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Abstract. Background. Studies in developing countries have shown that children with measles have low serum retinol concentrations and that lower retinol levels are associated with measles-related mortality. Vitamin A therapy has been shown to reduce mortality among African children with acute measles. Objectives. To determine whether serum retinol concentration is low among children with measles in the United States and to determine whether retinol concentration is associated with illness severity. Setting. Pediatric referral hospital and clinic in Milwaukee, WI, during the measles outbreak of 1989-1990. Patients. One hundred fourteen patients less than or equal to 5 years of age evaluated for serologically confirmed measles with serum obtained within 5 days following rash onset. Methods. Serum retinol concentration was determined by high-performance liquid chromatography. Clinical data were collected by hospital record review, A modified Pediatric Risk of Mortality (PRISM) score was used to assess physiologic instability as a measure of illness severity; Results. Retinol concentrations ranged from 0.25 to 1.718 micro mol L (median 0.58 micro mol/L); 82 (72%) patients had low retinol concentration (less than or equal to 0.70 micro mol/L). Median retinol concentrations were lower among hospitalized patients (0.56 vs 0.70, P = .006) and patients with pneumonia (0.52 vs 0.64, P = .02) but higher among children with otitis media (0.63 vs 0.54, P = .01). Higher modified PRISM scores, reflecting greater physiologic instability were associated with lower retinol concentration (beta coefficient -.0147, P = .025). In multivariate analysis, higher modified PRISM scores were associated with lower retinol concentration (beta coefficient... [ABSTRACT FROM AUTHOR]

ABSTRACT. Estimates of the incidence of child maltreatment fatalities vary widely; most experts believe they are underreported. To investigate the suspicion that fatal maltreatment was underreported in Missouri preschool children, a statewide, population-based study was conducted using nine data sources. The study cases included the 384 children younger than age 5 who died from 1983 through 1986 and whose death certificates were coded with an external cause (injury) or whose deaths were substantiated as abuse or neglect fatalities by the Missouri Division of Family Services. Each fatality was categorized as one of the following: definite maltreatment, probable maltreatment, possible maltreatment, non-maltreatment, or inadequate information. Of the 121 cases classified as definite maltreatment, only 47.9% had codes consistent with maltreatment on their death certificates. The Division of Family Services had substantiated 79.3% of definite maltreatment cases as abuse or neglect fatalities. The Federal Bureau of Investigation Uniform Crime Reports database reported only 38.8% of these cases as homicides. In 37.2% of the cases, there was at least one criminal conviction. Child maltreatment fatalities are drastically underreported as such in Missouri because of inadequate investigations, lack of information-sharing between investigators and agencies, and reporting systems that fail to capture the contribution of maltreatment as a cause of death. Missouri has created a statewide system of child fatality review panels and a child fatality surveillance system to address the problems documented in this study. [ABSTRACT FROM AUTHOR]

Presents the position of the American Academy of Pediatrics on the role of firearms in childhood and adolescent morbidity and mortality in the United States. Statistics on firearm death and injury in adolescents; Details on risk factors; Recommendations on firearms and adolescents.

Abstract. Injuries remain the leading cause of mortality in children and disproportionately affect poor children. Prior injury prevention efforts have neglected the injury prevention needs of these children. One hundred thirty-three care givers of medically indigent urban children younger than 6 years old were interviewed regarding living conditions, previous injuries, and safety practices and knowledge. Functional smoke detectors and fire extinguishers were present in 75% and 27% of homes, respectively. Few respondents, regardless of previous poisoning experience, were cognizant of ipecac, had it in their homes, or had a good response to a possible poisoning. Few homes had locked storage space, and most hazards were stored suboptimally. While the frequency of the use of automobiles was low, rides in a variety of vehicles were common with 63% of children who usually were restrained inadequately. Additionally, 89% of children aged 35 to 59 months and 6% of those younger than 3 years old sometimes bathed without adult supervision. These findings indicate the dramatic need for injury prevention programs focused on low-income urban families. Specific concerns include exposure to fires and burns, falls, hazardous travel conditions, dangerous chemical, choking, and drowning. Lack of information and isolated care givers may result in poor supervision and responses to injury of these children. We suggest potential interventions in each area. [ABSTRACT FROM AUTHOR]

Abstract. Standard mortality and morbidity data are important but incomplete descriptors of child health. Simple prevalences of individual conditions fail to capture fully the nature of ill health in childhood. More enlightening are comparative prevalences: cross-nationally, in different population subgroups, or as trends over time. A longitudinal perspective that provides information on high-risk states and that the nature of their impact on various aspects of health over time adds another dimension to an understanding of child health needs. A better understanding of the meaning of "health problems" in children and documentation of their distribution in the population will help to tailor better the organization and delivery of preventive, curative, and restorative child health services to child health needs. [ABSTRACT FROM AUTHOR]

Abstract. Each year in the United States, approximately 3000 children and adolescents younger than age 20 die as a result of homicides, suicides, and unintentional injuries from firearms. The young children, relatives, neighbors, and friends of the 30 000 adults killed by firearms each year in the United States are also affected by this uniquely American epidemic. It is estimated that half of all American homes contain 200 million firearms, including 60 million handguns. Increasingly, pediatricians are becoming involved in efforts to reduce the prevalence of injuries from firearms, as parent educators, experts on children and adolescents, and advocates in the political process. This commentary is intended to aid in the last of these roles. The advocacy goal is identified as reducing the accessibility of guns in the environments of children and adolescents. The pros and cons of 17 possible approaches--ranging from mandatory safety courses in schools to handgun bans--are presented. It is concluded that, while there is no perfect approach, many available approaches will help; there is every reason to be both bold and optimistic. [ABSTRACT FROM AUTHOR]

Excluding the first week of life, sudden infant death syndrome (SIDS) is the greatest single cause of death during the first year of life and second only to accidents as the greatest killer of children under age 15. All cases of SIDS occurring in King County, Washington (170) during a 44-month period were studied. Birth certificate from all children born in the county during the same period were utilized for comparison. Findings include a characteristic age distribution at (peak at 2 to 3 months), preponderance in males, low birth weight babies, and in lower socioeconomic class families. "Seasonality" and apparent "time clustering" were present in the infants. All SIDS infants died during sleep in a silent fashion, Forty-four percent of the babies had an upper respiratory infection in the 2-week period prior to death. The epidemiologic findings point to viral infection as playing a major contributory role in SIDS. Pediatrics, 49:860, 1972 SUDDEN DEATH, INFANT DEATH, EPIDEMIOLOGY. [ABSTRACT FROM AUTHOR]

Falls from heights accounted for 20% of accidental deaths of children in New York City during 1966, and 67% of the children were under 5 years of age. A retrospective study of falls involving more than 10 feet during 1966 to 1968 at a single Bronx hospital affiliation disclosed that 55 children were hospitalized from this cause. Five of these hospitalized patients died, and two were found to have significant residua. This retrospective study of hospitalized patients indicates that falls from heights were a health hazard mainly for preschool males during the warmer summer months in the high rise slums of the south Bronx. Preschool children fell exclusively from windows and fire escapes, with little regard for height. Older children fell from dangerous play areas of lesser height. The need for routine installation of effective window guards is obvious. [ABSTRACT FROM AUTHOR]

Presents information on the vital statistics in the U.S. for 1966. Number of births; Death statistics; Infant mortality.

The author comments on the article "Disparities in Inpatient Intensity of End-of-Life Care for Complex Chronic Conditions (CCC)" by Johnston et al in 2019. Topics discussed include the highest treatment intensity in 30 days before death for ethnic adolescents and children from low-income households, and varying views on when to discuss end-of-life matters for CCC patients and families. The author notes that interaction challenges hamper talks on limiting treatments that may not prolong life.

The article focuses on the inability of emergency departments (EDs) in the United States to deal with the demands of psychiatric emergencies among children and young adults. Topics discussed include the link between the rise of suicidal chief complaints and the lack of ED preparedness; the reasons for the increasing ED visits related to mental health problems; federal agencies involved with promoting ED preparedness; and importance of adequate medical training in addressing the issue.

The article discusses a 2018 study which showed a 3.6% mortality rate within the first 90 days after hospital discharge among children in Sub-Saharan Africa. Topics covered include the occurrence of half of deaths within 30 days of discharge, with 80% occurring without seeking of medical attention, and the possible use of a model to identify postdischarge mortality risks and to implement interventions. Also noted is the possible use of community outreach programs to improve health outcomes.

The article discusses a study on the modes of death among child mortalities in the U.S. from 2011 to 2014. Topics covered include such mutually exclusive categories as withdrawal of life-sustaining technology and nonescalation of care, infants' accounting for 60% of children's deaths, and the strong link of hospital location to mode of death. Also noted is the finding that pediatric palliative care (PPC) was received by less than one-third of children who died.

The article discusses a study by P. J. Gates and colleagues, published within the issue, on pediatric preventable adverse drug events (pADEs), published between 2000 and 2017. Topics include an overview of pADEs, examples of the impact of inconsistencies in the approaches to measuring pADEs on the public understanding of pADEs, and the need for precise, consistent methods for detecting pADEs in children.

An introduction is presented in which the editor discusses various reports within the issue on topics including strategies and initiatives to improve child health, the promotion of better health condition for people worldwide and prevalent diseases that are associted with child mortality.

The article looks at a study that focuses on the strong predictive utility of predictive risk modeling (PRM) relative to child maltreatment and health. Topics mentioned include breakthrough represented by PRM in forecasting negative child outcomes, lack of clarity about the role of child protective services, and a decision to offer voluntary preventive services to the 10 percent of highest-risk children or the top 20 percent.

Studies the types of deaths that occur among children while attending day care facilities in the United States. Natural deaths; Unintentional injury deaths; Measures to reduce children's risk of death in the day care setting.

Deals with the incidence of drowning in infants, children and adolescents. Statistics on infant and child mortality in the United States caused by drowning; Locations of drowning incidents; Preventive measures against drowning.

Presents an article related to the health and survival of disadvantaged children. Reasons for the limited success of the campaign launched by the United Nations Children's Fund called the Child Survival Resolution; Analysis of the oral rehydration therapy; Fundamental causes of the death of children.

Focuses on the use of oral rehydration therapy (ORT) to prevent death in children due to diarrhea in the United States. Prevalence of diarrhea among children; Processes involved in ORT; Factors that influence the implementation of ORT; Costs of ORT implementation.

Comments on a study which described the results of tests on child-resistant medicine containers. Application of coordinated maneuvers on medicine containers; Ability of children to open medicine containers; Discussion of accidental poisoning as a cause of morbidity and mortality in children.

The author discusses some studies related to the harms of tobacco and nicotine exposures to children. Topics mentioned include poverty as barrier to reducing and eradicating second-hand and third-hand smoke exposure in children, the impact of environmental tobacco and second-hand smoke exposure on health and addiction in children and young adults, and the estimated number of child deaths each year attributable to second-hand smoke exposure.

Child mortality remains a global health challenge and has resulted in demand for expanding the global child health (GCH) workforce over the last 3 decades. Institutional partnerships are the cornerstone of sustainable education, research, clinical service, and advocacy for GCH. When successful, partnerships can become self-sustaining and support development of much-needed training programs in resource-constrained settings. Conversely, poorly conceptualized, constructed, or maintained partnerships may inadvertently contribute to the deterioration of health systems. In this comprehensive, literature-based, expert consensus review we present a definition of partnerships for GCH, review their genesis, evolution, and scope, describe participating organizations, and highlight benefits and challenges associated with GCH partnerships. Additionally, we suggest a framework for applying sound ethical and public health principles for GCH that includes 7 guiding principles and 4 core practices along with a structure for evaluating GCH partnerships. Finally, we highlight current knowledge gaps to stimulate further work in these areas. With awareness of the potential benefits and challenges of GCH partnerships, as well as shared dedication to guiding principles and core practices, GCH partnerships hold vast potential to positively impact child health. [ABSTRACT FROM AUTHOR]

BACKGROUND: A nonphysician clinician (NPC) training program was started in Uganda in 2009. NPC care was initially supervised by a physician and subsequent care was independent. The mortality of children under 5 (U5) was analyzed to evaluate the impact of transitioning NPC care from physician-supervised to independent care. METHODS: A retrospective review was performed of a quality assurance database including 3-day follow-up for all patients presenting to the emergency department (ED). Mortality rates were calculated and χ² tests used for significance of proportions. Multiple logistic regression was used to assess independent predictors of mortality. RESULTS: Overall, 68.8% of 4985 U5 patients were admitted and 28.6% were "severely ill." The overall mortality was significantly lower in physician-supervised versus independent NPC care (2.90% vs 5.04%, P = .05). No significant mortality difference was seen between supervised and unsupervised care (2.17% vs 3.01%, P = .43) for the majority of patients that were not severely ill. Severely ill patients analyzed separately showed a significant mortality difference (4.07% vs 10.3%, P = .01). Logistic regression revealed physician supervision significantly reduced mortality for patients overall (odds ratio = 0.52, P = .03), but not for nonseverely ill patients analyzed separately (odds ratio = 0.73, P = .47). CONCLUSIONS: Though physician supervision reduced mortality for the severely ill subset of patients, physicians are not available full-time in most EDs in Sub-Saharan Africa. Training NPCs in emergency care produced noninferior mortality outcomes for unsupervised NPC care compared with physician-supervised NPC care for the majority of U5 patients. [ABSTRACT FROM AUTHOR]

The author reflects on the declining developments in pediatric health. He reveals that the decline in child mortality rates has slowed. Moreover, previous success of community-based child health initiatives has been eroded by HIV/AIDS incidence, conflict and poverty. He also reveals that nearly 10 million children under age 5 are dying each year. He proposes establishing fellowship training in pediatric global health. Areas of competency that should be developed in the training are discussed.

Presents a letter to the editor about the risk of children's death in a district hospital in Kenya.

Discusses the perspective of the United Nations Children's Fund (UNICEF) regarding programs for children survival and the overall health and well-being of children. Priorities of the UNICEF which underpin the Millennium Development goals endorsed at the 2000 UN Millennium Assembly; Factors which contribute to the child mortality rate; Issues which challenge child survival and well-being.

Presents an abstract of the article `Unexpected Non-HIV Causes of Death in Children Born to HIV-Infected Mothers,' by Thomas J. Starc, et al. published on the `Pediatrics' magazine's electronic pages.

Comments on a study conducted by R.A. Hoekelman and I.B. Pless on trends in child mortality in the United States (U.S.) in the 20th century. Decline in mortality of children; Causes of the decrease in mortality rates in the U.S.; Comparison between mortality rates in the U.S. and Japan.

Describes case reports on two fatalities involving children in Minnesota caused by electrically operated garage doors. Discussion on how the accidents happened; Direct physiological effects of the accidents which caused the death of children; Precautions in order to lessen the chances of accidents involving children.

Presents the position of the American Academy of Pediatrics on unexpected infant and child deaths in the United States. Individuals that needs to participate in an adequate death investigation; Things to consider in carrying out an investigation; Recommendations for child death investigations.

Discusses a study which described the rates of change in asthma mortality among children in the United States from 1968 to 1987. Information on the study population; Incidence of asthma mortality in the country; Correlation between age and asthma mortality; Conclusion.

The article offers information on several articles related to pediatrics including "Addressing Childhood Obesity Requires Dedicated Clinic Time," by E. R. Roumm, "Considering Child Abuse From Another Angle," by J. Scheller, and "Reducing Preventable Child Mortality at School," by M. D. Bergren, which can be commented by sending a letter to the editor through the Submit a Response button.

An abstract of the article "Partial-Exchange Blood Transfusion: An Effective Method for Preventing Mortality in a Child With Propofol Infusion Syndrome," by Ronald Wong and colleagues is presented.

INTRODUCTION: Although prevention remains the cornerstone for the management of thalassemia, hematopoietic stern cell transplantation (HSCT) is the only curative approach. OBJECTIVE: Our goal was to assess our experience with HSCTs for the treatment of patients with thalassemia. METHODS: From 1994 to 2006, 96 HSCTs have been performed in 84 thalassemic children from Greece, 3 with sickle cell/thalassemia and 1 with sickle cell disease. According to Pesaro classification, of these 84 children, 20 were in class I, 35 were in class II, and 29 were in class III. Donors were 84 histocompatible siblings and 4 unrelated volunteers. The graft was of bone marrow in 85, cord blood in 3, bone marrow and cord blood in 4, and peripheral blood stem cells in 4. The conditioning regimen consisted of busulfan, cyclophosphamide, and antilymphocyte globulin. RESULTS: All except I patient received engraftments. Ten patients rejected the graft. Eight received another transplant from the same donor, 7 of which were successful. Four patients died; causes of death were graft-versus-host disease (GVHD) (2), disseminated toxoplasmosis (1), and brain hemorrhage (1). At: a median follow-up time of 6.5 years, 84 of 88 children survived, 81 were cured and free from transfusions, and 3 remained transfusion-dependent. Severe acute GVHD developed in 18 children, and chronic GVHD developed in 8 patients. The overall survival rate, event-free survival rate, rejection rate, and transplant-related mortality rate were 95%, 94%, 11%, and 5%, respectively. Event-free survival was 100% for class I, 95% for class 11, and 87% for class III. Eleven children had mixed chimera (residual recipient hematopoiesis) with normal levels of hemoglobin. CONCLUSIONS: HSCT is a highly effective treatment for thalassemic patients who have a fully matched donor (related or unrelated). Younger age at transplant secures excellent results with reduced morbidity and mortality rates. [ABSTRACT FROM AUTHOR]

Reports on the mortality of children with AIDS. Problems with the supply and administration of azidothymidine (AZT) to AIDS patients; Brief information on AZT.

Presents the first published mortality statistics of children under five years of age in the United States in 1842.

Reports on the support of health officer Robert Sanders of Tennessee's Rutherford County for a law requiring child restraints in cars. Number of children who died from highway accidents each year; Percentage of child fatalities and injuries that will be avoided with such restraints.

Reports that the number of child fatalities from motor vehicle accidents in the United States have remained the same despite the use of automobile safety seats for children. Estimated number of children who are killed every year in traffic accidents since 1983; Increase in the use of seatbelts for children; Statistics on child fatalities from motor vehicle accidents in 1990.

Presents information on child mortality rates in the United States as of February 2, 1992.

Focuses on the mortality rate of children in London, England under 5 years of age in the 1790s. Average births annually; Statistics on the mortality of children during the period.