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'Rule of Trees' points up tragedy in child health bureaucracy

¹ President, American Academy of Pediatrics

Two infants, not one, die of malnutrition while being breastfed! Two mothers, not one, are prosecuted for manslaughter, and the New York Times publishes two editorials, not one, expressing rage because two infants, not one, are denied Medicaid despite their eligibility. According to the rule of threes, there will be a third.

I first heard of the rule of threes during residency. Simply stated, when a child presents with an uncommon disease, or a common disease presents in an uncommon way, the rule says to expect, within a short time, two similar events. To this day, I remember when the rule worked. I was alerted by one unusual ingestion to two others that followed. I remember three children who were diagnosed with osteomyelitis, and three children who were admitted to the hospital with malignancies with unusual presentations. All of these "threes" occurred within a period of weeks.