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This Month in Archives of Pediatrics and Adolescent Medicine
September 2005

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2005;159(9):800. doi:10.1001/archpedi.159.9.800

Prior studies on end-of-life decision making have focused on adults or newborns. In this report from the Netherlands, Vrakking and colleagues studied end-of-life decisions in children beyond the newborn period. More than one third of deaths involving children aged between 1 and 17 years were preceded by end-of-life decisions. In 12%, there was a decision to refrain from potentially life-prolonging treatment. Parents were involved with all end-of-life decisions; in most cases pediatricians considered the child too young to participate in these decisions. The proportion of end-of-life decisions was lower for children than for neonates or adults.

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Concerns about food allergies are common. This systematic review addressed the question of whether feeding hydrolyzed infant formulas from birth can reduce the risk of allergies. Nine prospective studies examined the effect of extensively hydrolyzed formulas. Extensively hydrolyzed casein formulas do appear to reduce the risk of subsequent allergies, although they are expensive and less palatable. Studies of partially hydrolyzed whey formulas indicate that they also reduce the risk of allergy and are less expensive and more palatable than extensively hydrolyzed formulas. Most studies have been conducted in high-risk populations; the application of this study to the general population of infants is not known.

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Both in Japan and the United States, there is an emerging recognition of Kawasaki syndrome pedigrees with multiple affected members. This study reports on 18 families with multiple affected members. Occurrence in siblings represented 0.5% of children with Kawasaki syndrome in San Diego, Calif, and Boston, Mass. There were also 9 more complex pedigrees with 24 affected children. In these complex pedigrees, the onset of the disease was separated temporally and often geographically as well. No clear pattern of inheritance emerged. Given the existence of sibling cases and complex family pedigrees, physicians should counsel affected families and make them aware of the possible increased risk of Kawasaki syndrome among first-degree relatives.

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Nearly all adult smokers begin to smoke before the age of 18 years. However, there has been very little research on young children’s receptivity to tobacco or alcohol. In this study, role-playing scenarios for 2- to 6-year-old children and observations of their play behavior were used to assess children’s perception of the social utility of alcohol. When asked to select items for themselves and their friends from a miniature grocery store, 28% of children bought cigarettes and 62% bought alcohol. Parents’ smoking and drinking habits influenced the likelihood of selecting tobacco and alcohol, as did watching movies rated PG-13 or R. This study suggests that children are highly attentive to the use and enjoyment of alcohol and tobacco and have well-established expectations about how cigarettes and alcohol fit into social settings.

Grocery store setup for the role-playing scenario.

Grocery store setup for the role-playing scenario.

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