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Objectives Our aim in this study was to identify patient-level barriers to attending pediatric type 1 diabetes mellitus (T1DM) clinic and to better understand the demographic and clinical characteristics of these reporting barriers. Methods Patients were recruited from pediatric T1DM clinics throughout British Columbia. Barriers to attending clinic were identified through a survey. Demographic and clinical characteristics of patients who reported difficulty attending clinic appointments were compared with those who did not. Results Of the 197 study participants, 31% reported difficulty attending appointments. Commonly reported barriers were distance to clinic and missing work. Younger child age and residing in northern regions increased the odds of reporting a barrier, whereas residing on Vancouver Island decreased odds of reporting a barrier. There were no differences in glycated hemoglobin levels between the 2 groups. Conclusions Approximately 1 in 3 patients identified challenges in attending T1DM appointments in British Columbia. Further research is needed to determine whether similar challenges exist in other provinces.

Manufacturers label their sleeping bags with a temperature rating to assist consumers in selecting a bag that will provide them with an acceptable level of thermal protection under the expected conditions of use. These temperature ratings are typically based on thermal manikin testing and whole-body heat loss models. Due to physical and physiological differences between children and adults, existing adult sleeping bag temperature rating models cannot be applied to children's bags. Therefore, a model for determining the temperature ratings of children's sleeping bags is proposed. Issues related to measuring the thermal insulation of children's sleeping bags are also discussed. The results of the model indicate that an older child has a higher temperature rating than a younger child for the same level of insulation. This is due to the higher sleeping metabolic rate of younger children.

Aims Approximately 1/3 of all children will sustain a fracture before they turn 16 years old. Most are accidental but some are due to abuse, with the younger child at highest risk. We sought to assess how robustly such young children presenting to the Emergency Department (ED) in our Trust are assessed for abuse. Methods Both authors reviewed the notes for all children aged Results 34 had appropriate safeguarding information completed at Triage. In 75% of cases, the ‘mandatory’ Safeguarding Questions on the ED card were completed by the doctors. Only half of the assessments included a comment about development. 8 had ‘high risk’ injuries by radiological type– all were spiral fractures however none were under 12 months of age. The authors were concerned about 2 of these cases which either contained insufficient information or were not discussed with paediatrics when the mechanism was not absolutely clear. Only 44% of children were fully examined. In several cases, there was disparity between the opinion given in ED and that of the reviewers. The authors felt that an extra 7 patients had potential safeguarding concerns and should have been discussed with paediatrics, with a further 6 cases where there might have been safeguarding risk but information was insufficient. Interestingly, however, all eight who were seen by paediatrics were felt to be accidental or due to an underlying condition (two had genetic bone disorders and one had rickets). In several instances, the expected actions from the reviewers were not completed – see table 1. Conclusion Whilst some positives were demonstrated including some excellent individual assessments, use of interpreters and triage actions, the audit establishes the need for improvements in assessment of safeguarding risk.

Two children of 4 and 18 years of ages developed multiple supratentorial metastases at 3 years and 8 months follow up respectively, following their gross total microsurgical excision of medulloblastomas. Both the children received standard doses of craniospinal irradiation following surgery. An adjuvant chemotherapy was also offered to the younger child (of 4 years), who developed recurrence at posterior fossa along with supratentorial metastases. It is concluded, that early supratentorial metastases may occur even following gross total excision, craniospinal irradiation and chemotherapy of medulloblastomas. Probable routes of dissemination remain subarachnoid, cerebrospinal fluid and leptomeningeal.

PURPOSE To evaluate the current vision screening criteria regarding amblyopia and refractive errors, with emphasis on screening limits and retesting, in Region Vastra Gotaland (VGR), Sweden. Visual acuity (VA) screening is performed by nurses at primary healthcare centres (PHCs) in 4-year-old children and at school in 6- or 7-year-old children. Children with VA 0.19 logMAR) at either eye are referred. If VA is 0.65 in one or both eyes, a retest is performed by nurses at PHCs and schools, the children are then referred if VA is 0.10 logMAR). METHODS We included all children aged ≥5 and

In recent decades, research on health care design and planning has highlighted the strong relationship between environmental characteristics and human health. According to a patient-centered model, the focus on the hospital environment is important in reducing the negative effects of hospitalization on the patient, especially in the case of children. In a hospital Pediatric Unit, a pictorial intervention, characterized by natural landscapes with cartoon characters, was introduced. The study sought to evaluate the effects of this intervention on the affective qualities attributed to the hospital environment by parents whose children were hospitalized; our main hypothesis was that the pictorial intervention would benefit parents, enhancing the positive and reducing the negative affective perception of the hospital environment. A total of 502 parents of admitted children aged 0–11 completed a questionnaire to describe the affective perception of the hospital environment, 200 before the pictorial intervention was performed, and 302 (200 parents of children with acute illness, 102 of children with chronic pathology) after it. Results revealed that the parental affective perception of the hospital environment significantly improved after the pictorial intervention, with almost no differences in relation to severity of child illness (acute versus chronic); a younger child age was negatively related to parental affective perception of the unit only in the condition without the intervention. Data suggest that the pictorial intervention represents a useful technique to create more welcoming hospital environments, reducing the negative affective perception of the unit in parents facing the stress of their child's hospitalization.

This article focuses on key stages in the assessment of psychiatric disorders in children and adolescents. The main stages of the assessment interview are considered, including preparation for the interview, interview with the family, interview and observation of the child, interview with the parents, physical examination, and investigations, as well as the gathering of information from other sources. Some contextual factors are then considered in the formulation of the child’s difficulties. Key points are discussed as to how assessment of the adolescent may differ from that of a younger child and how the interview with an adolescent may be conducted in an ‘adolescent-friendly’ fashion.

Many controversies remain in Perthes'. These algorithms are presented as a way through the maze of contradictory and incomplete evidence. Catterall has emphasised the importance of clinical examination in the assessment of cases of Perthes' and this is particularly important in the younger group, many of whose hips heal very round, despite rather adverse-looking X-rays early on, because they have maintained an excellent, almost normal, range of movements. The older child or early adolescent with Perthes' requires urgent attention, as the femoral head lacks the regenerative capacity of the younger child. Before any operation in Perthes', action must be taken to unstiffen the hip. Containment procedures will fail if performed on a stiff hip and even salvage procedures are best performed on a hip that has been loosened as much as possible. Surgeons need to recall that most untreated Perthes' do not require intervention until the age of 40. If our interventions on the child result in hip replacement being required in the 20's, then we have not done that patient a service.

Hand trauma in children is common, but often inadequately assessed and treated. The types of injury vary with age depending on the pattern of hand use. Assessment of the injury, particularly in the younger child, can be difficult, given the inability or reluctance of the child to co-operate, both in providing a history and allowing an examination of the injured hand. The established principles of treatment for hand trauma, detailed elsewhere in this text, apply equally to children, but the healing and growth potential of the child has specific implications for management. The management plan also has to take into account the varying capacity of the child for co-operation with active rehabilitation programmes.

Two consecutive cases of chronic dislocation of the head of the radius after missed Bado type-I Monteggia lesions are presented. Reduction was successfully achieved in both patients after ulnar corticotomy, gradual lengthening and angulation of the ulna using an external fixator. Open reduction or reconstruction of the radio-ulnar capitellar joint was not undertaken. The age at injury was seven years in the older and two years in the younger patient. The time from injury to treatment was five years in the older and three months in the younger child. At follow-up, nine years after completion of treatment in the older and eight months in the younger patient, both show satisfactory movement, function of the forearm and reduction of the head of the radius. This technique may be considered in missed Monteggia lesions before open procedures on the radio-ulnar capitellar joint are undertaken.

The surgical treatment of Perthes’ disease by femoral or innominate osteotomy is not as effective in those over the age of eight years as it is in the younger child. This has prompted the search for other types of management in those who are older. The preliminary results of the use of a lateral shelf acetabuloplasty for such cases have shown encouraging results at two years. The concern with such an operation is that it might interfere with the growth of the outer aspect of the acetabulum and so prejudice the long-term outcome. We describe a review at maturity of 26 children presenting with early disease after the age of eight years who were treated by lateral shelf acetabuloplasty. The results suggest that the outcome is improved; 22 of 27 hips were rated as Stulberg groups 1 to 3. Poor results occurred in children, particularly girls, presenting with Group-4 disease over the age of 11 years.

A group of 13 child sex abusers over the age of 65 years is described. They are similar in most respects to sex offenders against children in other age groups, with regard to the seriousness of the abusive behaviours described, but they differ in terms of being of higher socioeconomic status, having stable backgrounds and reporting low rates of personal sexual victimization. These factors may contribute to their apparent skill in avoiding detection. In common with younger child sex abusers, these elderly offenders demonstrate low levels of psychiatric illness, and in particular of organic disorders. There appears to be an increased tendency by the courts to consider non-custodial disposal options for elderly sex offenders as they are perceived as being less of a risk and their physical frailty may make them less able to tolerate the rigours of prison life.

The management of nasal deformities in children often presents the clinician with a challenging dilemma. In the younger child, emphasis should be placed on correction of the nasal airway whereas, in older children, external cosmetic deformity can be considered with safety. Appropriate surgical techniques will ensure an appropriate outcome. Careful planning, as well as sensitivity to growth and development of the nasal structures should be considered when such a procedure is to be undertaken. Older children and adolescents present no unique difficulties in septorhinoplasty and the usual principles commonly applied to adults may be followed. A safe and effective technique can be designed for each child and adolescent afflicted with both internal and external nasal deformities.

Acne vulgaris is classically considered a disease of adolescence. Although it most commonly occurs and has been best studied in that age group, it can develop at any time during childhood. It is important that health care practitioners recognize the manifestations of neonatal, infantile and childhood acne, as well as the differential diagnosis and best therapeutic approach in the younger child. Acneiform eruptions in infants and toddlers can occasionally be associated with scarring or with other significant disorders that may be life-threatening. In this article, the authors draw on their own clinical experience as well as the available literature to suggest an age-based approach to managing acne in children from the neonatal period through age 11 years.

This study identified and quantified rambling and trembling properties of the postural control system of children 4–12 years of age. Forty five children of varying ages (4-, 8-, and 12-years) and 15 adults stood upright on a force plate and performed 5 trials with and 5 trials without vision with each trial lasting 30 s. Center of pressure, rambling, trembling, mean sway amplitude, and predominant frequency were obtained. Results revealed that the displacement of the center of pressure and overall rambling trajectories were age-related with younger children swaying more than older children and adults. Similarly, overall trembling trajectories for younger children were larger compared with older children and adults. These results suggested that a younger child’s larger body sway mostly results from difficulties using sensory information when estimating overall body position and velocity in an upright stance and is less a result from the noise in the postural control system.

This paper reflects on issues raised by work with children in an ongoing child mobility study in three sub-Saharan African countries: Ghana, Malawi and South Africa. There are now 70 school pupils of varying ages involved in the project, but the paper is particularly concerned with the participation of those children 14 years and under. We examine the significant ethical issues associated with working with younger child researchers, and linked questions concerning the spaces open to them in African contexts where local cultural constructions of childhood and associated economic imperatives (which commonly drive family and household endeavour) help shape the attitudes of adults to children’s rights and responsibilities and inter-generational power relations.

Objective To analyze the characteristics of post-tonsillectomy bleeding and its management comparing with adults. Methods A retrospective chart review of 1489 patients who underwent tonsillectomy in our institution (June 2003–June 2006). Results Post-tonsillectomy bleeding rate was 3.1%, 2.5% and 10.8% in younger children (age ≤ 11 years), older children (12 ≤ age ≤ 15 years) and adults (age > 15 years), respectively. Although adults showed an unimodal peak time for onset of post-tonsillectomy bleeding, children showed a bimodal peak time. In the younger child group, all of the 28 bleeders had spontaneous hemostasis. However, in the older child group, there was no spontaneous hemostasis. Bleeding was controlled under local anesthesia in 3 patients and 2 patients required general anesthesia for bleeding control. In the adult group, spontaneous cessation of bleeding occurred in 25 patients (60.9%) and hemostasis under local or general anesthesia was performed in 16 (39.1%) patients. Conclusions Post-tonsillectomy bleeding occurred more frequently in adults than in children. Spontaneous hemostasis was more prevalent in children than in adults. Post-tonsillectomy bleeding in the younger child group was controlled with close observation alone.

In the 1980s home care, in contrast to hospital care, was reported substantially to reduce costs for third-party payers who provided funding for technology-assisted children. Savings were realized primarily because parents substituted for nurses, eliminating or reducing those costs. Third-party payers' savings thus were directly related to the number of hours parents assumed care. Because home care relies on parents doing some of the work of nurses, decisions regarding nursing hours must consider family factors in addition to medical factors. We evaluated the number of nursing hours 31 Minnesota families with technology-assisted children received, as well as the factors that determined the allotment of nursing hours. Most families (96.8%) received some hours of nursing hours. Most families (96.8%) received some hours of professional nursing care per day, and 16.1% received 24-hour care. Multiple regression, however, showed that family factors, rather than the child's medical condition, influenced the number of hours, with married, lower-income families with a younger child receiving the fewest. Further discussion and study are recommended to understand more fully the impact family factors have on the allotment of nursing hours and home care costs.

We studied 23 LeLievre's operations (lateral arthroereisis of the subtalar joint using the bank bone) performed in 13 patients for the treatment of paralytic pes plano-valgus. 9 patients (15 feet) had the diagnosis of mild cerebral palsy and 4 patients (8 feet) had psycho-motor retardation. 11 patients (19 feet) had Vulpius' operation or Achilles tendon lengthening simultaneously. The average age at surgery was 6 years and 11 months (range, 3 to 13 years) and the average duration of follow-up was 8 years (range, 4 to 13 years). On the weight-bearing films, lateral tab-first metatarsal angle and lateral talo-calcaneal angle were measured to evaluate the postoperative results.The overall results were excellent in 7 feet, good in 6, fair in 2 and poor in 8. Using the metacarpal or metatarsal bone and combined procedure with vulpius' operation or Achilles tendon lengthening, the results were excellent in 7 feet, good in 4, fair in 2 and poor in none.This operation is to be indicated for i) paralytic pes plano-valgus which resists conservative treatments, ii) the patient who had psycho-motor retardation or mild cerebral palsy, and iii) the younger child who is 7-8 years old or less.

This paper analyzes the radio frequencies (RF) exposure in the head tissues of children using a cellular handset or RF sources (a dipole and a generic handset) at 900, 1800, 2100 and 2400 MHz. Based on magnetic resonance imaging, child head models have been developed. The maximum specific absorption rate (SAR) over 10 g in the head has been analyzed in seven child and six adult heterogeneous head models. The influence of the variability in the same age class is carried out using models based on a morphing technique. The SAR over 1 g in specific tissues has also been assessed in the different types of child and adult head models. Comparisons are performed but nevertheless need to be confirmed since they have been derived from data sets of limited size. The simulations that have been performed show that the differences between the maximum SAR over 10 g estimated in the head models of the adults and the ones of the children are small compared to the standard deviations. But they indicate that the maximum SAR in 1 g of peripheral brain tissues of the child models aged between 5 and 8 years is about two times higher than in adult models. This difference is not observed for the child models of children above 8 years old: the maximum SAR in 1 g of peripheral brain tissues is about the same as the one in adult models. Such differences can be explained by the lower thicknesses of pinna, skin and skull of the younger child models.

We report persistent galactorrhoea and raised prolactin in a woman taking methadone, which is commonly prescribed for the treatment of opiate dependence. A heroin smoking 28 year old mother of two (younger child aged 4), with hepatitis C (of nine years' duration), weighing 50 kg, was first prescribed 30 mg methadone a day for opiate dependence. She reported newly emergent galactorrhoea after four months of taking …

Geleophysic dysplasia is an autosomal recessive short-limbed, dysmorphic syndrome. The condition is frequently associated with cardiac valvular disease, which may result in secondary hypertrophy and cardiac failure. We describe two distantly related Pakistani children with classical features of geleophysic dysplasia. Pulmonary stenosis was recognized in both within a few months of birth. The younger child shows no signs of cardiac decompensation at the age of 7 years whilst her older cousin has developed a significant pulmonary gradient requiring surgical intervention in the second decade of life. The natural history of his disorder highlights that the cardiac involvement seen in apparently stable forms of geleophysic dysplasia is frequently progressive.

Enzyme replacement therapy is widely used as treatment for mucopolysaccharidosis I (MPS I), and there is evidence that this produces improvement in certain clinical domains. There does appear to be variation in the response of clinical features to treatment once these are established. In a reported sibling pair, when enzyme replacement therapy was commenced pre-symptomatically in the younger child, the natural history of the condition appeared to be affected. We present data from three siblings treated with enzyme replacement therapy at different ages which supports this finding.

Acne can occur at all ages. Several reviews have recently been published on this topic [1, 2, 3]. This monograph will cover the diagnosis and therapy of acne in the younger child.

In the study described in the article, two children had their prescribed behind-the-ear (BTE) hearing aids retro-fit to become open-fit (OF) BTEs. One child, age 12y, had a bilateral, high-frequency, sensorineural hearing loss (BHFL), with normal hearing in the low frequencies. The other child, age 6y, had a bilateral, reverse-slope, sensorineural hearing loss (BRSL), with normal hearing in the high frequencies. Sound localization measurements were made at Day 1 unaided and with the OF-BTEs and 1 year post for both children. Both children spontaneously reported an immediate improvement in the quality of their own voice when first exposed to the OF-BTEs. Only the younger child showed immediate localization advantage over unaided when using the OF-BTEs. However, changes in localization accuracy over time were measured for both children that could be attributed to “relearning” to localize with a new acoustic coupling of the hearing aid to the ear. After using OF-BTE hearing aids for 1 year, both children, wh...

The small bowel is the most difficult intestinal segment to examine. Radiologic tests are mostly insensitive and double-balloon enteroscopy is unsuitable for the younger child. Capsule endoscopy is a novel wireless method of investigation of the small bowel. The primary indications for capsule endoscopy include evaluation of obscure gastrointestinal bleeding, small bowel Crohn's disease, and polyposis syndromes. Capsule endoscopy offers an accurate and effective means of investigating the small bowel in children. Capsule retention is a potential complication of capsule endoscopy. This review provides the indications, safety, and limitations of wireless capsule endoscopy in children. (Korean J Pediatr Gastroenterol Nutr 2010; 13: 1∼6)

Caring for disabled children has become increasingly the responsibility of parents, even when the medical care is complex. To assess the time commitment required, 133 mothers of disabled children were asked to estimate by specific task categories the extra time required to care for the children. Total average daily care time was reported at 12 hours and 6 minutes, with 6 hours and 30 minutes consumed in "vigilant" tasks (i.e., watching a child who cannot be left alone and/or providing emotional support). Multiple regression analysis showed an increase in total caregiving hours associated with a younger child who was more physically and mentally impaired, and who required more medical treatments. The amount of time required by parents to care for their chronically ill children of necessity results in lost opportunities. Because this burden is experienced primarily by women and because professional nurses could alleviate some of the burden, this issue deserves further study.

Pigmented villonodular synovitis is rare in the younger child. Polyarticular involvement in this condition, regardless of patient age, is distinctly uncommon. The authors describe a case of pigmented villonodular synovitis involving multiple joints in a young boy who also had congenital anomalies of the genitourinary tract. Although rare, pigmented villonodular synovitis should be considered in the differential diagnosis of multiple joint swellings in children with congenital anomalies.

English monosyllables were elicited from five adults, from seven children aged 4 to 7 years, and from six of these children, plus a younger child, 14 months later. The durations of clustered and unclustered consonants were measured oscillographically, and patterns of durational change for segments in similar phonetic contexts were compared for the three speaker groups. All common word-initial clusters of English were included. Overall, more mature speakers imposed more organization upon the segments of consonant clusters: the younger child group resembled the adults less than the older group did, with the latter resembling each of the other groups about equally. Within this general pattern, several factors influenced the maturity of production of particular clusters: in older children, manner of articulation of the whole sequence and place of articulation of individual segments were the strongest determinants of maturity of execution, whereas the cluster’s size (two vs three segments), and whether it was homorganic or nonhomorganic, appeared to be more influential with the younger children. The children generally appeared to change gradually towards the adult norm with age, but the patterns of modification for some clusters, notably those involving voiceless stops, moved away from the adult pattern in the older children’s speech.

Suprapubic aspiration (SPA) was compared with midstream urine collection (MSU) in the diagnosis of urinary tract infection (UTI) in a busy paediatric out-patient department in Northern Nigeria, where usually only one specimen can be taken before starting antimicrobial therapy. SPA in 287 children was compared with 175 MSU collections. Urine was obtained at the first attempt in 260 (91%) SPA's which were easy to perform and safe. MSU collections were more difficult, particularly in the younger child. In 51 cases MSUs were compared with SPAs taken immediately before, and gave an accurate indication of urine infection with no false negative or positive cultures. It is concluded that when only one urine specimen can be collected before starting antimicrobial therapy, a single MSU specimen gives an adequate result if correctly collected and plated out. When accuracy of diagnosis is essential or if a MSU cannot be obtained, SPA is indicated. A white cell count on unspun urine proved to be the most successful sideroom test for urinary tract. Counts in excess of ten cells per mm3 were found in 62% of patients with positive cultures.

This report relates the case histories of two sisters who demonstrated the typical symptoms of progeria at birth. One of these children had died previous to this study. The familial occurrence underlines the thesis that progeria is an autosomal-recessive disorder. The examination of the cultured skin fibroblasts from the younger child showed a clear decrease in cell growth. On the other hand, the immunfluorescent examination of skin biopsies and cultured skin fibroblasts revealed no atypical distribution of collagen types.

greatest tolerance for galactose as measured in the newborn period seemed to have the fewest speech and language difficulties. Moreover, a str iking similari ty in language and motor disabilities was noted in the siblings with galactosemia, despite the fact tha t the younger child in each pair had never been exposed to a postnatal accumulat ion of galactose-l-phosphate and had not been sick in the newborn period. Thus the damage does not seem to have originated solely from the postnatal accumula t ion of galactose-l-phosphate; this finding supports the possibility of a prenatal effect.

Summary In a white American family with no evidence of Negro or Mediterranean ancestry, two children, aged one and three and one-half years, suffered from sickle-cell anemia since early infancy. Their father had sicklemia without anemia. In all the sickling was of the slow type, which requires from twelve to twenty-four hours to appear. Both children were stunted in growth, the girl being more dwarfed than her baby brother. The removal of an enlarged spleen in the younger child failed to affect the anemia or the sickling, while the spleen in the other patient was small. The noteworthy features in these cases, in addition to their ethnologic interest, concerns the early age at which symptoms of anemia appeared in both children and the slow type of sickling. It is suggested that even in anemia of white American children, the possibility of sickle-cell anemia should be remembered and a moist blood film examined after kept twenty-four hours.

Myringotomy can be a simple surgical procedure, but the younger child presents special problems. The type of instrument used, how it is introduced, the modality of anesthesia, and the emotional makeup of the child (and the parent) all need special attention if the operation is to go smoothly for both patient and physician.

Summary The case histories of 445 children with primary tuberculosis or pleural effusions are examined and analyzed. The serious nature of the disease is emphasized and the frequency and gravity of complications are discussed. In the child under 6, primary pulmonary tuberculosis takes a longer period to become arrested than in older children. Also the younger child is more liable to develop pulmonary complications, with the two exceptions of uncomplicated pleural effusion and parenchymatous spread. He will need a period of bed rest under observation, which can best be carried out in an institution. A proportion of older children will also require the same form of treatment.

Evaluation of 115 children who had irradiation to the liver reveals an increase in abnormality of the parameters studied when large volumes of liver are irradiated or when the liver is irradiated following resection. To some extent, this is dependent on dose but abnormalities have been observed at doses below 2,499 rads and as low as 1,200 rads. Possibly, this may be related to the increased sensitivity of the younger child who generally received these lower dosages.Although evaluation in the chronic phase shows no significant difference of abnormality of age as related to dose, there does appear to be a slight trend in the acute phase of irradiation to implicate sensitivity of children under 1 year.

Iron‐deficiency anemia persists in the face of a simple solution. The plight of the infant and younger child is emphasized; the needs of the menstruating and pregnant woman are also considered.

The condition appeared in sisters after the first half year of life. In the elder operation was not performed until the age of sixteen months and three years, respectively, with the loss of one eye and vision of 5/200 in the other. The younger child was brought to operation at nine months of age with conservation of useful vision. From the Department of Ophthalmology and Otolaryngology, University of Minnesota. Read before the Minnesota Academy of Ophthalmology and Otolaryngology, February 10, 1933.

Several aspects of trichotillomania in childhood are described and discussed. Case records of twenty-one children not older than 15 years of age, who were seen in the previous 5 years, were examined. The female/male ratio was 2.5:1 (fifteen girls and six boys); the age range was 2 to 15 years. Although trichotillomania may, at first sight, often impress as an apparently inexplicable persistent habit, further analysis shows that this symptom often develops in a climate of psychosocial stress in the family, e.g., hospitalizations of child or mother, the additional stress inherent in moving to a new house, or developmental problems such as sibling rivalry, inability to focus activities and play in the younger child, and school problems in the older child.

The present study investigated children's responses to a peer's childhood depression. Younger children in third and fourth grade and older children in fifth and sixth grade were exposed to one of four films. The four films portrayed a female peer who was either depressed or not depressed and who had experienced numerous recent life stresses or no recent life stress. Overall, children rated the depressed peers as less likeable and attractive, as engaging in fewer positive current and future behaviors, and as needing therapy more than a nondepressed peer. There was a tendency to rate the depressed peer with high life stress more positively than the depressed peer with low life stress; this tendency decreased with age. Girls rated all of the peers and especially the stressed peers more positively than did the boys. The results are discussed in terms of the implications of children's social interaction for the initiation or maintenance of childhood depression.

Laparoscopic examination was performed successfully on 14 patients with 17 nonpalpable testes. The procedure was successful in determining the location in 16 of 17 nonpalpable testes, and this information was beneficial for selecting the subsequent operative approach. Laparoscopy was safe in the younger child (10 patients were 3 years old or less and 7 patients were less than 2 years old), and it added an insignificant increase in operative time.

Subjects with GD have elevated LH & FSH and achieve greater rise in both after LRF (Silver, Yen 1973). Estrogens exert inhibitory action on FSH & LH release (Yen et al 1972). To ascertain an effect of estrogen on LH and/or FSH to LRF in GD, 8 females 7-20 yrs, were studied; 4 XO, 1 XO/XY, constitutional delay, hypopituitarism, normal female. LRF, 50-100 ugm IV, was followed by 0.1 mgm EE daily 3-7 days, with 1-7 days off EE prior to second LRF test. In 3 young XO GD, 7 days EE decreased basal FSH (mean 17.6 mIU/ml before EE, 6.1 after EE) and the FSH peak to LRF (mean FSH peak 64.1 before EE, 16.1 after); LH was not significantly affected. With 3 days EE, a 7 yr. XO/XY had no change in LH, FSH responses. An older XO had an LH rise to LRF after 3 days EE, with a decreased FSH responsiveness. LH levels with LRF (after EE) were decreased in a normal female and constitutional delay. The younger child with GD lacks ovarian feedback mechanism and may have chronic endogenous secretion of LRF which induces pubertal LH response, as shown in these studies. LH & FSH responses to EE varied with age.

Rectoscopy is the direct instrumental visualization of the rectum; rectosigmoidoscopy is such visualization of both the rectum and the sigmoid flexure of the colon. It is striking, in view of the frequency of intestinal disturbances in infants and children, that a standardized technic of rectosigmoidoscopy, the only procedure available for the direct observation of the rectum and sigmoid flexure, for use with young children and its advantages have not been described in the literature. A survey reveals a few vague references to sporadic efforts to use the procedure, but the data are too general or too brief to be of practical value. When practiced, it was used primarily in older children, probably because of the easier management and simpler instrumentation, and seems to have been restricted to the rectum. The problem with the older child is not unlike that with the adult. However, with the younger child and the infant

To the Editor: —On April 11, a child, aged 7, was playing with another boy, aged 13. and in some manner a toy blank cartridge pistol, which had been loaded with a 22-caliber cartridge, with the bullet whittled down to allow it to enter the bore of the pistol, was discharged, the bullet entering the younger child's back, between the lower ribs and the crest of the ilium. In spite of everything that could be done, even to opening the abdomen in the hope of tracing the bullet, which had been followed from the rear as far as the spine, the child died about thirty-six hours after the accident. It was found that the toy pistol causing the child's death had been purchased for the celebration of last Fourth of July. Attorneys, physicians, and business men, together with the press, at once took up the matter of a prohibitive ordinance