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Letters from readers

Safer drugs, childhood obesity, and a plan to deliver flu vaccine this season

A toddler likes to wind her hair around her thumb and then suck her thumb.

Disorders associated with international adoptions include fetal alcohol syndrome and ADHD. What type of physician would you recommend for evaluation of a child adopted internationally?

Frank A. Oski, Walter W. Tunnessen, and Catherine Caldwell Brown are remembered by a colleague for their inestimable contribution to this publication.

Because families will call on their child's pediatrician to interpret the results of expanded neonatal screening, it is important to consider the implications of these programs.

Pediatricians have an obligation to aid children and adolescents who are exposed to family alcohol or other drug abuse or dependence. Asking the right questions, showing empathy, and guiding patients and families to available resources are the keys to motivating change.

How you talk to and play with your young child can make a big difference in her language ability, even if she has already been referred for evaluation or therapy because of the pediatrician’s concerns about late talking. Here are some recommendations for promoting development of speech.

This has been a contentious and generally unproductive session of Congress, with little major legislation passed, authorization bills still incomplete, and much attention paid to pushing potentially awkward votes on such issues as keeping the phrase "under God" in the Pledge of Allegiance and reinstating the military draft. Some $145 billion worth of tax cuts sought by President George W. Bush were enacted—without alternative sources of revenue identified. Legislation that would legalize reimportation of prescription drugs from Canada failed to get a hearing.

Once more, the United States doesn't have enough of a vaccine—this time, flu vaccine. Just as the influenza season was about to start, the bad news hit the headlines: The entire output of the California-based Chiron company's influenza vaccine has been condemned by the authorities in the United Kingdom, where Chiron's vaccine, Fluvinir, is manufactured. US authorities had counted on 100 million doses of flu vaccine this year—up from 87 million available last year. About half that amount was to be supplied by Chiron.

You remain concerned that he has a serious problem. Might he have one of the more common diagnoses in a 2-year-old who refuses to walk?

Collecting stool specimens from an infant who has diarrhea is difficult, especially if the stool is watery and soaks into the diaper before it can be collected.

These suggestions are something you can give to patients who seems at first glance to need very little.

Your young patients are more likely to survive to very old age than did previous generations. Will they flourish as senior citizens or be limited by illness and disability? In large measure, that depends on whether their families put into practice the advice you give—advice that comes out of an expanding body of remarkable, illuminating research.

It's time for the closely watched Medical Economics magazine annual survey of physicians' earnings, and—in the latest findings, from 2003—you and your colleagues are once again (almost) at the bottom of the pile.

On October 5, 2004, the United States learned that only half the anticipated doses of influenza vaccine would be available in preparation for the upcoming flu season because Chiron Vaccines, one of only two manufacturers of inactivated influenza vaccine, had its license to manufacture Fluvirin suspended. This may be the most abrupt and untimely interruption of the vaccine supply we have experienced but, as health-care providers for children well know, it isn't the first.

Once more, the United States doesn't have enough of a vaccine—this time, flu vaccine. Just as the influenza season was about to start, the bad news hit the headlines: The entire output of the California-based Chiron company's influenza vaccine has been condemned by the authorities in the United Kingdom, where Chiron's vaccine, Fluvinir, is manufactured. US authorities had counted on 100 million doses of flu vaccine this year—up from 87 million available last year. About half that amount was to be supplied by Chiron.

Not all children with delayed speech are "little Einsteins" or garden variety "late bloomers." Some have a speech-language disorder that will persist unless warning signs are recognized and intervention comes early. Includes a Guide for Parents.

The medical office of the future is here, and it's electronic. Personal digital assistants (PDAs), tablets, and wireless applications are already making significant inroads into daily practice for many pediatricians. Within a few years, every clinician will probably be using them.

Child safety seats are ubiquitous in modern America &#8212 and many are used in dramatically unsafe ways. Used incorrectly, safety seats can harm.

Children who don't talk about high-profile disasters such as the September 11, 2001, terrorist attacks or, before that, the shootings at Columbine High School aren't coping &#8212 they're avoiding. Pediatricians can help them come to terms with their fears.

Here is startling news: Much of what you know about childhood and adolescent vaccines is passing out of date. New vaccines in development and new mortality data mean that recommendations for vaccination against influenza, hepatitis A, meningococcal disease, varicella, human papillomavirus, and rotavirus are on the move.

Going to the movies may be dangerous to children's hearing. A Hawaii-based researcher found that while sound levels in movie theaters do not exceed government safety standards, the volume may still be loud enough to damage hearing.

All terrain vehicles are a clear and constant danger to children. That's the grim conclusion by researchers at St. Louis Children's Hospital. A retrospective review of children admitted to that institution with ATV-related injury revealed a significant increase in the number and severity of injuries over the study period. An abstract of that study was reported at a gathering this week of the Section on Surgery at the AAP 2004 National Conference and Exhibition.

Balancing work, family, and self is a practical skill, not wishful thinking. Pediatricians who fall out of that kind of personal balance can expect a raft of unpleasant consequences in their professional domain: poor clinical communication, worse medical outcomes, more conflict, and more malpractice suits.

Founding board members of the National Meningitis Association (NMA) know all too well the devastating effects of meningococcal disease. Their adolescent or young adult children have either died or suffered permanent disability as a result of the disease. This week, the NMA came to the Exhibit Hall of the AAP 2004 National Conference and Exhibition to encourage pediatricians to educate their patients' parents about meningococcal disease and the benefits of immunization.

Pediatricians who believe they know the latest on sudden infant death syndrome (SIDS) may be in for a surprise. The American Academy of Pediatrics plans to issue a new statement on the syndrome in 2005.

The news this week from the floor of the commercial Exhibit Hall of AAP 2004 National Conference and Exhibition is that the most common allergic reaction has a cure. More than 55 million Americans develop allergic contact dermatitis from exposure to poison oak, poison ivy, or poison sumac (Toxicodendron species) every year. According to a report by researchers at St. Luke's Hospital & Health Network in Bethlehem, Pa., relief with the new soap product of alcohol solubles and anionic surfactants is just 30 seconds away.

You, as a pediatrician, can change the world. Not every time and not with every issue, but political advocacy by AAP members does carry clout in Washington.