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Seventy-three adolescents, referred to the University of Washington Adolescent Clinic for school underachievement were evaluated for this study. Four times more adolescent boys than girls were referred for this problem. Twenty were found to be psychogenic underachievers, 40 had evidence of specific learning disorders, and 13 were mentally retarded. The problems of school achievement were not recent in onset but had, in most cases, been recognized in the early grades. The onset of puberty and rapidly approaching maturation, however, awakened the concerns of the parents and the teachers regarding the need for more diagnostic evaluation, vocational and academic planning, and guidance on managing the associated behavioral problems. The physician's role in management of school underachievement and the need for earlier recognition and therapeutic intervention is discussed.

The pediatrician can be useful to the young person with a drug problem if he: (1) is aware of the different motivations for drug abuse by adolescents and how to approach them, (2) recognizes the need for confidentiality, (3) provides factual information in a non-authoritarian manner and listens and counsels as indicated, and (4) manipulates the environment-to relieve school and family pressures and to help youngsters find better challenges. Drug abuse in children and adolescents is a major source of concern to parents, educators, law enforcement agencies, and physicians. For the pediatrician as well as the others, a challenge exists to find more appropriate ways of help for young people who turn to drug abuse for the answer that is not there.

The American Academy of Pediatrics is deeply concerned with the increasing social health problems in today's society, particularly those that relate to the function of the family as a unit and to the behavior of its children and youth. Some of the signs of the serious social, moral, and ethical crisis facing us are: increasing illegitimacy, early marriage, dangerous drug use, rising incidence of venereal disease, family fragmentation manifested in divorce, and lack of restraint within the mass media in presenting sexually stimulating material to young and immature persons. It is the Academy's conviction that all segments of the society of responsible adults, lay and professional, must mobilize now in support of personal and collective action to help children and adolescents grow to a healthy maturity as intellectually, socially, and sexually secure individuals. We join with other national organizations, such as the National Congress of Parents and Teachers, the American Medical Association, the National Education Association, and support the interfaith statement of the nation's major religions in officially supporting health education, including family life and sex education. We urge programs that will create a vigorous and healthy social climate in which family life can flourish and which foster mature sexual behavior in each individual. With this larger goal in mind, we propose and endorse the following general programs and actions. 1. Every concerned adult, lay or professional, must be encouraged to examine his own values and behaviors in order to develop an openness which permits a meaningful rapport with children and youth.

A product of affluence and changing life-styles, obesity has become one of our most prevalent and serious nutritional problems. It is estimated that there are more than 10 million adolescents and young adults in the United States who are obese; most will remain so in spite of periodic attempts at weight control. Most physicians have little objection to treating a bright, young, highly motivated middle-class adolescent girl who is only slightly overweight. It is the passive, physically inactive youngster with longstanding obesity who elicits a feeling of futility, hopelessness, and despair on the part of the physician. Our present therapeutic approaches to the obesity problem produce notoriously poor results. If one uses weight loss solely as the criterion of success, there is little evidence that treatment of juvenile obesity by most current methods (caloric restriction, exercise, and counseling) produces better long-term results than no therapy at all. Evaluation of measures

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."

This review and update is designed for the pediatrician working in developing countries. It is a well-organized collection of topics by authorities in their respective fields based on a tropical pediatrics update course, sponsored by the Liverpool School of Tropical Medicine during the recent International Year of the Child. The chapters are well written, well organized, and well referenced. Although it is always difficult to capture the flavor and ambience of a symposium in which clinical demonstrations, seminars, and group interchange augment the formal lectures, the editor has done a good job of extracting those topics with particular relevance to tropical settings. The book is divided into sections covering neonatology, general pediatrics, infectious and parasitic diseases, and child health services adapted to tropical and developing areas, It is difficult to review a highly advanced field such as neonatology, which has become synonymous with sophisticated equipment and technology. While still making

Two cases of acute childhood pancreatitis of unknown origin showed clinical and laboratory findings strongly suggestive of Reye syndrome. At laparotomy in one patient and autopsy in the other, severe pancreatitis was discovered. Although the criteria of Reye syndrome are presently somewhat controversial, the diagnosis is being entertained with increasing frequency due to greater awareness. When considering Reye syndrome as a diagnostic possibility, it is important to exclude pancreatic disease.

Research has demonstrated that Sudden Infant Death Syndrome (SIDS) is emotionally devastating to families. An episode of apnea occurring at home requiring resuscitation is commonly referred to as near-miss SIDS. The relationship between nearmiss SIDS and SIDS is unclear, and the effect upon the family has been less well defined. 40 families who had experienced a near-miss SIDS episode responded to a questionnaire, 25 in writing and 15 by telephone. The questionnaire was completed 1 to 38 months after the episode. 37 of the respondents were present when the apnea occurred. 33% of the caretakers checked the baby as part of their routine activity, and 18% had a premonition that something was wrong and went to check the baby. 63% described it as “one of the hardest things in my life.” 10% described the experience as similar to a death in the family. Only 5% believed that their baby would have survived without resuscitation and 63% believed that their baby would die without intervention. As a result of this episode 20% decided not to have any more children, but half of these later reconsidered this decision. The average duration of time before things returned to normal was 3.7 (S.D. ± 3.8) months. These findings suggest that there is a significant psychological impact as a result of a near-miss SIDS episode, consistent with post-traumatic stress disorder, and that support services should be available to the family.

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.