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Newborn infants (neonates) are known to have reduced function of their polymorphonuclear (PMN) leukocytes (neutrophils, a type of white blood cells important in the immune response), but large, longitudinal studies of PMN characteristics in infants as they develop have not been performed. To learn more about this issue, blood samples were obtained from 37 healthy infants at birth and then at intervals until the age of two and one half years. Groups of older children (between 5 and 15 years) and adults were also included. PMN were evaluated for adherence and chemotaxis (the extent to which they were attracted to certain chemicals), both of which are essential for mounting an immune response. The results showed that PMN chemotaxis is impaired in neonates (measured at 40 percent of the adult level) but rises to adult levels by the age of two weeks. PMN adherence was also reduced in neonates, but did not reach the adult level until the age of 15 years. Maximum mortality as a result of infection in neonates is during the first week after birth, a period during which PMN chemotaxis is low. Some potential physiological consequences of these findings are briefly discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Parents sometimes have problems determining a child's temperature with a thermometer. About 50 percent of low socioeconomic status mothers and 12 percent of middle socioeconomic status mothers cannot read a thermometer. Sixty percent of 25 adolescent mothers stated that they could not read a thermometer and when tested, only eight percent could accurately read one. A recent study assessed the ability of 100 mothers in a suburban pediatric practice and 100 mothers in an urban hospital-based practice to read a glass thermometer. Those mothers using a private practice were white and had an average age of 30 years. Those mothers using a hospital-based practice had an average age of 23 years, and 60 percent were hispanic, 33 percent were black, and seven percent were white. Mothers using a private practice had an average of three years of college experience, while those mothers using a hospital-based practice typically completed the 11th grade. All private practice mothers owned a glass thermometer and stated that they could read a thermometer. Sixty percent of hospital based mothers stated they owned a glass thermometer and 57 percent of them said they could read a thermometer. When their ability to read a thermometer was assessed, 93 percent of private practice mothers could accurately read a thermometer, while only 10 percent of the mothers using a hospital-based practice could read one. It is suggested that thermometers which are easier to use, such as digital thermometers, be employed to measure the temperature in a child with possible fever, especially in lower socioeconomic families. (Consumer Summary produced by Reliance Medical Information, Inc.)

• We assessed the ability of mothers to subjectively determine the presence or absence of fever in their children when compared with simultaneous temperature determination obtained by thermometer. Mothers who said their children were febrile were correct 52.3% of the time; those who said their children were afebrile were correct 93.9% of the time. The sensitivity was 73.9% and specificity was 85.6%. Ninety percent of children aged 2 years or younger with temperatures of 38.9 °C or higher were correctly identified as febrile. Administration of antipyretics to both febrile and afebrile children was greater among those whose temperature was determined at home by thermometer than among those whose temperature was determined by subjective criteria. We conclude that maternal subjective fever assessment criteria are useful as a screening method to rule out the presence of fever at all ages and that mothers can identify high fevers in most young children without the use of a thermometer.(AJDC 1984;138:976-978)

Sir.—Reye's syndrome has been linked to antecedent viral illness, especially varicella and influenza. In addition, an association with aspirin use has bee documented. There has been a marked reduction in the incidence of Reye's syndrome over the past three years, and at our institution we have seen no cases during this period compared with an average of 2.5 cases per year previously. Some have postulated tha decreased aspirin use by children is in part responsible for the decline. Many pediatricians now counsel parents never to use aspirin for their children. Others warn against use during an outbreak of chickenpox or influenza. We sought to compare the ownership and use of antipyretic agents in a private practice with that in a hospital-based clinic population.One hundred patients in a largely white, middle-class private pediatric practice were compared with one hundred patients in a lower-class, pre-dominantly Puerto Rican, English-

• Previous studies have suggested that poor, urban parents are often unable to identify the presence of fever by use of a mercury glass thermometer. We investigated whether 145 mothers whose children received care in an urban hospital ambulatory care center could accurately read a thermometer. If they could not, their ability to identify zones of temperature, either by use of colors or numbers, was assessed. Although 57.9% of parents owned a mercury glass thermometer, only 9.7% could accurately read three thermometers presented to them. When those parents who were unable to accurately read were asked to identify the zones of temperature within which the mercury fell, 87.0% could successfully identify number zones; 78.6% could correctly identify color zones. Teaching the zone-reading techniques required only 15 to 30 seconds. We conclude that for parents unable to read a thermometer by conventional means, the use of color zones or number zones is a technique that is easily taught and reliably carried out.(AJDC. 1990;144:1011-1012)

• We assessed the utility and accuracy of a temperature-sensitive pacifier in screening for fever in ill children under 2 years of age. Of 189 candidates for study, 83 (42%) did not use pacifiers, and of the 106 who did, 25 (24%) could not sustain a suck for five minutes of direct observation. Among those 81 children who could sustain five minutes of sucking, only two of 20 children with rectal temperatures above 100°F (37.8°C) were correctly identified as febrile. Furthermore, seven of eight children with temperatures of 102°F (38.9°C) or greater were incorrectly identified as being afebrile. There were no false-positive fever assessments in afebrile infants. The temperature-sensitive pacifier tested in this study does not accurately identify fevers in most infants who are shown to have fevers by rectal temperature determination. The use of this pacifier for screening fever in ill infants cannot be recommended.(AJDC 1988;142:171-172)

• The use of infant walkers within a large prepaid pediatric group practice was investigated. Of 195 patients (age range, 5 to 15 months) surveyed during a three-month period, 150 patients (77%) used infant walkers. Of those, 47 patients (31%) had suffered mishaps. These included closed head trauma, fractures, lacerations, tooth evulsion, and soft palate perforation. There is no proved benefit associated with the use of such walkers. The risk of injury associated with the use of infant walkers should be of concern for those physicians who care for preambulatory children.(Am J Dis Child 1982;136:205-206)

Sir.—The excellent article by Williams et al1 validates previous findings that "baseline intervention," including an interactive reminder sticker, information pamphlet, and dispensing syringe, results in a high rate of compliance with medication taking. However, to assess follow-up appointment keeping, the home visit made on day 8 as part of "measurement strategy" must also be considered to be a part of the baseline intervention provided in their study. Does this visit change the likelihood of parents keeping a follow-up ear check appointment?To answer this question, we performed a study from December 1982 to June 1983, among patients treated for otitis media with amoxicillin suspension between 8:30 am to 4:30 pm, Monday to Friday, at the Hartford (Conn) Hospital Pediatric Ambulatory Care Center, who filled their prescriptions at the Hartford Hospital outpatient pharmacy. During the study period, we attempted to have a lay health care worker make an unannounced

Sir.—I believe that Drs DeAngelis and Fosarelli1 have made a number of unwarranted assumptions regarding follow-up appointments. First, their methodology is open to question, in that reviewing emergency room charts completed by residents demonstrates that documentation, especially of follow-up plans, is often incomplete and varies between house officers. It has been my experience that this variation in documentation tends to be situational, with deterioration during busy periods and after midnight. Interpretation of the data reported in the article thus becomes more difficult.Second, although pediatric texts and many academicians do in fact advise follow-up visits for all children with ear infections, this policy is questionable with respect to older children who have not had frequent recent infections. At our institution, we generally do not reappoint school age children with uncomplicated otitis, but instead tell them to call or return if symptoms persist or recur after therapy is completed.

In Reply.—We acknowledged in our article that crawling and cruising are potentially dangerous activities for infants and that a control group of children who did not use walkers would have been desirable. However, since the publication of our article, the Consumer Products Safety Commission reported that in 1981 an estimated 23,900 infants received medical attention, and more than 10,200 infants required emergency room treatment after accidents associated with infant walkers (Pediatric News, April 1982, p 7). More than half of those accidents were falls down a flight of stairs, and approximately a third involved walker tip-overs on a flat surface. We believe that the findings of this report confirm the validity of our data.The Hendricks are right in implying that infants and children are at risk for injury from many sources. It is not infancy, however, that is the hazard. Rather, it is the infant's environment—an environment created