Understanding autism: parents and pediatricians in historical perspective

Both primary care providers and subspecialists in pediatrics encounter families who are actively involved in the diagnosis and treatment of their children. Parents of children with an autism spectrum disorder in particular are often aware of scientific issues, and their expertise and desire for a medical cure for autism sometimes put them at odds with the medical team. We investigated the role of parents and advocates in autism research and treatment over the last 50 years. Our review of scientific publications and archival sources documents how parents and advocacy groups have done the following: (1) organized research funding; (2) constructed clinical research networks; (3) suggested new avenues for research; (4) popularized empirically based therapies; and (5) anticipated paradigmatic shifts in the understanding of autism. We believe that this historical account will help pediatricians and researchers recognize that families can contribute to expert understanding of complex medical conditions such as autism and that the existence of partnerships with families of children with autism is a critical component of future research and treatment programs.     

Early detection of visual disorders by pediatricians]

A group of pediatricians from Northern France whose aim was to develop research projects in ambulatory pediatrics, elaborated a method of rapid assessment of visual acuity that can be applied by the pediatrician in the consulting room. This test was included in the routine examination of children between the age of 2 1/2 and 4, the age of 3 years being the most appropriate. The method is simple, reliable, reproducible and cheap since it is part of the pediatrician's consultation. Visual defects can be detected at an early stage and children can be treated when they still have a maximum chance of being cured. Thus it appears a useful test in terms of prevention of disease and public health.     

Children with psychiatric disorders examined by established pediatricians]

OBJECTIVE: Studies concerning children with psychological disorders presented in the paediatric practice are rare. We therefore investigated rates of attendance and rates of referral to other specialists from theses practices. METHOD: The data were collected by the paediatricians and recorded according to a list of psychosocial symptoms. Frequencies were compared with results of a similar study concerning general practitioners. The chi-square seemed to be appropriate as test of significance. RESULTS: 18 paediatricians were included in the study. 8.3% of children seen by these professionals were thought to show signs of psychological deviance. The accompanying physical disorders hereby were the more prominent presenting symptoms. Only in 1.3% of the cases were psychological disorders the sole reason for the visit. In 30% of the cases were psychological problems a follow up referral to another institution was recommended. Rates of attendance and of follow-up referral were more frequent in rural practices than in practices of a university town. In general practices, 20.3% of children were noted as psychologically disturbed. CONCLUSIONS: The study reveals the important role played by paediatric practices in the mental health care, especially in rural regions. The low rate of psychological disorders as the only reason for attending a paediatric practice indicates that there may be an attendance pattern in which physical symptoms are initially used as a vehicle for subsequently presenting psychological disturbance.     

Role of pediatricians in advocating life support training courses for parents and the public

Available literature suggests a need for both initial cardiopulmonary resuscitation basic life support training and refresher courses for parents and the public as well as health care professionals. The promotion of basic life support training courses that establish a pediatric chain of survival spanning from prevention of cardiac arrest and trauma to rehabilitative and follow-up care for victims of cardiopulmonary arrest is advocated in this policy statement and is the focus of an accompanying technical report. Immediate bystander cardiopulmonary resuscitation for victims of cardiac arrest improves survival for out-of-hospital cardiac arrest. Pediatricians will improve the chance of survival of children and adults who experience cardiac arrest by advocating for cardiopulmonary resuscitation training and participating in basic life support training courses as participants and instructors.     

Optimizing the early parent-child relationship: windows of opportunity for parents and pediatricians

This article explores child and parent risk factors that can affect the early parent-child relationship and highlights how a relational approach can be used in pediatric primary care to optimize early social-emotional development in the context of family-centered care. Risk factors, such as prematurity, parental mental illness, and a history of adverse care-giving experiences, can affect the parent-child relationship and influence later infant social-emotional development. The pediatrician, because of the ongoing relationship with the family, is in an optimal position to identify concerns, initiate interventions, and provide support and services to support the development of the early parent-child relationship.     

Ectopic pregnancy in adolescents: a clinical review for pediatricians

Pediatricians caring for sexually active female adolescents and young adults need to be aware of the history, symptoms, and signs of an ectopic pregnancy. A thorough history and physical examination, including the pelvic examination, as well as specific diagnostic tests such as repeated quantitative hCG measurements, and ultrasonography when indicated, are crucial to proper and early diagnosis of a nonruptured ectopic pregnancy manageable by laparoscopy. The key to early diagnosis is to include ectopic pregnancy in the differential diagnosis in any sexually active female patient who has abnormal vaginal bleeding or abdominal pain. With early diagnosis, close observation, and appropriate management, the outcome is more likely to be favorable, with minimal morbidity and risk of death.     

The consequences of parental smoking in children: pediatricians must act]

Prenatal and childhood passive tobacco smoke exposure resulting from parental smoking may have severe side effects, such as low birth weight, prematurity, sudden infant death syndrome, upper and lower respiratory tract infections and asthma. By giving information to parents, and particularly by emphasizing the dangers of passive smoke exposure for their children, pediatricians have a critical role to play in their prevention. This may also be helpful for adolescents who are starting to smoke actively by trying to understand the needs that they express by this behavior, and encouraging them to go to a stop smoking counseling center.     

Expectations of pediatric sport participation among pediatricians,patients, and parents

As the number of pediatric and adolescent athletes involved in competitive sports continues to grow, and as the competitors in youth sports trend toward a "win at all costs" mentality, pediatricians are increasingly being asked to provide sports medicine treatment and counseling for athletic children. This article outlines the demographic changes in the pediatric and adolescent athlete population in the United States and explains how the pediatrician can become a more effective caregiver to the athletic patient.     

Treatment of acute diarrhea: prescription patterns by private practice pediatricians]

Acute gastroenteritis remains a frequent illness in infants and children with still important morbidity and mortality rates. Oral rehydratation solutions (ORS) and early refeeding are the main recommendations. Indication of drugs remains limited. OBJECTIVE: To evaluate the management of acute diarrhea by private practice pediatricians of France. METHODS: A questionnaire concerning ORS, dietary formula, antidiarrheal diet, antibiotherapy, antidiarrheal drugs was sent to all 2907 private pediatricians of France. RESULTS: Six hundred twenty-nine questionnaires were analyzed (22%). Three hundred and ninety-seven pediatricians (63%) prescribed systematically an ORS, 294 (47%) changed formula, 412 (66%) prescribed a regimen. Antibiotic was prescribed after coproculture (81%), when glairy and bloody diarrhea (65%), associated infectious disease (63%), toxi-infectious syndrome (42%) or immunodeficiency were present (28%). Most pediatricians (97%) prescribed at least one drug: diosmectite (84%), Lactobacillus acidophilus (63%), Saccharomyces boulardii (62%), racecadotril (62%), loperamide (28%), attapulgite de Mormoiron (26%), nifuroxazide (20%). Drugs were prescribed more often for their effectiveness than for comfort. CONCLUSION: This study demonstrates the discrepancies that remain between recommendations and practical care in the treatment of acute diarrhea in children. Private French pediatricians often prescribe drugs.     

Counseling smoking parents of young children: comparison of pediatricians and family physicians

BACKGROUND: Secondhand smoke is a major cause of morbidity in young children, and exposure to smoking parents is the principal source. Physician visits for young children present an opportunity to effect behavioral change among smoking parents. OBJECTIVE: To survey pediatricians and family physicians in their knowledge and practice of smoking cessation counseling with parents. DESIGN: Cross-sectional mail survey. SETTING: Urban California. PARTICIPANTS: Pediatricians and family physicians in urban areas of California, younger than 65 years, practicing in an ambulatory setting, and randomly selected from the American Medical Association Physician Masterfile. MAIN OUTCOME MEASURES: Reported frequency of asking about tobacco use, using cessation counseling techniques with smokers, and perceived barriers to providing cessation services. RESULTS: Of the 1000 mailed surveys, 899 were eligible and 499 (56% response rate) were returned and completed. A higher proportion of pediatricians compared with family physicians were women (44% vs 29%; P<.01) and nonwhite (44% vs 32%; P =.01). Family physicians compared with pediatricians were more likely to report referring a parent to a smoking cessation program (41% vs 30%), giving pamphlets on smoking cessation (40% vs 28%), asking for a quit date (41% vs 18%), scheduling a follow-up visit to discuss quitting (27% vs 5%), and recommending nicotine replacement therapy (41% vs 13%) (for each comparison, P<.001). Pediatricians were more likely to report recording in the medical record smoking by a parent as a problem for the child (65% vs 48%; P<.001), but a higher proportion of pediatricians perceived that parents would ignore the advice (39% vs 24%; P<.001) and lacked interest in quitting smoking (45% vs 27%; P<.001). Pediatricians were more likely to agree that they lacked smoking cessation counseling skills (26% vs 7%; P<.001). Multivariate models showed that pediatricians were less likely to report performing 5 of 14 smoking cessation techniques in at least 50% of smoking parents. CONCLUSIONS: Pediatricians appear to lack training to implement smoking cessation counseling with smoking parents. Physicians in private practice are less likely to counsel smoking parents. Educational interventions for pediatricians are needed to decrease secondhand smoke exposure for young children.     

The intimidation of British pediatricians

British pediatricians who diagnose and treat child abuse cases have come under attack by the British press and by parents who have been investigated for possible abuse. Now the General Medical Council also is intimidating these pediatricians. The General Medical Council is the licensing authority for physicians in the United Kingdom. This has resulted in fewer pediatricians being willing to care for abused children or to testify in child abuse cases. In the United States, the recent recognition of the pediatric subspecialty of child abuse pediatrics should help set standards for child abuse medical evaluation and testimony.