bluuebunny/crossref_metadata_2025_split huggingface dataset:
Health Assessment and Screening During Adolescence
Authors: SCHWARTZ RICHARD H. 
Published: December 2021

To the Editor.—
In the July 1987 supplement to Pediatrics, Drs Marks and Fisher1 suggest using a liver enzyme screen such as γ-glutamyl transpeptidase to detect alcohol-induced liver damage in the adolescent patient. I question the wisdom of this recommendation on two grounds. First, to my knowledge, there are no published reports concerning the accuracy and sensitivity of such a test in the adolescent patient. Evidence from my own experience, moreover, refutes the recommendation of Drs Marks and Fisher.
`A New Era in Therapy for Hyperbilirubinemia"
Authors: LUCEY JEROLD F. 
Published: December 2021

The article by Kappas et al in this issue (pp 485-497) represents a promising and exciting new approach to the prevention of neonatal hyperbilirubinemia. This important advance is based on a decade of careful basic research before this first clinical study in infants was carried out. Pediatricians have long dreamed of the day when the bilirubin problem would be solved and they would be free of the constant worry about "what to do for a certain level of serum bilirubin."
There is an ancient Chinese proverb: "A journey of a thousand miles begins with a single step." Kappas et al have taken that step.
Rape and the Adolescent
Authors:   Committee on Adolescence
Published: December 2021

In recent years, the problem of rape and sexual abuse of young persons has received increasing medical and societal attention. Nearly 50% of reported rape victims are adolescents.1-3 Whereas the vast majority of offenses involve girls, the incidence of sexual assaults on young men also seems to be increasing.
Although community resources may vary considerably, most metropolitan areas now have special programs on facilities to assist the victims of sexual assault. Such assistance usually includes advice regarding the management of the acute crisis as well as guidelines for the collection of evidence and preparation for trial should legal action follow. Because so many of the victims are adolescents, they are being seen with increasing frequency in pediatric emergency rooms.
The adolescent who is forcibly assaulted may display a wide range of behaviors, such as hysterical crying, giggling, on agitation, and may have feelings of degradation, anger, rage, helplessness, and nervousness and rapid mood swings. The victim is often angry, confused, and filled with selfblame. Alternatively, the adolescent may appear calm and controlled, masking internal turmoil. In cases of forcible assault, long-term sequelae such as fears, nightmares and sleep disturbances, disturbed peer and sexual relationships, and psychosomatic complaints may develop. Some victims fear retaliation from their attacker and develop ritualistic behavior as a defense. Some believe their bodies to be permanently damaged and may even fear death as a consequence of the violent act they have experienced.
For the victim, the circumstances of the initial medical evaluation may be frightening and stressful.
Chlamydia and Suspected Sexual Abuse
Authors: HAMMERSCHLAG MARGARET R. 
Published: December 2021

To the Editor.—
I read with interest the study by Fuster and Neinstein.1 However, I wish to address several aspects of the report regarding the significance of genital infection with Chlamydia trachomatis in children, clinical findings, and diagnosis.
The question of whether genital infection with C trachomatis in a prepubertal child is an indicator of sexual abuse is still controversial. Although it has been demonstrated that an abused child can acquire the infection after rape,2 the organism can also be present as the result of persistent perinatal infection.
Pediatrician's Role in Emergency Medical Services for Children
Authors:   Provisional Committee on Pediatric Emergency Medicine
Published: December 2021

To reduce the morbidity and mortality of critically ill and injured children, comprehensive care must be provided. This includes effective services and treatment from the onset of the illness or injury through definitive care. Pediatricians should counsel families not only about prevention of disease and injury but also about access to pediatric emergency care resources in their region. If the interval between recognition of illness and delivery of care is to be reduced to a minimum, a prehospital protocol must be established. Parents as well as prehospital care providers must be knowledgeable about their community's prehospital protocol for life-threatening illness or injury.
Primary care pediatricians need to establish networks with hospital-based pediatricians, emergency physicians, pediatric surgeons, and other pediatric medical and pediatric surgical specialists so that there is clearly assigned responsibility for provision of pediatric emergency care.1 When available, a pediatric surgeon should take charge of the child with multiple traumatic injuries. Optimally, the pediatric emergency care delivery system will be comprehensive and designed to meet the unique needs of children. The specific objectives of an emergency medical services for children (EMS-C) system should remain constant even though available resources may vary from region to region. For an EMS-C system to be most effective, practitioners need to develop the knowledge, skills, attitudes, and experience necessary to provide essential life support for ill and injured children.
Many regions currently have well-developed emergency medical services (EMS) systems with outstanding capability and sophistication but most have been designed to meet the needs of adults.2
SIDS or Murder?
Authors: DIMAIO VINCENT J. M. 
Published: December 2021

To the Editor.—
It was with resignation that I read the paper by Oren et al1 about SIDS and familial occurrence. It is my opinion, as well as that of a number of other forensic pathologists to whom I showed the article, that the five deaths in group I of this article (infants born to families with two or more siblings who died of SIDS) are in all medical probability homicides by smothering. The individual clinical findings of these cases is not given, but from experience, I would say that one or more of these children in each family were brought to physicians and emergency rooms a number of times with a history of apneic episodes, that, if admitted, they never experienced these episodes in the hospital (unless they were alone with a parent), and that they were subsequently brought in dead after suffering a fatal apneic episode.
Megaloblastic Anemia Characterized by Microcytosis: Imerslund-Grasbeck Syndrome With Coexistent α-Thalassemia
Authors: RUSSO CAROLYN L. , HYMAN PAUL E. , OSEAS RONALD S. 
Published: December 2021

Imerslund-Grasbeck syndrome is a hereditary autosomal recessive condition of selective vitamin B12 malabsorption in the terminal ileum, resulting in chronic megaloblastic anemia.1,2 The purpose of this report is to describe a child with coincident Imerslund-Grasbeck syndrome and α-thalassemia, who also had a vitamin B12-sensitive microcytic anemia.
CASE REPORT
When R.S. was 15 months of age his mother reported that progressive anorexia and lethargy had developed. There was no history of chronic diarrhea, vomiting, frequent infections, or pica; there was no family history for blood dyscrasias.
R.S. was a black boy who weighed 8.3 kg (less than the fifth percentile); his length was 74 cm (less than the fifth percentile), and his head circumference was 45 cm (second percentile).
Commercialization of Children's Television and Its Effect on Imaginative Play
Authors:   Committee on Communications
Published: December 2021

Toy-based television programs, commonly known as program-length commercials, and television-activated toys exploit children as consumers. Of more urgent concern is their potential to promote violent and aggressive behavior, increase the intellectual passivity with which children view television, and inhibit imaginative play.1
Almost all of the 20 best selling toys on the market today are based on television programs. More than half of these toys have violent themes. Many glorify war. Clearly, the commercialization of children's television promotes violence as well as sales. It does little to entertain or educate our children.
Television-activated toys take the exploitation of program-length commercials one step further. These toys are activated by inaudible signals broadcast during a program. They are referred to as "interactive," but no descriptor could be more misleading. Although the television affects the toy and the child, no reciprocal interaction occurs.
Television-activated toys represent the third, and potentially most hazardous, phase in the commercialization of children's television. Initially, the promotion of toys on television was limited to commercials. After the toy was purchased, the child decided when and how to play with it. In the next phase, program-length commercials were developed to market toys and to show children how to play with them.
The development of television-activated toys almost completely eliminates the creative role of the child. Children need only to buy the toy; the television will play with it for them.
Parents should consider a child's playtime as an active, creative process that requires imagination. Television-activated toys interfere with this process.
What Is `Significant' and DTP Reactions
Authors: WILKINS JEANETTE 
Published: December 2021

To the Editor.—
I read with interest the article by Hoffman et al.1 The authors conclude from this study that DTP immunization is not a significant factor in the occurrence of SIDS because only five (1.8%) of the case infants died within 24 hours of receiving the DTP vaccine. Their data are welcomed and provide convincing evidence that the DTP vaccine does not contain a potent toxin contributing to infant sudden death.
However, if one assumes that the adverse reaction to the DTP vaccine may result from an immunologic intravascular complexing of particulate antigen (whole-cell or disrupted pertussis organisms) with specific antibody to produce a Jarisch-Herxheimer reaction,2,3 then the adverse reaction may not occur within 24 hours of inoculation.
School Bus Seat Belts?
Authors: LAWS HARRY F. 
Published: December 2021

To the Editor.—
The recently debated issue of whether or not to put seat belts on children riding school buses seems to be gaining momentum and attempts are being made to amass data supporting their usage on grounds of safety. My observation is that safety, although it is important, is not the most important issue today on school buses. Discipline, or lack thereof, is more of an issue. Data already exist to support the use of seat belts to improve children's behavior, and it would seem to me that recommending seat belts on school buses for that purpose makes much better sense and would be rapidly adopted by school officials! Perhaps we need to adjust the thrust of our argument!
Aspirin and Reye Syndrome
Authors: BARAL JIM 
Published: December 2021

To the Editor.—
I read with interest the article by Orlowski et al.1 As a coauthor of the original article on Reye syndrome,2 and as the author of a relevant letter published in the New England Journal of Medicine,3 I was surprised that the authors did not review these previous submissions, in which it was stated that 11 of the 21 patients in the original study were given aspirin before the onset of their syndrome.
Treatable Dystonia Presenting as Spastic Cerebral Palsy
Authors: FINK JOHN K. , FILLING-KATZ MICHELE R. , BARTON NORMAN W. , MACRAE PAULA RAVIN , HALLETT MARK , COHEN WARREN E. 
Published: December 2021

To the Editor.—
Cerebral palsy is a disorder with nonprogressive motor impairment that begins in early infancy and is characterized by spasticity or involuntary movements.1 It is classified according to the primary motor disturbance present (spastic, extrapyramidal, hypotonic, and mixed). Approximately 65% of patients with cerebral palsy have the spastic type.2 The term does not imply a specific cause. Prematurity, anoxia, infection, trauma, and metabolic or other pathologic processes may be responsible in individual patients.
Asthma
Authors: SMITH THOMAS F. , MELTON ALTON L. 
Published: December 2021

To the Editor.—
We would like to applaud the letter by Plaut et al (Pediatrics 1988;81:174) urging that pediatricians not hesitate diagnosing asthma in children whose wheezing is eradicated by antiasthma medicines. Parents may be upset if some of the myths about asthma are not dispelled at the same time. However, parents of children referred to our medical center are often more upset to find that their pediatrician has been giving their child antiasthma medicines for years without calling it asthma.
Physician Reimbursement
Authors: COHEN GEORGE J. 
Published: December 2021

To the Editor.—
In the excellent study of physician reimbursement by Hickson et al (Pediatrics 1987;80:344-350), there seems to be an implication that more health care visits than stated in the American Academy of Pediatrics' guidelines constitute excessive cost and perhaps unnecessary patient-doctor interaction. The suggestion that limiting compensation to just the visits in the guidelines might be a technique of cost control is really self-defeating. The authors have already demonstrated that more well-child visits decrease the number of emergency room visits, which are far more expensive.
Ribavirin Use Questioned
Authors: DASHEFSKY BARRY , WALD ELLEN R. , GREEN MICHAEL 
Published: December 2021

To the Editor.—
The report by McMillan and colleagues1 of the nonpredictiveness of certain clinical and laboratory tests in determining the duration of hospitalization of patients with respiratory syncytial virus adds to our understanding of this important respiratory pathogen. However, we disagree with the authors' implied assumption that ribavirin therapy might be expected to shorten hospitalization and with their concluding recommendation "to institute aerosolized ribavirin therapy for essentially all infants with documented respiratory syncytial virus infection who require hospitalization."1(p26)
Ribavirin Use Questioned
Authors: MCMILLAN JULIA A. , WEINER LEONARD B. 
Published: December 2021

In Reply.—
The concerns of Dashefsky et al regarding the validity of the studies that led to the FDA approval of aerosolized ribavirin for the treatment of patients with respiratory syncytial virus infection are well described in their critical review of those studies.1 We agree that none of those studies provided the kind of conclusive quantification of ribavirin's efficacy that should preclude further placebocontrolled trials. Nonetheless, ribavirin is on the market, and physicians who care for young infants hospitalized with respiratory syncytial virus infection must decide whether and when it should be used.
Physical Examination for Brain Injury
Authors: MARGOLIS PETER , NICHOLS VIRGINIA 
Published: December 2021

To the Editor.—
Rivara et al (Pediatrics 1987;80:579-584) suggest that children without positive clinical findings following head trauma may still be at substantial risk for brain injury. In the abstract of their article, they state, "No clinical findings, alone or in combination, accurately identified all patients with abnormal findings on CT scan."(p579) In particular, the authors noted that, of 51 patients with a Glasgow Coma Scale of 13 to 15, 16 (31%) had abnormal CT findings.
TrophAmine
Authors: HEIRD WILLIAM C. 
Published: December 2021

In Reply.—
The purpose of the study reported in the paper1 to which Zlotkin refers was to evaluate the efficacy of a new parenteral amino acid mixture (ie, TrophAmine) with respect to maintaining "normal" plasma amino acid concentrations and promoting nitrogen retention in low birth weight infants. Because the study was not a controlled trial in which this amino acid mixture was compared with another mixture, a concerted effort was made to avoid drawing conclusions or stating claims regarding the efficacy of this amino acid mixture relative to other mixtures.
Prevention of Lead Poisoning in Children—An Issue for Both Developing and Industrialized Countries
Authors: GUTHRIE ROBERT 
Published: December 2021

To the Editor.—
This is in response to two articles1,2 concerning lead exposure in fetuses and children. Recent evidence has begun to document the threat to the human species of prenatal, as well as postnatal, exposure to low levels of blood lead concentration. Studies in Australia3 and the United States4-6 have described the problem for industrialized countries, and reports from England7,8 and the United States and Kuwait9 have produced evidence for developing countries.
What is particularly disturbing is that the blood levels of prenatal as well as postnatal exposure that have produced permanent deficits in the CNS of children are not much greater than the blood levels found in most of us living in modern, industrialized society.
Congenital Absence of the Hymen Only a Rumor?
Authors: JENNY CAROLE 
Published: December 2021

In Reply.—
The letter from Mor and Merlob in which they note that all of their large group of infants examined for congenital malformations had hymens1 reinforces the fact that congenital absence of the hyman occurs rarely, if at all. If one were to recalculate confidence intervals using their data pooled with the data from our study done in Seattle,2 the expected frequency of congenital absence of the hymen in the population that could allow the inspection of 25,068 and 1,131 infants without finding the malformation would range from .00011 to 0 at the 95% confidence level.
The data from Mor and Merlob's group help put the myth that girls are often born without hymens to rest!
Peripheral Aneurysms in Children—A Link to Trauma
Authors: BAGWELL CHARLES E. , CAFFEE H. HOLLIS , TALBERT JAMES L. 
Published: December 2021

Evaluation of soft tissue masses is a common component of pediatric practice and usually includes adenopathy v soft tissue neoplasia in the differential diagnosis. Recent experience with a young child referred for an enlarging axillary mass, which was found to be an aneurysm of the axillary artery, illustrates the natural history ofthis uncommon lesion and its frequent association with trauma in the pediatric population.
CASE REPORT
A 45/12-year-old boy had a 3-month history of an enlarging right axillary mass. Although the child remained asymptomatic, gradual enlargement of the mass was described. The parents could recall no history of injury to the affected extremity (including arterial puncture for blood gas analysis) but, when questioned further, did describe transient discomfort several months previously when an adolescent sibling had grabbed him suddenly by the upper arm while running alongside and lifted him from the ground when he tripped and fell.
Black Child Care Practices in the Midwest
Authors: WALBURN JOHN N. , PERGAM JEANNETTE M. , PERRY SAMUEL H. , JENSEN JANE 
Published: December 2021

A recent incident involving a shocked first-year pediatric resident who observed a black teenage mother chewing part of a tuna sandwich and feeding the resultant "mush" to her 8-month-old infant stimulated us to look for documentation of various child-rearing practices that were familiar to us from our work with mothers of various ethnic groups.
There is ample literature describing cultural beliefs about disease causation and cure; however, we could find little that described day-to-day parenting behaviors. We surveyed 68 black child care providers in Omaha, concerning their knowledge and use of child-rearing practices for infants (Table).
METHODS
A questionnaire approved by the University of Nebraska Medical Center Institutional Review Board was administered nonrandomly to black care givers by personnel in our pediatric clinics or by public health nurses during home visits.
Pediatric Guidelines for Infection Control of Human Immunodeficiency Virus (Acquired Immunodeficiency Virus) in Hospitals, Medical Offices, Schools, and Other Settings
Authors:   Task Force on Pediatric AIDS
Published: December 2021

Acquired immunodeficiency syndrome (AIDS), the most severe manifestation of infection with the human immunodeficiency virus (HIV), has been diagnosed in more than 900 children younger than 13 years of age throughout the United States as of May 1988, 77% of whom were infected in utero or perinatally secondary to maternal infection. Risk factors for maternal infection include intravenous drug abuse or sexual contact with partners who are intravenous drug abusers or bisexual. The remainder of children, including a high proportion of hemophiliacs, have been infected by blood or clotting factor infusion between 1979 and 1985. In addition, adolescents have acquired infection through sexual activity and intravenous drug use, as well as transfusion of contaminated blood or blood factors.
The criteria for diagnosis of AIDS in children differ in some ways from those for adults, and the most recently published diagnostic criteria (Morbidity Mortality Weekly Report, Aug 14, 1987) include the expanded spectrum of disease, such as recurrent bacterial infections and encephalopathy, as well as including children with presumptive diagnosis of AIDS-associated diseases such as lymphpoid interstitial pneumonitis. There is no accurate estimate of the numbers of infected asymptomatic children or of infected children with milder symptoms that do not meet the criteria for the diagnosis of AIDS. Although most cases of pediatric HIV infection have been identified in New York City, Newark, Miami, and Los Angeles, cases are appearing in other locations. Thus, HIV infection in childhood is becoming more widespread, but in many states it is still rare.
Because the cause of AIDS is a virus transmissible from human to human, pediatric health care workers must adjust infection control guidelines to meet this new threat.
MEDLINE Off-line—A Better Way?
Authors: MENKE JAMES A. , MCCLEAD RICHARD E. 
Published: December 2021

In Reply.—
We can only agree with Desch and Johnson's comments, particularly regarding the rapid changes that are occurring in the on-line database industry. We also agree that for the novice the use of the Grateful Med program in conjunction with the National Library of Medicine's database is probably the best method. However, for those who are not novices or for those who plan to do a great deal of searching, BRS Colleague may be more appropriate.
Medicating Children With Attention Deficit Disorder
Authors: WIENER JERRY M. 
Published: December 2021

To the Editor.—
I read the position statement by the American Academy of Pediatrics, Committees on Children With Disabilities and Drugs (Pediatrics 1987;80:758-760) regarding medication for children with attention deficit disorder. It is encouraging that the American Academy of Pediatrics has undertaken to bring this information to its membership; it is disappointing that, in discussing evaluation and treatment, there was no acknowledgment of any role for the child psychiatrist, even though the vast majority of research into diagnosis and treatment has been done by child psychiatrists and published in the psychiatric literature.
Medicating Children With Attention Deficit Disorder
Authors: COHEN HERBERT J. 
Published: December 2021

In Reply.—
The AAP Committee on Children With Disabilities concurs with several of the issues raised by Dr Wiener. We note the need for counseling for children with ADHD and clearly support referrals to child psychiatrists when these children need psychiatric help. We also agree that working with the family represents a major component of the treatment of children with ADHD.
The selection of drugs such as methylphenidate over antidepressants represents our attempt to focus treatment on the use of this drug for ADHD itself.