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Efforts to decrease childhood injuries from bicycle accidents should be directed towards education about helmets and safe riding skills. The medical records of 52 children injured in bicycle accidents were reviewed. The patients and their guardians were then interviewed, and accident reports were reviewed when available. Of the 52 cases, 56% were caused by a fall, and 44% by collision with another vehicle. Of these collisions, 87% were the fault of the cyclist, and 43% involved the cyclist's failure to stop or yield at an intersection. None of the cyclists was wearing a helmet and 56% of them suffered head injuries. The primary reasons for not wearing a helmet were that the riders or their families never thought of it, or they thought it was unnecessary.

Objective: To determine the association between bicycle helmet legislation and bicycle safety education and the use of bicycle helmets by children under age 16 years. Design: Anonymous questionnaire and direct observations of bicycle helmet use. Setting: Four predominantly white, upper-middle class suburbs of Cleveland, Ohio. Participants: All students in grades 1 through 7 attending public school on the day of the survey and children riding bicycles in a direct observational study. Interventions: Beachwood had bicycle helmet legislation and safety education. Orange had only bicycle helmet legislation. Pepper Pike and Moreland Hills did not have bicycle helmet legislation or safety education. Results: In Beachwood, 416 (67.6%) of 615 children who owned a bicycle reported always wearing their helmets, and 72 (85%) of 85 children directly observed were wearing bicycle helmets. In Orange, 103 (37.2%) of 277 children who owned bicycles reported always wearing helmets, whereas 41 (17.9%) of 229 children in Moreland Hills and 78 (21.5%) of 362 children in Pepper Pike reported always wearing helmets. Helmet use was significantly (P, Bicycle safety education combined with legislation requiring children to wear bicycle helmets may be effective in increasing bicycle helmet use. Elementary school children in four neighboring communities of similar racial and socioeconomic makeup answered a survey on safety, including frequency of bicycle helmet use. One community had a helmet ordinance and had conducted an extensive helmet promotion campaign in the schools. Another community had a helmet ordinance but no education program. The other two communities had neither regulations nor education concerning bicycle helmets. Only 18-22% of children who owned bicycles in these towns indicated they always wore helmets, compared with 37% in the community with legislation alone and 68% in the community with both legislation and education. These results suggest that while helmet legislation is somewhat effective in increasing use, legislation plus safety education can encourage even more children to use bicycle helmets.

The use of cotton-tipped swabs to clean children's ears may lead to earwax impaction. The formation of a plug of wax in the ear is called impaction. The ear-cleaning habits of 651 children between the ages of two weeks and 20 years were evaluated. Children or their parents completed questionnaires about their use of cotton-tipped swabs, ear drops and soap and water. The children's ears were then examined by a pediatrician who rated the degree of wax blocking the ear canal. Blockage was similar in both ears in 85% of the children. Blockage of at least 75% occurred in 7% of both the left and right ears. Blockage of 100% of the ear canal occurred in 2.9% of the left ears and 2.6% of the right ears. Those who ever used cotton-tipped swabs had the highest level of blockage in both ears. Among those who had used the swabs in the previous two months, association with significant blockage was found only for the left ear.

The accurate measurement of body temperature is essential to making valid diagnoses, especially in children. Central nervous system thermoreceptors, located in the hypothalamus of the brain, are involved in body temperature regulation. The tympanic membrane (eardrum) and the hypothalamus share the same vascular supply, and the tympanic membrane is a readily accessible site for the measurement of core body temperature. Thermoscan is a device developed for measuring tympanic membrane temperatures (TMT). Without direct contact, it measures the thermal infrared energy emitted from the eardrum. Temperature readouts are instantaneously and easily obtained, the procedure is noninvasive, and risks for patients and health care providers are minimal. A study conducted at the Cleveland Clinic Foundation enrolled 137 children less than 18 years of age to: (1) compare TMT readings with temperatures obtained using IVAC electronic thermometers for oral and rectal measurements; (2) determine the effect of middle ear disease on TMT; and (3) identify parent, patient and physician acceptance of the TMT procedure. The speed (2.5 seconds per reading), ease, and patient acceptance of the TMT procedure impressed parents and physicians. There was strong agreement between oral, rectal and tympanic membrane temperature readings. The results of the small number of patients with ear disease and wax build-up were not conclusive. The issue of examiner variability was not addressed; all readings were made by a single investigator. Some parental concerns were raised about the accuracy of the TMT readings. These concerns should be addressed by public education programs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Children with serous otitis media have accumulation of a thin, viscid serum-like fluid in their middle ear. The condition can result in the loss of hearing. Preliminary studies have suggested that serous otitis media may be successfully treated with the glucocorticoid steroid dexamethasone, given through the nose. The research on steroid treatment of serous otitis media since 1966 is reviewed and summarized. Treatment with antibiotics for bacterial infections, one of the possible causes of serous otitis media, plus a brief treatment with steroids may cause a temporary beneficial effect. However, the effectiveness of treatment with steroids, given through the nose or systemically (throughout the whole body), has not been proven without doubt. No adverse effects of treatment of middle ear infections with steroids have been shown. Large carefully controlled studies with long-term follow-up are needed to further evaluate the effectiveness of treatment of serous otitis media with steroids. (Consumer Summary produced by Reliance Medical Information, Inc.)

Introduction The Special Olympics in Greater Cleveland, like many school systems and camps, offers group setting preparticipation examination (PPE) to all participants at low or no cost to the participants' [...]

Telephone follow-up calls to parents who brought their child to a free immunization fair were not successful in encouraging them to take their child to a pediatrician for a regular exam. The fairs were held at two sites in Cleveland, one in a white working class suburb and one in a poor black community.

Mammalian bite wounds Trauma Equipment Nondrug Cotton swabs Debrioement equipment IV equipment* * Appropriate for hospitalized patients Materials for Gram's stain and culture 19-gauge needle (for irrigation) Normal saline Suturing [...]

• We studied promoting seat belt use by school-aged children through discussions with their pediatricians. The study population consisted of 242 well children observed coming to and leaving from a private pediatric practice. Only four (5%) of 73 control patients who did not wear their seat belts coming in wore them going out. For intervention patients, this figure was 29 (38%) of 77. At one-year follow-up by questionnaire, there were no statistical differences between the percentage of seat belt use in control (67%) vs intervention (62%) patients. However, pediatricians' reported percentage of patients routinely counseled about seat belt use prior to the start of the study was highly correlated with patients' observed prestudy seat belt use. Pediatricians should include education about automobile safety as a part of all well-child visits.(AJDC 1987;141:1305-1307)

The article presents an interview with Cleveland Clinic's pediatrician Michael Macknin who discusses his way to help parents encourage their children to eat healthy foods, description of a healthy plate, and importance of starting healthful habits at an early age.

Offers advice on medical and health issues. Zinc lozenges for colds; Stopping eczema from itching; Getting the essential amino acids from vegetables; Response of asthma to acupuncture.