This document contains a letter to the editor regarding a patient's speech being affected by theophylline use for asthma treatment. Specifically: - A 4-year-old boy being treated for asthma with inhaled beclomethasone and oral theophylline exhibits stammering speech only when taking theophylline. - The parents note the stammering occurs with each instance of theophylline use in the past and present. - The doctor finds no literature on similar cases and seeks reports from other practitioners to help manage this potential adverse effect.

1. 1981;68;749-750Pediatrics
Michael M. McCarthy
Speech Effect of Theophylline
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2. LETTERS TO THE EDITOR 749
at the age of 18 months, the children attend a nursery
school part time for group activities. The maternal assist-
ants receive continuing education on child rearing.
This system, officialized in 1972, appears to confer
benefits on the children,8 their families, the health service
of the Center for Maternal and Infant Protection, and the
maternal assistants.
Like family care, the environment thus offered to the
child is “natural” and open as opposed to the structured,
closed environment of specialized centers, no matter how
high their quality may be. The child grows in a family
setting, bonds to his/her caretaker, relates to varied real-
life situations: meeting neighbors, shopping. . . . Further-
more he/she gets the same health surveillance as his/her
day care center counterpart and some group stimulation.
The public health infrastructure offers medical compe-
tence while families pay in proportion to their income.
Flexibility of this type of care also reduces costs for the
health service of the Center for Maternal and Infant
Protection, eg, no building and furniture maintenance
and no operation of a kitchen responsible for up to 60
daily meals of various compositions.
Fringe benefits and employment security offered to the
maternal assistants act positively in turn upon children’s
well-being by contributing to the stability of care inas-
much as inconsistency of care per se is a risk factor
(Institut National de la Sante et de la Recherche M#{233}di-
cale (INSERM, U. 185): Relations entre le developpe-
ment de l’enfant et son mode de garde dans la premiere
enfance, 1979).
REFERENCES
THU HOANG, PHD
Universit#{233}Paris V
UER Etudes M#{233}dicales et Biologigues and
Institut National de la Sante et de
la Recherche M#{233}dicale
a Villejuif: U 170 (statistiques)
16 bis, avenue Paul-Vaillant-Couturier
94800 Villejuif, Paris, France
1. International Labor Office: Woman-power, the World’s Fe-
male Labour Force in 1975 and the Outlook for 2XJO. ILO,
Geneva, 1973
2. Organization for Economic Cooperation and Development:
Women and Employment. OECD, Paris, 1980
3. Howell MC: Employed mothers and their families. Pediat-
rics 52:252, 1973
4. Howell MC: Effects of maternal employment on the child.
Pediatrics 52:327, 1973
5. Zambrana RE, Hurst M, Hite RL: The working mother in
contemporary perspective: A review of the literature. Pedi-
atrics 64:862, 1979
6. BeLsky J, Steinberg LD: The effects of day care: A critical
review. Child Dev 49:929, 1978
7. Sibbison VH: The influence of maternal role perceptions on
attitudes toward and utilization of early child care services,
in Peters D (ed): A Summary ofthe Pennsylvania Day Care
Study. Pennsylvania State University, 1973
8. Caisse d’Ailocations Familiales: Cr#{232}chesfamiliales et travail
d’#{233}quipe.Technical Actions Soc 12:9, 1973
Questions Value of Name Change:
RLF/ROP and IF
To the Editor.-
I wish to disagree with the Second International
Retrolental Fibroplasia Conference. They wish, as they
have written in a recent issue ofPediatrics (67:751, 1981),
to “dislodge the established misnomer, RLF.” They wish
to substitute two names, ROP and IF. I refrain from
mentioning what ROP and IF, abominable acronyms,
stand for, and go on to what is more important.
The purpose of a name is to describe something so
that, in one brief word, a future scholar, investigator, or
bookworm can quickly grasp what the writer has in mind.
If, after every advance in our understanding of a disease,
the name is changed, then the ignorant reader, who is
presumably the one to whom any written matter is ad-
dressed, will be led on a wild goose chase, especially if he
is looking up an historical subject. He will waste time, as
he searches through previous volumes of medical litera-
ture, because every few years the name and all references
to the disease he is pursuing will suddenly change.
No disease has a perfectly appropriate name. It is lucky
that no international conferences want to change the
names of measles, chickenpox, whooping cough, rheu-
matic fever, etc, just because more is known about these
conditions; the confusion would be troublesome.
Also, unfortunately, many modern medical writers and
editors of medical journals have become addicted to
acronyms. Whose time do they save? Only the typist’s.
The poor reader, who generally likes to skim many arti-
des, can no longer do so. Acronyms with which he is not
familiar have to be discovered by reading the opening
paragraphs. There isn’t time to do that, if one wants
inteffigently to glean what is ofinterest in each thick issue
of the many medical publications that now bombard us.
I plead, therefore, to all writers and editors to avoid
acronyms like the plague-excuse me, I meant to say
black death. I can read black death just as fast as I can
BD.
RICHARD L. DAY, MD
Lakeview Terrace
Westbrook, CT 06498
Speech Eftect of Theophylline
To the Editor.-
Although symptoms of generalized central nervous sys-
tem stimulation (eg, irritability, restlessness, and insom-
nia) are recognized side effects of oral theophylline ther-
apy,”2 I have recently encountered a patient who exhibits
a single, isolated behavioral change while receiving the-
ophylline. Review of pertinent literature reveals no simi-
lar reported cases.
This 4-year-old white boy developed asthma at age 17
months. Poor symptomatic control during the past six
months has necessitated two hospitalizations and three
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3. REFERENCES
1. Vaucher Y, Lightner ES, Walson PD: Theophylline poison-
ing. J Pediatr 90:827, 1977
2. Wyatt R, Weinberger M, Hendeles L: Oral theophylline
dosage for the management of chronic asthma. J Pediatr 92:
125, 1978
Circumcisions: Knowledge Isn’t Enough
Year No. of Term No. of Circum-
Male Infants cisions
1975 2,484 2,288
1976 2,887 2,687
1977 3,088 2,851
1978 3,184 2,950
1979 3,298 3,068
% of Infants
Circumcised
92
93
92
92
93
750 PEDIATRICS Vol. 68 No. 5 November 1981
short courses of oral corticosteroids. Currently, the pa-
tient’s condition is well controlled on inhaled beclometh-
asone and oral Theo-dur, 200 mg every 12 hours (23 mg/
kg/day). Serum theophylline level five hours after a
Theo-dur dose is 12 gig/mi.
The parents report that, every time the patient has
taken theophylline, both in the past and during the
present regimen, he has begun to exhibit stammering
speech. Although he can pronounce words without diffi-
culty, he repeats some words eight to ten times before
advancing to the next word. The association between the
speech problem and medication may be coincidental, but
both parents adamantly maintain that the stammering is
observed only when the patient is on theophylline.
I can find no data encouraging me to reassure the
parents that this speech aberration is not a potentially
permanent adverse effect of theophylline, nor have I been
of assistance regarding their concern that his speech will
invite teasing in school. Similar observations from other
practitioners might therefore be ofbenefit in management
of this patient.
MICHAEL M. MCCARTHY, MD
Pediatric Allergy Associates
348 East Virginia
Phoenix, AZ 85004
agreement with Osborn et al’ in that the 1975 policy
statement by the American Academy of Pediatrics2 has
apparently had little impact on the incidence of circum-
cision at our hospital.
HOWARD J. BENNETT, MD
MARK WEISSMAN, MD
Department of Health Care Sciences
The George Washington University
Medical Center
Washington, DC 20037
REFERENCES
1. Osbom LM, Metcalf TJ, Mariani EM: Hygienic care in
uncircumcised infants. Pediatrics 67:365, 1981
2. Committee on Fetus and Newborns: Report of the ad hoc
task force on circumcision. Pediatrics 56:610, 1975
In Reply.-
Statistics concerning circumcision are not readily avail-
able in the United States. During our study on hygiene,
we polled Utah hospitals to ascertain the number of
male births and the number of circumcisions performed.
The percentage of infants circumcised varied from 0 to
100%, with a statewide average of 87%. The majority of
physicians responding to the questionnaire practiced in
Salt Lake County. Our poll indicated that their estimates
of the incidence of circumcision were remarkably accu-
rate.
TABLE. Birth Record Data on Circumcision at Largest
Hospital in Salt Lake County
To the Editor.-
In their article, Osborn et al’ discuss the results of a
study in which physicians were questioned about their
knowledge ofthe natural history ofthe foreskin and about
the advice they give parents concerning hygienic care of
uncircumcised infants. We agree completely with their
recommendations and have routinely cautioned parents
against too vigorous retracting and cleansing of the fore-
skin. We were surprised, however, that 80% of the physi-
cians surveyed felt that only 10% or less of their male
infants are uncircumcised. This prompted us to review
the birth records at our hospital for the last three years
(Table). Although we found a higher percentage of uncir-
cumcised infants at our institution, these data are in
TABLE. Birth Record Data on Circumcision at The
George Washington University Medical Center
Year No. of Term No. of Circum- % of Infants
Male Infants cisions Circumcised
1978 1,500 1,190 79
1979 1,620 1,240 77
1980 1,590 1,290 81
The Table reports the number of circumcisions per-
formed in the county’s largest hospital.
LUCY M. OSBORN, MD
Division of Ambulatory Pediatrics
UCLA Center for the Health Sciences
Los Angeles, CA 90024
Air in the Ductus?
To the Editor.-
The article “Paraplegia Due to Peripheral Venous Air
Embolus in a Neonate: A Case Report” (Pediatrics 67:
472, 1981) needs further discussion.
Although it is possible that the foramen ovale (FO)
was the site of cross-over of air from venous to arterial
circuits, it is equally possible that the ductus was the
shunt site in this 24-hour-old infant. The ductus is usually
functionally closed by age 24 hours but is capable of
reopening in response to hypoxia. Anatomic closure, the
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4. 1981;68;749-750Pediatrics
Michael M. McCarthy
Speech Effect of Theophylline
& Services
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