Complementary and alternative medicine use among children in the Washington, DC area.

OBJECTIVE: To determine the prevalence and reasons for complementary and alternative medicine (CAM) use among children in primary pediatric care practice in the Washington, DC area. DESIGN: Cross-sectional survey of parents at 4 Children's National Medical Center Pediatric Research Network (PRN) practices from July 1998 through November 1998. Survey information included demographics, child health problems, satisfaction with health care, and CAM use over the past year. RESULTS: Parents completed 348 surveys. Forty percent (138) of parents were CAM users themselves, whereas 21% (72) had treated their child with CAM over the past year. Factors positively associated with child CAM use included parents' use of CAM (P <.0001); greater parent age (P =.0005); greater child age (P =.001); and complaints of frequent respiratory illnesses, asthma, headaches, and nosebleeds. Ethnicity and parental education were not associated with child CAM use. Over 50% of pediatric CAM users reported specific vitamin supplementation, whereas 25% used other nutritional supplements or elimination diets, and over 40% used herbal therapies. Thirty-two percent of CAM users had visited a CAM practitioner; 81% of pediatric CAM users would have liked to discuss it with their pediatrician, but only 36% did so. CONCLUSION: Treatment of children with CAM is common and is frequently undertaken by parents without the knowledge or advice of their pediatrician.

Diagnosing infantile anorexia: the observation of mother-infant interactions.

OBJECTIVE: This study has three objectives: (1) to delineate the diagnostic criteria for infantile anorexia, including the onset of persistent food refusal during the infant's transition to spoon- and self-feeding, acute and/or chronic malnutrition, parental concern about the infant's poor food intake, and mother-infant conflict, talk, and distraction during feeding; (2) to determine the interrater agreement of child psychiatrists when diagnosing infantile anorexia based on these criteria; and (3) to describe the use of the Feeding Scale as a diagnostic tool. METHOD: One hundred two toddlers, ranging in age from 12 to 37 months, were assessed by two child psychiatrists and assigned the diagnosis of infantile anorexia, picky eater, or good eater. In addition, observers who were masked to the toddler's diagnosis rated mother-infant interactions with the Feeding Scale to permit objective evaluation of those interactions. RESULTS: Two child psychiatrists were able to assign toddlers to infantile anorexia, picky eating, and healthy, good eating groups with a high level of agreement. The objective scale for rating mother-infant interactions showed a high level of agreement between two masked raters and a good level of agreement between masked raters and the child psychiatrists' diagnostic assessment. CONCLUSIONS: Infantile anorexia can be diagnosed with high reliability by child psychiatrists. Evaluation of mother-infant interactions is a useful diagnostic tool.

Urinary tract infections in infants and children. Guidelines for averting permanent damage.

Urinary tract infection (UTI) is common in childhood and, early in life, is often associated with vesicoureteral reflux or other urinary tract anomalies. Since the combination of reflux and infection can cause renal scarring and impaired renal function, identification of children at risk and provision of close follow-up are important. Diagnosis in the first year of life relies on a high index of suspicion on the part of the clinician, as signs and symptoms are nonspecific. Reliable cultures are the cornerstone of accurate diagnosis and will be the basis for selection of acute and long-term management. Vigilant follow-up of all children with UTI can prevent ultimate morbidity.