DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY. 1976, 18

the answers, the senior should regard this as important a part of management as checking the drip rate. It can be, after all, preventive paediatrics. It may be obvious to us that we are dealing with “just another febrile fit”, but to a parent who has never heard of such an entity the child has just been at Heaven’s gate. As well as it being an act of charity to enlighten and forewarn about fevers and fits, such advice may also prevent many a sleepless night “listening for him breathing”, with subsequent disturbance in the parent-child equilibrium.

We must also give parents repeated opportunities to express their worry. On admission they may be speechless with anxiety. An invitation to attend the consultant’s round may provide the necessary chance to open up, and will also give the paediatrician a chance to explore and expand parental understanding of the illness. Knowing which illnesses are most emotive will also help at this stage to curb future anxiety. It is worth spelling out the risks of over-protection and lax discipline that will now be undoubted temptations for parents, and the playing-up or clinging behaviour which may be temporarily expected in the child. Even though it may demand superhuman willpower to treat a recently ill child as ‘normal’, this should be our aim for the very near future. In conditions likely to recur, each recovery should be regarded as what we all expected. However, fears of future brain- damage, of being a respiratory cripple and so on, should also be recognised and allowed opportunity of expression-and the fears should be met-both during the admission and at subsequent outpatient visits.

There are many very sensible parents who regain balance and restore the child to normal family life with promptness and relief. There are others who take the discussion only partly to heart. One of these was the mother of a small survivor from meningococcal septicaemia, who closed the conversation with fine discrimination: “We don’t mind her being a bit spoilt, but we wouldn’t want her ruined.” At least these parents understood that the outcome largely rested with them.

City General Hospital, Newcastle Road, Stoke-on-Trent ST4 6QG.

JANET GOODALL

REFERENCES 1. Sigal, J., Gagnon, P. (1975) ‘Effects of parents’ and pediatricians’ worry concerning severe gastroenteritis

2. Green, M., Solnit, A. (1964) ‘Reactions to the threatened loss of a child: a vulnerable child syndrome.’ in early childhood on later disturbances in the child’s behavior.’ Journal of Pediatrics, 87, 809.

Pediatrics, 34, 58.

“WE WOULD GREATLY APPRECIATE A COPY OF YOUR ARTICLE”

WITH photocopying processes as simple as they are nowadays, automatized requests for reprints are obsolete and should stop.

A request comes for a reprint of a ‘letter to the Editor’, 10 lines in length. Postage from the United States is 12 cents; postage back is 11 pence. Time taken is several weeks; the writer could have had a photocopy immediately. It is not only doctors who have this behavioural deviance-psychologists have it too.

Of course it is flattering to be asked for a reprint, even though there may be only one request. Some authors order 500 or lo00 reprints which they mail around, but epoch-making

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ANNOTATIONS

articles deserving such circulation are rare. John Lorber had more than a thousand requests for his article on spina bifida’, and rightly enough, and other authoritative authors often are asked for a great many reprints.

Another abuse is to ask the 10 authors of a multi-author book each to send a reprint of their respective chapter, and Lo! there’s the book for the price of 10 stamps.

There is for the requester a real disadvantage in reading only offprints; if he looked up the journals in which the articles appeared he would often find an article he would be delighted to have discovered. To quote Malcolm Crichton’s recent article on obfuscation2:

“A final point concerns cross-fertilization. With medical writing as forbidding as it is, workers tend to read only papers in their own fields, disregarding others since-as many freely admit-they can’t understand them. But medicine is still too young, and its inter- relations too poorly defined, to encourage premature fragmentation of knowledge. It is impossible to guess the cost here in wa5ted time, duplicated findings, and buried pearls. But such a cost surely exists, and must be reckoned with.” As far as I am concerned, I don’t have reprints of my letters to Editors (even of the few

they do print) and printed postcards won’t get reprints from me any more. Letters may, and the chance increases if they have pretty stamps on them.

5~ Netherhall Gardens, London NW3 5RN.

RONALD MAC KEITH

REFERENCES 1. Lorber, J. (1971) ‘Results of treatnient of myelomeningocele.’ Det~eloprnen/ol Medicine ond Child

2 . Crichton, M . (1975) ‘Medical obfuscation : structure and function.’ New Englond Joiirnal of Medicine, Neurology, 13, 279.

293, 1257.

SCREENING FOR LANGUAGE DISORDERS IN PRE- SCHOOL CHILDREN

PARENTS often ask paediatricians to say whether their children’s speech is ‘normal’. SCHWARTZ and M U R P H Y ~ describe some observations of speech development which the paediatrician may make at an office examination to pick out the children who need further study.

Spoken language is the primary means by which social and interpersonal relationships are made and spoken language is also the major mode of instruction at school. The pre- school years are the optimum time for development of language, therefore the early detection of delay or abnormality of the development of language and speech is necessary if the affected children are to be helped. I f the children become fixed at an early stage of language development, the gap between them and their peers in attainment of language development can become widened and then remedial speech programmes may have less effect and be less successful in helping the children.

The main part of the article by SCHWARTZ and MURPHY delineates in fair detail the areas of language comprehension and language production which the paediatrician should observe. Reduction of verbal output ( i . ~ . naming an object without elaborating on its function), or the impoverishment of abstract vocabulary could make the observer suspect a language disability. Also typical of language-disordered children is lateness in developing

97