THE EDITORS’ PERSPECTIVES

Severely aggressive school studentswith psychiatric illness

In one of the Boston school districts, students with ahistory of repeated aggressive behavior may be referred for acomprehensive psychiatric evaluation. In this issue of The Jour-nal, Rappaport et al report an initial qualitative study of 33students. There was a very high rate (32/33) of severe anduntreated psychiatric illness, which was complicated in manycases by learning disorders. The average student evaluated had 3diagnoses. In addition, 33% had a history of substance abuse and30% had other chronic medical conditions. Such students mustbe common in school systems across America, and many arenever diagnosed. Even in the school district from which thesestudents were drawn, three times as many such cases receiveddisciplinary action as opposed to psychiatric evaluation. Rappa-port et al argue convincingly for the benefits of a comprehensivepsychiatric evaluation and treatment.

—Robert W. Wilmott, MDpage 252

Maternal obesity and breastfeedingThere have been studies showing that breastfeeding may

be protective against the development of obesity in the child. Ithas been less clear whether obesity in the mother has an impacton the success and duration of breastfeeding. Oddy et al reporton a study of over 1800 mothers and infants in Australia. Theyfound that obese women were more likely to discontinue breast-feeding compared to normal weight women. This relationshipremained significant even after controlling for potential con-founders. The reasons for a shorter period of breastfeedingamong mothers with obesity are not clear; they could be relatedto physical factors, hormonal differences, or other issues. Thissuggests that mothers with obesity deserve greater attention andsupport to achieve better results with breastfeeding.

—Stephen R. Daniels, MD, PhDpage 185

This Month in

THE JOURNAL OFPEDIATRICS

August 2006 • Volume 149 • Number 2

Copyright © 2006 by Mosby, Inc.

The Journal of Pediatrics (ISSN 0022-3476) is published monthly by Elsevier Inc., 360 Park Avenue South, New York, NY 10010. Business and Editorial Offices:1600 John F. Kennedy Blvd., Suite 1800, Philadelphia, PA 19103-2899. Accounting and Circulation Offices: 6277 Sea Harbor Drive, Orlando, FL 32887-4800.Periodicals postage paid at New York, NY, and additional mailing offices. POSTMASTER: Send address changes to The Journal of Pediatrics, Elsevier PeriodicalsCustomer Service, 6277 Sea Harbor Drive, Orlando, FL 32887-4800.

The Journal of Pediatrics August 2006 1A