Objective. To review the clinical course of 16 children with recalcitrant dermatomyositis (DM), who were treated with oral methotrexate (MTX) in addition to prednisone.Methods. Sixteen patients with recalcitrant DM who were treated with MTX in addition to prednisone were followed between 1984 and 1990. The patients' clinical responses to treatment, including alterations in muscle strength and muscle enzyme levels, changes in prednisone dosage, and development of toxicity or complications were reviewed retrospectively.Results. All 12 patients who received MTX for at least 8 months regained normal muscle strength. In 11 of the 12, the prednisone dosage could eventually be tapered to 5 5 mg/day. Complications during MTX treatment required discontinuation of MTX in 5 patients, and were unrelated to the cumulative dose of the drug. Active disease recurred in 5 patients in whom MTX had been discontinued after apparent clinical remission had been achieved.Conclusion. MTX, in combination with prednisone, is a useful adjunct in the treatment of recalcitrant childhood DM. However, recurrence of disease after withdrawal of MTX suggests that the drug may have a suppressive, rather than a remittive, effect. Most children with dermatomyositis (DM) can be treated successfully with corticosteroids ( 1-3). However, some patients relapse after initial improvement, have an incomplete response, or develop untoward side effects. In these patients, a variety of immunosuppressive treatments, including methotrexate (MTX), azathioprine, cyclophosphamide, hydroxychloroquine, and plasmapheresis, have been used as adjuncts to corticosteroid therapy (4-9). Although no controlled trials of these agents in either childhood or adult DM have been reported, there are several reports of retrospectively analyzed patient series in which the efficacy of MTX in the treatment of adults with DM has been investigated (10,ll). In addition, several case reports suggest that MTX may be useful in the treatment of childhood DM. In this investigation, we evaluated the clinical courses of 16 children with recalcitrant DM treated with MTX in addition to prednisone, in order to examine the efficacy and safety of this treatment regimen . PATIENTS AND METHODSThirty-four children with definite childhood DM were followed up prospectively by the same observers, in the pediatric rheumatology clinic at the Floating Hospital for Infants and Children, between 1984 and1990. Sixteen of these patients had recalcitrant DM and were treated with MTX in addition to prednisone. These 16 children were the subjects of the present investigation.Data evaluated included sex, age at onset of DM, disease duration (pre-prednisone and pre-MTX), muscle strength (at presentation to the Floating Hospital and at initiation of MTX), clinical responses to treatment including changes in prednisone dosage and development of toxicity or complications, and duration of followup. Classification of the clinical course of each patient prior to the institution of

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The objective of this prospective study was to determine the impact of early literacy anticipatory guidance (AG) with provision of books on language development in 3-year-olds in an early literacy program at a University-affiliated inner-city pediatric clinic. The Peabody Picture Vocabulary Test (PPVT-III) and the Expressive One Word Picture Vocabulary Test (EOWPVT-R) were administered to 33-39-month-old children exposed to an early literacy program, which included AG and provision of an age-appropriate book at each well-child visit starting at 2 months old. Children with developmental delays were excluded. Parental surveys on literacy and demographic data were obtained. Univariate and multivariate analyses were performed. Sixty-four children were evaluated; 88% African American, 89% Medicaid recipients. Fifty-eight percent of families reported family-centered literacy orientation. The PPVT-III scores directly correlated with the number of AG visits with book given x number of books purchased (r2 = 0.025, p = 0.0006). Higher scores in EOWPVT-R were predicted by race and the number of visits with books given x number of books purchased (r2 = 0.182, p = 0.0009). All families reported reading together, half reporting positive family-centered literacy. Given the same number of books purchased for each child, the outcome scores were higher the greater the number of clinic visits wherein AG included early literacy and provision of books.

Obesity is a common nutritional problem among children. Using the Futrex 5000A method of bodyfat measurement, this prospective study determined the percentage bodyfat in a self-selected, indigent, predominantly black population and the accuracy of perceived body image. Bodyfat exceeded the optimal range in 39% and 67% of female and male children, respectively. Females tended to view themselves as fatter and males perceived themselves as thinner than their actual composition. Parents were more accurate in their perception of obesity in their daughters (88%) than in their sons (52%). Children did not recognize the importance of exercise in preventing obesity. Bodyfat measurement and counseling should be done at an early age to improve this remarkable lack of perception about obesity.

BACKGROUND: Apnea in an infant can be a diagnostic dilemma for the treating pediatrician. It is suggested that in some infants, gastroesophageal reflux (GER) might be a factor in the pathogenesis of apnea, although its role as a cause of apnea is still controversial.OBJECTIVE: To evaluate the prevalence of GER in infants presenting with recurrent brief apneic periods.PATIENTS AND METHODS: A retrospective review of the medical records of all the infants who underwent prolonged esophageal pH studies for brief apneic episodes (n=105) at the Kosair Children’s Hospital in the six years from January 1992 to December 1997 was performed. Infants presenting with apparent life-threatening episodes were excluded.RESULTS: Of 105 infants, 72 (68.6%) were younger than two months of age and 22 (21%) were born preterm. Fifty of 105 infants (47.6%) had positive esophageal pH studies for acid reflux. Among infants with positive pH studies, only 21 (42%) had associated gastrointestinal or feeding complaints.CONCLUSION: GER is present in a large number of infants presenting with brief apneic episodes. Though the relationship between the two is still not fully established, GER may be a significant risk factor for such apneic episodes in infants.