^{THE INTERNATIONAL CHILD AND YOUTH CARE NETWORK}
HOME  /  OTHER JOURNALS

EXTRACTS FROM OTHER JOURNALS RELATING TO CHILDREN, YOUTH AND FAMILIES — IN THE FIELDS OF HEALTH, SUBSTANCE ABUSE, EDUCATION, PSYCHOLOGY, SCIENCE

April 2002

California's Anti-Smoking Campaign Is a Success
More than ever before, Californians are breathing cleaner air at work and in their homes thanks to the tough anti-smoking laws and educational campaigns in that state, researchers say.
Compared with a decade ago, the number of workers reporting smoke-free workplaces has nearly tripled, according to a report published in the May issue of the American Journal of Public Health, journal of the American Public Health Association (news - web sites).
"Over the past decade, Californians have reported steadily decreasing exposure to secondhand smoke in the workplace, as well as increased smoke-free home environments, which indicates that clean air legislation combined with education is making an impact," said lead author Elizabeth A. Gilpin of the University of California, San Diego.
The percentage of people working indoors who say their workplace is smoke-free increased from 35% in 1990 to 93% in 1999. Indoor workers who say they are exposed to secondhand smoke decreased from 29% to 16%, the authors report.
And fewer people are smoking in their homes, according to the investigators, who note that smoke-free homes jumped up to 74% in 1999 from 38% in 1992. What's more, nearly half of all smokers reported having smoke-free homes.
"The 6.6% of indoor workers who failed to report that their indoor workplace is smoke-free, and the 15.6% of indoor workers reporting exposure to secondhand smoke in their work area in the past 2 weeks in 1999 indicate that compliance is not complete," Gilpin's team writes. "This study cannot determine whether lack of compliance is due to lack of knowledge of the law or lack of enforcement," they add.
The reduction of smoking is largely due to increased public awareness of the dangers of secondhand smoke, the researchers point out.
"Educating the public will continue to be the most effective method of keeping California's indoor air free of secondhand smoke," Gilpin said in a prepared statement.
"Awareness programs targeted at demographic groups will reinforce existing mass media messages. Being armed with information about the dangers of secondhand smoke is the best way for everyone--smokers and non-smokers--to change behaviors," she concluded.
California began in 1994 to phase in its ban on smoking in nearly all indoor workplaces. The trend has since spread throughout the country and around the world.
SOURCE: American Journal of Public Health 2002 May.

Child Prostitution a Global Problem
 An estimated 1 million children around the world are forced into prostitution every year and the total number of prostituted children could be as high as 10 million, according to a report released Thursday.
"Child prostitution, like other forms of child sexual abuse, is not only a cause of death and high morbidity in millions of children, but also a gross violation of their rights and dignity," write co-authors Brian M. Willis, of the US Centers for Disease Control and Prevention (news - web sites), and Dr. Barry S. Levy of Tufts University in Boston, Massachusetts, in the April 20th issue of The Lancet.
Both boys and girls can be prostituted and, according to the report, some of the children are as young as 10 years old.
"Most of these children are exploited by local men, although some are also prostituted by paedophiles and foreign tourists," the authors write.
In their report, the investigators estimate the number of children exploited by prostitution is highest in India with estimates between 400,000 and 575,000; Brazil is second with estimates between 100,000 and 500,000; the US is third with 300,000 children; and in fourth place is Thailand and China with 200,000 children each.
With regard to illnesses, Willis and Levy report that, worldwide, millions of children are infected with sexually transmitted diseases, have abortions, attempt suicide and are raped each year. They note that in parts of southeast Asia, 50% to 90% of children rescued from brothels are infected with HIV (news - web sites).
"A coordinated international campaign is needed to prevent child prostitution, provide services to children who are prostituted until they can be removed from prostitution, and implement effective recovery and reintegration programmes," Willis and Levy note.
"For (such a) campaign to be successful, it will require global coordination, implementation at national, regional and community levels, and the leadership of many health professionals.
"The prostitution of children and the related health consequences have been accepted for far too long. The time has come to make them unacceptable." Levy and Willis conclude.
SOURCE: The Lancet 2002;359:1417-1421.

US Teens Suffering Weekday Sleep Deprivation
 Many American adolescents who sleep late on the weekends may be trying to compensate for chronic sleep deprivation during the week, researchers say. And, they warn, catching extra sleep on non-school days won't make up for this deprivation.
"Definitely teenagers need more sleep, and getting more sleep would help them in regards to all aspects in their life--healthwise and potentially in terms of grades and other things," said study lead author Dr. Kathryn J. Reid of Northwestern University in Evanston, Illinois.
Reid and her colleagues surveyed 729 boys and girls aged 12 to 17 at the time of their admittance to the same juvenile detention center. The teens were also asked about their drug and alcohol use, history of mental and physical disorders and socio-economic backgrounds. |
Presenting her findings on Thursday at the American Academy of Neurology's annual meeting in Denver, Colorado, Reid said that 45% of the adolescents reported being sleepy a lot during the day. And while just over 70% said they felt refreshed upon waking, 15% said they regularly counted on drugs to help them fall asleep.
The investigators found that regardless of age, the youths racked up the same amount of daily sleep--an average of 8.5 hours during the week versus just over 9.5 hours on the weekend. However, they noted that the older teens tended to have different nighttime and morning habits--going to bed and waking up later then the younger teens during both the week and weekend.
Reid and her team pointed out that sleep time duration among the teens was generally longer than had been observed in previous studies--perhaps because not all the adolescents were attending school with early morning start times.
Suggesting that early class start times may be forcing teens to artificially lose sleep, the researchers noted that those teens going to school slept less during the week then those who didn't--but that all the teens slept the same amount of time on the weekends.
Reid told Reuters Health that further analysis of the research would examine how sleep deprivation--and its relationship to early school start times--might negatively impact the mental health, academic performance and behavior of teens, as prior research has indicated.
Already, she noted, the evidence is in that natural sleep patterns among teens are not the same as those found among either adults or very young children.
"Teenagers tend to be 'delayed'--that is, they naturally go to bed later and wake up later than children of other ages or adults," said Reid. "And they tend to need more sleep than an adult does. The standard for adults is between 7.5 to 8.5 hours, while for teenagers it's between 9 and 9.5 hours."
Acknowledging and allowing for this distinction, Reid added, could help parents and educators ensure that children get the sleep they need.
"I think it would depend on each individual, but I think being aware that your child needs to get a decent amount of sleep is important," she said. "Because the impact of sleep loss is immediate and it builds up over time.... Generally, kids are trying to catch up on the weekends--but it's not going to help them during the next week. You can't bank sleep. You can't sleep 12 hours today and expect that you can get away without sleeping the next night or sleeping less."

Teens' Self-Esteem Linked to Virginity Loss
 Self-esteem appears to be linked to when young teens lose their virginity, new study findings suggest. And self-esteem seemed to play a different role for each gender. While girls with higher self-esteem were less likely to have sex early, the researchers found, the opposite was true for boys.
Previous research has examined the various negative consequences of early sexual intercourse in adolescents, but few studies have aimed to identify the role self-esteem plays when young people choose to begin having sex.
In the current study, lead investigator Dr. Gregory D. Zimet of Indiana University School of Medicine in Indianapolis and colleagues evaluated 188 students when they were between the ages of 12 and 14 and were in the seventh grade. The study participants had identified themselves as virgins in a questionnaire that also measured various aspects of their self-esteem. Nearly 2 years later, the same teens, now in aged 14 to 16 and in ninth grade, were surveyed again with the same questionnaire.
"Self-esteem functioned differently for boys and girls in terms of its relationship with the initiation of sexual intercourse," Zimet told Reuters Health in an interview.
"Seventh-grade girls with high self-esteem were less likely to subsequently initiate intercourse, whereas seventh-grade boys with high self-esteem were more likely to initiate intercourse," he said.
While the researchers propose several possible explanations for the findings in their study, which is published in the April issue of the journal Pediatrics, Zimet told Reuters Health that they have no definitive explanation.
"In a sense," he said, "the different findings from boys and girls may reflect the larger society's differential attitudes about sexuality based on gender.
"Given that sexual behavior among girls has often been characterized by society as more socially deviant, it may be that high self-esteem in girls acts as a protective factor by helping them to resist peer pressure to become sexually involved before they are ready," Zimet noted.
"Also, girls with low self-esteem may initiate a sexual relationship in order to feel better about themselves, by providing themselves with the comfort derived from intimacy and/or a sense of maturity," he suggested.
"In contrast, given that sexual behavior among boys has often been characterized as more acceptable, early sexual initiation for boys may be seen as a badge of honor," Zimet pointed out.
Also, those boys who have higher self-esteem may be more socially confident and more likely to find willing partners than boys with low self-esteem, he explained.
The results of this study, according to Zimet, suggest that sex education programs should consider the complex, gender-specific nature of self-esteem and "not assume that 'one-size-fits-all."'
He added, "Clearly, it makes little sense to try to lower the self-esteem of young adolescent boys. However, the findings do suggest that helping girls to feel more self-confidence and self-respect may help them to delay initiation of sexual intercourse."
SOURCE: Pediatrics 2002;109:581-584.

Parent's Depression Ups Kid's Risk of Anxiety
 Having at least one parent with major depression increases a child's risk for depression as well as substance abuse and anxiety disorders in late adolescence and early adulthood, new study findings show. What's more, the child's depression is likely to be more severe than the parent's, a team of German researchers report.
"This study has once more demonstrated that offspring of depressed parents constitute an important high-risk group," write lead study author Dr. Roselind Lieb, of the Max Planck Institute of Psychiatry in Munich, Germany and colleagues.
"Specifically, the early detection of mental health problems in offspring of depressed parents seems to be crucial, as this would allow the treatment of early manifestation of mental problems before they cause clinical impairment," the authors add.
The study results are based on surveys of 2,427 German youth, aged 14 to 24 years, and their parents.
Forty-two percent of the mothers and 23% of the fathers were either diagnosed with major depression or experienced at least one depressive episode, the investigators report in the April issue of Archives of General Psychiatry. For one third of the study sample, only the mother had major depression, but for 16%, both parents were affected.
A follow-up survey, conducted 3.5 years after the initial survey, revealed that nearly one in five offspring had experienced at least one episode of major depression and about 4% had symptoms of lifetime dysthymia--a milder, chronic form of depression, Lieb and colleagues report. Those with at least one depressed parent had a roughly three-fold greater risk of depression than their peers with non-affected parents.
Further, children of depressed parents had an earlier onset of depressive disorders and more severe depression than children of nonaffected parents. They also reported having more depressive episodes, being more impaired in their social and leisure activities and seeking more treatment for depression than did their peers, study findings indicate.
What's more, in addition to a higher rate of depressive disorders, children of depressed parents also had higher rates of substance abuse and dependence disorders and anxiety disorders, such as obsessive-compulsive disorder, than did their peers with nondepressed parents, the investigators report. Those with one depressed parent were generally at similar risk for the various mental disorders to those with two depressed parents. Overall, 43% of the youth reported having substance use disorders, including nicotine dependence and drug and alcohol abuse and dependence, and 35% reported having anxiety disorders, study findings indicate. Those with at least one depressed parent were reportedly 40% more likely to have a substance abuse disorder and 60% more likely to have an anxiety disorder than individuals with nondepressed parents.
"Major depression in parents increases the overall risk in offspring for onset of depressive and other mental disorders and influences patterns of the natural course of depression in the early stages of manifestation," the researchers conclude.
SOURCE: Archives of General Psychiatry 2002;59:365-374

Young Love May Hold Clues to Later Depression
 New research suggests that teenage romance may have a profound influence on depression later in adolescence.
In a small sample of eleventh grade girls, the risk of becoming depressed later in adolescence was related to the quality of the girls' first romantic relationship, reported researchers from the University of North Carolina at the biennial meeting of the Society for Research on Adolescence in New Orleans.
The results are based on a survey of 54 girls that focused on their current levels of depression, their age during their first romantic relationship, and the amount of intimacy and companionship they felt from that relationship.
The authors found that girls who felt they had a less than ideal relationship based on measures of intimacy and companionship were more likely than others to be depressed during their late adolescence.
Researchers have only begun to examine romantic relationships in adolescence, lead author Suzanne Levy told Reuters Health, so there is much to be learned. However, this study shows that the type of relationship may have a bigger impact than the age at which a girl begins dating.
"Maybe it's more the experience during that first relationship, not just the age," she said.
Other aspects of the dating experience that are important to examine, Levy added, are how much time the couple spends alone versus in a group, whether they venture out on dates or only see each other in school, and how aware parents are of the relationship. Interestingly, Levy found that, contrary to what she expected, parental support of early relationships did not help teens ward off later depression. However, Levy cautioned that these results do not mean that there is nothing parents can do.
The authors measured parental support of dating relationships by asking adolescents if their parents supported dating now, and not during those first relationships; therefore, Levy explained, this study could not show if parental support had changed over the years. And 54 people may not be a large enough group to detect the positive effects parents can have on relationships.
"I think there's lots of ways parents can help--we're just not sure of those ways yet," Levy said.
In another presentation at the same conference, researchers showed that teens who are more preoccupied with romantic thoughts--both in early and middle adolescence--are more likely to be depressed and exhibit aggressive behaviors like acting out.
"Perhaps these romantically preoccupied teens exhibit a ruminative style of coping, which then in turn leads to symptoms of psychopathology, whereas their non-preoccupied peers tend to distract themselves more from romantic thoughts," lead author Laura Keys of the University of Vermont speculated in an interview with Reuters Health.
The study is based on questionnaires given to 81 seventh graders and 74 tenth graders.
The researchers found that both boys and girls with relatively more romantic thoughts were more likely to be depressed or act out, but girls reported more romantic thoughts than boys. In addition, younger children with many romantic thoughts were more likely than romantically preoccupied tenth graders to act out, exhibiting what are known as externalizing behaviors, or have symptoms of depression.
"In other words, romantic preoccupation is linked to depressive symptoms and externalizing behaviors in teens, but even more so for young adolescents," Keys explained.
The lead authors of both studies cautioned that their results only establish links between factors, and do not show that one factor causes the other. For example, Levy said that the teens in her study who are depressed are perhaps more likely to look back on their previous relationships and rate the experience as less intimate than it really was. Keys added that teens who already have behavioral problems or symptoms of depression may be more likely to seek out romantic experiences and think about them more.
Both agreed that more research is needed into adolescent relationships, but that interest in the topic appears to be growing.
"It looks like researchers are starting to realize what an important role romance plays in the teenage years," Keys said.

Men Face Abuse as Often as Women: UK Researcher
Men are just as likely as women to be victims of domestic abuse, but are too embarrassed to talk about it, a British researcher said on Friday.
Professor John Archer of the University of Central Lancashire analysed 17 international studies from the US, Canada, New Zealand and the United Kingdom published over the last 20 years.
The report included acts of physical aggression such as slapping, hitting, kicking and even extreme violence such as murder.
Women were more likely than men to receive physical injuries as a result of domestic attacks, but men were equally likely to be victims of less violent forms of abuse, he said at a British Psychological Society conference in Manchester.
"If you take into account all acts of physical aggression, then there's about equal numbers of men and women being abused," he told Reuters Health in a telephone interview.
When he looked at the number of cases that resulted in injuries, he found that 38% were men and 62% were women.
"The expectation I had was that it was going to be overwhelmingly the women who got injured. Given that they are more likely to be injured, why is it that they engage in acts of aggression with their partners?" Archer asked.
"Women might think they can get away with this kind of abuse because the men who are the victims are not taken seriously. They are seen as 'whimpish' and are ridiculed. Men are supposed to put up with a little bit of injury," he said
The study also looked at the level of fear experienced by the victims of domestic violence. He found that the levels were higher in women but the difference was not as big as he had expected.
This research could help change the way police handle domestic violence situations and may lead to an increase in counselling services for male victims, Archer suggested. But he acknowledged this sort of change was likely to take some time.
A follow-up report on his research will be published in Psychological Bulletin, the main review journal of the American Psychological Association, later this year.
 

Home Affects Mental Development of Fragile X Kids
 An enriched, structured home environment can aid in the mental development of children with an inherited form of retardation known as fragile X syndrome, a new study shows. In fact, the researchers found, such an environment was more beneficial for the retarded children than their healthy siblings.
The findings imply that "the more that a family can encourage learning, enrich the household, and structure the household so that distractions are minimized and routines are maximized, the better these children will be at developing attentional skills," study author Dr. Jennifer Dyer-Friedman of Stanford University in California, told Reuters Health.
The effects of fragile X syndrome range from mild learning disability and hyperactivity to severe impairment or autism. The syndrome results from a defect in a gene on the X chromosome known as FMR1.
To better understand factors that influence the mental or cognitive development of children with fragile X syndrome, Dyer-Friedman and colleagues evaluated 120 families that had one child with the inherited developmental disability and another sibling without the disease. The researchers conducted 8-hour, in-home visits to assess the IQ of the parents and children and to evaluate the home environment. The findings are published in the March issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
Parental IQ was the strongest predictor of cognitive outcome in unaffected children, Dyer-Friedman noted. However, "the predictive value of parental IQ was somewhat less strong for affected girls and significantly less strong for boys affected with fragile X," she said. "It means that the mutation is mitigating the impact of parental IQ."
She continued, "The enrichment and structure of the home had much more of a predictive value for the fragile X kids than for the unaffected kids. Unaffected kids' intelligence is strongly determined by their genetic material. For those with fragile X, the home environment had a significant impact on overall cognitive aptitude as well as their freedom from distractibility."
The research team has obtained funding to conduct a study of these same families over time, the Stanford researcher said. "We hope this lays the groundwork for more studies on the effectiveness of home-based, school-based, and therapist-provided interventions," she added, "because we believe interventions are very important. We just don't know yet what works for whom."
SOURCE: Journal of the American Academy of Child and Adolescent Psychiatry 2002;41:237-244.

Parents Who Kid Around Raise Better Kids - Study
 Parents who use humor, rather than sarcasm, to resolve the inevitable conflicts that arise during their child's adolescent years may have children who are better able to regulate their own emotions during difficult situations, new study findings suggest.
"Parents who joke in a light-hearted fashion during tense or stressful situations...may make their adolescents feel more comfortable and accepted, less anxious, and more willing to communicate in a positive manner," lead study author Elizabeth Stanley of Arizona State University told Reuters Health.
"Perhaps parents can use and create an appreciation for humor in the home as a way of fostering positive coping skills and preventing maladaptive functioning in their children," she added.
Stanley and her colleagues, under the direction of Dr. Nancy Eisenberg, studied 139 youth aged 11 to 16 and their parents. Each adolescent-parent pair participated in a 6-minute conflict resolution task that was videotaped.
Overall, parents who used humor--joking, lightheartedly using absurd statements, etc.--during the exercise were more likely to report that their child was resilient, socially competent, better able to regulate his or her emotions and exhibited less problem behavior than parents who used derisive humor, such as sarcasm and malicious mimicking, study findings indicate. \
Further, parents who used joking-style humor were also reportedly more likely to have children who used humor in a similar fashion.
In general, parental humor was associated with adolescent resiliency through the adolescents' ability to regulate their emotions, according to Stanley and her team. The adolescents' resiliency then led to their social competence.
One explanation for the overall relationship between parental humor and adolescent social competence may be that "parents who model humor for their children have adolescents who are more likely to be able to access that humor to help them cope and function in socially appropriate ways," Stanley speculated. "On the other hand, it may be the case that kids who are well regulated and socially competent are better able to control their anger and aggression in stressful situations and use humor instead, which feeds into the parents' use of humor," she added.
Stanley hopes to determine the exact nature of the relationship in future research.
The study findings were presented on Sunday during the ninth biennial meeting of the Society for Research on Adolescence in New Orleans, Louisiana.

Study Confirms Damage to Cocaine Babies
 Mothers who use cocaine during pregnancy put their child at risk of mental retardation and other developmental problems, a study said on Tuesday.
While previous studies of "crack babies" who were exposed to cocaine in the womb have produced mixed findings about drug-related problems, researchers at Case Western Reserve University said most of that research was flawed while theirs was careful and comprehensive.
They monitored 218 cocaine-exposed babies for two years and compared their progress to 197 unexposed children born at the same Cleveland hospital in the mid-1990s. Mothers and their infants were tested initially for cocaine, and all the mothers came from a lower socioeconomic stratum where the risk of prenatal drug use was higher.
The study, which appeared in this week's Journal of the American Medical Association, found that 14 percent of the cocaine-exposed children were mentally retarded at age 2, double the rate of the nonexposed children and nearly five times the rate expected in the general population.
Nearly double the cocaine-exposed group suffered mild cognitive delays reflecting diminished memory, language, and problem-solving skills. Cocaine-using mothers were also heavier users of alcohol and tobacco than nonusers in the study, producing other detrimental effects such as on their children's motor skills.
Study author Lynn Singer, a pediatrician and psychiatrist at the university, said the contradictory findings of previous studies reflected high dropout rates, small sample sizes and neglect of environmental factors such as a poverty.
The study's results argued for improved prenatal care as well as boosting the quality of stimulation in the children's environment that "can have a large effect on children's mental development independent of cocaine or other drug exposure," Singer said in a statement.
"We hope that this study will convince public policy and health providers that there needs to be a major emphasis on the provision of drug treatment, including smoking cessation, and mental health services for women -- especially poor women who are currently underserved," she said.

Sports Cause Most Accidental Injuries Among Kids
Soccer or basketball may teach your child how to be a team player and instill a love of physical activity, but according to the results of a new study, playing sports is the leading cause of accidental injuries among US kids.
Researchers reviewed data on injury-related visits to pediatricians in the US by more than 6,300 children younger than 19 and found that nearly 20% of all accidental injuries could be blamed on sports and overexertion.
Sports-related injuries increased with age, peaking in adolescence, and white kids were more likely to visit the doctor for an injury related to sports than black or Hispanic children were, the report indicates. Open wounds, sprains and contusions were among the most common injuries and basketball, football, and baseball or softball caused more injuries than other sports.
Accidental falls, bites and stings, knives and scissors also account for a large percentage of the more than 10 million injury-related doctors' office visits that occur each year, the researchers report in the April issue of Pediatrics. Boys, older kids and those living in the Western US were more likely to visit a pediatrician for an injury.
Younger children were more likely to be injured by an accidental fall.
The findings point to several preventable causes of childhood injury and identify youngsters who might be at high risk, according to Dr. Simon J. Hambidge and colleagues from the University of Colorado in Denver. In the US, accidental injuries account for 44% of all childhood deaths--a greater percentage than all infectious diseases combined and twice the rate in other developed countries.
"Identifying potentially preventable external causes of injury and characteristics of children who are more likely to be injured is important both for injury prevention programs and for the education of physicians who care for children," Hambidge and colleagues conclude.
Using chest pads for baseball and helmets for football can help to lower the rate of injuries among older children, the researchers advise, while avoiding walkers and using stair gates can help prevent injuries among younger kids.
SOURCE: Pediatrics 2002;109:559-565.

Belittling, Shaming Child Causes Lasting Damage
Parents need to shower their children with kudos and kisses rather than harsh criticism, according to newly released guidelines from pediatricians on psychological abuse.
"Physical wounds heal, but psychological scars can last a lifetime," Dr. Charles Johnson, professor of pediatrics at Ohio State University in Columbus and chairman of the American Academy of Pediatrics' (AAP) committee on child abuse, told Reuters Health.
The report, entitled "The Psychological Maltreatment of Children," is the first set of guidelines issued by the AAP to address the issue of psychological mistreatment of children. Published in the April issue of the journal Pediatrics, the report aims to help pediatricians screen for and spot this form of abuse.
The report's authors define a variety of ways that parents can psychologically damage a child, including belittling, shaming, or exploiting; terrorizing, such as threatening violence against them or a loved one; denying emotional responsiveness, such as rejecting or denying affection; and acting inconsistently, for example by making contradictory or unrealistic demands.
According to Johnson, of the million instances of child abuse reported annually, around 5% to 7% of all reported cases consist exclusively of this form of psychological abuse.
The report helps pediatricians spot children experiencing psychological mistreatment by advising which are at greater risk: those whose parents are involved in a contentious divorce, those who were unwanted or unplanned, those whose parents abuse drugs or alcohol, and those who are mentally or physically handicapped.
Children who are mistreated are at greater subsequent risk of suffering a variety of ailments, including depression and suicidal thoughts, low self-esteem, impulse control problems, eating disorders, substance abuse problems, antisocial behavior, delinquency, learning impairments and poor health.
In addition to being on the lookout for children being abused in this way, pediatricians should attempt to guide parents towards more appropriate parenting techniques, Johnson noted.
"A lot of parents say, 'I love my child,"' notes Johnson. "But do they love their child as it is--or as they want it to be?" He encouraged parents to put themselves in their child's shoes and try to reinforce positive behavior rather than to criticize negative behavior. "The way to shape behavior is to reward what you want to see," he said.
SOURCE: Pediatrics 2002;109:e68.

___