Misdiagnosis of Reye's-like illness.
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Biopsy↗
Biomedical subjects
B W Forsyth
Publications and source records attributed to B W Forsyth.
A novel approach to training pediatrics primary care residents.
From 1984 through 1987, 12 pediatrics residents from the Yale University School of Medicine took part in a three-year program that emphasized four areas in primary care: well-child care, developmental-behavioral pediatrics, chronic illness, and adolescent medicine. Program evaluation included a videotaped interview, an assessment of the residents' skill in the management of patients' behavioral problems, and multiple-choice examinations. The program residents improved their interviewing skills more than did the comparison residents, particularly in the process and psychosocial content areas, and also did better in the management of patients' behavioral problems. There was no difference in factual knowledge of behavioral and developmental pediatrics and adolescent medicine. While traditional residency training in primary care may provide the resident with comparable cognitive knowledge, such training may not always improve the resident's ability to apply the knowledge in the primary care setting.
Child↗
Perceptions of vulnerability 3 1/2 years after problems of feeding and crying behavior in early infancy.
The long-term consequences for infants with problems of feeding and crying behavior remain unknown. The purpose of this research was to determine whether such children are later perceived by their parents as vulnerable and more often have behavior problems and have different personalities than children without problems in infancy. The implications of managing such problems by changing milk formulas is explored. Mothers of 379 infants were enrolled in the postpartum period. Information about problems of feeding and crying behavior was obtained at 4 months. Thirty-six percent of the infants had problems and the formula had been changed for 17%. At 3 1/2 years, 320 (84%) mothers completed a questionnaire. Children who had had problems were more often perceived as vulnerable (relative risk [RR] 1.86; 95% confidence interval [CI] 1.09, 3.19) and more often had behavior problems (RR 1.78; 95% CI 1.03, 3.07). There were no differences in personality. Children whose problems had been managed by changing milk formulas were more often perceived as vulnerable (RR 2.18; 95% CI 1.05, 4.53). Although allergies were reported significantly more often for those children who had had problems, there were no differences in the prevalence of asthma or eczema. Problems of feeding and crying behavior in early infancy and the way they are managed may have long-term implications for the child.
Child Behavior Disorders↗
Persistent perceptions of vulnerability following neonatal jaundice.
Treatments for neonatal jaundice are generally considered both safe and effective. We hypothesized that such treatments would be associated with symptoms of the vulnerable child syndrome, persisting up to 6 months. Mothers of otherwise healthy infants who had jaundice and demographically similar infants without jaundice born at Yale-New Haven (Conn) Hospital were surveyed and compared 6 months after discharge from the hospital. By 6 months, the infants with jaundice had significantly more feeding difficulties, eg, they were less likely to be breast-feeding. Unexpectedly, the mothers of infants with jaundice switched from being less likely to leave their infants with someone else at 1 month to leaving the infants significantly more than mothers of infants in the comparison group. Although the mothers of infants in the comparison group reported a similar number of infant health problems, the mothers of infants with jaundice were more likely to judge the problems as serious and to have taken the infant to an emergency department. The benefits of treating jaundice in otherwise healthy infants should be weighted against the risks of developing the vulnerable child syndrome.
Adult↗
New epidemiologic evidence confirming that bias does not explain the aspirin/Reye's syndrome association.
To determine the validity of the aspirin/Reye's syndrome association, we developed an epidemiologic investigation to assess the effects of five potential sources of bias. A case-control study incorporated procedures to avoid temporal precedence and susceptibility bias. These included classifying cases as having monophasic or biphasic patterns of illness and matching for severity of symptoms at zero-time. To evaluate the effect of a potential recall bias, an "alternate-condition" control group was enrolled. A medical record review study was conducted to assess the potential for diagnostic bias, and a blanket surveillance of all hospitals in a region was conducted to evaluate reporting bias. Twenty-four case subjects and 48 matched controls were enrolled. Eight-eight percent of case subjects and only 17% of controls had received aspirin prior to the onset of Reye's syndrome (matched odds ratio, 35; 95% confidence interval, 4.2 to 288). Further analyses demonstrated that the association could not be attributed to the five potential sources of bias.
Adolescent↗
Lead screening at pediatric teaching programs.
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Child↗
Mirror image of environmental deprivation: severe childhood obesity of psychosocial origin.
We report 12 children with severe obesity in very early childhood who had no evidence of organic causes for their obesity and whose families evidenced psychosocial dysfunction comparable to that often seen in growth failure of psychosocial origin. Features seen include family disorganization, separation of mother and child, displacement of child care to others, maternal depression, denial of the growth abnormality, hostility towards health care providers, and inconsistent medical follow-up. In all cases, parental limit setting was impaired. We suggest that this condition should be called "severe obesity of psychosocial origin." Very severe obesity of early childhood may be conceptualized as the mirror image of growth failure. Like growth failure, it requires evaluation and management focused on psychosocial issues. Research is needed to clarify the prevalence, diagnostic features, and optimal treatment of obesity of psychosocial origin.
Body Height↗
Colic and the effect of changing formulas: a double-blind, multiple-crossover study.
This study investigated the effect of changing the formulas of colicky infants and addressed the methodologic flaws of earlier studies. Attention was paid to issues of designing a blind study, providing a washout period, and measuring and reproducing the effect. In this randomized, double-blind trial, three changes of formula were made: for each of four 4-day periods, colicky infants alternately received a casein hydrolysate formula (Nutramigen) and a formula containing cow milk. Mothers recorded crying in diaries and indicated which crying episodes they considered to have been caused by colic. Nine infants were started on Nutramigen and eight on the cow milk formula. With the first formula change there was significantly less crying and colic in infants when they were fed Nutramigen than when they were fed cow milk (p less than 0.01); with the second change there was less colic when infants were fed Nutramigen (p less than 0.05) but not significantly less crying. By the third change there were no significant differences between formulas. Further analyses demonstrated that there were more clinically meaningful positive responses (a change in crying by at least one third) to Nutramigen than to cow milk (p less than 0.05). However, only one subject had a clinically meaningful response in colic to all three formula changes. These results demonstrate that in some instances, colic improves with elimination of cow milk formula. However, the effect diminishes with time, and only infrequently is the effect reproducible.
Animals↗
Mothers' perceptions of problems of feeding and crying behaviors. A prospective study.
During early infancy, problems of crying, colic, spitting, and feeding difficulties often provoke anxiety and lack of self-confidence in parents. We studied prospectively what proportion of mothers felt that their infants had problems of this type and determined risk factors for perceived problems identified in the early postnatal period. The mothers of 189 breast-fed and 184 formula-fed infants completed questionnaires post partum and responded to a follow-up interview at four months. Thirty-five percent of mothers in each group reported that their infants had moderate or severe problems of feeding or crying behavior. Risk factors for perceived problems were identified using stepwise logistic regression analyses. Inquiry about, and early attention to, risk factors may alleviate the parents' concerns and possibly affect the development of these problems.
Bottle Feeding↗
Problems of early infancy, formula changes, and mothers' beliefs about their infants.
Problems of early infancy are sometimes managed by changing an infant's formula from a cow milk formula to a soy protein or casein hydrolysate formula ("special formulas"). This study was designed to determine the frequency of formula changes, mothers' reports of problems that lead to such a change, and mothers' beliefs about the causes of these problems. Mothers of 189 breast-feeding (BF) and 184 formula-feeding (FF) infants were enrolled postpartum. Follow-up data were obtained by telephone interviews at 4 months. After starting a cow milk formula, 11% of the BF and 25% of the FF infants were given special formulas. Mothers frequently reported problems related to feeding, bowel movements, and crying behavior; 32% of infants with such problems were given special formulas. Excessive crying and colic were the most common problems leading to a formula change. When a formula was changed, mothers more frequently believed that the cause of the problem was intrinsic to the child (P less than 0.001) and that their infant had had a "disease or illness" (P less than 0.001). When formula changes occurred, 26% of mothers believed that their infants were allergic to cow milk. These beliefs may affect a mother's perceptions of her child's vulnerability.
Behavior↗