Maternal depression: a concern for pediatricians.

Maternal depression is common in clinical experience but has not been fully addressed in the pediatric literature. Depression can refer to either depressive symptoms or a diagnosable depression. Depression among mothers occurs frequently, is persistent, and is related to other factors such as low social class and marital disharmony. Studies demonstrate an association between a mother's depression and adverse outcomes for her child including low birth weight, behavior problems, somatic complaints, poor growth, accidents, and affective illness. Affect and child-rearing characteristics of depressed mothers seem to be important factors in mediating these poor outcomes. Pediatricians have a special role in helping depressed mothers and their children.

Television's impact on children.

Television has a major impact on children's knowledge, attitudes, and behavior. Research has demonstrated the association between television viewing and four areas: (1) children's aggressive behavior; (2) racial and sex-role stereotypes; (3) decreased interest in reading and school activities; and (4) poorer health habits and attitudes. Methodological limitations make it difficult to draw firm conclusions about a causal relationship between television viewing and children's behavior. Representative studies in these four areas are reviewed, important methodological concerns are pointed out, and conclusions from the research findings are drawn. The implications of the data for pediatricians and other health professionals are discussed.

Impact of maternal work outside the home during pregnancy on neonatal outcome.

The impact of mothers' work during pregnancy upon neonatal outcome has not been fully elucidated. A study of maternal health habits and neonatal outcome conducted from 1977 to 1979 at Boston City Hospital assessed the effects of paid work outside the home during pregnancy, particularly third trimester work in a standing position, upon duration of gestation and intrauterine growth, while controlling for potentially confounding variables. Postpartum, 1,690 low-income women were interviewed to provide detailed information on their sociodemographic and health characteristics. Of the 1,507 women whose work status during pregnancy could be classified, 55% did not perform paid work outside the home or attend school, 7% worked into the third trimester in a standing position, and 38% had other work histories or attended school. Infants were examined according to a standard protocol by pediatricians blind to mothers' work history. There was no significant relationship between the mothers' work history during pregnancy and the infants' length of gestation, weight, or head circumference at birth, when confounding variables were controlled statistically by multiple regression analyses. However, women who worked in a standing position into the third trimester delivered infants who were longer than infants born either to mothers with other work histories or to mothers who did not work or attend school. Healthy women with uncomplicated low-risk pregnancies who feel well enough to attend school or work during pregnancy, even in a job requiring some standing, may do so without fear that their infant will suffer shortened gestation or impaired intrauterine growth.

Cocaine use during pregnancy: prevalence and correlates.

Cocaine use during pregnancy was assessed by interviews and urine assays obtained prenatally and immediately postpartum from 679 urban women enrolled in prenatal care. Of these, 17% were found to have used cocaine at least once during pregnancy. Eight percent had urine assays positive for cocaine metabolites using the enzyme-mediated immunoassay technique with a cut-off of 300 ng/mL of benzoylecgonine. Of the cocaine users, 24% denied use at the time of the interview and were identified solely by urine assay. Cocaine users were significantly (P less than .01) less likely than nonusers to be married, Hispanic, or black born outside of the United States and were less well nourished. Users reported significantly (P less than .01) more sexually transmitted diseases, prior low birth weight infants, spontaneous and elective abortions, and greater use of alcohol, cigarettes, marijuana, opiates, and other illicit drugs during pregnancy. Because cocaine use is correlated with many potential risk factors, large sample sizes and multivariate statistical techniques are needed to determine whether cocaine use during pregnancy poses an independent risk for adverse neonatal outcomes.

Neonatal neurobehavioral and neuroanatomic correlates of prenatal cocaine exposure. Problems of dose and confounding.

Complex methodologic challenges face researchers studying the effects of prenatal cocaine exposure on infant outcome. These include unavoidable imprecision in ascertaining the gestational timing and dose of cocaine to which the fetus was exposed and difficulties in identifying and quantifying the confounding, mediating, and moderating variables. Review of research on neonatal behavioral and cranial ultrasound findings following in utero cocaine exposure is used to illustrate these issues. We conclude that there are measurable but not dramatic dose-related effects of prenatal cocaine exposure on infant central nervous system structure and function. The effects of dose of prenatal cocaine exposure on later child development remain to be determined. Such research would be facilitated by a scientific consensus delineating relative doses of prenatal cocaine exposure.

Developmental approach to injury prevention.

Children's developmentally diverse temperament, motivation, and competencies, when viewed through the lens of the agent-host-environment model, help us understand the child's contribution to the occurrence of injury. Pediatricians can use this information to individualize their safety counseling.

Primary care pediatricians' roles and perceived responsibilities in the identification and management of depression in children and adolescents.

OBJECTIVE: To describe primary care pediatricians' 1) approach to the identification and management of childhood and adolescent depression and 2) perception of their skills, responsibilities, and barriers in recognizing and managing depression in children and adolescents. DESIGN AND METHODS: National cross-sectional survey of randomly selected primary care pediatricians that assessed the management of recalled last case of child or adolescent depression, attitudes, limitations to care from barriers and skills, and willingness to implement new educational or intervention strategies to improve care. RESULTS: There were 280 completed surveys about child and adolescent depression (63% response rate). Pediatricians overwhelmingly reported it was their responsibility to recognize depression in both children and adolescents (90%) but were unlikely to feel responsible for treating children or adolescents (26%-27%). Those with most of their practice in capitated managed care were less likely to feel responsible for recognizing depression in either children or adolescents. Forty-six percent of pediatricians lacked confidence in their skills to recognize depression in children, and few of them (10%-14%) had confidence in their skills in different aspects of treatment with children or adolescents. Diagnostic, assessment, and management details for their last recalled case of depression in a child or adolescent were provided by 248 of these pediatricians. In addition to referring 78%-79% of the cases to mental health care professionals, 77% of pediatricians provided a wide range of brief interventions. Only 19%-20% prescribed medication. Major factors cited that limited their diagnosis or management were time (56%-68%) and training or knowledge of issues (38%-56%). Fewer pediatricians noted limitations due to insurer or financial issues (8%-39%) or patient issues (19%-31%). The 35% of pediatricians who were motivated to change their recognition and management of suspected depression were significantly more interested in implementing in the future a variety of new strategies to improve care. CONCLUSION: Primary care pediatricians felt responsible for recognizing but not for treating child and adolescent depression. Although the lack of confidence and lack of knowledge and/or skills and time issues are major barriers that limit pediatricians in their treatment of childhood and adolescent depression, pediatricians varied in their readiness to change, with some being more willing to implement new strategies to care for depression. Educational and practice interventions need to focus on how to assist all pediatricians in diagnosis and to prepare these motivated pediatricians to manage depression in primary care settings.

Mental health of adolescent mothers: the implications of depression and drug use.

Childbearing and child rearing during adolescence result in poor health and psychosocial outcomes for some mothers and their children. Whereas the mental health problems of adolescent mothers are common in clinical experience, they are infrequently investigated and discussed in the literature. Mental health problems such as depression and/or drug use may be key factors in determining which mothers and their children will have poor outcomes. The purpose of this paper is to explore how depression and drug use may affect the health and development of adolescent mothers and their children. Because of their relevance to adolescent motherhood, this paper brings together information from three research areas: adolescent depression, adolescent drug use, and maternal depression.

Depression among adolescent mothers: a pilot study.

Eighteen women less than 22 years old, who had their first child during adolescence, were assessed with a standard in-depth diagnostic interview for the presence of and/or history of depression and other disorders. Eight of the 18 women (44%) had experienced at least one episode of major depressive disorder at some point in their lives. A majority of episodes had their onset during pregnancy. Moreover, six women (33%) were experiencing a diagnosable form of depression at the time of the interview. Most of the women who had been depressed experienced at least part of their depression while they were raising their children. Whereas these preliminary findings need to be replicated due to the small sample size, they draw attention to the need for the integration of mental health assessment and treatment in service programs for adolescent mothers.

Cord blood immune biomarkers in small for gestational age births.

Fetal growth restriction is a risk factor for development of adulthood diseases, but the biological mechanism of this association remains unknown. Limited biomarkers have been studied in settings of preterm birth and maternal inflammation, but the relationship between a wide range of immune biomarkers and fetal growth has not been studied. The hypothesis of this study was that fetal growth restriction is associated with altered immune biomarker levels. We examined the relationship between small for gestational age (SGA) status and 27 umbilical cord blood immune biomarkers. This study was part of a large-scale cohort study of preterm birth and low birth weight conducted at Boston Medical Center, an inner city, predominantly minority patient population. Growth status was determined based on birth weight standardized to an internal reference. There were 74 SGA births and 319 appropriate for age (AGA) births with complete clinical and biomarker data. Adjusting for covariates and using AGA as reference, SGA births had lower levels of log IL-1ß (ng/l; ß -0.38, 95% CI -0.57, -0.19, P < 0.01), log BDNF (ß -0.29, 95% CI -0.55, -0.03, P < 0.05) and log NT-3 (ß -0.46, 95% CI -0.77, -0.15, P < 0.01). No associations were found between other biomarkers and SGA. In conclusion, three biomarkers were selectively associated with SGA status. Our results provide information that could be used to guide additional studied aimed at determining mechanisms that contribute to fetal growth.

Adolescence and its discontents: attentional disorders among teenagers and young adults.

Attention deficit disorder (ADD) is the most commonly diagnosed childhood behavioral condition in the United States. This condition has important implications for and influences on adolescent development and adult functioning including emotional and conduct disorders, poor socialization, and school underachievement. In addition it has only been appreciated recently that some symptoms of ADD persist and can be identified among adolescents and young adults. In some situations, ADD may be newly identified during adolescence. Similar to younger children with ADD, a multi-modality approach to the management of adolescents with ADD is recommended.