Lead POlSO#{241}ii iiIT.7J/7/]/ (:1//(/ ‘(i! ;i Pediatrics in Review Vol 13 No 12 December 1992

EDITOR Robert J. Haggerty University of Rochester School of Medicine and Dentistry Rochester, NY

Editorial Office: Department of Pediatrics University of Rochester School of Medicine and Dentistry CONTENTS 601 Elmwood Ave. Box 777 Rochester, NY 14642

ASSOCIATE EDITOR ARTICLES Lawrence F. Nazarian Panorama Pediatric Group Rochester, NY

443 Child Sexual Abuse ABSTRACTS EDITOR Carol D. Berkowitz Steven P. Shelov, Bronx, NY MANAGING EDITOR 453 Failure to Thrive/Growth Deficiency Jo Largent, Elk Grove Village, IL L$dhiam G. Bithoney, Howard Dubowitz EDITORIAL CONSULTANT Victor C. Vaughan, III, Stanford, CA Harwood Egan EDITORIAL BOARD Moris A. Mgulo, Mineola, NY 461 Lead Poisoning Russell W. Chesney, Memphis, 7N Michael Weitzman and Deborah Glotzer Catherine DeAngelis, Bakimoxe, MD Peggy C. Ferry, Tucson, AZ Richard B. Goldbloom, Halifax, NS 469 Index of Suspicion John L Green, Rochester, NY Robert L Johnson, Newark, NJ John L Green, David M. Tejeda, Alan M. Lake, Glen Arm, MD Lawrence E. Nazarian Frederick H. Lovejoy, Jr, Boston, MA John T. McBride, Rochester, NY Vincent J. Menna, Doylestown, PA Lawrence C. Pakula. Timonium, MD ABSTRACTS Ronald L Poland, Hershey, PA James E. Rasmussen, Ann Arbor, Ml James S. Seidel, Torrance, CA Richard H. SINs, Newark, NJ 460 Inheritance Patterns in Tourette Syndrome Laurie J. Smith, Washington, DC WIlliam B. Strong, Augusta, GA 471 Changes in Laboratory Values During Adolescence: Jon Thgelstad, Greenville, NC Vernon T. Tolo, Los Angeles, CA Alkaline Phosphatase Robert J. Toulouklan, New Haven, CT Terry Yamauchi, Little Rock, AR 472 Changes in Laboratory Values During Adolescence: Morltz N. Ziegler, Cincinnati, OH

Cholesterol EDITORIAL ASSISTANT Sydney Sutherland 472 Cor Pulmonale PUBLISHER 474 Exercise Intolerance American Academy of Pediatrics Errol R. Alden, Director, Department of Education DEPARTMENT OF CORRECTIONS Jean Dow, Director Division of PREP/PEDIATRICS Deborah Kuhlman, Copy Editor

PEDIATRICS IN REViEW (ISSN 0191-9801) Is 488 Erratum owned aid controlled by the American Academy of Pediatrics. It Is published monthly by the American Academy of PedIatrics, 141 Northwest INDEXES Point BIvd, P0 Box 927, Elk Grove VIllage, IL 60009-0927. Statements aid opinions arpreseed in PIcs in Review are those of the authors and not 475 CumulatIve Subject Index necessarily those of the American Academy of Pediatrics or Its Committees. Recommendations included in this publication do not indicate an 489 CumulatIve Author Index ac*alve cotaieofPener*or serve aetanderd of medlcat care. Subscription price 1992: MP Fellow $85; AAP Candidate Fellow $65; AllIed Health or Resident $65; Nonmember or Institution $115. Current single price Is $10. Subscription claims COVER wilbehonoreduplo 12morlhsfromthepublIcon date. “The Knitting Lesson” (ca 1860) by Jean Francois Millet (1814-1875). Second-class postage paid at ARLINGTON Renowned for his peasant palntlnp, Millet In this painting illustrates the HEIGHTS, LIJNOIS 60009-0927 aid at aidlilonal cycles of life and the passing on of shills from one generation to another. - moss #{149}AMERICAN ACADEMY OF PEDIATRICS, One of the major tasks of pediatricians Is to teach parents and children 1992. AN rights reserved. Printed in USA No pert skills to promote health. May we do It as gently and lovingly as this may be duplicated or reproduced without mother teaches her daughter knitting. (From the Museum of ne Ails, permission of the Mierlowi Aowismy of Pel Massachusetts) POSTMASTER: Send address changes to PEDIATRICS IN REVIEW, American Academy of PedIatrics, P0 Box 927, Eli Grove Village, IL ANSWER KEY 60009-0927. _ The prkaing and production 1. D 2. B; 3. E 4. D 5. D’, 6. A 7. D 8. D 9. E 10. A 11. B; 12. C; of Pertrics in Review Is U U 13. E 14. E made possible, in pert by R088 an eduradonal ati from PECATRIC Roes Lordes. EDUCATION PSYCHOSOCIAL PROBLEMS Sexual Abuse

innocence of the perpetrator will be anatomical dolls among professionals in measurement in prepubescent girls. Am I assessed. sexual abuse evaluation. Child Abase Dis Child 1989;143:1366-1368 NegI. 1988;12:171-180 17. American Academy of Pediatrics. Testifying in court is frequently 9. Summit RC. The child abuse accom- Committee on Child Abuse and Neglect. stressful and anxiety-provoking. To modation syndrome. Child Abase NegI. Guidelines for the evaluation of sexual facilitate the process, the physician 1983;7:177-193 abuse of children. Pediatrics. 1991; should review medical notes with the 10. Reinhart MA. Sexually abused boys. 87:254-260 Child Abase NegI. 1987;11:229-235 18. Jenny C, Kirby P, Fuguay D. Genital attorney who issued the subpoena. It 11. McCann J, Voris J, Simon M, Wells R. lichen sclerosis mistaken for child sexual is also helpful for the physician to re- Comparison of genital examination tech- abuse. Pediatrics. 1981;83:597-599 member that he or she is not the one niques in prepubertal girls. Pediatrics. 19. DeJong AR, Finkel MA. Sexual abuse of on trial; rather, the physician is there 1990;85:182-187 children. Curr Probl Pediatr. 1990;20: to rebate the medical findings in a 12. Woodling BA, Heger A: The use of the 489-567 colposcope in the diagnosis of sexual 20. Hobbs CJ, Wynne JM. Buggery in complex case in which undoubtedly abuse in the pediatric age group. Child childhood-A common syndrome of child there will be other experts. Although Abase NegI. 1986;10:111-114 abuse. Lancet. 1986;2:792-796 the physician usually is assigned the 13. Chadwick DL, Berkowitz CD, Kerns DL, 21. McCann J, Woris J, Simon M, et al. role of child advocate, it is important et al. Color Atlas of Child Sexual Abase Perianal findings in prepubertal children Chicago, IL: Year Book Medical not to get caught up in the legal bat- selected for non-abuse: A descriptive Publishers; 1989 study. Child Abase NegI. 1989;13:211- tle, but to remain neutral and advo- 14. McCann J, Wells R, Simon M, Voris J. 216 cate for the truth. Genital findings in prepubertal girls 22. Gellert GA, Durfee M, Berkowitz CD. selected for non-abuse: A descriptive Developing guidelines for antibody testing study. Pediatrics. 1990;86:428-439 among victims of pediatric sexual abuse. Prognosis 15. Jenny C, Kuhns MLD, Arakawa F. Child Abase Negl. 1990;14:9-17 The prognosis for sexually abused Hymens in newborn female children. 23. Davis AJ, Emans SJ. Human papilloma children varies. Studies on adolescent Pediatrics. 1987;80:399-400 virus infection in the pediatric and 16. Goff CW, Burke KR, Rickenback C, adolescent patient. I Pediatr. 1989;115: suicide, depression, and eating disor- Buebendorf DP: Vaginal opening 1-10 ders show a high prevalence of sex- ual abuse in these populations. The medical problems are addressed read- PIR QUIZ iby by the use of antibiotics when ap- 1. Each of the following statements A. Normal anus. propriate; the psychological trauma is about child sexual abuse is true B. Perianal scarring. except: C. Normal hymen. more enduring. Appropriate referrals A. The perpetrator is usually D. Markedly distorted hymen. for counseling should be initiated in known to the child. E. Imperforate hymen. B. Perpetrators are predominantly all abused children. It is hoped that 4. Assuming you encounter the clini- male. cessation of the abuse and involve- cal situations listed below, for C. Developmentally delayed and which one is sexual abuse the ment with therapy will improve the physically disabled children only acceptable explanation? long-term outlook for these children. are increased risk. at A. A 6-year-old girl with a pos- D. Less than 1% of sexual abuse itive VDRL test and fluores- victims are REFERENCES male. cent treponemal antibody E. Accusations of sexual abuse tests. 1 . Green AH. True and false allegations of arising within custody disputes B. A 12-month-old boy with per- sexual abuse in child custody disputes. I are particularly difficult to meal warts. Am Acad Child Psychiatr. 1986;25:449- resolve. 456 C. A 9-year-old girl with bacte- 2. Paradise JE, Rostain AL, Nathanson M. 2. A 6-year-old girl is brought to rial vaginosis. Substantiation of sexual abuse charges your office after disclosing to her D. A 4-year-old girl with Tricho. when parents dispute custody or visitation. teacher that her mother’s boy- monas vaginitis. Pediatrics. 1988;81:835-839 friend “touches my privates.” To E. An 18-month-old girl with 3. Elvik SL, Berkowitz CD, Nicholas E, obtain the most reliable informa- Chiamydia conjunctivitis. tion from the girl, you would do Lipman JL, Inkelis SH. Sexual abuse in 5. You strongly suspect a 7-year-old except: the developmentally disabled: Dilemmas each of the following boy has been sexually abused. A. Explore the allegations pri- of diagnosis. Child Abase NegL 1990; Each of the following statements 14:497-502 vately with the child. regarding your responsibility for 4. Seidel JS, Elvik SL, Berkowitz CD, Day B. Carefully validate the child’s reporting and testifying about responses in a series of sepa- C. Presentation and evaluation of sexual child sexual abuse is true except: misuse in the emergency department. rate interviews. A. You are legally required to re- C. Use open-ended, nonleading Pediatr Emerg Care. 1986;2:157-164 port your concerns. 5. Berkowitz CD. Sexual abuse of children questions. B. You do not need to be certain and adolescents. Adv Pediatr. 1987; D. Record the child’s responses that sexual abuse actually verbatim. 34:275-312 occurred. E. Suggest that the girl draw her 6. Jones DPH, McQuiston M. Inten’iewing C. Failure to report suspected memory of the event(s). the Sexually Abased ChiI#{128}LDenver, CO: sexual abuse may result in The C. Henry Kempe National Center for 3. A 9-year-old girl alleges that her civil action against you. the Prevention and Treatment of Child stepfather had vaginal and anal D. In most states, you can be Abuse and Neglect; 1985 intercourse with her 6 months successfully sued by the re- 7. Sgroi SM, Porter FS, Buck LC. Valida- ago. Anatomic findings consistent ported parties or parents if tion of child sexual abuse. In: Sgroi SM, with penetration by an adult penis sexual abuse of the child is ed. A Handbook of Clinical Inter’ention include each of the following not confirmed. in Child Se.wal Abase. Lexington, MA: except: E. You may be obliged to pro- Lexington Books; 1982:39-79 vide future court testimony. 8. Boat BW, Everson MD. Use of

452 Pediatrics in Review VoL 13 No. 12 December 1992 GROWTH ANi DEVELOPMENT Failure to Thrivi

PIR QUIZ 6. True statements about growth 7. Each of the following has been E. A complete battety of deficiency in infants and children identified as a risk factor for screening tests for biochemical include each of the following growth deficiency except: abnormalities to rube out except A. Poverty. inherited biochemical A. Organic causes should be B. Single parent. abnormalities. rigorously excluded first, C. Feeding problems. 9. Which one of the following would because appropriate therapy D. Prematurity. be inappropriate for the successful will quickly reverse the E. Parental neglect. management of the child with growth deficiency. 8. The clinical assessment of growth deficiency? B. Growth deficiency typically is children with growth deficiency A. Initially attempting to manage defined as a child below the properly includes which one of the problem with frequent fifth percentile on the following? visits on an outpatient basis. standardized growth charts for A. Hospitalization of all children B. Administering a multivitamin both height and weight in the for close observation and preparation that includes zinc absence of constitutional assessment of feeding and iron. delay. patterns. C. Instituting behavioral training, C. Parental growth should be B. The detailing, by history, of a especially with regard to considered in determining typical week’s diet. nutrition and feeding whether a child is growth- C. Careful administration of a techniques. deficient. Denver Developmental D. Instituting family counseling D. Chronic malnutrition usually Screening Test. and intervention as is the immediate cause of D. Careful assessment of the appropriate, with a goal of growth deficiency. child’s nutritional status, maintaining an intact family. E. Rarely is a single factor including triceps skinfold and E. Addressing all factors entirely responsible for growth midarm circumference simultaneously that contribute deficiency. measurements. to the child’s growth deficiency.

ABSTRACT ______Inheritance Patterns in Tourette Syndrome

Tic Disorders In Childhood. Golden 0. The combination of an uncontrol- concordance rate of 53% and for Pediatrics In Review. 1987;8:229-234 lable chronic motor tic disorder with dizygotic twins a rate of only 85%. The Inheritance of Gilles de Ia Tourette’s vocal tics that are manifested by Further evidence for the inherited Syndrome and Associated Behaviors. Pauls D, Leckman J. N Engl I Med. echolalia, coprolabia, or echokinesis predisposition of chronic tic disorders 1986;315:993-997 suggests Tourette syndrome. This is in twins is supported by a concord- Diagnosis of Tourette Syndrome in by far the most serious of the chronic ance rate of 77% in monozygotic Childhood. Lacey D. Chin Pediatr. tic disorders, with a prevalence of 1 twins and 23% in dizygotic twins. 1986;25:433-435 in 2000. Boys are affected three to The Glues de la Tourette Syndrome: The Comment: Recognizing that such Current Status. Robertson M. BrI four times more often than girls. patterns of inheritance exist in the Psychiatr. 1989;154:147-169 As more families are identified spectrum of chronic tic disorders Brief Report: A Prevalence Study of Gilles who have a variety of chronic tic seen in children demands a careful de Ia Tourette Syndrome In North Dakota disorders, an autosomab dominant School-Age Children. Burd L, Kerbeshian history and physical examination of pattern of inheritance with sex- J, Wikenheiser M, Fisher W. JAm Acad the affected individual and near Child Psychiatr. 1986;25:552-553 specific expressions and variable relatives within the family. To penetrance is evident. Of interest is The spectrum of tic disorders in ascertain better the risk of subsequent that in such family pedigrees, more children is neither so uncommon nor children being affected with Tourette fathers are affected with chronic transient that pediatricians can disre- syndrome or the need to provide gard or take lightly a parent’s or motor tics than are mothers, who more often manifest obsessive-compul- other reassuring and appropriate recom- teacher’s observations about a child’s mendations, a careful pedigree sive disorders. In the instance of a involuntary motor movements or analysis must be done. vocal utterances. Rather, such infor- homozygous individual, the mation warrants a more detailed penetrance is about 94% for Tourette syndrome, about 50% for the Fernando A. Guerra, MD, MPH, history about the child and family, San Antonio Metropolitan Health especially as it pertains to other heterozygous individual, and less than 0.3% for normal individuals. District members who have tics or obsessive- San Antonio, TX compulsive disorders, particularly Observations of the Tourette disorder when they are chronic. in monozygotic twins suggest a

460 Pediatrics in Review VoL 13 No. 12 December 1992 I PREVENTION Load Poisoning

A Report to Congress. Atlanta, GA: US Leviton A, Allred EN. The long-term lead poisoning. I Pediatr. 1988;1 12:799- Department of Health and Human SCIVicCS/ effects of exposure to low doses of lead in 804 Public Health Service, 1988; Doc. No. 99- childhood: An 11-year follow-up report. N Watson WS, Hume R, Moore MR. Oral 2966 Engi I Med. 1990;322:83-88 absorption of lead and iron. Lancet. Bellinger D, Leviton A, Waternaux C, Piomelli 5, Rosen IF, Chisoim JJ Jr, Graef 1980;2:236-237 Needleman H, Rabinowitz M. Longitudinal Jw. Management of childhood lead Weinberger ML, Post EM, Schneider T, Helu analysis of prenatal and postnatal lead poisoning. I Pediatr. 1984;105:523-532 B, Friedman J. An analysis of 248 initial exposure and early cognitive development. Rosen JF, Markowitz ME, Bijur PE, et al. mobilization tests performed on an ambula- N Engi I Med. 1987;316:1037-1043 L-line x-ray fluorescence of cortical bone tol)f basis. Am I Dis Child. 1987;146: Centers for Disease Control. Pvensi,zg Lead compared with the CaNa2EDTA test in lead- 1266-1270 Poisoning in Young Children A Statement toxic children: Public health implications. Ziegler EE, Edwards BB, Jensen RL, by the Centers for Disease Control. Atlanta, I’mc Nail Acad Sci USA. 1989;86:685-689 Mahaffey KR, Fomon SJ. Absorption and GA: US Department of Health and Human Shannon M, Graef J, Lovejoy FH. Efficacy retention of lead by infants. Pediatr lies. Services/Public Health Service; 1991 and toxicity of D-penicillamine in low-level 1978;12:29-34 Charncy E, Kessler B, Farfel M, Jackson D. A controlled trial of the effect of dust- control measures on blood lead levels. N Engi I Med. 1983;309:l089-1093 Chisolm ii, Jr. Mobilization of lead by PIR QUIZ calcium disodium ededate: A reappraisal. 10. True statements about the signif- 13. An ideal program for screening Am I Dir Child. 1987;141:1256-1257 icance of blood lead levels in- children for lead poisoning Committee on Environmental Hazards and dude each of the following, should include: Committee on Accident and Poison A. Screening all children in Prevention. Statement on childhood lead A. Lead does not cross the elementary school. poisoning. Pediatrics. 1987;79:457-465 Qy.Slech DA, Weiss B, Cox C. Mobil- placenta unless the maternal B. Measuring blood lead levels blood lead level exceeds _I, if the erythrocyte proto- ization and redistribution of lead over the porphyrin level is less than course of calcium disodium ethylene- 60 g/dL. B. The blood lead level may not 35 p.g/dL diamine tetraacetate chelation therapy. I accurately reflect the total C. Ensuring that all children are Phal7nacol E*7 Ther. 1987;243:804-813 screened once at age 6 Farfel MR, Chisolm JJ, Jr. Health and body burden of lead. C. Children with blood lead 1ev- months regardless of risk environmental outcomes of traditional and els greater than 60 p.g/dL are factors. modified practices for abatement of usually symptomatic. D. Recognizing that elevated residential lead-based paint. Am I Pub D. Children with toxic lead 1ev- eiythmcyte protoporphyrin Health. 1990;80:1240-1245 levels due to iron-deficiency Fulton M, Raab G, Thomson 0, Laxen D, els may not show adverse effects for some time. anemia rule out the probabil- Hunter R, Hepburn W. Influence of blood E. The prevalence of toxic ity of lead poisoning. lead on the ability and attainment of blood levels in children in E. Confirming screening tests children in Edinburgh. Lancet. 1987;l: by blood lead levels per- 1221-1226 the United States exceeds that of any other chronic formed serially. Graziano JH, Lolacono NJ, Meyer P. Dose- disease. response study of oral 2,3.dimercapto- 14. Appropriate management of chil- succinic acid in children with elevated blood 11. Important sources of lead in the dren with elevated blood lead lead concentrations. I Pediatr. 1988;113: environment that may contribute levels include each of the fol- 751-757 to childhood poisoning include lowing, except: Kassner rr, Shannon M, Graef J. Role of each of the following, ercep#{252} A. Identifying the source of lead forced diuresis on urinary lead excretion A. Paint used in house interiors exposure. after the ethylenediamine tetraacetic acid prior to 1977. B. Providing a diet rich in iron, mobilization test. I Pediatr. 1990;117:914- B. City water sources. calcium, and zinc. 916 C. Old houses undergoing C. Removing all lead-based Mahaffey KR, Annest JL. Association of rehabilitation. paint only after the child can eiythrocyte protoporphyrin with blood lead D. Airborne emissions from be removed from the site. level and iron status in the second National smelters and refineries. D. Controlling household dust Health and Nutrition Examination Survey, E. Leaded gasoline. with frequent wet-mopping 1976-1980. Environ Res. 1986;41:327-338 using a high-phosphate 12. The following are false state- Markowitz ME, Rosen iF. Assessment of lead detergent. ments about the long-term ef- stores in children: Validation of an 8-hour E. Administrating chelation fects of lead in children, ercep#{252} CaNa2EDTA provocative test. I Pediatr. A. They do not correlate with therapy onty for asympto- 1984;104:337-341 matic children. the magnitude of the blood Markowitz ME, Rosen JF, Bijur PE. Effects bead bevel. of iron deficiency on lead excretion in B. They are negligible for blood children with moderate lead intoxication. I lead levels less than 25 pg/ Pediatr. 1990;116:360-364 dL Needleman ML, Gatsonis CA. Low-level lead C. They may be significant after exposure and the 10 of children: A mets- fetal exposure to a maternal analysis of modem studies. JAMA. 1990; level of 10 to 15 p.g/dL. 263:673-678 D. They can be prevented with Needleman HL, Gunnoe C, Leviton A, et al. appropriate treatment of Deficits in psychologic and classroom symptomatic children. performance of children with elevated E. They are rare if the child has dentine lead levels.N Engl I Med. been asymptomatic. 1979;300:689-695 Needleman HL, Schell A, Bellinger D,

468 Pediatrics in Review VoL 13 No. 12 December 1992 particularly true in children whose worsen during sleep. pulmonale is made by the ausculta- upper airways are obstructed or those Cor pulmonale is reversible if the tory finding of a very loud, narrowly who have obstructive sleep apnea. A contributory and causative factors can split or single second heart sound. normal sleep state generally is be relieved. If the chronic problem This may be associated with a associated with decreased ventilation. cannot be managed primarily, then palpable impulse. In advanced cases Breathing frequently is irregular and methods to ensure or improve oxygen there may be murmurs of pulmonary unaffected by environmental levels or pulmonary vascular or tricuspid insufficiency. Hepato- factors-much different from the resistance should be attempt- megaly and peripheral edema may waking state. Studies of normal sleep ed. Supplemental oxygen not only occur. indicate a significant decrease in the decreases the level of hypoxemia, but The EKG frequently is used for ventilatory response to CO2 also acts as a pulmonary vasodilator the diagnosis of cor pulmonale. inhalation when compared with the and will lower pulmonary vascular However, it may lag significantly conscious state. Therefore, sleeping resistance. Direct pulmonary behind the development of the states may exacerbate hypoxia and vasodilators also may be tried. clinical picture. With the onset of cor increase right ventricular pressure in Digitalis and diuretics also have been pulmonabe, EKGs are frequently any situation where cor pulmonabe prescribed where evidence for right normal. In time, however, right exists. Conditions causing upper ventricular failure exists. ventricular hypertrophy develops and airway obstruction may especially The clinical diagnosis of cor the frontal plane axis shifts right- ward. Right atrial hypertrophy with typical peaked P waves (P 4I Statement of Ownership, Management and pulmonale) may be seen. One should Circulation not, however, rely on the EKG for (Required by 39 U.S.C. 3685) the diagnosis. Similarly, electro- 1A T.t1 of P.bhc.,i., 10 PUSLICAT1ON NO 2 0.1. of F.g Pediatrics in Review 6 j cardiographic changes toward normal IIIII 09/30/92 3. F. Q#{149}ny of 1u,s No of .sm. Pbh.h.d 35 An..t S,bsc,euo P lag in those in whom cor pulmonale Monthly. January - December A%rnaIy 115.00 has reversed.

4 Co.p4.t Math.g Add..u of K.o. Ofl.cs of P.bkcst,on (5,,..,. Cu,. C..e,. See, ..d ZIP+4 C#{227} M. p.en American Academy of Pediatrics 141 Northwest Point Boulevard, Elk Grove Village. IL 60007 Carl N. Stee& MD S MeI..g Add.s, .f th. H.sdqnsnes of Gs..,I B..ess Offices of ths PbksM (N.. p’wv,) American Academy of Pediatrics Director, Division of Pediatric 141 Northwest Point Boulevard. Elk Grove Village, IL 60007 Cardiologj e s ed [email protected]#{149} M.h,.g Add.,s o PwbI4Pm’. Ides’. s.d Mewg..g #{163}dito (ThU . MUST NOTS, hM.*) Pnbhsh., (N ..d Ckv hd.ant Albert Einstein College of Medicine/ American Academy of Pediatrics 141 Northwest Point Boulevard, Elk Grove Village. IL 60007 Montefiore Medical Center

Robert J. Haggerty. MD Bmn NY University of Rochester. Departieent of Pediatrics, 601 E1mWOOd Avenue. Rochester, NY 14642 Edeo. ..d *k.th... Add,,w j_o Largent Comment: Pediatricians need to American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, IL 60007

, ‘)*,., Uf ‘ . . s, . a. ,m.n , .nsad,,. ,,...g . become sensitive to the early diagno- I , fu,d . th , u d ‘.il .. ,5 ,..* b, s.., *, ithd by sis of cor pulmonale in children who F,a Nims c_ M.li Addrsss exhibit upper airway obstruction pri- American Academy of Pediatrics 141 Northwest Point Boulevard (Non-profit oreanisation under section 501C Elk Grove Village, IL 60007 marily as a result of large tonsils and of_Internal_Revenue_Code) adenoids. After the initial report by Kravath et al (Pediatrics 1977;6: C K.o... 8..dhoAdes. M0fl559S5. d OWe’ S.c.my Ned... O*.ag a. Ned.g Pec.m a. Mo., of Tste$ A,.o,,m of Ss’d.. Mong.g.s 0’ 05w’ S.cw.ti., i95, “ ,. .. 865-871), it became clear that signif- F,m Nese icant enlargement of tonsils and ade- noids resulting in upper airway obstruction can precipitate chronic

a Fo Co,pite. by No.pofn O.genz.ts.. AShOHZSd 1, Ms C Specs ste. (OWN 5ns 424 12 ..1y hypoxia, hypercarbia and, as a result, The psposs. f.ctio.. ...d .op.ofi .*.ns of ,h$s o.e..ution nd ds . smpt stC fe Fsds..I nco. . pw.psss fCb* (1) 2) increased pulmonary vascular resis- J Has Not Chsg.d D...g H.. Chs.qd Du.ng p.bh* ..,e . P.nad.g 12 Mo.nt, P’.c.d.g 12 Me.nt’s -h.s ‘vS & .ww.v) tance resulting in the potential for cor 10 ew New. 01 C.c.IiUe As..gs No Copes E.ch I.... O....g Acne) No Copes of SngI. Iii.. (5,, ,.,,,.(,.. ‘‘‘w .&) Pwc.d.g 12 M.rnh. Pbhhed N.w.,t to Fdg 2,1. pulmonale and significant congestive

A TusiN. 31,940 31,815 failure. Pediatricians, therefore, must

B P#{243}d,.div R.q,t.d Csn,A#{149}t.o. 0 0 be sensitive to this condition, and if 1 Sa4s th.O.gh d..Ie., .ld cs.e.s. ,u.e .s.do,i s.d cowus. SAss

2 Me) S.bscp,’o. the diagnosis of significant upper air- 23,554 24,364 way obstruction is made on this ba- C Tu.IP.d..d/o,R.qw.st.dCnA.t.o. 23,554 24.364 sis, early surgical intervention should 0 s’.. O.eb,so. by Mel. Ces. o. 0th.. Ms..s 0 S.’pls. .“d OtIs. F,.. Copes be considered in light of the potential I Tot.lDosobtno(SesofC,dD) 23,554 24,364 serious sequelae. In the most severe

F Cop.osNotD.swbowd sop sIte p.on’sg 8. 386 7,451 cases cited in the literature, children

O.uIO1uIONO*$Ag.OtS 0 0 have presented as early as 2 and 3 years of age. G 31,940 31,815

I I Sopeso.. od To). of E&.se. Psbksfr*’. s,ooss Mwwg... a. Oo.oo I cirtify thst th. statsmsnts m.d. by ( ,‘ / me sbov. w. correct and coms /: /1.-. tianaging Editor Steven P. Shelov, MD

PS Peon 3526. i.o, 1991 (SftfsS(99w O o’u) Abstracts Editor

Pediatrics in Review VoL 13 No. 12 December 1992 473 ABSTRACT

Exercise Intolerance disease states, must be considered. A group of asthmatic children studied Pediatric Sports Medicine for the sodium is the preferred second-line by Orenstein et ab demonstrated Practitioner. Bar-Or 0. New York, NY: agent. reduced working capacity compared Springer-Verlag, mc; 1983:74,88-108 Exercise Testing in Children. Nixon PA, Just as “all that wheezes is not with nonasthmatic controls. The Orenstein DM. Pediatr Pulmonol. asthma,” all that is exercise-limited subgroup of subjects who participated 1988;5:107-122 cannot always be attributed to in a 4-month running program Exercise Conditioning in Children with asthma. The child’s aerobic exercise showed significant increases in work Asthma. Orenstein DM, Reed ME, Grogan capacity is determined by both the tolerance and cardiovascular fitness Fr, Crawford LV. I Pediatr. 1985;106: 556-560 availability of oxygen to the compared with the asthma patients Cardiovascular Evaluation of the Child and exercising muscle and the muscle’s who did not participate in the Adolescent Before Participation in Sports. capacity to use the delivered oxygen. training program. Driscoll Di. Mayo Clin Proc. 1985;60:867- In addition to the lung’s ability to In summary, the most common 873 provide oxygen to the blood, other cause of exercise limitation in The most common and yet occa- critical factors for oxygen delivery pediatrics is exercise-induced asthma. sionabby overlooked cause of exercise include the heart’s ability to pump However, a much wider variety of intolerance in pediatrics is exercise- oxygenated blood to the working etiologies must be considered in the induced asthma (EIA). Most muscles (stroke volume x heart rate) patient who complains of exercise susceptible individuals require at and the oxygen-carrying capacity of intolerance. An atypical history least 5 to 6 minutes of strenuous the blood (ie, normal hemoglobin mandates an evaluation that should exercise to precipitate an attack. concentration). Bar-Or nicely include exercise testing. Exercise Activities that require short bursts of illustrates, using the Fick principle, testing also may be used to provide energy, such as baseball, rarely cause the various mechanisms leading to proper training regimens to patients EIA. The symptoms classically occur reduced aerobic power. with disease (ie, cystic fibrosis, shortly after completion of the When a patient presents with a asthma). Exercise testing is an activity and include excessive dysp- history of exercise intolerance, a underutilized tool in pediatrics. When nea, wheezing, or cough. Symptoms careful history must be obtained. If ordering an exercise test, it is reach their peak within 5 to 10 atypical symptoms are present, such important to communicate the pur- minutes and recovery is usually as chest pain or syncope, a thorough pose of the test beforehand, because complete by 30 to 90 minutes. Cold, evaluation for cardiac etiologies a progressive test is not the optimal dry air induces more severe attacks should be performed, including test for EIA, and tests directed at the than warm, humid air. The patient’s exercise testing. Although rare, diagnosis of EIA will not be a current state of airway reactivity also exercise may be life-threatening in reliable estimate of cardio- will influence the severity of this group of patients. vascular fitness. response to a similar exercise stimu- In addition to the physiologic Jeffrey M. Ewig, MD lus. Inhaled beta agonists, given 10 causes of exercise limitation, Albert Einstein College of Medicine! minutes before exercise, are the deconditioning, either habitual, Montefiore Medical Center treatment of choice. Cromolyn psychological, or secondary to Bro,u, NY

Pifi Quiz-CME Credit

The American Academy of hours per issue by the American annual credit summary, you must Pediatrics is accredited by the Ac- Academy of Family Physicians. be enrolled in PREP or subscribe creditation Council for Continuing (Terms of approval: Beginning to Pediatrics in Review and return Medical Education to sponsor con- date January 1992. Enduring Mate- the PIR Quiz Card by February 28, tinuing medical education for phy- rials are approved for 1 year, with 1993. PIR Quiz Cards received sicians. As an organization option to request renewal. For spe- after this deadline will be recorded accredited for continuing medical cific information, please consult in the year it is received; with education, completion of the PIR the AAFP Office of Continuing cards from the 1992 PIR journals, Quiz meets the criteria for 2 hours Medical Education.) accepted through December 31, of credit, per issue, of the Ameri- The questions for the PIR quiz 1994. can Academy of Pediatrics’ PREP are located at the end of each arti- The PIR Quiz card is bound into Education Award. dc in this issue. Each question has the January issue. Complete the The American Academy of Pedi- a SINGLE BEST ANSWER. To quizzes in each issue and send it atrics designates this continuing obtain credit, record your answers to: American Academy of Pediat- medical education activity for 2 on the PIR Quiz Card found in the rics, PREP Office, P0 Box 927, credit hours, per issue, in Category January issue, and return the card Elk Grove Village, IL 60009-0927. 1 of the Physician’s Recognition to the Academy. (PREP group par- The correct answers to the ques- Award of the American Medical As- ticipants will receive the PIR Quiz tions in this issue appear on the in- sociation. Card and Self-Assessment Credit side front cover. This program has been reviewed Reply Sheet under separate cover.) and is acceptable for 2 Prescribed To receive CME credit on the 1992

474 Pediatrics in Review VoL 13 No. 12 December 1992 CUMULATiVE SUBJECT INDEX

The following index covers subjects in Pediatrics in Review in Volumes 11 (1989-1990), 12 (1990-1991), and 13

(1992). Each entry includes the volume and page number of the article in which the subject appears. (abs) = abstract Additionally, the index includes subjects addressed in the Self-Assessment (SA) Exercise for 1992. Each entry includes the question number and year in which the subject appears.

A

Abdomen health counseling, 12:344 Aminopeniciblin (amoxicilbin), masses, 11:172, 13:25, 129(abs) hematuria, 11:101 SA92:#37 identification, 12:196 medicine, 13:216, 381 Amniocentesis, 13:334 pain, 13:130 pubertal and psychosocial Amniotic fluid, suction, 13:237(abs) acute, SA92:#285 development, 12:249 Amoxicilbin, sinusitis and, infants and bleeding and, 12:107 substance abuse, 13:314 children, 12:217(abs) functional, SA92:#1 44 Adrenal insufficiency, 13:435; Amphetamine, 13:330 in intussusception, 13:391 SA92:#62 withdrawal, SA92:#42 in torsion of ovary, 13:183 Adrenarche Amphotericin B, 13:152 referred, SA92:#191 premature pubarche, SA92:#1 11 Anal fissures, 13:443 recurrent, 13:397(abs) pubertal and psychosocial Analgesia, pain management, 12:237 trauma, 13:238(abs) development, 12:249 Anaphylaxis, 13:387; SA92:#1 67 Abscess Adenoid hypertrophy, SA92:#300 ANA-see Antibody, antinuclear brain, SA92:#17, #217 Aeromonas, diarrhea, 13:97(abs) Androgen therapy, 13:5(abs) peritonsiblar, 13:74(abs) Afebrile seizures, 13:305 Anemia, 13:55, 461; SA92:#35 retropharyngeal, 12:113 Aganglionic megacolon, SA92:#21 2 aregenerative and aplastic, crisis, tubo-ovarian, 13:216 Aggression, 13:72 12:142 Absence seizures, 13:305 behavior, 13:144 autoimmune hemolytic, 13:469 Abuse, 13:443, 453 children and adolescents, 12:218 cystic fibrosis, in, 13:183 ofdrugs, 13:314 Aging out, 13:224 hemolytic, 13:236(abs) sexual, 13:443 AIDS-see Acquired immuno- hypochromic, 13:55 normal prepubertab female deficiency syndrome iron deficiency, 13:379; SA92:#34 genitalia, 1 1 :30(abs) Airway microcytic, 13:55 physical signs and emotional obstruction, 13:403 perinatal, blood loss and, 12:47 sequelae, 1 1:286(abs) upper physiologic, SA92:#308 Academic achievement, meningitis, obstruction, sleep apnea and, Anesthesia, neonatal, 12: 127(abs) 13:112(abs) 12:373(abs) Angioedema, 13:130, 387 Academic failure, drug abuse, 13:314 Alcohol, 13:381 Animal bites, 13:394(abs) Accutane, 13:364 abuse, 13:314 Anion gap, 13:391; SA92:#156 effects on fetus, 12:282 consumption during pregnancy calculating, SA92:#1 37 Acidosis (point-counterpoint), 12:375 Aniridia, abdominal masses, 12:196 dehydration in infancy, 11:139 use, 13:144 Ankle, 13:429 electrolyte abnormalities, Alkaline phosphatase, 13:471(abs) Anorexia nervosa, 13:43; SA92:#16, SA92:#1 45 Alkabosis, metabolic, SA92:#1 70 #232, #252 renal tubular, 13:391 Allergic rhinitis, 13:323 Antibiotic Acne, SA92:#120 Allergy, 13:312 otitis media and, 11 :238(abs) Acquired immunodeficiency syndrome additives, SA92:#1 66 prophylaxis, 13:355 hemophilia and, 12:275 cow milk Anticonvubsant Acrodermatitis enteropathica, 13:157 celiac disease and, 12:325 drugs, 13:305 Acycbovir, 13:107 dyes, SA92:#166 fetal toxins, 13:364 leukemia and, 12:313 unproven techniques, 12:22(abs) therapy, 13:75 Addiction, 13:381 Alopecia, common causes, 12:25 Antiepibeptic drugs, 13:413 Addison disease, 13:435 Alpha-fetoprotein, 13:334 Antihistamines, 13:23, 387 Adenitis, cervical, 13:113 Alport syndrome, SA92:#43 Antimicrobials Adolescents, 13:224, 471(abs), Amaurosis fugax, adolescents, otitis media and, 11:133, 13:23 472(abs) 12:302(abs) Antinuclear antibody, 13:130 amaurosis fugax, 12:302(abs) Amblyopia, 13:7 Anxiety, 13:381 athletic training, testosterone Amenorrhea, 13:43; SA92:#16 Apgar score, 13:88 response, 11 :283(abs) Amino acids, supplements, 12:103 one minute, CPR, newborn, 12:136 growth curves and height estimates, Aminoglycosides, 13:413 Aplastic crisis, 13:236(abs) 11 :70(abs)

Pediatrics in Review VoL 13 No. 12 December 1992 475 14 1

Apnea, 13:113, 116(abs), 174 septic predisposing factors, 1 1: 100(abs) sleep limb pain, 12:39 respiratory failure, SA92:#1 75 upper airway obstruction and, limping and, 12:268 Ataxia, 13:113 12:373(abs) Aspergilbosis Athlete’s heart, 13:151(abs) Apophysitis, limping and, 12:268 allergic bronchopulmonary, Atbantoaxial Appendicitis, 13:216 SA92:#91 dislocation, SA92:#1 47 acute, 13:49(abs) cystic fibrosis, SA92:#91 instability, 13:35(abs); SA92:#206 diagnosis, SA92:#1 81 Asphyxia Atopy, 13:49(abs) evaluation by ultrasonography, CPR, newborn, 12:136 Atopic disease, 13:312 13:49(abs) perinatal, SA92:#81 Atresia nonperforative, 11 :276(abs) Assessment bowel, 13:50 Apple juice, chronic diarrhea, eight-week, 13:88 esophagus, 13:50 13:399(abs) fifty-two-week, 13:88 vaginal, 13: 129(abs) Arnold-Chiari syndrome, 13:1 16(abs) five-year, 13:88 Attention deficit hyperactivity disorder, Arrhythmia four-year, 13:88 13:37(abs); SA92:#49 cardiac, 13:469 sixteen-week, 13:88 children and adolescents, 12:218 surgical treatment, 12:379(abs) three-year, 13:88 Atypical tuberculosis, 13:371 Artbralgia, limb pain, childhood, 12:39 twenty-eight-week, 13:88 Autism, infantile, SA92:#185 Arthritis, 13:130 twenty-four-week, 13:88 Autoimmune complications, SA92:#33 Asthma, 13:214, 283, 403; SA92:#208 hemobytic anemia, 13:469 juvenile, SA92:#33 acute, short-term corticosteroids in, neutropenia, 11: 125(abs) pauciarticular, SA92:#79 11 :253(abs) Automobile safety, SA92:#1 reactive, 12:10(abs) exercise-induced, 13:474(abs) Autosomal inheritance, 13:138 rheumatoid, limping and, 12:268 pneumothorax, 13:398(abs)

B

Bacteremia, osteomyelitis, 12:292 dysfunctional uterine 13:43, 83 Brachial plexus injuries, 13:77(abs) BAL, lead, 13:461 vaginal, SA92:#47 Brain tumor, cures in childhood cancer, Barbiturates, 13:381 Blindness, meningitis, 13:1 12(abs) 11:311 overdose, 13:395(abs) Blood Branhamella, 13:283 Battle sign, SA92:#55 loss, 13:36(abs) Breast Becbomethasone, 13:323 recombinant erythropoietin, 12:244 disorders, 13:74(abs) Behavior transfusions, in autoimmune health counseling for adolescents, adolescent, 12:218 hemobytic anemia, 13:469 12:344 antisocial, 12:218 Blood cultures self-examination, 13:74(abs) problems, 13:312 indwelling umbilical arterial Breast-feeding Benzodiazepines, 13:381 catheters, 11 :204(abs) and drugs, SA92:#195 Beriberi, 13:185 young febrile child, 1 1:284(abs) failure, 1 1:248(abs) Beta agonists, 13:403 Blood gases, capillary vs arterial, overview, 11:163 Bethanechol, gastroesophageal reflux, SA92:#70 special infant formulas and, 12:55 13: 198(abs) Blood pressure, newborn, SA92:#1 34 vitamin K deficiency and, Bicarbonate, normal levels, SA92:#298 Blow-out fracture, 13:422 12:303(abs) Bicycles, safety helmets, 11:237(abs) Body mass, 13:396(abs) Breast milk, vitamin D-see Milk, Biliary atresia, 11:57 Bone age human neonate, 11:79 growth hormone and short stature, Breath test, celiac disease and, 12:325 Bilirubin, neonatal hyperbiirubinemia 12:355 Breech presentation, 13:237(abs) (commentary), 12:259 pubertal and psychosocial Bronchiectasis, SA92:#1 55 Birth defects, 13:334 development, 12:249 Bronchodilator, wheezing infants, Birth weight Bone aspiration, osteomyebitis 11 :287(abs) bow diagnosis, 12:292 Bronchopulmonary dysplasia, mineral excretion and, Bone marrow SA92:#153, #235 12: 101(abs) failure Bronchospasm, 13:403 special infant formulas, 12:55 neonatal, 12:47 Bruxism, 13:16 very low transplantation, 12:364 Bulimia, SA92:#172 ocular complications, 11:228(abs) Bone tumor, 13:469 indications for hospitalization, skin to skin contact with mother, diagnosis, 12:292 SA92:#1 62 1 1:77(abs) evaluation, 12:333 prognosis, SA92:#1 92 Bleeding, 13:163 Botulism Bulk, dietary, SA92:#133 in hemophilia, 13:183 infantile, SA92:#60 Burkitt lymphoma, childhood, 12:171 intramuscular, hemophilia and, muscle disease 12:275 children, 12:73

476 Pediatrics in Review VoL 13 No. 12 December 1992 I r 2 C

Calciuria, 11:21 Chemoprophylaxis, meningitis, Colitis Calculus, renal, 11:21 13:370(abs) lower gastrointestinal bleeding, Calmette-Gu#{233}rin bacillus, effect on Chemotherapy 12:85 tuberculin test, 13:343 childhood cancer, 11:311 Coma Caloric requirements, SA92:#200 osteosarcoma, 12:333 impending signs, SA92:#48 Cancer pediatrician and (commentary), 12:5 neuron-specific enolase in, hepatocellular, 13:203 Chest pain, pneumothorax, 13:398(abs) 12:312(abs) liver, 13:203 Chest roentgenograms, 13: 196(abs) Commentaries ofbone, 13:49 Child abuse A rare and special privilege, 13:123 pediatrician and (commentary), 12:5 physical abuse, SA92:#1 38 Caring for the child with cancer and prognosis, childhood, 11:311 prevention, 13:64 the family: Lessons learned from Candidiasis, 13:152 guidelines, 12:304(abs) children with acute leukemia, 12:6 Cannulation, 13:239(abs) Childhood asthma, 13:403 Congenital cardiovascular defects, Cantrell’s pentralogy, chest wall Chlamydia infants with Down syndrome, deformities, 11:147 Fitz-Hugh-Curtis syndrome and, 11:99 Carbamazepine, effects on fetus, 12:282 12:319 Guides for record review, 12:131 Carbohydrate intolerance, 13:437(abs) trachomatis, 13:443 Hospital management of indirect Carbon dioxide, sleep, 13:473(abs) Chboramphenicol, 13:413 neonatal hyperbilirubinemia by the Carboxyhemoglobin, 13:295 Chlorhexadine, 13:283 office-based physician, 12:259 Cardiac arrhythmias, 13:469 Choking, current first aid Inpatient care: The general Cardiac surgery recommendations, 12:54(abs) pediatrician’s future, 12:165 neurobogic sequelae, 1 1:255(abs) Chobecystitis, SA92:#1 57 “It” happens, 11:291 Cardiogenic shock, 13:358(abs) Cholelithiasis, SA92:#1 57 “Lethargic” and other adjectives, Cardiopulmonary resuscitation infants, children, and adolescents, 13:363 newborns 12: 136, (commentary) 11:268 Literacy and the pediatrician, 13:36 Cholesterol, 13:471(abs) 11:161, 11:259 Cat scratch disease, 13:371 Chondrodysplasia, chest wall On consulting and being consulted, Cataracts, 13:7 deformities, 11:147 13:124 Catecholamines, urinary, identification Chorionic villus sampling, 13:334 Oral rehydration-Is it really that of abdominal masses, 12:196 Chorioretinitis, toxoplasmosis and, easy?, 11:5 Catheters 12:227 Pediatrician and school readiness, indwelling umbilical arterial, blood Chromosome 11:67 cultures, 11 :204(abs) translocation, SA92:#40 Pediatrician’s response to a stillbirth peripheral venous, inifitration, 22, 13:197(abs) or death of a neonate, 12:163 1 1 : 196(abs) Chromosomal disorders, Klinefelter Pediatrician-The Rodney Cebiac disease syndrome, 13:435 Dangerfield of medicine, 11:69 differential diagnosis, 12:325 Chronic cough, 13:49(abs), 403 1-800: please admit, 12:195 Celbulitis Chronic illness, 13:224 Pickles, pizza, and PREP, 13:3 orbital, SA92:#248, #286 Chronic nonspecific diarrhea, PREP and time-limited certification, perianal streptococcab, 12:248(abs) 13:397(abs) 11:195 periorbitab, SA92:#1 88, #286 Cimetidine, peptic ulcer disease and, Reader’s comments and questions, Central nervous system 12:15 11:1 disease, 13:130 Circumcision, 13:163 Reviewing the pediatrician’s disorders of, 13:157 bleeding, 12:275 personal medical records, 12:133 leukemia, 12:313 Cirrhosis, 13:203 Screening for vision problems in Cephabosporin, SA92:#65, #218 Cbonidine, 13:381 pediatric practice, 13:4 Cerebral cavernous malformation, Cbotrimazole, 13:152 Slowing down, 11:131 incidence and occurrence, 12:24(abs) Clubfoot, SA92:#64 The pediatric hospital consultant, Cerebral palsy, 12:73; SA92:#81, #108 Clumsiness, neurologic signs, 13:125 seizures, 13:305 SA92:#1 07 The pediatrician and the care of Cerebrospinal fluid Coagulation disorders, 13:163 children with malignancy, 12:5 examination, SA92:#245 Cocaine, 13:364 The role of the pediatrician in school obstruction, 13:295 acute intoxication, 11:254(abs) health, 12:69 Cerebrovascular accidents, 13:379 effects on fetus, 12:282; SA92:#99 The satisfactions of pediatric Cervicitis, 13:216 Cognitive practice, 12:99 Cervix development, 13:88 The value of recording telephone cancer, sexually transmitted diseases impairment, 13:461 contacts, 12:372 and, 12:383(abs) “Cold” urticaria, 13:387 Congestive heart failure, 13:33 Chelation, 13:55 Colds, 13:283 Community programs, 13:64 Chemical injuries, eyes, 13:422 Colic, 13:16

Pediatrics in Review VoL 13 No. 12 December 1992 477 I 1

Compartment syndrome, in hemophilia, Polycythemia with congenital heart Cromolyn sodium, nasal, 13:323 13:183 disease, 13:379 Cross-infection, 13:283 Compliance, 13:224 Sibling rivalry, 13:72 Crying, 13:16 barriers to, 13:224 Contact lenses, 13:422 Crigler-Najjar syndrome, jaundice in Comprehensive services, 13:64 Contact sports, SA92:#53 infancy, 11:79 Computed tomography, 13:238(abs) Contraception, 13:216 Cromolyn, 13:403 Conduct disorders, children and Conversion reaction, SA92:#256 Cyanosis, acute SA92:#71 adolescents, 12:218 Convulsions, afebribe, 13:305 Cyanotic congenital heart disease, Condyboma acuminata, 13:443 Coordination, 13:224 13:379 Congenital heart disease, 13:358(abs) Cor pubmonale, 13:1 16(abs), 473(abs) Cystic fibrosis, 13:73(abs), 1 16(abs), Conjunctivitis, SA92:#26 Corneab injuries, 13:422 183, 185; SA92:#5, #7 Consent Coronary artery disease diagnosis, SA92:#61 for treatment, SA92:#128 exercise and lipid profile, dietary management, SA92:#222 informed, SA92:#128 11 :223(abs) gastroesophageal reflux and infant, Constipation Corticosteroids, 13:403 12:371(abs) dietary management, SA92:#1 33 in autoimmune hemobytic anemia, hypoalbuminemia and, 12:384(abs) Hirschsprung disease, 11: 108(abs), 13:469 neonatal manifestations, SA92:#221 13:25 short-term, acute asthma, vitamin K deficiency, 12:84(abs) irritable bowel syndrome, 11 :253(abs) Cystinuria, 11:21 13:397(abs) Cough, 13:438(abs) Cystitis newborn, SA92:#212 chronic, SA92:#203 acute, SA92:#71 Consultation with the specialist Counseling febrile infant, 11:71 Allergy, 13:312 health Cytokines, transfusion, neonates, Behavior, 13:312 adolescents, 12:344 12:298 Eye injury, 13:127 violence, 12:68(abs) Cytomegalovirus, 13:107, 283 Otitis media, 13:23 Couramin, rifampin, 13:354(abs) transmission, SA92:#51 Cover test, strabismus, 13:7

D

Day care, 13:283 gross motor, SA92:#284 Digoxin, 13:413

chemoprophybaxis, 13:370(abs) infants, SA92:# 109, #261 , #284 Diphtheria-tetanus toxoids pertussis infections, 13:354(abs) language, SA92:#83, #272, #288 sudden infant death syndrome and, Deafness, SA92:#272 infant, SA92:#250 1 1 :275(abs) congenital, SA92:#288 plateau or regression in central vaccine Decongestants, 13:23 nervous system disorders, 13:157 risks, 12: 125(abs) topical Diabetes insipidus, SA92:#296 Disability, 13:224 infants, SA92:#266 head trauma, SA92:#296 developmental side effects, SA92:#266 nephrogenic, SA92:#230 early intervention, 12:305 Dehydration Diabetes mebbitus, 13:364; SA92:#234 visible, 13:224 hypernatremic, SA92:#1 84 insulin-dependent 11:239 Discitis, limping and, 12:268 hypertonic, SA92:#184 Diabetic ketoacidosis Disease prevention, health counseling hyponatremic, SA92:#225 dehydration in infancy, 11:139 for adolescents, 12:344 hypotonic, SA92:#225 outpatient management, 11:297 Disseminated intravascular coagulation, infancy, 11:139 Diarrhea, 13:283 13:163 Dental procedures, prophylaxis, in acrodermatitis enteropathica, hemophilia and, 12:275 SA92:#68 13: 157 Diuretics, SA92:#1 70 Depressants, 13:381 acute, 11:6 ototoxicity, SA92:#1 16 Depression bloody, 13:97(abs) Diuretic therapy children and adolescents 12:218 chronic, 13:397(abs) complications, SA92:#304 drug abuse, 13:314 celiac disease and, 12:325 Divorce maternal nonspecific, 13:399(abs) effects on children, 11:197 developmental disability and, immunocompromised host, DMSA treatment, bead, 13:461 12:305 11 :4(abs) Doctor-patient communication, health Dermatomyositis lactose intolerance, 13:437(abs) counseling for adolescents, 12:344 juvenile, 12:117 Diazepam Dobbs, anatomically correct, 13:443 Dermoid cysts, 13:371 rectal administration, 13:413 Down syndrome, 13:35(abs), 334; Desensitization, 13:387 for febrile seizures, 13:298 SA92:#147, #206 Desferrioxamine, 13:55 human milk, 13:413 congenital cardiovascular defects Desmopressin, hemophilia and, 12:275 Diet, 13:312 with (commentary) 11:99 Development diarrhea, 13:399(abs) developmental disabilities Bayley scales of infant, SA92:#20 DiGeorge syndrome, 13: 197(abs) early intervention, 12:305

478 Pediatrics in Review VoL 13 No. 12 December 1992 I . I growth with, 12:164(abs) hypersensitivity, 13:387 Duplication of intestine, 13:50 life expectancy, 12:71(abs) ingestion, SA92:#1 8 Dwarfism, congenital, dysplasias and, recurrence, SA92:#85 interactions, 13:113 12:149 Drowning prevention and public advocacy Dyshormonogenesis, goiter and, 11:190 hypothermia, SA92:#249 initiatives, 13: 314 Dyskeratosis congenita, clinical near, management, SA92:#21 1 testing, 13:314 disorders of neutropenia, 12:208 Drug abuse, 13:314 therapy Dyslexia, 13:231; SA92:#265 cocaine fetal effects, 12:282 Dysmenorrhea, 13:83 effects on fetus, 12:282 treatment programs, 13:314 following pelvic inflammatory conduct disorders and children and Drugs disease, 13:216 adolescents, 12:218 nonsteroidab anti-inflammatory, Dysmorphobogy, 13:364 maternal SA92:#1 73 Dyspepsia, SA92:#267 effects on fetus, 12:291 stimulant, SA92:#49 Dysplasias evaluation by pediatrician, 12:11, DiP immunization schedule, bronchopubmonary-see 282 SA92:#54, #96 Bronchopubmonary dysplasia screening, 12:207(abs) Duane syndrome, 13:7 congenital dwarfism and, 12:149 smokeless tobacco, 12:297(abs) Duchenne muscular dystrophy, Dysuria, 13:443 Drug children, 12:73 dependence, 13:381

E

Ear, middle, otitis media, 11:133 Enolase, neuron-specific, 12:312(abs) Erythropoiesis, erythropoietin role in, Eating disorders, adolescents, 10:37 Enterocobitis 12:244 Edema, in cystic fibrosis, 13:183 lower gastrointestinal bleeding, Eiythropoietin, recombinant, advances, Eczema, SA92:#87 12:85 12:244 atopic, high-risk infants, 1 1 :276(abs) Enuresis, nocturnal and diurnal, Erythroprotoporphyrin test, 13:461 EDTA, penicibbamine, 13:461 differences, 12:167 Escherichia coil, enterotoxigenic, Educational intervention, developmental Environmental hazards, 13:461 SA92:#8 disabilities, 12:305 Epidemiology, 13:283 Esophageal Effusion Epilepsy, 13:75, 305 atresia, SA92:#1 39 exudative, SA92:#239 Epiphysis injury, SA92: #46 pleural, SA92:#239 fractures, 13:429 varices, SA92:#5 transudative, SA92:#239 slipped capital femorab, 13:157 upper gastrointestinal bleeding, Electrocardiogram, cor pulmonale, limping and, 12:268 pediatric patient, 12:107 13:473(abs) Epistaxis, recurrent, 12:213 Esophagitis, 13:174 Electrolytes, metabolism, infancy, EPSOT-lead screening, 13:461 corrosive, SA92:#1 14 11: 153 Epstein-Barr virus, 12:107 Ethanol intoxication, SA92:#1 8 Emancipated minors, SA92:#128 Erb palsy, 13:77(abs) Eustachian tube, otitis media, 11:133 Encephalitis, herpes, 13:107 Erythema Ewing sarcoma, 13:469 Encopresis, SA92:#9, #45 infectiosum, 13:236(abs) evaluation, 12:333 Endocarditis mubtiforme, review, 11:217 limping and, 12:268 etiology, SA92:#283 toxicum, SA92:#307 Exercise prophybaxis, SA92:#68 Erythroblastosis, 13:334 infants, 12:95(abs) subacute, SA92:#283 Erythrocytes, recombinant intolerance, 13:474(abs) Endocrinology, obesity and, 11:43 erythropoietin, 12:244 Exostosis, 13:371 Endometriosis, 13:83 Eiythromycin, pertussis, 13:438(abs) Eye goggles, 13:422 Endometritis, 13:216 Eye injuries,13:422

F

Failure to thrive, 13:391, 453 technique, 13:453 Fifth disease, 13:236(abs) celiac disease and, 12:325 Fetal Fine motor development, 13:88 Family factors, drug abuse, 13:314 alcohol syndrome, 12:282; 13:364 First aid, choking, current Family support services, 13:64 (point-counterpoint), 12:375, 380 recommendations, 12:54(abs) Fanconi syndrome, clinical disorders anomalies Fitz-Hugh-Curtis syndrome, 13:216 of neutropenia, 12:208 causes, SA92:#106 Chlamydia and, 12:319(abs) Fatigue, in Addison disease, 13:435 lead exposure, 13:461 Fixation newborn, 13:88 Fears, 13:16 toxins, 13:364 Fluid Febribe seizures, 13:298 Fetus, drug effects, 12:282 requirements, renal failure, Feeding Fever, leukemia and, 12:313 SA92:#1 13 problems, 13:33 Fibrous dysplasia, 13:371 resuscitation, SA92:#27, #93

Pediatrics in Review VoL 13 No. 12 December 1992 479 I I Flunisobide, 13:323 Forced expiratory volume, 13:403 basilar skull, SA93:#55 Food Foreign body, SA92:#47, #141 stress allergy eyes, 13:422 limping and, 12:268 cow milk, SA92:#309 Formula, infant, special 12:55 Free erythrocyte protoporphyrin, 13:461 hypersensitivity, 13:387 Fracture, 13:429 Fussy infants, 13:16

G

Gait disturbance, 13:113 Genitalia, prepubertal female, Gray baby syndrome, 13:413 Galactosemia, SA92:#21 3 1 1 :30(abs) Grieving, SA92:#205 Gallium scan, osteomyelitis, 12:292 Genitourinary system Griseofulvin, 13:152 Gardnerella, 13:443 disease, febrile infant, 11:71 Group B streptococcal infection, 13:435 Gastroenteritis hematuria, 11:101 Growth, 13:396(abs) acute, documentation of, 12:372 Giardia infection, 13:283 constitutional Gastroesophageab reflux, 13: 1 17(abs), diagnosis, SA92:#44 growth hormone and short stature, 174 treatment, SA92:#44 12:355 cystic fibrosis and infant, Gbomerubonephritis, SA92:#1 15 cystic fibrosis, 13:73(abs) 12:371(abs) Gluten-free diet, celiac disease and, deficiency, 13:453 pH monitoring in, 12:383(abs) 12:325 development and, 13:88 Gastrointestinal bleeding Glycogen storage disease, SA92:#1 23 failure, 13:399(abs) lower, 12:85 evaluation, 11:117 growth hormone for, 12:355 runners, 1 1:62(abs) Glycosylated hemoglobin, SA92:#234 Growth hormone upper, 12:107 Goiter, colloid, 11:184 therapy, SA92:#220 Gastroschisis, 13:50 Gonadal dysgenesis, 13:43; SA92:#24 treatment of short stature, 12:355 Gaucher disease, SA92:#1 23 Gonorrhea, 13:216, 443; SA92:#90 Guillain-Barr#{233} syndrome, 13:113; Genetics, 13:138, 197(abs) Gower sign, 13:391 SA92:#1 79 counseling, SA92:#40 Graft-versus-host reaction, bone Gynecomastia, 13:371 obesity and, 11:43 marrow transplantation, 12:364 pubertal and psychosocial Genital anatomy, 13:443 Granubocytes, transfusions, neonates, development, 12:249 12:298

H

Haemophilus infiuenzae, 13:283 Heart Hematuria laboratory testing, SA92:#161 arrhythmia evaluation, 11:101 meningitis, 13: 1 12(abs) surgical treatment, 12:93(abs) following trauma, SA92:#1 54 rifampin, 13:354(abs) disease Hemihypertrophy, abdominal masses, Half-life, drugs, 13:413 congenital, 13:118(abs), 197(abs) 12:196 Haboperidob, 13:37(abs) failure Hemoglobin dissociation, SA92:#30 Hand-foot-mouth disease, SA92:#197 congenital, 13:118(abs) Hemogbobinopathies, congenital, 12:47 Handicapping conditions, SA92:#205 congestive, 13:33 Hemobysins, 13:469 Handicaps, nutrition and, 11:109 Heat Hemolytic anemia, 13:469 Handwriting, dyslexia, 13:231 exhaustion, SA92:#4 Hemophilia, 13:138, 163, 183, 334 Hay fever, 13:323 stroke, SA92:#4 treatment and risks, 12:275 Head banging, 13:16 Height Hemoptysis, SA92:#1 05 Head circumference, SA92:#21 9 adult calculation, SA92:#302 Hemorrhagic disease of the newborn, Head injury prediction, SA92:#294 13:163, 185 children and adolescents, 12:9(abs) velocity, SA92:#294 Henoch-Schoenlein purpura, 13:130 intracranial trauma, 12:179(abs) Helkobacterpylori Hepatitis, 13:203, 283; SA92:#228 Headache, SA92:#14, #39 gastritis, SA92:#223 chronic active, 13:203 migraine, SA92:#148 peptic ulcer disease, children, 12:15 transfusion-caused, 13:203 Health care Hemangiomas Hepatitis B preschool Spitz nevi and, 11:262 immunization, SA92:#1 24 high-risk, 12:181 Hemarthrosis, hemophilia and, 12:275 occupational exposure, SA92:#1 24 Health supervision, evaluation by Hemachromatosis, 13:55 prophylaxis in newborn, SA92:#77 pediatrician, 12:11, 291 Hemangiomas, 13:371 vaccination, hemophilia and, 12:275 Hearing Hematemesis, upper gastrointestinal Hepatoma, 13:203 impairment, SA92:#272 bleeding, 12:107 Hepatomegaly, SA92:#228 meningitis, 13: 112(abs) Hematocrit Hepatosplenomegaly, SA92:#1 64 boss, sensorineural, SA92:#1 26 normal values, newborn, SA92:#165 Hereditary angioneurotic edema, 13:387 Hematogenesis, spread, osteomyelitis, Hernia, incarcerated, infant, 11:87 12:292 Heroin, SA92:#198

480 Pediatrics in Review VoL 13 No. 12 December 1992 I r Herpes Hydrocephalus, 13:293(abs), 295 Hyperphosphatasia, mental retardation encephalitis, SA92:#1 22 myebomeningocele, SA92:#50 and, 12:126(abs) genitabis, 13:443 secondary to brain stem tumors, Hypersensitivity, treatment, 13:387 simplex virus, 13:107 12: 190(abs) Hypersplenism, 13:55 virus-6, roseola, 12:255(abs) Hydrogen breath test, 13:437(abs) Hypertension, 13:130 zoster, 13:107 Hydrometrocolpos, 13:129(abs) portal, 11:57 Hip Hydronephrosis, 13:25 Wilms tumor, 12:196 congenital dislocation, 11:249 Hydrops fetalis, 13:236(abs); Hyperthyroidism limb pain, 12:39 SA92:#274 tachycardia, sinus, SA92:#78 Hirschsprung disease, 13:25, 50; Hydroxazine, urticaria, 13:387 Hypervitaminosis, 13:185 SA92:#21 2 Hymen, injuries, 13:443 Hyphemia, 13:422 constipation, 1 1 : 108(abs) Hyperactivity Hypoalbuminemia, cystic fibrosis and, Histocytosis X, 13:371 children and adolescents, 12:218 12:384(abs) Hodgkin disease, non-Hodgkin Hyperbibirubinemia, SA92:#227 Hypocalcemia, 13: 197(abs) lymphoma and, 12:171 conjugated, SA92:#41 Hypochboremia, dehydration in infancy, Homovanilbic acid, abdominal masses, hepatitis, 13:203 11:139 12:196 in hemolytic anemia, 13:469 Hypoglycemia Hospitalization infant, SA92:#22 evaluation, 11:117, 309(abs) necessity (commentary), 12:195 neonate, 11:79, 12:259 neonatal, SA92:#227 preparation, 13: 126(abs) (commentary), 13:113 Hypokalemia, SA92:#1 45 psychobogic preparation of children, documentation of, 12:259 dehydration in infancy, 11:139 12:332(abs) sepsis, SA92:#41 electrocardiography, SA92:#1 0 Human immunodeficiency virus (HIV), Hypercholesterolemia, SA92:#1 60 Hyponatremia, SA92:#62 SA92:#80 Hypercyanotic spell, SA92:#1 17 dehydration in infancy, 11:139 exposure, evaluation by pediatrician, Hyperinsulinemia, evaluation, 11:117 factitious,SA92:#207 12:11, 291 Hyperinsulinism, SA92:#1 3 Hypopituitarism, evaluation, 11:117 infection, 13:443 Hyperkalemia Hypoproteinemia, in cystic fibrosis, Human milk, drugs, 13:413 dehydration in infancy, 11:139 13: 183 Human parvovirus B19 infection treatment, SA92:#280 Hypospadias apbastic crisis, 12:142 Hyperbeukocytosis, leukemia and, newborn, 11:37 pregnancy, 11:93(abs) 12:313 Hypothermia, SA92:#244 pregnancy and, 11:115(abs) Hyperlipoproteinemia, SA92:#1 60 treatment, SA92:#249 Hyabine membrane disease Hypematremia, dehydration in infancy, Hypothyroidism surfactant replacement therapy, 11: 139 congenital, SA92:#86 12:261 Hyperoxaluria, 11:21 newborn, 11:15 Hydrocebe, inguinal hernia and, 11:87 Hypotonia, SA92:#108

I

Ibuprofen, overdose, 12:331(abs) vaccination, 13:98 parvovirab, SA92:#274 Idiopathic thrombocytopenic purpura, Immunoglobulin, intravenous, recurrent, 11:180 13: 163 neonates, 12:298 streptococcal, SA92:#276 Iliopsoas hemorrhage, hemophilia and, Imperforate hymen, SA92:#21 , #52 urinary tract, SA92:#215 12:275 Impetigo, etiology, SA92:#271 with leukemia, 12:313 Imipramine, SA92:#268 Index of suspicion, 13:33, 113, 157, Infectious diseases, 13:283 Immediate hypersensitivity, 13:387 295, 391, 469 Infectious mononucleosis, Immune globulin, 13:143(abs) Infancy, 13:16 documentation of, 12:134 administration, SA92:#292 Infant neurobogic complications, SA92:#63 intravenous administration, SA92:#3 inborn errors of metabolism, 11:205 Infertility, 13:216 Immunization, 13:98; SA92:#54, #57, preterm-see Premature infant Ingestion, SA92:#1 14 #110, #204 skin to skin contact with mother, caustic, SA92:#46 incomplete records 1 1:77(abs) heroin, SA92:#198 evaluation by pediatrician, 12:11, Infantile spasms, SA92:#291 tricycic antidepressants, SA92:#268 291 treatment, SA92:#275 Inguinal hernia, acute scrotum and, school entry, 13:98 Infection infant, 11:87 simultaneous administration, adenoviral, SA92:#1 31 Inherited disorders of central nervous 12:83(abs) anaerobic, SA92:#226 system, 13:157 Immunodeficiency chlamydial, 13:216 Injury, 13:429 bone marrow transplantation, 12:364 congenital, SA92:#263 recurrent immunizations, SA92:#57, #277 dental, SA92:#226 evaluation by pediatrician, 12:11, toxoplasmosis and, 12:227 fungus, 13:152 291 treatment, SA92:#292 group B streptococcal, 13:143(abs) Insect venoms, 13:387

Pediatrics in Review VoL 13 No. 12 December 1992 481 I H I Interview, drug abuse, 13:314 increased, diagnosis, SA92:#48 Iron Intestinal obstruction, 13:130; increased in infants, SA92:#1 01 deficiency, SA92:#23 SA92:#1 19 Intraosseous infusions, emergency, anemia, 13:461 management, SA92:#59 1 1:31(abs) fortification, 13:36(abs) Intracranial hemorrhage, hemophilia Intrauterine growth retardation, 13:334 requirements, SA92:#34, #142 and, 12:275 Intussusception, 13:50, 391 Irradiation, cranial, leukemia and, Intracranial herniation, SA92:#135 Iodine, deficiency, 11:190 12:313 Intracranial pressure IQ scores, 13:231 Irritable bowel syndrome, 13:397(abs) Isoniazid, 13:343

J

Jaundice-see Hyperbilirubinemia Juvenile delinquency, 12:218

K

Kalbman syndrome, 13:43 Kidney Klinefelter syndrome, 13:435 Kawasaki disease, disease, 13:130 Klumpke paralysis, 13:77(abs) laboratory findings, SA92:#98 enlargement, 13:25 Knee, 13:429 Kerion, 13:152; SA92:#305 failure, chronic, 11:277 pain, in bone tumor, 13:469 Ketoconazobe, 13:152 stones, 11:21

L

Lactase deficiency, 13:437(abs) complications, 12:313 Lithium, 13:364 Lactation, failure, 1 1 :248(abs) lessons learned from children effects on fetus, 12:282 Lactose (commentary), 12:6 Lithotripsy, nephrobithiasis, 11:21 and formulas, SA92:#269 limping and, 12:268 Liver intolerance, 13:397(abs), 437(abs); pediatrician and (commentary), 12:5 transplantation, 11:57 SA92:#74 Leukocyte, transfusions, neonates, Long QT interval, 13:469 acute diarrhea, 11:6 12:298 Lorazepam, seizure management, Language delay, 13:231 Leukokoria, 13:7 12:31(abs) Lead, 13:461 Lid lacerations, 13:422 Low birth weight, prevention, 13:64 poisoning Limb pain Lumbar puncture, SA92:#245 fetal, 11:318(abs); 12:14(abs) childhood, 12:39 Lying, children and adolescents, 12:218 management, 13:461 osteosarcoma and, 12:333 Lyme disease Learning problems, 13:312 Limb-girdle muscular dystrophy, causative agent, SA92:#94 Left upper quadrant mass, 13:25 13:391 limb pain Legg-Cabv#{233}-Perthes disease Limp childhood, 12:39 limping and, 12:268 examination of children, 12:268 limping and, 12:268 Length growth, 13:88 osteosarcoma and, 12:333 Lymph nodes, 13:371 Lens, 13:422 Lipid storage disease, SA92:#1 23 Lymphoma, non-Hodgkin, 12:171 Leukemia Lipidosis, SA92:#1 64 Lymphadenopathy, 13:371 bone marrow transplantation, 12:364 Lipomas, 13:371

M

Magnetic resonance imaging mitral valve prolapse, 1 1 : 159(abs) suction, 13:237(abs) osteomyebitis, 12:292 pneumothorax, 13:398(abs) Medical record review Mababsorption, 13:185, 437(abs) Marijuana abuse, 13:314 asthma, 13:203 acute diarrhea, 11:6 Mastoiditis, SA92:#1 50, #242 otitis media, 13:355 celiac disease and, 12:325 Maturation, SA92:#201 seizures, 13:75 Malignancy, 13:371 Measles Medical records pediatrician and (commentary), 12:5 immunocompromise, SA92:#1 78 acute gastroenteritis, 12:374 Mallory-Weiss syndrome, diagnosis and immunization, SA92:#1 10 acute pharyngitis, 12:134 management, 12:107 prophybaxis, SA92:#1 78 commentaries, 12:131, 132, 259, Malnutrition, 13:453 transmission, SA92:#1 10 372 Mantoux test, 13:343 Meckeb diverticulum, 13:50 documentation of hospital care in the Marfan syndrome Meconium, office, 12:259 cardiovascular involvement in, aspiration, indirect neonatal hyperbiirubinemia, 12:46(abs) radiologic findings, SA92:#66 12:259

482 Pediatrics in Review VoL 13 No. 12 December 1992 review of, 12:131 Methybmabonic acidemia, SA92:#1 56 Mouth breathing, 13:323 in Program for Renewal of Metocbopramide, 13: 1 17(abs) Movement disorders, Certification in Pediatrics, gastroesophageal reflux, 13:198(abs) drug-induced, SA92:#237 13: 131 Miconazobe, 13:152 prochborperazine-induced, telephone contacts in, 12:372 Microcephaly, SA92:#21 9 SA92:#237 Medication Middle ear effusion, 13: 355 Mucoceles, 13:371 administration to children, 13:195 Migraine Mucosab ulceration palatability, 13:195 adolescents, 12:302(abs) clinical disorders of neutropenia, Melanomas, 13:371 Milk 12:208 Menarche, pubertal and psychosocial cow 13:36(abs) Multiple sclerosis, 11: 13(abs) development, 12:249 enteropathy, celiac disease, optic neuritis and, 1 1:216(abs) Meningitis, SA92:#301 12:325 Munchausen syndrome by proxy, syrup bacterial, SA92:#127, #287 feeding, 6-12 months, 12:187 of ipecac, 12: 180(abs) complications, 13:1 12(abs) human Muscle Haemophi&c infiuenzae, SA92:#161 jaundice (point-counterpoint), disease, 12:73 prophylaxis, 13:370(abs) 12:67 weakness, 12:117 Meningococcab infection, 13:283, vitamin D, 13:185 Muscular dystrophy, 13:116(abs), 391 354(abs) intolerance, 13:437(abs) Myasthenia gravis, 13:38(abs) Mental retardation Minerals children, 12:73 early intervention by pediatrician, excretion Myebomeningocele, 13:1 16(abs), 12:305 bow birth weight infants, 293(abs) Metabolic disorders 12: 101(abs) Myopathy of central nervous system, 13:157 Mitral valve children, 12:73 Metabolism, inborn errors, 11:205 Marfan syndrome and, 11: 159(abs) juvenile, 12:117 Methamphetamine, 13:330 Mother-infant interaction, 13:453 Myringotomy, 13:355 Methemoglobinemia, acquired, Motor development, 13:88 12:72(abs)

N

Nafcillin, bone infections, SA92:#1 96 Nephropathy, IgA, SA92:#97 chronic hepatitis, 13:203 Narcotic agents, SA92:#39 Neural tube, hypothyroidism, 11:15 Nasal eosinophils, 13:323 defects, 13:334 infant development, 13:88 Nasopharyngeal suction, 13:237 (abs) screening for defects, 1 1: 127(abs) seizures, 13:305 Necrotizing colitis, infancy, 11:153 Neurobbastoma, 13:25 shock, 13:358(abs) Necrotizing enterocolitis, SA92:#1 21 identification of, 12:196 Niemann-Pick disease, SA92:#1 64 Neglect, 13:453 pediatrician and (commentary), 12:5 Night waking, 13:16 Neisseria meningitis, 13:370(abs) Neurofibroma, 13:371 Nitrofurantoin, pulmonary reactions, Neonatal Neurofibromatosis, 12:166 12:23(abs) behavioral assessment scale, 13:88 Neurogenic bowel, SA92:#262 Nonstress test, SA92:#28 drug withdrawal, 13:314 Neurobogic development, 13:88 Nontuberculosis adenitis, 13:371 left colon syndrome, SA92:#56 Neuromuscular disease, children, 12:73 Nosocomiab spread, 13:283 pneumonia, 13:435 Neutropenia Nurse home-visiting, 13:64 sepsis, 13:435 clinical disorders, 12:208 Nurse maid elbow, SA92:#36 Neonate leukemia and, 12:313 Nutrition, SA92:#1 42 blood boss, 12:47 neonates, 12:298 cow milk feeding 6-12 months, death (commentary), 12:163 transient, SA92:#72 12:187 Nephritogenic Escherichia coli, urinary Nevi, 13:371 enteral, SA92:#253, #279 tract infection, 11:71 Newborn, 13:163, 237(abs) handicapped child and, 11:109 Nephrotic syndrome, prognosis, abdominal masses, 11:172 obesity and, 11:43 12: 132(abs) cardiopulmonary resuscitation, parenterab, SA92:#253 12: 136

0

Obesity, 13:144, 396(abs) Obstructive lung disease, Opioids, pain management, 12:237 morbid, SA92:#12 13:473(abs) Oppositional defiant disorder nutrition and, 11:43 Omphabocebe, 13:50 children and adolescents, 12:218 Obstruction Oncogenes, cancer and the Optic neuritis, multiple sclerosis and, intestinal, SA92:#59, #285 pediatrician (commentary), 12:5 11 :216(abs) renal, SA92:#129 Ophthalmologic abnormalities, Oral contraceptives, 13:83 uteropelvic junction, SA92:#1 29 SA92:#21 3

Pediatrics in Review VoL 13 No. 12 December 1992 483 I ‘4 :: ;H#{149} 1 Orchiopexy, undescended testis Osteomyelitis chronic, SA92:#168, #238 and, 11:305 diagnosis, 12:292 complications, SA92:#242, #287 Organophosphates, SA92:#1 74 evaluation, 12:333 pathophysiobogy, 11:133 Osgood-Schbatter disease, 13:429; limping and, 12:268 peribymphatic fistulas and, SA92:#1 25 pathogen, SA92:#202 12:35 1(abs) limping and, 12:268 treatment, SA92:#1 96 recurrent, 13:23 Osmolality Osteosarcoma, 13:469 secretory, antibiotic treatments, serum, calculation of, SA92:#21 4 evaluation, 12:333 11 :238(abs) Osteochrondritis dissecans, 13:429 Otalgia, 13:355 Ovary, torsion of, 13:183 Osteochondromas, limping and, Otitis externa, SA92:#31 Overdose, opiate, SA92:#69 12:268 Otitis media, 13: 199(abs), 355; Oximetry, SA92:#30 Osteogenic sarcoma, 13:469 SA92:#26, #150, #180 Oxygen desaturation, 13:116(abs) limping and, 12:268 acute, SA92:#293 Oxygenation, 13:473(abs)

P

Pain, 13:429 school readiness and Phototherapy, jaundiced infant, chest, SA92:#2 (commentary), 11:67 11:79 in knee, referred from hip, 13:157 Pediatrician’s perspective Physical growth, 13:88 management, 12:237 Observations of a junior Pilomatrixomas, 13:371 postoperative pediatrician, 11:35 Pimozide, 13:37(abs) management in children, Odd thoughts on webb-child care, PKU-see Phenylketonuria 12:237 11:227 Pneumatoscopy, 13:355 recurrent abdominal, SA92:#144 Peer factors, drug abuse, 13:3 14 Pneumomediastinum, 13:398(abs) Pancreatic Pellagra, 13:185 Pneumonia enzymes, SA92:#222 Pelvic examination, 13:43 bacterial, SA92:#75 exocrine, SA92:#76 Pelvic inflammatory disease, 13:216 causes, SA92:#273 insufficiency, in cystic fibrosis, contraception, 13:216 mycoplasma, SA92:#303 13:183 Penicillin V, SA92:#1 02 presentation, SA92:#191 Pancreatitis, 13:32(abs) Peptic ulcer, 1 1 : 138(abs) Pneumothorax, 13:398(abs) Panic disorder, 13:381 causes in children, 12:15 Point-counterpont, 11:261, 12:35, Papanicolaou smear, SA92:#1 77 upper gastrointestinal bleeding 67, 379, 13:36 Papillomas, laryngeal, 1 1 : 132(abs) pediatric patient, 12:107 Poisoning, SA92:#259 Papular acrodermatitis, 13:203 Percentile charts, 13:396(abs) carbon monoxide, 13:6(abs), 295 Paracentesis, abdominal trauma, Periactin, urticaria, 13:387 dermatitis, SA92:#247 13:238(abs) Peribymph fistulas, infants and fetal, 12:14(abs) Parasitology children, 12:351(abs) organophosphate, SA92:#1 74 toxoplasmosis and, 12:227 Periodontal disease, SA92:#226 Poland’s syndrome, chest wall Parathyroid absence, 13:197 (abs) Perirectab abscess, leukemia and, deformities, 11:147 Parent-child centers, 13:64 12:313 Polyarteritis nodosum, hepatitis, Parenteral, alimentation, SA92:#1 04 Pertussis, 13:283, 438(abs) 13:203 Parotitis, SA92:#1 83 Pets, 13:283 Polycythemia, 13:379 Paroxysmal crying, 13:16 Pharmaceutical manufacturer, neonatal, SA92:#227 Partial complex seizures, 13:305 pediatrician and (commentary), Pobycystic ovarian syndrome 13:43 Partial thromboplastin time, 13:163 12:323 Polyhydramnios, 13:50 Parvovirus, 13:236(abs) Phamacokinetics, 13:413 Polymerase chain reaction, 13:138 Pasteurella infection, 13:394(abs) Pharmacology, children, 13:413 Polymyalgia rheumatica, 13:203 Patella, 13:429 Pharyngitis Polymyositis

. subluxation, limping and, 12:268 differential diagnosis, SA92:#1 51 children, 12:73 Patelbofemoral pain, 13:429 medical record documentation, juvenile, 12:117 Peak expiratory flow rate, 13:403 12:134 Positive end-expiratory pressure Pectus carinatum, chest wall streptococcal, SA92:#102, #151 (PEEP), SA92:#190 deformities, 11:147 antigen detection test for, Posterior urethral valves, SA92:#306 Pectus excavatum, chest wall 12: 13(abs) Potassium deformities, 11:147 Pharyngoconjunctival fever, daily requirements, SA92:#260 Pediatrician SA92:#1 31 effect on acidosis, SA92:#145 inpatient care, 12:165 Phenobarbitab, 13:298, 413 Potassium iodide, 13:152 pharmaceutical manufacturer and refractory status epilepticus and, Preauricular tags, 13:371 (commentary), 12:323 1 1:238(abs) Prepubertab children, 13: 151(abs) response to neonatal death Phenylketonuria, SA92:#241 Pregnancy 13:43, 216 (commentary), 12:163 Phenytoin, 13:413 alcohol consumption (point- counterpoint), 12:375

484 Pediatrics in Review VoL 13 No. 12 December 1992 I

ectopic, 13:216 Protein intolerance, SA92:#309 Pulmonary Prematurity, fluid management in, Prothrombin time, 13:163 disease, exercise, 13:474(abs) 11:153 Pseudostrabismus, 13:7 function tests, 13:403; SA92:#243 Prenatal diagnosis, 13:138, 334 Pseudotumor cerebri, SA92:#1 94 Pubsus paradoxus, 13:403 DNA, 13:138 Psoriasis Pupibbary response, infants, Prenatal screening, medical-legal dermatitis atopic, SA92:#15, #297 SA92:#255 liability, 11: 146(abs) Psychosocial Purpura, 13:130 PREP, Pediatrics Review and adjustment, 13:224 Pyebonephritis, febribe infant, 11:71 Education Program, 11:195 development, 13:88 Pyboric stenosis pickles, pizza, and (commentary), Puberty, SA92:#210 congenital or acquired, 13:3 delay, boys, 13:5(abs) 11 :296(abs) Primary care, 13:224 precocious, 11:229 diagnosis and management, Progressive systemic sclerosis, psychosocial development and, 11:292 SA92:#231 12:249 fluid management, infancy, Prolonged QT interval, 13:469 Public Law 142, developmental 11:153 Prophybaxis, rifampin, 13:354(abs); disabilities, early intervention, Pyogenic granuloma, 13:371 SA92:#1 36 12:305 Pyrazinamide, 13:343 Propranobob, 13:413 Public Law 99-457, developmental Pyrimethamine, toxoplasmosis and, Prostaglandins, 13:83 disabilities, early intervention, 12:227 12:305 Q

QT interval, prolonged, 13:469 R

Rabies, SA92:#118 tubular acidosis, 13:391 Retinal detachment, 13:422 Ranuba, SA92:#67 tumor, 13:25 Retinoblastoma, 13:7 Radiography, osteomyelitis, 12:292 Repetitive movements, 13:16 beukokoria, SA92:#1 40 Reactive airways, 13:403 Respiratory distress Retinol, 13:185 Reading syndrome, SA92:#270 Retinopathy of prematurity, development, 13:231 surfactant replacement therapy, 12: 106(abs); SA92:#1 03 disability, 13:231 12:261 Retrovirus, SA92:#80 Rectal bleeding, infants and children, Respiratory disturbance, Reye syndrome, SA92:#6 12:85 13: 1 16(abs) Reye-like syndrome, 1 1 : 1 16(abs) Recurrent abdominal pain, Respiratory failure, SA92:#1 75 Rhinitis, 13:323 13:397(abs) Respiratory infection Rhinovirus, 13:283 Reflex sympathetic dystrophy otitis media, 11:133 Rickets, 13:185; SA92:#290 syndrome, recurrent, 11:180 Rifampin, 13:283, 343, 354(abs); children and adolescents, Respiratory syncytial virus SA92:#1 36 12: 102(abs) recurrent wheezing and, Ringworm, 13:152 Rehydration 12:63(abs) Risk factors, 13:64 acute diarrhea, 11:6 Respiratory tract disease, bower, Rock music, 13:144 oral (commentary), 11:5 13: 196(abs) Rocky Mountain spotted fever, gastroenteritis, 12:372 Restriction fragment length SA92:#233 Renal polymorphisms Roseoba, herpes virus-6 and, aplasia, SA92:#5 hemophilia and, 12:275 12:255(abs) disease, SA92:#43 Resuscitation Rotavirus, 13:283 failure, 13:130; SA92:#113 newborn, 12:94(abs) Rumination, 13:174

S

Sabicylate, SA92:#209 School failure, prevention, 13:64 Screening poisoning, 13:33 School health, pediatrician in developmental, SA92:#20, #149, Salmonelbosis, SA92:#29 (commentary), 12:69 #186, #236 Salpingitis, 13:216 Scleroderma, SA92:#231 developmental disabilities early acute, 13:216 Schwachman syndrome, 11 :68(abs) intervention, 12:305 Sandifer syndrome, 13:174 clinical disorders of neutropenia, illicit drug use, 12:207(abs) Sarcomas, 13:371 12:208 lead, 13:461 Scabies, SA92:#297 diagnosis of celiac syndrome and, newborn, SA92:#213 School 12:325 preschoolers high-risk, 12:181 absenteeism, 12:1 16(abs) vision problems (commentary), 13:4

Pediatrics in Review VoL 13 No. 12 December 1992 485 IM

visual acuity test, SA92:#224 Sickle cell Stillbirth, pediatrician’s response Scrotum, acutely painful, 13:295 disease, 13:33, 334 (commentary), 12:163 Scurvy, 13:185 inheritance, 13:138 Stings, insect, SA92:#1 67 Sebaceous cysts, 13:371 Sinusitis, SA92:#146, #248, #281 Storage disease, SA92:#1 64 Sedatives, 13:381 infants and children, 12:217(abs) Strabismus, 13:7 Seizures, 13:75 Sleep Streptococcab perianal disease, rectal afebribe, 13:305 decreased ventilation, 13:473(abs) bleeding and, 12:248(abs) cardiac causes, 13:469 disturbance, 13: 1 16(abs) Streptococcus pyogenes, 13:283 febribe, 13:298 problems, 13:16 Streptomycin, 13:343 lorazepam, 12:31(abs) Smog, asthma, 13:403 Stridor, 13:113; SA92:#176, #254, neonatal, SA92:#1 63 Smoking, SA92:#32, #289 #258, #282 Self-esteem asthma, 13:403 Subcutaneous tumors, 13:371 conduct disorders and passive, 1 1 :62(abs) Subluxation, radial head dislocation, children and adolescents, 12:218 Sodium, fractional excretion of, SA92:#36 Separation anxiety, 13:16 SA92:#84 Substance abuse, 13:314, 381; Sepsis Sodium vabproate, 13:298 SA92:#69 clinical disorders of neutropenia, Soft neurobogic signs, 13:231 gonadal function and, 1 1 : 144(abs) 12:208 Solid food, SA92:#299 screening, SA92:#19 granubocyte transfusions and Sonography, 13:334 Sudden infant death syndrome neonates, 12:298 Sorbitob, diarrhea, 13:399(abs) diphtheria-tetanus toxoids-pertussis infant, 12:330(abs) Speech and, 11:275(abs) leukemia and, 12:313 and language problems, 13:119(abs) Suicide, 13:144 newborns, 13:163 delayed, hearing impairment, Sulfonamide Sequestration, SA92:#264 SA92:#82 cystitis, SA92:#88 crisis, 13:33 Spinal cord dysfunction, SA92:# 187 prophybaxis, otitis, 13: 199(abs) Serum sickness, hepatitis, 13:203 Spiramycin, toxoplasmosis and, 12:227 Supernumery nipples, urinary tract Sex chromatin anomalies, 13: 119(abs) Spirometry, SA92:#243 abnormalities and, 1 1 :145(abs) Sexual abuse-see Abuse, sexual Spitz nevi, 13:371 Surfactant, Sexual maturation 13:43, 88 hemangiomas and, 11:262 replacement therapy, 12:261 Sexual orientation, SA92:#199 Spleen, injury, 1 1 :260(abs) therapy, SA92:#270 Sexuality, 13:144 Splenomegaby, 13:25, 55 Surgery Sexually transmitted diseases, 13:216, Spondybitis, ankybosing, SA92:#79 corticosteroids, 13:403 443 Sporotrichosis, 13:152 psychologic preparation of children, cervical cancer and, 12:383(abs) Sports medicine, 13:474(abs) 12:332(abs) maternal anabobic steroids, 12:103 preparation, 13: 126(abs) evaluation by pediatrician, 12:11, Stanozobol, angioedema, 13:387 Sweat electrolytes, in cystic fibrosis, 291 Staphylococcus, 13:183 Shigella, 13:283 infection, 13:283 Sweat testing, SA92:#1 52 Shock, SA92:#27, #93 osteomyebitis, 12:292 Syncope Short bowel syndrome, 13:185 Staphybococcal scalded skin syndrome cardiac causes, 12:62(abs); 13:469 Short stature (SSSS), SA92:#89 Syndrome of inappropriate boys, 13:5(abs) Status epibepticus, 13:298 antidiuretic hormone secretion causes, SA92:#24 refractory, phenobarbitab for, (SIADH), SA92:#38 genetic 11 :238(abs) Synovitis growth hormone and, 12:355 Stealing, children and adolescents, limping and, 12:268 Shunt 12:218 toxic malfunction, 13:295 Steroids, 13:130 diagnosis, 12:292 ventricuboperitoneab, 13:295 anabolic, SA92:#92 Syphilis, 13:443 Siabadenitis, SA92:#1 83 athletic performance and, 12:103 Systemic bupus erythematosus, Sibling rivalry, 13:72 SA92:#11, #132 juvenile dermatomyositis, 12:117

T

Tabipes equinovarus, SA92:#64 children’s medicine, 13:195 Teratogenic effects, rifampin, Tanner stages, SA92:#58 Tebogen effluvium, abopecia 13:354(abs) pubertal and psychosocial differentiation, 12:25 Terfenadine, 13:323 development, 12:249 Temporomandibubar joint, Testes, torsion, 13:295 Technetium bone scan, dysfunction, 1 1 : 14(abs) Testicles, abnormalities in Klinefelter osteomyelitis, 12:292 Teratogens, 13:364 syndrome, 13:435 Television, 13:144 Teratogenesis, effects on fetus, Testicular Technical tips 12:282 self-examination, 13: 1 15(abs)

486 Pediatrics in Review VoL 13 No. 12 December 1992 I . torsion, 13:295 Thyroxine, hypothyroidism in Transibbumination, fiberoptic, of appendix, 13:295 newborn, 11:15 13:239(abs) tumor, 13: 115(abs) Tics, 13:37(abs) Transition to adulthood, 13:224 Testis, undescended, orchiopexy Tinea Transplantation and, 11:305 capitis, 13:152 liver,11:57 Testosterone abopecia differentiation, 12:25 Tranquilizers, 13:381 athletic training and, adolescents, corporis, 13:1552 Trauma, SA92:#154, #251 1 1 :283(abs) crusis, 13:152 eyes, 13:422 therapy, 13:5(abs) pedis, 13:152 Traveler’s diarrhea, SA92:#1 71 Tests, drug, SA92:#1 9 versicobor, 13:152 Trendelenberg sign, 13:391 Tetany, 13:185 Tobacco, SA92:#257 Trichomonas vaginalis, 13:443 Tetraobogy of Falbot, SA92:#1 17, smokeless, adolescents and, Trichotilbomania, abopecia #169 12:297(abs) differentiation, 12:25 Thalassemia 13:55 Tocopherol, 13:185 Tricyclic antidepressants, SA92:#268 Thalidomide, effects on fetus, 12:282 Tonsilbar hypertrophy, SA92:#300 Triglycerides Thelarche cor pulmonabe, 13:473(abs) cebiac disease and, 12:325 pubertal and psychosocial Torticollis, 13:174 medium-chain development, 12:249 congenital, treatment, SA92:#1 59 special infant formulas, 12:55 Theophylline, 13:403, 413 Tourette syndrome, 13:37(abs), Trimethoprim-sulfamethoxazole, toxicity, drug interactions, 13:113 460(abs) SA92:#1 71 Therapy, chronic, complications, Toxicity Trisomy 21, developmental disabib- SA92:#1 89 anabobic steroids, 12:103 ities, early intervention, 12:305 Thermoregulation, SA92:#244 chioramphenicob, SA92:#73, #229 Truancy, conduct disorders and, Thrombocytopenia, 13:163; furosemide, SA92:#1 16 children and adolescents, 12:218 SA92:#1 30 theophybline, SA92:#208 Trypsinogen, deficiency, cebiac Thromboembobism, hemophilia and, Toxoplasmosis, risks to fetus, disease and, 12:325 12:275 12:227 Tube feeding, SA92:#279 Thumb sucking, 11 :304(abs), 13:16 Tracheoesophageab fistula, 13:50; Tuberculin test, 13:343 Thymus absence, 13: 197(abs) SA92:#1 39 Tuberculosis, 13:343, 354(abs) Thyrogbossab duct cysts, 13:371 Tracheomabacia transmission, 13:283 Thyroid ventilation in, SA92:#189 Tuberous sclerosis, SA92:#216 carcinoma 12:363(abs) Transfusions, 13:55 Tumors of skin, 13:371 cyst, SA92:#182 granulocytes Turner syndrome 13:43; SA92:#25 disease, during pregnancy, 11:15 neonates, 12:298 growth hormone and, 12:355 tumor, SA92:#182 recombinant erythropoietin, Tympanometry, 13:355 Thyroiditis, adolescent, 11:184 12:244 Tympanostomy tubes, 13:23, 355

U

Ultrasonography, 13:32(abs), Urethritis, SA92:#90 Urine testing, drug abuse, 13:314 49(abs) Urinary tract Urobogic problems, myebo- pelvic, 13:216 abnormalities, supernumery meningocebe, 13:293(abs) testicular torsion, 13:295 nipples and, 1 1 : 145(abs) Urticaria, 13:387 Upper respiratory tract infections, infection, 11:71 Uvubitis, SA92:#1 12 13:283 Urine, orange color, 13:354(abs)

V

Vaccine Vaginosis, 13:443 VATER association, SA92:#5 diphtheria-tetanus toxoids- Valium, febrile seizures, 13:298 Ventriculoperitoneal shunt, 13:295 pertussis, 13:98 Vabproic acid, 13:364 Vermont Children’s Forum 13:64 Haemophilus inJluenzae, 13:98 Vancomycin, 13:413 Vertigo, SA92:#100 hepatitis, 13:203 Vanilbylmandelic acid, abdominal Vesicoureterab reflux, urinary tract hepatitis B, 13:203 masses, 12:196 infections, 11:71 influenza, 13:98 Varicebla, 13:107 Violence, 13:144 meningococcal, 13:98 leukemia and, 12:313 counseling, 12:68(abs) MMR, DTP, and OPV, maternal, 1 1 :152(abs) Visual impairment, dyslexia, 13:23 1 12:382(abs) -zoster virus, 13:283 Vitamin A, 13:364 pertussis, 13:98 Varioceles, treatment, 1 1 :310(abs) fetal effects, 12:282 pneumococcab, 13:98 Vascular ring, SA92:#258, #282 intoxication, 1 1: 126(abs) rubella, 13:98 Vascubitis, 13:130 Vitamin D Vaginal discharge, 13:443 juvenile dermatomyositis, 12:117 deficiency, SA92:#290

Pediatrics in Review VoL 13 No. 12 December 1992 487 I . #{149} #{149} . I Vitamin K Vitiigo, in Addison disease, 13:435 von Willebrand disease, 13:163; deficiency Volvulus, 13:50 SA92:#278 breast-fed infants, 12:303(abs) Vomiting, 13:174; SA92:#295 Vulnerable child syndrome, SA92:#240 Vitamins, 13:185 in intussusception, 13:391 fat soluble, SA92:#143 w

Walking, SA92:#284 Weight increase, 13:88 Wilms tumor, 13:25 Warts, 13:371 Weight velocity, fetal, SA92:#246 identification of, 12:196 Water, metabolism, infancy, 11:153 Wheezing, 13:403 pediatrician and (commentary), Weakness, 13:113, 474(abs) infants, bronchodilator treatment, 12:5 in Addison disease, 13:435 1 1:287(abs) Writing reversals, 13:231 Wechsler intelligence test, 13:231 recurrent, asthma, SA92:#193 x

Xerophthalmia, 13:185 X-linked recessive disorders, 13:138 z

Zidovudine, hemophilia and, 12:275

DEPARTMENT OF CORRECTIONS Erratum

The Answer Key in the November 1992 issue inadvertently included answers to questions that are included in the December 1992 issue. Answers 26 through 30 in the November issue should be ignored. The Answer Key correctly identified F as the answer for question #12. However, no place was provided on the PIR Quiz card for an F answer. Therefore, everyone who sent in the Quiz card will be credited for #12 regardless of their answer and will receive CME credit.

488 Pediatrics in Review VoL 13 No. 12 December 1992