News

A 4-year-old girl refuses to use the toilet anywhere but home

Be wary when a sick infant has an unusual diet, even if she appears well nourished.

Pediatricians need a keen understanding of the variables that influence how phototherapy lowers the bilirubin level and of how to deliver an optimal dose of light.

The frequency of poor school performance among children underscores the importance of identifying and addressing academic difficulty early. That's a job pediatricians can take on during the normal course of care.

Children are especially vulnerable to conditions ranging from mild heat cramps to life-threatening heatstroke. Early intervention and effective education are the keys to preventing disaster.

Medicaid money matters, seeking to restrict emergency contraception, nostalgia for the patient bill of rights

For every issue of Contemporary Pediatrics, the editorial staff and editorial board work to identify topics and authors that we think will provide useful information for you in daily practice. Surveys of pediatricians—conducted by the publisher and by independent organizations that track how well medical publications are read—demonstrate that our efforts across more than 20 years have, in great measure, succeeded.

A 5-month-old girl was brought to the emergency department (ED) 1 day after she had fallen from a countertop swing onto a tile floor. The child had been loosely buckled in the swing when the mother stepped into the next room. The mother heard a crash and the baby crying: when she came back into the room, the baby's 5-year-old sister was trying to disentangle her from the swing. The infant did not lose consciousness, was quickly comforted, and did not vomit. However, the mother noted that the baby's right thigh seemed tender and that a "black eye" was developing on the left lid. The family lived several hours from the hospital and decided to observe the baby during the night and make the trip to the ED the following morning.

As an avid reader of Consultant for Pediatricians, I would like to comment on a recently published case involving an 8-year-old boy with an erythematous left eyelid ("Photo Quiz," January 2005, page 24).

Over the past 5 years, methicillin-resistant Staphylococcus aureus (MRSA) isolates have become widespread throughout the United States as well as the world.1 In some regions, including our own Gulf Coast, MRSA accounts for the majority of S aureus isolates recovered from patients with community-acquired infections.

Web sites that promote anorexia and bulimia are used by a significant number of adolescents with eating disorders, according to a study from Stanford and Lucile Packard Children's Hospital (LPCH) researchers, presented at the Pediatrics Academic Societies 2005 annual meeting.

A vaccine for the human papillomavirus virus (HPV) will likely be available within two to four years and will probably be targeted to preadolescent children. Given the need for the consent of parents to administer the vaccine in that population, parents will play a key role in how widely accepted the vaccine is.

The American Academy of Pediatrics currently recommends that all internationally adopted children be tested for tuberculosis. But repeat testing may be necessary because of a significant number of false-negatives, according to a study presented at the Pediatric Academic Societies 2005 Annual Meeting in Washington, D.C.

Vaccination rates among underserved populations can be improved with a program that provides close individual follow up. A project led by Surabhi Vora, MD, MPH, Pediatric Immunization Program (PIP) Staff, Department of Pediatric Infectious Diseases, University of Chicago, set out to achieve at least 90% on-time adherence to AAP/ACIP immunization recommendations for parts of Chicago's inner-city. Of the 188 children enrolled to date, about 90% are up-to-date with immunizations based on AAP/ACIP guidelines. "This compares with a rate of 69.1% for the City of Chicago, as established by the 2002 NIS for 19-35 month olds, and 56% for African-American children at 13 months of age," said Dr. Vora.

Adolescents who own an alcohol promotional item (API), such as a tee shirt or baseball cap, are one-and-a half times as likely to try drinking alcohol than peers who don't sport such brand-imprinted items, according to a limited study by Dartmouth Medical School researchers. But if such a rise in risk is real, a solution is readily at hand, they say.

There's a perception among physicians in the specialty, according to Lydia Shrier, MD, that, "if they do something in one sphere-say, raise a family &#8212 they are sacrificing something in the other sphere-like their career." But is that true? Not so, she says, in many cases!

Researchers from Boston Medical Center (BMC) and Boston University School of Public Health (BUSPH) have found that low-income families in Boston that rely on food stamps have difficulty purchasing enough high-quality food-in part because of newer food pyramid recommendations for more fresh vegetables and fish in the diet. Proposed cuts in the federal Food Stamp being proposed by the Bush Administration may further put healthy food out of reach for many children in families that rely on this program. More than half of Food Stamp recipients are children.

More isn't always better when it comes to hospital admissions. In a study that controlled for severity of illness, white youth were found to be twice as likely to be admitted to the hospital for a minor illness than minority children.

Annual injuries from backyard trampolines have nearly doubled in the past decade, according to findings of a study by researchers at Rhode Island Hospital and its pediatric unit, Hasbro Children's Hospital. The study reviewed trampoline injuries to children from a sample of emergency departments across the United States.

Sleep-associated deaths are the leading cause of infant death in Arizona-and that state is the source of new information, presented at the 2005 Pediatric Academic Societies Annual Meeting, suggesting that most deaths attributable to SIDS, suffocation, and asphyxiation may be preventable.

Fewer than one in every 1,000 deliveries is stillborn but, of those that are, little is known about survival and neurologic outcome. Currently, the International Liaison Committee is considering a proposal to stop resuscitative efforts after 10 minutes on stillborn babies, even though most respond to resuscitative treatment beyond that time.