Steven D. Blatt

Sudden infant death syndrome and secretin treatment for autism.

The Back to Sleep Campaigns remain the greatest influence on the reduction of sudden infant death syndrome. Blatt and Meguid review updates on the effectiveness of these campaigns in reducing sudden infant death syndrome. They also review studies on why parents do not follow this proven advice. The contribution of the risks of other environmental factors are also reviewed. Also discussed are commentaries from a study reviewed last on the link between a prolonged QT electrocardiogram interval and sudden infant death syndrome. Church provides a cogent and timely review of the reported effectiveness of hormone secretin effectiveness in treating children with autism. This newly proposed treatment has been in the spotlight of the lay public, the popular media, and the scientific community. In short order, secretin as a treatment for autism has moved from a chance observation to the subject of a double-blind, placebo-controlled study.

Sudden infant death syndrome, child sexual abuse, and child development.

Since the introduction of the Back to Sleep Campaigns, there has been a dramatic reduction in sudden infant death syndrome in this country. Steven Blatt and Victoria Meguid review the literature surrounding sleep position. Investigators have continued efforts to find other modifiable risk factors of sudden infant death syndrome. A prospective study of more than 33,000 neonates found a link between a prolonged QT electrocardiogram interval and sudden infant death syndrome. Also discussed are investigations seeking to explain the relationship between smoking and sudden infant death syndrome. Ann Botash, Florence Jean-Louis and Mongkae Ploy Siripornsawan review the latest thinking on genital warts and their relation to specific viral etiologies and child sexual abuse. Other symptoms and signs of sexual abuse are the focus of a number of articles that can help the practitioner care for these unfortunate children. Catherine Church reviews medication options for children diagnosed with pervasive developmental disorders or autism spectrum disorders. Finally, in this article, risperidone, fluoxetine and naltrexone are reviewed.

Autism, child abuse, and sudden infant death syndrome

The current literature regarding the standard and nonstandard therapies for children with autism is reviewed. A long term, comprehensive, individualized, multidisciplinary approach remains the best treatment. Physicians caring for the victims of child abuse are frequently asked to render an opinion regarding soft-tissue bruising. A review of the literature suggests that estimation of the age of a bruise should not rely solely on color, but rather should be the result of careful history, a through physical examination, and possibly laboratory testing. The need for a standardized and systematic approach to sudden infant death syndrome is also reviewed. The psychological effects on the parents following sudden infant death is discussed and reveals maternal anxiety and depression and, to a lesser degree, paternal anxiety and depression following the loss of a child. Currently, sleep position continues to be a risk factor for sudden infant death syndrome, although immunizations may not be.

Child abuse, sudden infant death syndrome, and psychosocial development

A review of the literature on child abuse continues to emphasize the importance of careful attention to physical findings. Children who are allegedly sexually abused very often have no abnormal physical findings, yet they may be subjected to repeat examinations in an attempt to document possible physical effects of the abuse. Information is reviewed about the potential psychologic impact of these repeated assessments on young children. Controversy regarding the etiology of sudden infant death syndrome persists, and risk factors are reviewed. Changes in recommendations for infant sleep position by the American Academy of Pediatrics are not universally implemented. The importance of death scene investigations in cases of sudden unexplained infant death is emphasized. A review of the current research on infant colic does not provide many new insights, and the etiology remains controversial. The primary care pediatrician has an important role in providing advice and counseling, albeit on an empiric basis.

Blood lead levels in young children: US, 2009-2015

These rates, however, are inconsistent with what the State of New York reports to the Centers for Disease Control and Prevention (CDC), specifically the claims about reductions in elevated BLLs. The data reported on the CDC Web site actually suggest an increase in the percentage of tested children <6 years of age with elevated BLL. Data are available for 2009, 2012, and 2014. The percentage of tested children with confirmed very high BLL increased from 0.82% in 2009 to 1.6% in 2012 and to 2.2% in 2014. No data were provided for BLL of ≥5 mg/dL in 2009, before the CDC guideline revision. In 2012, the percentage of tested children <6 years of age with BLL of ≥5 mg/dL was 8.61%, and this increased to 9.58% in 2014. These data are contrary to the claim of the Onondaga County Health Department that there has been improvement. These reported increases in the percentage of tested children with reported high BLL and very high BLL over time is opposite of what the CDC and we have observed based on national data. The purpose of regional analysis in the Quest Diagnostics study was to bring attention to specific areas in which high BLLs are of greatest concern. Although there is a disconnect between the 40.1% high BLL that we report in the study and the 12.3% high BLL reported by the Onondaga County Health Department, even 12.3% is still more than 4 times the national average and would place the 3-digit ZIP code region 132 in the top 10 regions with the greatest rates of high BLL in the nation in this study. It is clear, regardless of methodology and specific statistics, that high blood lead levels in children are a problem in Syracuse.We applaud any and all attempts to reduce BLLs in children, and more work clearly needs to be done.

Child abuse, sudden infant death syndrome, and attention-deficit hyperactivity disorder

A review of recent literature helps to clarify normal variations in the physical examination of children who are thought to have been sexually abused. In many instances, no abnormal physical findings are discovered. Clinicians must continue to pay careful attention to the history and work with other professionals to implement appropriate management, despite the lack of physical findings. Guidelines for evaluating sudden and unexpected infant deaths are reviewed. The current recommendations of the American Academy of Pediatrics for infant sleep positions are discussed in light of epidemiologic studies in the United States and other countries. Attention-deficit hyperactivity disorder appears to respond best to a combination of stimulant medication, parent training in coping with behavior of affected children, and social skill training for the affected children themselves. A review of recent research failed to reach consistent correlations between resistance to thyroid hormone and attention-deficit hyperactivity disorder.