Your Voice

READERS' FORUM

This product is no longer used for fever

"Fever: Measuring and managing a sizzling symptom" (May) identifies PediaCare products as antipyretics that contain ibuprofen. PediaCare products currently do not contain fever-reducing medications such as ibuprofen and acetaminophen. PediaCare products are indicated to treat a child's cough and cold symptoms—not fever. Shipments of the two PediaCare products indicated for fever relief were discontinued last year (these products may still be on store shelves and in parents' medicine cabinets).

Barbara H. Korberly, PharmD
Pharmacia Consumer Healthcare
Peapack, N.J.

Getting to the root of digit sucking

As a board-certified pediatric dentist, I found the extensive review of digit sucking interesting ("Why we can't afford to ignore prolonged digit sucking," June). But why did the author only mention—in a parenthetical note near the end of the article—that dentists treat this common oral problem with appliances? I believe that parents should consult a dentist first to manage this oral habit and any associated oral sequelae.

Doron Kochman, DDS
Pittsford, N.Y.

Rosemarie Van Norman's behavioral approach to the problem of prolonged digit sucking is accurate and important for pediatricians to recognize. Dentists have been attempting to treat this behavior with intraoral appliances for many years. In my opinion—as a dentist, orthodontist, and speech and language pathologist who has treated such problems for 35 years—such appliances are almost always more of a detriment than an aid. These devices are invasive, difficult to manage, uncomfortable, often punitive, and address only the symptom of the behavior.

Van Norman does an excellent job of not only describing the causes of prolonged digit sucking but also presenting a comprehensive and clear therapeutic approach that addresses all aspects of the behavior. Fortunately, dental schools are increasingly aware of the behavioral basis of digit sucking and now stress behavioral approaches to remediation over appliances.

Robert M. Mason, DMD, PhD
Durham, N.C.

I was gladdened by Van Norman's call for an investigation into the effectiveness of fixed intraoral habit appliances ("oral cribs," "habit appliances") used by dentists and orthodontists to treat digit sucking. I am a librarian researching the literature of fixed intraoral habit appliances with a view to tracing the communication and flow of ideas in a specific branch of dentistry. I have researched the literature of these appliances beginning with the patent for the hayrake (a painful, spiked appliance still used) in 1936 to the present day. I have turned up references that give considerable cause for concern over the incidence of serious injuries to children from these appliances and their relative effectiveness when compared with the noninvasive therapies advocated by Van Norman. I will send, by e-mail, my complete list of references to fixed intraoral habit appliances beginning in the 1930s to any interested reader.