Conclusion
What happened to the six-month-old baby Dr. Stucky remembers so clearly?
“I only know what happened during the hospital stay,” she says. “This family clearly needed help and guidance. There was an overwhelming, clear [indication] that the mother had significant, major depression. She wasn’t feeding the baby. She was completely ignoring the child, and she acknowledged that. … The father was at work and thought that perhaps this baby was just ill or sickly. He was told that the baby was being taken to the doctor, and that wasn’t happening. He was naive and innocent in thinking that things were being dealt with and thinking that their baby was simply a baby who cried a lot and wasn’t gaining weight well.
“Once this was all [addressed], he jumped at the opportunity to have the mother in therapy and on medications. The mother herself was completely willing to give up the care. … In this case, the paternal grandmother took over the care of this child. The father would drop off the baby at her house during the day and pick up the baby at night. On weekends they would share the duties. That was the plan at discharge. … I can’t guarantee it, but it’s my sense that this worked very well.”
Keri Losavio is a medical journalist with more than 10 years’ experience.
References
- National Clearinghouse on Child Abuse and Neglect Information: http://nccanch.acf.hhs.gov/topics/prevention/index.cfm.
- “What Is Child Maltreatment?” From A Coordinated Response to Child Abuse and Neglect: The Foundation for Practice. National Clearinghouse on Child Abuse and Neglect Information: http://nccanch.acf.hhs.gov.
- Child Abuse Prevention and Treatment Act. Download the complete text from the Cornell University Legal Information Institute: www4.law.cornell.edu/uscode/42/ch67.html.
- “Monitoring Child Neglect.” Summary of discussions at a meeting co-sponsored by the Centers for Disease Control and Prevention (CDC) and Prevent Child Abuse America (PCA America), March 29, 2002.
PEDIATRIC SPECIAL SECTION
In the Literature
Optimizing Management of GERD: Medical therapy or surgical intervention?
Hassall E. Outcomes of fundoplication: causes for concern, newer options. Arch Dis Child. 2005;90:1047-1052.
Review by Ray Chan, MD
This narrative review provides a concise overview of gastroesophageal reflux disease (GERD) while specifically addressing surgical treatment. The author focuses on the potential complications of surgical treatment and cites several studies demonstrating a high rate of complications and patient dissatisfaction with their outcomes. In contrast, the review does cite several sources that concluded good outcomes; however, the article questions the conclusions of these studies due to study designs with poorly defined and subjective outcome measures.
In contrast to the discussion on fundoplication, the review offers a more favorable description of proton pump inhibitor therapy. In the concluding remarks Hassall argues that medical therapy options should be exhausted prior to surgical therapy. The author states that the risk of mortality and morbidity combined with less than desirable efficacy of fundoplication should caution clinicians from being too eager in recommending fundoplication.
Clinically significant GERD is a common inpatient problem. This article provides a good review of the pathophysiology of this disease and available treatment options. Unfortunately, this narrative review does not utilize a systematic method of identifying relevant studies nor does it include a systematic approach for critical appraisal of these studies. Nevertheless the caution it raises about fundoplication is a worthy one that should be explored further. It is interesting to note that prior to this review the author has received grant support and was a paid consultant for AstraZeneca and TAP Pharmaceutical Products Inc.