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Spastic quadriplegic cerebral palsy (SQCP)is a severe disability that is associated with abnormal physical activity, body composition, and food intake and with frequent malnutrition. This study examined the pattern of dietary intake, anthropometry, and energy expenditure in a group of subjects with SQCP aged 2-18 y and a normal control group. The energy expenditure pattern was determined from resting energy expenditure (REE, n = 61 SQCP; n = 37 control group) by using indirect calorimetry and from total energy expenditure (TEE, n= 32 SQCP; n= 32 control group) by using the doubly labeled water method. Physical activity, including the chronic spasticity of SQCP, was estimated from the ratio of TEE to REE. Abnormal growth and body composition were common and dietary intake was markedly overreported in the children with SQCP. Children with SQCP were divided according to body fat stores determined by triceps-skinfold-thickness measurements. The children with low fat stores had a lower REE adjusted for fat-free mass compared with the SQCP and control groups with adequate fat stores. TEE was significantly lower for the SQCP group than for the control group. The ratio of TEE to REE, indicating energy for nonbasal needs, was significantly lower in the SQCP children than in the control group, with the adequately nourished SQCP children hating lower ratios than the more poorly nourished SQCP group. The nonbasal energy expenditure, such as for physical activity and spasticity, of children with SQCP was low. The nutrition-related growth failure and abnormal pattern of REE are likely related to inadequate energy intake.

There are many dilemmas in the treatment of severely disabled newborns, including moral, legal, and medical questions. Although the American Academy of Pediatrics recommends that parents and physicians make such decisions only after a thorough review with consultants from medical, legal, and social fields, in practice this is not always possible. A prototypical example is children born with myelomeningocele, in which the spinal cord protrudes into an outpocketing through an imperfectly closed spine. In such cases, the best outcome from surgery is associated with prompt treatment, so careful consideration of moral and legal questions may be a luxury. Some medical workers feel that the shock brought by a disabled baby may involve too much stress for the parents to be able to absorb the information necessary for a proper decision. Other authorities feel, however, that emotional troubles do not automatically make parents unintelligent or prevent them from using their intelligence. In order to determine to what degree parents of children with myelomeningocele feel satisfied with the information provided to them during the critical neonatal period, a survey was conducted of 76 parents of 50 affected children. Although some previous studies have indicated that the primary determinant of parental satisfaction with information is the promptness with which it is delivered after the birth, in the present study, only 34 percent of the parents expressed satisfaction with the prompt information provided by the delivery hospital where the child was born. A much greater proportion, 80 percent, were satisfied with the information received at the tertiary care hospital where the infant was moved for treatment. In the cases of five infants, the decision was made to withhold treatment; there seemed to be no significant differences in gender, religion, or infant severity which played a role in this decision. It is interesting to note that fathers did, however, express significantly greater satisfaction in the care of the infant being given at the tertiary care center than did mothers. The authors emphasize that an appreciation of the feelings of parents in such emotional times is crucial to the appropriate practice of medicine. (Consumer Summary produced by Reliance Medical Information, Inc.)

• We analyzed the history, physical examination findings, and skull roentgenograms of 72 children with headaches secondary to brain tumors to determine distinguishing features. Of 56 children, skull roentgenograms were abnormal in 54% (30). Abnormal findings from either the neurologic or ocular examination were present in 68 (94%) of these children at the time of brain tumor diagnosis. These abnormalities developed in 51 of 60 children (85%) within two months of the onset of their headaches. Clues for earlier diagnosis were frequently present in those patients whose conditions were diagnosed more than four months after the onset of their headaches. Recognition of those findings could have resulted in the diagnosis of brain tumor in 69 of 72 children (96%) within four months of the onset of headaches. During the first four months of headache complaints, children should be monitored closely.(Am J Dis Child 1982;136:121-124)

• Although computerized tomographic (CT) findings are well recognized in numerous neurologic diseases of children, CT scan abnormalities of encephalitis have only been associated with herpes simplex infection. We describe two infants, one with coxsackievirus B2 meningoencephalitis and one with clinical encephalitis, whose CT scans were similarly abnormal during the acute phase of their illness. In both infants, recovery of both neurologic and developmental deficits was accompanied by resolution of the abnormalities of the initial CT scan. Speculation is offered as to the role of the CT scan in the assistance of the physician who must evaluate both the diagnosis and prognosis of infants who have a clinical picture of encephalitis.(Am J Dis Child 133:803-805, 1979)

It has frequently been noted that highlevel paralysis precludes community ambulation for children with myelomeningocele. Of the 87 children in our population with highlevel paralysis, however, 45 52 did achieve community ambulation by 5 years of age, while 42 48 did not. There was no significant difference between these two groups by sex, shunt status, scoliosis, or hip surgery prior to 5 years of age. Among the community ambulating group, there were significantly p < 0.001 more children who were not retarded, had received physical therapy for walking, and had compliant parents. We concluded, therefore, that community ambulation is a realistic goal for many children with myelomeningocele and highlevel paralysis.