bluuebunny/crossref_metadata_2025_split huggingface dataset:
Whole Cow Milk Feeding Between 6 and 12 Months of Age? Go Back to 1976
Authors: Oski Frank A. 
Published: December 2021

In 1976, the Committee on Nutrition of the American Academy of Pediatrics recommended that the non-breast-fed infant receive an iron-fortified proprietary formula during the entire first year of life.1 In 1983, the Committee on Nutrition reversed the previous recommendation and concluded, "If breast-feeding has been completely discontinued and infants are consuming one third of their calories as supplemental foods consisting of a balanced mixture of cereal, vegetables, fruits, and other foods, whole cow milk may be introduced."2 The Committee, in their report, acknowledged the fact that "there are many unanswered questions concerning the use of whole cow milk in the second half year of life." I believe that we now have answers to some of these questions and that we should return to the original recommendation discouraging the use of whole cow milk (WCM) until infants have reached their first birthday.
Studies performed since the 1983 report have demonstrated that the introduction of WCM prior to the first birthday is associated with an increased risk of occult gastrointestinal bleeding3 and an increased incidence of iron deficiency anemia.4,5 In addition, iron deficiency anemia in infants less than 1 year of age has been shown to be associated with cognitive and psychomotor impairment6-8; such impairment may not be correctable with iron therapy.7-9
Conduct Disorders in Children and Adolescents
Authors: Gottlieb Susan E. , Friedman Stanford B. 
Published: December 2021

Conduct disorder is the most prevalent psychopathologic condition of childhood. It is characterized by a persistent and repetitive pattern of aggressive, noncompliant, intrusive, and poorly self-controlled behaviors that violate either the rights of others or age-appropriate societal norms.1 These behaviors have a significant impact on the daily functioning of the child or adolescent and on the ability of parents and other adults to manage them.
The specific behavioral criteria for the diagnosis of conduct disorder can be conceptualized as either aggressive or nonaggressive in type (Table 1). Examples of aggressive behaviors are physical fighting and bullying, assault, vandalism, purse snatching, physical cruelty to persons or animals, breaking and entering, and arson. More serious aggressive behaviors are armed robbery, rape, and extortion.
Nonaggressive behaviors of conduct disorder include substance abuse, persistent truancy, running away from home overnight, frequent lying in a variety of social settings, theft not involving a confrontation with a victim, and chronic violation of rules or the basic rights of others.
Three subtypes of conduct disorder are identified in the Diagnostic and Statistical Manual of Mental Disorders, revised 3rd edition.1 These are descriptions of the functional contexts in which the particular behavior problems occur. The group type involves problematic behaviors that occur as part of an activity with peers.
The Interaction of Pubertal and Psychosocial Development During Adolescence
Authors: Litt Iris F. 
Published: December 2021

During the second decade of life, the physical changes of puberty interact with those of psychosocial and cognitive development to forge the young adult, who often bears little resemblance to the same individual as a child. This article reviews those elements of the developmental process that have an impact on the physician's ability to understand and care for the adolescent patient.
PUBERTY
Endocrine Changes
Release of inhibition on the hypothalamus unleashes an outpouring of releasing hormones, which stimulate the secretion of gonadotropins and growth hormone by the pituitary. These are produced in a sleep-augmented, pulsatile fashion that characterizes the onset of pubertal development. As a result, within the few years between the onset and completion of puberty, levels of estradiol increase eightfold in females, and levels of testosterone increase 18-fold in males. These hormonal changes stimulate the growth spurt and development of secondary sex characteristics.
Development of Secondary Sex Characteristics
Breast Development. In females, one of the earliest signs of puberty is development of the breast bud. The subsequent progression of breast development is orderly and predictable, thus forming one of the bases for the categorization in females of the stages of puberty, often referred to as Tanner stages or SMRs (sex maturity ratings).
Left Upper Quadrant Masses in Children
Authors: Vane Dennis W. 
Published: December 2021

The discovery of an abdominal mass in a child alarms and concerns both parents and the physician. The diagnosis and treatment of these lesions have undergone significant changes during the past few years, and the physician understandably may have some doubts about an appropriate diagnostic evaluation.
An improved outcome can be expected with early detection and prompt treatment. As is the case in evaluating all abdominal problems, a careful physical examination is critical and may obviate the need for further investigations. An accurate history is also important, but this often is clouded by information from parents or other historians who may not have all the data at their disposal. The child may be too young, may not remember the exact chronology and occurrence of events, or may be afraid to relate them. This is particularly true if the incident involved trauma related to an act forbidden by the parents.
It is critical that the child be calm and relaxed to make the examination effective, often a nearly impossible feat. This occasionally can be accomplished with a few words from the examiner and the assurance that no pain will result from simple palpation. Patience often is rewarded with a good examination; however, should this approach fail, the physician may resort to sedation.
POINT-COUNTERPOINT
Authors: Sinkin Robert A. , Davis Jonathan M. 
Published: December 2021

Because of the continued concern expressed by one of the readers regarding our article "Cardiopulmonary Resuscitation of the Newborn" (PIR. 12:5(Nov 1990):136-141), we have drafted the following statement.
The goal of our article was to provide the pediatrician with appropriate guidelines for this crucial and lifesaving intervention for newborn infants. However, possible confusion on the relationship of Apgar scores and resuscitation needs to be resolved. Apgar scores should not be used to make decisions regarding the course of initial resuscitation, and this is clearly stated in our article. Instead, decisions should be based primarily upon evaluation of an infant's respirations, heart rate, and color.
Amblyopia: Etiology, Detection, and Treatment
Authors: Magramm Irene 
Published: December 2021

Amblyopia is a preventable cause of visual loss in children that may be permanent unless it is detected and treated early. It may be caused by strabismus, refractive errors, or cataracts. Primary strabismus may lead to loss of vision from amblyopia and the loss of binocularity. Secondary strabismus may be a sign of primary visual loss in one or both eyes. The most serious disorder that may present as secondary strabismus is retinoblastoma. It is imperative to detect retinoblastoma early because of its morbidity and mortality.
Amblyopia is detected by assessing the visual acuity of each eye. Strabismus is detected by using the corneal light reflex test and the cover test. Focusing problems are detected by assessing the visual acuity and the red reflex. Cataracts and retinoblastoma may be detected by examining the red reflex of the eye.
Treatment of amblyopia consists of correcting the amblyogenic factor with appropriate glasses and surgery. The preferred eye is patched with an adhesive patch to stimulate visual development in the amblyopie eye.
The pediatrician plays a crucial role in the early detection of amblyopia, strabismus, and cataracts. The key to successful visual outcome is early recognition by the pediatrician, referral to the pediatric opthalmologist, and prompt treatment.
"Lethargic" and Other Adjectives
Authors: Menna Vincent J. 
Published: December 2021

An anathema for the general pediatrician is the task of ascertaining the significance of a child's symptoms relayed over the telephone by a parent. The use (or misuse) of certain words by a parent may determine whether a child is examined. Many other factors also are involved, including an anxious parent, the "vulnerable child" syndrome, a visiting grandparent, and a tired doctor.
"Lethargic" is the most common malapropism. We often have heard the history that a child has a fever and is lethargic. Is it meningitis, septicemia, or just a viremia? Being unsure, one certainly must see the patient. Usually, at the time of the office visit, it requires a receptionist and two nurses to restrain the patient.
Consultation with the Specialist
Authors: Strong William B. 
Published: December 2021

What is the likely pathophysiology of this event? What are the more common complications of hypoxemia in the older infant and young child? This clinical scenario is uncommon, but it represents one of the two feared central nervous system complications of cyanotic congenital heart disease, (ie, cerebrovascular accident and brain abscess).
A uniform response to hypoxemia of cardiac etiology is the production of erythropoietin to produce more red blood cells. This is a compensatory mechanism to maintain oxygen delivery to the peripheral tissues. Normally, hemoglobin is about 96% saturated with oxygen. Therefore, the oxygen-carrying capacity of blood with a normal hemoglobin concentration of 15 g/dL is approximately 20.3 mL of oxygen per 100 mL of blood (ie, 15 g of hemoglobin x 1.35 mL of O2 per g of hemoglobin = 20.3). The oxygen content of blood equals the oxygen-carrying capacity multiplied by the oxygen saturation. At a normal oxygen saturation of 96%, the O2 content of arterial blood (Hgb 15 g/dL) equals 19.5 mL/dL (96% x 20.3 mm3/dL) or 195 mL per liter of cardiac output.
The arterial O2 content of this child, assuming an average arterial saturation of 85%, will be 11.1 mL/dL. Therefore, every liter (10 dL) of cardiac output will carry 111 mL of O2 or 84 mL of O2 less than the child with a 15 g/dL hemoglobin level.
Failure to Thrive/Growth Deficiency
Authors: Bithoney William G. , Dubowitz Howard , Egan Harwood 
Published: December 2021

Definition
CLASSIFICATION AND TYPOLOGY
Although the diagnosis of "failure to thrive" (FTT) is made frequently, both the meaning of the term and its value as a diagnosis remain debatable. Because any serious disease can cause growth failure, the term FTT has little diagnostic usefulness. Classically, the etiology of FTT has been divided into organic and nonorganic types, with nonorganic FTT defined as growth deficiency without a diagnosable medical etiology and organic FTT defined as growth failure caused by a specific medical illness. A number of authors have questioned the adequacy of this dichotomous view, suggesting the need for a third category: "mixed" etiology. In this group of children, chronic, mild problems, such as recurrent otitis media in concert with behavioral problems, result in aberrant behaviors, such as difficult temperament, sleep disorders, and altered eating behavior, which together impair growth. Even in cases in which the growth deficiency is primarily due to organic or nonorganic causes, the problems seen in the children are often multiple (eg, infants who have cardiac failure also have feeding disorders). Given the multiple contributory factors to FTT and the lack of diagnostic specificity of the term, we recommend that it be abandoned in favor of the term "growth deficiency," which describes the presentation of this entity: An underweight, often stunted, undernourished child.
Update on Thalassemia
Authors: Giardina P. J. , Hilgartner M. W. 
Published: December 2021

Many advances in the understanding and management of the thalassmia syndromes have been made during the past several years. Our knowledge of normal globin gene function and of the consequences of specific mutations has been advanced by identification of the genetic defects causing thalassemia. Prenatal diagnosis is now possible with molecular biology technology.
Standards have been established for transfusion, splenectomy, prevention of postsplenectomy infection, and effective iron chelation therapy. Bone marrow transplantation is now available for those with a compatible familial donor. Research efforts currently are directed toward safer blood products, oral iron chelators, and improved understanding of the developmental regulation of globin gene expression for effective gene transfer.
Preventing Low Birth Weight, Child Abuse, and School Failure: The Need for Comprehensive, Community-Wide Approaches
Authors: Chamberlin Robert W. 
Published: December 2021

Based on numerous examples from this country and abroad, we now have a reasonable idea of how we can reduce substantially the incidence of low-weight births, child abuse, adolescent pregnancy, school failure, and school dropout. The most effective long-term strategy appears to be the development of a comprehensive, coordinated, community-wide approach focused on preventing low- and medium-risk families from becoming high-risk as well as providing intensive services to those who already have reached a high-risk status. The best results can be obtained when all levels of government and the private sector work together. In this partnership, the best outcomes appear to result when the state and federal governments, private corporations, or both provide technical assistance, additional funding as needed, and help in setting program standards, and when the community maintains local control over establishing priorities and implementation strategies. However, to reach these goals and to maintain program support over the long time periods needed to show positive results (4 to 8 years), it is necessary to become skilled in social marketing techniques to turn program need into demand and to develop a strong local and statewide advocacy group to facilitate passage of needed legislation and prevent funding cutbacks.
Pediatricians can modify their practices to make them more supportive to families and can work with other community leaders to bring about the changes in attitudes and about the changes in attitudes and funding priorities at the state and community levels that will be necessary to develop more effective preventive programs.
INDEX OF SUSPICION
Authors: Robertson William O. , Menna Vincent J. 
Published: December 2021

Clinicians often form a diagnostic impression at the time of a patient's first consultation. Usually, the initial impression is correct because commonly encountered illnesses come to mind and are, of course, most likely to be responsible. Sometimes, however, a less familiar disorder is responsible and will not be detected or will be diagnosed only after a prolonged delay unless the physician maintains a suspicion of the unusual.
This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
An 11-day-old infant — his mother's fourth — had an entirely normal delivery but was noted to be jaundiced on the fifth day of life. He was admitted to the hospital for phototherapy. The baby never had a bilirubin exceeding 17 mg/dL, but during the hospitalization he was diagnosed as having "apneic episodes" and was started on theophylline; he went home on that medication.
Assessment of Growth and Development During Infancy and Early Childhood
Authors: Vaughan Victor C. 
Published: December 2021

A prime function of the pediatrician is to monitor the developmental status of his or her patients. Sensitive monitoring demands a broad knowledge of developmental processes and issues and the ability to assess the data made available from the clinical examination accurately and efficiently.
Areas of Developmental Assessment
Developmental assessment is made in four broad areas during early childhood: physical or physiologic, neurodevelopmental, cognitive, and psychosocial.
PHYSICAL OR PHYSIOLOGIC DEVELOPMENT
This area comprises the changes in physical size, shape, and function that come with age. Many of these changes can be measured, such as height, weight, skinfold thickness, head circumference, body surface area, blood counts, enzyme activities, and hormone levels. These measurements can be compared with standard values that indicate the range of normal findings.
NEURODEVELOPMENTAL MATURATION
This area comprises changes in behavior that evolve with the passage of time, particularly those changes that depend primarily upon maturation. They include some reflex activities and many gross and fine motor skills, including visuomotor and other intersensory functions. These behaviors are assessed primarily by observation, often informally, but sometimes (when more critical appraisal is required) in a carefully structured setting.
COGNITIVE DEVELOPMENT
Cognitive development and neurodevelopmental maturation are closely related, and it is sometimes difficult to distinguish between them in the infant and young child.
Prenatal Diagnosis and Carrier Detection by DNA Analysis
Authors: Cutting Garry R. , Antonarakis Stylianos E. 
Published: December 2021

During the past 10 years, enormous strides have been made both in our ability to detect abnormal genes and in the number of genes that can be analyzed. The introduction of the polymerase chain reaction (PCR), a method that can enrich a region of DNA by a million-fold, enables gene diagnosis to be performed within hours instead of weeks and is moving DNA testing increasingly from the research bench to the hospital laboratory. The human genome is estimated to have about 100 000 genes, and almost 5000 of these genes have been categorized. The list of identified genes now includes those responsible for a number of relatively common genetic disorders, including cystic fibrosis, Duchenne muscular dystrophy, hemophilia A, sickle cell disease, and neurofibromatosis. At the present time, more than 200 genetic diseases can be diagnosed using DNA techniques. A sample of these is shown in the Table.
Inheritance of Abnormal Genes
Because individuals inherit one set of chromosomes from each parent, there are two genes at each locus, with the exception of genes on the X chromosome because there is only one X chromosome in males. Disorders produced by an abnormality in only one gene are termed dominant (eg, neurofibromatosis), whereas disorders that occur only when both genes are affected are termed recessive (eg, cystic fibrosis).
INDEX OF SUSPICION
Authors: Chapman Daniel D. , McCormick Marie C. 
Published: December 2021

This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
A prepubertal 12-year-old boy who is obese (192 lbs, 68 in) is seen in the office for pain in the anterior and medial aspect of the left knee. The knee is not tender to palpation and has a range of motion equal to the normal right knee. He is in a weight-reduction program consisting of an 1800-calorie diet and supervised exercise four times per week. No history of trauma is elicited.
Case 2 Presentation
During the past 2 months, you have seen an 8-month-old boy twice for ear infections. At the last visit, 3 weeks ago, he also had a rash over his buttocks and in the perianal area that you treated with zinc oxide cream.
Gastroesophageal Reflux
Authors: Orenstein Susan R. 
Published: December 2021

Gastroesophageal reflux is an important problem in children for several reasons. It occurs frequently; sometimes features perplexing and misleading symptoms; causes significant morbidity; and defies rapid, simple, and curative therapy. Thus, it is an important disorder for pediatricians to understand.
Definitions
Gastroesophageal reflux is the return of gastric contents into the esophagus. Confusion sometimes has resulted from failure to distinguish between gastroesophageal reflux as a single event and as a condition, as well as from failure to distinguish between a physiologic and a pathologic condition. A gastroesophageal reflux episode is a single instance of return of gastric contents into the esophagus. Confusion between this single event and the pathologic condition of gastroesophageal reflux disease has been perpetuated by the habit of diagnosing "gastroesophageal reflux" (meaning gastroesophageal reflux disease) on the basis of a single episode of reflux seen on a barium fluoroscopic study or during scintigraphic evaluation. It is important to understand that virtually all people reflux occasionally. The distinction between this physiologic gastroesophageal reflux and pathogenic gastroesophageal reflux (ie, gastroesophageal reflux disease) can be made either by demonstrating an abnormal quantity of reflux (increased frequency or duration of episodes compared to asymptomatic individuals) or by demonstrating that detrimental effects (such as malnutrition, esophagitis, or respiratory disease) have resulted from reflux.
Pelvic Inflammatory Disease in Adolescents
Authors: Paradise Jan E. , Grant Linda 
Published: December 2021

Pelvic inflammatory disease (PID) is a general term referring to infection and inflammation of the upper genital tract, primarily involving the fallopian tubes and uterus. Other terms for PID in common use include endometritis (infection of the uterus) and salpingitis (tubal infection with inferred endometrial involvement). This article reviews the epidemiology, diagnosis, and management of PID in adolescents.
Epidemiology of Pelvic Inflammatory Disease
Of the estimated 1.25 million women in the United States who acquire PID each year, 16% to 20% are adolescents. Of women who have had PID, one out of three experienced her first episode before she was 19 years of age. Two factors confer a particularly high risk of acquiring PID on adolescents: multiple sexual partners and a high prevalence of sexually transmitted infections.
Adolescent girls in the United States begin sexual activity at a mean age of 16.2 years. In 1988, 26% of 15-y-old women, 51% of 17-y-old women, and 75% of 19-y-old women reported having had premarital sexual intercourse. Three fourths of these sexually active adolescents had had two or more sexual partners, and 45% had had four or more sexual partners. It is not surprising that young women with more than one sexual partner during a 3- to 6-mo interval are more than four times as likely to develop PID than are those who have only one partner.