Citations

The families of 16 male staff physicians and 26 male residents were studied. All spouses completed the Abidin Parenting Stress Index (PSI) prior to a well-child visit. Home interviews were conducted to identify factors contributing to stress. PSI scores were similar in both groups. The interviews suggested that physician fathers had limited time and energy for parenting. Resident fathers were twice as likely as staff fathers to participate in child care when home. Parenting stress tended to stay the same in 25% of families or increased in 50% of families after residency training.

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).

To test the hypothesis that the frequency of biotinidase deficiency is greater in children with unexplained developmental delay or neurologic abnormalities than in the general population, we studied children seen at a large outpatient clinic over a four-year period who had one or more of these neurologic abnormalities and for whom no specific cause for their abnormalities could be found. The group totaled 274 children (163 boys; 111 girls) whose ages ranged from 2 weeks to 17 years. Characteristics were IQ/DQ, 30 to 70 in the 115 for whom scores were available; 41% had seizures; 15% had sensorineural hearing loss; 54% showed gross motor delay or ataxia; and 27% had decreased muscle tone. One patient with a classical clinical picture of biotinidase deficiency was diagnosed during the study period and was not included in the study. None of the patients with nonclassic findings had a deficiency of biotinidase activity. Our results suggest that biotinidase deficiency does not account for a large proportion of children with unexplained neurologic abnormalities or developmental delay. This does not negate the importance of biotinidase testing in children with clinical patterns specifically suggestive of the deficiency.

Twenty-seven children and adolescents were diagnosed as having astasia-abasia on the basis of a conversion reaction between 1965 and 1979. Follow-up information was obtained by questionnaire or a telephone interview from all but one patient over periods ranging from 5 to 22 years. Twenty-two patients thought that they were in good health, but nine patients had some minor complaints, such as leg weakness or stomach pains. Major symptom substitution had not occurred. No organic illness had been missed. One patient was in psychiatric care, two additional patients seemed to have continued mental problems, and one patient was in jail after having killed his parents.

Follow-up survival and health information were obtained, after a median of 27.5 years, from 132 patients who had been seen originally as children with nephrotic syndrome between 1951 and 1967. Ninety seven patients were alive. Recurring edema or proteinuria, or both, persisted in 15 percent of those still alive. Eight of 11 parous women reported relapses during pregnancy. There was no apparent increase in malignancies, atopic diseases, clinical defects in cell-mediated immunity, or cardiovascular diseases. Twenty two patients (17%) died of renal causes between 3 months and 8 years after the onset of nephrotic syndrome. Steroid resistance was the presenting feature universally predictive of a poor outcome; nine of the 11 such patients died and the other two are now receiving hemodialysis. Hematuria was present initially in 41 percent of the patients who died of renal causes, compared with 14 percent of those still alive. Hypertension was noted on the first examination in 22 percent of those who died of renal causes, compared with 10 percent of those alive.

Hypersensitivity pneumonitis is infrequently reported in children. This article describes a 15-year-old girl who presented with insidious onset of dyspnea and weight loss. A hamster and doves were housed in her bedroom. Chest radiographs showed bilateral nodular infiltrates. Pulmonary function tests showed a restrictive pattern with O 2 desaturation at rest. The diagnosis was substantiated by the presence of precipitating antibody to dove serum and droppings and by clinical improvement, along with marked improvement in pulmonary function test, after the doves were removed from her environment. The importance of making an early diagnosis to prevent debilitating fibrotic lung disease is emphasized. A detailed environmental history is essential.

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.

To study the effect of severe undernutrition on linear growth during adolescence, a report was obtained on the ultimate adult height of 71 patients who had had anorexia nervosa at or before age 16 years. At time of diagnosis (ages 9-16 years) median height percentile was 49; at adult follow-up (ages 18-29 years) the median height percentile was 55. This change favoring growth was statistically significant (p < 0.01). Height percentile was maintained or increased in 45 patients and decreased in 26 patients. In only four patients did it change by more than 20 percentile points downward; in 12 patients height percentile increased by more than 20 points. We conclude that, despite weight loss of up to 45 percent at or before age 16 years, most patients with anorexia nervosa continue to grow in stature according to expected norms.