Attention to infants in the first year.

The time spent by 158 infants in contact with their carers at 6, 13, 26 and 52 weeks was reviewed prospectively. Periods of contact in the categories of (1) physical care, (2) holding the crying or sleeping infant, and (3) playing and interacting with the infant were recorded using 24-h log diaries completed by the mother. The mean total carer contact time over a 24-h day did not change significantly in the first year, varying between 6.5 and 73 h. Between 6 and 52 weeks, time spent by the mother in physical care declined significantly from 207 to 143 min and in holding the crying or sleeping infant from 61 to 17 min (P < 0.05 and 0.0001 respectively). There were no significant changes in the amount of time spent in playing and interacting with the infant over the first year by the mother and father, the time being on average 52.7 and 25.0 min respectively. Play and interaction with a non-parental carer increased significantly from 14 to 69 min (P < 0.0001). Relationships between infant size and holding became weaker as the infant became older. Infant gender, socioeconomic status and duration of breast-feeding did not influence infant contact time.

Fetal and postnatal growth to age 2 years by mother's country of birth.

The objective of this study was to measure the physical growth of fetuses and infants in an inner city health district in the north of England and to compare their growth profiles according to mother's country of birth (British Isles or Indian subcontinent). The study was part of the Central Manchester Child Growth Project, a prospective longitudinal study of fetal and postnatal growth and development in a sample from the geographically-defined Central Manchester Health District. Data were collected from the beginning of the second trimester of pregnancy to the age of 2 years. One-hundred seventy-four singleton infants born at term ( > or = 37 weeks) had serial antenatal cephalometry every 3 weeks from the beginning of the second trimester and had serial head, length and weight measurements at birth and at the ages of 6, 13, 26, 52 and 104 weeks. Infants of Indian-born mothers tended to be lighter at birth than those of locally-born mothers, but the difference was not due to lower accumulation of soft tissue. Body length from 6 to 52 weeks in both groups of infants was similar. The major finding was the reduced head size in infants of Indian-born mothers, the difference being significant among boys, evident from mid-pregnancy and persisting postnatally to age 2 years. Reduced fetal growth is associated with the development of cardiovascular disease in adulthood, mortality from ischaemic heart disease being specifically linked with head size at birth. The reduced head size of boys of Indian-born mothers is of interest because male immigrants from the Indian subcontinent who live in England have an increased incidence of non-insulin dependent diabetes and a substantial excess mortality (standardised mortality ratio 313 at ages 20-29) from ischaemic heart disease.

Duration and pattern of crying in the first year of life.

In a prospective study of fetal and postnatal growth and development in a group of babies whose mothers were residents of an inner-city health district in the north of England, the total amount of crying of 157 infants was recorded at four periods during the first year of life by means of a 24-hour log. The mean number of crying episodes reduced from 4.4 at six weeks to 1.5 at one year. Early crying predicted later crying. It was not possible to predict which babies would cry a lot except that breast-fed infants tended to cry less. Mothers' perceptions of whether their babies cried a lot correlated with their perception of sleep difficulties. Rapid response to crying was associated with significantly less crying overall.

Sleep in the first year of life.

The sleep patterns of 174 infants were recorded on one typical day at six, 13, 26 and 52 weeks of age, using a 24-hour log. During the first year of life the number of episodes of sleep was reduced by about 50 per cent, but total sleep time was reduced by only two hours. A circadian rhythm was established by six weeks of age. Smaller infants slept more than larger ones in the first months of life. Sex or birth-order of the child did not affect the duration or number of sleep episodes, but sleep pattern related significantly to whether or not mothers found their infants difficult to feed. Introduction of weaning food at an early stage reduced the number of sleep episodes, but increased the average length of each episode. Socio-economic status showed no significant relationship with number of episodes or total length of sleep.

Sex difference in fetal head growth.

Growth of the fetal biparietal diameter (BPD) throughout the second and third trimesters was measured in a prospective longitudinal study. Linear-cubic equations were fitted to the data of individual fetuses and from these equations mean growth curves were produced for males and females. The head growth trajectories of males and females were significantly different. The study illustrates why the practice of dating pregnancies by ultrasonic fetal BPD measurement at about 16 weeks gestation can lead to error.

Incidence of childhood tuberculosis after neonatal BCG vaccination.

Neonatal BCG vaccination has long been offered routinely to children born at St Mary's Hospital (SMH), Manchester, England, whereas the city's other obstetric hospitals have generally restricted this procedure to children of Asian origin and those with a family history of tuberculosis. Among children aged 0-14 years who had been born to Manchester residents in 1965-80, 65 presented with tuberculosis in 1975-80 whilst still resident in the city. The estimated incidence rate was less than half as high among all children born at SMH as among those not born there, largely because the rate for those born and vaccinated at SMH was less than one-quarter of that for those born elsewhere. Children with Bangladeshi, Indian, or Pakistani surnames also shared in the reduced risk associated with vaccination. These findings strongly support the effectiveness of neonatal BCG vaccination.

An adolescent ward.

A ward has been set up for adolescents, who, being neither children nor adults, have special needs. It provides a pleasant and enthusiastic atmosphere that allows the patients to mix together socially alties is important, but not more than 20% should be long-stay patients. Those needing intensive care or specialised investigations and those likely to be a disruptive influence are excluded. No serious sexual problems have been encountered.

Three case reports of fetal growth retardation in the second trimester.

Antenatal and postnatal growth and development were assessed in a prospective study involving 100 children. 3 cases of second trimester growth retardation exhibiting varying degrees of catch-up growth are described.

Child health and paediatrics in the U.S.S.R.

Observations on child health and paediatrics made during a three weeks' visit to the USSR are recorded. There are separate health services for children and their organization is outlined, as are the training and career structure of the many thousands of paediatricians employed. Provision for handicapped children is briefly discussed and a few comments are made on social aspects of child care.

Growth hormone deficiency in children with brain tumors.

Nine children with brain tumors are described who have received various combinations of treatment, including surgery, radiotherapy, and chemotherapy. Many of the children were noted to be of short stature. Endocrine assessment was carried out from 2 to 10 years after treatment. The combined results of insulin tolerance and Bovril stimulation tests show an impaired growth hormone response in six of the nine children. Bone age is retarded in all cases, and the present height is below the 10th percentile in five of the six. The cause of this growth hormone deficiency is obscure, but further studies are in progress.

Residual disabilities in children treated for intracranial space-occupying lesions.

A retrospective study of 30 long-term survivors of cranial or craniospinal irradiation for intracranial space-occupying lesions has demonstrated physical and mental handicaps in the majority. This is most severe in those cases treated before the age of 11 years, and is not confined to those children having craniospinal or whole-brain irradiation. The mental handicap also appears to be progressive, but cannot be easily examined in this retrospective study.

The community paediatrician in an integrated child health service.

A concept of Community Paediatrics has been described comprising clinical care to individual children including identification, diagnosis, and care of the handicapped child, expertise in preventive paediatric techniques, and the provision of investigation and advice in connexion with social and educational proboems. Its relationship to Community Medicine, General Practice, and Consulting Paediatrics has been discussed and a long-term training scheme is outlined. In the immediate future the deployment is envisaged of senior clinical Medical Officers now employed by Local Authorities.