THE JOURNAL OF PEDIATRICS
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13. Smoljanovic T, Bojanic I, Hannafin JA, Hren D, Delimar D, Pecina M. Traumatic and overuse injuries among international elite junior rowers. Am J Sports Med 2009;37:1193-9. 14. Yang J, Tibbetts AS, Covassin T, Cheng G, Mayar S, Heiden E. Epidemiology of overuse and acute injuries among competitive collegiate athletes. J Athl Train 2012;47:198-204. 15. Adirim TA, Cheng TL. Overview of injuries in the young athlete. Sports Med 2003;33:75-81. 16. Centers for Disease Control and Prevention. Sports-related injuries among high school athletes–United States, 2005-06 school year. MMWR Morb Mortal Wkly Rep 2006;55:1037-40. 17. Rechel JA, Yard EE, Comstock RD. An epidemiologic comparison of high school sports injuries sustained in practice and competition. J Athl Train 2008;43:197-204. 18. United States Census Bureau. Census Regions of the United States. [Internet]. 2000 [cited August 14, 2013]. http://www.census.gov/prod/ 2002pubs/c2kprof00-us.pdf. Accessed September 28, 2014. 19. Brenner JS. Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics 2007;119:1242-5.
Vol. 166, No. 3 20. Bale P, Mayhew JL, Piper FC, Ball TE, Willman MK. Biological and performance variables in relation to age in male and female adolescent athletes. J Sports Med Phys Fitness 1992;32:142-8. 21. Quatman CE, Ford KR, Myer GD, Paterno MV, Hewett TE. The effects of gender and pubertal status on generalized joint laxity in young athletes. J Sci Med Sport 2008;11:257-63. 22. Bahr R, Reeser JC. Injuries among world-class professional beach volleyball players. The Federation Internationale de Volleyball beach volleyball injury study. Am J Sports Med 2003;31:119-25. 23. Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train 2007;42:311-9. 24. Ristolainen L, Heinonen A, Turunen H, Mannstrom H, Waller B, Kettuen JA, et al. Type of sport is related to injury profile: a study on cross country skiers, swimmers, long-distance runners and soccer players. A retrospective 12-month study. Scand J Med Sci Sports 2010; 20:384-93. 25. Dick RW. Is there a gender difference in concussion incidence and outcomes? Br J Sports Med 2009;43:46-50.
50 Years Ago in THE JOURNAL OF PEDIATRICS Malabsorption Defect Induced by Ingestion of Beta Lactoglobulin Davidson, M. J Pediatr 1965;66:545-54
T
his case study was conducted over a period of 8 years on a boy who developed diarrhea immediately after birth and continued to have both diarrhea and steatorrhea despite multiple formula changes. His diarrhea resolved only during periods of starvation. Lactose-free and hydrolyzed formula administration yielded the same results. Finally, he was fed Sobee, a soy-based formula, with improvement in diarrhea, steatorrhea, and weight. Once it was determined that the offending agent was likely related to cow’s milk protein, initial investigations were carried out to establish whether the casein or the whey fraction was the causal entity. Addition of whey protein to the soy formula induced identical symptoms. Whey protein is made of two proteins, alpha lactalbumin and beta lactoglobulin. Next, the investigators separately added alpha lactalbumin and beta lactoglobulin to the formula and were able to determine that it was the beta lactoglobulin that was the causative protein by calculating the coefficients of absorption of fat and wetness of the stool. In subsequent years, the patient was challenged with whey protein and whole milk and continued to have recurrence of diarrhea and steatorrhea. This pattern was maintained until he reached 6 years of age, at which time he no longer developed symptoms with exposure to cow’s milk. Exposure to beta lactoglobulin with pin-prick skin allergy testing yielded a wheal reaction. The presence of bloody stools comprised only a brief period in an otherwise prolonged history of symptoms. Today, the opposite is more often observed as bloody stools are considered a hallmark of cow’s milk protein allergy. We also know that cow’s milk protein allergy is IgE-mediated and can cause the above symptoms. In this case study, the authors went to great lengths to determine the cause of this child’s illness, a rarity in today’s practice. Of course Dr Davidson went on to have a very fruitful and rewarding career in pediatric gastroenterology. The American Academy of Pediatrics annually bestows the Murray Davidson award to a clinician, educator, and scientist who has made significant contributions to the field of pediatric gastroenterology, a true honor. Karla Hicks, MD Division of Pediatric Gastroenterology, Hepatology, and Nutrition Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio http://dx.doi.org/10.1016/j.jpeds.2014.09.045
606
Schroeder et al
www.jpeds.com
13. Smoljanovic T, Bojanic I, Hannafin JA, Hren D, Delimar D, Pecina M. Traumatic and overuse injuries among international elite junior rowers. Am J Sports Med 2009;37:1193-9. 14. Yang J, Tibbetts AS, Covassin T, Cheng G, Mayar S, Heiden E. Epidemiology of overuse and acute injuries among competitive collegiate athletes. J Athl Train 2012;47:198-204. 15. Adirim TA, Cheng TL. Overview of injuries in the young athlete. Sports Med 2003;33:75-81. 16. Centers for Disease Control and Prevention. Sports-related injuries among high school athletes–United States, 2005-06 school year. MMWR Morb Mortal Wkly Rep 2006;55:1037-40. 17. Rechel JA, Yard EE, Comstock RD. An epidemiologic comparison of high school sports injuries sustained in practice and competition. J Athl Train 2008;43:197-204. 18. United States Census Bureau. Census Regions of the United States. [Internet]. 2000 [cited August 14, 2013]. http://www.census.gov/prod/ 2002pubs/c2kprof00-us.pdf. Accessed September 28, 2014. 19. Brenner JS. Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics 2007;119:1242-5.
Vol. 166, No. 3 20. Bale P, Mayhew JL, Piper FC, Ball TE, Willman MK. Biological and performance variables in relation to age in male and female adolescent athletes. J Sports Med Phys Fitness 1992;32:142-8. 21. Quatman CE, Ford KR, Myer GD, Paterno MV, Hewett TE. The effects of gender and pubertal status on generalized joint laxity in young athletes. J Sci Med Sport 2008;11:257-63. 22. Bahr R, Reeser JC. Injuries among world-class professional beach volleyball players. The Federation Internationale de Volleyball beach volleyball injury study. Am J Sports Med 2003;31:119-25. 23. Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Athl Train 2007;42:311-9. 24. Ristolainen L, Heinonen A, Turunen H, Mannstrom H, Waller B, Kettuen JA, et al. Type of sport is related to injury profile: a study on cross country skiers, swimmers, long-distance runners and soccer players. A retrospective 12-month study. Scand J Med Sci Sports 2010; 20:384-93. 25. Dick RW. Is there a gender difference in concussion incidence and outcomes? Br J Sports Med 2009;43:46-50.
50 Years Ago in THE JOURNAL OF PEDIATRICS Malabsorption Defect Induced by Ingestion of Beta Lactoglobulin Davidson, M. J Pediatr 1965;66:545-54
T
his case study was conducted over a period of 8 years on a boy who developed diarrhea immediately after birth and continued to have both diarrhea and steatorrhea despite multiple formula changes. His diarrhea resolved only during periods of starvation. Lactose-free and hydrolyzed formula administration yielded the same results. Finally, he was fed Sobee, a soy-based formula, with improvement in diarrhea, steatorrhea, and weight. Once it was determined that the offending agent was likely related to cow’s milk protein, initial investigations were carried out to establish whether the casein or the whey fraction was the causal entity. Addition of whey protein to the soy formula induced identical symptoms. Whey protein is made of two proteins, alpha lactalbumin and beta lactoglobulin. Next, the investigators separately added alpha lactalbumin and beta lactoglobulin to the formula and were able to determine that it was the beta lactoglobulin that was the causative protein by calculating the coefficients of absorption of fat and wetness of the stool. In subsequent years, the patient was challenged with whey protein and whole milk and continued to have recurrence of diarrhea and steatorrhea. This pattern was maintained until he reached 6 years of age, at which time he no longer developed symptoms with exposure to cow’s milk. Exposure to beta lactoglobulin with pin-prick skin allergy testing yielded a wheal reaction. The presence of bloody stools comprised only a brief period in an otherwise prolonged history of symptoms. Today, the opposite is more often observed as bloody stools are considered a hallmark of cow’s milk protein allergy. We also know that cow’s milk protein allergy is IgE-mediated and can cause the above symptoms. In this case study, the authors went to great lengths to determine the cause of this child’s illness, a rarity in today’s practice. Of course Dr Davidson went on to have a very fruitful and rewarding career in pediatric gastroenterology. The American Academy of Pediatrics annually bestows the Murray Davidson award to a clinician, educator, and scientist who has made significant contributions to the field of pediatric gastroenterology, a true honor. Karla Hicks, MD Division of Pediatric Gastroenterology, Hepatology, and Nutrition Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio http://dx.doi.org/10.1016/j.jpeds.2014.09.045
606
Schroeder et al
