Pediatrics

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Pediatrics

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Behavioral Intervention May Promote Weight Loss in Overweight Mexican American Children

Cognitive-Behavioral Therapy for PTSD in Children and Adolescents: A Preliminary Randomized Controlled Trial. (J Am Acad Child Adolesc Psychiatry. 2007)

Dialectical behavior therapy for adolescents with bipolar disorder: a 1-year open trial. (J Am Acad Child Adolesc Psychiatry. 2007)

Clinical efficacy of group-based treatment for childhood obesity compared with routinely given individual counseling. (Int J Obes (Lond). 2007) "Conclusions:Family-based group treatment that stresses a health-promoting lifestyle and is given separately for parents and children, offers an effective mode of therapy to treat obese school-aged children."

Device Therapy

Grommets in otitis media with effusion: the most frequent operation in children. But is it associated with significant complications? (Eur J Pediatr. 2007) " CONCLUSION: It would appear that the complications associated with tympanostomy tube insertion are more frequent than anticipated, reaching 80% of operated ears under specific circumstances and in certain subgroups of children. These complications may resolve with conservative management, but in persistent cases surgical removal of the tubes is mandatory."

Ear Tubes Not Needed to Promote Learning " Most toddlers with frequent ear infections don't need ear tubes to preserve normal learning and behavior through primary school, according to a study challenging one big reason for these common procedures. Repeated ear infections -- even some colds -- can leave a fluid buildup that specialists long feared would dampen hearing and slow language and other learning. However, it now appears the hearing loss is too short-lived and mild to interfere with learning, at least in the vast majority of children."

Severe Obstructive Sleep Apnea Alleviated by Oral Appliance in a Three-Year-Old Boy. (Respiration. 2007) " In conclusion, we consider the use of an oral functional appliance for severe obstructive sleep apnea in children to be a valuable alternative to other treatment methods."

Drug Side-Effects and Interactions

Recurrent Urinary Tract Infections in Children (JAMA 2007) "Conclusion Among the children in this study, antimicrobial prophylaxis was not associated with decreased risk of recurrent UTI, but was associated with increased risk of resistant infections."

FDA issues new warnings on antidepressants "Young adults beginning treatment with antidepressants should be warned about an increased risk of suicidal thoughts and behavior, federal health officials said Wednesday. The Food and Drug Administration proposed labeling changes that would expand a warning now on all antidepressants. The current language applies only to children and adolescents. The expanded warning would apply to adults 18-24 during the first month or two of treatment with the drugs, the FDA said. "

Case Report: Valproic Acid and Risperidone Treatment Leading to Development of Hyperammonemia and Mania. (Journal of the American Academy of Child & Adolescent Psychiatry. 2007)

Adult Drugs for Sick Kids "A new study finds that close to 80 percent of children in U.S. hospitals are receiving drugs that have been approved only for grownups. The growing problem of 'off label' prescriptions."

Infant Deaths Associated with Cough and Cold Medications --- Two States, 2005 (MMWR 2007)

Should the use of selective serotonin reuptake inhibitors in child and adolescent depression be banned? (Psychother Psychosom. 2007) "Conclusion: An SSRI prescription is still a second-line option in severe and resistant forms of youth depression. However, in children and adolescents only specialists well trained in child and adolescent psychiatry should prescribe SSRIs."

Drugs

Over the Counter but No Longer under the Radar — Pediatric Cough and Cold Medications "Since 1985, all six randomized, placebo-controlled studies of the use of cough and cold preparations in children under 12 years of age have not shown any meaningful differences between the active drugs and placebo."

EpiPen use in children with food allergies.

Bisphosphonate therapy for children and adolescents with secondary osteoporosis. (Cochrane Database Syst Rev. 2007)

The Treatment for Adolescents With Depression Study (TADS): long-term effectiveness and safety outcomes. (Arch Gen Psychiatry. 2007)

Atomoxetine Treatment of ADHD in Children With Comorbid Tourette Syndrome. (J Atten Disord. 2007)

Efficacy and Tolerability of Second-Generation Antipsychotics in Children and Adolescents With Schizophrenia. (Schizophr Bull. 2007) "The available data from short-term studies suggest that youth might be more sensitive than adults to developing antipsychotic-related adverse side effects (eg, extrapyramidal side effects, sedation, prolactin elevation, weight gain). In addition, preliminary data suggest that SGA use can lead to the development of diabetes in some youth, a disease which itself carries with it significant morbidity and mortality. Such a substantial risk points to the urgent need to develop therapeutic strategies to prevent and/or mitigate weight gain and diabetes early in the course of treatment in this population."

Acute treatment of paediatric migraine: A meta-analysis of efficacy. (J Paediatr Child Health. 2007)

Antipsychotic medication for childhood-onset schizophrenia. (Cochrane Database Syst Rev. 2007)

Ibuprofen demonstrated to be superior pain relief for pediatric musculoskeletal injuries "A single dose of ibuprofen provides better pain relief than acetaminophen or codeine for children requiring emergency treatment for musculoskeletal trauma, according to the results of a randomized, controlled trial published in the journal Pediatrics."

No evidence that early use of inhaled corticosteroids reduces current asthma at 10 years of age. (Respir Med. 2007) "BACKGROUND: It is debated whether early treatment with inhaled corticosteroids (ICS) can change the natural course of childhood asthma. . CONCLUSION: No evidence was found that early use of ICS before age two in children with rBO reduces current asthma 8 years later."

Decongestants and antihistamines do not relieve symptoms of otitis media with effusion. (Am Fam Physician. 2007)

Short-Course Amoxicillin Effective in Mild Childhood Pneumonias "A three-day course of oral amoxicillin at 45 mg/kg/day is as effective as the double-dose regimen in treatment of non-severe pneumonias in children, according to results of a study from Pakistan."

Long-term, open-label venlafaxine extended-release treatment in children and adolescents with major depressive disorder. (CNS Spectr. 2007) "Conclusion: Most improvement with venlafaxine ER occurs during the first 6 weeks of treatment. Prescribers should be alert to signs of suicidal ideation and hostility in pediatric patients."

Ibuprofen best in relieving children's pain: study "Ibuprofen was superior to acetaminophen and codeine in relieving the pain from a broken bone or serious sprain suffered by children brought to the emergency room, Canadian researchers said on Monday."

Topical nasal steroids for intermittent and persistent allergic rhinitis in children. (Cochrane Database Syst Rev. 2007)

[Bisphosphonate therapy for children and adolescents with primary and secondary osteoporotic diseases.] (Orthopade. 2007)

Topical nasal steroids for intermittent and persistent allergic rhinitis in children. (Cochrane Database Syst Rev. 2007)

The pharmacological management of childhood anxiety disorders: a review. (Psychopharmacology (Berl). 2007) " CONCLUSION: There is good evidence to support the efficacy of several pharmacological agents including the selective serotonin reuptake inhibitors to treat pediatric anxiety and obsessive-compulsive disorder, although there are still many unanswered questions."

Exercise

The effects of vigorous exercise training on physical function in children with arthritis: A randomized, controlled, SINGLE-BLINDED trial. (Arthritis Rheum. 2007)

Safety and Feasibility of Inpatient Exercise Training in Pediatric Heart Failure: A PRELIMINARY REPORT. (J Cardiopulm Rehabil Prev. 2007)

General Information

Diagnosis and Treatment of Otitis Media (Am Fam Physician 2007)

Pediatric obstructive sleep apnea: current management. (ORL J Otorhinolaryngol Relat Spec. 2007)

Study: Try Honey for Children's Coughs "A teaspoon of honey before bed seems to calm children's coughs and help them sleep better, according to a new study that relied on parents' reports of their children's symptoms. The folk remedy did better than cough medicine or no treatment in a three-way comparison. Honey may work by coating and soothing an irritated throat, the study authors said. "

Maybe Your Kid Doesn’t Need His Tonsils Out "The investigators note most kids will outgrow the tendency to develop these problems, which means the long-term cost effectiveness of an adenotonsillectomy is negligible."

Are Too Many Babies Taking Antireflux Medications?

Evaluation and management of childhood and adolescent obesity. (Mayo Clin Proc. 2007)

Antibiotics Not Justified for Respiratory Tract Infections, Sore Throat, or Otitis Media

Infant cold medicines pulled for overdose risk "Drugmakers on Thursday voluntarily pulled kids’ cold medicines off the market less than two weeks after the government warned of potential health risks to infants. … Cold medicines being withdrawn include: Johnson & Johnson Pediacare Infant Drops and Tylenol Concentrated Infants Drops, Wyeth’s Dimetapp Decongestant Infant Drops, Novartis’ Triaminic Infant & Toddler Thin Strips and Prestige Brands Holdings’ Little Colds Decongestant Plus Cough."

Management of type 2 diabetes in youth: an update. (Am Fam Physician. 2007) "More than 13,000 youths are diagnosed with diabetes every year, making it one of the most common chronic childhood diseases in the United States.1-3 The prevalence of childhood type 2 diabetes has increased by 33 percent in the past 15 years,3 mirroring the increasing rates of overweight in this population.."

The Treatment for Adolescents With Depression Study (TADS) (Arch Gen Psychiatry. 2007) "Conclusions In adolescents with moderate to severe depression, treatment with fluoxetine alone or in combination with CBT accelerates the response. Adding CBT to medication enhances the safety of medication. Taking benefits and harms into account, combined treatment appears superior to either monotherapy as a treatment for major depression in adolescents."

Ban Sought on Cold Medicine for Very Young "Safety experts for the Food and Drug Administration urged the agency on Friday to consider an outright ban on over-the-counter, multisymptom cough and cold medicines for children under 6. The recommendation, in a 356-page safety review, is the strongest signal yet that the agency may take strong action against the roughly 800 popular medicines marketed in the United States under names like Toddler’s Dimetapp, Triaminic Infant and Little Colds."

Hot Air May Be an Effective Nonchemical Treatment of Head Lice

Management of Type 2 Diabetes in Youth: An Update (Am Fam Physician 2007)

It's Head Lice Season: Experts Offer Primer On Wiping Out The Head Invaders

All Probiotics May Not Be Equally Effective in Children With Acute Diarrhea

Public Health Advisory Nonprescription Cough and Cold Medicine Use in Children August 15, 2007 "What should parents know about using cough and cold products in children? • Do not use cough and cold products in children under 2 years of age UNLESS given specific directions to do so by a healthcare provider. • Do not give children medicine that is packaged and made for adults. Use only products marked for use in babies, infants or children (sometimes called “pediatric” use). • Cough and cold medicines come in many different strengths. If you are unsure about the right product for your child, ask a healthcare provider. • If other medicines (over-the-counter or prescription) are being given to a child, the child’s healthcare provider should review and approve their combined use. • Read all of the information in the “Drug Facts” box on the package label so that you know the active ingredients and the warnings. • Follow the directions in the “Drug Facts” box. Do not give a child medicine more often or in greater amounts than is stated on the package. • Too much medicine may lead to serious and life-threatening side effects, particularly in children aged 2 years and younger. • For liquid products, parents should use the measuring device (dropper, dosing cup or dosing spoon) that is packaged with each different medicine formulation and that is marked to deliver the recommended dose. A kitchen teaspoon or tablespoon is not an appropriate measuring device for giving medicines to children. • If a measuring device is not included with the product, parents should purchase one at the pharmacy. Make sure that the dropper, dosing cup or dosing spoon has markings on it that match the dosing that is in the directions in the “Drug Facts” box on the package label, or is recommended by the child’s health care provider. • If you DO NOT UNDERSTAND the instructions on the product, or how to use the dosing device (dropper, dosing cup or dosing spoon), DO NOT USE the medicine. Consult your healthcare provider if you have questions or are confused. • Cough and cold medicines only treat the symptoms of the common cold such as runny nose, congestion, fever, aches, and irritability. They do not cure the common cold. Children get better with time. • If a child’s condition worsens or does not improve, stop using the product and immediately take the child to a health care provider for evaluation. "

Management of Acute Otitis Media by Primary Care Physicians: Trends Since the Release of the 2004 American Academy of Pediatrics/American Academy of Family Physicians Clinical Practice Guideline (PEDIATRICS 2007) "CONCLUSIONS. Most primary care physicians accept the concept of an observation option for acute otitis media but use it only occasionally. Antibiotics prescribed for acute otitis media differ markedly from the guideline's recommendations, and the difference has increased since 2004."

Current issues in the management of acute bacterial sinusitis in children. (Int J Pediatr Otorhinolaryngol. 2007)

Pediatric obsessive-compulsive disorder: a guide to assessment and treatment. (Issues Ment Health Nurs. 2007)

Best Management of Fever From an Unidentifiable Source in Young Children " Fever that is clinically significant is typically defined as a rectal temperature higher than 100.4°F (38°C). Further evaluation is required for previously healthy, well-appearing children 3 to 36 months of age with a rectal temperature of 102.2°F (39°C) or higher. Several studies have shown that axillary and tympanic temperatures are unreliable in young children. Specific recommendations are as follows: . Any infant younger than 29 days, and any child who appears toxic, regardless of age, should undergo a complete sepsis work-up and be admitted for observation and administration of intravenous antibiotics after completion of a sepsis workup, until the source of the fever is found and treated (level of evidence, A). Work-up should include a complete blood cell (CBC) count with manual differential; blood cultures; lumbar puncture for cell counts, glucose, protein, and culture; and urinalysis with culture. . Laboratory evaluations for neonatal herpes simplex virus infection also should be considered in patients with risk factors for infection, particularly maternal infection at the time of delivery, as well as the use of fetal scalp electrodes; vaginal delivery; cerebrospinal fluid pleocytosis; and skin, eye, or mouth lesions. . [see more recommendations .]

Pertussis in Adolescents. (Adv Ther. 2007)

Should preschool wheezers ever be treated with inhaled corticosteroids? (Semin Respir Crit Care Med. 2007) "Unfortunately, neither corticosteroids nor any other currently available therapy modifies the long-term outcome of preschool wheeze. In conclusion, corticosteroid treatment may have a small role in preschool wheeze, in particular for those thought to have early asthma, but the uncritical application of recommendations that are appropriate for older children and adults with asthma has led to widespread overuse of these medications. There is an urgent need for better treatment of preschool wheeze."

Role of Zinc Administration in Prevention of Childhood Diarrhea and Respiratory Illnesses: A Meta-analysis (PEDIATRICS 2007)

Psychiatrists, Children and Drug Industry's Role ". the intersection of money and medicine, and its effect on the well-being of patients, has become one of the most contentious issues in health care. Nowhere is that more true than in psychiatry, where increasing payments to doctors have coincided with the growing use in children of a relatively new class of drugs known as atypical antipsychotics. These best-selling drugs, including Risperdal, Seroquel, Zyprexa, Abilify and Geodon, are now being prescribed to more than half a million children in the United States to help parents deal with behavior problems despite profound risks and almost no approved uses for minors. A New York Times analysis of records in Minnesota, the only state that requires public reports of all drug company marketing payments to doctors, provides rare documentation of how financial relationships between doctors and drug makers correspond to the growing use of atypicals in children. From 2000 to 2005, drug maker payments to Minnesota psychiatrists rose more than sixfold, to $1.6 million. During those same years, prescriptions of antipsychotics for children in Minnesota's Medicaid program rose more than ninefold. . Such payments could encourage psychiatrists to use drugs in ways that endanger patients' physical health, said Dr. Steven E. Hyman, the provost of Harvard University and former director of the National Institute of Mental Health. The growing use of atypicals in children is the most troubling example of this, Dr. Hyman said. "

Recommendations for the management of migraine in paediatric patients. (Expert Opin Pharmacother. 2007)

Coughs, Colds, Children, and Over-the-Counter Remedies

What is new in otitis media? (Eur J Pediatr. 2007)

Treatment of the Common Cold (Am Fam Physician 2007)

Twelve-Month Effectiveness of a Parent-led, Family-Focused Weight-Management Program for Prepubertal Children: A Randomized, Controlled Trial (PEDIATRICS 2007)

Children With Stroke Increasingly Treated With tPA "A new study shows that despite the lack of data on safety or efficacy, children with stroke are increasingly receiving treatment with tissue plasminogen activator (tPA), sometimes outside of the 3-hour time window and at larger doses than have been established to be safe and efficacious in adults."

What are we doing to our children?

Traumatic brain injury-mediated hypopituitarism. Report of four cases. (Eur J Pediatr. 2007) " Growth hormone was the most commonly affected pituitary hormone. The time interval between the injury and diagnosis of pituitary hormone deficiency was between 2.5 weeks to 1.5 years. Hormone replacement therapy permitted normal completion of growth and development. Awareness among physicians treating children with traumatic brain injury of the risk of hypopituitarism is necessary to optimise the outcome."

Guidelines

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): II. Treatment and Ongoing Management (PEDIATRICS 2007)

Guidelines for Adolescent Depression in Primary Care (GLAD-PC): I. Identification, Assessment, and Initial Management (PEDIATRICS 2007)

Medication Guide for treating Depression

NGC - Treatment of childhood overweight. (2007)

NGC - Urinary tract infection-child. (2006)

New Pediatric Guidelines for Self-Injecting Epinephrine for Anaphylaxis Treatment "Anaphylaxis is usually mediated by an immunologic mechanism involving immunoglobulin E and resulting in sudden systemic release of mast-cell and basophil mediators including histamine and tryptase. Although there are many clinical presentations of anaphylaxis, respiratory compromise and cardiovascular collapse are of the greatest concern because they may be fatal. Many different triggers for anaphylaxis episodes have been identified, but food and insect stings are the most frequently reported triggers in the community setting, often necessitating emergency care plans for anaphylaxis occurring outside the hospital/medical setting. Epinephrine is the mainstay of anaphylaxis therapy. Adjunctive therapy with antihistamines and, for those with asthma, inhaled selective ß2-adrenergic agonists, such as albuterol, may be helpful but cannot replace epinephrine. . Based primarily on anecdotal evidence, the recommended epinephrine dose for anaphylaxis in children is 0.01 mg/kg, not to exceed 0.30 mg. The preferred route of administration for first-aid treatment is intramuscular injection of epinephrine into the vastus lateralis of the lateral thigh, which allows early peak epinephrine concentration needed for effective management. . Symptoms of anaphylaxis may include hives, pruritis, flushing, dyspnea, wheeze, stridor, syncope, crampy abdominal pain, and vomiting."

Immunotherapy

Internet Sites

Treatment Information

DrugBank (drug structure)

FDA - MedWatch (Drug Alerts)

Drug-Food-Supplement Information

Drug Information Online

Drug Interaction Checker

DrugDigest (drug interactions)

FDA - Drug Interactions: What You Should Know

NIH - Botanical Dietary Supplements: Background Information

NIH - Drug, Supplements, and Herbal Information

NIH - Herbal Supplements: Consider Safety, Too

NIH - Medicines

NIH - Vitamin and Mineral Supplement Fact Sheets

Nutrition

Other

Other Treatments

Risk factors for recurrent gastroesophageal reflux disease after fundoplication in pediatric patients: a case-control study. (J Pediatr Surg. 2007)

Self-hypnosis helps kids with frequent headaches "Self-hypnosis training is an effective treatment for chronic recurrent headaches in children and adolescents, new research suggests. Dr. Daniel P. Kohen, from the University of Minnesota in Minneapolis, and Dr. Robert Zajac, from Glencoe Regional Health Services, also in Minnesota, assessed the outcomes of 178 consecutive young people, average age 11 years, who were taught self-hypnosis to deal with their headaches. "

Experimental

Radiotherapy

Supplements-Vitamins-CAM

Efficacy of Folic Acid in Children With Migraine, Hyperhomocysteinemia and MTHFR Polymorphisms. (Headache. 2007)

Use of Complementary and Alternative Medicine in a General Pediatric Clinic (Pediatrics 2007)

CAM Use and Children

Coenzyme Q10 Deficiency and Response to Supplementation in Pediatric and Adolescent Migraine (Headache: The Journal of Head and Face Pain 2007)

Surgery

Rhinosinusitis in children: the role of surgery. (Pediatr Allergy Immunol. 2007)

Adenotonsillectomy or watchful waiting in patients with mild to moderate symptoms of throat infections or adenotonsillar hypertrophy: a randomized comparison of costs and effects. (Arch Otolaryngol Head Neck Surg. 2007) "CONCLUSIONS: In children undergoing adenotonsillectomy because of mild to moderate symptoms of throat infections or adenotonsillar hypertrophy, surgery resulted in a significant increase in costs without realizing relevant clinical benefit. Subgroups of children in whom surgery would be cost-effective may be identified in further research."

Tonsillectomy and adenoidectomy techniques: past, present and future. (ORL J Otorhinolaryngol Relat Spec. 2007)

Pediatric obstructive sleep apnea: current management. (ORL J Otorhinolaryngol Relat Spec. 2007) "Management of OSAS traditionally includes tonsillectomy and/or adenoidectomy to which most of the cases respond. However, other risk factors and coexisting conditions should be carefully investigated and treated prior to considering surgical treatment."

Behavioral Changes in Children With Mild Sleep-Disordered Breathing or Obstructive Sleep Apnea After Adenotonsillectomy. (Laryngoscope. 2007)

Sleep apnea surgery won't improve kids' behavior "Children with sleep apnea who have their adenoids and tonsils removed sleep and breathe better, but their behavior and performance in school doesn't seem to improve after the operation, a study shows. Up to 3% of children have sleep apnea, or interrupted breathing during sleep, and removing the tonsils and adenoids will cure sleep apnea in most young patients, Dr. Evelyn Constantin of Montreal Children's Hospital in Quebec, Canada and colleagues note in the Journal of Pediatrics. Several studies have linked sleep apnea to developmental and behavioral problems, so Constantin and her team wondered if treating the condition with adenotonsillectomy would address these issues as well as breathing and sleep problems. "

Adenotonsillectomy and obstructive sleep apnea in children: A prospective survey. (Otolaryngol Head Neck Surg. 2007) " SIGNIFICANCE: Adenotonsillectomy may not resolve obstructive sleep apnea in children."

Short-term results in 53 US obese pediatric patients treated with laparoscopic adjustable gastric banding. (J Pediatr Surg. 2007)

Transplantation

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