Clinical Pediatrics

Wilcox, W.D.; Nieburg, P.; Miller, D.S.

doi: 10.1177/000992288902800901pmid: 2670392

The term "failure to thrive" (FTT) has been used for more than 50 years to describe the infant or young child whose growth falls substantially behind that of his or her peers. Currently, the predominant use of FTT is to describe a child's growth failure resulting from caloric or maternal deprivation or both. Despite widespread use, the term FTT lacks a clarified definition.In this study the authors review 22 current reference texts in general pediatrics, pediatric nutrition, and pediatric gastroenterology and 13 recent journal articles addressing FTT. Only 9 of the 22 texts and 9 of the 13 journal articles describe FTT in quantitative terms, but even these references lack consensus on the anthropometric indices used and their criteria for abnormality.The absence of a standard, scientifically credible definition for FTT, which reflects the dynamic nature of this syndrome, continues to produce an ambiguous body of literature on the subject.

Oberklaid, Frank; Harris, Claire; Keir, Eddie

doi: 10.1177/000992288902800902pmid: 2766643

One hundred thirty-three children with school problems referred to a hospital-based multidisciplinary clinic were screened audiologically to determine the frequency of auditory problems, and to determine whether one could predict auditory problems from clinical data. Ninety-three (69.9%) failed one or more parts of the screening procedure. Twenty-two children (7.9% of the total group) had abnormal hearing acuity, 33 (30.6%) abnormal speech discrimination in noise, and 73 (62.4%) abnormal short term auditory memory. These figures are significantly higher than those found in a representative sample of school children.Not one of 16 items from parent and teacher questionnaires and neurodevelopmental findings predicted auditory acuity or speech in noise problems; there were correlations between short term auditory memory items and parental and teacher rating of a language problem, teacher rating of reading and sequencing problem, and neurodevelopmental finding of auditory sequencing problem. In view of this inability to clinically predict auditory processing deficits, the authors suggest that a full audiological assessment, including short term memory and speech in noise testing, is warranted as part of the evaluation of children with learning difficulties.

Kowal-Vern, Areta; McFadden, John

doi: 10.1177/000992288902800903pmid: 2504528

Taylor, James A.; Grube, Baiba; Heimbach, David M.; Bergman, Abraham B.

doi: 10.1177/000992288902800904pmid: 2504529

Toxic Epidermal Necrolysis (TEN) is a life-threatening disorder with reported mortality rates of 25-60 percent in pediatric patients. The authors report on their experience in managing six children using a standardized treatment protocol in the intensive care unit of a regional burn center. Areas of sloughed skin were covered with porcine xenograft (pig skin) until reepithelialization was complete. There was one death in the series, and one child had ophthalmologic complications. Treatment in a multidisciplinary burn center is recommended for children with TEN.

Talmi, Yoav P.; Cohen, Avner H.; Finkelstein, Yehuda; Versano, Itzhak; Zohar, Yuval

doi: 10.1177/000992288902800905pmid: 2504530

Cervical adenopathy as the sole presentation of tuberculosis is seen infrequently in the pediatric age group. Despite modern treatment and public health measures, tuberculous cervical adenitis persists, and its prompt diagnosis and treatment are important from both a clinical and preventive health perspective. The authors report five cases of children with ages ranging from 8 to 17 years, in whom cervical adenitis was the only presentation of infection with Mycobacterium tuberculosis. The clinical presentation and methods of diagnosis and treatment are described, and the difficulty of differentiation between infections with M. tuberculosis and non-tuberculous mycobacterial infections is stressed. Tuberculous cervical adenitis should be considered in cases of an elusive diagnosis of a cervical mass in the pediatric patient.

Rathore, Mobeen H.

doi: 10.1177/000992288902800906pmid: 2670393

Presti, Blair; Kircher, Tobias; Reed, Chuck

doi: 10.1177/000992288902800907pmid: 2766644

The performance of a rapid capillary blood glucose monitor, the Glucoscan 2000, was evaluated in a neonatal patient population by comparison with a reference method on 283 paired patient samples. The median glucose was 56 mg/dL (3.1 mmol/L). The slope of the regression line was .93 with a correlation coefficient r of .82. The average error in Glucoscan values at low, intermediate and high glucose ranges was 43%, 20% and 12% respectively. Precision analysis by replicate determinations also showed an increased coefficient of variation, 7.4%, at low glucose values.The Glucoscan 2000 lacks sufficient accuracy and precision at low glucose values to serve as the exclusive analytic test for the diagnosis of neonatal hypoglycemia.

Accardo, Pasquale; Caul, Jefferies; Whitman, Barbara

doi: 10.1177/000992288902800908pmid: 2475286

In children examined at a child development clinic the incidence of excessive water drinking was almost exclusively confined to the foster care population. A series of 11 patients is compared with other reports of excessive water drinking as a marker for parent-child problems and inadequate nurturance. The parent-child interaction patterns were characterized as rejecting and both overprotective and overindulgent. The family adaptational styles tended to be chaotic and rigid, and the family cohesion styles disengaged or separated. Excessive water drinking can be considered a marker for problems in parenting.

Claytor, Risa N.; Barth, Kristen L.; Shubin, Charles I.

doi: 10.1177/000992288902800909pmid: 2766645

The records of 944 children who had been examined by one pediatrician for alleged sexual abuse were analyzed. Sixty-four percent of the females and 34 percent of the males had positive findings suggestive of ano-genital injury. The data indicated that in girls with no evidence of injury, the hymenal opening diameter varied directly with age, but in those with evidence of injury, the opening size could not be correlated with age.

Van Dyke, Don C.; Alexander, Randell C.; Perlman, Stanley; Smith, Wilbur J.; Dekowski, Steven A.

doi: 10.1177/000992288902800910pmid: 2766646

Cases of fusiform bacteria sepsis have been reported infrequently in the pediatric literature. This case demonstrates the severe metastatic complications of fusiform bacterial sepsis including osteomyelitis, with multiple pathological fractures, sepsis, and abscesses of the liver. In the diagnostic evaluation of the etiology for this uncommon infection, child abuse was discovered in all children of this family. In children with uncommon infections and no underlying etiology, child abuse should be considered.