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The response to "Teen wants sexual history kept off record" (Behavior: Ask the experts, April) is very well thought out and essentially correct, but it left me with a concern. As the wife of a noncustodial parent (NCP), I am familiar with some of the laws (although I am by no means an expert) that govern the rights of a father or mother who is the NCP. Federal law guarantees the right of NCPs to all medical, dental, and school records of their children. Given the desire of the mother and teenager (in this particular Behavior item) to keep this information from the father, I would first ask if the parents are married. If the parents are divorced, then the question becomes, which law takes precedence? The one protecting teens or the one protecting NCPs? Protecting the rights of NCPs is an issue dear to me because of my husband, and the net effect of creating a "shadow record" would be to deprive the NCP of all rights to medical information contained in that record. That would, in turn, continue what I believe is a march toward removing NCPs from active participation in their children's lives. Many NCPs, both mothers and fathers, fight a daily battle to remain involved in those lives. Seemingly harmless actions can sometimes have very long-term effects.
The author replies: I appreciate Ms. Baroni's concern. NCPs are parents who have a valuable role in their child's well-being. Many have to work hard and struggle to stay in their child's life in the face of such obstacles as geographical distance, remarriage, and, sometimes, hostility.
Often, matters involving adolescents' privacy, parental rights, and NCPs' rights come down to a question of prioritieswhose right should take precedence? Given the barriers to providing needed health care to teenagers, I give prioritywithin limitsto the adolescent's right to privacy, because without a degree of trust no care will be sought, no treatment will be given, and no record will be available to anyone. The teenager bears the greatest medical risk and is the physician's primary responsibility. In setting this priority, I mean no disregard to anyone else.
Will someone tell me why all medical journals do not provide readers with the correct pronunciation of drug names? For example, zanamivir ("Zanamivir prevents family spread of influenza," Journal Club, January 2001). How can anyone remember medications if we cannot even say their names? Help! Zan-amivir? Zana-miv-ir?
The Editor replies: We hear and sympathize with Dr. Gorlick's cry for help. Other than one-time assistancethe correct pronunciation is zan-AM-e-veerwe decline, with regrets, to provide this service in Contemporary Pediatrics, in part because the information is likely available elsewhere. One possible source? The representatives of pharmaceutical manufacturers who come calling at the office.
I would like to add to the American Academy of Pediatrics' recommendation that young babies be put to sleep on the back to prevent SIDS. I routinely tell parents to place the baby on her back and at the same time elevate her head 30 degrees. They can do this either by putting the infant in a car seat in the crib or placing a towel or pillow wedge under the mattress. Elevating the head above the stomach also reduces gastroesophageal reflux and makes the baby more comfortable if she has nasal congestion.
When my son was having problems with colic and reflux symptoms at 3 or 4 weeks of age, I put him to bed in his car seat within the crib. I did this until he was about 6 months old. Besides significantly ameliorating his symptoms, it allowed his parents better sleep. I would add that it would not be safe to put children 8 months and older in a car seat in the crib.
Little boys not only get the giggles during testicular examination but often grab their scrotum, which interferes with my assessment. This exam technique works well for boys 4 to 8 years of age: Right before I pull down their underwear, I tell the boys to hold onto their ears. It doesn't stop the giggles, but they do keep their hands on their ears and out of the way.
Imagine the look on the face of an 18-month-old patient when you walk into the exam room holding a big, colorful spinning pinwheel in front of you. The patient hardly notices you because he is virtually hypnotized by the flashy colors and whirling blades. You can then capitalize on his interest, and the exam will proceed smoothly. Even older patients enjoy the pinwheel approach. They will try to spin it with their own breath, which helps you assess breath sounds without even asking.
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Readers' Forum. Contemporary Pediatrics 2001;9:21.