Pediatrics Update



The most up-to-date information in Pediatrics

February  2013



NSAIDS for Corneal Abrasion

Corneal abrasion from minor injury to the eye is common in both adults and children. Should you prescribe topical nonsteroidal anti-inflammatory drugs (NSAIDs) for analgesia ? How safe is this practice? What is the evidence ?
Read the recent PRETx review ( in Canadian Family Physician Journal



Tonsillectomy for Strep Throat

So after how many strep throat infections do you suggest a tonsillectomy ? Well… it
depends who you ask – a pediatrician or an ENT surgeon.
Read State-of-the-Art Review in Pediatrics


Pertussis Epidemic

MMWR came out with a report on the recent pertussis epidemic in Washington State. This is just the beginning and Wisconsin is even suffering more.


Therapy for Colic ?

If we had only 1 cent for every infant with colic coming to see the pediatrician…… A study from Cairo, Egypt, looked at Helicobacter pylori as a reason for infantile colic.

Of the 55 patients presenting with infantile colic, 45 tested positive for H pylori in the stool. Of 30 healthy controls, only 7 were positive. This needs to be further investigated !

See Archives Ped and Adoles Med.


Predicting ER Visits in Diabetes

Do you have diabetic pediatric patients over 6 years, that are boys and are on Medicaid insurance ? a good chance they will repeatedly end up in an emergency department according to a study from the University of New Mexico. Four years worth of charts show insurance provider, age and gender are the most predictive variables. Read Pediatric Emergency Care.


Guillain-Barré Syndrome Review

An interesting paper on Guillain-Barré syndrome. Not always the classic text book acute progressive weakness. Retrospective review of cases over a decade shows that differentiating classic from “unusual” Guillain-Barré presentation is difficult.


Low Acuity ER Visits

Do your patients end up in the emergency department with low acuity issues ? Read on advice and directions to ED alternatives – American Medical News


FDA cuts BPA

No more bisphenol A in Baby Bottles and Cups !  FDA cuts BPA.


Play More Expand Less

Playing on Several Sports Teams Reduces Obesity Risk in Teens. See pediatrics.

After phone surveys of over 1700 families from New Hampshire and Vermont (13% obese, 16% overweight), the authors found a clear inverse correlation between multiple group sports activity and overweight/obesity state.

Active commuting to school was also connected to reduced risk of obesity.


GPS for Puffers

Now FDA approved. The asthmapolis gadget.


Facebook and Depression

Does facebook cause older adolescents to be prone to depression or not ? A new study by Moreno et al from Wisconsin suggests that college students do not have more depression if they used more facebook than others. But note that the study is based on an initial online screening tool for depression and only a week long self-reporting on social media use. Is this enough of a follow-up ?. Read Journal of Adolescent Health


Alternating Antipyretics

Read a recent PRETx ( review on alternating acetaminophen and ibuprofen for pain in children. Canadian Family Physician.


Obamacare Impact

Obamacare is making waves. According to the Daily Caller, 83% of physicians in the US have considered leaving their practices over Obama’s health care reform (as per survey released by the Doctor Patient Medical Association). The country may be left with 90,000 physicians short in less than a decade.


Studies in Children

FDA regulations are working. Another company will trial meds in kids, in order to gain extended patent.


Reacting to Food

A very nice prospective observational study in pediatrics about allergic reactions to foods in preschool Children. 512 infants 3-15 months with documented or likely allergy were followed-up for 36 months in 5 centers.

Reaction rate was 0.81 per year (367/512 subjects reporting 1171 reactions) and half reported more than one reaction. The anticipated ‘offenders’ were milk, eggs and peanut.
Half of the time, the food causing a reaction was provided by parents.

Interestingly, in 11% of the time, the children were purposeful exposed to these avoided
The authors report undertreatment of severe reactions with epinephrine and the need for better education.


Severe Bacterial Infection Score

Still no Holly Grail. Looking for markers of severe illness (severe bacterial infections (SBI)) in young infants with fever in an ongoing effort. A group from Europe looked at the usefulness of the “Lab-Score” – a combo of C-reactive protein, procalcitonin and urine dipstick, as published in Pediatric Infectious Disease Journal.
In a multicenter retrospective study they found SBI in 287 (28%) patients and invasive bacterial infections (IBI) in 23 (2%).
Area under the received operator curve was 0.83 for SBI and 0.85 for IBI (max=1). Use of “Lab-score” in those patients would misdiagnose 7 (30%) infants with IBI.
So the authors suggest to use the “Lab-score” to rule-in, but not rule-out SBI. The hunt for the score continues.


Overdiagnosing ADHD

A very interesting study from Switzerland documenting how some providers overdiagnose ADHD based on assumptions and the “typical case”, rather than the diagnostic criteria. Among a 1,000 child psychologists, psychiatrists, and social workers received a survey with vignettes of a child with a full spectrum ADHD and 3 other cases with some of the ADHD spectrum but not enough for a diagnosis. Yet, over 16% of the providers diagnosed those 3 cases as ADHD. The overdiagnosis was twice as often if the cases were presented as boys. Published in Journal of Consulting and Clinical Psychology.


Celiac Disease and Immunization

With a significant increase in celiac disease in Sweden, investigators reviewed the National Swedish Childhood Celiac Disease Registry to identify correlation with Swedish vaccination programs, especially with early vaccinations. Compared to a normal cohort without celiac, there was no correlation between early vaccination and the high incidence of celiac. The search for other sources continues. Read in Pediatrics.


Probiotics and Allergic Rhinitis

A group from Taiwan conducted an RCT with atopic children with current allergic rhinitis, and looked at the effect of probiotics given daily over 12 weeks compared to placebo.

Lactobacillus salivarius reduced rhinitis symptoms and use of medication, despite no differences in immunological or blood cell variables. So how do they work is still unclear. See Indian Pediatrics.


Water Safety

A resource to keep in your office or home. As summer is soon to be here (in some parts of the World) – here is some sound advice on water safety. Clip and save.
From the Children’s Safety Network.


Smart Phone for Otitis Rescue

Is the end of Pediatrics near ? With this promising new smart phone add-on, parents will be able to quickly determine otitis media….. maybe. Clinical Pediatrics predicts there is still a lot of work to do before the office and emergency room will be empty.


Track Migraine

The mHealth movement continues. Adolescents can track triggers, duration and intensity of migraine headaches using a new Cincinnati Children’s app.


Children Still Suffer

Children still suffer more than adults. More than half of all patients with appendicitis had not received pain medication in this National Hospital Ambulatory Medical Care Survey (1992 through 2006). Children received much less narcotics than adults.  We must do more for pain management in children !


Physicians and Drug Reps

Say What ? cutting the cord between physicians and drug company reps is dangerous for patients ?

See Forbes provocative piece.


Geographic Variability of Food Allergy

Analysis of a randomized survey of families of more than 38,000 children show that living in cities with population density increases prevalence of food allergy (6.2% in rural areas to 9.8% in urban centers). Odds ratio of 1.7 for food allergy in urban versus rural areas. Findings were still significant after adjusting for race/ethnicity, gender, age, household income, and latitude.


The ‘First Dinner’

Nutritious and Delicious to prevent obesity. Any good original recipe for a lunch made by kids ?
They may win an invitation for brunch at the white house. See the “State Dinner” initiative at The First Lady rocks !


Localized Purpuric Rash

Is blood work needed when investigating well infants with localized purpura or petechiae with no fever ? Probably not, based on findings from Australia published in Ped Emergency Care


Acute Rhinosinusitis

Recent Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults – worth reading.
Full text available from Clin Infect Dis.


The Benefits of Friends

Friends, the old way (….not Facebook friends) are critical for supporting physical activity in children 5-12 years old. The immediate social network during a 12-week after-school program affected activity levels in children, as reported in Pediatrics by a group from Tennessee.


The Best Children’s Hospitals in the US

Side by side. Congratulations to Boston Children’s Hospital and Children’s Hospital of Philadelphia for being ranked #1 by US News.


Anaphylaxis Following Immunization

Anaphylaxis following immunization is so rare. A report from a national database in the UK and Ireland show only 7 true cases (of 15 reported) after over 5 million shots. None following ‘routine’ infant and preschool immunization.

This practice remains one of the best ‘life saving’ procedures known to mankind. Archives of Disease in Childhood reports.


Children Grow Online

Do you know children that grow online ? See this PBS show now ! Today’s adolescents live inside their online experience.


Boxing for Children – a Health Issue ?

The art and sport of boxing – how safe is it to our children ?


CT scans induce radiation exposure and Cancer

Reduce radiation exposure from CT scans. Think a lot before ordering a scan, as rate of leukemia and brain tumors may increase based on this retrospective study in Lancet


Baby Genome for a Price

The future is already here, as we can identify child’s genetics with maternal blood sampled at about 18 weeks pregnancy with a paternal saliva. Will all parents want the test ?


Free Med School ?

‘Of the 15 highest-paid professions in the United States, all but two are in medicine or dentistry’. Why Med School should be free ? read the NY Times.


Hypertonic Saline for Wheezing

A group from Israel report in ‘Pediatrics’ a randomized, controlled, double-blind study of children with wheezing in the Emergency, who received either hypertonic saline 5% (4 mL, n = 16) or normal saline (4 mL, n = 25) with albuterol, twice every 20 minutes and 4 times a day when admitted.

While clinically both groups improved the same, children on hypertonic saline had a much shorter time in the hospital and a lower admission rate.

Time to consider (yet again) hypertonic saline ?


The Clinical Picture of a Perforated appendix

Determining clinically that a child has perforated appendix is challenging. A group from Taiwan suggest in Pediatric Emergency Care that younger age, longer duration of abdominal pain, fever, muscle guarding, and elevated C-reactive protein are significantly associated with a perforated appendix.


Healthy Swimming

Good review from the CDC on Healthy Swimming/Recreational Water safety. Ready for summer ?


Biomarker for Head Injury

A serum test called “S100B” taken during the first 3 hours of management of children with minor head injury may be the next big thing. The test has the potential to reduce need for CT scans, based on this study from France, in Clinical Chemistry Journal.


Music and the Brain

Dr. Charles Limb, ENT, think that there is enough evidence to say that musical experience, musical exposure, musical training, all of those things change our brain. From CNN.


Cancer and Folic Acid

Rates of Wilms tumor, primitive neuroectodermal tumors (PNET) and ependymomas were significantly lower with prenatal folic acid supplementation in a large Minnesota and Missouri epidemiological study, in Pediatrics.


Internet Exposure in Childhood

How much Internet exposure is healthy for children ? Not as much as they have, according to this report from CNN. In the days of limited attention span and very limited focus, maybe we should limit Internet exposure. Read CNN.


Nebulizers or Pressurized MDIs for Asthma

Nebulizers versus pressurized metered-dose inhalers in preschool children with wheezing;
Read full text from Canadian Family Physician;


Marketing Breast Milk Substitutes

An interesting read on the 30+ years of history of the WHO International Code of Marketing Breast Milk Substitutes (formula). Why was the USA the only country to vote against it and what did HIV do for breastfeeding and formula. June Pauline Brady writes in Arch Dis Child


Nighttime wakening post maternal Java

Infant sleep, or lack thereof, is a source for a lot of concerns among parents. Does caffeine consumption during pregnancy and by nursing mothers have consequences on sleep of infants at the age of 3 months.

The study (obviously) is from Brazil and was published in Pediatrics.

Bottom line – yes, but not significantly. Almost 900 mothers that consumed caffeine in pregnancy (20% of them heavy consumers) and 14% at 3 months postpartum participated in the study. More infants in the heavily caffeinated group had nighttime awakening (>3 episodes per night), but the numbers were not statistically significant.


Hypertension on the Rise

The changing face of hypertension in children. Sedentary life-style, obesity and fast paced dietary habits resulted in much more primary hypertension. Read a review [full text available] from New Orleans in Int Journal of Nephrology


Analgesia for Vaccinations

The 5s study – swaddling, side/stomach position, shushing sounds, swinging and sucking, can provide good analgesia for vaccination pain. See CNN report


Time Magazine challenges  Attachment parenting

Attachment parenting – the controversy continues. Who is the boss – the parent or the baby and how many B’s are truly enough ? Now TIME magazine and CNN video segment open the issue for further discussion.


Seizure Alert

How cool is that – a wristband sensor system, developed by Rosalind Picard and colleagues at the MIT Media Lab and Boston Children’s Hospital – will detect seizures and sound an alarm when a threshold is reached. Wow !


Prolonged Pregnancy and ADHD

‘Eventually all babies come out’, says my ObGyn friend. But based on a new study from the Netherlands post-term birth (over 42 weeks) is associated with more behavioral and emotional problems in early childhood, like ADHD. Are we going to see a higher rate of induced labor ?.


Overweight and Diabetes

Not that we needed more reasons to recommend keeping a normal weight for teens – USA Today reviewed a recent NEJM study from Colorado – overweight teens have a tough time keeping diabetes under control.