ABSTRACT S Assistant Editor: Michael j. Maloney, M.D.

There are several significant issues raised in these pediatricabstracts. Thearticle byPastore etal. onschool­based health centers points out that 34% of the studentspresentedfor mentalhealth services, 15% pre­sented for sexuality-related care, and 50% knew someone who had been murdered. Child psychiatryconsultation will be critical as more states fund health centers for kids in schools. The complex topic ofweaning toddlers from bottle feedings by age 15 months is addressed byFrazier et al., who point out thatincome and education do not stop parentsfrom allowing children to take milk bottles to bed, leading todental complications. Theperennialproblem ofinfant crying is covered byvan der mzl et al., whofoundthat 20% of mothers reported problematic infant crying. Unfortunately, manyparents respond to cryingbyshaking, slapping, andputting the baby tosleep in theprone(face down)position. These articles shouldbe required readingfor all newparents.

Surprisefindings for me were that kidsget mostof their vitamins from cereal (see Subar et al.); mostkids with chronicfatigue outgrow theirillness (see Krilov et al.), although a weaknessofthisstudywas thattelephone calls were usedasfollow-up instead ofinterviews; and 4.8% ofHIV blood tests by western blotwere false-positives (bad news, thengood news) according to Kleinman et al.

Readers may sendabstractsofrelevantpediatricarticles forpossible publication to Michael j. Maloney,M.D., Chestnut Lodge, 500 west Montgomery Avenue, Rockville, MD 20850-3892.

-M.j.M.

School -Based Health Center Utilization: A Survey of Users and Nonusers. Do ris R. Pastore, MD , Linda juszczak, RN , PNP, Mart in M. Fisher, MD,Stanford B. Friedman, MD

Background.·As school-based health centers (SBHCs) cont inue to grow, it remains important to study use of the cente rs. The extent to which mentalhealth problems exist in the students with access to the centers, whether those students are using the available services, if they are satisfied with theservices, and the reasons for nonuse by those students who do not enroll arc all meaningful questions. Methods:The above issues were studied in an urbanhigh school with a 2-year.o ld SBHC by administering questions during physical education classeson health center use and mental health concerns. The630 respondenrs were 45% male, 55% female, 6 1% black, 29% Hispanic , 54% in grades 9 or 10, 46% in grades II or 12. Results: Sixry percent of thestudents were registered in the SBHC; 40% were not registered. Seventy-five percent of registered students reported average use (:5;3 visits); females weremore likely than males (P = .017) to be frequent (>3 visits) users of SBHC services. Mental health problems among all participants included depressionin 3 1%, use of alcohol 1 time or more per month in 2 1%, use of alcohol daily in 5%, suicidal ideation in 16%, history of a suicide allempt in 10%,knowing someone who had been murd ered in 50%, and being in at least I fight at school in 26% . Frequent users, average users, and nonusers did notdiffer by age, grade, race, or any of the measured ment al health problem s. Among the 472 students who completed the survey section on SBHCperceptions, 305 described health center use: 92% were satisfied with health center services, 79% were comfortable being seen in SBH C , 74% believedvisits were kept confidential, 61% told their parents about each visit, and 5I% considered the SBHC their regular health care source. The health centerwas used for ment al health services by 34% and sexuality-related care by 15%. T he 167 students who described reasons for not using the SBH C mostfrequently reported that they already had a physician (60%), did not need it (50%), prefer continuing previous health care (45%) , did not get aroundto it (30%) , parents were opposed (20%) , were not comfo rtable (19%) , did not know about the service (19%) , and did not want problems known(19% ). Conclusions: We conclude that, in th is urban high schoo l, (I) average users, frequent users, and non users did not differ in the mental healthproblems measured in this study: (2) those who used the SBHC indicated strong satisfaction with the care received; and (3) those who did not use theSBHC chose to stay away for a variery of reasons, most commo nly the availabiliry of other care or the percept ion of lack of need. Arch Pediatr AdolescMed 1998;I52:763-767

Parental Barriers to Weaning Infants From the Bottl e. John nie P. Frazier, MD, Debbie Counri e, MD , Lamia Elerian, MD

Background.· Optimal bottle weaning should occur between 12 and 15 months of age. We hypoth esized that high-risk populations have different parentalalii tud es, learned behaviors, and knowledge of weaning practices. Objectio«:To determine whether high-risk popul ations are less likely to wean theirchildren by 15 months of age than low-risk populations. Methods: A cross-sectional survey using a convenience sample of parents was conducted at 3communiry-based pediatric clinics. Spanish- and English-speaking parents with weaned and unweaned children 12 to 36 months of age were included inthe study. A self-administered qu est ionnaire was completed at a clin ic visit. T he que st ionn aire add ressed aspects of parents' sociodemographiccharacteristics and included feeding history; weaning practices; sources of informati on abou t weaning; and parental behaviors, ali itudes, and knowledgeof age at which the child should be weaned. Results: One hundred eighty questionn aires were completed. Marital status was related to weaning behavior.Seventy-six percent of single mothe rs had weaned their children in a timely mann er, whereas 48% of married moth ers had done so (Xl = 7.70; P= .008).Parental education, race, and income were not significantly related to the timeliness of weaning. When respondents rated the helpfulness of multiplesources, only the health clinic was found to be significantly more important for the timely weaning group (r =- 2.13; P =.04) . Parents with timely weanedchildren stated that the mean ± SO optimal age for weaning is 13.6 ± 3.2 months. Parents with unweaned and late-weaned children stated that the mean ±

SO optimal age is 19.9 ± 6.6 months. Bedtime bottle feeding were reported in more than 87% of the unweaned group. Sixty-nine percent reported poordental development associated with delayed weaning. Conclusions: Married parents are at risk of late weaning. Parents continue to allow their children tosleep with milk bottl es in their mouths in bed at night. Parents are not aware of the medical problems associated with late-weaning. Late-weaning parents

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ABSTRACTS

are not knowledgeable abour current weaning recommendations. Current approaches are not effective in altering set patterns of inappropriate weaninghabits . Additional interventions and innovative parental educat ion methods are needed to improve age-appropriate weaning practices. Arch PediatrAdolesc Med 1998;152:889-892

Mothers' Reports ofInfant Crying and Soothing in a Multicultural Population. M.E van der Wal. D.C. van den Boom. H . Pauw-Plornp, G.A. de Jonge

Objectives: To investigate the prevalence of infant crying and maternal sooth ing techniques in relation to ethnic origin and other sociodemographi cvariables. Design: A questionnaire survey amo ng mothers of 2-3 month old infant s registered at six child health clinics in Amsterdam. the Netherlands.Subjects: A questionn aire on sociodemographic characteristics and crying behaviour was completed for 1826 of 2180 (84%) infant s invited with the irparent s to visit the child health clinics. A questionnaire on soothing techniques was also filled out at home for 11 42 (63%) of these infant s. Results:Overall prevalences of "crying for three or more hours/24 hour day." "crying a lot ," and "difficult to comfort" were 7.6%. 14.0%. and 10.3% .respectively. Problematic infant crying was reported by 20.3% of the mothers . Of these infants . only 14% met all three inclusion criteria. Problematiccrying occurred less frequently among girls. second and later born children. Surinamese infant s. and breast fed infants . Many mothe rs used soothingtechniques that could affect their infant's health negatively. Shaking. slapping . and putting the baby to sleep in a pron e position were more commonamong non-Dutch (especially Turkish) moth ers than among Dutch mothers . Poorly educated mothers slapped the ir baby more often than highlyedu cated mothers. Conclusions: Mothers' report s of infant crying and soothing varied sociodemographically. Much harm may be prevented bycoun selling parents (especially imm igrants) on how and how not to respond to infant crying. Health education should start before the child 's birth.because certain sooth ing techn iques could be fatal, even when practiced for the first time. Arch Dis Child 1998;79:312-31 7; reprodu ced with permissionfrom the BMJ Publish ing Group

Dietary Sources of Nutrients Among US Children, 1989-1991. Amy E Subar, PhD. MPH. RD. Susan M. Krebs-Smith. PhD. MPH. RD. AnnettaCook. MS. and Lisa L. Kahle. MS

Objective To ident ify major food sources of nutrients and dietary constituents for US children. Methods: Twenry-four-hour dieta ry recalls were collectedfrom a nat ionally representative sample of children age 2 to 18 years (n = 4008) from the US Depa rtment of Agriculture's 1989-1991 Co ntinuing Surveyof Food Intakes by Individual s. For each of 16 dietary constituents. the contribut ion of each of 113 food groups was obt ained by summing the amountprovided by the food group for all individuals and d ividing by tot al intake from all food groups for all individuals. Results: M ilk. yeast bread.cakes/cookies/quick breads/donuts. beef. and cheese are among the top 10 sources of energy. fat. and protein. Many of the top 10 sour ces ofcarbohydrate (yeast bread. soft dr inks/soda s. milk. ready-to-eat cereal. cakes/cookies/quick breads/donuts. sugars/syrups/jams. fruit drinks. pasta. whitepotatoes); protein (poultry. read-to-eat cereal. pasta); and fat (potato chips/corn chips/popcorn) also contributed >2% each to energy intakes . Ready­to-eat cereal is among the top contributors to folate. vitamin A. vitam in C. iron . and zinc intakes. Fruit d rinks. containing little juice. contribute - 14%of total vitamin C intakes. Conclusions: Fortified foods are influentia l cont ributo rs to many vitamins and minerals. Low nutrient-dense foods are majorcontributors to energy. fats. and carbohydrate. This compromises intakes of more nutr itious foods and may imped e compliance with current dietaryguidance. Pediatrics 1998; 102:913-923

Course and Outcome of Chronic Fatigue in Children and Adolescents. Leonard R. Krilov, MD. Martin Fisher. MD. Stanford B. Friedman. MD.David Reitman. MD. Francine S. Mandel . PhD

Purpose:To describe the epidem iology. symptoms. and psychosocial characteristics of children and adolescents evaluated in a chronic fatigue program anddetermine the course and outcome of the syndrome in these patients. Method: Du ring the summer of 1994. chart review was performed for the 58pat ients evaluated between 1990 and 1994 and a telephone follow-up was cond ucted with 42 of the 58 families. Patients were predominantl y female(71%) and white (94%) . with 50% between the ages of 7 and 14 years and 50% between the ages of 15 and 21 years (mean age 14.6 years). Results: Attime of presentati on . 50% of pat ients had been fatigued for I to 6 months and 50% had been fatigued for 7 to 36 months . Sixty percent indicated thefatigue had begun with an acute illness and 60% had a history of allergies. Most commonly reported symptoms were fatigue (100%). headache (74%),sore thro at (59%). abdominal pain (48%). fever (36%). and difficult ies with concentration and/or memory (33%) . Most patients had a worsening ofschool performance and a decrease in social activities. On follow-up. there was significant improvement in many patient s during the summer after the firstvisit. with cont inued improvement in most patients during the second and third years. At time of the follow-up telephone call. 43% of families consideredtheir ch ild "cured" and 52% considered their child ren "improved." wherea s only 5% considered the ir ch ild to be "the same." Statistical analysesdemonstrated no demographic or clinical factors that distinguished between those who did or did not part icipate in the follow-up study. or between thosewho did or did not do well on follow-up. Conclusions:T hese data demonstrate that children and adolescents with chronic fatigue have a syndrome that issimilar to that described in adult s. but that the syndrome differs in several ways. most specifically. presentat ion earlier in the course of the illness and amore op timistic out come. Pediatrics 1998; 102:360--366

Low-Dose Hydrocortisone for Treatment of Chronic Fatigue Syndrome: A Randomized Controlled Trial. Robin Mckenzie, MD. Ann O'Fall on , RN.Janet Dale. RN. MPH. Mark Demitrack, MD. Geetik a Sharma. MD. Maria Deloria . Diego Garcia-Borreguero, MD . William Blackwelder. PhD .Stephen E. Straus. MD

Context: Chronic fatigue synd rome (CFS) is associated with a dysregulated hypothalamic-pituit ary adrenal axis and hypocorti solem ia. Objective: Toevaluate the efficacy and safety of low-dose oral hydrocort isone as a treatment for CFS. D~sign : A randomized. placebo-controlled. double-blindtherapeutic trial. conducted between 1992 and 1996. S~tting: A single-center study in a terti ary care research institu tion. Patients: A total of 56 womenand 14 men aged 18 to 55 years who met the 1988 Cente rs for Disease Control and Prevention case criteria for CFS and who withheld concomitanttreatment with other medication s. Intervention: Oral hydrocortisone. 13 mg/m2 of body surface area evety morning and 3 mg/m 2 every afternoon. orplacebo . for approximately 12 weeks. Main Outcome Measures: A global Wellness scale and other self-rating instruments were completed repeatedly

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