bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fears and Phobias
Authors: Schowalter John E. 
Published: December 2021

Definitions
Fears and phobias represent a major segment of the psychological distress experienced by children while growing up. It is important to distinguish between the two.
Fears are a normal part of life and usually are most vivid and ubiquitous during childhood. Fear is the emotional and physiologic response to an external danger. At their best, fears help keep one safe. The fear of being burned, being accosted by strangers, disappointing parents by doing poorly on an examination, or ending up in jail all can lead to a more healthy and productive life. One could speculate that heights and snakes are among the most common fears among adults because those ancestors who avoided snakes and high places were most likely to live long enough to ensconce these tendencies in the gene pool.
The differential diagnosis of fears and phobias is easier during adulthood than it is during childhood. This is because the child's physical and cognitive immaturity can confound reality testing on developmental and psychopathologic bases. The toddler who is so small, helpless, and unable to understand the forces of physical and human nature accurately often has many normal fears. These typically may include strangers, their parents' leaving, monsters, the dark, or going to sleep.
Consultation with the Specialist
Authors: Hardy Stephen C. , Walker Allan 
Published: December 2021

Acetylcholine (ACh), a common neurotransmitter in the human, acts in the brain at the neuromuscular junction and throughout the autonomic nervous system. Cholinergic receptors have been separated into two main groups: nicotonic (present at the neuromuscular junction) and muscarinic (present at all ganglia of the autonomic nervous system and postsynaptically in the parasympathetic nervous system).
Anticholinergic medicines act at muscarinic sites. The first anticholinergic drugs were extracts of belladonna plants, which were used for centuries for their antimotility and antisecretory properties. These drugs generally are ineffective blockers of ACh at nicotinic receptors and cause neuromuscular blockade only at excessive doses.
Because antimuscarinic medications block the effect of the parasympathetic nervous system, they affect the gastrointestinal (GI) tract. In general, the parasympathetic nervous system stimulates the GI system. Cholinergic impulses cause increased tone and motility of the stomach and intestines and increased secretion of gastric and intestinal fluids. Exocrine pancreatic secretion and gallbladder contraction also are stimulated by cholinergic activity. Anticholinergics reverse these responses.
The prototypical anticholinergic, atropine, decreases output of gastric, intestinal, and pancreatic secretions; decreases motility and tone of the GI tract; and relaxes the gallbladder. Atropine not only interferes with cholinergic activity in the GI tract, it affects the entire body increasing heart rate, depressing salivary and bronchial secretion, decreasing sweating, dilating the pupils, inhibiting accommodation, inhibiting micturition, and causing constipation.
BACK TO BASICS
Authors: Woodin Kathleen A. , Morrison Susan H. 
Published: December 2021

Introduction
Unlike physicians practicing in the 1940s, who had only sulfonamides and penicillin to treat infections, practitioners now choose from a broad (and sometimes overwhelming) number of antibiotics. However, trends in emerging antimicrobial resistance may force us to take a giant step backward to that frightening situation of the past of having bacteria that are essentially "untreatable" by any of our available antibiotics.
This article is an overview of some of the microbiology, pharmacology, and physiology critical to the rational use of antibiotics in today's practice. It summarizes the basic mechanisms of action of some commonly used antibiotics and briefly discusses the emergence of resistance to several common pathogens.
Structures of Bacteria Important to Antibiotic Action
The outermost component of most bacteria is the cell wall, a multilayered structure located external to the cytoplasmic membrane. The cell wall is composed of an inner layer of peptidoglycan, a complex interwoven lattice of linear sugars (glycan) that are cross-linked by peptide chains. Peptidoglycan provides the rigid support by which the cell maintains its characteristic shape.
Gram-positive and Gram-negative bacteria differ in their cell wall structures (Figure). In Gram-positive organisms, the peptidoglycan layer is a thick (15 to 80 nm) multilayer and may have a thin layer of teichoic acid outside the peptidoglycan.
The Changing Face of Anemia in Infancy
Authors: Graham Elinor A. 
Published: December 2021

Introduction
The pattern of anemia in infancy is changing in North America. The major factors contributing to anemia include iron endowment at birth, adequacy of dietary iron, frequency of infection, and the genetic background of a child. The characteristics of all of these factors are changing in the pediatric population. As more premature infants survive, their inadequate birth endowment of iron results in iron deficiency at an earlier age. Because of widespread use of iron-fortified formulas or iron supplementation with breastfeeding, iron deficiency now causes less anemia in the first year of life. As iron nutrition of infants has improved, anemia associated with infection has been identified more frequently. Increased work force participation of mothers has resulted in more exposure to infections by infants in child care. An increase in the percentage of children who are of Asian and African genetic backgrounds has increased the prevalence of inherited hemoglobin disorders among children. Newborn screening for hemoglobinopathies has resulted in more frequent identification of these disorders.
Decline in the socioeconomic status of children in the United States adds to the complexity of this picture. More than one factor often produces anemia in an infant from a poor family, and the anemia may have a greater impact on the psychosocial development of a child from a low-income background.
Cystic Fibrosis
Authors: Colin Andrew A. , Wohl Mary Ellen B. 
Published: December 2021

Cystic fibrosis (CF) is an autosomal recessive inherited disorder caused by mutations of both alleles of the CF gene. These mutations result in abnormalities in the production or function of the gene product, a protein known as the cystic fibrosis membrane conductance regulator (CFTR). The CF gene is large (250 000 base pairs) and located on chromosome 7. A deletion of three base pairs that results in the absence of phenylalanine at codon 508 is the most common defect (designated F 508) and accounts for about 70% of the mutant genes in North American populations. Other genotypes observed with some frequency (but &lt;3%) are G542X, G551D, W1282X, W1303K, and R553X. The twelve most common CF gene mutations account for approximately 85% of cases in North America. Mutations other than F508 number more than 200 and account for the remaining cases. Most of these 200-odd mutations are "private," observed only in the affected kindred. Because the CF locus has so many DNA sequence changes associated with disease, precise genetic testing cannot replace clinical criteria for diagnosis, and the sweat test remains an important diagnostic test.
The CF gene is expressed in epithelial cells of the pancreas, sweat and salivary glands, intestine, and reproductive and respiratory tracts, particularly in the submucosal glands.
Craniosynostosis
Authors: Marion Robert W. 
Published: December 2021

On the surface, premature closure of one or more sutures of the skull may appear to be a straightforward malformation that leads to a specific, recognizable pattern of symptoms and signs, an anomaly that can be corrected simply by a surgical procedure. But in fact, craniosynostosis, which occurs in approximately I in 2500 children, is a dynamic process, the external reflection of a series of complex conditions that may cause an underlying abnormality not only in the skull but in other systems.
In most cases, surgical repair of both the fused sutures and the resulting craniofacial asymmetry will resolve the primary problems caused by craniosynostosis, namely, compression of the brain because of lack of space, functional anomalies of the eye due to aberrant placement of the orbits, and sometimes, grotesque distortion of the facies.
Developmental Testing
Authors: Gilbride Kathleen E. 
Published: December 2021

Many screening tools are available to the pediatrician; the ones described here are just a sample of some that are used commonly. Understanding the purpose and limitations of each screening measure, in terms of reliability, validity, sensitivity, specificity, and the population for which it was designed, will help the pediatrician use these tools effectively to identify children at risk for developmental delay. Most importantly, the pediatrician should view screening tests as one source of information to be used in an overall strategy of developmental surveillance that includes careful historical review, systematic clinical observations, and solicitation of parental concerns and attitudes.
Pediatricians play a central role in monitoring the development of infants and children during the course of providing well child care. Parents turn to pediatricians for help in determining whether their child has a temporary lag in development, a serious delay or disorder, or a significant behavior problem that should be addressed. With the passage of PL 99-457, pediatricians also play a key role in referring children at risk to early intervention services. By employing a strategy of developmental surveillance, with periodic developmental screening, the pediatrician can determine when a child should be referred for more extensive developmental or psychological testing, which will aid in the process of diagnosis and treatment of developmental disabilities and behavioral disturbances. Knowledge of the screening and testing measures used commonly, as well as their limitations, will result in more accurate interpretation of the data derived from such measures. Once delays are diagnosed and treatment is initiated, repeated assessments over time will serve to identify areas in need of continuing intervention while indicating gains made in specific areas of developmental functioning. Throughout this process, the pediatrician's role as advocate for the child and family serves as a bridge to other professionals and services, with the ultimate goal of facilitating the optimal development of the child.
INDEX OF SUSPICION
Authors: Amin Sanjiv B. , Devries Jeffrey M. , McQuilkin Patricia , Quion Nathalie , DeWitt Thomas G. 
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 15-year-old girl comes to your office complaining that she has experienced intermittent, sudden episodes of chest pain, fatigue, palpitations, and sensations of difficulty breathing and lightheadedness for 2 months. These episodes occur several times daily and are unaccompanied by other symptoms such as syncope, wheezing, swelling of the extremities, or fever. She denies being worried, but reports that her parents are very frightened because a 16-year-old male cousin died recently while playing soccer, and two other relatives, a 27-year-old cousin and a 29-year-old uncle, died suddenly during exercise.
The physical examination reveals a somewhat anxious girl complaining of mild precordial chest pain. Her temperature is 36.9°C(98.4°F) orally, respiratory rate is 16 breaths/min, heart rate is 110 beats/min, and blood pressure is 100/60 mm Hg; weight and height are at the 75th percentile.
Babies Who Are Small for Gestational Age
Authors: Russell Barbara K. 
Published: December 2021

Small for gestational age (SGA) is a term applied to a heterogeneous population of babies who do not meet the expected growth parameters for their gestational age. The definition of SGA is variable, but the clinical definition used most often is any baby who weighs less than 2500 g and falls below the 10th percentile on the growth chart for its gestational age. These infants are at increased risk for hypoglycemia, polycythemia, and temperature instability and suffer higher neonatal mortality rates.
Although they often are used interchangeably, the terms SGA and intrauterine growth retardation (IUGR) are not always synonymous. Approximately 60% of infants classified as SGA are constitutionally small babies who are small for gestational age but not growth retarded.
Leukocyte Disorders: Quantitative and Qualitative Disorders of the Neutrophil, Part 2
Authors: Boxer Laurence A. , Blackwood R. Alexander 
Published: December 2021

The differential diagnosis for a patient presenting with recurrent infections is formidable, given the complexity of the immune system. The clinical presentation of a patient who has a qualitative neutrophil abnormality may be similar to that of one who has an antibody or complement disorder. In general, evaluation for phagocytic cell disorders (Table) should be initiated among those patients who have at least one of the following clinical features: 1) Two or more systemic bacterial infections; 2) Frequent, serious respiratory infections, such as pneumonia or sinusitis, or frequent bacterial infection, such as cellulitis, draining otitis media, or lymphadenitis; 3) Infections presenting at unusual sites (hepatic or brain abscess); and 4) Infections associated with unusual pathogens (ie, Aspergillus pneumonia, disseminated candidiasis, or infections with Serratia marcescens, Nocardia sp, and Pseudomonas cepacia).
Disorders of Neutrophil Function
HYPERIMMUNOGLOBULIN E SYNDROME (JOB SYNDROME)
Hyperimmunoglobulin E (hyper-IgE) syndrome is an autosomal dominant disorder with incomplete penetrance that is characterized by elevated levels of serum IgE and recurrent staphylococcal abscesses (Table). Neutrophils in these children exhibit impaired chemotaxis, although phagocytic function is normal. Clinically, hyper-IgE syndrome must be distinguished from severe atopic dermatitis. Both disorders are characterized by the development of severe dermatitis in the presence of elevated IgE levels.
Consultation with the Specialist
Authors: Richards B. Stephens 
Published: December 2021

Slipped capital femoral epiphysis is the most common orthopedic hip disorder occurring in adolescence. In this condition, the femoral head (epiphysis) displaces, or slips, on the femoral neck through the region of the growth plate. This may result from traumatic forces acting on a normal growth plate (physis) or from ordinary forces acting on a weakened growth plate. In the latter situation, resistance to shear-type forces within the physis is decreased. This leads to the growth plate giving way when exposed to modest forces, such as running, skipping, or twisting. The femoral head may displace abruptly, analogous to a fracture, and may be exquisitely painful to the patient. Or, the femoral head may displace gradually, maintaining a stable relationship between it and the femoral neck, and may present clinically only as an ache in the groin. Regardless of the clinical presentation, the proper management requires urgent surgical intervention in an effort to avoid further displacement. Thus, early diagnosis is of utmost importance in the management of slipped capital femoral epiphysis.
Epidemiology
The general incidence of this condition is 1 to 3 per 100 000, with a slightly higher incidence in African-American children. Males are affected twice as often as females. The children are obese (the weight being 2 standard deviations above the mean for the child's age) in 67% of cases.
Recurrent Abdominal Pain in Childhood
Authors: Barbero Giulio J. 
Published: December 2021

Recurrent abdominal pain (RAP) in childhood is a common complaint that may be difficult to diagnose and manage. Apley has reported that 10% of children have three or more episodes severe enough to impair activity and function over at least a three-month period. RAP appears less often in preschool children and, when present at earlier ages, it usually occurs in brief episodes rather than the more frequent and intense pattern that is characteristic of the school-aged child. RAP is more frequent in girls and is particularly prominent as a symptom in early adolescence. Occasional abdominal pain is a universal symptom in childhood and its significance is often difficult to assess. A practical approach is to determine the frequency, severity, and limitations produced by the pain before further exploration of its cause.
DIAGNOSIS
Recurrent abdominal pain in childhood can be divided into disturbances of gastrointestinal functions and a variety of pathologic disease or organic categories. A combination of the disturbance of function and other organic disease can also be present as the basis for the pain. Fewer than 10% to 15% of referred children reported in various studies have been found to have pain of organic origin. It is important to recognize that many patients and their parents are fearful of the pain as a symptom and are not easily able to incorporate a concept of disorder of a gastrointestinal function at the onset.
Practical Aspects of Pediatric Management of Families with Twins
Authors: Siegel Sheila J. , Siegel Michael M. 
Published: December 2021

Tommy, a rather large 4 year old, invited his younger twin friends over to play. He expected to be the leader as he knew he was older and was certainly lots bigger. Although the twins included him, they joined together so as to dominate the interactions. By the end of the afternoon, looking totally overwhelmed and somewhat bemused, Tommy turned to his mother and said, "Next time only invite one of them, or get another Tommy." Parents, friends, teachers, doctors, any of us who spend time with twins find them fascinating, puzzling, and occasionally a little overwhelming. Twins and parents of twins bear the brunt of this curiosity in the barrage of questions that often assail them: "What is it like to have twins?" "Is it twice as hard to raise two as it is to raise one?" "What is it like to be a twin?" Perhaps the not uncommon wish to have been a twin or to have twins is behind this phenomenon, or perhaps it is the rarity with which twins occur that explains this curiosity. Such attention, however, aggravates major problems most common to twins.
Parents often seek pediatricians' advice about raising their children. In this article we will address childrearing issues but from the perspective of parents of twins.
An Ounce of Prevention Is Worth a Pound of Cure
Authors: WEINSTOCK IRVING 
Published: December 2021

Continuing medical education is being conducted in many overseas sites. The physician who contemplates such trips should be prepared for the more common medical emergencies which may occur to him, his family, or other travelers on such trips. Dr Irving Weinstock, an experienced pediatrician and traveler on such educational programs, has provided a short list of items that he considers useful. Since this journal is dedicated to successful continuing pediatric education, being so prepared may help.
R.J.H.
In preparing for an overseas trip, I have found it useful to include the pharmaceuticals and medical supplies listed in the Table. The journey will be more enjoyable and pleasant, knowing that you are prepared for most contingencies.
Adolescent Sexuality
Authors: Duke Paula Maguire 
Published: December 2021

The shaping of sexual beliefs, attitudes, and behavior begins at birth, continues throughout childhood, and is dramatically influenced by puberty. At this time, teenagers must incorporate their changing physical appearance into their self-image, ideally including knowledge and acceptance of their bodies. In addition, they must explore and learn ways of interacting with their peers, sexually and otherwise.
When thinking about how a pediatrician can best serve the needs of an adolescent, especially with regard to sexuality, it becomes clear that there is very little requirement for "treatment" in the traditional medical sense, ie, prescriptions, surgery, physical therapy, etc. Instead, the greatest contribution comes from eliciting and answering questions, providing information about the teenager's current physical and social environment, and bringing to his or her awareness changes and issues that might come to the fore in the near future. The process of taking the history and performing the physical examination provides numerous opportunities to gather and dispense information, as will be illustrated below.
Practice experience as well as research data indicate that issues of importance to the prepubertal or early pubertal child differ from those of the mid or late adolescent. This natural separation will form the framework for the following discussion, although it must be realized that some adolescents cannot be so neatly categorized.
Sunburn: Effects and Management
Authors: Leach James 
Published: December 2021

The salutary benefits of basking in the sun have been sought by human beings since ancient times. Regarded in the past as a deity, the sun still confers its radiant benedictions on its modern devotees who have been persuaded by contemporary fashions that a dark brown tan is a sure sign of well-being, both physical and psychological. At some time, virtually all ardent sun-worshippers discover the unpleasant acute cutaneous reaction commonly called sunburn.
PHYSICAL PROPERTIES OF SOLAR RADIATION
Constituting a continuous spectrum, the electromagnetic radiation from the sun ranges from the highly energetic short wavelengths to the less energetic longer wavelengths. The wavelengths that impinge on the earth's surface are between 290 and 3,000 nm. On the basis of our visual physiology, they can be arbitrarily divided into visible, ultraviolet, and infrared waves.
The portion of solar radiation that elicits the sunburn reaction lies between 290 and 320 nm in the ultraviolet band and is traditionally designated ultraviolet B (UVB). The earth's stratosphere effectively absorbs the potentially more harmful shorter wavelengths. This filtering is accomplished by the thin ozone layer that continually absorbs ultraviolet radiation (UVR) from 200 to 320 nm, completely cutting out all radiation less than 290 nm. The longer ultraviolet wavelengths from 320 to 400 nm, designated ultraviolet A (UVA), are approximately one thousandth as effective as UVB in evoking erythema.
Care of the Foreskin
Authors: Boyce W. Thomas 
Published: December 2021

The pediatrician inclined to read further in the extensive literature on neonatal circumcision may well be more impressed with the intensity of the arguments than with the finality of the conclusions. For many, circumcision (or its abolition) has become a cause, with all the attendant rhetoric and dogma. Yet one is struck by the high level of ambivalence with which most of us approach the issue, both as pediatricians and as parents.
One source of this ambivalence may be the uncertainty surrounding the proper role of the pediatrician in decisions regarding circumcision. Should we act simply as purveyors of medical information, leaving the decision entirely to parents? Or are we obligated to assume a position of advocacy, actively arguing for or against circumcision? At the very least, the pediatrician should be prepared to summarize for parents the evidence that may affect their decision and to provide the appropriate information and support to those who decide against the operation.