"Some is not a number, soon is not a time." Perhaps these words from Dr. Don Berwick sum up how critical it is that each and every child healthcare provider keeps the spirit of advocacy burning brightly in their quest to prevent childhood injuries. As one of the leading causes of morbidity and mortality during childhood in the United States, injuries should garner more attention given that most are preventable. Deciding tomorrow to solve today’s problems is not enough. One preventable injury is too many.

Although the number of product recalls each day may seem reassuring to some that industry is serving the public good by remaining vigilant, it is less reassuring to realize that most of these recalls do little to remove products from consumers’ homes. It is alarming to find that many products marketed to families have little to no testing done to assure their safety. Even more alarming is the realization that the Consumer Product Safety Commission (CPSC) has little to no power to enact or enforce product safety standards.

This issue of Pediatric Annals should serve as a "wake-up call" to all child healthcare professionals that we are literally "on the front lines" in the battle to prevent injuries to children by providing anticipatory guidance as well as alerting families to any product recalls. After reviewing this issue, the participant will be better prepared to serve as an educator of parents, a resource to communities, and an advocate for change.

Pediatricians do not pay enough attention to sleep. This statement may seem at first brash, but when one considers the age range cared for by the practicing generalist, one quickly realizes that sleep is rarely discussed at routine well visits beyond the first 6 to 12 months. Nearly one-third to one-half of a child’s life is spent asleep, especially during the first few years of life. And sleep often becomes a contentious challenge during adolescence. But sleep is rarely addressed as part of the overall health of a child until it becomes an issue.

As more specialists in pediatric sleep are trained, we are learning that many common complaints encountered in the office may be related to poor or ineffective sleep. Better definitions of disorders of the circadian rhythm, so vital to well being, are being described, and strategies are employed to correct them. Improved understanding of disorders of arousal and nocturnal epilepsy will help the office physician target interventions and diagnostic studies. Finally, an appreciation for the impact of snoring and obstructive sleep apnea has led to a targeted approach to surgical versus non-surgical interventions.

"To sleep, perchance to dream," although a small part of Hamlet’s famous soliloquy, is perhaps not so far off in describing how vital sleep is to our overall health. Today’s hectic, overscheduled, techno-centric life does not allow adequate rest for our children, much less their parents. After reviewing this issue of Pediatric Annals the participant will be better prepared to assess a child with sleep disturbance as well as serve as a vigorous advocate for better sleep hygiene as a part of overall health maintenance.

Whether detected on a routine blood count during well-child care delivery or incidentally during the evaluation for an acute illness, anemia is encountered frequently in the primary care setting. Although the diagnosis of iron defi ciency is commonplace, the prospect of a red cell membrane disorder, metabolic dysfunction, or hemoglobinopathy must not be dismissed. Indeed, sickle cell disease represents one of the most common genetic disorders encountered in pediatrics and requires that the provider be knowledgeable, if only to help serve as a resource to parents and the local medical community.

In the past few decades, great strides have been made in understanding the biomolecular basis for several of the causes of childhood anemia. With a team approach, diseases once thought to be devastating are now managed with excellent long-term life expectancies. New therapeutic agents that stimulate the production of fetal globin are helping to ameliorate the more severe complications of sickle cell disease and beta-thalassemia.

This issue of Pediatric Annals offers a comprehensive review of childhood anemia and provides an excellent opportunity for the participant to sharpen diagnostic and therapeutic skills in this area. After completing this issue, the provider will be positioned to serve not only as a source of education to their patients but also as a member of the care team necessary to maximize the positive outcome for each patient.

From the time Abraham Jacobi set up milk stations and dispensaries for the delivery of care to children, the practice of pediatrics has had disease prevention and health promotion as some of its core values. Dramatic changes over the past several decades have made it difficult to apply the classic disease model to prevention and health promotion, with evidence for the benefit of some long-standing care guidelines lacking while their wisdom remains without question. This poses a daunting challenge to the primary care provider, who is increasingly asked to follow only those guidelines for care delivery that are supported by the strongest evidence.

The development of the Bright Futures Guidelines has been nearly two decades in the making, with efforts focused on optimizing health maintenance while acknowledging the ever changing developmental needs of children. Recognizing the need for stronger evidence behind some of the proposed guidelines, the authors have appropriately dubbed many as evidence-informed. Indeed, the latest edition of the Bright Futures Guidelines is specifically geared toward successful deployment in the busy primary care office, with emphasis placed less on disease detection and more appropriately on the evolving needs of the family.

This issue of Pediatric Annals provides several excellent reviews that will allow the participant to better understand the most recent guidelines for health supervision and prevention, and more importantly, successfully integrate the guidelines into their daily care of children.