Keeping kids in and burglars out, Confronting the dilemma of autism, Resources for pediatricians. Eye on Washington



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Keeping kids in and burglars out

Two Johns Hopkins University undergraduates have developed a window guard aimed at preventing young children from falling out of windows, while allowing easy entry by emergency crews yet deterring criminals. The window guard is equipped with a hinged gate that can be opened from the inside by adults but that requires too much finger strength and mental skill to be opened by a child younger than 9 years—the age group at highest risk of accidentally falling out a window. The window guard opens from the outside when a firefighter strikes the bars with an axe, but a loud alarm is activated when the guard is struck, which should repel intruders.

Inventors Mike Barnard, 22, and Howard Ku, 23, developed the gate during a two-semester course in which they tackled real-world engineering assignments. Andrew E. Lincoln, assistant research professor at the center, said: "Their gate is accessible to adults but not to young children. It has a burglary deterrent but is also accessible to firemen. This was an attempt to come up with something that was a happy medium for both sides."

Barnard and Ku plan to patent the guard and find a manufacturer to build it in large quantities. Estimated cost to consumers if they succeed? Approximately $175 a unit. The project was funded by the Center for Injury Research and Policy and The Johns Hopkins University Bloomberg School of Public Health.

Confronting the dilemma of autism

When a child is given a diagnosis of "autistic spectrum disorder," parents are shattered. Usually well aware that something is "not right" with their child, they are confused by the elusive nature of the disorder, depressed because no "cure" exists, and understandably eager to follow up every intervention they hear about from friends or stumble over on the Web. Pediatricians are often at a loss, ill-trained to make the diagnosis and with little information about interventions that may help.

The May 2001 issue of Pediatrics includes several items intended to bring some order to this chaos. First, the issue contains new guidelines from the American Academy of Pediatrics on the diagnosis and management of autism, defined as "some degree of impairment in reciprocal social interaction and communication, often accompanied by repetitive behaviors or restricted interests and activities and characterized by wide variation ranging from mild peculiarities to severe disability." The guidelines stress that pediatricians should listen attentively when parents express concerns about development and maintain a high index of suspicion for autism. Screening tools specific for the autistic spectrum may be used, provided they are culturally and linguistically appropriate.

Pediatricians who feel unable to evaluate a child for possible autism should refer the family to a specialist or a multidisciplinary team with expertise in this area. Once the diagnosis is made, the pediatrician should offer parents information about behavioral and educational interventions, support organizations, and genetic counseling. Pediatricians should also become familiar with the alternative therapies many families pursue and approach the issue of nontraditional remedies with compassion.

Second, this issue of Pediatrics includes information on two notions about autism that many parents espouse: a purported connection between the measles-mumps- rubella (MMR) vaccine and onset of autism and use of the enzyme secretin to treat the disorder. The idea that autism is associated with the MMR vaccine is explored in a technical report that is based on a detailed review of the evidence by an expert panel. The panel found no evidence of such an association. (For a summary of three new studies that undercut public concern about an association of MMR vaccination and autism and other conditions, see the first item in Journal Club in the May 2001 issue of Contemporary Pediatrics.)

As for secretin, much touted on the Web as a possible cure for autism, Pediatrics reports on the first controlled trial of a course of porcine secretin therapy on 64 children with diagnosed autism. The study showed that children who received two doses of secretin did no better than those who received a placebo in regard to measures of language, cognition, and autistic symptoms.

Resources for pediatricians

Responding to the complex needs of today's families isn't easy. These resources can help.

• A national education campaign to foster early childhood development sponsored jointly by From Zero to Three, a national nonprofit organization, and the Johnson and Johnson Pediatric Institute. Called The Magic of Everyday Moments, the campaign has produced a series of five booklets that look at developmental periods synchronized with the recommended timing of well-child visits over the first 15 months of life. The booklets and posters are available without charge by calling toll-free 877-565-5465.

• From the American Academy of Pediatrics (AAP), the 2001 Family Shopping Guide to Car Seats, to help parents sort out the confusing terminology of car seats, determine which type their child should have, and find out the price and characteristics (weight limits, harness type) of hundreds of seats listed by brand name. The guide can be downloaded from the AAP's Web site, www.aap.org/family . (For more on vehicle safety, see "Airbags and children: A mixed blessing" in our April issue.)

• From Riley Hospital for Children in Indianapolis, the Riley Kidometer, a software program to help clinicians care for children. Containing the same information as is in the Harriet Lane Handbook, the program works with handheld computers like the Palm III and provides a database of normal values by age. The program can be downloaded from www.kidometer.com .

• From the Center for Management of Children with ADHD at Children's Hospital of Philadelphia, a family- and school-based intervention program described in Homework Success for Children with ADHD. The book is authored by Thomas J. Power, PhD, director of the center, and is published by Guilford Press.

• From the American Speech-Language-Hearing Association, a consumer Web site (www.asha.org ) for families seeking information about communication disorders. Physicians and other professionals can find information tailored to their needs at http://professional.asha.org .

• From Memorial Sloan-Kettering Cancer Center, a Web site for children with cancer, and their families, at www.mskcc.org/pediatric .

Eye On Washington

Washington, D.C., in summer tends to be hot and steamy—a place anyone with a summer home in a more pleasant climate would surely flee. Unfortunately for members of Congress, now that the July 4th recess is over they must return and try to rack up some legislative accomplishments before getting out of town for the rest of the summer. Congress still has before it the so-called Patients' Bill of Rights, which gives insured consumers somewhat more clout than they've had heretofore in dealing with the managed care industry. The Senate bill, among its many provisions, guarantees insured patients that their coverage will include visits to pediatricians.

Despite the bill's considerable popularity with voters, President George W. Bush has threatened to veto the Senate version; the House may attach amendments that would make it more palatable. The president has said that he supports a patients' bill of rights that "encourages quality health care without encouraging frivolous and junk lawsuits that threaten the very existence of an important health-care policy in America." Specifically, President Bush objects to provisions of the Senate bill that give patients broader rights to sue, with less stringent caps on damages, than he would prefer. At this point, fundamental reforms of the health-care system are not on anyone's political radar screen.

The political dilemma posed by patients' rights is not the only difficulty President Bush faces. He must also make up his mind whether to please the anti-abortion constituency within his party by continuing to ban federal funding of research on embryonic stem cells, or to go along with those who lobby on behalf of a broad range of debilitating diseases that may benefit from stem cell research. The AAP supports federal funding for embryonic stem cell research using donated embryos that would otherwise be discarded.

As the president struggles with the stem cell decision (he recently met with medical ethicists), recent proposals to allow states to define an unborn child as a person eligible for coverage under the Children's Health Insurance Program (CHIP) may be intended to propitiate abortion foes.

In other parts of the federal health-care establishment last month, events of note included:

• The Centers for Disease Control and Prevention's report on their successful attempts to "place" disease prevention messages in the heart of our most popular TV shows, from the importance of sun screen in an episode of "Beverly Hills 90210" to an "ER" scene in which character Mark Greene, MD, strides into the emergency room waiting area and announces that anyone who asks to have an antibiotic prescribed for the flu will be turned down. Half the patients in the room then get up and walk out....

• The Department of Agriculture insisted that Excel Corporation recall 190,000 pounds of fresh ground beef and pork suspected of contamination with Escherichia coli. The meat was distributed to Kroger stores in Alabama, Georgia, Kentucky, South Carolina, and Tennessee.

• The National Practitioner Data Bank, according to the inspector general of the Department of Health and Human Services, is not fulfilling its mission of rooting out inept physicians from hospitals and health maintenance organizations (HMOs). According to the report, in the last decade, 84% of HMOs and 60% of hospitals never reported a single adverse disciplinary action taken against a staff member. Possible explanations include a low priority on reporting from institutions that are more concerned with their bottom line and guided by a fear of lawsuits.

• The Food and Drug Administration (FDA) issued a warning to manufacturers that including herbal additives in food products may not meet the FDA legal standard that "novel ingredients" be "generally recognized as safe." While there is little evidence that such herbs as echinacea, Ginkgo biloba, and Siberian ginseng (all found in various soft drinks) are dangerous, proof that they are safe is equally scanty. Herb-laden foods and beverages have grown into a $700 million market annually, according to the New York Times.


October 7­12, American College of Surgeons, New Orleans. For information, contact postmaster@facs.org.

October 20­-24, American Academy of Pediatrics National Conference and Exhibition, San Francisco.

For registration information, go to www.aap.org .

November 4­8, American College of Chest Physicians, Philadelphia. To register, send e-mail to registration@chestnet.org.

November 8­10, A.I. Dupont Institute Marrow Transplantation in Children. St. Augustine, Fla. For information, e-mail mtrigg@nemours.org.

November 9­11, American Institute of Ultrasound in Medicine: Fetal Echocardiography, Las Vegas. For more information, call Stacey Blessing at 301-498-4100.

November 11­14, American Heart Association Annual Meeting, Anaheim, Calif. For information, call Carole Bullock at 214-706-1279, or e-mail caroleb@heart.org.


Updates. Contemporary Pediatrics 2001;8:13.

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