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Background: Compliance with the requirements of the Individuals with Disabilities Education Act (IDEA) in the United States is monitored through review of cross‐sectional reports from three discrete, age‐defined programmes (early intervention [EI], early childhood special education [ECSE)] and school‐age special education [SE]) to promote the timely, efficient and effective delivery of appropriate services to all eligible children. Analysis of longitudinal data is required to discern how children use services across programmes to provide the necessary context for IDEA oversight and to identify areas for programme or policy interventions to reduce barriers to service use and promote equity. Methods: We applied sequence analysis to a data linkage across five public record systems among 15 626 New York City children born in 1998 who had records from birth through third grade. Results: Five predominant patterns of service use were identified: (1) multiple therapies across EI/ECSE/SE (13%), (2) EI without transition to Department of Education schools or services (24%), (3) EI and intermittent ECSE/SE (16%), (4) older entry into EI and both speech and occupational therapy throughout ECSE/SE (9%) and (5) limited EI use and mostly speech therapy in ECSE/SE (38%). Each pattern had distinct demographics (e.g., pattern 2 was disproportionately White and from low poverty neighbourhoods; pattern 4 was disproportionately male and Black; pattern 5 was disproportionately Latino) and academic outcomes (e.g., pattern 1 had largest proportion in a SE school and not tested in third grade; pattern 3 had third grade tests scores that were similar to overall citywide mean scores). Conclusions: The differences in demographic profiles across the five patterns of service use illustrate the systemic inequities in the delivery of these important services. Delayed entry and limited use of EI services among children of colour underscore the need for equity goals to increase early referral and optimize service use. [ABSTRACT FROM AUTHOR]

All health care workers should routinely be tested for tuberculosis. A pediatrician was tested after his 15-month-old son developed tuberculosis. The pediatrician tested positive and a chest X-ray revealed that he had active tuberculosis. He began treatment and a letter was mailed to all parents of children seen by the practice. A total of 181 children were tested and three tested positive. Of the 286 parents who were tested, 37 tested positive. Eighty-six percent had been born outside the US., The following report describes the contact investigation of a pediatrician with tuberculosis (TB). The pediatrician's disease was discovered in late February 1993 after tuberculin skin testing (TST) of his 15-month-old son was positive (13-mm induration). Further investigation to identify the source of the child's infection revealed a positive (15-mm induration) TST in the pediatrician. The pediatrician had been symptomatic with a cough since September 1992. The pediatrician had a chest radiograph that revealed numerous cavitary lesions and a sputum smear that was positive for acid-fast bacilli. An investigation was initiated to assess whether the transmission of Mycobacterium tuberculosis had occurred in the pediatrician's office to patients, families, or other visitors. The investigation was later extended to include the hospitals and the day care center where the pediatrician worked. Methods. A letter was mailed to parents of children served by the practice, explaining the potential exposure to TB and requesting that all persons who visited the office after September 1, 1992 complete an interview and Mantoux TST. Mass interviewing, testing, and test interpretation within the practice took place seven times during March and April 1993. Results. At the completion of screening, 181 (87%) of 208 children who had close contact with the index case were reliably skin-tested and returned for interpretation. Three (1.7%) of the 181 children were TST-positive ([is greater than or equal to]5 mm). Thirty-seven (13%) of the 286 adults tested and returning for interpretations were TST-positive ([is greater than or equal to]10 mm). Thirty-two (86%) of the 37 adults who tested positive were foreign-born. Conclusion. This investigation highlighted the need for identifying childhood TB infection as a sentinel event for adult disease. It also demonstrated the difficulty associated with deciding the extent of contact investigation of a health care worker with TB. Finally, the investigation emphasized the importance of maintaining regularly scheduled and appropriate testing for TB infection in health care workers and the need for health care workers to be cognizant of their own risk and be able to identify, especially in themselves, signs and symptoms of potential TB disease. Pediatrics 1997,100:19-23; tuberculosis, pediatrician, screening., Between 1953 and 1988 the number of tuberculosis (TB) cases in the United States reported among children The following report describes a contact investigation of a pediatrician with TB. This [...]

Beliefs held by pediatric caregivers may contribute to under-vaccination of their patients. Thirty-seven private pediatric caregivers and 25 public clinic pediatric caregivers in Jersey City and Paterson, New Jersey responded to a survey of immunization policies. Private caregivers were less likely than clinic caregivers to vaccinate children at unplanned but opportune moments such as a follow-up visit after a minor infection, at emergency room visits, or when the child accompanied a sibling to an appointment. Private caregivers were less likely to believe that all vaccines for which the child was eligible should be administered at each visit. Defending this, private caregivers were more likely to believe that multiple injections should be avoided to minimize distress to the child, that they increased the incidence of side-effects, or that parents preferred avoidance of multiple injections. Private caregivers were also less likely to vaccinate children with minor illnesses. These policies and beliefs run contrary to standard recommendations for pediatric immunization., ABSTRACT. Background. In 1991, the fourth largest measles outbreak in the nation (824 cases) occurred in the Jersey City, New Jersey area. Data from a subsequent intervention trial in Jersey City demonstrated that vaccinations were more likely to be delayed for children who had received care from private rather than public clinic providers. In addition, failure to administer multiple indicated vaccines at a single visit was associated with vaccination delay, and reluctance to administer multiple vaccines was more common among private providers. These findings prompted an investigation of vaccination beliefs and practices among urban pediatric providers. Methods. A telephone survey of vaccination beliefs and practices was administered to all pediatric providers in both private and public clinics in the Paterson and Jersey City areas. Results. Private providers were less likely than public clinic providers to consider vaccinating children during emergency room visits (relative risk [RR] = 2.2; 95% confidence interval [CI] = 1.2-4.2) or hospital admissions (RR = 13.2; 95% CI = 1.9-92.7) and less likely to believe that all recommended vaccine doses should be administered simultaneously (RR = infinite; lower 95% confidence limit = 3.0). Private providers were less likely to consider administering live-virus vaccines to children with minor acute illnesses and low-grade fever (RR = 2.2, 95% CI = 1.2-3.8) or killed-virus vaccines to children with minor acute illnesses without fever (RR = 3.4; 95% CI = 1.4-8.5) or with low-grade fever (RR = 2.2; 95% CI = 1.2-3.9). Private providers were more likely to believe that multiple injections should be avoided because of potential psychological and physical trauma to the child (RR = 4.0; 95% CI = 1.3-12.3). Conclusions. Adherence to Standards for Pediatric Immunization Practices by pediatric providers could improve vaccine coverage rates among urban children. Pediatrics 1995,96: 889-892, pediatric, vaccination, urban, immunization., ABBREVIATIONS. AFDC, Aid to Families with Dependent Children; RR, relative risk; CI, confidence interval; MMR, measlesmumps-rubella vaccine; DTP, diphtheria and tetanus toxoids and pertussis vaccine; CII, Childhood Immunization Initiative; OPV, [...]

An outbreak of methemoglobinemia in children caused by nitrite poisoning illustrates the need for caution when there is a possibility of human exposure to high levels of nitrites. Methemoglobinemia is an anemia caused by a chemical reaction in the blood that interferes with the blood's oxygen-carrying capability. In 1992, more than 40 children from one elementary school experienced headaches, nausea, and vomiting. Some children exhibited bluish skin and mucous membranes. The symptoms appeared within 45 minutes after lunchtime. Medical tests indicated methemoglobinemia. Appropriate treatment was initiated and all children recovered in less than two days. Researchers traced the methemoglobinemia outbreak to nitrite-contaminated soup from the school's cafeteria. The soup was prepared in a boiler that had been treated with anti-corrosive, nitrite-containing additives., Background. On October 20, 1992, >40 children from one elementary school visited the school nurse due to the acute onset of blue lips and hands, vomiting, and headache during and after the school lunch periods. Forty-nine children were seen by physicians that day and l@ were hospitalized. Laboratory analysis revealed methemoglobinemia in many of the children. All recovered in 36 hours. Objective. A case-control study was supplemented by environmental and laboratory investigations to determine the outbreak source. Methods. Cases were selected based on the laboratory diagnosis of methemoglobinemia (methemoglobin level >2%). Children whose methemoglobin levels were missing or

Background Early intervention (EI) and special education (SE) are beneficial for children with developmental disabilities and/or delays and their families, yet there are disparities in service use. We sought to identify the birth characteristics that predict EI/SE service use patterns. Methods We conducted a retrospective cohort study using linked administrative data from five sources for all children born in 1998 to New York City resident mothers. Multinomial regression was used to identify birth characteristics that predicted predominant patterns of service use. Results Children with service use patterns characterized by late or limited/no EI use were more likely to be first-born children and have Black or Latina mothers. Children born with a gestational age ≤31 weeks were more likely to enter services early. Early term gestational age was associated with patterns of service use common to children with pervasive developmental delay, and maternal obesity was associated with the initiation of speech therapy at the time of entry into school. Conclusions Maternal racial disparities existed for patterns of EI/SE service use. Specific birth characteristics, such as parity and gestational age, may be useful to better identify children who are at risk for suboptimal EI use. [ABSTRACT FROM AUTHOR]