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The increasing emergence of legislation providing for minors' consent for health care furnishes a range of basic medical, legal, and social issues which require the thoughtful consideration of physicians caring for youth. The legislative provisions referred to account for a variety of consent situations ranging from the care of a specific illness or disorder to the dramatic lowering of the age for which consent for health care can be given. The ultimate conflict in the matter of minor's consent is between the basic rights and responsibilities of parents concerning their children and the emergence of the concept that youths have the right to make decisions relating to their bodies and their care. When the preservation of privacy and confidentiality affects the utilization of health care by youth, the conflict must be resolved. Not only have state legislatures provided varying opportunities to resolve some of these issues, but also two major health organizations concerned with the health of youth have provided model acts which would serve as a basis for enabling young people to consent for confidential, comprehensive health care. In recent years society has demonstrated a tendency to permit young people to determine a variety of aspects of their own affairs well before the traditional age of majority. In regard to health decisions, a number of situations have emerged in which the rights of youths deserve consideration. These include circumstances in which the person might avoid health care if the parents have to be informed, when a communication breakdown between the young person and the parents has taken place, if a need for emergency care occurs when parents cannot be reached, or when young people are living away from home in an adult life style. Legislative responses to the sociohealth concerns affecting youth do not take a moral or judgmental position, nor do they infer a lessening of the importance of family integrity. They do respond to a number of reality health matters with high incidence which have emerged, particularly in the past decade. These laws do not require physicians to treat young people on their own consent, nor do they forbid physicians from informing parents if this is considered in the best interest of the patient. Furthermore, it is important for the physician to persuade youths to involve their parents and gain their support and understanding. Minors' consent can serve to restore interrupted communication between young people and their families. The appearance and evolution of the "emancipated minor" and the "mature minor" concepts is recognition of the capacity of the adolescent to determine his own affairs and give an informed consent. The age at which human beings reach maturity is variable, and competent decision making is not assured by arrival at a certain chronological age.

As a result of the sharp rise in venereal disease during the past decade, which seriously threatens the health of our young people, pediatricians must become actively involved: 1. in the prompt identification, treatment, and epidemiologic control of venereal disease in young people and newborn infants; 2. in developing and promoting social legislation related to the treatment of minors; 3. in encouraging and participating in effective educational programs for youth on venereal disease. A heightened alertness to the possibility of venereal disease is required by every physician.

Young people who find themselves in juvenile court facilities constitute a group who traditionally have displayed a high incidence of health problems. Many have had inadequate care in the past, and enter with preexisting medical and dental conditions. Whether or not they are in good physical health, they often are handicapped in the area of mental health. The conditions which necessitate removing them from their homes and placing them in institutions may aggravate, or even cause, physical and mental health problems. When society undertakes to remove children and youth from their homes and place them in institutions away from the care of their parents, it assumes certain obligations. Among these obligations is care of their physical and mental health. Health programs in juvenile court facilities must be broad and comprehensive and must go beyond the mere provision of medical care. The extent of the health care which should be offered to an individual will depend on the length of time he is in the institution. But, every institution which confines juveniles should have a health program designed to protect and promote the physical and mental well-being of residents, to discover those in need of short-term or long-term medical and dental treatment, and to contribute to their rehabilitation by appropriate diagnosis and treatment and provision of continuity of care following release. The standards given here are designed to attain these goals. ADMINISTRATIVE STRUCTURE OF THE HEALTH PROGRAM Health Council 1. Each institution should have a multidisciplinary health council to set the policies of the health program. 2. The council may be organized within the institution or by the authority which operates the institution.

Whereas, certain minors are not obtaining adequate medical, dental, or other health care due to current legal and medical obstacles, Whereas, providers of medical, dental, and other health care are now vulnerable to legal action for giving care to minors, Whereas, there is a need for coordination, stimulation, and support of access to medical, dental, and other health care for certain minors in need of such care without violating the rights of parents to protect and promote their minors' health, Be It Enacted by the Legislature of the State of-----,as follows: Section 1. For the purposes of this act: (1) "Minor" means any person under the age of majority as defined by the State statute or under 18 years of age, whichever is lower; (2) "Health Professional" means state licensed physician, psychologist, dentist, osteopathic physician, nurse, and other licensed health practitioner; (3) "Health Services" means health services specified by the state, appropriately delivered by different health professionals including examination, preventive and curative treatment, operation, hospilization (admission or discharge), giving or receiving blood and blood derivatives, receiving organ transplantation, pledging donation of organs after death, the use of anesthetics, and receiving contraceptive advice and devices; (4) The masculine shall include the feminine. Section 2. Any person who reaches the age of majority or 18 years of age or is on active duty with or has served in any branch of the Armed Forces of the United States shall be considered an adult in so far as the consent for health services is concerned.

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.

One must be cognizant of the fact that there is probably more confusion in relation to diagnosis and appropriate criteria for the use of medication for the treatment of hyperkinetic children than there is regarding the choice of medication. Many physicians, as well as the general public, do not truly appreciate the differential diagnosis of the overactive child. The symptoms may be an expression of basic personality, anxiety, subclinical seizure disorders, strictly in the eyes of the beholder, or true hyperkinesis; the latter is the only condition in which stimulants might be expected to be beneficial. The use of drug therapy in the management of the hyperkinetic child does not differ appreciably from drug therapy in other treatable maladies. In both instances prescription drugs should be prescribed only by appropriately licensed physicians. Although the screening of patients may frequently be done by other disciplines, the ultimate selection of patients remains the responsibility of the prescribing physician. Rarely is hyperkinesis an isolated symptom. Hopefully, the selection of the drug to be used is based on such factors as history and physical examinations with appropriate emphases and the weighing of risks (that is, the ramifications of the untreated patient versus side effects and long-term sequelae of medication). A satisfactory means of evaluating the effects of therapy and periodic reevaluations (follow-up) should be included. Whatever the diagnostic nomenclature, the "indications" depend largely on clinical acumen rather than pathognomonic findings. There is some agreement about the indications for the clinical use of stimulant drugs for hyperkinetic children even though there must be a trial on the medication before its efficacy can be determined for a particular child.

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

Mental retardation produces untold disability with resultant economic uselessness and human misery. With the possible exception of mental illness, mental retardation is the most significant handicap of our society. Of the approximately 4,200,000 children born annually in the United States, 3%, or 126,000, will never achieve the intellect of a 12-year-old child; 0.3%, or 12,600, will remain below the 7-year intellectual level, and 0.1%, or 4,200, will spend their lives as completely helpless individuals with intellectual development in the imbecile range and will be unable to care for their own basic needs.7 The problem of mental retardation has always been with us, but several factors have recently served to magnify the problem. One of these is the increase in the complexity of our society; another is society's increasing demands for educational achievement and technical competence. This has altered the significance of mental retardation, so that persons who would previously

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.

UNTIL a decade ago there has been little recognition or appreciation in medical practice of the adolescent age as a unique period of physiological and psychological growth and development. "... the pediatrician had been preoccupied with infectious diseases and acute medical needs such as (those of) premature infants, transfusions, feeding problems... the internist with the ills of adulthood and advancing age." 1 The recognition of a need to provide medical care for the adolescent by Gallagher 2 and others 3 has led to the development of special clinics and ward services throughout the United States and Canada. It has been estimated that by 1970 over half of the population of the United States will be under 25 years of age. 4 While the mortality and morbidity of this age group is low, 5 hospitals, physicians, public health personnel, and others concerned with the health of the nation will be faced with

Progress in the treatment of infectious disease has advanced with remarkable speed and efficiency in the last 20 years. With the advent of antibiotic therapy, many of the bacterial infections which were hitherto not easily managed have been controlled with a resultant decrease in mortality and morbidity. As the number and the severity of bacterial diseases decrease, viral infections have become increasingly more important clinically, particularly because an effective antiviral agent has not been developed, but also because the specific viral etiology of an increasing number of clinical conditions has been elucidated. In the past, most efforts aimed at containing virus disease have been through the institution of preventive measures such as immunization with killed virus particles or the use of attenuated live virus which produced mild or subclinical infections. Passive immunity with pooled sera or one of their fractions has also provided some degree of protection or modification of