If you are a member of the media and would like to talk with a study author, please contact Communications at (847) 434-7877.

AAP Contact: Mindy Weinstein, at 847/434-7131, or Hollis Heavenrich-Jones, at 847/434-7084

Information in this mailing is embargoed for release: Monday, March 7, 2005, 12:01 am (ET)

In this mailing:

The Table of Contents from the March issue of Pediatrics, the peer-reviewed scientific journal of the American Academy of Pediatrics (AAP), and Pediatrics electronic pages, the Internet extension of Pediatrics. These are available electronically and can be viewed at:

Current issue TOC:
http://www.pediatrics.org/current.shtml
Future issue TOC:
http://www.pediatrics.org/future.shtml

Also in this mailing, information on:

AAP CLINICAL REPORTS
1. Tobacco, Alcohol, and Other Drugs: The Role of the Pediatrician in Prevention, Identification, and Management of Substance Abuse
2. Chronic Abdominal Pain in Children

STUDIES IN PEDIATRICS
3. A Rose by Any Other Name? Objective Knowledge, Perceived Knowledge, and Adolescent Male Condom Use
4. The Use of Folk Remedies Among Children in an Urban Black Community: Remedies for Fever, Colic, and Teething
5. No License Required: Severe Pediatric Motorbike-Related Injuries in Ohio
6. International Collaborative Study of Intracytoplasmic Sperm Injection-Conceived, In Vitro Fertilization-Conceived, and Naturally
Conceived 5-Year-Old Child Outcomes: Cognitive and Motor Assessments
7. Changing Conclusions on Secondhand Smoke in a Sudden Infant Death Syndrome Review Funded by the Tobacco Industry
8. Calcium, Dairy Products, and Bone Health in Children and Young Adults: A Reevaluation of the Evidence
9. National Autism Prevalence: Trends from United States Special Education Data
10. Effects of Seating Position and Appropriate Restraint Use on the Risk of Injury to Children in Motor Vehicle Crashes
11. Home Use of the GlucoWatch G2 Biographer in Children with Diabetes
12. Annual Summary of Vital Statistics-2003
13. Association of Race/Ethnicity with Emergency Department Wait Times

SPRING BREAK TIPS
It's almost spring, and lots of families will visit sunny climates for some rest and relaxation - otherwise known as "spring break."
It's great to get away, but parents also need to protect their children from the sun's harmful rays. The AAP has some spring break
tips for babies, kids and for the whole family. The tips can be found at http://www.aap.org/advocacy/releases/marspringbreaktips.htm

NATIONAL POISON PREVENTION WEEK
Some 30 children die every year due to unintentional poisonings, and approximately one million phone calls are placed to poison control
centers annually by adults seeking help when children have swallowed something harmful. The AAP supports National Poison Prevention Week,
March 20-26, to prevent such tragic events. For more information, visit http://www.poisonprevention.org/main.html

===================================================================================================

AAP Contact: Mindy Weinstein, 847-434-7131, or Hollis Heavenrich-Jones, 847-434-7084

Information in this mailing is embargoed for release: Monday, March 7,12:01 am (ET)

Below are news briefs on clinical reports appearing in the March issue of Pediatrics, the peer-reviewed, scientific journal of the American
Academy of Pediatrics (AAP). To receive the full text of this report, please contact AAP Communications. The clinical reports will be posted
on the AAP Web site on March 7 at http://www.aap.org

1.
Beginning in the late 1960s and early 1970s, substance abuse became widespread among adolescents, and more recently, among pre-adolescents. A revised clinical report from the American Academy of Pediatrics (AAP) entitled, "Tobacco, Alcohol, and Other Drugs: The Role of the
Pediatrician in Prevention, Identification, and Management of Substance Abuse" addresses how pediatricians can incorporate substance-abuse
prevention into daily practice, acquire the skills necessary to identify young people at risk of substance abuse, and provide or facilitate
assessment, intervention and treatment as necessary.

2.
Chronic abdominal pain is a common pediatric problem encountered by pediatricians and other medical caregivers. The American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition have issued a clinical and technical report, "Chronic Abdominal Pain in Children" in order to provide guidance in the evaluation and treatment of children with chronic abdominal pain. Functional abdominal pain, meaning pain without evidence of an underlying disease, is the most common cause of abdominal pain in children. Neither anxiety, depression, behavior problems nor the presence of associated symptoms (such as nausea, headache and joint pain) can help discriminate between functional pain and pain from a disease. However, the presence of alarm symptoms such as weight loss, gastrointestinal bleeding, persistent fever, chronic severe diarrhea or significant vomiting may suggest a higher likelihood of disease and is an indication to run diagnostic tests. For chronic abdominal pain not associated with organic disease, it is recommended that reasonable treatment goals be established, with the main aim being the return to normal function rather than the complete disappearance of pain.

END

========================================================================================================

AAP Contacts: Mindy Weinstein, 847-434-7131 or Hollis Heavenrich-Jones, 847-434-7084

Information in this mailing is embargoed for release: Monday, March 7,
12:01 am (ET)

Below are news briefs on studies published in the March issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP), or Pediatrics electronic pages, the Internet extension of Pediatrics.

3
Authors of the study, "A Rose by Any Other Name? Objective Knowledge, Perceived Knowledge, and Adolescent Male Condom Use," examined two of the factors that go into determining adolescent male condom use. They looked at objective knowledge, which is actual knowledge that can be tested, and perceived knowledge, or what a person believes they know about a subject. The authors found that a particular group of adolescent males, those with low objective knowledge but high perceived knowledge, were far less likely to use a condom than the other groups. In fact, these males who believed they knew more about condoms than they actually knew were three times less likely to use a condom the first time they had sex. The authors concluded that these findings are important for health care providers and health programs that promote condom use among male adolescents. They suggested that addressing perceived knowledge in addition to objective knowledge may increase condom use.

4
Current folk remedy use in the urban black community is not necessarily attributable to restricted access to medical care and financial poverty. Instead, its use represents a tradition handed down by elders of the culture as part of child rearing, according to the study, "The Use of Folk Remedies Among Children in an Urban Black Community: Remedies for Fever, Colic, and Teething." Researchers conducted interviews with caregivers of healthy black children who were patients at the general pediatric clinic at Children's Hospital of Michigan in Detroit. Folk remedies are herbs, food products, or household items used to treat symptoms of illness but not prescribed by a medical doctor. Examples include placing sliced potatoes or onions in socks to reduce fever, use of catnip to treat colic and a penny tied on a string around an infant's neck to relieve teething symptoms. The researchers assert that it is important for physicians to be aware of folk remedies so that appropriate information is obtained in medical histories and so that families can be educated about remedies that are potentially harmful. As a result, compliance may be improved by blending folk and traditional medicine in a comprehensive plan accepted by both patients and health care providers.

5
Motorbikes, including motorcycles and dirt bikes are becoming increasingly popular among children and adolescents, and injuries from motorbike crashes are becoming more common. Urban, white boys with medical insurance are the most commonly injured in Ohio according to the study, "No License Required: Severe Pediatric Motorbike-Related Injuries in Ohio." Of the 182 children hospitalized for motorbike injuries between 1995 and 2001, 89.6 percent were male, 89 percent were white, 68.7 percent had commercial medical insurance and 71.4 percent were from urban areas. The study also found that most injured children did not wear a helmet and sustained multiple injuries. The authors conclude that high-risk populations need to be targeted to reduce injuries, and requiring helmet use while operating motorbikes should be pursued.

EDITOR'S NOTE: In another study, "National Hospitalization Impact of Pediatric All-Terrain Vehicle Injuries" researchers found evidence supporting increases in childhood all-terrain vehicle (ATV) injuries, as well as increased number of hospitalizations to children.

6
The Pediatrics study, "International Collaborative Study of Intracytoplasmic Sperm Injection-Conceived, In Vitro Fertilization-Conceived, and Naturally Conceived 5-Year-Old Child Outcomes: Cognitive and Motor Assessments," provides parents with reassurance that children conceived through artificial insemination have normal intellectual and motor development. The study examined the cognitive and motor development outcomes of children conceived through intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF). The research is based on single births and did not look at multiple births. The authors found that the outcomes for these children were comparable to that of naturally-conceived children. The study confirms that despite past concerns about ICSI and IVF procedures bypassing natural sperm-selection barriers, ICSI and IVF children go on to do just as well as their naturally-conceived peers.

7
Prenatal and postnatal exposure to tobacco smoke has been shown to harm maternal and child health, and major health reports show that secondhand smoke has been linked with Sudden Infant Death Syndrome (SIDS). The study, "Changing Conclusions on Secondhand Smoke in a Sudden Infant Death Syndrome Review Funded by the Tobacco Industry" shows that executives at tobacco company Philip Morris responded to company concerns that wide public appreciation of the adverse effects of secondhand smoke on maternal and child health could have a negative effect on the social acceptability of smoking and, hence, cigarette sales by commissioning and influencing a review article on SIDS. The final publication included recognition that maternal smoking during pregnancy is a risk factor for SIDS, but the original conclusion that secondhand smoke also increased the risk of SIDS was changed to state that the role of secondhand smoke is "less well established." This effort to distort the medical literature occurred after tobacco companies signed the "Master Settlement Agreement" with states, at which time they promised to reform their earlier behavior. The authors conclude that it is important for pediatricians and parents to understand that secondhand smoke increases the risk of SIDS and that "the tobacco industry's disinformation campaign can be counteracted within clinicians' offices."

8
Authors of a review article say there is little evidence to support nutrition guidelines that focus on increasing consumption of milk or other dairy products to promote child and adolescent bone strength. Further, authors of the article, "Calcium, Dairy Products, and Bone Health in Children and Young Adults: A Reevaluation of the Evidence," found no evidence to support the notion that milk is a preferred source of calcium. According to the authors, although dairy products tend to contain more calcium in absolute amounts than calcium-rich plant foods, when absorption is taken into account, the amount of plant food needed to get the same amount of absorbable calcium is modest. They go on to say that many of the studies used to set recommended levels of calcium intake are calcium supplementation trials, rather than dairy product trials, that last 1 to 3 years. They report that even in these trials, increases in bone mineral density associated with supplemental calcium intake have not been shown to persist into adulthood or even beyond the treatment period.

EDITOR'S NOTE: A commentary on this study, "Bone Health: It's More Than Calcium Intake," also appears in the March issue of Pediatrics.

9
Reports in the past few years seem to indicate a large increase in the number of children with autism in the U.S. Researchers on the study, "National Autism Prevalence: Trends from United States Special Education Data" analyzed national special education data collected from 1992 to 2001 to compare trends in prevalence of autism with trends in prevalence of other disabilities. Consistent with other reports, this analysis shows that autism prevalence in school-age children has been increasing dramatically with time. In addition, the researchers found indications that the rate of increase may now be slowing - although they caution that these signs of slowing could also be the byproduct of changes in the way schools are using certain special education classifications. The study also reports that the large increases in autism prevalence do not seem to be accompanied by comparable decreases in other special education classifications, and points out that even though autism can now be diagnosed in children at young ages, children still appear to be acquiring autism special education classifications for the first time at older ages.

10
Although using an age-appropriate safety restraint provided more protection for children involved in motor vehicle crashes than riding in the back seat, doing both at the same time worked synergistically to provide the best protection. That was the finding of the study, "Effects of Seating Position and Appropriate Restraint Use on the Risk of Injury to Children in Motor Vehicle Crashes," in which researchers at the Children's Hospital of Philadelphia analyzed in-depth national surveillance data from insurance claims records for nearly 18,000 children under age 16 involved in crashes over a 4-year period. The authors concluded that their results supported the current focus on age-appropriate restraints in recently upgraded state child restraint laws. They noted, however, such laws would be even more beneficial if they also required all children under 13 to ride in the back seat.

EDITOR'S NOTE: More information on this topic can be found in Car Seats - General Guidelines

11
A non-invasive continuous blood glucose-monitoring device used by adults and adolescents can also be used and tolerated by toddlers and children under seven, according to the study, "Home Use of the GlucoWatch G2 Biographer in Children with Diabetes." The GlucoWatch G2 Biographer (GW2B) is a device worn on the forearm, ankle or upper arm that takes readings of glucose levels automatically up to six times an hour. It is not meant as an alternative to the traditional "finger-pricking" testing method, but as a supplement to information obtained from standard home blood glucose monitoring devices. The GW2B alerts the wearer to high and low glucose levels. Infants and young children who are unable to verbalize symptoms are at particular risk for missed repeated hypoglycemia with potential long-term cognitive defects, and could greatly benefit from near-continuous monitoring.

EDITOR'S NOTE: More information on this topic can be found in Understanding Childhood Diabetes

12
The "Annual Summary of Vital Statistics-2003," the yearly report of births, fertility rates, and causes of death, revealed some new highs and lows. The total number of births and the fertility rate increased 2 percent. The birth rate for teenaged mothers dropped 3 percent to a record low. The teenage birth rate has fallen by one third since 1991. Birth rates declined for women aged 20 to 24 years old, but rose for women 25 to 44 years. The number, rate and proportion of births to unmarried women all increased in 2003. Smoking during pregnancy declined to 11 percent, down from 19.5 percent in 1989. Prenatal care utilization improved slightly for 2003: 84 percent of women began care in the first trimester of pregnancy. The percent of infants delivered preterm continued to rise and the percentage of children born at low birth weight is at the highest level reported since 1970. The twinning rate increased, but the rate for triplet plus births declined slightly. Infant mortality rose (7.0 per 1000 live births), marking the first increase in four decades. Life expectancy reached a record high of 77.3 years as death rates continued to decline. Among children aged 1 to 19 years, preventable injuries continued to account for a large proportion of deaths; the first and second leading causes of childhood death were accidents and homicide respectively.

13
The study, "Association of Race/Ethnicity with Emergency Department Wait Times" found that non-Hispanic white children have shorter wait times in the emergency room than black or Hispanic children. The researcher surveyed 20,633 emergency room visits among children less than 15 years of age over a four-year period. The mean wait time for all race/ethnicity groups was 43.6 minutes with Hispanic children waiting 54.5 minutes compared with 48.7 minutes and 38.5 minutes for black and non-Hispanic white children respectively. According to the authors of the study, there are several potential explanations for the difference in wait times including language barriers, availability of primary care, differences in triage practices, payer status and hospital characteristics. Additional study is needed to determine root causes and to identify solutions addressing this disparity in the delivery of pediatric emergency care.

END