Faculty Bibliography

Children who are frequently or persistently absent from school tend to perform poorly in school and are likely to drop out before graduation from high school. Excessive school absence was significant implications in terms of maladaptive behavior, wasted opportunities, and future unemployment and welfare costs. Epidemiologic information about this problem suggests that physical and mental health problems of students or their families are the sole or contributing cause of this behavior in more than 50% of cases. Excessive school absence may signal such health problems as poor coping with or management of chronic illness, masked depression, teenage pregnancy, substance abuse, inappropriate responses to minor illnesses, or severe family dysfunction. School absence patterns appear to be a readily available, easy-to-use marker of childhood dysfunction which lends itself to screening large numbers of children for unmet health needs. Attention to this area of child behavior as part of routine health care will frequently uncover previously unrecognized health problems in children and their families

This paper reports findings from a comprehensive study of families of pediatric patients with cystic fibrosis, cerebral palsy, myelodysplasia, and multiple handicaps receiving care in clinics of two teaching hospitals in Cleveland. In 239 families with normal siblings 6 to 18 years old, mothers completed the Psychiatric Screening Inventory for a randomly selected sibling in this age group. Results were compared to data on 1,034 randomly selected children from a cross-section of Manhattan households. The proportion of siblings with serious impairment was not significantly different from the Manhattan sample. Although on the total inventory siblings did not score significantly higher than the comparison sample, they did score significantly higher on the mentation problems, fighting, and delinquency subscales. The diagnostic categories of the disabled children had no significant effect on siblings' scores, nor did level of disability. Neither siblings' sex nor age bore any relationship to their psychologic functioning. A sibling's birth order in relation to the disabled child had a significant interaction effect with sex on psychiatric impairment. Little relationship was found between a mother's perceived effects of caring for a disabled child on attention to siblings and sibling's disorder

A retrospective record review was used to examine utilization of a pediatric walk-in clinic available to an entire urban community and to evaluate the effectiveness of follow-up care for a sample of the users of this facility who receive their regular pediatric care at a local comprehensive child health center. Results indicate that this walk-in facility is used extensively for the care of nonemergency conditions. The findings did not, however, support the generally accepted belief that a disproportionate number of Medicaid-supported and minority children overuse emergency type facilities. Utilization did not differ by race or medical care financing. Only 35.6% of the children who were advised to make a follow-up visit to the health center actually did so. White children complied significantly more often than black children (48.0% vs 15.8%). A larger percentage of patients for whom follow-up was optional (48.5%) than for whom follow-up was recommended (35.6%) made a return visit. Noncompliance with recommendations concerning follow-up care of adult users of emergency type facilities is a well recognized problem; the present study demonstrates a similar problem among children

The white blood cell count, the differential cell count, and morphological changes in leukocytes can provide valuable diagnostic information that can aid the physician in determining the cause of illness. These simple laboratory tests, all too frequently either abused or ignored, when employed with precision can supplement but not supplant clinical judgment