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This Month in Archives of Pediatrics and Adolescent Medicine
August 2008

This Month in Archives of Pediatrics & Adolescent Medicine

Author Affiliations

Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Pediatr Adolesc Med. 2008;162(8):711. doi:10.1001/archpedi.162.8.711
Effect of Pediatric Physical Therapy on Deformational Plagiocephaly

Deformational plagiocephaly (DP) is a condition commonly seen by pediatricians, and prior studies on the effects of treatment have been limited. In this randomized controlled trial, 65 children with DP were randomized at 7 weeks of age to either a 4-month physical therapy intervention or to their parents receiving a brochure with standard advice on DP. The risk for severe DP was reduced by 46% at 6 months and 57% at 12 months in the intervention group. Early diagnosis of positional preference and early physical therapy are effective in preventing later, more severe problems.

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Photograph of the infant with the thermoplastic measuring ring and digitally drawn lines indicating which measurements were taken.

Occult Depressive Symptoms in Adolescent Patients

Adolescent depression is a common and potentially serious disorder that is both underrecognized and undertreated. Since many adolescents have limited contact with primary care providers, all opportunities to diagnosis depression should potentially be used. Biros and colleagues sought to examine whether the emergency department might be a feasible site to diagnose depression using a brief standardized questionnaire in adolescents seeking emergency care. Among the 967 patients enrolled in the study, 20% had moderate to severe depressive symptoms. Depressive symptoms in these adolescents were independent of race, family income, or family stability. While the use of the emergency department as a site for screening is controversial, efforts must be expanded to address the need for care of adolescents with mental health problems.

Community Supports After Surviving Extremely Low-Birth-Weight, Extremely Preterm Birth

The endemic problem of prematurity and low birth weight continues in the United States, resulting in many high-risk children surviving extremely premature birth. Using data from the National Institute of Child Health and Human Development Neonatal Research Network, Hintz et al examined the current need for special outpatient services at 19 to 22 months of age in 2315 infants born at less than 28 weeks' estimated gestational age. Nearly all infants (96%) had used at least 1 special service since discharge, 55% had used more than 3, and 19% had used more than 5. Infants who required many services were born at lower gestational ages, more likely to have intracranial hemorrhage or chronic lung disease, and less likely to be living with their mothers at follow-up. These results strongly support the need for proactive outpatient resource planning at the local and national levels and for more focused development of coordinated, integrated care for these complex children.

Positive Parenting May Protect Early-Maturing Girls From Aggressive Behavior

Early puberty in girls is related to a variety of behavior problems, including conduct problems, delinquency, and substance abuse, and many of these problems persist into late adolescence and early adulthood. Mrug and colleagues sought to determine whether positive parenting practices could lessen the effect of early pubertal timing on these behavior problems. Among 330 fifth-grade girls from 3 metropolitan areas, maternal nurturance, communication, and parental knowledge about their child's activities moderated the relationship between early puberty and aggression in relationships. The study shows that positive parenting can protect early-maturing girls against the risk of engaging in problem behaviors.

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Maternal nurturance, communication with caregivers, and parental knowledge moderate the relationship between early puberty in girls and aggressive behavior in the Healthy Passages study. Low and high levels of parenting practices correspond to 1 SD lower than and higher than the mean, respectively.