Does crying turn tympanic membranes red?

The diagnosis of acute otitis media is based on several clinical factors. One of these factors is the color of the tympanic membrane (TM). Crying can cause flushing and hyperemia of the face. The purpose of this study is to determine whether crying affects the color of tympanic membranes. Infants and toddlers (age 30 months or less) evaluated in an outpatient clinic or primary care pediatrician's office for routine well-baby checks who received at least 2 parenteral immunizations were enrolled on a convenience basis. Ill children were excluded. The initial physician assessed crying and TM color/visibility. Following immunizations, a second physician assessed crying and the TM color/visibility. Color differences were stratified by the degree of crying. One hundred twenty-one study subjects received 2-5 parenteral immunizations. TM colors were most often in the pink range or less. Only 2 TMs were assessed as light red and none were assessed as red. Twenty-eight percent of the TMs with greater crying on the second exam were noted to be redder on the second exam compared to the first exam versus 11% for the comparison group (p=0.0007); 19% of the TMs with greater crying on the second exam were noted to be redder by 2 or more increment levels compared to the first exam versus 5% for the comparison group (p=0.0004); 31% of the TMs with greater crying on the second exam at the 3+ and 4+ level were noted to be redder on the second exam compared to the first exam versus 14% for the comparison group (p=0.003). Our data indicate that, in some instances, crying can result in an increase in pinkness of the TM. Crying in well children does not result in a red tympanic membrane.

The essential role of research in community pediatrics.

Several recommendations in the American Academy of Pediatrics policy statement "The Pediatrician's Role in Community Pediatrics" underscore the essential role of research as an agent of change to promote the health and well-being of children. This article provides (1) a framework for thinking about research in community pediatrics, (2) special considerations important in conducting community-level research, (3) an example of community-level research that has significantly decreased mortality in children (prevention of sudden infant death syndrome), (4) an example of a current issue illustrating the importance of community pediatrics research (promotion of school readiness), and (5) a discussion of future directions for research. Many of the leading health problems facing the United States as outlined in Healthy People 2010 are problems that affect children or have their roots in childhood and are likely to be addressed by community-level research and interventions. It seems clear that pediatricians should be learning to participate in, advocate for, and conduct more community pediatrics research.

Sun protection policy in elementary schools in Hawaii.

INTRODUCTION: Childhood sun exposure is a major risk factor for skin cancer, the most common form of cancer in the United States. Schools in locations that receive high amounts of ultraviolet radiation have been identified as important sites for reducing excessive sun exposure. METHODS: The objective of this study was to determine the prevalence of sun protection policies, environmental features, and attitudes in public elementary schools in Hawaii. Surveys were sent to all (n = 177) public elementary school principals in Hawaii. Non-respondents were called three weeks after the initial mailing. The survey asked about sun protection policies, environmental features, and attitudes toward sun protection. The survey was designed to measure all seven components of Guidelines for School Programs to Prevent Skin Cancer, issued by the Centers for Disease Control and Prevention. RESULTS: Seventy-eight percent of schools responded to the survey. Only one school had a written school policy. Almost all schools (99.3%) scheduled outdoor activities during peak sun hours. School uniforms rarely included long pants (6.5%), long-sleeved shirts (5.1%), or hats (1.5%). Current policies did not support or restrict sun protection habits. Almost one third of those surveyed were in favor of a statewide policy (28.1%), and most believed excessive sun exposure was an important childhood risk (78.9%), even among non-white students (74.5%). CONCLUSION: Results of this study suggest the following: 1) school personnel in Hawaii are concerned about childhood sun exposure; 2) current school policies fail to address the issue; 3) most schools are receptive to developing sun protection policies and programs; and 4) students appear to be at high risk for sun exposure during school hours.