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July 2010

18. Wells Jc. A Hattori chart analysis of body mass index in infants and children. Int J Obes Relat Metab Disord 2000;24:325-9. 19. Davies PS, Lucas A. Quetelets index as a measure of body fatness in young infants. Early Hum Dev 1989;20:135-41. 20. Wells JC, Fewtrell MS, Williams JE, Haroun D, Lawson MS, Cole TJ. Body composition in normal weight, overweight and obese children: matched case-control analyses of total and regional tissue masses, and body composition trends in relation to relative weight. Int J Obes (Lond) 2006;30:1506-13. 21. Schmelzle HR, Fusch C. Body fat in neonates and young infants: validation of skinfold thickness versus dual-energy X-ray absorptiometry. Am J Clin Nutr 2002;76:1096-100.

22. Gibson R. Principles of nutritional assessment. 2nd ed. New York: Oxford University Press; 2005. 23. Bayley N. Bayley Scales of Infant Development. 2nd ed. San Antonio, TX: The Psychological Corporation; 1993. 24. Stata statistical software, release 9.2 for Windows. College Station, TX: StataCorp LP; 2007. 25. Koo WW. Body composition measurements during infancy. Ann N Y Acad Sci 2000;904:383-92. 26. Wells JC, Fewtrell MS. Is body composition important for paediatricians? Arch Dis Child 2008;93:168-72. 27. Wells JC, Fewtrell MS. Measuring body composition. Arch Dis Child 2006;91:612-7.

50 Years Ago in THE JOURNAL OF PEDIATRICS A Report of 16 Tumors of the Spinal Cord in Children; The Importance of Spinal Rigidity as an Early Sign of Disease
Richardson FL. J Pediatr 1960;57:42-54.

ifty years ago in The Journal, Richardson described 16 children with tumors involving the spinal cord. The diagnoses were difcult, he chronicled. Indeed, for these 1950s children, poliomyelitis was the more typical etiology of spinal symptomatology, and a pediatricians tools were limited to lumbar puncture and myelography. Richardson lamented the delay to diagnosis, a median of 7 months. Do we fare better today making this diagnosis? No! One report of 25 children with primary spinal cord tumors found an average of 7.8 months to diagnosis.1 Have we heeded Richardsons lessons? Perhaps not. Richardson identied the presence of painful spinal rigidity in most cases. Specically, these children often resist exion at the vertebral column because of pain, preferring instead to ex at their hips or knees. We cannot forget the early manifestations he points out, such as irritability, sudden screaming at night, anorexia, weight loss, constipation, fear of moving about, head tilt, waddling gait, and anhidrosis below the level of the tumor. We could also add the clinical pearl of scoliosis with a left thoracic curvature, a rare nding, but highly indicative of a tumor or occult syrinx. With time, more obvious neurologic ndings ensue: paraparesis, absent or increased reexes, paresthesias, or enuresis. We still tend to forget the presentation of these tumors. Spinal ependymoma, astrocytoma (glioma), meningioma, neurobroma, lipomas, dermoid cyst, or other aggressive cancers are found only after misdiagnosis and delay. Richardson remains on target: Routine investigations, such as x-rays of the vertebral column, are regarded too frequently as satisfactory evidence of the absence of disease..It is not justiable to delay myelography for weeks or months, during which time the patient may be in considerable pain, until serious deterioration gives additional clinical or neurological signs. We could simply substitute magnetic resonance imaging for myelography. Make haste, and dont waste. Painful spinal rigidity and other aforementioned ndings merit a sooner rather than later trip to the magnetic resonance imaging suite. Paul Graham Fisher, MD Departments of Neurology, Pediatrics, Neurosurgery, and Human Biology Stanford University Palo Alto, California

1. Crawford JR, Zaninovic A, Santi M, Rushing EJ, Olsen CH, Keating RF, et al. Primary spinal cord tumors of childhood: effects of clinical presentation, radiographic features, and pathology on survival. J Neurooncol 2009;95:259-69.

Infant Overweight Is Associated with Delayed Motor Development