\s=b\ Febrile seizures are a common pediatric problem, yet there is a great deal of disagreement about the appropriate diagnostic evaluation of a child with this disorder. We reviewed the routine diagnostic tests performed on 100 consecutive children admitted with their first "simple" febrile seizure. The studies performed included lumbar puncture, measurement of blood glucose, serum calcium, serum electrolytes, and BUN levels, blood cell count, urinalysis, skull roentgenograms, and EEG. Though resulting in a significant expense, these routine investigations proved to be of little diagnostic value. Based on this experience and a review of the current literature, we concluded that diagnostic procedures should be performed only when specifically called for by the patient's condition or medical history. (Am J Dis Child 1981;135:431-433) Approximately 3% to 5% of all chil-11 dren will have experienced at least one febrile seizure by the time they enter school.'1 More than 80% of these febrile seizures may be classi¬ fied as "simple": a single, isolated seizure that occurs in a febrile child between 1 month and 7 years of age with no sign of acute neurological disease, lasting 15 minutes or less, and without focal features.' As shown by a recent nationwide survey of pediatricians, there is a great deal of disagreement about the appropriate diagnostic evaluation of children with first febrile seizures.4 Some have recommended that lumbar punctures be performed routinely, along with determinations of blood glucose, serum calcium and phospho¬ rous, electrolyte, and BUN levels. Additionally, blood cell count, urinalysis, skull roentgenograms, and EEG are often routinely performed/'" Re¬ cently, however, the value of these investigations has been seriously questioned.7 * Much of this confusion is attributable to the lack of informa¬ tion on the yield of commonly per¬ formed diagnostic procedures, and perhaps to the failure to distinguish between simple and complex febrile seizures. Lumbar punctures are often per¬ formed on children with febrile sei¬ zures to exclude meningitis as the cause of the seizure. Thirteen percent to 18% of the children with meningitis may initially appear with a febrile seizure, and approximately 40% of these children may have no clinical signs of meningeal irritation." "' The majority of these children without clinical evidence of meningitis were, however, younger than 2 years of age, and a careful differentiation of simple and complex febrile seizures was not attempted by the authors of these reports. Many believe that a history of previous febrile seizures or the iden¬ tification of a potential source of fe¬ ver outside of the CNS preclude the necessity for a lumbar puncture in a child with a febrile seizure. However, a significant number of children with febrile seizures who are diagnosed as having meningitis have a history of previous febrile seizures or a potential source of fever outside of the CNS.!M" Wolf et al reviewed 308 lumbar punctures performed on children with their first febrile...

A survey of 237 pediatricians currently practicing in Connecticut revealed that 97 (41%) recommend routine sterilization of infant formula for a mean of 4.4 months. Eight bottles of proprietary formula were prepared in a controlled manner: four utilizing the "terminal heating method" of sterilization and four utilizing the "clean method" without sterilization. While the "terminal heating method" resulted in less bacterial contamination, three of the bottles prepared by the "clean method" had negative coliform counts and the other bottle had a minimal count. Ten bottles prepared without sterilization were randomly selected from mothers who had brought their infants for well-child care. With the exception of a small inoculum of enterotoxin-producing Staphylococcus aureus in one bottle, no enteropathogens were identified. The implications of this study for the routine preparation of infant formula are discussed.

I am not sure that Lewak's theme1 is borne out by his case description. Despite the absence of findings at autopsy, it is difficult for me to think of this infant as being a victim of sudden infant death syndrome. As a matter of fact, I would respectfully suggest that this baby had pertussis. This would certainly not be an unusual mode of death.

The clinical description of the little girl's disease which is provided in the article by Manzella et al1 is certainly sufficient for a diagnosis, and biopsy rather than being "essential" is an unnecessary and unwarranted intervention. I am puzzled by the diagnostic term "toxic epidermal necrolysis" as used here. What is described is a typical instance of erythema multiforme bullosa (Stevens-Johnson syndrome), a disorder which involves the mucous membranes as well as the skin. This entity is readily distinguishable from the staphylococcal scalded skin syndrome (toxic epidermal necrolysis, staphylococcal scarlet fever, Ritter's disease of the newborn) by the fact that the latter patients exhibit neither bullae nor mucous membrane involvement.