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Updates  Sep 2016


migraineBurden of Injury

Pediatrics continue to transition from in-house hospitalization to community based care. Combining data from primary care, specialty care, ED, urgent care, and inpatient settings, published now in JAMA Pediatrics by Arbogast et al from Philadelphia, suggests a much greater burden of injury from head injuries. Primary care physicians care from the majority of concussion.


A more than 8000 patients, almost 82% had their first visit within primary care of the Children’s Hospital of Philadelphia’s (CHOP) network and ¾ of children 5-17 year olds entered the hospital via primary care setting.


PACThe Guilt Factor

A sigh of relieve heard by parents world-wide with a recent study from Australia suggesting that letting babies cry themselves to sleep does not cause the emotional, behavioral or parent-child attachment concerns we were worried about.




o2We’ve Got The Power (without the Electric power)

Gone are the days we used to connect children to the power bar for asthma-relieving inhalations. Those metered dose inhalers with a tube-shaped spacers made the trick, at least for older children. A Swedish study just published in Journal of Asthma suggests that spacers with metered dose inhalers are at least as effective as nebulizers in getting the beta agonist mist to treat preschool children with virus induced wheezing or asthma. The Swedish team prospectively randomized pre-school children to receive beta-agonists in the pediatric emergency department when they had acute asthma exacerbation.

Among the 100 recruited patients 0-6 years of age, physiological measures (heart rate, respiratory rate, oxygen saturation) were similar between groups as well as the length of stay (2.5 hours) and hospitalization rate (11-15%). Parents’ ease of use and device acceptance was the same.

Bottom line – parents do not need to spend more money on nebulizers connected to the home electric circuit. Even young children can do as well with cylinder spacers and a puffer connected to its end.

Read more on asthma Mitselou  et al



migraineTreating Migraine through your Nose

Acute migraine headache is diagnosed much more frequently among children these days.

Meckler and Goldman wrote a review on treatment with intranasal sumatriptan. It is safe and mostly effective option for children and adolescents. While they suggest larger trials to overcome limitations such as ‘placebo effects’ intranasal administration is the way to go.

Learn more about intranasal sumatriptan



big-gulpSoda Ban

The proposed “soda ban” in New-York made waves and brought fame to Mayor Michael Bloomberg in recent months. The idea is simple – one can not buy soda drinks larger than 16 oz. While you can buy 3 or 4 of those if you are eager to gulp large amount of sugar, it is a measure to curb consumption of sugary drinks in hopes of reducing obesity.

Authors of a paper in Journal of Pediatrics suggest another reason to avoid large soda cups, or any soda at all. Among almost 3000 families children in the Fragile Families and Child Wellbeing Study is a prospective birth cohort study, 43% consumed at least one serving of soda per day. After adjusting to demographics, consuming any soda drinks daily was associated with an aggressive behavior. The effect was ‘dose-dependent’ and children with 4 or more soda drinks were almost 5 times more likely (4.7; 95% CI, 3.2-6.2) to score high on aggressive behavior scale and the attention problems subscale. Can soda be ‘the source for all evil’ ?

Learn about the ban


solar-sterilizerSterile Everywhere

Once in a while medicine is reinvented – check out this solar autoclave, activated by nanoparticles. Humble idea that crosses borders and bring medical sterile equipment everywhere.




potatoGenetics of Watching TV

A group from Philadelphia reported recently in Pediatrics, that among over 1500 parents interviewed online, the time parents spent watching the ‘tube’ was strongly predicting their child’s television time. This was a better predictor than access to television in the home, access to television in the child’s bedroom, rules-at-home or parent-child co-viewing. The findings were consistent to children in all age groups.

Children’s excessive television viewing is associated with several negative phenomena in childhood, including obesity.  Since ‘the apple doesn’t fall far from the (screen) tree’, educating parents about their own viewing habits is a must by those providing care for children.


xboxAutism, ADHD and Video Gaming

Psychologists from Missouri investigated three groups of boys and their video gaming patterns.  Parents of boys with autism spectrum disorder, ADHD and typical development were surveyed. Interestingly, boys with autism spent almost twice the daily time playing video compared to developmentally typical boys (2.1 hours a day). Both autism and ADHD was associated with greater in-room video game access and greater problematic video game use (yes, there is a score for that, based on measures associated with behavioral addiction model).

The findings are of interest, since hyperactivity and impulsivity are associated with criminal involvement in the future, and ‘problematic gaming’ may be a prelude for future problems. As for boys with autism –  spending a long time on a game console may be part of their potential social skills deficiency.


hamburgerFood Surveillance

Children will eat anything. They also tend to choke  on anything. A descriptive study based on data from the National Electronic Injury Surveillance System–All Injury Program reveal that a staggering number of children 0-14 years (over 110,000) were treated in emergency departments in the US over the period 2001-9 for chocking on food. The average age was 4.5 years.

What is most concerning is that a third of children were in their first year of life. Hard candy, other candies, meat and bone were the most common food associated with choking. 1/10 needed hospitalization.

The investigators suggested surveillance, food labeling and redesign as important strategies, but the likely most effective path should be educating their parents.


lactoProbiotics and Atopy

The rise of probiotics is of interest to many pediatricians. Seen in previous decades as a complementary medicine substrate with little to no proof of effectiveness, probiotics slowly gained press as well as scientific evidence of value in some conditions and as part of well being of children.

In a meta-analysis published by reviewers from a few US states, published in Pediatrics, the effect of probiotics on atopy and asthma in children was reviewed.  Bottom line : while not significantly reducing asthma or wheezing episodes, probiotics are effective in reducing total immunoglobulin E, reducing the risk of atopic sensitization when administered pre-natally for positive result on skin prick test and/or elevated specific IgE to common allergens, and also post-natally for skin prick test. The star was Lactobacillus acidophilus, with an increased risk of atopic sensitization.


shopping centreShopping Mall Pediatrics

Few pediatricians are great business movers and shakers. Business organizations are starting to be better pediatricians, or at least to provide pediatric services. Large chains like Walgreens started offering immunizations and nurse practitioners in hundreds of locations. Time covered a recent JAMA paper shedding more light on the phenomenon and how families take advantage of pediatric retail clinics for minor health issues. Who said you need a full-fledged pediatrician for a runny nose ?

While pediatricians and the American Academy of Pediatrics are concerned, effortless access, perception of who needs to see our children and smart marketing will win. Retail pediatrics is here to stay.


prematureBack to the Future

In the days of high tech ‘i’ devices and computer running everything, a collaboration between investigators in the US and Zambia went back to the …. plastic bag. They randomized 104 premature Zambian newborns (26-36 weeks gestation or 1-2.5 kg birth weight) to be put in a plastic bag or not at birth, along with standard warming (blanket or radiant warmer). The ‘plastic-bag babies’ were warmer at 1 hour post delivery (0.4 degrees). Incubator manufacturers be on guard.  Read in Pediatrics.



computerGuess Who is on Facebook

Pediatricians from Cincinnati Children’s asked over 250 parents, mostly African Americans and Medicaid insured, if they use technology. Well, the answer was yes, they do !  80% had internet at home and 71% had smartphone. That allowed them to be connected to email (91%), Facebook (78%) and Twitter (27%). Parents were connected and eager to receive practical clinical information, if ‘approved by their child’s medical provider’. Time to connect those patients to reliable information online. Read in Pediatrics.



COUGH-SYRUPCough Up an Explanation

Persistent cough in children makes everyone anxious and mostly…. tired. The child, the parents and the pediatrician. The authors of a recent paper in the journal Cough (very appropriate journal for the topic) from the UK and Malaysia explain the ‘prolonged acute cough’ phenomenon – not really acute, not truly chronic. From post bronchiolitis to post pertussis, this paper help organize a differential diagnosis. Yet, the cure for cough is still just being patient. Read full text.



concussionRecurrent Head Injury – Double the Pain

Emergency physicians at Boston Children’s Hospital followed patients 11-22 years old after acute concussion until symptom resolution. Those with previous concussion suffered twice as long (24 days compared to 12 days). Those with a previous concussion in the same year – suffered triple the agony (35 days).



tvTelevision Injuries on the Rise

A group from Columbus, Ohio, reviewed the ‘National Electronic Injury Surveillance System’ and found an average of almost 20,000 TV related injuries annually among children. This number represents only those that needed to visit a hospital, so the true figure is probably much higher. The vast majority (65%) are children under 5 years of age. The most concerning finding was the colossal increase in number of injuries over the last two decades, especially of devices falling from dressers and the like.



bpaPlastic Bottles and Obesity

In an ongoing effort to discover the environmental aspects of obesity, a group from Kaiser Permanente, Oakland, published in PLOS one a paper on the association of urine Bisphenol-A (BPA) and obesity. Available in all plastic products, and found to be in 92% of children, the group examined over 1300 students in grades 4 to 12 from three schools in china.

After adjustment of the analysis to known confounders, urine BPA level was associated with more than two-fold increased risk of having weight >90th percentile among girls 9–12 years old (adjusted odds ratio of 2.32). No such association was found in boys.

While supporting previous findings, it is not clear why the correlation was observed only in girls. It seems that with multitude of risks, BPA should be avoided.


anThe Fascination of the First Sound

With the first pediatric auditory brain stem implant in the US, little Grayson can now hear voices. Sanjay Gupta and CNN on the unique implant and the amazing story of Grayson and his foster parents




katy-perryWho’s Advice to Follow – Katy Perry Or Dr Mark Offit  ?

The New York Times piece by Dr Mark Offit, head of infectious diseases at CHOP (Children’s Hospital of Philadelphia) on why we should not take vitamins.  The well-oiled marketing machine, and the culture of mega-vitamins have always been pushing aside meta-analyses and scientific evidence. Will Dr Offit’s upcoming book on alternative medicine be the trigger to sensible parenting when it comes to vitamins ?  Clinical Pediatrics conference prediction: NO. The Katy Perry effect (read the article to understand why) is still heard loud and clear.


sim1Life Like Experience – Scripted

Resuscitation is one of the most scary experienced to health care providers. They are rare and stressful. Simulation, the new version of ‘mock codes’ are becoming more and more high-fidelity and the research behind them gaining momentum.  Not the least important is the debriefing after the simulated scenario: “so what did we learn here”. A group from 14 centers led by Dr Cheng from Canada published in JAMA Pediatrics a report on the use of a standardized script to facilitate team debriefings after a simulation session of a resuscitation. Scripted debriefing improved knowledge and leadership skills for subsequent simulations.


hpvHPV Vaccine Works

Despite confusion and disbelief among parents who do not understand why 11 year old girls need a vaccine for sexually transmitted diseases, HPV vaccine, now marketed for four years or so, is already making a significant (and surprising) impact.

Markowitz and others from the Centers for Disease Control and Prevention (CDC) report in the Journal of Infectious Diseases that among girls 14–19 years of age, HPV prevalence decreased 56% from 11.5% in 2003–2006 to 5% in 2007–2010, when serotypes covered by the vaccine are tested. Even one dose (and not 3 as recommended) had a significant impact. A total of more than 2000 girls were involved in the study throughout the years covered.

Now with two approved vaccines available, and more boys vaccinated, it will be interesting to see further reduction in HPV and likely cervical cancer.


steroidsTarget Lesions Reviewed

Seeing in the office a rash such as erythema multiforme (EM) on a child, the care givers are worried and push to get ‘something’ – would you give systemic steroids ?  A recent review paper by Chan suggests we hold on. The recommendation is to hold treatment for EM-minor (and consider topical steroids), and that systemic steroids for EM-major remains controversial.


DSC_0049Finish This Antibiotics

Most children probably do not finish the course of antibiotics they receive from their pediatrician. Furthermore, how come we give all children the same length of treatment. Shouldn’t we treat them based on personalized regimen – their age ?   severity of symptoms ? clinical improvement ? Interesting BMJ article.



bedtimeBedtime Reading – DSM-5 is Published

After a decade of revisions the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is now released by the American Psychiatric Association.
Expect a lots of changes and mental health “shift” in pediatrics.



prescriptionEthics Board – A friend or Foe

Be part of the ‘inner circle’ – here is a recipe to make ethics your friend and not your foe – at least by these UK based authors.




erWhat Would ER’s Dr Doug Ross Say ?

So how many of your patients come out of the emergency department and know exactly what the nurse, physician assistant or emerg doc told them ?     probably very few. Limited health providers’ time and level of understanding by patients and families have always been a problem. A group from Augusta, Georgia, report in Pediatric Emergency Care their effort to improve discharge instructions for common pediatric conditions such as fever, vomiting or diarrhea and wheezing. They randomized families to regular discharge or to watching a 3 minute video with some discharge instructions. Of more than 436 caregivers, parents receiving video discharge instructions scored a post discharge questionnaire significantly higher in the emergency (12 vs 9) and 2 to 5 days after discharge (11 vs 8). At follow-up, 29% of the written and 42% of the video groups rated their discharge instructions as being extremely helpful. In the age of YouTube and Vimeo, watching the “tube” is probably better the written instructions.


PACHoney, Can You Clean the Pacifier ?

The fear of botulism is the fundamental cause of recommending no honey be given to infants in their first year of life. A group from a county hospital pediatric clinic in Houston, Texas, asked parents about the practice of cleaning pacifiers with Honey. Surprisingly, 11% of about 400 families use this ‘method’. This is a group of children with a ‘potential’ for severe illness. One of the challenges is likely the level of awareness to the risks. Only about 20% of all parents were aware of botulism as a risk. As always, knowledge is power. Read Pediatrics.



soapDear Doc ! Wash your hands – Big Bro sensing you






docSepsis Explained

Protocols, advice, interesting reminders about treating sepsis





vialBeware of Medication Changes

A group from Boston determined recently that changing adult prescription drugs resulted in pediatric medication exposures and poisonings. The findings were among all age groups, mostly among 0 to 5 years old, and opioids were the biggest ‘offenders’.   These poisoning reports were not benign. Emergency department visits were highest for events related to hypoglycemics (60%) and beta-blockers (60%); serious injuries and hospitalizations occurred with opioids (27% and 35%) and hypoglycemics (20% and 50%). Read in Pediatrics.


award10 Best

Which are your 10 best medical advancement in the last decade ?  Here is CNN’s list.




srngThe Doctor Will Not See You Now

Patients may diagnose themselves, using technology, and prescribe themselves medications without ever seeing the doctor. Sounds far-fetched until learning that the Food and Drug Administration (FDA) is seriously considering this option.





Can We Prevent Asthma ?

Pediatric research established the connection between viral infection (such as respiratory syncytial virus) and asthma. In a recent New England Journal of Medicine issue the Dutch RSV Neonatal Network reported a randomized, double-blind, placebo-controlled trial and found that premature infants that were given palivizumab (monoclonal antibody for respiratory syncytial virus) had a significant 61% decrease in the total number of wheezing days during their first year of life, compared to not receiving the (extremely expensive) regimen. Reduced wheezing persisted after the prophylaxis period. Is this the future of asthma prevention ?  time will tell.

Read NEJM paper and Editorial.


scaleThe Real Risks of Early Life Obesity

A group from Australia followed children from early life to 8 years of age and found the correlation that pediatricians intuitively think about. Weight gain from 0-18 months is significantly associated with later childhood overweight and obesity. More importantly, it is also correlated with excess central adiposity, higher systolic blood pressure, higher inflammatory markers (CRP) and greater carotid artery wall thickness. Read in pediatrics.


zzzCo-sleeping High in SIDS

What was known as one of the risk factors for sudden infant death syndrome (SIDS) is now curved in “stone”. Sharing a bed with a baby increased their risk of SIDS fivefold, even without any other known risk factor such as smoking at home and alcohol use. The trend of co-sleeping is abundant in many countries, so advice from the pediatric provider is important. While the rate of SIDS declined in the last decade to 1 in 2000 babies, the decline has plateaued. BMJ Open.  Picture: rubyblossom on flickr.



JedwardFrom Now On Only ‘Jedward’ ?

So a group from Ireland had to find an answer to the question – how do children like their hospital glove  – ‘Jedward’ or ‘Mohawk’  ?

First a clarification on ‘Jedward’ for those not watching The X Factor TV show. The name relates to the twin performers John and Edward Grimes, known by the name Jedward, who have a unique hair do. ‘Mohawk’  needs no explanation.

Distracting kids during a procedure is important and in the age of iPad and video on demand, some clinicians are still looking for low-cost, easy to use bed-side distractions. So to answer the ‘Jedward’ or ‘Mohawk’ was provided by the Irish investigators who randomized children arriving to their hospital and 75 picked the ‘Jedward’ version and 61 the ‘Mohawk’ version of the glove-baloon.

One thing is for sure – never let the kids play with the glove – this is a choking hazard !

Picture: Wikipedia


inhalerAsthma Review

Nice review on the management of Asthma. Full text in Paediatric Child Health.





satDesaturation a Killer for Premature Babies

In a world wide effort to improve quality of life and reduce mortality of premature babies younger than 28 week gestation, three international randomized, controlled trials, compared oxygen saturation of 85-89%, to a level of 91-95% on disability-free survival at 2 years of age.

Lower oxygen saturation was associated with reduced rate of retinopathy of prematurity (relative risk 0.79) but was also associated with an increased rate of necrotizing enterocolitis (relative risk 1.31).

But more importantly, when a trial stops early, such as this one, the message is clear – there is no need for more research. In this large trail, now in the New England Journal of Medicine, interim analysis showed an increased rate of death at 36 weeks in the group with a lower oxygen saturation.


PACNipple Confusion

While past recommendations were against pacifier use in children that breastfeed, a recent PRETx review in Canadian Family Physician suggests that breastfeeding cessation is more a parental decision than use of pacifiers.  Free full-text.



RBCBacteremic SCD Patients

Routine penicillin prophylaxis and conjugate vaccines are making a difference. This time it is for children with Sickle Cell Disease. While up to 5% were shown to be bacteremia in the past, a recent study from Boston Children’s reports 18 years’ worth of data, and only 9 out of over 1100 children with febrile episodes had bacteremia. There was no morbidity or mortality, even in children discharged from the emergency. Pediatrics is getting closer to the vision of managing children outside the hospital. The paper in Pediatrics.


Texting-While-DrivingTexting Epidemic

The Centers for Disease Control and Prevention’s 2011 national Youth Risk Behavior Survey continues to provide alarming data on generation “young”. Among over 8500 adolescents 16 years old or over (US national representative sample), almost half report texting while driving during a 30 days period. Risky in itself, the authors from Atlanta found that these students are more likely to engage in additional risky motor-vehicle behaviors. Now in Pediatrics. t

Tell your adolescent patients, or just text them the link for this YOUTUBE video from “Responsible Young Drivers” :


breatfeed-timeFormula To Help Breastfeeding ?

A group from University of California San Francisco reports randomizing newborn babies who lost 5% or more of their birth weight at 1-2 days of life to continue just breastfeeding or receive some additional formula. For those receiving supplementation – rate of formula use at 1 week was lower and rate of breastfeeding at 3 months was higher. The bottle may have just been what these babies needed – a bridge to better breastfeeding. Read in Pediatrics.



xboxLet the (exer)Games Begin

The last recommendation you may expect from the pediatrician is to prescribe children with more video gaming. A study from Australia, now in Journal of Pediatrics, may suggest just that.

Active console games (exergaming) on Xbox 360–Kinect in a small group of children (15) induced significant increase in heart rate and increased energy expenditure, but only if the game was ‘high intensity’ such as 200m Hurdles. Low intensity game like bowling did not ‘do the trick’. Well, this actually make sense. An even better recommendation for children and their parents  ?   do the actual 200m hurdles outside !


EATHow Often Should They Eat ?

In a meta-analysis published in Pediatrics by a group from Greece, eating frequent meals was associated with lower body weight. The author reviewed 1707 papers and ended summarizing 11 studies with over 18000 children. The findings were true especially in boys.



utiHow Far Do you Go (to Test Urine)

Fever – the essence keeping pediatric medicine awake at night. With advanced vaccination, invasive testing in the non-verbal febrile child is diminishing slowly. But Urinary Tract Infection is still a culprit. In Annals of Emergency Medicine a good review of past search for UTI and the shifting paradigm for testing less. The authors from New York conclude that it is reasonable to withhold or delay testing for urinary tract infection if signs of other sources are apparent or if the fever has been present for fewer than 4 to 5 days. In the “fever without a source” we still need to “chase” UTI.


emergencyIn Case of Emergency

Children account for 20% of US emergency department visits, yet specialized peds emergency is far from perfect. A group from Boston, Massachusetts called over 200 randomly selected Emergency Departments and found lack of progress compared to a decade ago. Only a third had pediatric departments, only 1/8 had intensive care units and only a tenth had a separate pediatric ED. Most EDs treated only mild-to-moderate cases of childhood bronchiolitis and asthma and only half were able to care for children with acute appendicitis. In case of Emergency our children may be in trouble. Read International Emergency Medicine.


wristbandSaliva Against Allergies

‘Best news ever’ for parents cleaning their children’s pacifiers by putting it in their mouth ! Of  184 infants 18 and 36 months of age whose parents sucked on their pacifiers to clean them during the first 6 months of life had only a 1/3 of the risk of developing eczema at 18 months of age, compared to children whose parents did not cleaning the pacifiers this way. So possibly saliva stimulate baby’s immune system. Forget hot water, soap or alcohol rub to pacifiers – start sucking on them to clean. See Pediatrics.


fatigueChronic Fatigue Syndrome

More and more evidence is available that chronic fatigue syndrome (CFS) affects children and not only adults as thought before. Among close to 550 adolescents in a specialized UK clinic, the rate of depression among children with CFS the prevalence of depression is close to 29%. As one would expect, this high rate, much more significant than in the population of adolescents, was associated with the amount of disability.



hamburgerCouch Potato – The Scientific Proof ?

Among 91 adolescents 13-15 who completed a week long random surveys on their activities (primary, secondary, and tertiary attention), watching TV as a primary activity was associated with higher BMI. The amount of time spent watching television was unrelated to BMI.

Could it be commercials seen on the screen ?  preferring energy-dense, nutritionally questionable foods ?  eating while distracted by TV ?   asks the authors from Boston Children’s.

Another interesting finding was that duration of use or extent of attention paid to video games or computers was not associated with BMI. It would have been interesting to determine if “computer time” means active engagement (compared to watching streamed video) that suppressed the desire to eat. Read more in Pediatrics.


pediatricianConflicting Advice By Pediatricians

Why pediatrics is so exciting and pediatricians so contradictory with their advice …… a great post by Claire McCarthy, MD, a Boston Children’s Hospital pediatrician, on the different pieces of advice we give parents. This one started from discussing sleep advice, but the issue is true for all aspects of parents’ advice.



ctSave those CTs

Will you be satisfied with a drop of almost 50% in the rate of CT scans for children with suspected appendicitis ?   we will. Less radiation (and reduced risk of cancer in the future), reduced cost and likely even shorter wait for operation ?

All a group from South Carolina had to do was to sit down and create clinical practice guideline. Pre-guidelines as many as 90% of children had a CT scan, and after implementation – only 48%. Ultrasound rate increased significantly but the no-imaging group also tripled. Published in Pediatric Emergency Care.

Maybe others just need to ‘sit’ and create guidelines.


everyday-hOne Story

A brave girl. An impossible diagnosis. A 12 year old with an emotional story about Familial Adenomatous Polyposis, a colon resection and how genetic testing changed her life, for now at least. Sanjay Gupta in Everyday Health.




bottleErrors Can Happen at Home

Look for errors at home as well as in the hospital and clinic setting. After reviewing almost 1000 medications in the homes of children with cancer, a group from Massachusetts School of Medicine report 3.6 errors/100 patients and 36 errors/100 patients with potential for injury. Still lots to do, even at home !




nutsFood Allergy on the Rise

Food allergy increases in the US. 8% have allergy and 30% of them more than one allergy. Dr. Wayne Shreffler from Massachusetts General and Dr. Ruchi Gupta from Chicago on this interesting NPR’s Radio show. GoEpiGo !




prescriptionAnti-acne Compliance Very Low

Compliance with anti-acne meds seems very low. In a study led by a pharmacist from University of Michigan, reviewing prescription databases of over 24000 patients (90% under 18 years old), average adherence rate to acne drugs was only 11.7%. Patients were less adherent to antibiotics and topical retinoids. The use of oral antibiotics dramatically reduced acne-related outpatient visits (by half) and reduced acne-related total health care cost by half !

Why are they not filling the script ?


cinnamonI Dare You

Our (childrens’) life by YouTube. In a new paper in Pediatrics, investigators from Miami are concerned about the “Cinnamon Challenge” seen over 50,000 times on YouTube, and resulted in adolescents needing ER visits and hospitalizations. The video calls to try and swallow a tablespoon of cinnamon powder in 60 seconds with no water. The main problem with cinnamon is that it is a caustic powder that neither dissolve nor biodegrade in the lungs. Extensive cough, vomiting, nosebleed, and chest tightness were among the more serious symptoms.


keep-calmCoping With Stress after Boston Marathon Bombing

Children want to know. Children need to know. And they usually have three questions on their mind, even if they do not articulate them well. Parents, teachers and pediatric health care providers must de-stress and allow children to understand the news. Psychology Today provides some practical advice to helping children cope with the stress.



znSmall Metallic Element That Makes a Difference

Zinc supplementation made a huge difference to the lives of millions of children in developing countries. Zinc is a safe and effective measure to shorten diarrhea-related illness in children and to possibly reduce other complications – including death !. Read in Canadian Family Physician.


notesMusic to My Ears ….and for Neonatal Health

In a New York based randomized clinical trial, almost 300 premature babies in a neonatal intensive care unit were monitored while listening to lullabies. Cardiac and respiratory function was improved and even feeding behaviors and sucking patterns were better. But maybe more important, the music significantly decreased parental stress perception. Read the Pediatrics paper.



sleepSleeping (slim) Beauty

Sleep was shown over the years to improve physical and mental health. In a large cohort from Philadelphia, published in pediatrics, investigators report that the BMI of adolescents 14-18 years of age can benefit from sleep.

Follow-up on almost 1400 adolescents from ninth to twelfth grade found that the largest increase in BMI observed at the 90th BMI percentile. Each additional hour of sleep was associated with decreases in BMI at percentiles 10th to 90th. Increasing sleep from 7.5 to 10 hours per day at age 18 predicted a reduction in the proportion of adolescents with BMI >25 by 4%.

The challenge of getting adolescents off their computer and social media outlets, and have them sleep more is yet to be addressed.


o2Heliox for Bronchiolitis

While the season of bronchiolitis in North America is almost over, effort to find supportive therapy for the viral induced illness are continuing.  In pediatrics, a group from the UK, reported an RCT looking at Heliox (21% oxygen + 79% helium) and Airox (21% oxygen + 79% nitrogen) for over 300 infants with bronchiolitis.

Length of treatment required to alleviate hypoxia and respiratory distress was not different between the two groups. When heliox was given via a nasal cannula – treatment was ineffective.


vial Autism and Vaccine (Again)

Following the decade-old Institute of Medicine (IOM) report determining no causal relationship between vaccines and autism, a new study in the Journal of Pediatrics challenges the belief that “too many vaccines too soon” may be associated with autism.

Comparing 256 children with autism spectrum disorder compared with 752 children without autism spectrum disorder, the amount of antigens from vaccines received on one day of vaccination and the amount of antigens from vaccines received in total during the first two years of life was not different.

“vaccine phobia” will continue to affect many parents’ decision making when it comes to vaccinating children, but the this study may provide health care providers with more tools to explain the safety of vaccines.


docParents Don’t Follow The Doctor’s Orders

Two-thirds of parents say they don’t always follow the advice they get from their child’s doctor, according to a new poll from the University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health. Enhancing health literacy will also increase compliance. We can tell them what they need to know, answer parents’ questions and refer them to resources.


PRETx-logoAntidepressants for functional gastrointestinal disorders in children

We know very little on treating functional gastrointestinal disorders in children and keep on learning how little we know. This recent Canadian Family Physician Journal review paper from the PRETx program ( reflects on the use of antidepressants. Not enough evidence for their effectiveness.



AEDs And Child Life Saving

Kids Play – AEDs are easy to use and can save lives. High school students can use them effectively the first time they see them. Read Contemporary Pediatrics with a nice summary on AEDs.




otitisClarity Around Otitis Media Diagnosis and Treatment

The American Academy of Pediatrics came out this month with an updated Clinical Practice Guideline for the ‘The Diagnosis and Management of Acute Otitis Media’. Bottom line – make the correct diagnosis (redness and effusion are not otitis), reduce pain as part of treatment, antibiotics for severe otitis in everyone 6 month and older, antibiotics for non-severe bilateral otitis in 6-23 month of age, choose observation (and reassessment) or treatment for non-severe unilateral otitis in 6-23 month of age or any otitis in older children.

Amoxicillin still the drug of choice. Give antibiotics with lactamase coverage for recurrent infections, recurrent purulent conjunctivitis and non-responders to Amox.

A must read for everyone treating children !


meds2The High Toll of Giving Drugs To Children

Zed et al in Journal of Pediatrics reviewed papers with medication-related ED visits and hospital admissions. 0.5%-3.3% ended up in emergency department, 0.16%-4.3% had to be admitted, and up to two thirds were preventable !

From wrong prescription to overdose, allergic reaction and adverse drug reactions – all were documented well. The biggest offenders : antibiotics, CNS drugs, analgesics, hormones, cardiovascular and respiratory drugs and even vaccines.


obesityBreastfeeding Good But Not For Obesity Prevention

In a finely designed study, Martin et al found breastfeeding does not promote reduced obesity later in life. In a cluster-randomized controlled trial in Belarus, with over 17 000 breastfeeding mother-infant pairs in 31 hospitals, child adiposity and circulating insulin-like growth factor (IGF)-I were not affected by exclusivity breastfeeding. Children may still be overweight or obese.


medsAny Kids Without Stimulants ?

Read the CNN piece on enhancing attention using stimulants in healthy children. The American Academy of Neurology position paper againt the common practice of prescribing stimulants (and other drugs) to boost cognitive function in healthy children and teens.



azithroFDA Warning On Azithromycin Intensify

Based on a New England Journal of Medicine paper on the known risk for prolonged QT interval and torsades de pointes – a new FDA warning is published. Should an ECG be done on every child on Azithro  ?



sim1Proton pump inhibitors for irritable infants

They cry – so lets treat them. While tolerated, PPIs in infants and children who cry do not show efficacy. They can cause gastro, pneumonia and other complications. Read this PRETx update in Canadian Family Physician.




NSAIDS for Corneal Abrasion

Tonsillectomy for Strep Throat

Pertussis Epidemic

Therapy for Colic ?

Predicting ER Visits in Diabetes

Guillain-Barré Syndrome Review

Low Acuity ER Visits

FDA cuts BPA

Play More Expand Less

GPS for Puffers

Facebook and Depression

Alternating Antipyretics

Obamacare Impact

Studies in Children

Reacting to Food

Severe Bacterial Infection Score

Overdiagnosing ADHD

Celiac Disease and Immunization

Probiotics and Allergic Rhinitis

Water Safety

Smart Phone for Otitis Rescue

Track Migraine

Children Still Suffer

Physicians and Drug Reps

Geographic Variability of Food Allergy

The ‘First Dinner’

Localized Purpuric Rash

Acute Rhinosinusitis

The Benefits of Friends (the real ones….)

The Best Children’s Hospitals in the US

Anaphylaxis Following Immunization

Children Grow Online

Boxing for Children – a Health Issue ?

CT scans induce radiation exposure and Cancer

Baby Genome for a Price

Free Med School ?

Hypertonic Saline for Wheezing

The Clinical Picture of a Perforated appendix

Healthy Swimming

Biomarker for Head Injury

Music and the Brain

Cancer and Folic Acid

Internet Exposure in Childhood

Nebulizers or Pressurized MDIs for Asthma

Marketing Breast Milk Substitutes

Nighttime wakening post maternal Java

Hypertension on the Rise

Analgesia for Vaccinations

Time Magazine challenges  Attachment parenting

Seizure Alert

Prolonged Pregnancy and ADHD

Overweight and Diabetes

Why Vancouver ?


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