bluuebunny/crossref_metadata_2025_split huggingface dataset:
Counseling of Parents Around the Birth of a Baby
Authors: Charney Evan 
Published: December 2021

One of the pediatrician's most pleasant tasks is counseling families around the birth of a child. It is a joy if the baby is healthy, more difficult (though even more important) if there is an abnormality. In this article, the physician's postpartum role with the full-term, basically healthy infant will be discussed; although the comments apply to the preterm or ill child as well, in those instances a good deal more is involved, and is outside the scope of this presentation.
Of necessity, a discussion of this kind is subjective, reflecting the biases and experience of the author. There is very little recorded knowledge on this topic, and physicians have evolved a variety of approaches that probably work equally well. The point here is for the health provider to keep certain issues in mind; how they are dealt with will vary with the personality of physician and patient, and with the practice pattern of the community. In fact, if the postpartum visit is the first contact with a new family—a common phenomenon—its major purpose is for family and physician to get to know each other's "style." The pediatrician wants to know what kind of parents he will be dealing with—are they basically a stable couple, confident of their abilities, or do they seem less secure? Is there a supportive relationship? Are they married? Is the mother very organized, with written lists of questions prepared, or does she seem more casual, with few questions? Who does the talking in the interview? The parents, in turn, are watching to see whether the physician is brusque or relaxed, authoritarian in his manner or more nondirective.
Evaluation of Growth and Maturation in Adolescence
Authors: Rosenfeld Ron G. 
Published: December 2021

The term adolescence denotes the period of time between the onset of puberty and the completion of physical maturation. During these transitional years, full reproductive capacity is attained, manifested by spermatogenesis in the male and ovulation in the female. Concomitantly, major physical changes occur, including (1) full maturation of the gonads, external genitalia, and secondary sexual characteristics, (2) alterations in lean body mass and fat distribution, and (3) rapid skeletal growth, ultimately terminated by fusion of the epiphyses and the attainment of final adult stature.
Although we are accustomed to equating adolescence with the teenage years, the last century has been characterized by a progressive lowering of the normal age for pubertal development, so that presently, 50% of girls in the United States reach puberty while in elementary school. The implications of this earlier physical maturation, particularly in terms of sexual education and contraception counseling are readily evident. Furthermore, as the normal onset of puberty occurs earlier, the psychological ramifications of pubertal delay and short stature in adolescence become increasingly pronounced. It is not unusual, nowadays, to see 13 or 14-year-old patients (and their parents) who are concerned about delays in sexual maturation and skeletal growth, and while the majority of such patients are found to be normal variants, their anxieties and concerns are nonetheless real.
The Pediatrician's Role in Public Law 94-142
Authors: Wright Gregg F. 
Published: December 2021

In the seven years since it was passed, Public Law 94-142, The Education for All Handicapped Act of 1975, has generated new services for handicapped children and in the process has raised many difficult financial, political, educational, medical, and ethical questions. It has changed the scope of public schools and the personnel within them, and it has changed the expectations of parents, physicians, and educators alike. There is currently much talk of the possible repeal of PL 94-142. This review will emphasize the importance of a pediatric voice in this future. The changes that have come about as a result of PL 94-142 will not easily disappear even if the bill were to be repealed. On the other hand, a strong voice of advocacy for handicapped children will be needed to ensure that the positive lessons learned from PL 94-142 will be continued.
PL 94-142 itself, as a law, is only one component of a constellation of surrounding issues affecting handicapped children. One must consider separately the actual provisions of the law, the constitutional and case law on which it was based, the federal regulations that have been published and updated to interpret the law, the state plans formulated by each state to comply with the law and regulations, the funding that may or may not be appropriated at federal, state, and local levels to support the programs, and the actual practices within local school districts attempting to comply (or circumvent) these state requirements.
Cryptorchidism
Authors: Allen Terry D. 
Published: December 2021

Recent developments, particularly in the field of endocrinology, have substantially altered many conventional concepts about descended testis. The disease can no longer be viewed solely as a mechanical problem in descent, and there is an increasingly greater emphasis being placed upon the early resolution of the disorder in an effort to maximize ultimate testicular function. In this brief review, some of the controversies and current philosophies regarding this subject are explored.
THE ENDOCRINOLOGIC QUESTION
Although etiologic considerations in cryptorchidism have always included the possibility of inadequate hormonal stimulation, this concept has generally been overshadowed by one that emphasizes mechanical impediment to descent. This viewpoint seemed justified by the fact that endocrine therapy had never yielded more than modest results and by the feeling that it was difficult to account for unilateral cryptorchidism on the basis of a generalized endocrinopathy. After all, "if inadequate hormonal stimulation were the cause of maldescent of one testis, why did the other one descend?" The recent work of Job and associates in Paris, however, has shattered many of these arguments with the revelation that endocrine abnormalities can indeed be identified in patients with cryptorchidism and that furthermore these abnormalities canbe identified in patients with unilateral cryptorchidism as well as in those with bilateral disease.
Otitis Media with Effusion: An Approach to the Management of Persistent Symptoms and Signs in the Pediatric Patient
Authors: Kaleida Phillip H. , Stool Sylvan E. 
Published: December 2021

Otitis media with effusion continues to be a major public health problem because of its prevalence and potential consequences. We know too little regarding its pathogenesis, management, and long-term consequences. These gaps in our knowledge make it difficult to formulate precise plans of management. Research, necessary at both the clinical and basic-science levels, often is especially difficult because of the large number of variables to be considered in this condition.
It is important for the pediatrician to be aware of the variable natural history of otitis media, and of the variable hearing loss accompanying the middle-ear effusion. Pneumatic otoscopy is more sensitive in diagnosing OME than mere visualization of the tympanic membrane. Finally, tympanostomy tubes appear to be beneficial in most children for whom they are indicated; but vigilance is required to detect potential complications both of the disease and of the treatment(s).
Feigin16 recently summarized the state of the art of otitis media with effusion: "One of the great paradoxes of modern medicine is that our knowledge is often most incomplete with respect to the disorders that afflict mankind with the greatest frequency. Such is the case with otitis media."
Cerebral Palsy and Toe-Walking
Authors: TAFT LAWRENCE T. 
Published: December 2021

A few readers of the article on cerebral palsy (PIR 1984;6:35-42) have indicated that persistent toe-walking may be a "normal" phenomenon. I know of no reported series of normal children who toe-walked at preschool age and older. In my own experience, walking intermittently on the toes without an obvious organic cause does occur. It probably reflects a mannerism whose dynamics remain unexplained. The concern is that persistent toe-walking without an evident organic cause may lead to heel cord contractures. Also, I have noted that toe-walking is seen in children who have personality, behavior, and/or learning problems. Admittedly, this association may simply reflect the type of children referred to me and cannot be applicable to the general population.
I have speculated that if toe-walking in beginning walkers reflects the infant's compensatory attempt to throw his or her center of balance behind the hips so as not to fall forward when trying to establish walking balance, then, in those infants with subtle neuromotor balance problems, toe-walking may persist longer than usual. One might further speculate that, in spite of final maturation leading to better balance, toe-walking, which becomes unnecessary for balance, is continued as a "habit."
Osteogenic Sarcoma
Authors: Tebbi Cameron K. , Freeman Arnold I. 
Published: December 2021

Osteosarcoma is the commonest bone cancer seen in children and adolescents. Its peak incidence is during the adolescent growth spurt, and it occurs more frequently in taller individuals. The commonest site of occurrence is around the knee, ie, distal femur or proximal tibia. The classic presentation consists of pain and swelling at the tumor site. The tumor has a propensity to occur in the metaphyses of long bones, with destruction of normal bone as well as neoplastic new bone formation. Bone scans reveal the tumor.
The standard therapeutic approach has been amputation of the involved extremity with a resection line at least 10 cm above the most proximal extent of the tumor. Amputation alone has yielded a cure rate of approximately 20%. Recently, "limb salvage" (en bloc resection) with removal of the tumorous bone and replacement by a graft or endoprosthetic device has been used. This technique saves the limb but likely does not offer better function in the lower extremity and is associated with an increased risk of local recurrence in the "salvaged" limb.
In the last 10 years, use of adjuvant chemotherapy may have improved the cure rate to approximately 50%, but this result is still being debated. For patients who have a limb amputation, an immediate fitting for a temporary prosthesis is best, later followed by a permanent prosthesis. Psychologic support is extremely important for these youngsters as they not only face the fear of death from cancer, but also of mutilation from therapy.
Brachial Plexus Injury in the Newborn Infant
Authors: Molnar Gabriella E. 
Published: December 2021

Brachial plexus palsy occurs at a frequency of approximately four cases in 1,000 births. The most obvious signs of trauma to the brachial plexus in the newborn are limp hypotonic arm, paucity or lack of movements, and abnormal posture of the affected limb.
ETIOLOGY
In most cases, there has been a complicated delivery with prolonged, difficult labor. The infant is often large. The mechanism of injury is traction upon the brachial plexus. Excessive stretching may occur in either breech on vertex presentation, as the head and neck are forced into lateral flexion to deliver the shoulders. The slightly higher incidence on the right side is attributed to the greater frequency of left occiput anterior presentation.
Experimental studies have shown that resistance to structural disruption by tensile forces differs in various segments of the brachial plexus. Neuronal elements surrounded by soft tissues are less vulnerable to injury than nerve roots; the latter are adjacent to bone as they exit through the foramina and course along the grooves of the transverse processes.
ANATOMY
Clinical signs relate to the site of the lesion. The distribution of weakness reflects the anatomy of the brachial plexus (Figure), whereas the abnormal postures of the affected extremity are caused by the imbalance and unopposed action of muscles that remained innervated.
Back Pain in Children
Authors: Bunnell William P. 
Published: December 2021

Back pain in a young child or adolescent is an unusual complaint and must be regarded as a possible indication of the presence of significant pathology. Functional and mechanical causes of back pain in this age group are uncommon; therefore, it is most important that a vigorous attempt be made to establish the primary diagnosis. The purpose of this paper is to review the distinctive features of the history and physical examination that may lead to accurate diagnosis, and to outline a logical approach to the laboratory and radiographic evaluation for each of the major causes of back pain.
HISTORY
A carefully obtained medical history is frequently the most helpful factor in establishing a diagnosis. In addition to providing important information, it also establishes an attitude of mutual trust and understanding between the physician and patient. A skillfully taken history can help the physician gain vital insight into the patient's attitude toward his or her disease and suggest areas to be emphasized for further evaluation. Specific aspects of the history that are most revealing include: the mode of onset, nature and severity of the pain; a change in symptoms; and associated systemic complaints (Table 1).
The mode of onset should be determined as specifically as possible.
Mixed Connective Tissue Disease in Childhood
Authors: Singsen Bernhard H. 
Published: December 2021

Rheumatic diseases with overlapping clinical features have been known since at least 1900 under such descriptive designations as "sclerodermatomyositis," "lupoderma," "rupus," and others. These hybrid descriptors recognize the occasional mixing of features of the classic rheumatic disorders, rheumatoid arthritis, scleroderma, dermatomyositis, and systemic lupus erythematous (SLE), in the same patient. However, because of the absence of precise pathogenetic and etiologic information, even the traditional rheumatic diseases have been largely classified on the basis of aggregations of clinical, histologic, and immunologic findings.
In 1972, Sharp and colleagues first described 26 adults with a new syndrome, which they defined as mixed connective tissue disease (MCTD). A major contribution of Sharp and his colleagues was to name and attempt to classify an overlap syndrome in explicit clinical terms and to associate it with specific autoantibodies directed against "extractable nuclear antigen" (ENA). One year later, the first child with MCTD was reported, and in 1977 a series of 14 children with MCTD was first investigated.
Where does mixed connective tissue disease, in both children and adults, stand now after more than a decade of study? Directly, the concept of MCTD has focused our attention upon the description of overlapping features of the rheumatic diseases, and it has forced us to confront whether "lumping" or "splitting" descriptors serves the patient from a therapeutic or prognostic point of view.
The Joy of Pediatrics
Authors: Nazarian Lawrence F. 
Published: December 2021

When I was trying to get into medical school, part of my answer to the question about why I wanted to be a doctor was that I like people. I gave that response with some reservation because I had been warned not to come up with such a trite reply. But it was true, so I said it.
A major reason I chose pediatrics as a career is the joy I get from children. After 20 years in this work, I still get a tremendous kick from the unconditional smile of a 4-month old baby or the exuberant hug of a toddler.
Identifying and Coping With a Drug-Using Adolescent: Some Guidelines for Pediatricians and Parents
Authors: Schwartz Richard H. , Cohen Peter R. , Bair Glenn O. 
Published: December 2021

The use of alcohol and drugs by American adolescents is a problem of epidemic proportions. Adults must consider repetitive psychoactive drug use by an adolescent as a possible cause of problem behavior, academic underachievement, chronic apathy, episodes of running away, serious accidents, and suicide attempts, regardless of the adolescent's family or social background. Parents must learn to be courageous enough to seek help to define the cause of such behavior, and the physicians to whom they turn must be knowledgeable of the diagnosis and management of a drug-using adolescent. The purpose of this paper is to provide information to help the pediatrician understand frequent drug use; its behavioral, social, emotional, and physical consequences for both the user and family; and to help affected families take an active role in the management of their drug-using adolescents.
FOUR PHASES OF CHEMICAL DEPENDENCY
Chemical dependency (an increasingly preferred term for compulsive use of mood-altering drugs) is an illness with psychosocial, spiritual, ethical, emotional, and physical components. It may occur in four stages of progressive severity: (1) experimentation—learning the euphoric "high;" (2) actively seeking drug-induced euphoria; (3) preoccupation with the self-perceived need to get "high" in order to cope with life's stresses. Usually, tolerance to the effects of the drug occurs, leading to use of larger quantities or "stronger" drugs to achieve the desired degree of euphoria;
Acute and Chronic Sinusitis: Diagnosis and Management
Authors: Wald Ellen R. 
Published: December 2021

Acute (less than 30 days' duration) infections of the paranasal sinuses are seen in children, usually as complication of viral upper respiratory tract infections or allergic inflammation. Chronic (more than 30 days' duration) sinusitis may result when acute sinusitis is not recognized as such or is inadequately treated. Although there are few data on which to base an estimate of the frequency of these disorders, acute sinusitis is commonly encountered in pediatric practice, and chronic sinusitis is not rare.
EMBRYOLOGY, ANATOMY, AND PHYSIOLOGY
A brief review of the embryology, anatomy, and physiology of the paranasal sinuses will facilitate an understanding of the clinical manifestations of acute and chronic sinusitis. All of the sinuses develop as outpouchings of the nasal mucosa. The maxillary and ethmoid sinuses develop between the third and fifth months of gestation and are pneumatized soon after birth. Although the frontal and sphenoid sinuses also develop during gestation, they remain primitive for several years. The frontal sinuses are not distinct from the anterior ethmoid sinuses until they reach the superior orbital ridge at about 2 years of age; they assume a supraorbital position at 2 to 4 years of age and are in the frontal position at about 6 years of age. The sphenoid sinuses first become well pneumatized at 2 to 3 years of age.
Pulmonary Function Testing: A Practical Guide to Its Use in Pediatric Practice
Authors: Eigen Howard 
Published: December 2021

Pulmonary function testing is a useful and important method by which to evaluate patients with or suspected of having lung disease. Pediatricians in the past have taken too little advantage of these techniques in their offices or through referral to pediatric pulmonary function laboratories and, when they have used them, have all too often relied on laboratories designed for adult patients. As with such tests as tympanometry and audiometry, pulmonary function testing should be incorporated into the daily practice of the modern pediatrician. The outlay for equipment is within the means of all pediatricians, and the charges to the patient for testing are quite reasonable, especially because they may be offset by savings from fewer emergency room visits and from a reduction in hospitalizations.
One person in the office must function as "technician" and is referred to as such in this article. In most offices, this person will have other responsibilities as well, but having one person fill the role of pulmonary function technician will improve the reliability of the results of the pulmonary function tests performed.
Although new techniques are being developed for testing young children and infants, these are beyond the scope of office practice because of the time and equipment they require.
Vulvovaginitis in the Child and Adolescent
Authors: Emans S. Jean 
Published: December 2021

Vulvovaginitis is one of the commonest gynecologic complaints seen in pediatric practice. The young child is particularly susceptible to nonspecific infections secondary to poor hygiene but can also have specific infections from respiratory or enteric pathogens or sexually acquired organisms. The adolescent with vaginal discharge usually has a specific vaginal or endocervical infection, often sexually transmitted. In addition, symptoms of dysuria or urinary frequency suggestive of a urinary tract infection in the adolescent may frequently result from vaginitis or Chlamydia trachomatis genital infection. This article brings the pediatrician up to date since the review in Pediatrics in Review 5 years ago.1
CAUSES OF VULVOVAGINITIS IN THE PREPUBERTAL CHILD
In the newborn period, the vagina is well estrogenized from maternal hormones, and the hymen appears redundant, pink, and succulent. As the influence of maternal hormones wanes during the first few weeks of life, the vagina becomes reddened and atrophic, and the hymen appears as a thin membranous crescent (Fig 1). The pH is 6.5 to 7.5. Because of inadequate hygiene, the lack of protective hair and labial fat pads, and the lack of estrogenization, the vulvar skin is susceptible to irritation and is easily traumatized by medications and clothing. For example, if a child sits for a few hours in nylon leotards and tights, transient erythema and discomfort in the vulvar area may result.
Bee, Wasp, and Hornet Stings
Authors: Maguire James F. , Geha Raif S. 
Published: December 2021

Insect stings are a common pediatric problem. The vast majority of such stings are nothing more than a brief and relatively trivial annoyance, producing only a mild local reaction. However, allergic reactions to stings from venomous insects are not rare and can be potentially life threatening. Actuarial surveys indicate that at least 40 deaths per year occur in the United States as a result of severe reactions to venomous insect stings. This article will review the nature of reactions to stinging insects, discuss the diagnostic and therapeutic approaches to stinging insect allergy, and point out some of the problems that remain incompletely resolved in these areas.
STINGING INSECTS
Bees, wasps, and hornets (Figure) are members of the order Hymenoptera and account for the majority of anaphylactic reactions to venomous animals and insects in the United States. The apid family includes the bumblebee and the honeybee, both of which are relatively nonaggressive. The bumblebee is large, slow moving, and noisy, rarely accounting for stings. Honeybees cause problems particularly among beekeepers and their families but may also be encountered by people who are gardening or mowing lawns in aareas where the bees are pollinating flowers or clover. Children are most commonly stung by honey bees while barefoot.