Faculty Bibliography

The dread disease? Chicken pox. There are other more serious infections (bacterial meningitis, AIDS, trichinosis, cholera, leprosy), but chicken pox spreads wildly, far more easily than any of those. One kid with chicken pox sitting in a waiting room can infect every other vulnerable child there. One hospital worker who is exposed to chicken pox and then comes to work can close down an intensive-care unit. Chicken pox is the scourge of the pediatric ward; no other infection so regularly provokes such panic

For babies born with hypoplastic left heart syndrome (HLHS), the malformation of the heart can possibly be corrected with two operations but they are risky. The case is discussed of one such baby where the parents were faced with weighing the suffering against the survival rate and deciding whether to allow the surgery

A discussion of claiming authority in a situation which is rightfully yours is presented. Sometimes its hard to take an authoritative stance, more so for women than for men

Dr Perri Klass warns that temperatures that in older children are no cause for alarm may signal serious difficulty in infants

The next wave of the deadly AIDS epidemic is starting to hit the children of the inner city

Dr Perri Klass warns that temperatures that in older children are no cause for alarm may signal serious difficulty in infants

Many physicians and hospitals are screening and questioning patients more thoroughly lately, in an effort to cut down on patient drug abuse and medical liability

Well, to begin with, there are developmental screening tests that are helpful and should be applied to babies periodically as a matter of course. As indicators of normal social development, for example, a 6-to-8-month-old may play peek-a-boo, smile spontaneously and resist having a toy pulled away. Language skills should include turning toward a voice, laughing, squealing and making ''dada'' and ''mama'' sounds - though she may not specifically associate them with her parents. She should be able to bear some weight on her legs and sit without support (gross motor skills) and she should reach for an object, and successfully pass it from one hand to the other (fine motor). The absence of any one of these behaviors by itself does not mean a serious problem exists. Some babies don't like peek-a-boo. But taken together, or with other bits of abnormal behavior, they may well be matters of concern. As the baby grows into a toddler, the range of normal behavior broadens to include all manner of tantrums, obstreperous behaviors and power struggles. ''Does she say 'no' a lot?'' I ask parents. ''Does she even know the word for 'yes'?'' For some parents, this period is exhausting but delightful; there is, after all, something very endearing about the way a 2-year-old stands up to the world. For other parents, the toddler years are one battle after another, and, inevitably, they start to wonder whether something is wrong. Hyperactivity, for example, can be a real problem and can develop into a real handicap, but it is hard to diagnose because among most toddlers perpetual motion and short attention spans are the norm. Other nonmedical, developmental problems are more common and far less serious but are often nevertheless difficult for the families to put up with, and hard for the pediatrician to treat. Bed-wetting, for example. As a basic rule of thumb, nighttime loss of bladder control in a child of 5 or more who is able to stay dry during the day is unlikely to have any medical cause. The pediatrician will check for urinary-tract infections. Usually, however, the bed-wetting problem has emotional roots. School phobias and separation anxiety are also seen in this age group, and may well require counseling and therapy from someone beyond the general pediatrician. All these problems need to be treated - it's important to help a child learn to stay dry all night, or overcome a fear of school. It's important, too, to help the parents deal with their own shame, failure, anger or guilt, often engendered by their child's wet sheets or scenes at the schoolroom door

Child abuse is an epidemic in this country. A nurse describes her reaction to questions following an incident when her son was accidentally burned. The need for constant vigilance to protect innocent children is stressed

I heard Larry's frightened voice on the phone: ''[Benjamin]'s been burned. I'm bringing him to the emergency room. Meet us there!'' Click. I am sure it never occurred to them to equate our situation with that of, say, a mother working the night shift in a factory, while her husband, exhausted from his own day shift, took care of the child (Family under extreme stress . . .). Still more fortunately, just as I was about to suggest that someone call the restaurant to verify the story, Benjamin decided to tell his own version. No longer in pain, he was now immensely pleased to be the center of attention, and he favored the assemblage with a dramatic account featuring ''bad dumb man'' with ''bad dumb cigarette.'' More disturbingly, we seem more alert to possible child abuse among the poor. The extreme end of the spectrum is the doctor-parent, that is, me in my scrubs sitting there and reminding doctors, you are dealing with people who are just like you, your profession, your social class - could such people possibly abuse their children? In our hearts, most of us are all too inclined to answer no, though we shouldn't have needed the Joel Steinberg case to remind us that child abuse can exist at all social levels. Still, it seems that, given any level of suspicion, the poor are more likely to be reported, more likely to have their children taken away. Most of us, working the pediatric emergency rooms, know this. The fear in my mind is always that I will take care of some upper-middle-class child, elect to believe the parents (who speak my language), send the child home with them - and the child will come back dead. So I push myself into asking more and more questions of these parents, annoying them, sometimes embarrassing myself. Then I still have to decide whether or not to call in social service. If I do, the social worker will reinterview the parents, will decide with me whether to file a legal motion, informing the state that a child is at risk. If we do, the Department of Social Services will investigate the family, and decide whether to ''substantiate'' our motion. It's a cumbersome process, but it's the only means at hand, the only way to protect the child at risk