For 14 years I have served as the Editor-in-Chief of Pediatric Annals, and it has been both educational and enjoyable for me. As the journal is now adapting to the contemporary world of medical publishing, with much greater emphasis on online-only platforms (among other changes), I have decided that this will be my final issue, and a new Editor-in-Chief will soon be appointed. I want to thank John C. Carter (Chief Operating Officer) and all the others at SLACK Incorporated, my Associate Editor Dr. Robert Listernick, and the members of the Editorial Board as well as all the guest editors for their great advice and support over the years. Among other things, I am going to greatly miss the opportunity to publish items from my extensive medical stamp collection. I hope that you have all enjoyed them as well as the broad range of outstanding pediatric articles published in the last 165 or so issues.
This issue is the second of two that are guest edited by Drs. Valarie Wong and Chris Koutures on youth athletes and sports medicine, covering a wide range of relevant topics in this field.
Zika Virus and Lead
As I write this column in mid-February, much of the nonelection-based news is about pediatric stories: the Flint, Michigan water disaster leading to widespread lead exposure of young children, and the presumed Zika virus-associated outbreak of congenital microcephaly and brain abnormalities centered in Brazil and Ecuador but involving at least 30 countries in the Western Hemisphere. One common theme of these two stories is that the affected children mostly live in impoverished circumstances. In Brazil, the most affected areas are the poorest, where there is little or no control of the populations of Aedes aegypti mosquito that transmit Zika virus (as well as dengue, yellow fever, and chikungunya) that can lead to fetal infection affecting brain development and result in microcephaly and other developmental abnormalities. A possible connection of Zika virus infection to Guillain-Barre syndrom is also under investigation. In Flint, a decaying city that is without even a single large grocery store in its city limits, the primarily indigent population of African-American and other children of color have been exposed to toxic lead levels because of the failure of state and federal governments to address the city water supply for almost 2 years. In this election year, there have been increasing calls from within both political parties to address the pockets of real poverty that exist within many of our urban and rural areas of the United States.1 Without question, poverty correlates directly with impaired child health, as child health providers know only too well. I hope that I live to see significant reductions in the numbers of American children growing up in poverty.
Another lament is the status of school lunches in America. A recent New York Times column2 contrasts school lunches in the US to those in other developed countries, eg, France, where a school lunch of scallops, lamb skewers, and a cheese course is typical. This report highlights that the US government provides just over $3 per student per lunch, but that school districts typically require food departments to cover their overhead costs with this support, leaving less than $2 for food, leading to schools serving highly processed heat-and-serve meals. Overall, the four leading calorie sources in the average US child's diet are pizza, grain-based desserts, soda, and bread, and they are exposed yearly to $2 billion in food and beverage ads targeting children. Very recently, Congress turned down efforts to roll back key school nutrition standards passed in 2010 that require schools to serve more fruits and vegetables and whole grains,3 but additional funding would be highly beneficial.
According to gunviolencearchive.com,4 at least 147 children up to age 17 years (including 33 younger than age 12 years) were killed by guns from January 1 to February 14, 2016. Incredible!
I have not written much about Kawasaki disease (KD) in this column over the years despite the fact that it is one of my prime academic interests. For at least 30 years, I have been honored to know Dr. Tomisaku Kawasaki, the now 91-year-old Japanese general pediatrician, who first described this significant pediatric illness in 1967.5 The most important advice I can provide to pediatric providers regarding KD is to be alert to the possibility of incomplete (sometimes called atypical) KD. This refers to children who have at least 5 days of fever and fewer than the four classic features required for diagnosing typical (or classical) KD. These children are at essentially the same risk as typical KD patients for developing coronary artery complications that can lead to myocardial infarcts in childhood or later as young adults. When suspicious of incomplete KD, please use assessment of inflammatory markers (usually erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]) to help distinguish the incomplete KD patients (usually with ESR >40 mm/h and/or CRP >3 mg/dL) from those with viral illnesses or drug exanthems. Remember that timely administration of intravenous immunoglobulin with aspirin is highly effective in preventing coronary disease. That's my parting advice!
This Month's Stamps
The examples from my medical stamp collection that will close my last column are actually philatelic covers. The 1958 Argentinian First Day of Issue cover celebrates “Lucha contra la Leucemia,” the fight against leukemia. In 1958, childhood leukemia was universally fatal, although today the large majority of children with leukemia are cured. The second cover is from Ethiopia, in 1988, and is stamped by four remarkable stamps that show children with measles, tetanus, whooping cough, and diphtheria, all vaccine-preventable infections.
This 1958 Argentinian First Day of Issue cover celebrates “Lucha contra la Leucemia,” the fight against leukemia.
This cover from Ethiopia, with four remarkable stamps, shows children with measles, tetanus, whooping cough, and diphtheria, all vaccine-preventable infections.
- Kristof ND. Compassionate conservatives, hello?The New York Times. January28, 2016.
- Siegel BE. The real problem with lunch. The New York Times. January16, 2016.
- Aubrey A. Food fight fizzles as senate nears compromise on school nutrition rules. http://wamu.org/news/16/01/20/food_fight_fizzles_as_senate_nears_compromise_on_school_nutrition_rules. Accessed February 15, 2016.
- Gunviolencearchive.com website. Accessed February 15, 2016.
- Kawasaki T. Acute febrile mucocutaneous syndrome with lymphoid involvement with specific desquamation of the fingers and toes in children [in Japanese]. Arerugi. 1967;16(3):178–222.