bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Neurodiagnostic Tests: A Modern Perspective
Authors: Ferry Peggy C. 
Published: December 2021

The past decade has witnessed unprecedented advances in our ability to study the pediatric nervous system by various imaging and electrophysiologic recording techniques. A profusion of imaging devices and "brain mapping" machines have been developed and aggressively marketed to neurologists. The pediatric practitioner now has a veritable "Chinese menu" of various neurodiagnostic tests from which to choose in evaluating a child who has a neurologic complaint. The quality of the images obtained from newer studies, particularly magnetic resonance imaging (MRI), is truly astounding, and it is tempting to order such a study when evaluating almost any child with a neurologic problem.
Deciding which test to order as a screening procedure, which one might be most useful as a secondary examination, or which study should be performed as the most definitive diagnostic procedure can be difficult. These questions may result in a "shotgun" approach or a "full diagnostic onslaught,"1 with all available tests being done when one or two might have been sufficient.
The pediatrician's dilemma during the modern era is clear: Despite the increased quality of images now available, the newer tests are expensive (Table 1), and their overuse in the pediatric population has contributed significantly to the higher costs of evaluating children who have neurologic disorders.
Office Care of Wounds
Authors: Lease John G. 
Published: December 2021

All children experience a variety of minor injuries, the vast majority of which can be cared for easily by a competent parent. Wounds of a larger scope, wounds of a complex nature, or wounds with secondary complications require consultation with the pediatrician. Knowledge of the principles of treatment is essential and must be tailored to individual parental abilities, home environment, and emotional concerns. The purpose of this article is to outline common problems and to give suggestions for efficient office management.
Tetanus Prophylaxis
All wounds, regardless of etiology or size, should be considered as potential sources of tetanus. Therefore, it is incumbent upon the primary provider to ensure adequacy of tetanus prophylaxis (Table).
Lacerations
Pediatricians see a variety of lacerations. Those which do not come to medical attention through the emergency department are usually within the scope of the primary provider. Occasional surgical referral may be necessary because of the nature of location of the wound.
If bleeding has not ceased by the time of initial presentation, a small gauze dressing should be applied with direct, constant pressure for 15 min. Large, bulky dressings are inefficient for applying pressure at the exact bleeding site. Careful documentation should include location, orientation, depth, and exact length of the laceration.
Care of the Normal Newborn
Authors: Kendig James W. 
Published: December 2021

A variety of changes have occurred recently in perinatal care that influence the role of the pediatrician. These include new prenatal assessment techniques (ultrasonography and fetal electronic monitoring), an increased attention to the ambiance of delivery with family participation, and more rapid hospital discharge. This review will focus on the role of the general pediatrician in the care of the normal newborn in this new setting.
Prenatal Pediatric Visit
The pediatrician's role in the care of the normal newborn should begin with the prenatal pediatric visit during the third trimester of the pregnancy. This visit usually occurs in the pediatric office; some practitioners can schedule time for a home visit. This first meeting between parents and pediatrician frequently serves as the foundation for two decades of mutual trust, confidence, and communication. The topics that should be discussed and recorded at this visit are listed in Table 1. Serious potential problems identified during this visit may require discussion with obstetrical and neonatal colleagues.
The prenatal visit should include discussions about maternal nutrition; the hazards of alcohol, cigarette smoking, and other drugs to the unborn baby; and the dangers of passive smoking once the infant is home. The pediatrician should inquire about maternal illnesses and medications.
Consultation with the Specialist
Authors: Goldbloom Richard B. 
Published: December 2021

When it comes to much that has been written about the association between behavior and allergy, the term "scientific literature" may be one of the major oxymorons of the current era. Megatons of forest products have been consumed in examining and reexamining the possible associations between children's behavior and consumption of sugar, artificial sweeteners, food additives and colorings, and assorted specific foods. Generally speaking, conviction has taken precedence over scientific evidence. A review of publications on the subject yields a conglomeration of positive, negative, and inconclusive results (mostly the latter two). Evaluation of such studies is complicated by pervasive methodologic design errors, the major ones being lack of double-blinding in test situations and the assumption of guilt (ie, causality) by statistical association.
Beliefs
Both physician and parental belief in a linkage between food and behavior begins during the child's early infancy. Excessive crying ("colic") is the most common problem leading to formula change, which leads many parents and doctors to believe that the infant is allergic to cow milk, especially if the crying seems to decrease following the change, although such allergy rarely is proven. As Forsythe and colleagues 1 have noted, changing an infant's formula may not be an innocuous practice, especially if it leads to an erroneous belief that the infant has some intrinsic abnormality, thereby altering the parent's perceptions of the child's vulnerability.
Amphetamine and Methamphetamine During the 1990s
Authors: Morgan John P. 
Published: December 2021

A 1981 review of toxicity and illicit use of amphetamine noted that governmental actions had diminished the diversion of pharmaceutical amphetamine and methamphetamine. Much of the illicit market prior to 1972 had been supplied by diversion of legitimately manufactured material, chiefly through careless (or even criminal) wholesaling. Following the reduced availability of diverted amphetamine, a number of events transpired. A market of fake "look-alike" products evolved. These were produced in formulations that resembled popular amphetamine products and that contained available over-the-counter stimulants, such as ephedrine and caffeine. Between 1980 and 1982, a very popular "triple product" appeared that contained caffeine, ephedrine, and phenylpropanolamine. The look-alike problem was diminished by a series of actions taken by the federal Food and Drug Administration in 1984 that outlawed the legal marketing of any such combinations.
Illicit synthesis and marketing of methamphetamine continues. Although distribution remains limited chiefly to southern California, it has clinical importance. While a volatile version of methamphetamine ("ice") has received wide exposure in the American media, its true clinical impact apparently remains limited.
Definitions and Terminology
Amphetamine refers to a unique chemical, for which there are a number of precise terms: methylphenethylamine, phenylisopropylamine, and 2-amino-1-phenylopropane. Use of the term "amphetamines" is careless; there is no basis for using the plural term.
Prenatal Diagnosis
Authors: DiLiberti John H. , Greenstein Mark A. , Rosengren Sally Shulman 
Published: December 2021

The enormous progress witnessed in the field of prenatal diagnosis during the past two decades is likely to continue into the future. Improved imaging techniques are likely to enhance the resolution of noninvasively obtained fetal images considerably over their current excellent quality. Although this undoubtedly will be true for ultrasonography, the increased speed of magnetic resonance equipment may offer a new realm of imaging possibilities. Computerized image processing, analysis, and three-dimensional reconstructions all should make interpretation of fetal images easier and more understandable to the nonspecialist. Advances in molecular genetics will continue to accelerate, greatly expanding the range and accuracy of prenatal diagnosis.
The alert pediatrician who is sensitive to genetic issues may, by early detection of pediatric disorders and careful family history assessment, be in a position to identify families at risk for serious genetic conditions and provide the opportunity to make informed decisions on reproductive options that avert a major tragedy. The pediatrician, working with obstetric colleagues, should be part of a team effort to support families going through prenatal testing. Familiarity with these rapidly changing technologies will make it far easier to support the family needing additional explanation about prenatal diagnosis issues.
Childhood Tuberculosis During the 1990s
Authors: Starke Jeffrey R. 
Published: December 2021

Despite the availability of effective antituberculosis drugs, tuberculosis remains an important cause of morbidity, mortality, and healthcare expenditures in the United States. It is estimated that more than 10 million people in the United States are infected with the tubercle bacillus. More than 26 000 new cases of clinical tuberculosis occur every year, 1600 of which occur in children. Factors that serve to sustain tuberculosis in the United States include infection with the human immunodeficiency virus (HIV), influx of foreign-born individuals at increased risk of developing tuberculosis, and poverty and poor access to medical care experienced by large segments of the population.
The Centers for Disease Control (CDC) has a goal of eliminating tuberculosis from the United States by the year 2010. If this goal is to be achieved, programs must focus on children because they are the future reservoir for the disease. Tuberculosis cases in children are important public health markers for a community insofar as they represent ongoing transmission of the disease and at least a partial failure of current tuberculosis control efforts.
Epidemiology of Childhood Tuberculosis
The incidence of tuberculosis in the United States declined steadily for a 25-y period until 1985, when it leveled off (Fig 1). More than 26 000 cases of tuberculosis were diagnosed in the United States during 1991; almost 1600 cases occurred in children &lt;15 y.
Croup and Related Disorders
Authors: Custer Joseph R. 
Published: December 2021

The airway of children is vital, but easily obstructed because it is narrow. Although there are many potential causes of upper airway obstruction (Table 1), a few diagnoses predominate. For example, in one study of 322 children presenting with stridor, 89% of cases were caused by croup, 8% by epiglottitis, and 2% by nonbacterial tracheitis.1 This review will cover these common airway infections as well as obstruction caused by inhalation of foreign bodies, spasmodic croup, and retropharyngeal abscess. Each of these diseases can progress to critical airway obstruction and hypoxia, causing organ damage or death.
Individuals caring for children must be prepared to diagnose and treat airway emergencies expeditiously. Appropriate management of acute upper airway obstruction tests the organization of emergency care systems. Successful management of airway emergencies requires a team approach, including the skills of the primary physician and the staff of the emergency department, radiology department, and operating room (eg, anesthesiologist, otolaryngologist). Management of these cases can be anticipated, and prospective protocols can and should be established. Regional intensive care units, transport teams, emergency room personnel, primary care physicians, anesthesiologists, and otolaryngologists can agree on a prospective management scheme such as that outlined in Table 2.
The issue of airway protection prior to or during transport to a tertiary care institution is controversial.
Role of the General Pediatrician in the Management of Human Immunodeficiency Virus Infection in Children
Authors: Rand Thomas H. , Meyers Alan 
Published: December 2021

Human immunodeficiency virus (HIV) infection is a chronic progressive disease affecting an estimated 20 000 children in the United States. Management of this infection and its complications is evolving rapidly and requires the coordinated services of a number of disciplines, which may be facilitated by centers having programs in pediatric HIV infection. However, much of the care for an HIV-infected child can be supervised by a primary care physician, particularly during the early phase of infection, when anticipatory health monitoring is emphasized. Many pediatricians have had no experience with HIV infection during residency training, and those who have may have cared only for inpatients who had advanced immunodeficiency. The trend in medical care for HIV infection is toward early detection and management, as in other chronic diseases of childhood. This review summarizes those aspects of HIV infection most likely to be encountered in general pediatric practice.
There are several distinct problems in the delivery of care for infants and children who are infected with HIV:
1) At this time, HIV infection is a progressive, ultimately fatal disease. Interventions are directed at preserving function and quality of life.
2) HIV is an infectious disease. Preventing transmission should be addressed at every opportunity, both to point out activities having potential for transmission and to reassure families of the safety of other types of contact.
Consultation with the Specialist
Authors: Duncan Charles C. 
Published: December 2021

Skull fractures may be divided into the three following general categories: linear fracture of the cranial vault, depressed fractures, and basilar skull fractures. Neurologic care of infants and children should be based on neurologic condition rather than the presence or absence of a fracture. In other words, decisions regarding hospitalization should be based on the history and examination rather than the presence or absence, for example, of a linear calavarial vault fracture.
Linear Fracture of the Cranial Vault
Linear calavarial vault fractures in infants may be somewhat less common than in older children, but they occur with similar force because of the flexibility of the thinner bone. When fractures do occur, a sufficiently large loss of blood due to significant subgaleal or intracranial bleeding may cause shock. Hence, hematocrits need to be measured frequently in minor head injuries in infants who have skull fractures; other assessments of blood volume may need to be made as indicated clinically.
Depressed Fractures
The flexibility of the skull also leads to a higher incidence of depressed fractures or so called "ping pong" fractures, where the normal convex contour of the cranial vault is reversed in the presence of minimal or no break. Some ping pong fractures may elevate spontaneously, but the majority will remain depressed unless elevated surgically.
Managing Patients Who Have Asthma: The Pediatrician and the School
Authors: Majer Lani Smith 
Published: December 2021

In addition to the medical and health education challenges faced by pediatricians managing patients who have asthma, school-based asthma management is a concern. This article is a companion to the Pediatrics in Review article "Managing Patients with Asthma: The Pediatrician as Emergency Physician, Chronic Illness Specialist, and Teacher" (1992;13:213-215). School-based management has become necessary and more complex with the increased awareness of the school's responsibilities and increased emphasis on aggressive preventive care. Effective management of asthma at school is critical because it can:
• promote a supportive learning environment,
• promote optimal school performance by controlling symptoms and medication side effects, thereby reducing absences,
• provide the necessary support in the event of an emergency, and
• enable students to achieve full participation in physical activities.
This article will review the steps used by practicing pediatricians to manage patients who have asthma in school effectively (Table).
Evaluation of School Policies and Programs
A complete asthma management plan includes a detailed evaluation of asthma management in the school. The evaluation determines whether appropriate school policies are in place for proper asthma management. Critical issues include environmental control, medication administration, asthma monitoring, emergency care, attendance, and physical and health education. Appropriate environmental control policies eliminate or minimize identified allergens and irritants from the school.
Sexuality in Children
Authors: Haka-Ikse Katerina , Mian Marcellina 
Published: December 2021

When factors shaping children's personality and behavior are considered, there is a tendency to overlook sexuality. In the broadest sense, sexuality is part of human development from birth onward, going through various stages before reaching adult meaning and expression. It is not limited to experiencing sexual feelings and procreating; it also involves the capacity for intimacy, affiliation, communication, mutual respect, and responsibility. These faculties are at least as important as the physical aspects, and their expressions imply complex social and emotional developmental processes. Unfolding sexuality must be supported externally so that it can reach maturity without major conflicts or distortions.
The pediatrician involved with children and their families on a continuing basis is in a position to inform and assist parents and children in the healthy development of children's sexuality. Pediatric intervention can take the form of anticipatory guidance, counseling whenever specific questions or concerns arise, and referral, as necessary, to other therapeutic resources.
Healthy Development of Sexuality
In all developmental stages, sexuality is intertwined with other basic developmental issues, such as formation of secure attachments, a positive self-concept, sense of trust and respect for others, realistic freedom from shame and guilt, and motivation to achieve.
Good parenting is fundamental to all these issues.
Poisoning in Children and Adolescents
Authors: Woolf Alan D. 
Published: December 2021

Definition
A poisoning can be defined as the exposure of the victim to an agent that, by transference of chemical or radiant energy, can cause symptoms and signs of organ dysfunction leading to injury or death.
Epidemiology
Childhood poisonings continue to challenge the diagnostic and treatment skills of the pediatrician. Of more than 1.7 million poisoning exposures reported to 72 poison centers in the United States in 1990, 60.8% involved children less than 6 years of age (Table 1). Fortunately, young children account for fewer than 4% of poisoning-related fatalities. Generally, childhood poisonings involve products in use and occur when a parent is distracted. The profile of a toddler at high risk for repeated poisonings is one who is active, is inquisitive, and has oral behaviors. Frequently, these children are described as negativistic; a power struggle between parents and child over putting forbidden objects in the mouth may be evident. Parents of these children may be socially isolated, burdened with physical or psychiatric problems, and hampered by insecurities regarding their own competence as parents.
Clinical Aspects
TOXIN INFORMATION
The history and physical examination are of paramount importance in reaching the correct diagnosis of the poisoned child. The pediatrician must find out what toxin(s) might be implicated in the poisoning: the exact ingredients and their concentrations.
Consultation with the Specialist
Authors: Poland Ronald L. 
Published: December 2021

Routine eye prophylaxis for newborn infants against gonococcal ophthalmia is a standard procedure in perinatal centers around the world. Gonococcal ophthalmia is a purulent eye disease that has its usual onset between the second and fifth days of life. Prior to the introduction of routine eye prophylaxis, it was a common cause of blindness in infancy. The use of 1% silver nitrate drops as prophylaxis against gonococcal ophthalmia soon after birth has reduced its incidence in the United States to less than 0.03% of infants.
The success of 1% silver nitrate prophylaxis depends somewhat on the use of proper technique. Each eyelid is wiped gently with sterile cotton prior to administration of the agent. Two drops of the solution are introduced into each conjunctival sac and not rinsed out; rinsing has been shown to reduce effectiveness. Because of the successful introduction of silver nitrate prophylaxis, Neisseria gonorrheae is no longer the most common infectious cause of conjunctivitis in newborn infants.
Although silver nitrate prophylaxis is a highly effective preventive measure, it has its drawbacks—primarily in the form of chemical conjunctivitis. Chemical conjunctivitis is a nonpurulent inflammation of the eye, with 1) swelling and a watery discharge occurring within several hours of instilling 1% silver nitrate, 2) a maximum inflammatory response around 48 hours, and 3) clearing by the fourth day in the absence of secondary infection.
Consultation with the specialist
Authors: McBride John T. 
Published: December 2021

Snoring is the audible consequence of the pharyngeal airway collapsing when one inspires. Snoring can disrupt sleep, cause a variety of important but nonspecific symptoms, and suggest the presence of the obstructive sleep apnea syndrome, which can lead to cor pulmonale and sudden death. Therefore, the review of systems for a child at any age should include questions regarding snoring and breathing during sleep. Most normal children snore at one time or another, and many, particularly those who have nasal allergies, snore almost nightly. Pediatricians should be able to identify which snoring children do not require treatment or referral, which are candidates for tonsillectomy or adenoidectomy, and which should be referred for polysomnography (sleep study) or more specialized evaluation.
Physiologic Sources of the Problem
Snoring and obstructive sleep apnea do not represent structural upper airway narrowing alone, but rather an imbalance between the degree of airway narrowing and the ability of the respiratory centers in the brainstem to use the muscles of the pharynx and tongue to maintain airway patency. For each child who has tonsillar hypertrophy and who snores, there are many who have larger tonsils who do not snore because they use their pharyngeal muscles to keep the airway open during sleep.