Pediatricians and the promotion and support of breastfeeding.

OBJECTIVES: To survey pediatricians on their breastfeeding knowledge, attitudes, and practices and to compare these results with those of a 1995 study. DESIGN: Cross-sectional follow-up survey. SETTING: The Periodic Survey of Fellows survey conducted by the American Academy of Pediatrics. PARTICIPANTS: The survey was completed by 875 pediatrician members of the American Academy of Pediatrics from November 1, 2003, through May 21, 2004. MAIN OUTCOME MEASURES: Pediatricians' recommendations on management, opinions about the benefits and promotion of breastfeeding, and relationship to personal breastfeeding experience were compared with the results of the 1995 survey. RESULTS: Compared with the results of the 1995 survey, in 2004, pediatricians were less likely to believe that the benefits of breastfeeding outweigh the difficulties or inconvenience (adjusted odds ratio, 0.60; 95% confidence interval, 0.47-0.76), and fewer believed that almost all mothers are able to succeed. More pediatricians in 2004 reported reasons to recommend against breastfeeding. Pediatricians in 2004 were more likely to recommend exclusive breastfeeding (adjusted odds ratio, 1.55; 95% confidence interval, 1.23-1.94) and follow supportive hospital policies. Respondents with personal breastfeeding experience were 2.3 times more likely to recommend supportive policies (adjusted odds ratio, 2.3; 95% confidence interval,1.74-3.08) in 2004 than in 1995. Those with no personal breastfeeding experience were also slightly more likely in 2004 to recommend these policies (adjusted odds ratio, 1.49; 95% confidence interval, 1.09-2.03). CONCLUSIONS: Although pediatricians seem better prepared to support breastfeeding, their attitudes and commitment have deteriorated. Personal experience mitigates poor attitudes and seems to enhance breastfeeding practices among those surveyed.

Informed consent and confidentiality for adolescents.

This article reviews the rights of adolescents to consent to medical treatment, their expectation of privacy, and the applicable New Jersey state law.

Acute pancreatitis in children from Valproic acid: case series and review.

Valproic acid (VPA) is a commonly prescribed medication approved for use in the United States for epilepsy, migraine, and bipolar disorder. Although the common adverse effects associated with VPA are typically benign, less common but more serious adverse effects can occur. These include hepatotoxicity, teratogenicity, possible polycystic ovaries with the potential for sterility or carcinogenesis, and pancreatitis. A characteristic clinical profile has been determined for several of these adverse effects. We report four children with VPA-induced pancreatitis, one of which was fatal, and review the literature. Three of these children presented within a 4-year period (1995-1999) at the same institution. Because previous reviews have included either a small number of patients, or both pediatric and adult patients, we reviewed only pediatric cases to minimize any effect from adults with more serious co-existing medical illnesses. We attempted to determine the following: (1) if there are any characteristics that are predictive of pancreatitis and whether it will be fatal; (2) whether different clinical and laboratory characteristics exist for nonfatal vs fatal cases; and (3) if a specific pediatric patient profile, similar to that with VPA associated hepatotoxity or polycystic ovary-androgenism syndrome, could be identified.

Auditory hallucinations associated with migraine.

OBJECTIVE: Two children experienced auditory hallucinations during migraine (one with migraine without aura and one with migraine with aura). These hallucinations only occurred during headache. BACKGROUND: Auditory hallucinations are rarely reported in patients with migraine. These patients often have other psychiatric or neurologic disorders such as affective disorder or epilepsy. METHODS: Case report and a review of the literature. RESULTS: No other neuropsychiatric disorder was identified in either patient at presentation or upon follow-up. CONCLUSIONS: Auditory hallucinations can rarely occur in patients with migraine. Further study of this association might provide insight to any relationship between migraine, auditory hallucinations, and the temporal lobe.

Public perceptions of cerebral palsy.

Neurologic disorders are often described in terms that relate to symptoms rather than specific etiologic factors. Such descriptive terms are confusing to healthcare professionals and to the parents of children in whom these disorders are diagnosed. Cerebral palsy is one example of a descriptive term that is applied to a disorder that is heterogeneous in its etiology, morbidity, and mortality. A random sampling of 100 adults selected from the waiting room of a suburban ambulatory pediatrics office associated with the University of Medicine and Dentistry of New Jersey-School of Osteopathic Medicine (Stratford, NJ) was surveyed with a 20-item questionnaire on their perceptions of the term cerebral palsy and its associated disability and prognosis. Subjects' responses suggest that a percentage of the general population holds several misconceptions about the disorder, including the belief that the disorder has a genetic etiology (40%) and that affected children cannot speak (20%), die earlier than unaffected children (57%), and cannot hold jobs as adults (20%) should they survive to adulthood. A small percentage of subjects believe that cerebral palsy is infectious (4%) and that parents should restrict their children from associating with those affected (3%). Our study population was somewhat homogenous in that most respondents were educated and most were middle to upper-middle class. Yet, even in this population, the term cerebral palsy is ambiguous to many and may have negative connotations. Further studies are needed to address whether a higher frequency of negative perceptions are present in more socioeconomically diverse populations.