American Pediatrics Research Articles

The foundation of the Hospital Infantil de México, today Hospital Infantil de México Federico Gómez

In the early years of the 20th century, no hospital in Mexico held the capacity to address the health problems of Mexican children, making it necessary to build a modern institution to take care of these issues. This situation mobilized a group of doctors led by Dr. Federico Gomez Santos to seek the acknowledgement of the President, Abelardo L. Rodriguez, of the urgent need of a children's hospital. Later, the President approved the project for its construction in 1933. After 10 years of struggle in the political, social and economic fields, and with the support of presidents Lazaro Cardenas and Manuel Avila Camacho, the Hospital Infantil de Mexico was inaugurated on April 30th, 1943. Today, 75 years after its creation, the hospital has withstood the test of time maintaining intact its principles of assistance, teaching and research, and emerging as the cradle of Mexican and Latin American pediatrics.

Increasing access to quality healthcare for children who are incarcerated: American Pediatric Society issue of the year (2023-2024).

Increasing access to quality healthcare for children who are incarcerated: American Pediatric Society issue of the year (2023-2024).

A Good Time to Be Born

A Good Time to Be Born

Point-of-Care Ultrasound for the Evaluation and Management of Febrile Infants.

Febrile infants frequently present to the emergency department (ED) and account for a vulnerable population at significant risk for serious bacterial infection. Appropriate evaluation and management are key to favorable outcomes but can present challenges for providers, especially in EDs where ill children are infrequently seen and pediatric-trained staff may not be available. Point-of-care ultrasound (POCUS) is integrated into the care of adults in the ED but is less commonly used for infants. We present a review of the current literature and proposed approach to using POCUS for bladder catheterization, lumbar puncture (LP), and vascular access in the resuscitation and evaluation of febrile infants. Point-of-care ultrasound can be a useful adjunct in the evaluation of febrile infants by facilitating higher success rates of infant bladder catheterization, LP, and intraosseous and intravenous (IV) line placement. Ultrasound has been shown to be a reliable method of evaluating bladder volumes before the catheterization of infants, reducing the number of attempts needed to obtain an adequate urine sample for testing and culture. Point-of-care ultrasound has also been shown to improve the yield of LPs in infants. Ultrasound is a rapid and accurate way of identifying the appropriate location and depth of needle insertion. Point-of-care ultrasound has also been shown to facilitate obtaining IV access in infants as well as confirming the proper placement of intraosseous lines. A growing body of evidence suggests that POCUS is a useful adjunct in the initial evaluation and resuscitation of febrile infants. It is the position of both the American Academy or Pediatrics, American College of Emergency Physicians, and the authors of this article that emergency physicians should be familiar with the indications and applications of POCUS in children. This technology should be used as an adjunct to improve success rates when performing bladder catheterization, LP, and obtaining intravenous/intraosseous access for infants.

American Pediatrics and the Transition from Mental Health to Illness Since the 1960s

Abstract:American pediatricians are now bearing the brunt of massive increases in demand for treatment of mental illness in children and adolescents, areas in which many pediatricians have not been well trained. It would be logical to encourage policy measures to increase pediatricians’ expertise in this area to improve access to care. But the expanses in demand for services are about much more than increased incidence of biologically-based illnesses. Instead, pediatricians are caught juggling between their traditional focus on health and prevention and a rapid rise in broad socially, culturally, and economically mediated distress among young people and their families. This article explores the historical context of pediatricians’ engagement with mental health and the hazards of the push toward treatment for mental illness. The historical perspective can help us develop policy more directed to broader goals of improving the mental health of our nation’s children and adolescents.

Advances in clinical diagnosis and treatment of Williams syndrome

Williams syndrome is a rare disease caused by 1.5~1.8 Mb gene deletion in the chromosome 7q11.23 region, with autosomal dominant inheritance.The incidence is about 1/10 000.It involves the cardiovascular system, nervous system, endocrine system and so on, and is most likely to cause damage to the cardiovascular system.The mortality of sudden cardiac death in patients with Williams syndrome is higher than that in healthy population.At present, suspected patients were screened by Lowery score and the American pediatrics score, then were evaluated by imaging examination and were diagnosed by gene detection.The main therapy is symptomatic treatment.Therefore, it is important to ensure an accurate diagnosis and prompt treatment.In the article, the research progress of the clinical diagnosis, gene diagnosis, gene therapy and prognosis is reviewed. Key words: Williams syndrome; Etiology; Clinical diagnosis; Therapy

Use of text messaging for maternal and infant health: a systematic review of the literature.

Text messaging is an increasingly popular communication tool in health interventions, but has been little studied in maternal and infant health. This literature review evaluates studies of text messaging that may be applied to the promotion of maternal and infant health. Articles from peer-reviewed journals published before June 2012 were included if they were experimental or quasi-experimental studies of behaviors endorsed either by the American College of Obstetrics and Gynecology, the American Pediatrics Association, or the United States Preventive Services Task Force; included reproductive age women (12-50 years) or infants up to 2 years of age; and were available in English. Qualitative studies of text messaging specific to pregnant women were also included. Studies were compared and contrasted by key variables, including: design, time-period, study population, and results. Forty-eight articles were included, 30 of which were randomized controlled trials. Interventions vary greatly in effectiveness and soundness of methodology, but collectively indicate that there is a wide range of preventative behaviors that text message interventions can effectively promote, including smoking cessation, diabetes control, appointment reminders, medication adherence, weight loss, and vaccine uptake. Common methodological issues include not accounting for attention affect and not aligning text message content to measured outcomes. Those interventions that are based on an established theory of behavior change and use motivational as opposed to informational language are more likely to be successful. Building on the growing body of evidence for text message interventions reviewed here, as well as the growing popularity of text messaging as a medium, researchers should be able to use this technology to engage difficult to reach populations.

Editorial introductions

Editorial introductions

2011 Joseph W. St Geme Jr Lecture: Five Things I'd Like to See Changed in American Pediatrics, Five Lessons I've Learned

In response to limitations in access to subspecialty care, I present personal observations and suggestions related to education of future pediatricians regarding development of critical thinking skills, care of complex and chronically ill patients, development of empathy, and restoration of responsibility that may help ameliorate this serious problem. Toward this end, I also offer 1 approach, a 24/7 telephone consultation network, for enriching interaction of primary care providers (PCPs) and subspecialists who can potentially provide rapid access to needed advice, reduce demand for subspecialty appointments, bolster decision-making and expertise, and realign resources with need. Data were obtained from 579 requests by PCPs for telephone consultation by subspecialists in 8 areas (including child psychiatry). Of calls, 27% took <5 minutes and 79% took 5 to 15 minutes. Of calls, 28% resulted in a clinic visit; 8% prompted hospital transfer, hospital admission, or referral to an emergency department; and the remaining 64% resulted in continued management by PCP with reinforcement of the plan. Assuming most inquiries would have resulted in referral to a subspecialist were there no telephone consultation, we estimated that 70% (8+64%) of consultations realigned resources with need, resulting in large saving of unnecessary clinic visits, travel, expense to families, lost days at work, or missed school. Development of rapid telephone consultation networks could provide increased access to care for those children in greatest need, use limited resources more efficiently, foster collegial and productive relationships between medical providers, and increase expertise of PCPs and subspecialists.

Calciferol Deficiency Mimicking Abusive Fractures in Infants: Is There Any Evidence?

T he history of calciferol metabolism and biochemistry is tightly intertwined with that of American pediatrics. Rickets was a widespread affliction of children in urban areas in the 19th and early 20th centuries. Mellanby recognized the anti-rachitic properties of a fat-soluble substance that was incorrectly named ‘‘vitamin’’ D. Shortly thereafter, Eliot undertook a seminal clinical trial in New Haven that demonstrated the ability of cod-liver oil to prevent rickets in infants. Within decades, supplementation of nursing infants became nearly universal, and clinical rickets largely disappeared. In the latter part of the 20th century, lax prescribing of calciferol supplements to nursing children, combined with an increasing number of mothers of darkly pigmented infants choosing to breast feed, led to a resurgence of clinical rickets. Because we are well into the 21st century, clinical rickets in infants again is largely disappearing. As this has happened, there has been an increasing interest in the possibility that degrees of calciferol deficiency insufficient to cause frank rickets could still have deleterious skeletal effects. This interest has been informed by recent information in adults suggesting that levels of calciferol (as assessed by 25hydroxycholecalciferol [25(OH)D]) we have previously considered normal may actually be low. This, in turn, has led to the suggestion that mild degrees of calciferol deficiency, in the absence of actual rickets, could predispose the infant to fractures. It is sometimes argued that such subclinical calciferol deficiency could explain some fractures that have been ascribed to abuse. Multiple longbone fractures have long been recognized as an indicator for child abuse. The implications for the child when fractures caused by abuse aremistakenly attributed to fractures caused by rickets are potentially life-threatening. Similarly, misdiagnosis of abuse in the setting of clinical rickets has significant legal, social, emotional, and clinical implications. In this commentary, we will provide a review of our current understanding of the metabolism of calciferol in infants. We will then discuss recent data defining normal levels of calciferol at various ages, including in infants. We will examine the fracture risk associated with actual clinical rickets and the evidence that this risk is present with milder degrees of calciferol deficiency. Lastly, we will consider the proposition that mild degrees of calciferol deficiency can predispose infants to fractures mimicking those caused by non-accidental trauma of infants.

Correction to "Vitamin D: An Evidence-Based Review"

[ In the abovementioned article (Kulie T, Groff A, Redmer J, Hounshell J, Schrager S. J Am Board Fam Med 2009;22(6):698–706), the AAP was referred to as the Association of American Physicians and the Association of American Pediatrics. The organization should have been entitled the American

Estudios Clínicos Controlados Aleatoreos, en la Pediatría de Latino América (1996-2005)

ABSTRACT Randomized Controlled Clinical Studies in Latin American Pediatrics Objective: To analyze the production of RCS among children and adolescents in Latin American countries,between 1996 and 2005. Method: In an observational bibliometric study, all available RCS in PUBMED andLILAC data bases for that period were reviewed. Included were studies of children between 0 and 18 yearsof age, from 19 Latin American countries; 400 references were included. As a control, all pediatric researchfrom the State of New York, USA, for that same period of time was collected. The following parameters wereevaluated: number of RCS per country, affiliation, pediatric area, and adjustments were made for populationand GNP for each country. Results: Countries with the highest number of publications per year (RCS/yr)were: Brazil (14.6), Mexico (8.6), Chile (5.5), Argentina (3.9). During that same period of time, the State ofNew York published 26.7 RCS per year. Overall, in Latin America most published specialities were Nutrition(16%), Respiratory Diseases, Dental problems, Vaccinations, Neonatology. In New York, the most frequentspecialty reviewed was Psychiatry/Psychology (23.6%). In Chile and Brazil, more than 85% of the studieswere performed in Universities, in Mexico and Argentina in Hospitals and other organizations either publicor private. Over 90% were published in Journals with ISI impact index.

New Guidelines for Maternal and Neonatal Resuscitation

New evidence has prompted changes in our national cardiopulmonary resuscitation guidelines for both neonates and adult patients. The purpose of this article is to provide an overview of the changes recommended by the American Heart Association, Academy of American Pediatrics, and the American College of Obstetrics and Gynecology. In addition, a strategy for implementing these guidelines into practice is suggested.

The importance of β-carotene as a source of vitamin A with special regard to pregnant and breastfeeding women

Vitamin A is essential for growth and differentiation of a number of cells and tissues. Notably during pregnancy and throughout the breastfeeding period, vitamin A has an important role in the healthy development of the fetus and the newborn, with lung development and maturation being particularly important. The German Nutrition Society (DGE) recommends a 40% increase in vitamin A intake for pregnant women and a 90% increase for breastfeeding women. However, pregnant women or those considering becoming pregnant are generally advised to avoid the intake of vitamin A rich liver and liver foods, based upon unsupported scientific findings. As a result, the provitamin A carotenoid beta-carotene remains their essential source of vitamin A. Basic sources of provitamin A are orange and dark green vegetables, followed by fortified beverages which represent between 20% and 40% of the daily supply. The average intake of beta-carotene in Germany is about 1.5-2 mg a day. Assuming a vitamin A conversion rate for beta-carotene for juices of 4:1, and fruit and vegetables between 12:1 and 26:1; the total vitamin A contribution from beta-carotene intake represents 10-15% of the RDA. The American Pediatrics Association cites vitamin A as one of the most critical vitamins during pregnancy and the breastfeeding period, especially in terms of lung function and maturation. If the vitamin A supply of the mother is inadequate, her supply to the fetus will also be inadequate, as will later be her milk. These inadequacies cannot be compensated by postnatal supplementation. A clinical study in pregnant women with short birth intervals or multiple births showed that almost 1/3 of the women had plasma retinol levels below 1.4 micromol/l corresponding to a borderline deficiency. Despite the fact that vitamin A and beta-carotene rich food is generally available, risk groups for low vitamin A supply exist in the western world. It is therefore highly critical to restrict the beta-carotene supply from diet, particularly from sources of beta-carotene with high consumer acceptance such as fortified juices (e.g. "ACE juices") or dietary supplements (e.g. multivitamins for pregnant women). For the part of the population unable to meet vitamin A requirements according to the DACH recommendations, sufficient intake of beta-carotene may be crucial to help improve and maintain adequate vitamin A status and prevention of developmental disorders. At this time it has to be urgently advised against restricting the beta-carotene supply or putting warning labels on beta-carotene fortified products. It is, however, highly recommended to improve the available data on nutrient intakes in Germany, especially for pregnant and breastfeeding women. For them, recommendations to be aware of potential nutrient intake inadequacies might prove useful.

A Special Issue: Coding for Children With Special Health Care Needs

A Special Issue: Coding for Children With Special Health Care Needs

The 75th Anniversary of the American Academy of Pediatrics

How far the American Academy of Pediatrics and pediatrics as a medical discipline have advanced during the last 75 years is eloquently evidenced in our 75th anniversary meeting, with thousands of attendees and hundreds of speakers, discussing an extraordinarily broad range of scientific, public health, socioeconomic, and governmental issues. My task is to explore with you how American pediatrics and the academy have evolved and especially some of the social, professional, and scientific forces and personalities that shaped the pediatrics of today. Knowing where we came from may give us insights into where we are likely to go in the next 75 years. It was not until the late 1800s that pediatrics began to emerge as a separate specialty in the United States, largely because of the influence and efforts of 4 physicians: Drs Abraham Jacobi, Job Lewis Smith, and L. Emmett Holt of New York, New York, and John Howland of Baltimore, Maryland. Jacobi, an immigrant from Germany, established a children’s clinic in the New York Medical College and was appointed as professor of infantile pathology and therapeutics in 1860. It was largely because of Jacobi that pediatrics became recognized as a specialty separate from obstetrics, and because of his effective leadership and eloquence, he has been appropriately called the father of American pediatrics. Guided by Jacobi, a unique aspect of pediatrics evolved. In the rest of medicine, specialization encouraged physicians to focus their attention on a particular body part or disease, but pediatrics did the opposite. Pediatric expertise was holistic, age specific, and emphasized growth and development, prevention, and, especially, nutrition. It is important to describe some sea changes that occurred in the United States during the first half of the 19th century, which altered American society and indirectly determined the structure of American pediatrics. With increasing industrialization, … Address correspondence to Howard A. Pearson, MD, FAAP, Department of Pediatrics, Yale University School of Medicine, PO Box 208064, New Haven, CT 06520-8064. E-mail: howard.pearson{at}yale.edu

Introduction: Addressing the Millennial Morbidity—The Context of Community Pediatrics

The test of the morality of a society is what it does for its children. Dietrich Bonhoeffer1 Pediatrics is a contextual specialty concerned about children, their families, and the communities in which they live. Historically, US pediatricians have demonstrated a deep appreciation of the relationship between community forces and child health outcomes. Abraham Jacobi, MD, and Job Lewis Smith, MD, the founders of American pediatrics, fought to ensure a clean water supply and decent housing for poor urban infants and children who were poor. They set the stage for pediatric activism in the community. In the decades since then, pediatricians have grappled to incorporate knowledge about the influences of the external environment into the practice of pediatrics.2 Although the morbidity and mortality of children have changed over the past 150 years, the need for engaging in the community with families and community-based partners has not. Rather, the salience of community pediatrics has risen as the effects of societal forces have intensified and knowledge of the bioenvironmental interface has become more sophisticated. This supplement is a collection of articles about training and practice in community pediatrics that offers specific examples of clinical practice and research aimed at fulfilling the promise that our profession has made to children in our society. The past century has seen astounding changes in the configuration of childhood health and illness (Table 1). In the early 1900s, infant mortality was as high as 140 per 1000 live births per year3; child health clinicians struggled to handle malnutrition and contagious illnesses. The major biological and medical breakthroughs of the midcentury created the basis for the subspecialty care of children with congenital and acquired organ-system illness. By the 1960s and 1970s, acute infectious morbidity increasingly was held in check by antibiotics and vaccines. Pediatricians began … Address correspondence to Judith S. Palfrey, MD, Children's Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail: palfrey{at}fas.harvard.edu

Unlocking the brain: attempts to improve mental function of microcephalic retarded children by "craniotomy".

"Is it sufficient glory to don a white apron and swing a carbolized knife and is therein a sufficient indication to let daylight into a deformed cranium and on top of a hopelessly defective brain, and to proclaim success because the victim consented not to die of the assault? Such rash feats of indiscriminate surgery, if continued, moreover in the presence of fourteen deaths in thirty-three cases, are stains on your hands and sins on your souls. No ocean of soap and water will cleanse those hands, no power of corrosive sublimate will disinfect the souls." These passionate words, delivered by Abraham Jacobi, the father of American pediatrics, at the International Congress in Rome in 1893, and later in the article "Non nocere" (42), epitomize the growing antagonism to the attempts by many prominent surgeons to improve the gloomy fate of severely retarded, microcephalic children by "liberating" their brains from their presumed bony chains by "linear craniotomy." This article portrays how the fallacious 19th-century concepts of the relationship between the capacity of the cranial cavity and intelligence, backed by "scientific racism" together with the changing attitude toward retarded and malformed children, generated a surgical solution for microcephalic idiocy. It describes how hopeful surgeons, neurologists, and pediatricians, encouraged by the advances in anesthesia and asepsis, lost their judgment and disregarded logic and evidence. They generated a wave of enthusiasm and hope that soared from the United States and France through the British Isles, Europe, and as far as Ceylon and Australia to end in a ripple of bitter disgrace under caustic criticism, leaving a scar on the recently budding field of neurological surgery.

Abraham Jacobi, MD: father of american pediatrics and advocate for children’s health

Dr. Abraham Jacobi, often called the “father of American pediatrics,” rose from humble beginnings in Germany to the highest positions in pediatrics and medicine in the United States. Most of the history of American pediatrics during the second half of the 19th century is reflected in Jacobi’s writings and work. This article presents a brief overview of his life and character, focusing on the important roles he played in establishing the field of pediatrics as a distinct specialty and in advocating for children’s health issues.

Committee report: American Pediatrics: milestones at the millennium.

Committee report: American Pediatrics: milestones at the millennium.