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In a move that has sparked con-siderable reaction from the pharmaceutical manufacturers, the Surgeon General has issued an advisory against the use of aspirin and other medications containing salicylate to treat chicken pox, influenza, and influenza-like illnesses in children.

The warning came because the use of such drugs has been associated with Reye's syndrome, a rare, acute, life-threatening condition that occurs most commonly in children who are recovering from viral infections. The syndrome is characterized by vomiting and lethargy that may progress to delirium and coma. Researchers at the Centers for Disease Control (cdc) estimate that between 600 and 1,200 cases occur in the U.S. each year; between 20 and 30 percent of these are fatal. Permanant brain damage has been reported in survivors.

Several studies have suggested recently that administration of the drugs may be a factor in the origin of the syndrome. Two federal agencies--cdc and the Food and Drug Administration--have reviewed the issue recently, as has the American Academy of Pediatrics.

All have concluded that until more information is available, parents, physicians, and other health professionals should be aware of the risk.

The perception that fatal violence against children has increased has been verified by the Centers for Disease Control (cdc), which reported last week that homicide is now among the top five causes of death for people 1- to 17-years-old.

Showing a six-fold increase in the crime since 1925, the statistics reveal that homicide accounts for 5.1 percent of all deaths, nationally, of those under 18. This compares with a homicide rate of 1 percent for people over 18. In general, homicides by parents constitute the minority--29 percent--of the cases.

In an accompanying editor's note, cdc officials point out that the numbers show two distinct patterns of child homicide. For children under 3 years old, homicide is often characterized by family violence, "ill-defined circumstances," and "the use of bodily force rather than guns or knives." This pattern could, the editors of the report say, "be defined as fatal child abuse."

For older children, a different pattern predominates. Those child homicides committed against children 12 years old or older are characterized by violence that involves people outside the family, is associated with arguments or the offender's criminal behavior, and involves the use of guns or knives.

"This pattern may represent a child thrust into an adult environment or life style for which he/she is not developmentally prepared and in which he/she is not properly supervised," the report says.

This major and increasingly common cause of death is generally ignored but "merits public health attention and might be defined as fatal parental/societal neglect," the report says. Homicides of children between the ages of 3 and 12 are a mix of these two patterns, according to the editors.

Preventive measures, which could be based on parent education, family planning, neighborhood networking, and stress reduction, could be one way of combatting the problem, the editors say. But they note that further research is needed to see if these practices are indeed effective. The report appeared in the cdc's June 11 Morbidity and Mortality Weekly Report.

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