Search

During the past four years (1959-1963) 27 adolescent girls have been observed and treated for atopic dermatitis. This paper is concerned with these adolescent patients, and particular interest has been directed toward the relationship of the skin lesions to various changes in the menstrual cycle. Eczema was first described by Besnier1in 1892 and the term atopic dermatitis was coined by Coca and Sulzberger2,3in 1934. Despite the vast amount of literature concerning atopic dermatitis since that time, relatively little has been written about the natural course of atopic dermatitis during adolescence.4-7Most typically, atopic dermatitis or eczema is a highly pruritic, sometimes exudative, cutaneous syndrome usually beginning in early life. It is frequently the first manifestation of a constitutional abnormality intermittently associated with the development of allergic rhinitis and/or asthma.5It may be divided into three important phases representing different morphologic features clinically: Phase 1

In January 1964, the Surgeon General's office released its report demonstrating the strong potential relationship between cigarette smoking and lung cancer as well as the pulmonary and cardiovascular diseases which afflict thousands each year.1 Since that time, an estimated 30 million Americans have quit smoking; but, during the last two years, there has been a noticeable increase in per capita cigarette consumption among women and teen-age girls.2 Every day 3,200 adolescents between the ages of 12 and 18 take up smoking (exclusive of those who are just experimenting with smoking, the 10- to 12-year-olds).3 The Bureau of Census estimates that the number of teen-agers smoking rose from 3 million to approximately 4 million between 1968 and 1972. The proportion of smokers in the 12 to 18 age group increased from 14.7% to 15.7% among boys and 8.4% to 13.3% among girls.4 Analysis of research by the Department of Health, Education, and Welfare on teen-age populations indicates there are many environmental factors that affect the initiation of the smoking habit; however, by far the strongest influence is the smoking behavior of parents and siblings.5 If both parents smoke, the teen-ager has about twice the likelihood of being a smoker than if neither parent smokes (the rates are 18.4% to 9.8% respectively). If an older brother or sister smokes, the teen-ager is twice as likely to become a smoker himself.5 When the combined effect of smoking of parents and older siblings is considered, the concept of family patterns is reinforced. The lowest level of smoking is found among teen-agers who live in nonsmoking households.

In a previous statement approved by the Executive Board of the American Academy of Pediatrics, and subsequently by the House of Delegates of the American Medical Association, the American College of Obstetricians and Gynecologists emphasized the magnitude of the problem of teenage pregnancy and the responsibilities of professionals involved in the care of these young people. Rapid changes in contemporary attitudes and in legislation have caused many physicians and their patients to consider abortion as an acceptable solution to an unwanted pregnancy in adolescent girls. These changes place a heavy responsibility on pediatricians and other physicians caring for adolescents, particularly in regard to their special need for compassionate and considerate understanding. Although the American Academy of Pediatrics prefers neither to sanction nor to forbid the use of abortion to terminate an unwanted pregnancy in the teen-age girl, it does have the responsibility to insist that physicians considering this recourse provide for appropriate counseling and support for these adolescent girls and other involved persons, including the young fathers. In circumstances where the pediatrician is unable to provide adequate counseling support, he should act as the pivotal person in arranging for a social worker, pastor, or other experienced counselor to conduct this essential of care, both before and after the procedure. Consistent with his accredited role in preventive medicine, the pediatrician must make certain that adequate information and sex counseling are available to his teenage patients. Contraceptive advice and prescription for the sexually active teenage girl should be accompanied by investigation and alteration of contributing issues wherever possible.

In October 1970, the Academy identified itself with those who favored Separating marijuana from the group of drugs subject to stringent narcotic laws. It recommended that individuals who were found to be in possession of the drug for personal use, or were present where the drug was being used, should be charged with a misdemeanor rather than a felony.1 Subsequently, the Committee on Drugs in a statement on drug abuse legislation noted its concern with marijuana.2 This position is based on the fact that marijuana is clearly not a narcotic and does not appear to have a potential for physical dependence. It should not be construed, however, as favoring the legalization of marijuana. A decision in this regard must await the development of further research on the properties of the drug. The potency of marijuana has not been standardized and may vary widely. Furthermore, anecdotal accounts exist of the adulteration of marijuana with other chemical agents to produce a more profound effect. It has therefore been difficult to determine with precision the effects of marijuana as it is commonly used. The limited research findings that are currently available would not appear to indicate any significant harmful physical effects from the smoking by humans of moderate amounts of plain marijuana. The recent report from the Department of Health, Education and Welfare3 states that "although the state of intoxication is frequently vivid as described by the (marijuana) user, an observer may see little change from a normal state. Mild states of intoxication often go completely undetected. Physiological changes are notably minimal."

Problems relating to human reproduction are among the critical issues of our time, and it is appropriate that pediatricians contribute to the solution of these problems. The changing dimensions of comprehensive pediatric care, more specifically the significant numbers of pregnancies being reported in young persons, support this position. For example, national statistics show that 44% of all pregnancies occur in persons under 20, and one out of four mothers on Aid to Families with Dependent Children in New York is pregnant before 16. At least four roles can be identified for the pediatrician: 1. Genetic counseling: the pediatrician has already become proficient in giving knowledge to parents of the incidence of inborn errors of metabolism, chromosomal abnormalities, and other problems associated with genetic inheritance patterns. 2. Sex education: he often provides sex education to individual patients, families, and parents, in addition to teaching groups in his own practice and in schools, churches, or youth organizations. 3. Family planning and pregnancy counseling: he may provide assistance in these areas in behalf of the parents or adolescents. This assistance may involve a wide range of clinical advice and treatment, including the concept of spacing (rhythm method), contraceptive devices, or oral medication, whatever is considered most suitable for the individual. All alternatives for dealing with an unwanted pregnancy should be seriously discussed with the teenage girl and the other persons involved, including the parents if feasible. The pediatrician is in a unique position by the nature of his close association and relationship with the adolescent patient to provide this important personal service.