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Selected Abstracts from Pediatrics KLEIN, N. , HACK, M., GALLAGHER, J. & FANAROFF, A. A. (1985). Preschool performance of children with normal intelligence who were very low-birth-weight infants . 75:531-537. Children who were very low-birth-weight infants «1 ,500 g), bene- ficiaries of modern neonatal intensive care, are now of school age. To evaluate their school performance 80 children born in 1976 who had very low birth weight (mean birth weight 1.2 kg, mean gesta- tional age 30 weeks) were examined at age 5 years. Sixty-five children were neurologically intact and had normal IQ (2::85) on the Stanford-Binet; 5 children were neurologically abnormal and 10 had IQ below 85. Of the 65 children with normal intelligence and no neurologic impairments. 46 were single births and enrolled in preschool. These 46 children were matched by race, sex, and family background with classmate control children who had been born at full term. Outcome measurements included the Siosson Intelligence Test , the Woodcock-Johnson Psycho-Educational Battery (includ- ing subscales of Picture Vocabulary, Spatial Relations, Memory for Sentences, Visual Auditory Learning, Quantitative Concepts, and Blending), and the Berry Developmental Test of Visual-Motor Integration. No significant differences in IQ were found between children who were very low-birth-weight infants and control chil- dren; however, children who were very low-birth-weight infants performed significantly less well on the Spatial Relations subtest of the Woodcock-Johnson and on the Visual-Motor Integration test. Similar results were found for nine sets of twins and their control children. Recognition of these perceptual and visual-motor prob- lems may permit appropriate early remedial intervention and pre- vent the compounding of these difficulites. GUANOOLO, V. L. (1985), Munchausen syndrome by proxy: an outpatient challenge. 75:526-530. Primary health care providers are well aware of the physical findings that suggest a child has been intentionally maltreated. Practitioners must also be aware of a more subtle form of child abuse in which the parent victimizes the child by presenting fictitious medical history that initiates a sequence of unnecessary diagnostic and therapeutic interventions. A 4 112 -year saga of such a case, an example of Munchausen syndrome by proxy in the outpatient setting, is reported. seem to be quantifiable, easily ascertainable behavior patterns that could alert pediatric health professionals to the existence of more pervasive disturbances in child and family. WOOLF, A. & FUNK, S. G. (1985), Epidemiology of trauma in a population of incarcerated youth. 75:463-468. This study assessed the types, circumstances, frequency, and health consequences of trauma suffered by juvenile delinquents at a secure residential training school. A review of 369 medical records of 387 teenagers, aged 10-17 years, admitted to one such facility between 1978 and 198:! was made. Of the 369 students, 191 students (52%) suffered 391 separate trauma incidents serious enough to require II health care provider's attention . Circumstances surrounding the injuries included sports (36%), fights (20%), self-inflicted injuries (13%), suicide attempts (9%), incidents related to vocational studies (8%), and horseplay (3%). The most common types of injuries were musculoskeletal trauma, scratches, bruises and lacerations, and fractures. The usual sites of injury were the extremities, head, or neck. More than 50% of trauma incidents required a physician's attention initially or in follow-up; 28% of the injured were referred to an off-campus facility; 21% neces sitated radiologic or laboratory studies; 4% required hospitalization; and one student died. The average trauma rate for teenagers in this setting was 1.2 injuries per person per year; the average rate of hospitalizations for trauma was 0.04 hospitalizations per person per year. These data call for futher studies of trauma morbidity among adolescents in this and other settings and for innovative trauma prevention strategies. BILLMIRE. M. E. & MYERS, P. A. (1985), Serious head injury in infants: accident or abuse? 75:340-342. The medical records and computed tomography (CT) scans of all children less than 1 year of age admitted to the hospital with head injury over a 2-year period were reviewed. Sixty-four percent of all head injuries, excluding uncomplicated skull fracture, and 95% of serious intracranial injuries were the result of child abuse. The occurrence of intracranial injury in infants, in the absence of a history of significant accidental trauma, such as a motor vehicle accident, constitutes grounds for an official child abuse investiga- tion. Lozon , B., WOLF, A. W. & DAVIS, N. S., Sleep problems seen in pediatric proctice. 75:477-483. To determine whether sleep problems commonly seen in pediatric LIFSCHITZ, M. H., WILSON , G. S., O'BRIAN SMITIl, E. & DESMOND, pract ice, such as conflicts at bedtime and night waking, are associ - M. M. (1985), Factors affecting growth and intellectual function ated with more pervasive disturbances in the child or family, two in children of drug addicts. 75:269-274. groups of healthy children were studied. Interview data from a pilot The effects of maternal heroin and methadone use on head growth sample were examined to identify factors that might be important and neurodevelopmental performance was studied in preschool chil- in sleep problems, and then the results were validated with data dren of untreated heroin addicts (N = 25), women receiving rneth- from the second sample. The two samples included 96 white children adone therapy (N = 26), and a drug-free comparison group (N = between 6 months and 4 years of age. In each group, approximately 41) who had been followed from birth. The mean birth head circum- :10% had a sleep problem by the criteria that night waking involving ference of both groups of drug-exposed infants was significantly parents or bedtime struggles occurred 3 or more nights a week for below that of the comparison group; however , the only factors the month preceding the interview, accompanied by conflict or determined by multiple regression analysis as associated with head distress. Five experiences distinguished children with sleep prob- size at birth were maternal nutritional status and birth weight. By lems from those without: an accident or illness in the family, preschool age, head size did not differ significantly among groups. unaccustomed absence of the mother during the day, maternal The factors associated with postnatal head growth were birth depressed moodts), sleeping in the parental bed, and maternal weight, intrapartum risk score, and race. Data show an increased attitude of ambivalence toward the child. These experiences cor- incidence of low-average and mildly retarded intellectual perform- rectly classified 100% of pilot and 83% of validation sample children ance in the drug-exposed children. Regression analyses demon- as having a sleep problem or not. The similarity of findings in the strated that amount of prenatal care, prenatal risk score, and home two samples attests to the potential importance of sleep problems environment were most predictive of intellectual performance and as lin early childhood symptom. Bedtime conflicts and night waking that the degree of maternal narcotic use was not a significant factor. 1)) :\
