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In his introduction, “Anniversaries, ” Alistair G.S. Philip, the editor of NeoReviews until 2017, reminisces about the 1960s to 1990s, highlighting various advances that long ago became a part of the scientific and professional sediment in our field. However, all of these recollections preceded the inception of the all online journal, NeoReviews , one of the first of its kind. At the journal’s 10th birthday, Alistair assembled a collection of “seminal contributions” in neonatal-perinatal medicine that had been published in NeoReviews , (1) which were then subsequently published in a book, Milestones in Neonatal/Perinatal Medicine . (2) Moreover, Alistair’s masterful and judiciously thorough recounting of the history of our field of neonatology was published in 2005, entitled “ The Evolution of Neonatology. ” (3) In this commentary, we wish to acknowledge Alistair’s dedication in informing his readership about the scientific and clinical advances in neonatology. Here, we offer our own perspective on what has transpired over the last 20 years of NeoReview’s life, but with an eye toward the future. As Alistair has pointed out, the subfield of newborn medicine evolved within general pediatrics sometime in the late 1940s and 1950s, an unusual, but remarkable, legacy from Martin A. Couney and Pierre-Constant Budin and their “incubator babies” sideshows at amusement parks, world fairs, and exhibitions. (4) The term “ neonatology ” itself, however, was not introduced until 1960 by Alexander Schaffer (5) in close timing with the advent of intensive care nurseries, which were more than just special facilities for preterm infants. The original research defining the nascent field focused on thermoregulation, nutrition, and growth of a neonate, quickly distinguishing neonatology from general pediatrics because of the unique requirements of the newborn, especially the preterm infant. As survival of preterm infants increased over subsequent decades, advances in cardiorespiratory support and …

Background: Many children eligible for developmental therapies through early intervention do not receive such services, often due to practical barriers in accessing the early intervention system as well as distrust. In response to these difficulties, we created a Parent Navigator program to provide two full-time parents of individuals with developmental …

How quickly the 70 million infants, children, and adolescents living in the United States can reach appropriate levels of hospital care for potentially life-threatening illnesses or injuries is a critical, yet understudied, aspect of our nation’s pediatric public health preparedness.1,2 Although US health planning and policy efforts would benefit from a national understanding of how accessible general types of pediatric hospital services (newborn, emergency, and pediatric inpatient) and their more advanced counterparts (NICU, pediatric emergency, and PICU services, respectively) are, available studies have … Address correspondence to Alyna T. Chien, MD, MS, Division of General Pediatrics, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail: alyna.chien{at}childrens.harvard.edu

BACKGROUND: Pediatric emergency department (PED) overcrowding and prolonged boarding times (admission order to PED departure) decrease quality of care. Timely transfer of patients from the PED to inpatient units is a key driver that relieves overcrowding. In 2015, PED boarding time at our hospital was 10% longer than the national benchmark. We described a resident-led quality-improvement initiative to decrease PED mean boarding times by 10% (from 173 to 156 minutes) within 6 months among general pediatric admissions. METHODS: We applied Plan-Do-Study-Act (PDSA) methodology. PDSA 1 (October 2016) interventions were bundled to include streamlined mobile communications, biweekly educational presentations, and reminder signs. PDSA 2 (August 2017) provided alternative workflows for senior residents. Outcomes were mean PED boarding times for general pediatrics admissions. The proportion of PICU transfers within 12 hours of admission served as a balancing measure. Statistical process control charts were used to analyze boarding times and PICU transfer rates. RESULTS: Leading up to PDSA 1, monthly mean boarding times decreased from 173 to 145 minutes and were sustained throughout the study period and up to 1 year after study completion. The X-bar chart demonstrated a shift with 57 consecutive months of mean boarding times below the preintervention mean. There were no changes in PICU transfer rates within 12 hours of admission. CONCULSIONS: Resident-led quality improvement efforts, including education and streamlined workflow, significantly improved PED boarding time without causing harm to patients.

* Abbreviations: CVAD — : central venous access device MAGIC — : Michigan Appropriateness Guide for Intravenous Catheters miniMAGIC — : Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics PICC — : peripherally inserted central catheter At the interface of clinical practice and medical science, evidence emerges. In domains of clinical practice that lack adequate evidence, clinical decisions are guided by a combination of clinical experience, clinician intuition, and resource availability (material and personnel). Consequently, where evidence gaps exist, clinical care can feel autonomous and innovative but is often inconsistent and may generate adverse outcomes for patients who are underappreciated. For children with serious illness, clinical decisions regarding achieving and sustaining venous access predominantly occur without much evidence, resulting in more variability than predictability in selecting central venous access devices (CVADs). In this supplement, an international group of pediatric experts propose a way forward using the Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics (miniMAGIC) evidence framework,1 which used the RAND Corporation–University of California, Los Angeles Appropriateness Method. miniMAGIC … Address correspondence to Matthew M. Davis, MD, MAPP, Division of Academic General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital, 225 E Chicago Ave, Box 162, Chicago, IL 60611. E-mail: mmdavis{at}luriechildrens.org

BACKGROUND AND OBJECTIVES: The American Board of Pediatrics (ABP) certifies that general and subspecialty pediatricians meet standards of excellence established by their peers, immediately after training and over the course of their careers (ie, Maintenance of Certification [MOC]). In 2015–2016, the ABP developed the Maintenance of Certification Assessment for Pediatrics (MOCA-Peds) as an alternative assessment to the current proctored, closed-book general pediatrics (GP) MOC examination. This article is 1 of a 2-part series examining results from the MOCA-Peds pilot in 2017. METHODS: We conducted quantitative and qualitative analyses with 5081 eligible pediatricians who registered to participate in the 2017 pilot; 81.4% (n = 4016) completed a quarter 4 survey and/or end-of-year survey (January 2018) and comprise the analytic sample. RESULTS: The majority of pediatricians considered the MOCA-Peds to be feasible and acceptable as an alternative to the proctored MOC GP examination. More than 90% of respondents indicated they would participate in the proposed MOCA-Peds model instead of the examination. Participants also offered recommendations to improve the MOCA-Peds (eg, enhanced focus of questions on outpatient GP, references provided before taking questions); the ABP is carefully considering these as the MOCA-Peds is further refined. CONCLUSIONS: Pilot participant feedback in 2017 suggested that the MOCA-Peds could be implemented for GP starting in January 2019, with all 15 subspecialties launched by 2022. Current and future evaluations will continue to explore feasibility, acceptability, and learning and practice change as well as sustainability of participation.

Food insecurity is an important social determinant of health,1 a key indicator of limited resources and material hardship,2,3 and a source of significant stress as parents and other caregivers seek to provide healthy child nutrition.4 As such, food insecurity would be expected to adversely affect child growth5,6 and health and development more broadly.7,8 However, there has been limited study of associations between food insecurity and child outcomes during the critical period of early childhood.9–11 The authors of “Food Insecurity, Health and Development in Children Under Age Four Years” aim to address this gap by using a large sample of families at high risk for both food insecurity and child health disparities.12 Contrary to the authors’ hypotheses, limited relations between food insecurity and child obesity or other growth parameters were found in the study. The only significant associations were for children between 25 and 36 months old, for whom household food insecurity was associated with increased adjusted odds of obesity. In contrast, no significant associations were found after adjustment for … Address correspondence to Rachel S. Gross, MD, MS, Division of General Pediatrics, Department of Pediatrics, New York University School of Medicine, 462 First Ave, New York, NY 10016. E-mail: rachel.gross{at}nyulangone.org

* Abbreviation: ACE — : adverse childhood experience > The Editorial Board of the Section on Pediatric Trainees Monthly Feature is proud to feature an article by Dr Kavitha Selvaraj, who suggests that the effects of toxic stress can be combated through the development of physician–teacher partnerships. Her article concluded our series of featured essays on the Advocacy Campaign for 2016–2017. > > Catherine Spaulding, MD, Editor, Pediatrics , SOPT Monthly Feature I first learned about toxic stress the day my student “J” punched me in the face. As a seventh-grade biology and health teacher in an underserved neighborhood, I hoped to inspire the next generation of scientists. Unfortunately, the 5-week teachers’ boot camp left me woefully underprepared for the students’ constant behavioral outbursts, so little time was actually spent teaching. The most memorable incident started when I heard voices in the hallway yelling, “Fight! Fight! Fight!” and found my students, “J” and “N,” throwing punches. I positioned myself between the sparring students and yelled at them to stop. N backed away immediately, but J kept swinging with full force. His pupils were dilated, his face was sweaty, his respirations were fast and shallow. I implored him to stop, but instead, he stared at me blankly and punched me square in the face. Within moments, security guards arrived to escort J and N to the dean’s office, and the crowd dispersed. I stood there a moment longer, my cheek throbbing and my ego even more wounded, in shock at what had just occurred. After finding an ice pack for my swollen … Address correspondence to Kavitha Selvaraj, MD, MPH, MAEd, Division of Academic General Pediatrics and Primary Care, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Ave, Box 162, Chicago, IL 60611-2991. E-mail: kselvaraj{at}luriechildrens.org

BACKGROUND AND OBJECTIVES: Concern is often expressed about the satisfaction of new physicians and the potential match of their workplace goals with available positions. We studied the interface of desired professional activities with actual initial positions. METHODS: Survey study of all general pediatricians taking the 2012 General Pediatrics Certifying Examination. RESULTS: Of the 5210 who sat for the General Pediatrics Certifying Examination, 5163 (>99%) completed the survey. Of the total respondents, 45% self- identified as general pediatricians (N = 2327). Of those who completed training CONCLUSIONS: Despite concerns about young general pediatricians being able to find positions that meet their career goals, most were in jobs that approximated their desired allocation of professional time and focus of clinical work.

The CATCH (Community Access to Child Health) Program, which supports pediatricians who engage with the community to improve child health, increase access to health care, and promote advocacy through small seed grants, was last evaluated in 1998. The objective was to describe the characteristics of CATCH grant recipients and projects and assess the community impact of funded projects. Prospective data was collected from CATCH applications (grantee characteristics, topic area and target population for projects funded from 2006–2012) and post-project 2-year follow-up survey (project outcomes, sustainability, and impact for projects funded from 2008 through 2010). From 2006 through 2012, the CATCH Program awarded 401 projects to grantees working mostly in general pediatrics. Eighty-five percent of projects targeted children covered by Medicaid, 33% targeted uninsured children, and 75% involved a Latino population. Main topic areas addressed were nutrition, access to health care, and medical home. Sixty-nine percent of grantees from 2008 to 2010 responded to the follow-up survey. Ninety percent reported completing their projects, and 86% of those projects continued to exist in some form. Grantees reported the development of community partnerships (77%) and enhanced recognition of child health issues in the community (73%) as the most frequent changes due to the projects. The CATCH Program funds community-based projects led by pediatricians that address the medical home and access to care. A majority of these projects and community partnerships are sustained beyond their original CATCH funding and, in many cases, are leveraged into additional financial or other community support.

A controversy is raging as to whether e-cigarettes are adding to or merely replacing tobacco use among youth. The stakes for answering this question are high and will influence tobacco control policy decisions for the next decade. In this issue of Pediatrics , Barrington-Trimis et al1 demonstrate that e-cigarettes have expanded total adolescent tobacco use beyond what would have been expected by the trends of tobacco use in a Southern California population of 11th and 12th grade students. In 2004, before e-cigarettes had been introduced, ∼1 in 11 were smoking cigarettes; 10 years later, 1 in 7 were smoking cigarettes or e-cigarettes. In this sample, e-cigarette use has increased to the point that ∼10% use them. Furthermore, recent Food and Drug Administration deeming regulations are a step in the right direction but will not change the fundamental dynamic of rapidly increasing youth e-cigarette use.2 We think the science on expanding e-cigarette use among adolescents is sound, the list … Address correspondence to Jonathan P. Winickoff, MD, MPH, MGH Division of General Pediatrics, 125 Nashua St, Suite #860, Boston, MA 02114. E-mail: jwinickoff{at}mgh.harvard.edu

In reply to Mage and Donner, there are indeed limitations to the operational 1-year cutoff for sudden infant death syndrome (SIDS) and, in fact, our group has brought forth research challenging age conventions. However, the general Pediatrics readership understands definitions as they are conventionally used, and we did not believe our analysis was compromised by using terms as they are generally understood. Regarding the diagnoses included in the analytic composites, there is room for debate about … E-mail: richard_goldstein{at}dfci.harvard.edu

* Abbreviations: ICD-10 — : International Classification of Diseases, 10th Revision SIDS — : sudden infant death syndrome It is widely acknowledged that dramatic declines in the rate of sudden infant death syndrome (SIDS) in the United States resulted from recommendations that infants not be placed prone to sleep, first by the American Academy of Pediatrics in 1992,1 followed by the national Back to Sleep campaign 2 years later.2 Other recommendations, such as room-sharing without bed-sharing and avoidance of soft bedding, were introduced and reinforced over the next 2 decades and, with supine positioning, have been the mainstay of SIDS risk reduction guidelines.3,4 However, there has been much concern in recent years because the rate of SIDS (International Classification of Diseases, 10th Revision [ICD-10] R95) has plateaued and rates of other sleep-related infant deaths, such as accidental suffocation and strangulation in bed (ICD-10 W75) and ill-defined deaths (ICD-10 R99), have increased.2 Indeed, the rate of postneonatal mortality, which encompasses all of these diagnoses, has not declined since the late 1990s.2 The risk factors for these different categories of death are strikingly similar,5 and researchers have documented a diagnostic shift, ie, deaths that were previously classified as SIDS 2 to 3 decades … Address correspondence to Rachel Y. Moon, MD, Division of General Pediatrics, PO Box 800386, University of Virginia, Charlottesville, VA 22908. E-mail: rym4z{at}virginia.edu

During the 2011 Workshop on Perinatal Practice Strategies sponsored by the American Academy of Pediatrics Section on Perinatal Pediatrics, I reviewed the essentials of the American Board of Pediatrics (ABP) program for Maintenance of Certification (MoC). This article is a synopsis of that presentation. Although the principles of MoC are applicable across pediatric subspecialties (and many apply to General Pediatrics as well as the subspecialties), my comments in this article are directed primarily to clinicians interested in the MoC program as it applies to certificate holders in Neonatal-Perinatal Medicine (NPM).

OBJECTIVE: To describe and analyze the implicit curriculum of a general pediatrics inpatient setting and to understand how it maps onto competency-based goals and objectives in the explicit curriculum. METHODS: We conducted a case study on a general pediatrics floor, which entailed 143 hours of direct observation during 8 months and 39 in-depth interviews with pediatric residents and General Pediatric attendings who were observed on multiple occasions as they worked on the floor. Data were derived from field notes and interview transcripts. We inductively coded the data, clustered it according to competency domains, and systematically inspected it to derive themes about the convergence of the implicit and explicit curricula. RESULTS: The implicit curriculum, shaped by ordinary events, activities, and conversations, taught residents “how things work.” The implicit curriculum aligned well with the competency-based goals and objectives in the explicit curriculum; residents had frequent opportunities to meet >90% (29 of 32) of the written objectives. Nonetheless, no one referred to the explicit curriculum or to the competency domains throughout the study. In contrast to the neat list of goals and objectives in the explicit curriculum, the implicit curriculum was extraordinarily messy and dominated by 1 competency domain: patient care. Moreover, the implicit curriculum was not formally recognized as integral to a competency-based model of education. CONCLUSIONS: Representing the competency domains in ways that better reflect how learning opportunities in the implicit curriculum align with the goals and objectives in the explicit curriculum may increase awareness of the full range of residents' learning experiences.

OBJECTIVE. The goal was to determine the reasons given for nonparticipation in maintenance of certification by general pediatricians and pediatric subspecialists whose board certification had expired. METHODS. All United States-based pediatricians whose board certification had expired and who had not recertified as a generalist or subspecialist in 2004 or 2005 were surveyed. The total sample included 1001 pediatric generalists and 1237 subspecialists. We conducted a mail survey study, with a total of 3 mailings to nonrespondents. Analyses initially were conducted separately for generalists with expired certificates, subspecialists with active subspecialty but expired general pediatrics certificates, and subspecialists with expired subspecialty certificates (regardless of their general pediatrics certification status). RESULTS. The overall response rates were 68% for generalists and 76% for subspecialists. Of pediatricians who had allowed their certificates to expire, the majority still intended to recertify (65% of the generalists and 86% of the subspecialists, in their primary subspecialty). The most common reasons cited by the 35% of generalists with expired certificates who were not planning to participate in maintenance of certification were the expense, the time required to complete maintenance of certification, and the perceived lack of relevance to their current practice. The 14% of subspecialists who were not planning to recertify in their primary subspecialty most commonly cited the expense, a change in career path making recertification unnecessary, and the time required. CONCLUSIONS. Although the physicians in this study had allowed their certificates to expire, they still overwhelmingly believed that physicians who provide direct patient care should maintain their certification. There was general consensus among our respondents regarding the professional value to patients and peers of participation in the maintenance of certification program.

1. Julia M. Bledsoe, MD* 2. Brian D. Johnston, MD, MPH† 1. *Division of General Pediatrics and Director, Center for Adoption Medicine 2. †Division of General Pediatrics, Department of Pediatrics, University of Washington, Seattle, WA After completing this article, readers should be able to: 1. Describe the changes in the demographic, medical, and developmental characteristics of internationally adopted children. 2. Discuss the role of the pediatrician in assessing information made available to families prior to adoption of a child abroad. 3. List conditions commonly seen in children adopted internationally and characterize their medical, developmental, and social consequences. 4. Describe the current understanding of the long-term medical, developmental, and emotional outcomes of international adoption. International adoption is an increasingly common phenomenon. With nearly 20,000 foreign-born adoptees entering United States families every year, most pediatricians can expect to encounter one or more of these children in their practices. However, as the demographics and medical risks of intercountry adoption continue to change, it also is likely that prospective adoptive parents will seek pediatric advice prior to completing their adoption. The goal of this review is to highlight the general and specific concerns that pediatric clinicians should address as they prepare families for international adoption. In 1989, approximately 8,000 children were adopted into United States homes from foreign countries. Most came from Korea, relinquished by young mothers who were stigmatized by out-of-wedlock pregnancy (Figure⇓). Most of these children received United States-style pediatric care and were nurtured in well-funded foster homes until their adoption was completed, usually during infancy. Figure. Immigrant visas issued to orphans coming to the United States by country of origin, 1989 versus 2002. Source: United States Department of State. By 2002, the number of intercountry adoptions had more than doubled, with most children coming from either Russia or China (Figure⇑). This shift in country of origin was accompanied by a change in the general health and well-being of international adoptees. For example, among children available for adoption from Russia, as many as 30% were born preterm or were of …

Geographic circumstances: During Hurricane Katrina I received and triaged evacuees 325 miles from ground zero. I subsequently moved to Galveston, Texas, a town ravaged more than once by powerful hurricanes. About the author: I am currently working on the Gulf Coast in the division of general pediatrics at the University of Texas Medical Branch (UTMB) in Galveston. In the 1970s I attended medical school at Louisiana State University in New Orleans. After that I went to UTMB for my general pediatrics residency. I practiced general pediatrics in Longview, Texas, for 32 years afterward. I served as president of the Texas Pediatric Society. Currently, I am chapter vice-chair for the Texas chapter of the American Academy of Pediatrics (AAP) and a member of the AAP Committee on Practice and Ambulatory Medicine. I made a practice change partially because of Katrina but more as a result of an intense period of storms that affected the central Gulf Coast during the last 5 years. As a result of these storms UTMB has more actively sought innovative ways to meet the needs of people it serves so as not leave medical services vulnerable to hurricanes. I am the medical director of a new outpatient facility that serves both subspecialty pediatrics and general pediatrics. I am now living on the Texas coast as part of the faculty and am keenly aware of the needs for organized responses for the benefit of children in particular. I am a New Orleans native and have lived my entire life in the Gulf South region. I was reared in a family with strong Acadian heritage thanks to my mother and her forebears. The existence and effects of hurricanes have been part of a way of life for my family and countless others in this region. Stories that I can … Address correspondence to O. W. “Skip” Brown, MD, Department of Pediatrics, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0351. E-mail: owbrown{at}utmb.edu

The Initiative for Innovation in Pediatric Education (IIPE)1 is the next phase in a comprehensive reevaluation of pediatric residency education that began with the Residency Review and Redesign in Pediatrics (R3P) project.2 As the IIPE begins, it is worth reflecting on questions that arose repeatedly during the R3P project: Just what role does residency play in child health? Does it make a difference where one trains? Can residency improve later adherence to clinical guidelines? and Can residency modify the frequently steep learning curve of subsequent practice? This question is in the same category as whether it matters where one goes to medical school. The answer is elusive, but the imagined answer determines the structure and conduct of residency education. One extreme is that 3 years cannot possibly count for much. The other is that residency is all-important, and an attempt should be made to prepare everyone for everything. That ambitious goal governs our current approach to residency education.3 The goal was appropriate when virtually every pediatrician's practice was similarly broad. However, pediatric health care is increasingly dichotomized into low-acuity disorders treated exclusively in ambulatory settings, away from academic health centers (AHCs), and complex illnesses treated mostly within AHCs.4 Career choices follow epidemiology. Only 29% of third-year residents who intend to practice general pediatrics, just 13% of all third-year residents, plan to practice general pediatrics in both ambulatory and hospital settings.5 This is …

Objective.To determine the careers of graduates of the General Pediatrics Academic Development Program (GPADP) and the pediatricians from the Clinical Scholars (CS) Program 8 to 16 years after completion of their fellowship to assess the current state of the academic general pediatrician and to determine the current activities of divisions of General Pediatrics in US medical schools.Design.Analysis of questionnaire data from former fellows of the two programs, who trained during the years 1978 to 1988, as well as of data from questionnaires to all divisions of General Pediatrics (or their equivalent) in all medical schools in the United States.Population.Surveys were conducted of the 111 graduates of the GPADP and the 39 pediatricians from the CS program and all 127 US medical schools.Results.Of the 111 GPADP graduates, 101 were located, and 85 completed the questionnaire. Of 39 CS graduates, 36 were located, of whom 27 completed the questionnaire. Similarities were found between the two groups in percent being in academic positions (74%, GPADP vs 70.4%, CS), percent having achieved tenure (17.8%, GPADP vs 14.3%, CS), and percent of time spent in research (17%, GPADP vs 25%, CS). Considerable differences, however, were found in percent of time spent in direct patient care (35.7% time for GPADP and only 17.8% time for CS) and in direct teaching (25.1% time for GPADP and only 17.6% time for CS). The mean number of articles published was greater among CS professionals (21.4 vs 14 for GPADP, but not statistically significant), as was the mean number of research grants (6.75 by CS vs 4.02 by GPADP). The GPADP fellows had obtained more education grants and more service grants. Both groups were concerned about the lack of time and support for research. Few General Pediatrics divisions had ongoing academic fellowship programs.The current number of new fellows by divisions of General Pediatrics who are educated to do research is small. Only 30 related programs exist in all the medical schools in the United States. However, large divisions of General Pediatrics, responsible for large teaching and clinical service programs, are now in place in the majority of medical schools. This represents progress since 1978, when few generalists were in full-time academia.Conclusion.More than two thirds of both the GPADP graduates and CS professionals are now in academic departments. They have had modest success in obtaining grants, publishing articles, and achieving tenure, but large teaching and service demands and lack of research funds have made it difficult for both groups to be as productive in research as originally hoped. The field of Academic General Pediatrics now is established. It is the responsibility of graduates of these and similar programs to produce creative research and expand fellowship programs, as well as to do good clinical care, if a vigorous field of Academic General Pediatrics is to be achieved.

Canadian pediatric residents usually pursue training in general pediatrics or subspecialty pediatrics. Graduates can work in community-based settings, hospital-based settings, or a combination thereof. Furthermore, new graduates may work in large urban or rural/remote centers. To date, no study has profiled the training and career paths of Canadian pediatric residents. The goal of this study was to profile the training and career paths …

1. Howard Bauchner, MD* 1. 2. *Professor of Pediatrics; Director, Division of General Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA. Editor’s Note: Although this section of Pediatrics in Review usually presents clinical tables, clinicians also need access to information relevant to other aspects of their patients’ lives. The resources in this article represent a treasure trove that will educate and entertain the children under our care. Part of the joy of pediatrics is sharing information with families. Most of the time we provide medical information, but over the past few years there has been renewed interest in pediatricians supporting parents in their role as teachers. …

1. Joseph A. Zenel, MD, Editor-in-Chief The 35th year for Pediatrics in Review ( PIR ) starts with this issue. This past year was one of transition. Dr Larry Nazarian retired as editor-in-chief, the Rochester, New York, office closed, and the journal’s operations moved to the American Academy of Pediatrics (AAP) headquarters in Elk Grove Village, Illinois. Somewhere in the midst of this transition I became editor-in-chief and by summer was fully acquainted with the day-to-day operations and the people who make this an exceptional, educational journal. Also this summer, the efforts of many pediatricians at my other job came to fruition. I direct a new residency program, and by July the program achieved a full resident complement. Finally, the faculty could see the difference between beginning first-year, second-year, and third-year residents. Besides understanding the needs of the residents for each training year, the faculty expressed an awareness of the effect they had in helping a pediatrician evolve and a sense of worth in achieving that goal. For me, this beginning third year was the tipping point toward the residency’s success, which got me thinking. In the past, I helped start a new general pediatrics private practice. Two events occurred almost simultaneously. By the third year of practice, not only could my …

The role of a generalist in academic medicine has been diminished because of the proliferation of specialized research and treatment in the hands of the subspecialist. Yet many observers believe that this has resulted in gaps in research and teaching concerning common health problems, especially those seen in office practice. To correct this trend, The Robert Wood Johnson Foundation has supported for 10 years a fellowship program to prepare academic pediatric generalists. A total of 111 pediatricians have completed the fellowship. Two thirds are now in full-time academic positions. By late 1988, they had published 332 papers and had received more than $20 million in grant support. A majority of departments of pediatrics have relabeled their divisions of ambulatory pediatrics as divisions of general pediatrics and have broadened these divisions' responsibilities. In spite of some difficulty obtaining research support, the careers of these fellows and the changes in pediatric departments support the thesis that there is a need for and a rebirth of academic general pediatrics.

* Abbreviations: GERD — : gastroesophageal reflux disease Elsewhere in this issue of Pediatrics there appears an important article pointing to the hazards of using a disease label to describe a common, usually normal physiologic variant, regurgitation in small infants: “Influence of “GERD” Label on Parents’ Decision to Medicate Infants with Excessive Crying and Reflux” by Scherer et al.1 The authors’ concern is that acid-reducing medications are being overused and are rarely indicated. There are a few methodologic issues in their presentation, some of which they discuss, but their evidence is clear that use of the disease label “gastroesophageal reflux disease (GERD)” to diagnose any such regurgitation and crying makes parents more likely to favor the use of medication for the condition, even when there has been no confirmation by endoscopy, and even when the drug offered is acknowledged as being unlikely to be effective. This is compelling evidence that … Address correspondence to William B. Carey, MD, FAAP, Division of General Pediatrics, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104-4399. E-mail: carey{at}email.chop.edu

Television can be really bad for children. That is what study after study tells us. Watching too much television makes kids more likely to be overweight.1–4 It interferes with executive function5 and increases the risk of attentional problems.6,7 If they watch programming that contains sex, it can make them have sex earlier.8,9 It can make them more aggressive.10–12 And, in this issue, a study from New Zealand states that the more television you watch as a child, the more likely you are to have a criminal conviction, a diagnosis of antisocial personality disorder, or more aggressive personality traits as an adult.13 In the study, every extra hour of television watched by children on a weeknight increased by 30% the risk of having a criminal conviction by age 26. Clearly, it would be better for the physical and mental health of our children, not to mention their future prospects, if they listened to the recommendations of the American Academy of Pediatrics and … Address correspondence to Claire McCarthy, MD, General Pediatrics, Boston Children’s Hospital, Boston, MA. E-mail: claire.mccarthymd{at}childrens.harvard.edu

1. Megan H. Bair-Merritt, MD, MSCE* 1. *Assistant Professor of Pediatrics, Division of General Pediatrics & Adolescent Medicine, Johns Hopkins University, Baltimore, Md Pediatric medical research continues to grow exponentially, and because of the vast quantity of articles, keeping abreast of current literature may be overwhelming. In addition, individual studies often are constrained by small sample sizes, which limits the ability to detect significant relationships, and by recruitment from a single site, which limits generalizability. Rigorous literature reviews, therefore, are needed to synthesize available information …

We are pleased to announce that the Ambulatory Pediatric Association journal will move to a 6 times a year publication, Ambulatory Pediatrics , as of January 2001. Ambulatory Pediatrics will provide a forum for interesting and cutting-edge work in academic general pediatrics. Ambulatory Pediatrics will focus on the education of pediatricians, child health services research, emergency medicine, research methodology, complementary and alternative medicine, child health policy, and adolescent medicine. Ambulatory Pediatrics builds on the success …

To the Editor.— In "Technical Skills Required in General Pediatrics" the authors suggest that a basic list of 24 skills considered to be necessary by 95% of pediatricians surveyed serve as a guide for skills training in pediatric residency.1 As an educator in the field of adolescent medicine, I was alarmed to find that the pelvic examination was omitted. It was one of 72 skills to be ranked by general pediatric practitioners. I suspect that an element of sampling bias effected the omission of the pelvic examination as nonessential.

For some time I have felt that Pediatrics has been failing in its responsibilities to those of us who are in the daily practice of general pediatrics. Subject matter continues to be aimed more and more at the research-oriented, and is of decreasing value to the practicing pediatrician. I realize the necessity for continued research that it has to be published, and that every moment I practice I am utilizing and benefiting from the results of previous investigators. I am aware, too, of the economic factors that necessitate some articles.

After reading Dr. Gould's letter in the May issue (Pediatrics, 33:789), in which he cited the reasons for leaving the private practice of general pediatrics, I would like to enumerate the reasons which make it possible for my associate and myself to practice the new pediatrics with satisfaction. 1. We practice in an area that needs pediatricians. There are about 500,000 people and 2,000 hospital beds in our immediate area, and about 12 pediatricians. I and my associate are 2 of 3 pediatricians in a 500-bed hospital.