Broughton, Daniel D.

Population-based data on vanicella complications are presented using information both from national sample surveys of hospitalizations and physician office visits and from reviews of medical records for all cases occurring within one community (Olmsted County, Minnesota) during a specified period. Acute cerebellar ataxia is the most common neurologic complication of varicella and occurs about once in 4,000 vanicella cases among children younger than 15 years of age. Among adults, varicella pneumonia is the most common complication and results in hospitalization about once in every 400 varicella cases. Overall, varicella accounts for approximately 4,000 hospitalizations and 364,000 physician office visits annually in the United States and represents an important continuing source of childhood and adult morbidity.

Medical records were reviewed for all 173 cases of herpes zoster diagnosed among residents of Rochester, Minnesota, less than 20 years of age during the period 1960 through 1981. The incidence of zoster increased with age from 20 cases per 100,000 person-years in those residents less than five years of age to 63 cases per 100,000 person-years in those aged 15 to 19. Morbidity was less than has been described in adults, as only two patients required hospitalization and no postherpetic neuralgia or other late complications were diagnosed. The single case of subsequent cancer found in 1,288 person-years of follow-up was not significantly different from the number expected based on cancer incidence in the general Rochester population. The incidence of childhood zoster in patients with acute lymphocytic leukemia was 122 times higher than in children without an underlying malignancy. Chickenpox in the first year of life was found to be a risk factor for childhood zoster, with a relative risk between 2.8 and 20.9. Neither chickenpox in the second year of life nor recent vaccinations were found to be risk factors for childhood zoster.

To investigate the concerns of parents, questionnaires were given to the "first 100" parents waiting for their child's pediatric appointment in four different medical settings. They were asked to rate whether they worry "frequently," "occasionally," or "not at all" about 17 physical health issues, 16 psychosocial problems, 7 possible injuries, 4 instances of victimization, and 4 questions about parents' ability to provide discipline, affection, values and financial support. The response rate was 94% ; 89% were completed adequately for analysis. Parental concerns were compared to data from the National Center for Health Statistics about the statistical likelihood of the risks occurring. Ear infections (65%) were the most common health concern, followed by reaction to immunization (57%), common colds (51%), and cancer (50%). The greatest psychosocial concern was about children watching too much television (53%), followed by concerns about the quality of day care (50%). Three-quarters of parents worry about car accidents and 72% worry about abduction of their children. Parents worry significantly about their own contribution to their child's welfare: appropriate discipline (73%), affection (56%), values and being a role model (55%), and financial support (66%). Parents who had not completed high school worried more than parents who had more than a high school education (P < 0.03).

Among 1138 newborns in a Level II nursery, breast-fed and formula-fed infants were comparable in terms of sex, mode of delivery, gestational age, birth weight, and birth temperature. Breast-fed neonates subsequently lost more weight and a greater percentage of their birth weight (mean, 7.4% vs. 4.9%) than did formula-fed infants. Loss of more than 10 percent of birth weight was associated with short gestation and low birth weight and with breast feeding. Birth weight loss of ≥3 percent was associated with a risk of fever (≥37.5°C) among breast-fed and formula-fed infants, but there was no gradient of increasing risk of fever with increasing percentage weight loss beyond 3 percent. After weight loss and other significant variables were adjusted for in a multivariate analysis, breast feeding was not independently predictive of fever. Although breast feeding may be associated with weight loss, it is not prudent to assume that this is the cause of fever in a breast-fed neonate.

Objective. Sexual behavior in children can cause uncertainty in the clinician because of the relationship between sexual abuse and sexual behavior. Consequently, it is important to understand normative childhood sexual behavior. Design. Sexual behavior in 1114 2- to 12-year-old children was rated by primary female caregivers. These children were screened for the absence of sexual abuse. A 38-item scale assessing a broad range of sexual behavior (Child Sexual Behavior Inventory, Third Version) was administered along with the Child Behavior Checklist and a questionnaire assessing family stress, family sexuality, social maturity of the child, maternal attitudes regarding child sexuality, and hours in day care. Results. Sexual behavior was related to the child's age, maternal education, family sexuality, family stress, family violence, and hours/week in day care. Frequencies of sexual behaviors for 2- to 5-, 6- to 9-, and 10- to 12-year-old boys and girls are presented. Conclusions. A broad range of sexual behaviors are exhibited by children who there is no reason to believe have been sexually abused. Their relative frequency is similar to two earlier studies, and this reinforces the validity of these results.