study of seven children from three families, I offer my experience since 1944 and the reasons for what I recommend.
Thumb-Sucking Debate
Authors: FRIMAN PATRICK C. , BARONE VINCENT J. , CHRISTOPHERSON EDWARD R. 
Published: December 2021

In Reply.—
In the course of Dr MacKenzie's considerable clinical experience, she has established some strong opinions about thumb sucking and a method for its treatment. We have been treating thumb sucking for more than 10 years1 and have only recently subjected our method to an empirical analysis. Prior to conducting our analysis, we did an extensive library search for empirical studies on the etiology and treatment of thumb sucking. We did not find any data-based references for the inevitability of a "power struggle" between thumb-sucking children and their parents, for the primary prevention of thumb sucking, or for the efficacy of long-term supportive visits to the pediatrician for thumb sucking.
Why I Have Difficulty Being Enthusiastic About Recommending That Children Wear Helmets on Bicycles
Authors: CIASTKO ALLEN R. 
Published: December 2021

To the Editor.—
Dr Weiss in his study of bicycle helmet use in Pediatrics (1986;77:677-679) makes a plea to pediatricians and family physicians to advocate bicycle helmet use based on the frequency and severity of head injuries reported in other studies of bicycle accidents. Unfortunately, most studies quoted either reviewed bicycle injuries in isolation from other types of injury or were national death report statistics which represent only the tip of the iceberg (ignoring relative morbidity statistics).
SUCCESSFUL MANAGEMENT OF PROTRUSION OF THE TONGUE IN A FIVE-YEAR-OLD ENGLISH BOY (1805)
Authors: C. T. E. 
Published: December 2021

The following case report published in 1805 describes the successful treatment of a markedly protruding tongue in a young boy. The method is so simple that one wonders whether the author has not omitted something in the history.
On Thursday, May 24, 1804, Ralph Heighington, five years old, was admitted into the Sunderland Dispensary. He had been much distressed with worms, and for this complaint he was put under my charge. He had every appearance of scrofula, such as ophthalmia tarsi, and marks under the chin from scrofulous sores, etc.; but what chiefly attracted my attention was his tongue, which was so much enlarged in length, breadth, and thickness, that it hung out of his mouth considerably below the chin. It had a very disgusting appearance. The upper part of it was rugose, and indented with a few longitudinal fissures. The dentes incisores were gone; and the few remaining molares were much diseased, and ready to drop out. He could not utter a single syllable, but appeared to understand everything I said to him. The tongue began to swell before he was a year old; and increased so rapidly, as to prevent him from learning to speak a word. By the use of a few vermifuge medicines, a large quantity of worms were expelled, and, with them, all the concomitant symptoms disappeared. The tongue remained still much the same, being protruded without the mouth about three inches. The more he endeavoured to pull it within his lips, the further it appeared to be protruded. I thought it expedient to ... push back the tongue, and shut the mouth; but the moment he withdrew his hand, it burst without the mouth, the same as before. I ordered the tongue to be returned into the mouth, and retained there by means of a silk handkerchief, which was passed below the chin, and the ends firmly fastened at the crown of the head. By this means the jaws were kept perfectly close together. At first he appeared very uneasy, but being relieved occasionally, by taking off the handkerchief for a few minutes, and replacing it again, he was enabled to bear it; and, in the course of five weeks, the tongue became of the natural size and appearance, and he could pronounce several short words very distinctly. By these means, a perfect cure was effected.
Pediatric Lead Poisoning in 1987: The Silent Epidemic Continues
Authors: LANDRIGAN PHILIP J. , GRAEF JOHN W. 
Published: December 2021

Great gains in the understanding and control of childhood lead poisoning have been made since this disease was first diagnosed in the early years of this century. Efforts of pediatricians, public health officials, and enlightened regulators have brought about substantial reductions in the lead content of paint, food, milk, water, air, and, most recently, gasoline. Significant decreases in children's blood lead levels and in the incidence of lead poisoning have resulted. Few American pediatricians trained in the past decade have ever seen a child with the coma, papilledema, and convulsions of acute lead encephalopathy.
Despite these advances, the silent epidemic of childhood lead poisoning is not yet over. It is particularly well now that we function in this manner because some of the important issues that we are dealing with at this time are items that cannot be completed by this date. We will depend upon the new Executive Committee and new Executive Board to carry these issues to completion.
Last year, I spoke to you with a great deal of concern about our problems in medical liability. I expressed a conviction that an independent research on this subject could contribute to a real resolution of the problem. We have pursued this plan during the year and I can tell you now that, at the instigation of the Academy, the Institute of Medicine of the National Academy of Sciences has held a feasibility study and a planning meeting during this year. This has lead to the formation of a proposal for the research that is now waiting only for the funding to proceed.