Medical and lay publications give increasing, and sometimes overwhelming, coverage of genetic discoveries. Concrete progress in therapy, however, has been and will likely continue to be slow. Dr Scheuerle discusses the molecular, economic, and behavioral barriers to the development of genetic treatments. The economic disincentives to develop orphan drugs may hinder therapy for truly rare diseases. The lack of uniform compliance with existing effective therapies will limit the adoption of new treatments. While the genetic revolution had much potential, the complexity of genetics itself is great. Advancements will be made, but they are likely to occur only at a measured pace.
More than 500 000 children are currently in foster care in the United States, and the average stay in care is 33 months. There have been limited data on the effect of foster care on children's health and functioning. In this prospective, longitudinal study of 120 children in foster care, Horwitz and colleagues examined the improvement in children's functioning at 6 and 12 months after placement. After 12 months of care, children's functioning significantly improved, with mean scores well within the range of normal. Children who were older at placement and spent more time in care were the group most likely to show improvement. The results argue for a careful examination of the foster care environment to better understand the factors that most contribute to improved functioning.
In the United States, rates of sudden infant death syndrome continue to be higher in African American infants. This is potentially related to a higher rate of prone sleeping in these infants. Flick and colleagues conducted a randomized controlled trial among pregnant women and their mothers during the third trimester, during which education about sleep position was given. Including grandmothers in the education did not increase the rate of supine sleeping postnatally, though it did decrease the amount that the grandmothers worried about sudden infant death syndrome. It is clear that the Back-to-Sleep campaign must include all caregivers for the child.
While inhaled corticosteroids are widely recommended for the treatment of asthma, little is known about the effects of different inhaled steroids on growth rates. This randomized controlled trial compared twice-daily fluticasone proprionate with beclomethasone diproprionate in 4- to 11-year-old children during a 12-month period. The adjusted mean growth velocity in the fluticasone group was significantly higher than in the beclomethasone group. The fluticasone group also had greater improvement in lung function. The more favorable risk-benefit ratio for fluticasone that indicates that it may be preferable for the long-term treatment of children with asthma.
Previous reports have suggested that parent-imposed low-fat diets in the absence of nutritional counseling may have a negative effect on the growth and development of children. In this study of children referred by their primary care pediatricians for hyperlipidemia, parent-imposed diets resulted in lower energy intake and lower fat intake than the diets of control children. These children had lower vitamin E and zinc intake as well. The study indicates that overzealous dietary fat restriction can occur in parent-initiated diets.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2001;155(11):1192. doi:10-1001/pubs.Pediatr Adolesc Med.-ISSN-1072-4710-155-11-ptm1101