Faculty Bibliography

There are moments when I feel I have spent large parts of my professional life dropping off my own marginally ill children at school (or at day care) and then hurrying to work to examine children who are notably less sick but have been kept home by their parents and brought to see the doctor. Children should be fully immunized against pertussis (whooping cough) and measles, for example, and the American Academy of Pediatrics recommends an annual flu shot for all children from 6 months to 18 years old

OBJECTIVES: To assess the prevalence of low health literacy among adolescents, young adults, and child caregivers in the United States, the readability of common child-health information, and the relationship between literacy and child health. DATA SOURCES: MedLine, Educational Resources Information Center, National Library of Medicine, PsychInfo, Harvard Health Literacy Bibliography, and peer-reviewed abstracts from the Pediatric Academic Societies Annual Meetings. STUDY SELECTION: A systematic review using the following key words: health literacy, literacy, reading skill, numeracy, and Wide Range Achievement Test. MAIN OUTCOME MEASURES: Descriptive studies that used at least 1 valid measure of health literacy, studies that assessed the readability of child health information, and observational or experimental studies that included a validated measure of health literacy, literacy, or numeracy skills and an assessment of child health-related outcomes. RESULTS: A total of 1267 articles were reviewed, and 215 met inclusion and exclusion criteria. At least 1 in 3 adolescents and young adults had low health literacy; most child health information was written above the tenth-grade level. Adjusted for socioeconomic status, adults with low literacy are 1.2 to 4 times more likely to exhibit negative health behaviors that affect child health, adolescents with low literacy are at least twice as likely to exhibit aggressive or antisocial behavior, and chronically ill children who have caregivers with low literacy are twice as likely to use more health services. CONCLUSIONS: Low caregiver literacy is common and is associated with poor preventive care behaviors and poor child health outcomes. Future research should aim to ameliorate literacy-associated child health disparities

My favorite child-rearing book is 'Miss Manners' Guide to Rearing Perfect Children,' by Judith Martin, who takes the view that manners are at the heart of the whole parental enterprise. I called her to ask why. 'Every infant is born adorable but selfish and the center of the universe,' she replied. It's a parent's job to teach that 'there are other people, and other people have feelings.' 'It has a huge impact on people's lives - why wouldn't you bring it up?' she said. 'Do they look you in the eye? If you stick your hand out do they shake it? How do they interact with the parents; do they interrupt, do they ask for things, do they open Mommy's purse and take things out?' I like Miss Manners' approach because it lets a parent respect a child's intellectual and emotional privacy: I'm not telling you to like your teacher; I'm telling you to treat her with courtesy. I'm not telling you that you can't hate Tommy; I'm telling you that you can't hit Tommy. Your feelings are your own private business; your behavior is public

Dr. Barbara Howard, an assistant professor of pediatrics at the Johns Hopkins School of Medicine and an expert on behavior and development, told me that a child's manners were a perfectly appropriate topic to raise at a pediatric visit. Children with autism, whether mild or severe, have great difficulty learning social codes, deciphering subtle body language or tone of voice, and catching on to the rules of the game