bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cytomegaloviral Infections: Epidemiology, Therapy, and Prevention
Authors: Nankervis George A. 
Published: December 2021

The role of cytomegalovirus in human disease is a still-evolving story. Hanshaw presented an excellent review article on the subject in 1981 in this publication; this current review is an update, with particular emphasis on new concepts in the epidemiology and prevention of cytomegaloviral infection and disease.
Historically, evidence of infection with cytomegalovirus was first reported by pathologists in many parts of the world. They noted the presence of giant cells with intranuclear inclusions while examining a diversity of organs microscopically. Isolation of the virus and development of serologic techniques eventually enabled a definitive study of the agent, its pathogenesis and epidemiology. Biologically, it is one of the herpesviruses and, as such, is a DNA virus. Other members of the group include varicella-zoster, herpes simplex, and Epstein-Barr virus. Several different strains of cytomegalovirus exist, and they have specific characteristics which are of interest. The virus is cell associated and tends to be very labile; it has a tendency to become latent and may possibly have malignant potential.
EPIDEMIOLOGY
Prevalence
Infection with cytomegalovirus is found throughout the world. Studies of prevalence in a number of diverse populations have indicated that cytomegaloviral infection is ubiquitous. The major differences in prevalence between populations are related to the speed of acquisition of infection in various geographic and socioeconomic settings.
Allergy to Cow Milk-1985
Authors: Lee Eui Jung , Heiner Douglas C. 
Published: December 2021

Cow milk became the most popular nutrient for infant feeding in much of the world near the beginning of the 20th century. It remains so today, especially in industrialized countries, but this widespread dependence on cow milk is not without problems. Physicians who care for infants and children know that intolerance to cow milk is not uncommon. Cow milk allergy can be defined as an adverse immunologic reaction to cow milk protein, seen only rarely in those who ingest ordinary amounts of milk. The term is often mistakenly applied to other causes of milk intolerance, such as lactase deficiency and galactosemia, which must be differentiated and excluded.
Reports of the incidence of cow milk allergy in infancy have ranged from 1.9% to 7.5%. The incidence is lower in older children and adults, but precise data are not available for these ages either. The reported incidences vary with the manner of selection of patients and with differing diagnostic criteria. Moreover, there are few reliable laboratory tests available to the clinician who wishes to confirm the diagnosis. Many instances of intolerance to cow milk are mild or transient, and after milk is eliminated from the diet for a few months or years, the symptoms disappear. Only a small percentage (probably 0.1% to 1%) of the population has severe or lifelong cow milk allergy.
Understanding Allergic Rhinitis: Differential Diagnosis and Management
Authors: Shapiro Gail G. 
Published: December 2021

Chronic rhinitis is a common condition responsible for a substantial morbidity. Allergic rhinitis is the most frequent reason for chronic rhinitis in children. The physician must begin any evaluation with a thorough history and physical examination. Specific questions concerning the environment will be important if allergy is a possible diagnosis. The microscopic examination of nasal secretions may be helpful in corroborating evidence.
Treatment of allergic rhinitis should include a serious attempt to avoid exacerbating factors that have been identified from the history. Pharmacologic intervention with antihistamines, decongestants, and topical use of cromolyn or corticosteroids may be highly successful.
If such therapy must be constant to achieve an adequate therapeutic response or if the response is suboptimal, an evaluation for specific allergies, including skin testing to identify pertinent allergens, should be considered.
Bronchiolitis
Authors: Wright Peter F. 
Published: December 2021

Bronchiolitis is an acute respiratory disease of early childhood characterized clinically by upper respiratory tract signs of rhinitis and congestion and by lower respiratory tract signs of tachypnea, retractions, wheezing, and rales. The presence of wheezing differentiates bronchiolitis from many of the other entities to be considered in the child with respiratory distress. Fever and other systemic signs are not prominent components of bronchiolitis. Radiographically, there is evidence of hyperexpansion of the chest, thickening of the bronchial walls, and areas of atelectasis or interstitial pneumonia. Physiologically, there is evidence of hypoxia and hypercarbia with disequilibrium of perfuson-ventilation. Pathologically, there is evidence of damage to the mucosal epithelium with loss of ciliary function. There is an increased production of mucus, with a proliferation of goblet cells. Submucosal edema and lymphocytic infiltration are common. These changes are seen throughout the respiratory tract but are particularly prominent in the cells and submucosal lining of the bronchioles, with resultant obstruction of the small airways (Fig 1).
The pathologic events are obviously central to the whole process of the illness. An understanding of the mechanisms by which the pathologic changes in bronchiolitis evolve, and their implications for diagnosis, therapy, prognosis, and, ultimately, prevention, will be the focus of this review.
Prevention and Management of Infectious Diseases in Day Care
Authors: Aronson Susan S. , Gilsdorf Janet R. 
Published: December 2021

HOW MODERN PARENTS CARE FOR THEIR CHILDREN
Almost one third of American children are in day care, a term used to describe care provided to children by individuals other than their parents for fewer than 24 hours per day. Day care for children has been a part of American culture since the Civil War, when women began to enter the labor force. Today, 60.5% of mothers of children younger than 18 years of age are working (Table 1).
In the past decade, the proportion of mothers who are working outside the home has increased by about 20% among both mothers of pre-school children and mothers of school-aged children. More than 9 million children younger than the age of 6 years have mothers who work outside the home, and the majority are working full time. Even mothers of infants are working outside of the home in record numbers. As of March 1984, almost half (46.8%) of married mothers of children younger than 1 year of age were working outside the home. The trend is expected to continue; by 1990 the population of children requiring care while their parents work will reach 10.4 million. Although we tend to concentrate on child care arrangements for the youngest children, an even larger proportion of parents of school-aged children are working in the labor force.
Adverse Effects of Overdosage of Vitamins and Minerals
Authors: Barness Lewis A. 
Published: December 2021

Throughout almost three centuries, knowledge of the uses, needs, and metabolism of trace nutrients, vitamins and minerals, has been acquired. This knowledge can be divided into five phases.
The first phase occurred during a period of about 200 years and was one mainly of discovery. Animals and/or humans were noted to have diseases that were related to deficiencies. Thus, in 1753 a Scottish surgeon in the British navy showed that citrus fruit could prevent or cure scurvy, and about 200 years later ascorbic acid was isolated, synthesized, and used. Many of the trace elements were determined either to correct deficiencies or to be growth factors for animals. Discovery of knowledge continues but at a less rapid rate.
The second phase, which considerably overlaps with the first, is related to determination of the mechanism of action. This required, first, study of animals, then, tissues, and, now, cells and cell components. Many biochemical pathways have been determined, and many vitamins and minerals have been identified as part of enzyme systems. Still others are to be explored and determined.
The last three phases appeared irregularly but periodically, two with scientific input and one by hope, prayer, and deductin.1
The third phase was one of the determination of recommended daily requirements and allowances (RDA).
The Pediatrician as a Member of The Community
Authors: Mclnerny Thomas K. 
Published: December 2021

This simple statement by Dr. Haggerty, with its profound implications, has influenced my "extracurricular" activities significantly. It was delivered at a Grand Rounds shortly after I joined a pediatric practice in suburban Rochester, NY, while I was still impressionable and relatively uncommitted. At the same time. I became aware through firsthand experience of the very large role that school plays in determining the course of children's lives.
Our practice style is one of concern for the complete development of the child, not only physically, but also intellectually and emotionally. Thus, during the annual physical examinations, we inquire about progress in school and learn how children's natural intellectual curiosity can be encouraged or discouraged by different school environments.
There seemed to be little that I could do about the school's influence on children's development until some friends suggested that I consider joining the school board. My first response was to avoid this time-consuming, political, often "no-win" position of responsibility like the plague. However, Dr Haggerty's words kept coming back to me, piquing my conscience. After much deliberation, I decided to run and, with a great deal of help, was elected.
Acute Ataxia
Authors: Stumpf David A. 
Published: December 2021

Ataxia is a vague term. Disease processes from the cerebral cortex down to the muscle can produce ataxia. Thus, it is not a localizable symptom, and other aspects of the clinical state are necessary to clarify the localization of the disorder. The neurologic history and examination will clarify the nature of acute ataxia.
The development of acute ataxia in a child is a dramatic event for both families and physicians. The physician evaluating the ataxic patient should be thinking foremost about common, treatable causes. Generally, this includes infectious and metabolic causes. As in most neurologic disorders, the history and physical examination provide important and critical information. A wide differential diagnosis must be entertained (Table 1).
CLINICAL HISTORY
The history of the onset and nature of the ataxia can provide valuable clues to the diagnosis. Specific information should be sought concerning the exact nature of the ataxia; does it involve just the limbs, or are truncal, postural, or eye movements also affected? The presence of associated neurologic symptoms such as weakness, headache, head tilt, or lethargy may provide direction to the differential diagnostic thinking. Systemic symptoms such as fever or concomitant or antecedent illness are also important. Preceding viral infections should be carefully reported. Viral diseases such as varicella, mononucleosis, influenza, or mycoplasma infectoins are particularly likely to produce a postinfectious ataxia. A history of drugs or poisons that may have been accessible to the child should be sought.
Commentary on The Difficult Child
Authors: Chess Stella 
Published: December 2021

Dr William Carey has earned a well-deserved reputation as an important figure in the field of behavioral pediatrics. His studies and writings have enhanced our understanding of a number of behavioral issues that concern both pediatricians and mental health professionals. His major contributions have been in the field of temperament studies. Here, he has been a clinician-researcher who has made valuable theoretical, clinical, and methodologic contributions to the conceptualization of temperament, its systematic measurement, and its practical applications by the practicing clinician.
His present review of "The Difficult Child" gives us an authoritative and scholarly survey of one of the complex theoretical and practical issues of temperamental individuality in children. On the one hand, the review summarizes the pertinent research literature briefly but cogently. At the same time, Dr Carey's judgments and advice are not based on any academic approach but, on the contrary, reflect his own rich clinical and research experience in the field of temperament. My own comments will focus mainly on expanding Dr Carey's discussion of the basis for the concept of the temperamentally difficult child and his comments on practical management.
Our definition of difficult temperament grew out of two separate lines of investigation. First and foremost was the vivid impressions gained by Dr Alexander Thomas and myself as we interviewed the parents in our New York Longitudinal Study(NYLS), which we initiatead in 1956.
Giving to Our Patients—Should We Draw the Line?
Authors: Nazarian Lawrence F. 
Published: December 2021

"We've got a cut finger here. Can we meet you at the office right away?" The mother's voice on the phone was calm but insistent.
"Which child is this?" I asked.
" Well, actually, it's me. My doctor doesn't do suturing and I don't feel like waiting around the emergency room."
I had no problem telling her politely that I would call the hospital to let them know she was coming. Clearly, this was an inappropriate request to make of a pediatrician covering a large practice on a weekend, especially when other help was available.
But what about the parent who calls after hours regarding a diaper rash? How about the father who insists that you put a diagnosis other than "well child" on the charge slip, so his insurance will cover the routine examination? Does it change your mind when he points out that you discussed the child's headaches during the visit? How about the mother who wants erythromycin for her child "because it's the only thing that clears up his ears?"
Our orientation is to give our patients what they need. We are there to help and to give. Rightly so. And most of the time it is appropriate to give what is requested.
Counseling Families With Twins: Birth to 3 Years of Age
Authors: Becker Patricia Gallagher 
Published: December 2021

The difficulties and demands facing parents of twins or other multiple births are significantly greater than those facing parents of children born singly. Even routinely day-to-day care is sometimes different from that of a singleton. With the added stress in the home, parents will benefit from the pediatrician's advice on caring for their twins. Physicians need to be emotionally supportive and to offer suggestions such as changing breast-feeding technique, getting the father or other support person involved, and even linking these mothers with other mothers of twins. Discussion of feelings of inadequacy should be addressed during office visits.
This study suggests a need for more physician education concerning management of multiple-birth infants. Providing health care alone is not sufficient in the management of twins. Attention to and guidance in a wide variety of twin care measures is important if the pediatrician is to provide optimal care for the children and families involved in multiple births.
Intrauterine Growth Retardation
Authors: Warshaw Joseph B. 
Published: December 2021

Intrauterine growth retardation can result from a variety of environmental and genetic influences on fetal growth. The sequelae of intrauterine growth retardation resulting from impairment of nutrient flow include low birth weight with sparing of brain growth, polycythemia, and hypoglycemia resulting from decreased storage fuels and defective gluconeogenesis. Available data suggest that the vast majority of nutritionally growthretarded infants have normal postnatal development without significant difference in IQ or neurologic scores from normal infants. The outcome of infants in whom there is decreased growth potential relates to the condition underlying growth retardation and may, of course, result in later severe handicap.
Infants with nutritional intrauterine growth retardation may exhibit decreased fetal size and sparing of brain growth as an adaptive stage in the presence of lower oxygen and substrate availability. Under such conditions, a smaller size may decrease substrate and oxygen needs and improve outcome. All infants with intrauterine growth retardation, however, require follow-up and careful developmental evaluation.
Behavioral and Developmental Components of Child Health Promotion: How Can They Be Accomplished?
Authors: Green Morris 
Published: December 2021

Child health supervision has been a service highly valued both by the consumer and by pediatricians. In addition to improved public health practices, nutrition, housing, and other environmental factors, pediatric health promotion has made a major contribution to the improved health status of children which has occurred in recent decades in the United States. Although the current preoccupation with cost containment might suggest otherwise, the present question is not how we can do less in health promotion but how we can do more, and with better effectiveness, especially in relation to behavior and development. The potential for child and family health promotion in these areas remains largely unrealized.
We live in a society characterized by rapid change. By 1 990, one fourth of the children in the United States will spend part or all of their lives in one-parent families. Today, most mothers work outside the home. Parental divorce, separation, and remarriage are events now frequently experienced by children. Many upwardly mobile families are postponing parenthood and having few children or none. In our highly migratory society, grandparents and other relatives are less available to provide emotional and other support, especially for young parents and children.
NEED FOR NEW MODELS
In view of all this, the model of pediatric practice that has gradually envolved over the decades to provide care, in the beginning for infants with nutritional and acute infectious disorders, requires constant reevaluation and renewal if it is to remain responsive to emerging health promotion needs, particularly in relation to behaviour and development.
The Pediatrician, the Disabled Child, and the Family: A Special Relationship
Authors: Miller Robert L. 
Published: December 2021

Sooner or later, every practicing pediatrician will be asked to care for a baby who will be permanently disabled, such as a child with Down syndrome. To some, the request will be an unwelcome burden, to be dealt with as quickly as possible. To others, however, a new baby with a disability challenges the pediatrician to use all of his or her skills over a long period of time, receiving unexpected rewards in the process.
The first opportunity to establish a sound relationship comes when the pediatrician must inform the new parents about the diagnosis. The response to such unexpected news is always shock, denial, and guilt, with a healthy dose of anger. The pediatrician, who by nature is sensitive to the special needs of children and their parents, is in an ideal position to deal with the normal grief reaction.
Developmental Assessment and Early Intervention Programs for Young Children: Lessons Learned From Longitudinal Research
Authors: Chamberlin Robert W. 
Published: December 2021

We have good evidence that quality early intervention programs can be of considerable benefit to many children with established handicaps and their families and to children and families exposed to environments that severely restrict their opportunities to participate in development-promoting activities (Table). However, because a child's developmental status at any one time is the result of a complex interaction between the biologic characteristics of the child and his or her social environment and because development appears to progress over time through a series of mutually influencing "transactions" between the child and his or her caretakers rather than as a straight line from one point
[See table in the PDF file]
to another, we cannot accurately predict in which children problems will develop in the future. We do know that some children with mild and even moderate signs of neuromotor dysfunction "outgrow" them or at least compensate for them adequately without treatment, provided they are being reared in a development-promoting and emotionally supportive environment. We have also learned from studies of classroom settings and from our own clinical programs that monitor at-risk children for long periods of time that we can negatively influence a parent or child's perception of his or her normality and create a self-fulfilling prophecy.
Our proposal for handling this dilemma is to put more emphasis on prevention by seeing that every family in a community has access to the basic parent education and support services that can prevent many of these problems from occurring in the first place and/or can help those with mild to moderate signs of dysfunction effectively compensate for them. Therapy-oriented specialists can provide consultation to these programs to help children with special needs. Finally, to ensure that families in need actually connect with these preventive and/or treatment programs, the primary care providers, school personnel, and community health nurses need to work together in a communitywide screening/monitoring/referral System.
School Placement
Authors: Palfrey Judith S. , Rappaport Leonard A. 
Published: December 2021

As part of the current emphasis on health rather than disease, strength rather than weakness, many pediatricians are orienting their practices to explore and support optimum childhood functioning. This orientation is totally in concert with the declaration of the special education movement that professionals can no longer exclude children from school but must do everything they can to include even the most severely disabled child in the life of the community.
Pediatricians have a unique opportunity and responsibility with regard to school placement. Aware of the child's history and medical background, pediatricians can work creatively with schools and other agencies to design placements that will allow the child the greatest room for growth. Moreover, pediatricians can help establish intervention programs as soon as a child's disability is determined. As pediatricians take the opportunity to interact with other child development specialists and service agencies, there will be a common growth of knowledge about children, their needs, and the best services to meet these needs.
Oral Rehydration Therapy
Authors: Finberg Laurence 
Published: December 2021

The Committee on Nutrition of the American Academy of Pediatrics strongly supports the concept of the use of the oral route for rehydration and maintenance hydration of infants with enteritis as reviewed in this issue by Santosham et al. We place emphasis more forcefully on distinguishing the different stages of physiologic disturbance in such infants which, therefore, slightly changes our emphasis in the recommendations for therapy.
Even for mild dehydration, three stages are recognized: a state of clinical dehydration requiring rehydration, a maintenance fluid stage after hydration is achieved, and an early refeeding stage in which nutrition is restored.
These stages may merge into one another quickly, and in some patientsthe rehydration period may not ever present.