Changes in autonomic regulation with age: implications for psychopharmacologic treatments in children and adolescents.

Developmental changes in the cardiovascular system could have an impact on risks associated with psychopharmacological interventions. Children may be more vulnerable to adverse cardiac events due to immaturity in autonomic control of the heart. These changes are incompletely understood and are characterized in this study. A consecutive series of 70 boys, aged 6-14 years, was recruited. Developmental variation in the autonomic nervous system was evaluated by assessing heart period variability (HPV), pulse, and blood pressure in response to orthostasis. Increased age correlated significantly with greater heart rate and diastolic blood pressure response to orthostasis. HPV at rest and in response to tilt did not significantly correlate with age. Boys with family histories of hypertension had a significantly greater blood pressure response to orthostasis. These findings suggest that developmental age-related changes in the sympathetic nervous system, as reflected by changes of pulse and blood pressure response to tilt, occur across this age range. Parasympathetic changes, as reflected by HPV, do not. In light of these findings, more research is needed on children's and adolescents' relative cardiac risk with psychotropic medications as opposed to adults'.

Children's and women's ability to fire handguns. The Pediatric Practice Research Group.

OBJECTIVES: To evaluate whether strength differences between children and women might keep children from firing handguns and to determine how many young children can fire available handguns. DESIGN: One- and two-index finger trigger-pull strength was tested using a standard protocol. Data on trigger-pull settings of 64 commercially available handguns were obtained. SETTING AND PARTICIPANTS: Convenience sample of well children and their mothers at four Chicago (Ill)-area pediatric practices for health supervision visits, and of siblings of emergency department patients, during an 8-week period. INTERVENTION: None. MAIN OUTCOME MEASURE: One- and two-index finger trigger-pull strength of mothers and children. RESULTS: Twenty-five percent of 3- to 4-year-olds, 70% of 5- to 6-year-olds, and 90% of 7- to 8-year-olds have a two-finger trigger-pull strength of at least 10 lb, the fifth percentile one-finger trigger-pull strength of adult women. Forty (62.5%) of 64 handguns require trigger-pull strength of less than 5 lb; 19 (30%) of 64 require 5 to 10 lb. CONCLUSIONS: Significant overlap exists in the trigger-pull strength of young children and women, limiting the potential use of increased trigger-pull settings to discourage firearm discharge by children. Young children are strong enough to fire many handguns now in circulation.