American Academy of Pediatrics. Committee on Child Abuse and Neglect and Committee on Community Health Services. Investigation and review of unexpected infant and child deaths.

Although there is a continuing need for timely review of child deaths, no uniform system exists for investigation in the United States. Investigation of a death that is traumatic, unexpected, obscure, suspicious, or otherwise unexplained in a child younger than 18 years requires a scene investigation and an autopsy. Review of these deaths requires the participation of pediatricians and other professionals, usually as a child death review team. An appropriately constituted team should evaluate the death investigation process, review difficult cases, and compile child death statistics.

The circumferential supracrestal fiberotomy.

This article addresses the advantages and shortcomings of circumferential supracrestal fiberotomy procedures from the pragmatic perspective of practicing clinicians. The first part of this article reviews the anatomy, surgical techniques, and timing of the procedure. The significance of individual techniques and studies are discussed.

Child abuse: a time for new awareness.

There were 7602 cases of confirmed child abuse and neglect in Oklahoma in 1989. Twenty-five children died from abuse during the fiscal year. Physician training in diagnosis and management of child abuse must be expanded. Physicians are required by state statute to report all cases of suspected abuse to the Department of Human Services. Sexual abuse of children appears to be increasing. A coordinated multidisciplinary effort which involves physicians can help manage this threat to childrens' health.

The maladroit adolescent: learning disorders and attentional deficits.

Being maladroit in a society with increasing emphasis on performance is a formidable challenge to adolescent development. Helping maladroit adolescents achieve optimal potential is a challenge for physicians, educators, and others involved in their care. The first steps for professionals are recognizing SLD and ADD and understanding the configurations of these problems as they apply to adolescents and adults. Educators can prioritize academic concerns and evaluate and provide intervention strategies. Physicians can review new pharmacologic data and follow-up studies to help formulate clinical judgments, particularly around the area of medication. Along with counselors, physicians will provide better longitudinal care when aware of the social and behavioral outcomes reported for patients similar to theirs. Finally, awareness of resources facilitates multidisciplinary communication and provides access for patients and clients to needed medical, educational, and support resources. There has always been a sense of advocacy among those working with the adolescent whose exaggerated maladroitness stems from a problem with learning or attention. Perhaps this review will provide a data base from which advocacy can expand to specific action. That has been our goal.

A device for positioning the breast during angiography.

A patient positioning device to be used during angiography of the breast that can easily be mounted and removed from an existing table top is described. The device facilitates patient positioning, provides good compression of the breast, and permits the placement of a water bolus during the studies.

Teenage pregnancy.

The pediatrician's role in teenage pregnancy is multifaceted. The problem is a sociologic phenomenon with medical consequences. The pregnant teenager actually represents three patients: the mother, the baby, and the adolescent herself. Prepregnancy nutrition can be improved through pediatric education and advice. Sex education can be improved through the advocacy of pediatricians, who can discuss postponing parenthood until the end of adolescence with many of their patients. Services to prevent pregnancy can be offered by pediatricians. Unfortunately, in Oklahoma it is illegal to dispense contraceptives to minors without parental consent. Pediatricians should work to gain acceptance of laws modeled after the American Academy of Pediatrics' health care for minors policy. Lastly, support services to promote proper parenthood and establishment of families can be developed with pediatric input. The entire problem must be viewed in the context of current social patterns, an understanding of adolescent development, the significance of peer pressures, and the biological changes that make it possible for children to bear children.

PIP: This discussion of teenage pregnancy focuses on the following: the scope of the problem; identification of the pregnant teenager; causes of teenage pregnancy (biologic factors, the role of peers, societal influences, and contraception); the teenage father; complications of pregnancy; nutrition in teenage pregnancy (protein requirements, vitamins, minerals, and trace minerals); the options for a pregnant teenager; and prevention. Of much concern is the 61% increase in the total number of births to females aged 15 and younger in the U.S. between 1960 and 1977. Teenage pregnancy is not a new problem, yet in the last 20 years several factors have influenced the awareness of the problem and its consequences. Furstenberg identifies several reasons for increased attention devoted to teen pregnancy: an increase in the teenage population; more awareness of population control; more liberal teenage sexual behavior, coupled with a disdain for early marriage, and resulting in increased illegitimate birth; and governmental concern regarding socioeconomic conditions vis-a-vis teenage parenthood and poor educational, vocational, and social stability. Experience shows that the pregnant teenager is unlikely to have completed growth tasks, particularly the acquisition of independent thinking and a mature understanding of self. There is a significant population of females aged 12.5-15 years who biologically and physically are close to being mature women and are capable of becoming pregnant. That population grows larger monthly throughout the schoolage years. Repeatedly, teenagers encountered in practice, clinics, and an outreach educational project have reported that peer pressure is their single greatest motivator in regard to sexual behavior. In the last 20 years, the concept in advertising has been sex and an attitude of acceptance toward sexuality. If society acquiesces to the constant exposure of its young people to sex, it needs to provide a support system that enables the adolescent to deal effectively with sex. Adolescents frequently deny that they can become pregnant, and consequently they fail to even consider contraception. The potential teenage father needs to be prepared by education and counseling for either appropriate delay of his role as a father or coping with its premature occurrence. It appears that with the exception of preeclampsia and a small bony pelvis in the adolescent, the majority of complications of teenage pregnancy are more a function of lack of prenatal care than they are of maternal age. Factors related to nutrition that place the adolescent at risk during pregnancy include low prepregnancy weight, insufficient weight gain, obesity, existing medical complications, dietary faddism, pica, and low income or ethnic variances.

Outreach education: a possible preventer of teenage pregnancy.

PIP: In 1977 the Margaret Hudson Program in Tulsa began a Health Outreach project to reach pregnant girls enrolled in public schools. 143 girls participated in the program, which was taught by a registered nurse with a degree in psychology. The 20-hour curriculum focused on basic knowledge in sexual anatomy, pregnancy, labor and delivery, and child care. 38 girls were pre- and posttested; while pretest scores ranged from 52-84%, posttest scores ranged from 66-100%. In the same year a second program entitled "Teen Awareness" was developed for junior high girls, aimed at teaching responsible decisionmaking, and possible prevention of unwanted sexual activity. 247 students participated in the program; pretest scores ranged from 40-100%, while posttest scores ranged from 50-100%. Results documented poor level of information prior to the outreach course, with a measurable increase afterwards. Parental involvement in such programs is highly desirable.^ieng