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The Informed Parent

Scanning The Journals: Father’s Role; Growth-Hormone Deficiency; ADHD

by John H. Samson, M.D., F.A.A.P.
Published on Dec. 05, 1997

The Father's Role During Infancy:

Arch.Ped.Adol.Med. July 1997: V.151: p. 705

This study, out of Johns Hopkins University School of Medicine, shows that the father's participation in infant care-giving and decision-making is related to:

1. the mother's desire for the father's participation

2. the strength of the mother/father relationship

3. the mother's evaluation of the father as a parent

The statistics showed: 1. 81% of the mothers assumed some paternal involvement. 2. 30% of the mothers assumed the father would participate in child-care decisions 3. 34% of the mothers expected to share all decisions 4. 30% expected to share none. Fathers who had jobs and were without children from a prior relationship were more involved.

It is interesting to note that 19% of the mothers expected no paternal involvement and 30% expected to share no decisions on infant care with the father.

My own practice experience supports the concept that the mother's desire for paternal involvement is significant. I have had too many mothers indicate to me that raising children is the mother's job, and dad is not needed for routine care. The message comes across by word and body language. When the male child approaches preadolescence and mother's control diminishes greatly, then, with some reservation, she lets dad get involved.

Paternal involvement is multifactorial. But as this article points out, the mother's desires and expectations are prime factors in dad's participation in child-care.

Making a Rational Diagnosis of Growth-Hormone Deficiency:

Journal of Pediatrics, V. 131; #1, part 2, July 1997, p. 561

Many parents of children with short stature are always concerned about taking action that will help the child gain height. The question of growth-hormone deficiency always enters the discussion. Tracking linear growth is very useful in assessing the need to evaluate the presence of growth-hormone. Sometimes parental anxiety cannot be allayed by growth charts and calculation of height gain alone.

The actual measurement of G-H is arduous and expensive. The author points out that two serum factors, measured simultaneously, correlates well with actual G-H levels. He found that if serum insulin-like growth factor I and insulin-like growth factor binding protein 3 were both low, there was a good correlation with growth-hormone deficiency. Thus, these patients should have an evaluation of their growth-hormone levels.

As parents if your child has delayed height growth to the point that the pediatrician feels chemical assessment is needed, the measurement of these two serum factors, if normal, could save an involved actual growth hormone determination.

NOTE: Please refer to Scanning the Journals, May 1997 for an article and comments on administering growth-hormone to short stature patients who do not have a deficiency of this substance.

Comorbidity in ADHD: Implications for Research, Practice and DSM-V:

Journal American Academy Children and Adolescent Psychiatry, 36:8, Aug. 1997, p. 1065

This article indirectly focuses on a real problem in managing ADHD patients. It points out that many ADHD patients have associated psychological and learning disorder problems.

The value of the paper to the clinician is just that. A large percentage of patients who suffer from this have other conditions that need care as much as the ADHD. Too often physicians prescribe stimulant medication and never acknowledge or evaluate the child for these other diagnosis. If they are left untreated, the ultimate response to therapy is grossly inadequate.

It is imperative that ADHD patients receive a complete assessment for a coexisting psychological problem or learning disability. Simply prescribing Ritalin or Dexedrine is not adequate unless there is documentation of no associated emotional or learning disorder. As informed parents, expect more than an office visit and a prescription for stimulants in the management of your ADHD offspring.

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