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This Month in Archives of Pediatrics and Adolescent Medicine
May 2003

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2003;157(5):413. doi:10.1001/archpedi.157.5.413
Infant Sleep Position and Associated Health Outcomes

The decline in the incidence of sudden infant death syndrome associated with the change in infant sleep position to supine has been remarkable. However, this change was initially resisted because of fear of adverse health outcomes such as aspiration. In this longitudinal study of 3733 infants, Hunt and colleagues found that infants sleeping supine and on their side had no higher risk of any health condition studied compared with infants sleeping prone. In fact, infants sleeping supine had fewer sleep problems at age 6 months and fewer visits for otitis media. Infants sleeping on their side had outcomes intermediate between those sleeping prone and those sleeping supine. This study should give even greater impetus to national efforts promoting supine sleep position.

Longitudinal Care Improves Disclosure of Psychosocial Information

One of the tenets of primary care is that longitudinal care of patients promotes increased trust and improves patient-physician communication. In this study, Wissow and colleagues sought to examine how gender and ethnicity affect communication and how this in turn is modulated by the length of time the physician treats the the child. African American mothers were found to disclose less psychosocial information to white physicians than did white mothers, and for white mothers, having a female physician led to more disclosure of information than was the case for male physicians. These differences tended to lessen with time as the mothers and physicians came to know one another. Whereas the duration of the relationship was important, communication skills are more important and can be taught.

Antibodies Reactive to Rickettsia rickettsii Among Children Living in the Southeast and South Central Regions of the United States

Although Rocky Mountain spotted fever is the most common fatal tick-borne disease in the United States, it remains relatively rare. In this survey of 1999 children living in the southeastern and south central United States, 12% of children had Rickettsia rickettsii titers of at least 1:64. There was a strong relationship between increasing age and seroprevalence at each cutoff titer. Seroprevalence also varied with location, from 3.5% in Louisville, Ky, to 21.9% in Little Rock, Ark. These data suggest that infections with R rickettsii may be common and subclinical, and they point out the limited usefulness of single-antibody titers in diagnosing Rocky Mountain spotted fever.

Using Test Dummy Experiments to Investigate Pediatric Injury Risk in Simulated Short-Distance Falls

Short-distance falls, such as from a bed, are often falsely reported scenarios in child abuse. In attempting to differentiate between abusive and nonabusive injury, knowledge of factors that influence injury risk in falls could prove useful. Using a test dummy to model a 3-year-old child, Bertocci and colleagues examined the forces resulting in falls from bed height onto various surfaces. Whereas the type of impact surface did affect the forces generated, rolling from a lying posture off of a bed and onto a floor did not generate forces high enough to cause head, pelvis, or lower extremity injury.