The prediction of long-term functional outcomes of children with cerebral palsy.

Current information was obtained from 117 respondents, including 71 who completed interviews, of a population of 810 individuals who had been diagnosed with cerebral palsy between 1951 and 1974. Original chart reviews constituted the basis for predicting employment capabilities of the interviewed cohort. A comparison of predictions with actual functional outcomes demonstrated a tendency to pessimistic underestimation of long-term functional outcome, sounding a note of caution to paediatric developmentalists.

Overlooking: a sign of bilateral central scotomata in children.

Four children are reported who always looked above objects of visual interest (overlooking). All had bilateral central scotomata (loss of central visual field). Three had optic nerve disease selectively affecting the papillomacular fibers; the fourth had ocular colobomata affecting the maculae. Overlooking is an important sign of bilateral central scotomata in children: it is an adaptation to loss of central vision.

Home care for ventilator-dependent children. Psychosocial impact on the family.

The impact of providing home care for ventilator-dependent children was studied in a cross-sectional survey of 18 northern California families. Through the use of a confidential structured interview and the impact on Family Scale, we obtained information on family demographics; the childrens' medical conditions; financial, social, and personal impact on the family; and parental coping-mastery of the care of a ventilator-dependent child at home. Analysis of scores from the impact on Family Scale showed no differences in the perceived family impact between primary caretakers and their spouses. Primary caretakers in the sample, however, showed significantly reduced Coping subscale scores with a longer duration of home ventilatory care. This finding, if confirmed in future studies, has policy implications for physicians and other health professionals working with ventilator-dependent children and their families, especially those who care for children over long periods.

Health care needs and services for technology-dependent children in developmental centers.

In an attempt to document the trend toward a more seriously ill and medically needy population of children in California state developmental centers, we studied the medical status and health care needs of the pediatric and young adult population (birth to 22 years of age) residing in all acute care and skilled nursing care units in developmental centers in 1988. All children in California's state developmental centers are severely to profoundly mentally retarded and chronically disabled, and many have serious health problems. Of the 865 children in 5 developmental centers, 441 (51%) resided in acute and skilled nursing care units and were technology dependent (Office of Technology Assessment classification). We suspect that our findings (ethical and quality-of-care issues, staffing, licensing mandates, cost-of-care considerations) reflect the rapidly expanding population of children with special health care needs and may be important in planning for services in other states as well as in California.

Nail dysplasia and fetal alcohol syndrome. Case report of a heteropaternal sibship.

We found substantial dysplasia of fingernails and toenails in each of four siblings demonstrating other features consistent with a diagnosis of fetal alcohol syndrome (FAS). This aspect of examination is frequently overlooked in routine physical assessments. All four affected teenagers of this heteropaternal sibship demonstrated common features of FAS, including moderate mental retardation, maxillary hypoplasia, an elongated philtrum, and narrow palpebral fissures, as well as absence or dysplasia of two or more nails. Although nail hypoplasia has been previously reported as a minor finding in FAS, a literature review confirmed that nail dysplasia is found in more than 20% of individuals with FAS.

The effects of primary care versus traditional training on career choice in pediatrics.

In response to concerns questioning the relevance for future pediatric generalists of traditional hospital-based, subspecialty-oriented pediatric residency training, new residency programs emphasizing increased ambulatory, continuity care training experiences have been developed.We compared the career activities of physicians who had received their pediatric residency training in the traditional, predominantly inpatient program and in the predominantly ambulatory primary care program at the University of California, San Francisco. Three groups were surveyed: (1) pre-1975, those who received training in the traditional program before 1975, (2) post-1975, those who were trained in the traditional program after 1975 and (3) primary care, those who received their training in the primary care program beginning in 1975. The results indicate that more than twice as many former primary care residents as traditional residents are practicing primary care. Since the development of two pediatric training tracks, satisfaction with program relevance has increased among those who practice primary care. The results indicate that there is a greater commitment to primary care practice among residents trained in the primary care program.