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Lip biting in infancy
136
Brie/clinical and laboratory observations
SUMMARY
A case of scrotal gangrene in an 8-year-old child has been described. T h e patient's course and treatment has been compared to that of other patients previously described, most of w h o m were adults. REFERENCES
July 1964
cited by Gibson, T. E.: Idiopathic gangrene of the scrotum, with report of a case and review of the literature, J. Urol. 23: 125, 1930. 2. Thomas, J. F.: Fournier's gangrene of the penis and scrotum, J. Uroh 75: 719, 1956. 3. Kilby, J. O.: Gangrene of scrotum and penis, Brit. J. Surg. 49: 619, 1962. 4. Thiers, H., Moulin, G., Croisille, M.: Observation d'un cas de gangr&ne idiopathique des organes gdnitaux externes, Bull. de Dermat. et de Syphil. 68: 272, 1961.
1. Fournier, J. A.: Gangr&ne Foudroyante de la verge, M6decin prat., Par., 4: 589-597, 1883;
Lip biting in infancy Harvey Kravitz, M . D . ~ GHICAGO~ ILL.
TEXTBOOKS of pediatrics and other pediatric literature contain little information concerning "lip biting" in infancy. This activity is best described as a downward directed pressure of the upper lip which presses it against the lower lip so that it partially or completely covers the lower lip. Lip biting is seen sporadically at all age levels, but the purpose of our paper is the study of the onset, cessation, and the significance of the phenomenon. Lip biting can be considered a motor rhythm since a significant percentage of the infants exhibit rhythmic bite and release activity; it is not to be confused with lip sucking or lip licking. Lip biting in children has been described by Bakwin and Bakwin 1 and Kanner. 2 No mention of its occurrence in infancy is noted: METHODS
We observed 177 consecutive normal healthy infants seen monthly in our private practice. Also, a number of patients on the pediatric ward of St. Francis Hospital, Evanston, Ill., were studied and photographed. T h e infants were observed from
From the Department of Pediatrics, St. Francis Hospital, Evanston, Ill. ~Address, 2341 W. Devon Avenue, Chicago 45, Ill.
time of onset of lip biting to the time of its disappearance. T h e onset of eruption of the medial lower and the lateral lower incisors was recorded. RESULTS
T h e results are shown in Figs. 1 and 2. T h e average age at onset of lip biting was 4.8 months of age, and the average age at cessation was 10.1 months. Only 11 cases in the series were observed or reported not to show this activity; 94.3 per cent of the cases showed the phenomenon. T h e average age at onset of the eruption of the mandibular central incisors was 6.8 months in our patients. T h e mandibular lateral incisors erupted at an average age of 10.1 months. Nelson 8 stated that the mandibular central incisors erupt at 5 to 7 months while the mandibular lateral incisors erupt at 7 to 10 months. I n 36 cases the lip biting stopped with the eruption of the mandibular central incisors. I n no case did the eruption of the mandibular central incisors precede the lip biting. I n the other 130 cases the lip biting continued until the eruption of the mandibular lateral incisors. T h e average age a t cessation of lip biting in these latter infants was
Volume 65 Number 1
Brie[ clinical and laboratory observations
noted below the lower lip which m a y be interpreted as an indication of lip biting activity. Rhythmic biting of the !ip was observed in 37 cases.
50"
40uJ u)
< (J
Qr
DISCUSSION 30-
90-
If0 ea
Z
13 7
ill
10-
4
AGE ONSET
5
6
IN OF
7
8
MONTHS LIP'BITING
FIG.1 40-
~n .~ 30u u_ 0 20-
! !1,.,
m
;r 10-
I
10
AGE
IN
11
13-t4 15-1617-18 19-s
MONTHS
LIP'BITING STOPPED FfG,2
10.1 months, which agrees exactly with the average age of eruption of the mandibular lateral incisors in our series. In 9 infants in whom the onset of lip biting did not begin until 7 months or later, the onset of the eruption of the mandibular central and lateral incisors was also delayed in the cases from 11 to as late as 20 months of age. In 23 cases the lip biting was reported to have stopped with the eruption of the lower medial incisors and restarted with the eruption of the mandibular lateral incisors. Actual lip biting was observed during office examination in 108 of the 166 cases studied. The rest were reported by the mothers. Figs. 3 and 4 show infants with typical lip biting. In 12 cases a distinct linear erythema was
This phenomenon has undoubtedly been often observed, but its frequency a n d significance have not been appreciated. Apparently the phenomenon is a habit found only in humans. Harlow 4 has reported its absence in monkeys. The onset of lip biting at an average age of 4.7 months coincides with the onset of teething. The increased incidence of the symptoms at 4 or 5 months and the decreased incidence after 6 months correlate well with the time of eruption of the lower medial incisors. It was not observed to begin in any infant after the lower lateral incisors had erupted. In a number of cases the lip biting stopped or decreased in intensity with eruption of the medial mandibular incisors and then returned with increasing intensity when the lateral mandibular incisors erupted. Lip biting in infancy may be one of the few specific signs o f teething. The other signs suggestive of teething such as coughing, drooling, loose stools, and the like, are all nonspecific or coincidental. Approximately one-fourth of our cases showed rhythmic biting of the lip; it appears, therefore, that this phenomenon can b e considered one of the motor rhythms. It is probably a self-directed rhythmic counterirritant to pain due to teething. This theory has also been advanced to explain body rocking and head banging2 Our unpublished data on 90 cases of body rocking showed the onset to be at an average age of 5.6 months while the average onset of head banging was reported to be 8 months by Kravitz and colleagues. 6 Lip biting was not observed after the eruption of the mandibular lateral incisors in infants and young children. It is sometimes seen in children and adults during periods of emotional stress such as taking an examination or in intense athletic exertion, as Bakwin and Bakwin have noted. Pruzansky 7
138
July 1964
Brief clinical and laboratory observations
Fig. 4. Fig. 3.
thinks that lip biting, lip sucking, and lip licking in children m a y often be noted in 6and 7-year-old children and m a y be due to the eruption of the p e r m a n e n t incisors. REFERENCES
1. Bakwin, H., and Bakwin, R. M.: Clinical management of behavior disorders in children, Philadelphia, 1960, W. B. Saunders Company, p. 428.
2. Kanner, L.: Child psychiatry, Springfield, Ill., 1948, Charles C Thomas, Publisher, p. 539. 3. Nelson, W. E., Textbook of pediatrics, Philadelphia, 1959, W. B. Saunders Company, p. 25. 4. Harlow, H.: Personal communication. 5. Kravitz, H., Rosenthal, V., Teplitz, Z., Murphy, J. B., and Lesser, R. E.: A study of head banging in infants and children, Dis. Nervous System 31: 3, 1960. 6. Kravitz, H.: Unpublished data. 7. Pruzansky, S.: Personal communication.
Rubella virus: Nucleic acid studies using 5 iodo 2"-deoxyuridine Charles L. Cusumano, M.D.,* Gilbert M. Schiff, M.D., John L. Sever, M.D., Ph.D., and Robert J. Huebner, M.D. R u B E L L A virus has been propagated in tissue culture for about 2 years?, 2 T h e low From the Section on Infectious Diseases, Perinatal Research Branch, National Institute of Neurological Diseases and Blindness (C. L. C., G. M. S., and J. L. S.); and the Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, (R. ]. H.), National Institutes of Health, Bethesda, Md. *Address, National Institutes of Health, Bethesda, Md.
titers which have been obtained, however, h a v e prevented purification of the virus for detailed physical and chemical studies. Since it is desirable to know the nucleic acid type of rubella for the purposes of classification and further characterization of the virus, the present study utilizes an indirect method to determine it, namely, nucleic acid by observation of the effect of 5 iodo 2'-deoxy-
Brie/clinical and laboratory observations
SUMMARY
A case of scrotal gangrene in an 8-year-old child has been described. T h e patient's course and treatment has been compared to that of other patients previously described, most of w h o m were adults. REFERENCES
July 1964
cited by Gibson, T. E.: Idiopathic gangrene of the scrotum, with report of a case and review of the literature, J. Urol. 23: 125, 1930. 2. Thomas, J. F.: Fournier's gangrene of the penis and scrotum, J. Uroh 75: 719, 1956. 3. Kilby, J. O.: Gangrene of scrotum and penis, Brit. J. Surg. 49: 619, 1962. 4. Thiers, H., Moulin, G., Croisille, M.: Observation d'un cas de gangr&ne idiopathique des organes gdnitaux externes, Bull. de Dermat. et de Syphil. 68: 272, 1961.
1. Fournier, J. A.: Gangr&ne Foudroyante de la verge, M6decin prat., Par., 4: 589-597, 1883;
Lip biting in infancy Harvey Kravitz, M . D . ~ GHICAGO~ ILL.
TEXTBOOKS of pediatrics and other pediatric literature contain little information concerning "lip biting" in infancy. This activity is best described as a downward directed pressure of the upper lip which presses it against the lower lip so that it partially or completely covers the lower lip. Lip biting is seen sporadically at all age levels, but the purpose of our paper is the study of the onset, cessation, and the significance of the phenomenon. Lip biting can be considered a motor rhythm since a significant percentage of the infants exhibit rhythmic bite and release activity; it is not to be confused with lip sucking or lip licking. Lip biting in children has been described by Bakwin and Bakwin 1 and Kanner. 2 No mention of its occurrence in infancy is noted: METHODS
We observed 177 consecutive normal healthy infants seen monthly in our private practice. Also, a number of patients on the pediatric ward of St. Francis Hospital, Evanston, Ill., were studied and photographed. T h e infants were observed from
From the Department of Pediatrics, St. Francis Hospital, Evanston, Ill. ~Address, 2341 W. Devon Avenue, Chicago 45, Ill.
time of onset of lip biting to the time of its disappearance. T h e onset of eruption of the medial lower and the lateral lower incisors was recorded. RESULTS
T h e results are shown in Figs. 1 and 2. T h e average age at onset of lip biting was 4.8 months of age, and the average age at cessation was 10.1 months. Only 11 cases in the series were observed or reported not to show this activity; 94.3 per cent of the cases showed the phenomenon. T h e average age at onset of the eruption of the mandibular central incisors was 6.8 months in our patients. T h e mandibular lateral incisors erupted at an average age of 10.1 months. Nelson 8 stated that the mandibular central incisors erupt at 5 to 7 months while the mandibular lateral incisors erupt at 7 to 10 months. I n 36 cases the lip biting stopped with the eruption of the mandibular central incisors. I n no case did the eruption of the mandibular central incisors precede the lip biting. I n the other 130 cases the lip biting continued until the eruption of the mandibular lateral incisors. T h e average age a t cessation of lip biting in these latter infants was
Volume 65 Number 1
Brie[ clinical and laboratory observations
noted below the lower lip which m a y be interpreted as an indication of lip biting activity. Rhythmic biting of the !ip was observed in 37 cases.
50"
40uJ u)
< (J
Qr
DISCUSSION 30-
90-
If0 ea
Z
13 7
ill
10-
4
AGE ONSET
5
6
IN OF
7
8
MONTHS LIP'BITING
FIG.1 40-
~n .~ 30u u_ 0 20-
! !1,.,
m
;r 10-
I
10
AGE
IN
11
13-t4 15-1617-18 19-s
MONTHS
LIP'BITING STOPPED FfG,2
10.1 months, which agrees exactly with the average age of eruption of the mandibular lateral incisors in our series. In 9 infants in whom the onset of lip biting did not begin until 7 months or later, the onset of the eruption of the mandibular central and lateral incisors was also delayed in the cases from 11 to as late as 20 months of age. In 23 cases the lip biting was reported to have stopped with the eruption of the lower medial incisors and restarted with the eruption of the mandibular lateral incisors. Actual lip biting was observed during office examination in 108 of the 166 cases studied. The rest were reported by the mothers. Figs. 3 and 4 show infants with typical lip biting. In 12 cases a distinct linear erythema was
This phenomenon has undoubtedly been often observed, but its frequency a n d significance have not been appreciated. Apparently the phenomenon is a habit found only in humans. Harlow 4 has reported its absence in monkeys. The onset of lip biting at an average age of 4.7 months coincides with the onset of teething. The increased incidence of the symptoms at 4 or 5 months and the decreased incidence after 6 months correlate well with the time of eruption of the lower medial incisors. It was not observed to begin in any infant after the lower lateral incisors had erupted. In a number of cases the lip biting stopped or decreased in intensity with eruption of the medial mandibular incisors and then returned with increasing intensity when the lateral mandibular incisors erupted. Lip biting in infancy may be one of the few specific signs o f teething. The other signs suggestive of teething such as coughing, drooling, loose stools, and the like, are all nonspecific or coincidental. Approximately one-fourth of our cases showed rhythmic biting of the lip; it appears, therefore, that this phenomenon can b e considered one of the motor rhythms. It is probably a self-directed rhythmic counterirritant to pain due to teething. This theory has also been advanced to explain body rocking and head banging2 Our unpublished data on 90 cases of body rocking showed the onset to be at an average age of 5.6 months while the average onset of head banging was reported to be 8 months by Kravitz and colleagues. 6 Lip biting was not observed after the eruption of the mandibular lateral incisors in infants and young children. It is sometimes seen in children and adults during periods of emotional stress such as taking an examination or in intense athletic exertion, as Bakwin and Bakwin have noted. Pruzansky 7
138
July 1964
Brief clinical and laboratory observations
Fig. 4. Fig. 3.
thinks that lip biting, lip sucking, and lip licking in children m a y often be noted in 6and 7-year-old children and m a y be due to the eruption of the p e r m a n e n t incisors. REFERENCES
1. Bakwin, H., and Bakwin, R. M.: Clinical management of behavior disorders in children, Philadelphia, 1960, W. B. Saunders Company, p. 428.
2. Kanner, L.: Child psychiatry, Springfield, Ill., 1948, Charles C Thomas, Publisher, p. 539. 3. Nelson, W. E., Textbook of pediatrics, Philadelphia, 1959, W. B. Saunders Company, p. 25. 4. Harlow, H.: Personal communication. 5. Kravitz, H., Rosenthal, V., Teplitz, Z., Murphy, J. B., and Lesser, R. E.: A study of head banging in infants and children, Dis. Nervous System 31: 3, 1960. 6. Kravitz, H.: Unpublished data. 7. Pruzansky, S.: Personal communication.
Rubella virus: Nucleic acid studies using 5 iodo 2"-deoxyuridine Charles L. Cusumano, M.D.,* Gilbert M. Schiff, M.D., John L. Sever, M.D., Ph.D., and Robert J. Huebner, M.D. R u B E L L A virus has been propagated in tissue culture for about 2 years?, 2 T h e low From the Section on Infectious Diseases, Perinatal Research Branch, National Institute of Neurological Diseases and Blindness (C. L. C., G. M. S., and J. L. S.); and the Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, (R. ]. H.), National Institutes of Health, Bethesda, Md. *Address, National Institutes of Health, Bethesda, Md.
titers which have been obtained, however, h a v e prevented purification of the virus for detailed physical and chemical studies. Since it is desirable to know the nucleic acid type of rubella for the purposes of classification and further characterization of the virus, the present study utilizes an indirect method to determine it, namely, nucleic acid by observation of the effect of 5 iodo 2'-deoxy-