bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends in Breast-Feeding
Authors: Hendershot Gerry E. 
Published: December 2021

Starting from very high levels in the 1940s, breast-feeding declined steadily to low levels in the early 1970s, and then began an upward trend which has apparently continued until the present (Fig. 1). In the 1940s, breast-feeding was more common among disadvantaged women. The subsequent decline was also more rapid among the disadvantaged, however, so that by the early 1970s, disadvantaged women were considerably less likely than others to breast-feed. Because the increase since the early 1970s has not been so pronounced among the disadvantaged, they continue to have relatively low levels of breast-feeding. The causes of these trends and differentials are not well understood.
These are the principal conclusions drawn from a review of statistical studies of trends and differentials in breast-feeding in the United States. The studies included national health surveys conducted by the federal government, market research surveys conducted by infant formula manufacturers, and infant feeding surveys conducted by medical researchers. The studies differed markedly in their methods—a fact that affects their validity, reliability, and comparability. The first section of this paper discusses these data sources and their limitations. The next two sections discuss the downward trend in breast-feeding from the 1940s to the early 1970s, and the upward trend since. Each of these sections examines demographic differences in these trends. A short section that addresses possible causes of the trends and differentials follows those two sections.
SOURCES AND LIMITATIONS OF THE DATA
The principal sources of data on trends and differentials in breast-feeding are national fertility surveys, market research surveys, and special purpose infant-feeding surveys.
Pathogenesis of Prune-Belly Syndrome
Authors: BARR MASON , BURDI ALPHONSE R. 
Published: December 2021

To the Editor.—
In their recent report, Moerman et al1 argued that the prune-belly syndrome is caused by prostatic hypoplasia which produces a functional urethral obstruction. We would like to direct attention to a case we reported that casts some doubt on this hypothesis.2 Our report concerned an 11-week-old fetus with massive megacystis, ectasia of the nephrons, and attenuation of the abdominal muscle. The "prostatic" portion of the urethra was already largely dilated at a time when the prostatic buds are first appearing and well before these buds coalesce to form a gland.
Thyroid Hormone Poisoning: Therapy Questioned
Authors: LEHRNER LAWRENCE M. , WIER MICHAEL 
Published: December 2021

The letter from Kirkland et al points very clearly to the problem we addressed in our paper, and we appreciate the opportunity to restate it.
Prior to our report, the literature pertaining to thyroid ingestion can best be characterized as describing aggressive therapy, generally with a good outcome. Thus, the heroic treatment of our first case. However, after treating the first patient, we reviewed the mechanisms of thyroid hormone action and concluded that natural protective mechanisms exist and that aggressive therapy is rarely required.
Introduction to an Overview of Pediatric Patient Education
Authors: Fulginiti Vincent A. 
Published: December 2021

Today's physicians must deal with a public that is both informed and misinformed on children's health care. Adult school and college courses, magazine articles, film and television documentaries, and a host of books offer parents readily available information on pediatric health care, but some of these sources are inaccurate or biased, or both. Erroneous information is also disseminated by a variety of nonmedical practitioners and special-interest groups. They publicize their theories and methods by using authoritative-sounding statements and impressive, if meaningless, letters after their names.
The profession of pediatrics is faced with the challenge of being the single most important source that parents can turn to for accurate information concerning their children's health. The challenge extends beyond that goal: pediatricians must also be willing to utilize educational methods and materials with which they may currently have little or no familiarity. Some of these techniques and tools will be presented in the following papers.
As a first step in achieving these goals, pediatricians must recognize that patient education is a critical function of their practices. Next, they must become sufficiently motivated to act on this recognition of responsibility for patient education.
Pediatricians must learn what patients need to know, what the best and most practical methods are to deliver that information, and what types of materials are available or need to be developed to assist in the educational process. Practices should be structured so as to enable sustained patient education while allowing for future innovations in either methods or materials.
The goal of this conference is to strengthen individual patient education efforts and to convince pediatricians and the American Academy of Pediatrics that an organized, chapter-centered program should be established.
Zinc Deficiency: Cause of Hypoproteinemia or Its Result?
Authors: WEIZMAN ZVI 
Published: December 2021

To the Editor.—
I read with great interest the paper by Kumar and Anday.1 They suggest that hypoproteinemia in their patients is the direct result of zinc deficiency, which interferes with protein synthesis. However, in their discussion there is no mention of a different interpretation, namely that zinc deficiency might be the result of protein loss rather than a cause of poor synthesis.
Although liver disease and/or urinary protein loss have been ruled out, there are no data regarding a possible protein-losing enteropathy in these infants. Several disorders, such as cow milk intolerance (cases 1 and 3), congestive heart failure (case 2), gastrointestinal infections and infestations, immune deficiency states etc,2 are potential causes for abnormal enteric protein loss in these infants.
Infant Bioethics Committees
Authors: STRAIN JAMES E. 
Published: December 2021

In Reply.—
Donovan raises important questions about the value of the committees. These same questions are being asked by physicians and hospital administrators throughout the country. Despite the uncertainty of the structure and function of the committees, the American Academy of Pediatrics has chosen to publish guidelines to assist hospitals and physicians in establishing local infant bioethics committees. Although the Academy has taken a leadership role in developing the guidelines, it should be emphasized that consultants from several other organizations have been included in discussions of the Academy's task force.
Inadvertent Intra-arterial Injection of Penicillin: An Unseen Danger
Authors: STOLLER KENNETH P. , LOSEY ROBERT 
Published: December 2021

The inadvertent intra-arterial injection of penicillin has been reported in the buttock1-3 and in the thigh.4,5 The resulting lesion in the small arterioles leads to thrombosis and ischemic damage to tissues supplied by them.
Schanzer et al5 felt that accidental intra-arterial injections of penicillin were the result of a design flaw in the disposable, ready-to-use containers (Tubex) in which many of the penicillin preparations are supplied. This container consists of a glass tube with a 20-gauge, 3.2-cm needle at one end and a rubber disk (plunger head) with a threaded pin inserted in it at the other. The container is positioned in a metallic or plastic injector in which a plunger is screwed to the threaded pin permitting the contents to be ejected.
A Note on Interdisciplinary Research in Developmental/Behavioral Pediatrics/Psychology
Authors: Ellison Patricia H. , Kopp Claire B. 
Published: December 2021

In sum, we have offered a few observations about the practice of interdisciplinary research. Now, in addition to our rather specific suggestions, we want to add a few general comments about the interactions of professionals who are actually involved in interdisciplinary research.
Collaboration between physicians and psychologists can be enriching, stimulating, and rewarding. But it can also be problematic, because the former do not have much exposure to research and the latter do not have much exposure to clinical issues. Bringing these skills together may require many hours of discussion and reading each other's publications.
Overall, physicians need to improve their research skills. Reading statistics texts, taking courses, handling data sets, reviewing other researchers' statistical designs are all reasonable strategies.
Psychologists also need to expand their knowledge base. Reading the clinical literature is a start, but this ought to be supplemented by consistent exposure to the clinical milieu. The physician, who has access to the clinical milieu, needs to be sensitive to the question of exposure.
Our final comments about collaboration are perhaps the most sensitive ones. The maintenance of a solid physician and psychologist research collaboration requires thoughtfulness, understanding, tact, and nurturance. Consider the status and responsiblities of the physician. He or she often outranks the psychologist, has access to the subject population, daily confronts ethical issues surrounding patient diagnoses, and controls communication of information to child and family. A sense of being in charge develops. Consequently, the psychologist may be perceived as being an adjunct to the research, responsible for day-to-day operations and committing ideas to paper. This is not a good formula for research.
There are no easy answers for resolving these difficult interpersonal situations. Some interdisciplinary teams have found that frequent communication helps, others have turned to interinstitution collaborations, and a few have established written guidelines for almost all aspects of the research (responsibility for decision making, day-to-day operations, first authorship on articles, etc). Addressing these delicate issues in the beginning, with intermittent reexamination, will generally lead to a successful endpoint.
These reflections are offered to our colleagues in the hope that interdisciplinary research will thrive and become a mainstay of both pediatrics and developmental psychology. After all, facilitating the growth of the child is a primary goal for each discipline.
Cerebral Blood Flow Measurement Techniques in Infants and Children
Authors: Kirsch Jeffrey R. , Traystman Richard J. , Rogers Mark C. 
Published: December 2021

The tremendous growth of interest in neurologic intensive care and in the pathophysiology of the cerebral circulation in the past few years has resulted in increasing numbers of studies that document alterations in cerebral flow during the course of various diseases or as a response to treatment of them. Before pediatricians come to conclusions based on these studies, it is important to have an understanding of the techniques involved. The techniques are complex and difficult but are based on understandable principles. They also have limitations and are subject to misinterpretations.
Pediatricians should become knowledgeable about some of these techniques and their limitations because it is likely that they will be applied with increasing frequency in the next several years. We are on the threshold of exciting discoveries in abnormalities of cerebral blood flow and cerebral metabolism not only in critically ill children but also in children with congenital and learning disorders.
Recurrence of Rheumatic Fever
Authors: FEINSTEIN ALVAN R. 
Published: December 2021

To the Editor.—
In a case report on prophylaxis for rheumatic fever, Nordin1 expressed dismayed surprise that monthly injections of 1.2 million units of benzathine penicillin G (BPG) had failed to prevent the recurrence of rheumatic fever in a 9-year-old girl. Although BPG was clearly the best of the various antistreptococcal prophylactic regimens tested in randomized clinical trials conducted by my colleagues and me at Irvington House during the late 1950s and 1960s, BPG was not perfect.
THE CHILDREN OF READING GAOL: A Letter from Oscar Wilde, 1897
Authors: Cone Thomas E. 
Published: December 2021

A boy used to come and play in these streets.
Now he is alone.
Held by stone walls of a solitary cell.
Gray slits of life escape through bars immobilizing him with shadowy splints.
He sits on the floor wet with cold fear.
His face a white wedge of terror like a hunted animal.
He receives bread and water.
In burned out sockets there is wrath.
He has been crying all day.
He cannot understand prison.
He cannot realize what society is.
Darkness covers him with dreams of death.
Relative Risk
Authors: SHEPS SAM 
Published: December 2021

The article on injuries in a large, urban school district, provides valuable information regarding school accidents and injuries. Indeed the authors have carried out the most extensive analysis to date of the nature of school injuries and they have undertaken some interesting analyses in an attempt to understand the influence of a variety of school factors on accident rates.
However some of the data they report, specifically data in their tables 4, 5, and 6, may cause readers to misunderstand the concept of relative risk.
National Institutes of Health Report on Causes of Mental Retardation and Cerebral Palsy
Authors:   From the Task Force on Joint Assessment of Prenatal and Perinatal Factors Associated with Brain Disorders
Published: December 2021

Neurologic and communicative disorders affect 42 million Americans. Mental retardation is present in 780,000 school-age children, cerebral palsy affects 750,000 Americans, and nearly 2 million individuals have epilepsy. Among these 42 million are countless individuals who suffer combinations of these neurologic disabilities. In an effort to define our current state of knowledge about the prenatal and perinatal factors associated with brain disordens, the National Institute of Neurologic and Communicative Disorders and Stroke (NINCDS) and the National Institute of Child Health and Human Development (NICHHD) appointed a group of experts to survey current data in order to identify pregnancy- and birth-related events that may account for the continued incidence of neurologic handicap among infants and children. Their results were published in a report entitled Prenatal and Perinatal Factors Associated with Brain Disorders.
Despite rapid advances in obstetric and neonatal medicine during the past several decades, physicians, patients, and attorneys still believe that the major causes of brain disorders are related to birth trauma and problems of labor. The Committee found that, although it was once simple to say that a specific event such as birth trauma or asphyxia caused brain disorders, it is not usually possible to pinpoint a single cause and its effect. The normal brain's ability to repair or compensate for even major developmental disruptions, combined with the gross and subtle interactions of biologic, social and environmental factors, confounds the task of assigning etiologies to brain disorders.
The causes of severe mental retardation are primarily genetic, biochemical, viral, and developmental and not related to birth events.
Can Fussy Babies Be Spoiled?
Authors: TAUBMAN BRUCE 
Published: December 2021

In Reply.—
Dr Jones is of course correct that, in the literal sense, colic means abdominal pain. However, in my article1 the term is used in the clinical sense to refer to a medical syndrome of excessive crying of unknown cause beginning in otherwise healthy infants less than 3 months of age. Implicit in this definition of the syndrome is that the infants have no obvious gastroenterologic symptoms such as constipation, diarrhea, or vomiting, as was true of all the infants in the study.
Black Patients—White Doctors
Authors: RYAN RICHARD H. 
Published: December 2021

To the Editor.—
I think it is unfortunate that Dr Levy ("White Doctors and Black Patients: Influence of Race on the Doctor-Patient Relationship," Pediatrics 1985;75:639-643) practices in an area where black patients are perceived as uneducated, indigent, and uncooperative.
In northern Virginia, the black patients in our practice are generally well-educated, motivated, and committed to being good parents. As far as I can tell they have the same concerns as any parent (Has their child been molested? Will he or she read well, do well in school, have friends?) and the same strong desire for a healthy child who will be a productive citizen and have a family.
Annual Meeting of the Section on Pediatric Urology
Authors: GLASSBERG KENNETH I. 
Published: December 2021

The Section of Urology of the American Academy of Pediatrics met for three days in conjunction with the 53rd annual meeting of the Academy in Chicago. Papers and panel discussions that would be of interest to the pediatrician are summarized herein according to topic. As there has been an increasing number of basic research papers presented in recent years, the Section, this year, initiated a prize for basic research. Also new to the meeting was the awarding of the first annual Pediatric Urology Medal, which was given to Harry Spence for contributions made to the field.
TESTICULAR TORSION
Recent reports of unilateral testicular torsion have suggested that adverse effects may occur to the contralateral testicle, if the ischemic testicle is treated by surgical detorsion and left in place rather than removed.1-4 Three authors addressed this problem by investigating animal models.
Animal Models
In prepubertal rats undergoing experimentally produced testicular torsion, Rabinowitz and associates found histologic changes in the contralateral testicle. The changes in the contralateral testicle were dependent upon the duration of torsion and were significantly greater when the ischemic testicle was detorsed and left in place. The degree of histologic changes in the ischemic testicle, especially the degree of germ cell damage, was the best prediction of long-term damage to the contralateral testicle. In the animal model, these changes could be averted by removing the ischemic testicle. Although not going as far to recommend orchiectomy as the treatment of choice for all cases of torsion, Dr. Rabinowitz did suggest that a testicular biopsy in prepubertal boys with testicular torsion may be a reliable index to subsequent long-term contralateral damage if the ischemic testicle is detorsed and pexed rather than removed.
Smokeless Tobacco—A Carcinogenic Hazard to Children
Authors:   Committee on Environmental Hazards
Published: December 2021

The term smokeless tobacco refers to snuff, chewing tobacco, and other forms of tobacco that are placed in the mouth or nose and not ignited.1 An estimated 11 to 22 million Americans use smokeless tobacco regularly. The average user is between the ages of 18 and 30 years.1 Smokeless tobacco is a cause for concern among pediatricians because, despite the well-documented hazards to health, its use is increasing rapidly among children and adolescents.
Smokeless tobacco is a proven human carcinogen.2 As early as 1761, the British physician John Hill described cases of cancer in snuff users.3 Hill wrote "No man should venture upon snuff who is not sure that he is not liable to cancer, and no man can be sure of that." (In eighteenth century Britain, snuff was taken intranasally and caused cancer of the nasal cavity. Today, a pinch of snuff is typically tucked into place between the lip and the gum.) More recently, it has been confirmed that snuff is a major cause of oral cancer in this country, and a fourfold increase in risk of cancer of the mouth and pharynx has been reported among women who regularly used snuff.4 Among women who had used snuff for 50 years or more, the risk of cancer of the gingival and buccal mucosa was elevated 47-fold above background.4 These risks were independent of cigarette smoking.
Laboratory confirmation of the carcinogenicity of smokeless tobacco has been provided by identification of N-nitrosonornicotine and other carcinogenic nitrosamines in extremely high concentrations in both snuff and chewing tobacco.5
Health Hazards of Cow's Milk
Authors: OSKI FRANK A. 
Published: December 2021

In Reply.—
An exchange of letters in a journal is an unsatisfactory forum to conduct an international debate but I feel compelled to respond to the correspondence of Professor Tönz.
Professor Tönz expresses concern that my remarks may be interpreted as "recommending the abolishment of feeding practices that have developed over the centuries..." Are the feeding practices that Professor Tönz has in mind the introduction of whole cow's milk before the infant is 1 year of age or the use of whole milk after the first year of life? Neither practice has been in place for centuries "all over the world."
Normal Cerebrospinal Fluid Values
Authors: CORY MATTHEW J. 
Published: December 2021

To the Editor.—
I read with interest the article, "Normal Cerebrospinal Fluid Values in Children: Another Look," by Portnoy and Olson (Pediatrics 1985;75:484-487). Their data certainly have relevance to the problem of interpretation of minimal pleocytosis discovered in the evaluation of the febrile child. Perhaps, because they excluded patients with CNS disease from chart review, they failed to find an additional useful piece of information, ie, the incidence of bacterial meningitis in children with the same or similar CSF pleocytosis.
Normal Cerebrospinal Fluid Values
Authors: OLSON LLOYD C. , PORTNOY JAY M. 
Published: December 2021

In Reply.—
When the CSF findings from a large series of children with acute bacterial meningitis are analyzed, a small number will be found to contain few or no cells. Cory's analysis has looked at this in another way, namely, that, of all children with minimal pleocytosis, only a very few—or none—will have meningitis. Some will, however, and it is also important to recognize this. We did note in our article that bacteria may be present in otherwise normal CSF (our references 16 to 20).
Vietnamese Are Not Genetically Short
Authors: DEINARD AMOS S. 
Published: December 2021

To the Editor.—
Dr Stickler, in a recent commentary (Pediatrics 1984;74:559), mentions as an example of genetic short stature the child of a Vietnamese refugee. My experience during the past 5 years with the Vietnamese as well as the other Southeast Asian groups (lowland Lao, Hmong, and Cambodian) who have immigrated to the United States since 1979 suggests that their growth may be no different from that of post-World War II Japanese children, ie, with good maternal and postnatal medical care and nutrition, children will grow at levels comparable to American children on whom the growth curves were normed.
Views of Graham Challenged
Authors: GRAHAM GEORGE G. 
Published: December 2021

In Reply.—
Dr Christoffel and her colleagues would have been correct if they had surmised that the author's intent was to promote discussion of the way in which public policy has been and is made in such important matters as the nutritional status and health of our children, as well as the prevention of low birth weight and its associated morbidity and mortality. If they are regular readers of Pediatrics they know that the journal has long had a "Letters" section in which readers have the opportunity to comment on published material.
Chest Pain
Authors: SELBST STEVEN M. 
Published: December 2021

In Reply.—
Dr Rogers describes brief anterior chest pain, worse with inspiration, which he has labeled "benign pleuralgia." The etiology of this pain, as with most chest pain, is uncertain. Perhaps, the pain arises in the pain-sensitive pleura and then travels through the intercostal nerves in the chest wall. If such pain is not reproducible with palpation, and not related to recent exercise, I would not consider this to be of musculoskeletal origin.
Although some may prefer to consider this a distinct clinical entity, I would "lump" such vague, unexplainable pain in the idiopathic category.