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July 1989

Beware of Overtreating Children!

Author Affiliations

From the Departments of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, and The Mary Imogene Bassett Hospital, Cooperstown, NY.

Am J Dis Child. 1989;143(7):786-788. doi:10.1001/archpedi.1989.02150190036016

Some years ago I witnessed a clinical catastrophe involving a 4-year-old boy. A history of headaches led to skull roentgenograms that disclosed a large pituitary fossa. This triggered a series of clinical decisions that were climaxed by a carotid hemorrhage during transsphenoid biopsy. Autopsy revealed an empty sella and a benign lymphangioma in adjacent bone. The case was a source of fascination and much earnest and perplexed discussion. The consultants had little experience with similar cases and it was not entirely clear who was in charge. The cause of the headaches in this otherwise-normal boy was never known, and the long-range outlook without intervention was strictly speculative. However, it was an avoidable catastrophe and the case sensitized me to the factors that cause overtreatment of children. Four recent journal articles have crystallized some random thoughts about this problem.

  1. Stickler1 discussed two infants who underwent unnecessary surgery that completed a

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