Influence of attendance at day care on the common cold from birth through 13 years of age

OBJECTIVE: To describe trends in the occurrence of the common cold during the first 13 years of life among children who attended different childcare settings early in life. DESIGN: The Tucson Children's Respiratory Study involves 1246 children enrolled at birth and followed up prospectively since May 1980 through October 1984. Children with data regarding day care use during the first 3 years of life were included in this investigation (n = 991). Parents reported the occurrence of frequent (> or = 4) colds during the past year by questionnaire when each child was 2, 3, 6, 8, 11, and 13 years of age. Child care at home (no unrelated children), at small day care (1-5 unrelated children), or at large day care (> or = 6 unrelated children) was reported retrospectively by parental questionnaire when the children were approximately 6 years old. RESULTS: After adjusting for potential confounding variables, compared with children at home those in large day care had more frequent colds at year 2 (odds ratio [OR], 1.9, 95% confidence interval [CI], 1.0-3.4; P =.04), less frequent colds at years 6 (OR, 0.3, 95% CI, 0.1-0.9; P =.02) through 11 (OR, 0.4, 95% CI, 0.1-1.2; P =.09), and the same odds of frequent colds at year 13 (OR,1.0, 95% CI, 0.3-3.8; P =.95). In addition, compared with children in large day care for 1 year or less those attending large day care for more than 2 years had more frequent colds at year 2 (OR, 1.7, 95% CI, 1.0-3.0; P =.04), less frequent colds at years 6 (OR, 0.5, 95% CI, 0.2-1.1; P =.08), 8 (OR, 0.2, 95% CI, 0.1-1.0; P =.04), and 11 (OR, 0.3, 95% CI, 0.1-1.0; P =.05); and the same odds of frequent colds at year 13 (OR, 0.9, 95% CI, 0.3-2.9; P =.80). CONCLUSIONS: Attendance at large day care was associated with more common colds during the preschool years. However, it was found to protect against the common cold during the early school years, presumably through acquired immunity. This protection waned by 13 years of age.     

0～7岁儿童生长曲线的制定及其应用

目的：制订一套0-7岁儿童的百分位生长曲线图供儿童保健及临床工作使用。方法：根据1995年第三次中国九城市城郊7岁以下儿童体格发育横断面调查所获得的数据，采用9个市城区0-7岁79154名健康男女儿童（其中0-3岁儿童53954名）的年龄别身高（3岁以下为身长）、年龄别头围的平均值、标准差以及年龄别体重和身高别体重的百分位数，先用多项式方程将他们修匀，然后修匀后的值计算各百分位并绘制曲线图。结果：为0-3岁男女儿童制定了各自的年龄别体重、年龄别身高和身高别体重的3、10、25、50、75、90及97百分位曲线图。结论：使用简便、直观的生长标准曲线图有利于个体儿童的生长监测，早期识别生长偏离的现象，为促进儿童生长和健康服务。     

318名0～6岁儿童基础促性腺激素水平的测定

我们于 2 0 0 0年 4月～ 2 0 0 1年 12月运用免疫化学发光分析法 (ＩＣＭＡ) [1,2 ] 对 0～ 6岁正常儿童血清基础黄体生成素(ＢＬＨ)和基础卵泡刺激素 (ＢＦＳＨ)水平进行了观察 ,为小儿内分泌疾病的诊断和监测提供参考依据。对象0～ 6岁儿童 3 18名 ,男孩 167名 ,女孩 15 1名。所有对象均来自某寄读学校 (面向全国招生 )的正常体检儿童或因呼吸道感染而住院的儿童 (无发热 ,生长发育正常 ,无性早熟和其他疾病 )。 3 18名儿童被分为新生儿、～ 1岁、～ 2岁、～ 3岁、～ 4岁、～ 5岁、～ 6岁和～ 7岁共 8个年龄段 ,每个年龄段又分为男孩和女…     

Financing health care for disabled children

Information about health care use, charges, and out-of-pocket expenses is critical to the development of an equitable and efficient treatment system for disabled children. Data from the 1980 National Medical Care Utilization and Expenditure Survey were used, and differences in use, charges, and out-of-pocket expenses for children with and without limitations in their activities due to chronic health problems are described. The results indicate that children limited in their activities used more medical services than other children, especially hospital-based services and services provided by health professionals other than physicians. Charges and out-of-pocket expenses were two to three times higher on average for disabled children, compared with other children. Charges and out-of-pocket expenses were also skewed; 10% of the sample children accounted for more than 60% of total charges and out-of-pocket expenses for the disabled population. The skewed distribution of out-of-pocket expenses suggests that financial burdens are unevenly shared by families of disabled children. Several public policy options designed to result in a more equitable distribution of financial risks are discussed.     

Coordination of care for children with special health care needs

PURPOSE OF REVIEW: Coordination of care is an essential function of pediatric primary care, needed most by children with special health care needs (CSHCN). Although complex, its necessity has become better recognized with the recent increase in attention in the United States to the comprehensive "medical home" model of care. RECENT FINDINGS: Coordination is highly dependent on effective communication within the health care system and between the health care system and the larger community. While coordination may best be undertaken at the level of the physician practice, a team approach involving nonphysician staff and families as primary participants may be the best option in many cases. More attention is being paid at the health policy level to the implementation of coordination of care, although solutions to reimbursement barriers have yet to be implemented. Considerable progress on methods to improve care coordination in the primary care practice setting has been made recently. Many of these efforts have used quality improvement techniques adapted from the business world. Emerging measures of the process of care coordination are also being developed, although few studies have been published to date showing a positive impact of care coordination. SUMMARY: The value of coordination of care as an essential part of medical care for children with special health care needs is becoming widely recognized. Methods to implement it within pediatric primary care practices are being developed, although more data demonstrating its value are needed to inform policy changes.     

Prevalence of iron deficiency in Saudi children from birth to 15 months of age

A cross-sectional study was carried out to determine the prevalence of iron deficiency among healthy Saudi children from birth to 15 months of age. The groups studied were: newborns, 3-4 months, 5-6 months, 7-8 months, 9-10 months and 12-15 months of age. The age groups were dictated by the vaccination schedule. Serum ferritin was measured and transferrin saturation calculated in each subject. The lower limits of normal were taken as a transferrin saturation of less than 10% and a serum ferritin of less than 12 micrograms/l. A total of 333 serum samples was adequate for analysis. None of the newborns or the 3-4-month-old infants had evidence of iron deficiency. At 5-6 months only 3.3% of subjects had iron deficiency. In the subsequent older age groups the prevalence of iron deficiency increased significantly with age from 9.3% to 12.7% and reached 14.5% in the oldest age group. Screening for iron deficiency in children attending well-baby clinics and hospitals at ages of 12-15 months is recommended.     

Protecting children from sexual abuse by health care providers

Sexual abuse or exploitation of children is never acceptable. Such behavior by health care providers is particularly concerning because of the trust that children and their families place on adults in the health care profession. The American Academy of Pediatrics strongly endorses the social and moral prohibition against sexual abuse or exploitation of children by health care providers. The academy opposes any such sexual abuse or exploitation by providers, particularly by the academy's members. Health care providers should be trained to recognize and abide by appropriate provider-patient boundaries. Medical institutions should screen staff members for a history of child abuse issues, train them to respect and maintain appropriate boundaries, and establish policies and procedures to receive and investigate concerns about patient abuse. Each person has a responsibility to ensure the safety of children in health care settings and to scrupulously follow appropriate legal and ethical reporting and investigation procedures.     

Normal values of total serum IgE in children from birth to 16 years of age

Total serum IgE values were measured by solid phase radio-immunoassay in 250 normal children, 129 females and 121 males, whose ages ranged from birth to 16 years. IgE is not present in cord blood in contrast to the high maternal values but thereafter levels increase in a linear manner (y = 2.28 + 5.43 x, n = 250, r = 0.57, alpha less than 0.01). There was no significant difference between the sexes, both for the group as a whole as well as within age groups. There was no circadian variation. The distribution of the values in the age groups was log Gaussian and therefore the upper limit of normal should be defined as the 95% confidence intervals calculated from the log Gaussian distribution.