Ostensible versus actual reasons for seeking pediatric attention: another look at the parental ticket of admission.

The presentation of parental anxiety that appears excessive in view of the nature of the child's "chief complaint" is a frequent occurrence in pediatric practice. This study reviews 370 sick-patient visits in one pediatric office during a three-month period. Additional questioning in the area of parental anxieties concerning these symptoms revealed that in 125 instances (33.8%), the parent was entertaining unverbalized fears that something much more serious was wrong with the child than could be anticipated from the ostensible reason for seeking assistance. An analysis of the "actual reason for coming" reveals that the child's presenting complaint has become associated for the parent with (1) family history of serious life-threatening illness; (2) fears of loss and separation; (3) death; (4) the fears of another family member who is pressing for "answers" about the problem; (5) fears of loss of vital functions and a variety of other thought processes that have somehow become linked to the child's symptom. Techniques for recognizing and ameliorating this parenting difficulty are discussed.

Amoxicillin-clavulanate potassium compared with cefaclor for acute otitis media in infants and children.

One hundred thirty-three infants and children with documented acute otitis media (OM) were randomized to receive the oral suspension of either amoxicillin-clavulanate potassium or cefaclor. Beta-lactamase-producing bacteria were found in 10.9 and 14.5% of subjects treated with amoxicillin-clavulanate potassium and cefaclor, respectively. Subjects were reexamined at 5, 10, 30, 60 and 90 days after the initiation of therapy and whenever signs/symptoms of acute otitis media recurred. All but two children had resolution of otalgia/otorrhea during the initial treatment period. The drug groups were not significantly different in the percentage of evaluable subjects with otitis media with effusion at each scheduled follow-up visit. Recurrence of acute OM/otorrhea [corrected] developed in a similar percentage of subjects in both treatment categories. Both subjects with and those without middle ear effusion at 10 days had approximately a 50% recurrence rate of subsequent middle ear disease. Adverse side effects/complaints, which occurred in significantly more children treated with amoxicillin-clavulanate potassium, were generally mild and primarily gastrointestinal.

A comparative study of amoxicillin-clavulanate and amoxicillin. Treatment of otitis media with effusion.

A double-blind randomized clinical trial was conducted at two sites comparing amoxicillin-clavulanate potassium (Augmentin) and amoxicillin trihydrate for the treatment of otitis media with effusion ("secretory otitis media"). One hundred eight subjects were randomly assigned to receive a ten-day course of either drug regimen. Clinical response was assessed at ten days and four weeks after entry. For those without middle ear effusion at four weeks, recurrence rates were measured at 8, 12, and 16 weeks after entry. At ten days following entry, 29 (51.8%) of 56 subjects in the amoxicillin-clavulanate-treated group were effusion free compared with 16 (32.0%) of 50 subjects in the amoxicillin-treated group (P = .06). At four weeks following entry, 26 (50.0%) of 50 subjects in the amoxicillin-clavulanate-treated group were effusion free compared with 23 (51.1%) of 45 subjects in the group given amoxicillin. By the 16-week visit, eight (36.4%) of 22 subjects in the amoxicillin-clavulanate-treated group who were effusion free at four weeks had recurrence of effusion, compared with 12 (63.2%) of 19 subjects in the amoxicillin-treated group. This study suggests that there was a favorable clinical response immediately following treatment in the amoxicillin-clavulanate--treated subjects as compared with those treated with amoxicillin, but this benefit was not sustained at the four-week end point.

Patient and parent education, office laboratory procedures, and urinary tract infections.

This review of patient and parent education, office laboratory procedures, and urinary tract infections is written by three pediatricians in a group practice in Pittsburgh, Pennsylvania. The patient and parent education section covers the goals of child rearing and history taking (with emphasis on the "vulnerable child"), and reviews discipline, sleep problems, fever, smoking, and injury prevention. The office laboratory procedures section reviews the recent Clinical Laboratory Improvement Act of 1988. The urinary tract infections section reviews recent advances in diagnosis, treatments, prevention (the issue of circumcision), and radiologic studies.