National Reye syndrome surveillance, 1982

Despite the fact that influenza B was the primary influenza virus strain during the winter of 1981-1982, only 213 cases of Reye syndrome were reported to the Centers for Disease Control (CDC) between Dec 1, 1981 and Nov 30, 1982. This national reported incidence of 0.33 cases per 100,000 children less than 18 years of age is the lowest reported incidence since the Centers for Disease Control began surveillance in 1973. This relatively low incidence probably reflected, at least in part, the fact the influenza B activity was spotty and the illness relatively mild the winter of 1981-1982. The 213 cases were reported from 43 states; and in 56% of the patients, Reye syndrome occurred following a respiratory illness. The mean age of the children was 7.0 years; there were equal numbers of girls and boys; and 93% were white. Of the ten black patients, 80% were less than 1 year of age compared with 9% of the white patients. Of the 208 patients with reported admission stage, 45% were admitted in stage I or 0, a slightly lower proportion than that observed in the previous 2 years. Salicylate levels were obtained in 55% of the patients and were reported as "detectable" in 81% compared with 96% in 1981 (P = .003, chi 2). Of the 200 patients with known outcome, 70 patients died (a case fatality ratio of 35%).     

Inflammatory bowel disease in children and adolescents in Sweden, 1984-1995

BACKGROUND: A prospective study of inflammatory bowel disease (IBD) in Sweden was performed to investigate whether the incidence and morbidity have changed from 1984 through 1995. METHODS: Children 15 years of age or less with IBD were included--i.e., those with a definite diagnosis of ulcerative colitis (UC) and Crohn's disease (CD) and those classified as having indeterminate colitis (IC) and probable Crohn's disease (PCD). The study covered 56.5% of the pediatric population of Sweden. RESULTS: The diagnosis of IBD was made in 639 children, which corresponds to a mean annual incidence of 5.8 per 100,000. The incidence increased from 4.6 per 100,000 per year from 1984 through 1986 to 7.0 from 1993 through 1995. It reflected an increase in UC from 1.4 to 3.2 per 100,000 per year, which is a significant yearly percentage of increase (8%; confidence interval, 2-14%; P < 0.05). In contrast, no change occurred in the incidence of CD (1.2-1.3 per 100,000). The incidence of IC and PCD also remained fairly stable. The percentages of children who underwent surgery decreased from 17.3% in the first 6 years to 4.6% in the last 6 years (P < 0.001). Surgery was performed in 27.7% of CD and 5.3% of UC cases. The median age at diagnosis was 12.2 years for UC, 13.0 years for CD, 11.2 for IC, and 11.2 for PCD. At diagnosis, 48 children (7.5%) were 5 years of age or less, whereas most of the patients were 11 years of age or more (398 children, 62.3%). CONCLUSIONS: In Sweden, the incidence of UC has increased, whereas that of CD remains the same. A significant number of children were classified with IC and PCD. In most children, IBD was diagnosed when they were 11 years old or more, but some cases were detected even in those below 6 years of age. A decrease in the frequency of surgery occurred during the study.     

Number and cure rate of neuroblastoma cases detected by the mass screening program in Japan: future aspects

The annual incidence of neuroblastoma in Japan, a common malignancy of young children which has a very poor prognosis in progressive cases, was previously estimated to be 8.2 cases/million children under 15 years of age. Based on the Japanese National Census of the Population for 1982, the annual number of cases of this tumor is predicted to be 220. (Sawada et al: Med Pediatr Oncol 12:101-103, 1984). Before the mass screening program was started, one-fourth of all neuroblastoma cases were detected before the age of one by clinical symptoms and other findings. Since 1974, a neuroblastoma mass screening program for 6-month-old infants by means of a qualitative Vanilmandelic Acid (VMA) test has been in effect in Kyoto, Japan, for the prognostic improvement of neuroblastoma patients (Sawada et al: Am J Dis Child 136:710-712, 1982). A Neuroblastoma Mass Screening Study Group (NBMSSG) was organized in 1981 (Sawada et al: Lancet ii:271-272, 1984), and the mass screening program has grown to encompass eight selected areas. This group discovered 15 cases of neuroblastoma among 247,500 6-month-old infants, 1 of every 16,500, until the end of 1983, and 23 cases among 434,970, 1 of every 18,900, until the end of 1984. All cases were asymptomatic. As the incidence of infantile neuroblastoma detected by this program is projected to be 52.9-60.6 cases/million 6-month-old infants, it could be predicted that 80-91 neuroblastoma cases will be discovered annually in Japan by mass screening. The cure rate of 25 cases discovered by the mass screening and followed up over 20 months was 92% (Sawada: Lancet i:377,1986). In Japan, it should be possible to detect 135-146 cases--[symptomatic 55 = 220 X 1/4] + [80-91 cases detected by mass screening]--(61.4-66.4% of the total neuroblastoma cases) in infants under 1 year of age annually, and the cure rate of all neuroblastoma cases in Japan is expected to reach 60% or more.     

Cardiac sequelae of Kawasaki disease in Japan: statistical analysis.

The proportions of Kawasaki disease patients with cardiac sequelae in Japan were analyzed using nationwide survey data from the 6 1/2-year period July 1982 through December 1988. Of 46,864 cases of Kawasaki disease reported in the surveys, 7637 or 16.3% had cardiac sequelae such as dilation or stenosis of coronary arteries, myocardial infarction, and valvar lesions 1 month or more after onset. The prevalence of cardiac sequelae was particularly high in males, infants younger than 1 year, and children older than 5 years of age. In sequential observation, there was no correlation between the prevalence of cardiac sequelae and periods of high or low incidence of the disease. The prevalence of cardiac sequelae overall declined steadily over the observation period, perhaps as a consequence of increasing use of intravenous gamma globulin. However, children older than the age of 5 years manifested increasing prevalence of cardiac sequelae over the observation period, probably as a result of lower rates of intravenous gamma globulin administration.     

Changes in incidence and survival of Ewing sarcoma patients over the past 3 decades: Surveillance Epidemiology and End Results data

PURPOSE: The US population-based cancer registry Surveillance, Epidemiology, and End Results (SEER) database provides an opportunity to evaluate the incidence and survival rates of Ewing sarcoma (ES) for the past 3 decades. This analysis reflects trends for the diagnosis of localized versus metastatic disease and changes in ES survival in a setting of wide-ranging cancer care institutions across the United States, which is expected to be different from clinical trials published to date. MATERIALS/METHODS: Data from the SEER public-access database were reviewed for the diagnosis of ES of the bone among patients of 1 to 19 years of age between 1973 and 2004. Age-adjusted incidence was analyzed for the entire group and for localized and metastatic disease separately over the past 3 decades. Actuarial survival rates were examined for 3 intervals: 1973 to 1982, 1983 to 1992, and 1993 to 2004. RESULTS: The overall incidence of ES seemed to remain unchanged with an average of 2.93 cases/1,000,000 reported annually between 1973 and 2004. The proportion of patients with distant metastasis among all ES cases remained in the 26% to 28% range, whereas the percent of localized cases slightly increased from 57% in 1973 to 1982 to 67% in 1993 to 2004 and the proportion of unstaged cases decreased from 17% to 5%. The 5-year survival of localized disease increased from 44% in the first study decade to 68% in the period after 1993, whereas 5-year survival of metastatic disease increased from 16% to 39%. The corresponding 10-year survival increased from 39% to 63% for localized disease and from 16% to 32% for metastatic ES. CONCLUSIONS: The incidence of ES has not increased appreciably over the last 30 years. A marked decrease in the proportion of unstaged cases may be reflective of diagnostic improvement or changes in reporting. There is a clear improvement in survival for both localized and metastatic disease. Poorer outcome of metastatic patients still warrants intensification of therapy, which is currently being tested in several ongoing trials.     

Chronic inflammatory bowel disease in children in western Norway

The incidence of Crohn's disease (CD) and ulcerative colitis (UC) in children in western Norway was estimated in a prospective epidemiological study during the years 1984 and 1985. The total population in the area was 807,000 and the child population was 198,570 (1984). There were 27 new cases of chronic inflammatory bowel disease (IBD) in children aged 15 years or less, 10 new cases of CD, and 17 of UC. The mean annual incidence of CD in the child population was 2.5/100,000/year, whereas the incidence of UC in the child population was 4.3/100,000/year. Nearly all the children had abdominal symptoms. In this study, we found an incidence of CD in children that is the highest hitherto reported, to our knowledge. To the contrary, the incidence of UC was considerably lower than previously reported from northern Europe.     

An Incidence Peak of Juvenile Diabetes. Relation to Coxsackie B Virus Immune Response

ABSTRACT. All new eases of insulin dependent diabetes mellitus (IDDM) in children below 15 years of age were recorded prospectively during a 21–year period 1964–1984 in a defined uptake area with a relatively constant child population. The total number of children recorded was 222–111 boys and 111 girls. The number of new cases varied between 4 cases in 1968 and 20 in 1984; in 1983 seventeen new caw were recorded. Specific IgM antibodies against Coxsackie B virus (CBV), types 1–5 were measured by a reverse radioimmunoassay (RIA) technique in 24 consecutive patients collected during the period March 1982–January 1984, some of whom represented the recent period of a very high incidence of diabetes. Sixteen patients (67%) exhibited CBV IgM responses, strongly suggesting a current or recent CBV infection. The titres declined during the first few months of diabetes and seemed to be absent after the first half-year period. Among age-matched non-diabetic children scheduled for elective procedures during the same period, no cases with CBV-IgM antinbodies were detected. Only three of the 16 IgM-RIA-positive patients showed a signircant rise in the neutralising antibody titre against the same Coxsackie B type. It is concluded that CBV may play a pathogenetic role in induction of IDDM, and possibly more frequently so during periods with a high incidence of diabetes, at least in children below 15 years of age.     

Epidemiology of diabetes mellitus in children in Hong Kong: the Hong Kong childhood diabetes register

OBJECTIVES: To establish a registry for Chinese children with onset of type 1 (insulin dependent) diabetes mellitus before 15 years of age and to determine the incidence of childhood onset type 1 diabetes mellitus in Chinese children in Hong Kong. RESEARCH DESIGN AND METHODS: A registry was established in 1997 to collect childhood diabetes cases retrospectively from all districts in Hong Kong. The study included all newly diagnosed cases of diabetes with onset < 15 yr of age from 1st January 1984 to 31 December 1996. Primary ascertainment was based on review of medical records at all regional public hospitals in Hong Kong and survey of all the registered practitioners in Hong Kong. The secondary source of validation was made impractical, if not impossible, because of the recent implementation of the Personal Data Privacy Ordinance in Hong Kong. RESULTS: A total of 255 diabetic cases were identified, 227 type 1 diabetes mellitus (218 were Chinese), 18 type 2 diabetes mellitus and 11 secondary diabetes. 246 patients were Chinese and 9 non-Chinese. The age-standardized incidence of type 1 and type 2 diabetes mellitus in southern Chinese children in Hong Kong was 1.4/100,000/yr and 0.1/100,000/yr respectively for children < 15 yr of age during the study period. The incidence rates for type 1 diabetes were 0.9, 1.5 and 1.7 per 100,000/yr for 0-4 years, 5 to 9 years and 10 to 14 years age-groups respectively. The incidence for males was 1.2/100,000/yr and for females 1.7/100,000/yr. A significant increase in the incidence was demonstrated during the study period by simple linear regression (slope 0.14/100,000/year, r2 = 0.73, p = 0.0002) CONCLUSIONS: A diabetic registry is established in Hong Kong. This study documents a very low incidence rate of childhood type 1 diabetes mellitus in southern Chinese children in Hong Kong and we have seen an increasing incidence of the disease in the past 13 years.     

Outcome of childhood ulcerative colitis at 2 years

AIM: Ulcerative Colitis (UC) has an incidence of 1.4 per 100,000 in childhood. There is a paucity of data regarding outcome particularly with the increased use of early immunosuppression. This study reviews outcome at 2 years in a cohort with UC referred to a single centre. METHOD: Patients were recruited on the basis of a diagnosis made between 2000 and 2003 as a consecutive cohort. All had UC according to standard clinicopathological criteria. Children with indeterminate colitis were excluded. Follow-up data was collected at 2 years by case notes review. RESULTS: Thirty-two children are reported. The median age at diagnosis was 11 years (range 2-16). All were treated with corticosteroids and 5-ASA derivatives at diagnosis. The majority of patients (94%, 30/32) received more than one course of steroids. By 2 years azathioprine use was high with 75% (24/32) of patients on treatment for steroid-dependent disease. There were 6 extra-intestinal manifestations and 8 disease related complications occurring in 12 patients (38%). The colectomy rate was 9% (3/32) for unresponsive disease. CONCLUSION: There is a high need for Azathioprine in childhood UC. Colectomy rate at 2 years was around 10%. Extra-intestinal manifestations and disease related complications are common.     

Safety and tolerability of 1% pimecrolimus cream among infants: experience with 1133 patients treated for up to 2 years

Pimecrolimus is a calcineurin inhibitor developed for the topical treatment of atopic dermatitis. During the clinical development of 1% pimecrolimus cream, 1133 patients 3 to 23 months of age with mild to severe atopic dermatitis were treated for up to 2 years. The objective of this review is to discuss the safety and tolerability of 1% pimecrolimus cream among infants, on the basis of the combined results from all studies (4 pharmacokinetic studies and 6 clinical trials) conducted among these patients. Pimecrolimus blood concentrations measured for 35 patients were consistently low (< or =1 ng/mL in >80% of samples), irrespective of the disease severity and extent, and remained low during intermittent treatment for up to 1 year. The level of systemic exposure to pimecrolimus among infants was comparable to that observed for older pediatric patients enrolled in the same studies and treated in the same way with 1% pimecrolimus cream, which indicated that young pediatric patients are not at higher risk of significant percutaneous absorption of topically applied pimecrolimus, despite their large skin surface area/body mass ratio. The 6 clinical trials included a total of 1098 infants, who were treated for periods ranging from 4 weeks to 2 years. Most of these patients (60%) had moderate to severe disease at baseline. The most frequently reported adverse events were common childhood disorders such as nasopharyngitis, pyrexia, upper respiratory tract infections, ear infections, and bronchitis. During the double-blind (DB) studies or DB phases of studies, the incidence rates for the most frequently reported adverse events were similar for patients who received 1% pimecrolimus cream and patients who received the vehicle, except for the incidence of teething, which was higher among the pimecrolimus-treated infants (relative risk: 2.02; 95% confidence interval: 1.32-3.27). Treatment with 1% pimecrolimus cream was not associated with an increase in the overall incidence of nonskin infections, compared with the vehicle (relative risk: 1.015; 95% confidence interval: 0.88-1.18). The incidence density (ID) rates for total bacterial, fungal, parasitic, and viral skin infections during the DB studies or DB phases of studies were comparable for patients treated with 1% pimecrolimus cream and patients who received the vehicle. The ID rate of herpes simplex virus infections was 0.8 cases per 1000 patient-months of follow-up monitoring among patients treated with 1% pimecrolimus cream and 1.7 cases per 1000 patient-months of follow-up monitoring among patients who received the vehicle. Considering all 1098 infants treated with 1% pimecrolimus cream in DB trials and open-label studies, the ID rate of clinically diagnosed eczema herpeticum was 1.3 cases per 1000 patient-months of follow-up monitoring. Burning and erythema were the most frequently reported application site reactions, with ID rates of 2.0 and 1.2 cases per 1000 patient-months of follow-up monitoring, respectively. No sign of immunosuppression was found among infants treated intermittently with 1% pimecrolimus cream for up to 2 years; they demonstrated normal immune responses to vaccinations and did not show increases in the incidence of systemic infections or skin infections over time.     

Neuroblastoma: changing incidence and survival in young people aged 0-24 years. A report from the North of England Young Persons' Malignant Disease Registry

BACKGROUND AND PROCEDURE: Population based data for neuroblastoma in children and young adults under 25 years at diagnosis were ascertained from the Northern Region Young Persons' Malignant Disease Registry for the period 1968-1995. Age-standardised incidence rates were calculated (ASR) and changes in incidence and survival were investigated. Over the study period 144 patients were registered, of these 136 were children under 15 years at diagnosis (median age: 2.2 years, ASR: 8.6 cases per million children per year), and 8 were 15-24 years (ASR 0.6). RESULTS AND CONCLUSIONS: Incidence of childhood neuroblastoma in the North of England increased significantly over time; ASRs were 5.8 for 1968-1981 and 9.5 for 1982-1995 (rate ratio: 1.6, 95%; CI 1.2-2.3). The increase in incidence was seen in both infants and older children, and in both low stage and advanced disease. Overall 5 year survival was 15% for 1968-1981 and 40% for 1982-1995 (P < 0.0001). Significant improvements in survival were documented across different stage and age-groups, including those over 1 with stage 4 disease (0% versus 18%, P < 0.0001). Further research is needed to investigate the reasons for the increasing incidence of neuroblastoma.     

A population study of severe aplastic anemia in children. Incidence, etiology and course

The total number of registered cases of severe aplastic anemia in Denmark was 39 among children aged 0-14 years in 1967 to 1982 giving an annual incidence of 2.2 cases per 1 million children in a well defined and stable population. A probable cause of the aplastic anemia was found in 21 cases (54%). Exposure of the population to known etiological factors of aplastic anemia such as chloramphenicol, pesticides and hepatitis was constant in the study period, and accounted for 2, 5, and 2 cases, respectively. Other infections caused 6 cases, other drugs 2 cases, and organic diluents one case. Three children with constitutional aplasia developed severe aplastic anemia among a total of 6 Fanconi's anemias, 3 probable Fanconi's anemias, and 10 cases of erythrogenesis imperfecta diagnosed during the same 16 years. Thirteen patients (33%) died within 3 months after the diagnosis while on supportive treatment and low dose prednisolone supplemented with androgen treatment. Long term survival occurred in 10 patients (26%), of which 5 patients were in complete and 5 in partial remission.     

Clinical spectrum of Kawasaki disease in infants younger than 6 months of age

We report an unselected series of eight patients younger than 6 months of age with Kawasaki disease evaluated between January 1982 and May 1984. The incidence of coronary artery aneurysms (six patients) and the mortality (two patients) were unusually high in this small series. Because of the confusing clinical presentation in three patients, diagnosis was delayed until pathologic or echocardiographic evidence of coronary vasculitis or aneurysm was discovered. The currently accepted clinical criteria for Kawasaki disease may not always identify patients with the pathologic findings of the syndrome who are younger than 6 months of age. The diagnosis of Kawasaki disease and echocardiographic evaluation of the coronary arteries should be considered in young infants with prolonged fever of unknown origin.     

A Population Study of Severe Aplastic Anemia in Children

ABSTRACT. The total number of registered cases of severe aplastic anemia in Denmark was 39 among children aged 0–14 years in 1967 to 1982 giving an annual incidence of 2.2 cases per 1 million children in a well defined and stable population. A probable cause of the aplastic anemia was found in 21 cases (54%). Exposure of the population to known etiological factors of aplastic anemia such as chloramphenicol, pesticides and hepatitis was constant in the study period, and accounted for 2, 5, and 2 cases, respectively. Other infections caused 6 cases, other drugs 2 cases, and organic diluents one case. Three children with constitutional aplasia developed severe aplastic anemia among a total of 6 Fanconi's anemias, 3 probable Fanconi's anemias, and 10 cases of erythrogenesis imperfecta diagnosed during the same 16 years. Thirteen patients (33%) died within 3 months after the diagnosis while on supportive treatment and low dose prednisolone supplemented with androgen treatment. Long term survival occurred in 10 patients (26%), of which 5 patients were in complete and 5 in partial remission.     

Kawasaki syndrome clusters in Harris County, Texas, and eastern North Carolina. A high endemic rate and a new environmental risk factor

Sixty-one cases of Kawasaki syndrome (KS) occurred in Harris County, Texas, during the three-year period from January 1982 through December 1984. Fifty-five (90%) of these 61 patients were under 5 years old, for an annual endemic rate in children under 5 years old of 9.1 cases per 100,000 per year. To our knowledge this is the highest endemic rate reported to date in the continental United States. Between Aug 26 and Sept 19, 1984, seven children with KS were hospitalized in Harris County. The seven children were between 5 months and 5 years old. The number of cases in this cluster was unusual for late summer, which is generally a low-incidence season for KS in Harris County. More important, a case-control study of these children revealed that they resided significantly closer to a bayou or drainage ditch than did randomly selected matched control subjects. A similar association with drainage ditches or creeks was observed in a subsequent cluster of 13 cases of KS in seven eastern North Carolina counties. To our knowledge, this is the first report of a possible association between KS and residing near water.     

Incidence of type 1 diabetes mellitus diagnosed before age 20 years in Canterbury,New Zealand over the last 30 years

This study examined the epidemiological characteristics of type 1 diabetes mellitus (DM) presenting in Canterbury, New Zealand, between 1970 and 1999. All patients with type 1 DM aged 0-19 years at diagnosis within the Canterbury geographical region were either admitted to the regional hospital or seen acutely as outpatients in clinics at the same institution. Primary ascertainment of incident cases, through notification by the attending physician or paediatrician, began prospectively in 1982. Incident cases between 1970 and 1982 were ascertained retrospectively from clinic and hospital records. For the years 1970-99, there were 474 incident cases (256 males, 218 females). Incidence rates determined from 5-yearly census population denominators ranged from 2.40 to 26.59 patients/100,000 person years. The mean for 5-year periods, starting from 1970, increased from 6.79 to 22.79 patients/100,000 person years, i.e. a 3.4-fold increase over 30 years. The increase in incidence based on linear regression of these data is 0.59 patients/100,000 per year, or an annual increase of 5% derived from regression of the natural logarithms of the incidence data. These observations are consistent with the increasing attack rates for type 1 DM reported worldwide.     

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目的了解不同初治年龄对先天性肾上腺皮质增生症(CAH)患儿身高、骨龄、性早熟等方面的影响。方法将1982～2004年在上海新华医院和上海市儿科医学研究所内分泌、遗传代谢病专科诊治的32例CAH患儿(年龄:女≥8岁,男≥9岁),按初治年龄分为≤3岁组(14例)和>3岁组(18例),观察两组间末次复诊时骨龄与身高龄之差、性早熟例数及男女患儿发生性早熟的不同。结果14例初治年龄≤3岁患儿末次复诊时骨龄与身高龄之差[(3.0±2.0)岁]与18例>3岁组[(4.6±1.6)岁]比较差异有显著性(P<0.05),初治年龄>3岁组发生真性性早熟(9例)与≤3岁组(2例)比较差异有显著性(χ2=4.453,P<0.05)。男性患儿发生真性性早熟(9例)与女性患儿(2例)比较差异有显著性(χ2=4.794,P<0.05)。结论CAH患儿≤3岁得到诊治者其预测终身高较>3岁方诊治者明显改善,其性早熟发生率明显减少,男性CAH患儿较女性CAH患儿更易发生性早熟。     

The impact of the hepatitis B virus vaccine on the incidence of hepatitis B virus-associated membranous nephropathy

BACKGROUND: The hepatitis B virus (HBV) vaccine has resulted in a decline in the incidence of HBV carriage and hepatocellular carcinoma in southeast Asia. Vaccine efficacy in Africa has not been adequately assessed. OBJECTIVE: To report on the impact of HBV vaccination in South Africa on HBV-associated membranous nephropathy (MN) over 6 years. METHODS: King Edward VIII Hospital in Durban is the only tertiary referral center for the province of KwaZulu-Natal for children with renal diseases. The HBV vaccine was introduced into the South African Expanded Programme on Immunisation on April 1, 1995; vaccine coverage rates between April 1, 1995, and December 31, 2001, for children for the first, second, and third doses were 85.4%, 78.2%, and 62.0%, respectively. Hepatitis B virus status was determined using a radioimmunoassay (January 1, 1984-March 31, 1991) or an enzyme-linked immunosorbent assay. Membranous nephropathy was confirmed by the results of a renal biopsy. The hospital average annual incidence of HBV-associated MN was compared before and after vaccination and according to age groups. RESULTS: Between January 31, 1984, and December 31, 2001, there were 119 children with HBV-associated MN; their mean age was 7 years (range, 1-14 years), and 101 (84.9%) were males. The average annual rate ratio per 105 child population was 0.25. The overall incidence rate ratio showed a significant decrease from January 1, 2000, to December 31, 2001, compared with the preimmunization period (January 1, 1984-December 31, 1994) (incidence rate ratio, 0.12; 95% confidence interval, 0.03-0.50). Children from birth to the age of 4 years experienced no disease after 1998. Children aged 5 to 10 years showed a significant decrease in 2000-2001 compared with the prevaccination years (incidence rate ratio, 0.19; 95% confidence interval, 0.05-0.80). CONCLUSION: The HBV vaccine, even at low coverage for the full South African Expanded Programme on Immunisation schedule, reduced the hospital incidence of HBV-associated MN over 6 years.     

1984 milk-feeding patterns in the United States

This paper presents results of surveys conducted continuously during a period of years to assess the trend in the incidence of breast-feeding. From 1955 to 1984, questionnaires were mailed to a large nationally representative sample of mothers to determine the use of various milks for feeding infants during the first 6 months of life. Data from these surveys demonstrated the resurgence of breast-feeding both in incidence and duration through 1982. From 1982 through 1984, these increases continued but at a markedly reduced level.