There is increasing evidence that natural disasters have multiple negative effects on children's emotional and behavioral adjustment. Although a substantial proportion of children can develop posttraumatic stress disorder if left untreated, there is little research on effective postdisaster interventions. Chemtob and colleagues conducted a community-wide screening after Hurricane Iniki in Hawaii and assigned those with the worst symptoms to either individual or group therapy. Both types of treatment were effective in reducing symptoms and facilitating psychological recovery. The study provides a model for community response to large-scale disasters.
Prior studies have demonstrated that day care attendance in early life is associated with a lower risk of atopy, wheezing, and asthma later in childhood. This prospective birth cohort study followed up 498 children who had a family history of allergy or asthma. The risk of wheezing associated with attendance of day care in the first year of life decreased with age; early day care seemed to be protective against wheezing by age 4 years. However, diagnosis of a lower respiratory tract infection during the first year of life doubled the risk of later recurrent wheezing. These results suggest that the long-term protective effect of early day care attendance may be manifest by age 2 or 3 years.
This population-based study examined the cumulative incidence of attention-deficit/hyperactivity disorder (AD/HD) in children born in Rochester, Minn, between 1976 and 1982. By age 19 years, 7.4% of the population had met criteria for definitely having AD/HD, while an additional 8.6% had probable or questionable AD/HD. Stimulant medication had been used in 86.5% of children with a definite diagnosis of AD/HD. The study demonstrates that the incidence of AD/HD depends strongly on the stringency of the criteria used for diagnosis.
Exposure to violence, both as witnesses and victims, is common among young urban children. The long-term effects of such violence are still unclear. Delaney-Black and colleagues studied 299 urban first-grade children and their caregivers. Exposure to violence in the community was significantly associated with child IQ. Children scoring at or above the 90th percentile on both community violence exposure and distress reactions to this violence had a decrement of 7.5 IQ points and a substantially lower reading ability compared with children with the least amount of exposure. The potential effect of violence exposure on children emphasizes the need for interventions that address domestic and community violence.
The use of growth hormone therapy to treat the 1 million children in the United States with idiopathic short stature is controversial at least in part because of the lack of clear data on treatment effectiveness. This systematic review of the literature reports on 10 controlled trials and 28 uncontrolled trials of growth hormone treatment of idiopathic short stature. The controlled studies report a mean growth of 2.86 cm per year in the treated compared with the untreated group in the first year after treatment, and a 5- to 6-cm effect on final adult height. Similar results were found in the uncontrolled trials. The cost was approximately $35 000 per inch gained in final adult height.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2002;156(3):207. doi:10.1001/archpedi.156.3.207