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Self-administered treatments may overcome access barriers to evidence-based care for pediatric sleep problems. Two hundred thirty-nine families participated in a randomized controlled trial with 3 study arms: a DVD intervention condition (the Sleep Easy Solution), a Website comparison condition, and a Wait-List comparison condition. The primary outcome was trichotomous—Do you consider your child’s sleep a problem? (not a problem at all, a small problem, a very serious problem). DVD was superior to Wait-List in terms of the primary outcome ( P = .03; odds ratio = 0.44; 95% confidence interval = 0.21-0.93). Similarly, regarding secondary outcomes, DVD was superior to Wait-List in terms of longer continuous sleep periods ( P = .003), more favorable perceptions of the child’s overall sleep ( P = .001), and higher parental confidence in managing the child’s sleep ( P = .001). Results suggest that the DVD intervention is a promising self-administered treatment for pediatric insomnia.

Objective. Study aims to examine development in infants following prenatal heroin, methadone, and opioid exposure, which adversely affects central and autonomic nervous systems. Abrupt discontinuation results in neurologic and behavioral findings as Neonatal Abstinence Syndrome (NAS). Method. Following NAS treatment, 28 infants (mean age 55 days [range 21-98 days], 57% male) were assessed using Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III) Cognitive, Language, and Motor subscales. Outcomes were compared with a historical control. Results. Mean Language and Cognition scores were significantly lower ( P < .001) in the NAS group. Distributions of scores for Language ( P < .001) and Cognition ( P = .022) were also significantly different between NAS and historical control groups. Conclusion. Prenatal heroin, methadone, and other opioid exposure is associated with weaknesses in language and cognition. This information has important public health implications, drawing attention to an otherwise healthy infant population which may benefit from early intervention services.

This study examined the association between screen media use, media content, and language development among 119 Hispanic infants and toddlers. Children and their caregivers were recruited through an urban, Early Head Start program. Duration and content of screen media exposure was measured through a 24-hour recall questionnaire, and language development was measured at baseline and at 1-year follow up. Children in the sample spent an average of 3.29 hours engaged with screen media (median 2.5 hours per day). In both cross-sectional and longitudinal analyses, children who watched over 2 hours of television per day had increased odds of low communication scores. Whereas child-directed media was associated with low language scores, adult-directed media was not. Our findings support the mounting literature on the deleterious impacts of screen media in toddler’s language development. Guidance and alternatives to screen media use should be available to families in pediatric practices and early childhood centers.

Pinworm infection is a very common diagnosis in young children that is not always confirmed through laboratory evaluation before empiric therapy is prescribed. This article describes a toddler who was treated several times for pinworms because small white worms were seen in her perianal area. Laboratory analysis of parasite material found in her diaper later confirmed a diagnosis of dipylidiasis. Because the signs of dipylidiasis and pinworm infection overlap and the treatments for these parasitic infections are different, the laboratory should clinically confirm suspected persistent or recurrent pinworms.

Thirty-four toddlers were studied in a prospective, convenience sample comparison at their 18-month health supervision visit to examine the effect of prolonged (i.e., to 18 months of age) bottle feeding on both the daily volume of cow's milk intake and the toddler's iron stores (serum ferritin concentrations.) Seventeen toddlers had been weaned from the bottle by approximately 1 year of age, and 17 toddlers who remained on the bottle at 18 months of age were the compared group. The toddlers who remained on the bottle had significantly greater (P

The condition 47,XYY aneuploidy is the result of an additional Y sex chromosome attached to the normal XY pairing in males. Although prevalence rates are difficult to determine in the population owing to the apparent rarity of the condition, estimates have generally been in the range of approximately 1 to 1.5 per 10 000 live births. However, among individuals considered tall, rates have been cited from 0.46% at 181 cm through to an estimated 10% or greater at heights more than 200 cm. Early research appeared to support XYY males being prone to violence and criminal behaviour. However, other studies convincingly challenged that hypothesis. Case examples have provided a picture of males with XYY as being generally tall, with high rates of mental illness, intellectual disability, and speech and language problems. Several cases have been reported of individuals with comorbid autism and XYY. The majority of these have been identified with Kanner-type classic autism. Furthermore, other studies have described individuals with XYY as having psychosis, extreme behavioral rigidity, or stereotyped language and behaviour before Rutter and the DSM-III provided clear criteria for identifying and diagnosing autism. In these latter cases, the subjects appear to have manifested with undiagnosed autism. The majority of individuals with XYY and autism spectrum disorders are reported as having low intellectual functioning. Furthermore, much of the research and clinical literature pertaining to XYY with individuals with other identified pathology has recorded details of intellectually low functioning participants. Only one case has been reported in the literature of XYY of an individual with Asperger’s disorder. However, little of the Asperger’s presentation was described by Gillberg et al in their review of 20 high-functioning individuals with autism spectrum disorders. The current case presents details of an adolescent with XYY and comorbid Asperger’s disorder. Prior to the assessment described herein, his behavioral difficulties were considered by consulting medical and allied health practitioners as a result of XYY chromosomal syndrome due to multiple assumptions based on stereotypes, rather than full consideration of his presentation. Given misinterpretation of the individual’s presenting features and a long delay in receiving an appropriate diagnosis, this child was severely disadvantaged by failing to receive appropriate intervention for many years. Alex (assumed name) was a 12-year-old male who was 182 cm tall at the time of his assessment. He was moderately overweight and unfit, partly due to his ceasing team sport because of difficulties he experienced with coping with the social dynamics of his peer group. Alex was referred for specialist psychological assessment as a result of violent behavior at school, including physically injuring other students. This conduct had resulted in multiple exclusions from school. It was also disclosed that Alex’s parents were using significant physical force, including hitting with a leather strap, to try and manage his behavior in the home. His aggressive behavior had been a long-term issue, with poorly developed coping strategies and significant challenges with self-control. On entering high school, Alex became the target of daily bullying in the classroom and playground that led to increased externalizing behavior. Alex was born full term after a 4.5-hour induced labor. He was 3.4 kg at birth and remained in hospital for 5 days. Alex had some feeding and weight gain problems in the first 2 weeks, but these passed. As a toddler he had chicken pox and also experienced frequent ear infections around age 2 years. Alex was reported to have reached his developmental milestones within normal limits, although demonstrating muscle hypotonia and significantly pronated feet. He had corrective procedures requiring his feet being in plaster and hospitalization at ages 4, 6, and 8 years. Alex had his hearing tested at 4 years and no problems were found.

We hypothesized that parents of infants prefer growth at higher percentiles and are averse to growth at lower percentiles. Of 279 participating parents, only 10% desired their child’s weight to be in the lowest quartile. For children weighing in the lowest quartile, 57% of parents thought their child’s weight was “too low.” In contrast, 66% of parents whose child’s weight was in the top quartile preferred their child weigh that much. When viewing hypothetical infant growth trajectories, 47% ranked a growth chart demonstrating growth along the 10th percentile for weight as “least healthy” of 6 growth patterns, and 29% chose charts showing an infant at the 90th percentile for weight at age 1 as “healthiest.” In conclusion, parents are averse to growth at the bottom of the weight growth chart but are much less likely to feel negatively about growth at higher percentiles. This is troubling given the childhood obesity epidemic.

Duodenal web most commonly presents with a history of vomiting and failure to thrive in the early infancy period. This study reports on a child who had an initial presentation of feeding intolerance and rare nonbilious emesis. The unusual presentation of food refusal directed the investigation to an upper endoscopy to look for evidence of gastrointestinal mucosal disease such as gastroesophageal reflux disease, peptic ulcer disease, Helicobacter pylori infection, and food allergy including celiac disease. The finding of duodenal web with a central aperture was unexpected but explains the mild degree of her gastrointestinal symptoms.

Inappropriate baby bottle use is associated with tooth decay, anemia, and overweight, and it may adversely affect dietary patterns. Parents often do not follow guidance to wean by 18 months of life. We piloted a brief, counseling-based weaning intervention in an urban WIC agency among primarily Hispanic parent/toddler dyads. At baseline (n = 48), toddlers consumed a mean 4.7 bottles/day. At follow-up (n = 39), the intervention group consumed fewer mean bottles/day than controls (0.09 vs 2.0 bottles/day, P < .045). Half the toddlers in the experimental group and one third of the control groups weaned completely. Parents of weaned children were satisfied with the outcome.

Atrial fibrillation is a relatively rare form of arrhythmia in the pediatric population. When it is seen in an infant or child, it is often associated with a structural heart abnormality, particularly after surgical repair or palliation of congenital heart disease. Other episodes may be associated with metabolic derangements. This report discusses the unique case of a toddler with newonset atrial fibrillation that was devoid of a readily identifiable etiology. It also reviews the literature and the implications of such a case for the primary care practitioner.

The purpose of this study was to determine the effect of a pediatric self-care book (SCB) with nurse telephone support on use of health services. The study was performed in a pediatric department of Kaiser Permanente in a suburb of Denver, Colorado. Well patients seen at age 2 weeks to 2.5 months (infant group) or 14 to 19 months (toddler group) were enrolled. Intervention families received a copy of the book, Your Child's Health and were oriented on its use. Rates of sick visits, advice nurse calls, pharmacy prescriptions, emergency department visits, and hospital admissions were assessed. Visit and call rates were calculated, and mean rates of the SCB group and the control group were then compared. Of 1,104 enrolles, 527 received the SCB; the other 577 served as controls. The SCB group had 14.0% fewer total visits (excluding well-baby visits) than controls did (p=0.018). For infants and toddlers who were not first-borns, the intervention was associated with a statistically significant decrease in sick visits (23%), advice nurse phone calls (24%), and pharmacy prescriptions (26%); no statistically significant differences in study outcomes were seen among firstborn study subjects. Promotion of self-care in a group model health maintenance organization can decrease use of services by families of young children.

A 15-month-old girl was brought to the emergency department with a 7-day history of diarrhea, vomiting, pancytopenia, and bleeding. The patient was born in Mexico City, Mexico, where she lived with her parents and two elder preschoolaged siblings, all in good health. All the members of the family were poorly fed and slept in the same room under unhygienic conditions. Her vaccination scheme was up-to-date, and her previous medical history was unremarkable.

One hundred twenty-four urban children under 3 years of age admitted for fractures were retrospectively reviewed to determine the frequency of accidental and nonaccidental causes in this population. The fractures were categorized according to their mechanisms: motor-vehicle passenger or pedestrian accident, other accidents, or child abuse. There were no differences in the frequency of fractures by race, date of birth, or season in which the injury occurred. Skull fractures were most frequent (62%), followed by femur fractures (11%). There was a 26% increase in fractures between 1987 and 1989, especially in the non-motor vehicle cohort. Caretaker ignorance and/or carelessness was a common cause of fractures in the infant and toddler age group. Injuries were still occurring in spite of infant car seat use. The American public must be educated in preventive medicine and safety to decrease the senseless morbidity of our greatest resource.

ORAL ANTIBIOTIC TREATMENT of acute staphylococcal osteomyelitis in toddler and school-age children has proven a cost-effective and efficacious alternative to intravenous therapy. 1,2 Oral antibiotic regimens, however, have not been carefully studied in neonatal osteomyelitis. We recently treated an infant with oral antibiotics for multifocal group B streptococcal (GBS) osteomyelitis and suppurative arthritis and report our experience.