Selected Abstracts from Pediatrics

KLEIN, N., HACK, M., GALLAGHER, J . & FANAROFF, A. A. (1985),Preschool performance of children with normal intelligence whowere very low-birth-weight infants. 75:531-537.

Children who were very low-birth-weight infants « 1,500 g), bene­ficiaries of modern neonatal intensive care, are now of school age.To evaluate their school performance 80 children born in 1976 whohad very low birth weight (mean birth weight 1.2 kg, mean gesta­t ional age 30 weeks) were examined at age 5 years. Sixty-fivechildren were neurologically intact and had normal IQ (2::85) on theStanford-Binet; 5 children were neurologically abnormal and 10had IQ below 85. Of the 65 children with normal intelligence andno neurologic impairments, 46 were single births and enrolled inpreschool. These 46 children were matched by race, sex, and familybackground with classmate control children who had been born atfull term. Outcome measurements included the Siosson Intell igenceTest , the Woodcock-Johnson Psycho-Educational Battery (includ­ing subscales of Picture Vocabul ary , Spatial Relations, Memory forSentences, Visual Audi tory Learning, Quantitative Concepts, andBlending ), and the Berry Developmental Test of Visual -MotorIntegration . No significant differences in IQ were found betweenchildren who were very low-birth-weight infants and control chil­dren ; however, children who were very low-birth-weight infantsperformed significantly less well on the Spatial Relations subtest ofthe Woodcock-Johnson and on the Visual -Motor Integration test.Similar results were found for nine sets of twins and their controlchildren. Recognition of these perceptual and visual-motor prob­lems may permit appropriate earl y remedial intervention and pre­vent the compounding of these difficulites.

GUANOOLO, V. L. (1985), Mun chausen syndrome by proxy: anoutpatient challenge. 75:526- 530.

Primary health care providers are well aware of the physical findingsthat suggest a child has been intentionally maltreated. Practitionersmust also be aware of a more subtle form of child abuse in whichthe parent victimizes the child by presenting fictitious medicalhistory that initiates a sequence of unnecessary diagnostic andtherapeutic interventions. A 4'/2-year saga of such a case, an exampleof Munchausen syndrome by proxy in the outpatient setting, isreported.

Lozon, B., WOLF, A. W. & DAVIS, N. S. , Sleep problems seen inpediatric practice. 75:477-483.

To determine whether sleep problem s commonly seen in pediatricpractice, such as conflicts at bedtime and night waking, are associ­ated with more pervasive disturbances in the child or family, twogroups of healthy ch ildren were studied. Interview data from a pilotsample were examined to identify factors that might be importantin sleep problems, and then the results were validated with datafrom the second sample. The two samples included 96 white childrenbetween 6 months and 4 years of age. In each group, approximately:10% had a sleep problem hy the criteria that night waking involvingparents or bedtime struggles occurred 3 or more nights a week forthe month preceding the interview, accompanied by conflict ordistress. Five experiences dist inguished children with sleep prob­lems from those without: an accident or illness in the family,unaccustomed absence of t he mother during the day, maternaldepressed moodts), sleeping in the parental bed, and maternalatt itude of ambivalence toward the child. These experiences cor­rectly classified 100% of pilot and 83% of validation sample childrenas having a sleep problem or not . The similarity of findings in thetwo samples attests to the potential importance of sleep problemsas an early childhood symptom. Bedtime conflicts and night waking

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seem to be quantifiable, easily ascertainable behavior patterns thatcould alert pediatric health professionals to the existence of morepervasive disturbances in child and family.

WOOLF, A. & FUNK, S. G. (1985), Epidemiology of trauma in apopulation of incarcerated yout h. 75:463-468.

This study assessed the types, circumstances, frequency, and healthconsequences of trauma suffered by juvenile delinquents at a secureresidential training school. A review of 369 medical records of 387teenagers, aged 10-17 years, admitted to one such facility between1978 and 198:! was made . Of the 369 students, 191 students (52%)suffered 391 separate trauma incidents serious enough to require ahealth care provider's attention. Circumstances surrounding theinjuries included sports (36%), fight s (20%), self-inflicted injuries(13%l, suicide attempts (9%), incidents related to vocational studies(8%), and horseplay (3%). The most comm on types of injuries weremusculoskeletal trauma, scratches, brui ses and lacerations, andfractures. The usual site s of injury were the extremities, head, orneck . More than 50% of trauma incidents required a physician'sattent ion init ially or in follow-up ; 28% of the injured were referredto an off-campus facility; 21% necessitated radiologic or laboratorystudies; 4% required hospitalization ; and one student died . Theaverage trauma rate for teenagers in this setting was 1.2 injuriesper person per year; the average rate of hospitalizations for traumawas 0.04 hospitalizations per per son per year. These data call forfuther studies of trauma morb idity among adolescents in th is andother sett ings and for innovative trauma prevention strategies.

BILLMIRE, M. E. & MYERS, P . A. (1985), Serious head injury ininfants: accident or abu se? 75:340-342.

The medical records and computed tomography (CT) scan s of allchildren less than 1 year of age admitted to the hospital with headinjury over a 2-year period were reviewed. Sixty-four percent of allhead injuries, excluding uncomplicated skull fracture, and 95% ofserious intracranial injuries were the result of child abuse. Theoccurrence of intracranial injury in infants, in the absence of ahistory of significant accidental trauma, such as a motor vehicleaccident, constitutes grounds for an official child abuse investiga­t ion .

LIFSCHITZ, M. H., WILSON, G. S., O'BRIAN SMITIl, E. & DESMOND,M. M. (1985), Factors affect ing growth and intellectual funct ionin child ren of drug add icts . 75:269-274 .

The effects of maternal heroin and methadone use on head growthand neurodevelopmental performance was studied in preschool chil­dren of untreated heroin addicts (N = 25), women receiving meth­adone therapy (N = 26), and a drug -free comparison group (N =41l who had been followed from birth. The mean birth head circum­ference of both groups of drug-exposed infants was significantlybelow that of the comparison group; however , the only factorsdetermined by multiple regression analysis as associated with headsize at birth were maternal nutrit ional status and birth weight. Bypreschool age, head size did not differ significantly among group s.The factors associated with postnatal head growth were birthweight, int rapart um risk score , and race . Data show an increasedincidence of low-average and mildly retarded intellectual perform­ance in the drug-exposed children. Regression analyses dem on­strated that amount of prenatal care , prenatal risk score, and homeenvironment were most predictive of intellectual performance andthat the degree of maternal narc otic use was not a significant factor .