Clinical Pediatrics

This paper endeavors to assist the pediatric practitioner in determining when to refer a patient to a clinical child psychologist, and to give him some idea of what can be expected from a psychologic evaluation. The more specific the referral questions, the more meaningful the answers the pediatrician receives. In cluded are some pointers on preparing a child for a psychologic examination.

Emotional illnesses in children often appear with symptoms which at first may seem to be more indicative of some organic disease. Certain suggestive symp toms and signs may help the doctor assess a child's state of emotional health. An often neglected but important source of information is the child him self. If he seems to be healthier than his history, a further look into the family and social background becomes the pediatrician's concern. Uncovering a source of tension may safeguard the child's continued emotional wellbeing.

Congenital rubella syndrome (CRS) has been a nationally notifiable disease since 1965; however, reporting has been quantitatively poor. To improve surveillance, a National Registry for Congenital Rubella Syndrome was established in 1969. Since then, the Registry has received 133 case report forms from 28 states and the District of Columbia. Analysis of these reports shows that peaks of CRS births occurred seven to nine months after the peak incidence of rubella in 1969 and 1970. Estimates of the number of babies born with CRS per year far exceed the actual number of -reported cases. Since the ultimate goal of rubella immunization programs is the prevention of congenital rubella syndrome, improved surveillance of CRS is of prime importance in the overall rubella immunization effort.

Children in all parts of the world are today wearing charms around their necks or wrists. The nature of these charms is related to the views of a people on the role of their gods. Most people assume that there are gods who are benevolent and malevolent devils who work through demons, evil eyes, and witches. Talismans which record the name of the god, or one of his symbols such as a cross, or even of his supposed writings, enlist the assistance of that god. Amulets, in contrast, are for neutralizing the wicked effects of the malevolent gods. Favorite amulets include garlic bags, turquoise beads, and representations of the devil-god Baal. The familiar R is a talismanic invocation of ancient Horus, child-god of Egypt.

Since brain tumors continue to be the most common solid tumor in pediatrics, and cancer is still the number one killer of children (accidents excepted), better diagnosis of children's brain tumors should be the goal of everyone concerned with pediatrics.

Parents of 20 deceased leukemic children were interviewed to determine their reactions to the method of emotional management of their child's course. A common theme expressed by all parents was that they appreciated the physician's honesty; they wanted the hard facts of the child's illness and did not wish to be misled with unrealistic hopes. Most of the parents appeared to accept the reality of the disease and had no major emotional difficulties during the illness or after the child's death. Only occasional minor problems were encountered among the siblings after the child's death.

The incidence of perinatal asphyxia and evidence for gastric ischemia were investigated in six patients from the Yale-New Haven Hospital and 87 previously reported cases having neonatal gastric perforation. All our patients and 69 per cent of the collected series were found to have significant perinatal complications predisposing to asphyxia; five of our patients and 41 per cent of those reviewed had evidence of gastric ischemia as manifested by mucosal hemorrhage, ulceration, or necrosis. Gastric ischemia is the primary factor in neonatal perforation although pneumatic distention with separation of the gastric musculature, the effects of the acid pepsin response on the gastric mucosa, and direct trauma to the stomach wall are important contributing factors which make gastric perforation unique.

Neurologic abnormalities were found in 13 of 21 children studied seven years after having acute encephalitis, and EEG abnormalities were found in 8. The psychologic testing suggested that no significant loss of cognitive abilities had occurred, but these children showed decreased psychic energy and drives, with greater compliance and passivity. None had the hyperkinetic behavior which is traditionally believed to be a signal of acute encephalitis.

A newborn infant had an unusual reversible complication caused by light therapy for hyperbilirubinemia. A dark grey-brown color of the skin, urine, and serum developed on the fifth day, after 24 hours of light therapy. Serum bilirubin (direct and total), SGOT, and LDH were elevated. The infant recovered, and bilirubin and enzymes returned to normal after a period of three weeks. A possible pathologic mechanism for this complication is suggested.

Attitudes to sexuality have changed in the past generation. This is reflected in increased openness of sexual feelings and acceptance of sexual activity by today's adolescent. The physician treating teen-agers must be prepared to help these patients. At The Hospital for Sick Children, Toronto, Adolescent Clinic, 20 per cent of the female patients requested such service in 1971. This included sexual counseling, contraceptive information and supply, pregnancy diagnosis, and referral for continuing care or termination. Facilities for diagnosis and treatment of venereal disease must be available. Evidence of sexual activity in teen-age patients must be ascertained and necessary assistance must be available.