Screening for vision problems in pediatric practice.
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Child, Preschool↗
Biomedical subjects
R C Wasserman
Publications and source records attributed to R C Wasserman.
Recurrent otitis media and parenting stress in mothers of two-year-old children.
This study examined the impact of recurrent otitis media on mothers' perceptions of themselves and of their 2-year-old children. Fifty-two mothers of children with and without histories of recurrent otitis media completed measures that rated the level of stress in the mother-child relationship at two points in time. The mothers of children who experienced six or more episodes of otitis media in the first 2 years of life rated their children as significantly more demanding at age two and at follow-up 6 months later than did the mothers of children who experienced no more than one episode of the illness. At the first point in time, these mothers also rated themselves as significantly more depressed and less competent than did control mothers, a pattern that was maintained at the follow-up. Findings of the study suggest that recurrent otitis media early in life may contribute to adverse perceptions of child and self that may persist for some time after the child has been relatively disease free and further suggest that parental perceptions may mediate relationships between early recurrent otitis media and later developmental outcomes.
Adaptation, Psychological↗
Preschool vision screening in pediatric practice: a study from the Pediatric Research in Office Settings (PROS) Network. American Academy of Pediatrics.
In this cross-sectional study, the vision-screening process is described for 8417 children aged 3 to 5 seen for health supervision in a group of 102 pediatric practices in 23 states and Puerto Rico. Three hundred forty children who failed screening (63% of those who failed) were followed up 2 months after initial screening. The sample was 52% male, 86% white, 9% black, 3% Hispanic, and 1% Asian. Vision screening was attempted on 66% of children overall. Pediatricians' reasons for not screening were "not routine" (44%), "too young" (40%), and "screening done previously" (17%). Younger children were less likely to be screened than older children (39% of those aged 3), and Hispanics were less likely to be screened than other ethnic groups (P less than .001). Thirty-three percent of children received no screening for latent strabismus. Two months later, 50% of parents whose child had failed a vision test were unaware of this fact on questionnaire follow-up. Eighty-five percent of children referred to an eye specialist had made or kept an appointment. It is concluded that pediatricians need to increase vision screening among younger preschool children and communicate more effectively to parents the results of screening failure.
Amblyopia↗
Infant temperament and school age behavior: 6-year longitudinal study in a pediatric practice.
We conducted a retrospective cohort study in a pediatric practice to assess the association between parents' ratings of temperamental difficulty (observations of specific infant behaviors) and perceptions of temperamental difficulty (impressions of one's infant as compared with other infants) in infancy and behavior problems at school age. Mothers of 129 infants, who had completed the Revised Infant Temperament Questionnaire at the 4-month visit, completed the Child Behavior Checklist when the child was 6 years of age. Teachers of 102 of these children completed the teacher Child Behavior Checklist. Temperamental difficulty was defined by assessments of rhythmicity, approach/withdrawal, intensity, mood, and adaptability. Initial analyses revealed that low socioeconomic status (r = -.29, P = .001), ratings of temperamental difficulty (r = .17, P = .06), and perceptions of temperamental difficulty (r = .22, P = .02) at 4 months of age were associated with increased maternal rating of behavior problems at 6 years of age (all 2-tailed tests). However, a multivariate regression analysis showed only low socioeconomic status (P less than .01) and increased perceptions of temperamental difficulty (P = .02) associated with maternal behavior problem scores. Teacher behavior problem scores were associated only with low socioeconomic status (r = -.27, P = .01). These results suggest that the link between difficult infant temperament and later behavior problems is complex and probably reflects both child factors and parent attitudes about what constitutes typical infant behavior.
Child↗
Injury hazards in home day care.
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Accident Prevention↗
Recurrent infantile vomiting due to intentional ipecac poisoning.
Recurrent vomiting is a common symptom in infancy that, when severe, may prompt an extensive diagnostic evaluation. We report a 1-year-old infant whose recurrent vomiting eluded diagnosis until ipecac syrup was detected in vomitus and urine. Separation of the infant from the mother resulted in complete resolution of the symptoms. In Munchausen syndrome by proxy, a disorder in which a mother fabricates or induces illness in her child, most reported fatalities are due to intentional poisoning. In atypical cases of recurrent vomiting, early screening of body fluids for unexpected drugs, particularly ipecac, may prevent potentially fatal delays in diagnosis.
Female↗
Health care of physicians' children.
In anecdotal reports, problems have been cited in the health care of physicians' children, but no systematic study of this issue has been attempted. Pediatricians in a community of high physician density were interviewed to determine whether and how the health care of physicians' children differs from that of children of equivalent socioeconomic status. Of the community's 33 pediatricians, 94% responded to items in a 45-minute structured interview, for which test-retest reliability was demonstrated. Systematic differences in the care of physicians' children included delayed help seeking and increased self-referral to specialists by parents, and poor documentation of psychosocial history, less detailed instruction giving, and a reluctance to discuss problem behavior by pediatricians. Reasons cited by pediatricians for these problems included inappropriate assumptions concerning the medical knowledge of the physician's family, confusion between the roles of healer and help seeker, and embarrassment about discussing personal issues with colleagues. Pediatricians and physician parents need to become aware of and communicate about the potential for problems in the health care of physicians' children.
Adult↗
Bicyclists, helmets and head injuries: a rider-based study of helmet use and effectiveness.
We interviewed 516 bicyclists over age 10 regarding helmet use and head injuries. Although 19 per cent owned helmets, only 8 per cent were wearing them when interviewed. Riders wearing helmets were more highly educated and reported higher car seat belt use. Nearly 4 per cent of the bicyclists reported striking their heads in a cycling mishap during the previous 18 months; those wearing helmets at the time of the mishap were less likely to have sustained head injuries.
Adult↗
Evaluation of the capillary microhematocrit as a screening test for anemia in pediatric office practice.
The capillary microhematocrit test is widely used to screen pediatric patients for anemia. Recently, it has been suggested that this method produces spuriously elevated values compared with venous hematocrits measured by a Coulter electronic counter and might consequently fail to detect children who are truly anemic. To address this issue we studied 66 white children 9 months to 14 years of age whose capillary hematocrits were either below, equal to, or one or two points above the lower limit of normal for age. Venous specimens were obtained simultaneously with the capillary sample; hemoglobin, hematocrit, and mean corpuscular volume results were obtained using a Coulter electronic counter. Using published standards of venous hemoglobin, we determined the sensitivity, specificity, and predictive values of the capillary microhematocrit in this population of patients with low or borderline values. Twenty of the 66 patients had venous hemoglobin values less than the lower limit of normal. The sensitivity of the microhematocrit was 90.0%; the specificity was 43.5%. The predictive values for a normal (negative) hematocrit was 90.1%; the predictive value for a low (positive) hematocrit was 40.9%. We conclude that the microhematocrit method using capillary blood will miss very few patients with significantly low venous hemoglobin values and is thus an acceptable screening test for anemia. Because it does not require expensive equipment or special skill to obtain the specimen or perform the test, it is ideal for physicians' offices or nonhospital-based clinics.
Anemia↗
Why families change pediatricians. Factors causing dissatisfaction with pediatric care.
Dissatisfaction with their child's physician sometimes causes parents to transfer to a new provider. We studied the reasons for such transfers from four pediatric practices in Chittenden County, Vermont. Personal qualities of the physician, including the parent's perception of the physician's communication skills, his or her clinical competence, and the apparent level of concern were the most important factors that distinguished satisfied from dissatisfied parents. Structural features, including costs, waiting time, and continuity with the same physician, were less often sources of enough dissatisfaction to produce a transfer. Effectiveness and success in pediatric practice are dependent on competence, communication, and caring.
Appointments and Schedules↗
Helmet protection from head injuries among recreational bicyclists.
Head injuries account for the great majority of bicycling deaths and hospital admissions. Helmet use has been suggested as an effective means of preventing injury, but few studies have addressed this issue. We collected questionnaire data by mail from 191 recreational bicyclists who reported having fallen and struck their heads in a cycling mishap. Information was collected on the nature of the mishap, the extent of injury, and the helmet status of the rider at the time of the fall. Fifty-seven percent of riders were wearing helmets during the mishap. Helmet wearers were significantly older than those not wearing helmets. Helmet wearers experienced significantly fewer skull fractures (1% versus 11%) and facial soft tissue injuries (5% versus 18%) than those not wearing helmets (chi 2 = 6.7, 6.5; P = 0.01, 0.01). No other variables accounted for differences in injuries. These data support the contention that bicycle helmets are effective in preventing head injuries.
Adult↗