Faculty Bibliography

Intentional violence is a leading cause of mortality among teenagers and young adults. Whereas violence-related mortality is fairly well recognized among medical practitioners, the literature contains little information regarding violence-related morbidity or medically oriented approaches to preventing violence. Violence-related morbidity data for adolescents from one community revealed that 50% of the male respondents experienced at least one pushing or shoving fight per year, and that by age 16 25% had already been threatened by a weapon. These findings provided the impetus to incorporate regular violence counseling into the routine health care maintenance of adolescents at one health center. Our approach to violence-prevention counseling, obtaining a history of violence, and devising a treatment plan is described and advocated

Little information is available about bicycle-mounted child seats despite their general use for a decade. We analyzed two existing data sets to gain information about frequency, trend, and characteristics of bicycle-mounted child seat injuries to children 5 years old and younger. Available data suggest an increased frequency of these injuries, with the rate of passenger injuries rising from 17% to 28% of all reported bicycle-related injuries to children in this age group in California during the years 1977 to 1986. In a detailed sample of 52 injuries related to the use of bicycle-mounted child seats, 42% occurred when the bicycle crashed or tipped over and 25% occurred when the child fell out of the seat. Sixty-five percent involved the head and face, and 27% of the head injuries were serious. Substantial morbidity associated with these injuries could be amellorated if children using these seats wore appropriate bicycle helmets

The divorce rate in the United States is currently half the rate of marriages. Whether this rate will continue is not known. Millions of American children have already experienced their parents' divorce and millions more are likely to share the experience in the future. This makes divorce a problem that frequently appears in a pediatrician's patient population. Most children of divorce will experience it at the least as a potent transient stress that disrupts virtually all aspects of their lives. Many will accommodate to their new life circumstances successfully, but a substantial percentage will suffer long-term negative effects. Many of the problems of these children and their families can be anticipated, prevented, or alleviated by thoughtful and timely intervention. The pediatrician can be helpful by serving as the child's advocate, offering anticipatory guidance, helping the family weather the turmoil of the acute stage, screening for maladjustment or maladaptive behavior of children and parents, providing counseling, and referring the children and family for more specialized mental health input when indicated

Despite the magnitude and importance of the problem, little is known about why many students are absent from school. This study assessed what a sample of excessively absent students and their parents believed were the reasons for the students' absences. In response to an open-ended question about their main reason for absence, almost half of the students reported a health-related reason. When asked whether any of 15 potential problems contributed to their absence, many reported common and acute physical illnesses, headaches or stomachaches, and other aches or pains. Half mentioned factors relating to low motivation or a concern about the school environment. The parents' responses were remarkably similar except they were more likely to cite emotional problems of the student, school violence, and racial problems. When individual student's responses were compared with those of his or her parents, agreement on individual items were little better than would be expected by chance

Pregnancy and childbearing are well recognized as having significant, long-term consequences for teenagers. Recent literature documents an array of negative outcomes for children born to adolescents, with a range of factors identified as contributing to the problems observed in these children. These include (1) the characteristics of those teenagers most likely to become parents, (2) the social and economic consequences of early childbearing, (3) the increased biologic vulnerability of children born to teenagers, and (4) the nature of parenting by teenagers. It has been acknowledged that adolescent parents tend to come from high-risk families, have poor academic achievement, and live in our most disadvantaged communities and therefore, biologic, economic, and behavioral factors contribute to the increased likelihood of teenagers having children who are vulnerable to physical and developmental problems. Teenaged parents face many obstacles to economic and social success, and these further influence the environment in which their children grow up. Adolescents also experience many difficulties in adjusting to parenthood and display a range of suboptimal parenting practices. Whereas some of these factors appear highly resistant to change, others have clear clinical, programmatic, and policy implications

The number of days absent from school during the 1979-80 school year for 573 children aged 6-17 years in Berkshire County, Massachusetts was ascertained by parent reporting in a random household survey. Children with a wide range of chronic health impairments were reported as missing more school than their healthy peers (8.7 days vs. 5.8, p less than .001). Although there was a trend for children reported as having functional impairments to miss more school than those with chronic conditions without functional impairments (11.0 vs. 8.1), the difference was not statistically significant. Children with a variety of reported psychosocial difficulties missed more school than those without psychosocial difficulties for the sample as a whole and for those with reported chronic conditions. These findings document support for the assumption that children with a wide range of physical and psychological problems miss more school than their healthy peers and illustrate that the etiology of school absences is multifactoral and reflects behavioral as well as purely physical phenomena