Pediatrics

• Breastfeeding
• Child-Adolescent Nutrition and Overweight
• Diagnosis, Imaging, Screening
• Diseases and Conditions
• General Information
• Guidelines
• Internet Sites
• Immunization
• Infant Nutrition
• Risk Factors
• Risk Reduction
• SIDS (Sudden Infant Death Syndrome)
• Treatment

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REVIEW our Selected Pediatric Articles in 2007. Stay informed and updated!

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Breastfeeding

NIH – Breastfeeding (Medical Encyclopedia) “Recommendations: Choosing how and what to feed your baby is a personal decision that deserves careful and thorough consideration. Breast milk is the natural nutritional source for infants less than one year of age. Most health care professionals (including the American Academy of Pediatricians and the National Association of Pediatric Nurse Associates and Practitioners) recommend breastfeeding for your baby's first year. Breast milk is the best source of nutrition for the first 6 months of life. It contains appropriate amounts of carbohydrate, protein, and fat, and provides digestive enzymes, minerals, vitamins, and hormones that infants require. Breast milk also contains antibodies from the mother that can help the baby resist infections. Experts agree that breastfeeding your baby for any length of time, regardless of how short, is of benefit to you and your baby. You can provide your baby with breast milk directly by breastfeeding or by feeding your baby breast milk from a bottle. ... ADVANTAGES OF BREASTFEEDING Research shows that breastfed babies may have less frequent: • Ear infections • Stomach or intestinal infections • Low iron levels in the blood (iron-deficiency anemia) • Skin diseases (infantile eczema) • Infant allergies Breastfed babies may have less risk of developing: • Digestive problems such as constipation or diarrhea • Obesity or becoming overweight • High blood pressure • Diabetes • Tooth decay”

NIH – Breastfeeding “What are the benefits of breastfeeding? Breastfeeding offers many benefits to the baby: Breast milk provides the right balance of nutrients to help an infant grow into a strong and healthy toddler. Breastfed infants, and those who are fed expressed breast milk, have fewer deaths during the first year and experience fewer illnesses than babies fed formula. Some of the nutrients in breast milk also help protect an infant against some common childhood illnesses and infections, such as diarrhea, middle ear infections, and certain lung infections. Some recent NICHD-supported research also suggests that breast milk contains important fatty acids (building blocks) that help an infant's brain develop. Two specific fatty acids, known as DHA and AA, may help increase infants’ cognitive skills. Many types of infant formulas available in the United States are fortified with DHA and AA, and all formula available for preterm infants is fortified with these fatty acids.”

NHS - Breast-feeding (Video)

Highlighted Articles

Breastfeeding and Child Cognitive Development (Arch Gen Psychiatry. 2008) “Conclusion These results, based on the largest randomized trial ever conducted in the area of human lactation, provide strong evidence that prolonged and exclusive breastfeeding improves children's cognitive development.”

Advances in our understanding of the biology of human milk and its effects on the offspring. (J Nutr. 2007) "The most important short-term immunological benefit of breast-feeding is the protection against infectious diseases. There is also some evidence of lower prevalence of inflammatory bowel diseases, childhood cancers, and type I diabetes in breast-fed infants, suggesting that breast-feeding influences the development of the infant's own immune system. One of the most consistent findings of breast-feeding is a positive effect on later intelligence tests with a few test points advantage for breast-fed infants."

Optimal duration of exclusive breastfeeding: what is the evidence to support current recommendations? (Am J Clin Nutr. 2007) "That review concluded that infants exclusively breastfed for 6 mo experienced less morbidity from gastrointestinal infection and showed no deficits in growth but that large randomized trials are required to rule out small adverse effects on growth and the development of iron deficiency in susceptible infants. Others have raised concerns that the evidence is insufficient to confidently recommend exclusive breastfeeding for 6 mo for infants in developed countries, that breast milk may not meet the full energy requirements of the average infant at 6 mo of age, and that estimates of the proportion of exclusively breastfed infants at risk of specific nutritional deficiencies are not available. Additionally, virtually no data are available to form evidence-based recommendations for the introduction of solids in formula-fed infants. Given increasing evidence that early nutrition and growth have effects on both short- and longer-term health, it is vital that this issue be investigated in high-quality randomized studies."

Immunization

NIH - Immunizations - general overview (Medical Encyclopedia) “IMMUNIZING CHILDREN: Babies get so many shots these days! Many parents are concerned that the sheer number of vaccines might overwhelm, weaken, or use up a baby's immature immune system. But a baby's immune system is built to make antibodies to as many as 10,000 foreign proteins. If a baby were to receive all 11 available vaccines at once, this would engage only a tiny fraction of the immune system. … IMMUNIZATION SCHEDULE The recommended immunization schedule is updated at least every 12 months by organizations such as the American Academy of Pediatrics. Consult your primary care provider about specific immunizations for you or your child. The current recommendations are available on the Centers for Disease Control and Prevention (CDC) website at www.cdc.gov/vaccines. At every doctor visit, ask about the next recommended immunizations.”

NIH - Childhood Immunization “Vaccines help make you immune to serious diseases without getting sick first. Without a vaccine, you must actually get a disease in order to become immune to the germ that causes it. Vaccines work best when they are given at certain ages. For example, children don't receive measles vaccine until they are at least one year old. If it is given earlier it might not work as well.”

CDC - Recommended Immunization Schedules for Persons Aged 0--18 Years --- United States, 2008

CDC - Immunization Schedules (USA)

Childhood Vaccines: What They Are and Why Your Child Needs Them “Are there any reasons my child should not be vaccinated? In some special situations, children shouldn't be vaccinated. For example, some vaccines shouldn't be given to children who have certain types of cancer or certain diseases, or who are taking drugs that lower the body's ability to resist infection. The MMR vaccine shouldn't be given to children who have a serious allergy to eggs. If your child has had a serious reaction to the first shot in a series of shots, your family doctor will probably talk with you about the pros and cons of giving him or her the rest of the shots in the series. Talk to your doctor if you have any questions about whether your child should receive a vaccine.”

CDC - Common Questions Parents Ask about Infant Immunizations

NHS – Childhood immunisations (UK) “Childhood immunisation prevents a large variety of diseases. These include: Tetanus. An infection found in the soil that causes severe muscle contractions and breathing difficulties. Polio (short for poliomyelitis). A virus that first attacks the gut (bowel) but then travels to the nervous system. Polio can cause paralysis (when you can't move your limbs) in one or more parts of your body. Pneumococcal infections. These can affect anyone, but young children are at an increased risk of developing serious complications such as meningitis. Diphtheria. A highly contagious disease caused by a bacterium called Corynebacterium diphtheriae. It causes a serious throat and chest infection. Meningitis C. Caused by the meningococcus group c bacterium. In rare cases it can lead to blood poisoning and serious types of meningitis. Hib (full name is haemophilus influenzae type b). A bacterium that can cause pneumonia and meningitis. Whooping cough (pertussis) - causes prolonged coughing that can be very distressing. In children, complications can include brain damage. Measles. Caused by the measles virus and can result in a serious fever and rash. In severe cases, measles can be fatal. Mumps. Caused by the mumps virus. Mumps usually leads to inflammation and swelling of the salivary glands (the glands located just below the ears). In severe cases this can cause deafness. Rubella (also know as German measles). Caused by the rubella virus and can lead to a mild illness and rash. In later life rubella can be serious to an unborn child as it can potentially lead to several birth defects. Other immunisations Some children may require additional immunisations that are not part of the childhood immunisation programme. Your GP will be able to advise you if your child requires any further immunisations. These may include immunisations if your child has a chronic condition.”

Highlighted Article

Thimerosal exposure in infants and neurodevelopmental disorders: An assessment of computerized medical records in the Vaccine Safety Datalink. (J Neurol Sci. 2008) “Routine childhood vaccination should be continued to help reduce the morbidity and mortality associated with infectious diseases, but efforts should be undertaken to remove Hg from vaccines.”

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Pediatrics

Diseases and Conditions

NEWS:

A terrible ache that's not all in the head “ "The primary difference in children is that they can have migraine without headache pain. They are likely to have what's called 'abdominal migraine' which could be stomach ache in the navel area, loss of appetite, nausea and vomiting." Young children find it hard to explain their migraine symptoms, and are less likely to be able to push for treatment, adds Little. "There's a lot of stigma attached to it as well. People think it's attention seeking without realising how serious it is," he says. "It can affect their lives very seriously and particularly their studies, so we target teachers with information to get them to recognise the effect it can have on young people and there are allowances in exams. … If your child has migraine, it's important to talk to the school and make them aware of the child's condition, particularly if it is likely to cause absence. The Migraine Association of Ireland also encourages parents to help their children learn the signs that a migraine is coming, so they can let the teacher know and better manage the attack if it happens in school. And they offer the following tips for approaching schoolwork: • Take frequent breaks from long periods of studying, particularly if using a computer screen or if the work is stressful • Eat regularly throughout the day • Get some exercise and fresh air during the day - walk or cycle to school if possible • Watch caffeine intake (present in coffee and some soft drinks) - drink plenty of water instead • Make the study environment as comfortable as possible: keep good posture, light the area well and do stretching exercises to avoid stiffness and tension …“

Children with hay fever more likely to experience headaches, facial pain

Ear Infection in 61% of Kids' Colds: Tots Under Age 3 Get 5 Colds per Year, Most With Otitis Media “More than half of children who get colds -- 61% -- come down with otitis media, infection of the middle ear. About a quarter of the time, this infection has no symptoms, but the child has a buildup of fluid inside the ear. Fortunately, the risk of getting an ear infection after a cold drops quickly with age.“

Kids' anxiety may be due to untreated sleep apnea “"Preliminary findings," lead investigator Dr. Shalini Paruthi told Reuters Health, "suggest that children identified to be at risk for sleep-disordered breathing are more likely to be reported as having anxiety than children not at risk for sleep-disordered breathing." "Anxiety is known to be associated with hyperactivity, and hyperactivity is commonly observed in children with sleep-disordered breathing; however, even after we accounted for the relationship with hyperactivity, we still found a link between risk for sleep-disordered breathing and anxiety," Paruthi noted. “

Kids' neck size may point to risk of sleep apnea “Children with bigger neck sizes for their age seem to be more likely to develop obstructive sleep apnea (OSA) syndrome, researchers report. OSA occurs when soft tissues in the throat collapse and block the airway during sleep, so that breathing is briefly but repeatedly interrupted. Chronic snoring is often a sign of the problem. Because it disturbs sleep, it can lead to tiredness during the day as well as other problems.“

Link Between Migranes And Sleep Disorders In Children “Children with a migraine headache are more likely to have sleep disorders, such as obstructive sleep apnea (OSA) and lack of sleep, than children without a migraine, according to a research abstract on the effects of headaches on children's sleep patterns that will be presented on June 10 at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).”

Migraine Linked to Sleep Apnea in Children and Teens

Most Kids With Type 1 Diabetes Lack Vitamin D “Almost 75 percent of children and adolescents with type 1 diabetes have insufficient levels of vitamin D, researchers at the Joslin Diabetes Center in Boston report. A deficit in vitamin D can lead to bone problems later in life, especially among those with type 1 diabetes. While vitamin D is usually gotten from exposure to sunlight or from the diet, researchers suggest that supplements are needed to boost vitamin D levels. … Whether or not supplementing vitamin D would prevent all diabetes-related bone disease in diabetic children, the practice makes sense, particularly in light of a recent American Academy of Pediatrics recommendation doubling the intake of vitamin D for all children, Katz said. "All children should get ample vitamin D, at least 400 IU daily, from some combination of sun exposure, dairy products, and/or supplements," Katz said. "Those at high risk of deficiency, but not all children, should have levels monitored."”

Otitis in infancy may affect hearing for years “Infection of the middle ear compartment, called otitis media, in babies can affect the way their brains process sounds years after the initial infection, according to a recent report from India. Infancy is a time when the brain rapidly develops the ability to sort out and respond to input from the five senses. If these external stimuli are blunted or absent, however, the appropriate brain development can be impaired. Even otitis media of a short duration "in the first year of life can cause long-standing auditory processing deficits," Sandeep Maruthy from the All India Institute of Speech and Hearing in Mysore told Reuters Health. … If the finding holds true in studies of children followed for several years, Maruthy added, it would call for measures "to reduce the chances of auditory deprivation during the active episodes of otitis media." This might mean, for example, "speaking closer to the child or being louder while speaking to the child so as to compensate for the reduced hearing sensitivity." “

Otitis Media Complicates Most Cases of Upper Respiratory Infection in Young Children “Virus studies performed for 864 URI episodes yielded positive results in 63%. Rhinovirus and adenovirus were most often associated with URI. AOM occurred in roughly half of children with URI due to adenovirus, respiratory syncytial virus, or coronavirus and in approximately a third of those with URI due to influenza virus, parainfluenza virus, enterovirus or rhinovirus. Based on this study, Dr. Chonmaitree and colleagues suggest that "for young children, the strategy to prevent otitis media should involve prevention of viral URI. The strategy may be more effective if the priority is given to development of means to prevent URI associated with adenovirus and respiratory syncytial virus." “

Pinkeye - Topic Overview

Symptoms Persist as Bipolar Children Grow Up “The study adds to mounting evidence for the legitimacy of the diagnosis of BD in children, and reflects the “field’s continuing efforts to nurture developmental conceptualizations of psychiatric illnesses,” notes Leibenluft. The results are consistent with a 2006 study by Geller and colleagues, which found that child and adult forms of BD occurred within the same families. In taking stock of what has been learned about pediatric BP over the past couple of decades, Leibenluft points to a growing consensus that “unequivocal,” classic BD occurs in youth – albeit with continuing debate about whether children with persistent, severe irritability, but without distinct episodes of mania, should be assigned the BD diagnosis. There is also consensus that children with BD are severely impaired, with frequent relapses and other apparent psychopathology.”

Teenage Boys Have Higher CV Risk Than Girls

ARTICLES:

Cutting and Self-Injury

Influenza (flu)

Flu symptoms self-assessment: Do you have the flu?

Teen Self-Injury May Be Common

JOURNAL ARTICLES:

Academic performance in children with rolandic epilepsy. (Dev Med Child Neurol. 2008) “Our findings suggest that seizure onset before age 8 years and epileptiform discharges (more than 50% of the sleep EEG recording) in several tracings over more than a year are relevant markers for identifying patients at risk of developing academic difficulties.”

Acute abdomen in children due to extra-abdominal causes. (Pediatr Int. 2008) “ … the most frequent being pneumonia (n = 15), tonsillitis (n = 10), otitis media (n = 9), and acute leukemia (n = 5). CONCLUSION: Both abdominal and extra-abdominal causes should be considered by a pediatrician who is confronted with a child with acute abdominal pain.”

Allergic rhinitis in children. (Mo Med. 2008)

Anxiety and Somatic Complaints in Children with Recurrent Abdominal Pain and Anxiety Disorders. (J Pediatr Psychol. 2008)

Asthma mortality among Swedish children and young adults, a 10-year study. (Respir Med. 2008)

Biofilms and their role in otorhinolaryngological disease. (J Laryngol Otol. 2008)

Childhood eczema and asthma incidence and persistence: A cohort study from childhood to middle age. (J Allergy Clin Immunol. 2008) “CONCLUSION: Childhood eczema increased the likelihood of childhood asthma, of new-onset asthma in later life and of asthma persisting into middle age.”

Chronic abdominal pain in children. (Aust Fam Physician. 2008) “Chronic abdominal pain (CAP) refers to pain that has been present continuously – or occurring at least on a weekly basis when intermittent – for a minimum period of 2 months.1 It is a description not a diagnosis, and can be due to a functional disorder or organic disease. A functional disorder is one in which symptoms of disease occur in the absence of objective evidence for an organic process. Organic disease and functional disorders can coexist.1”

Chronic daily headache in French children and adolescents. (Pediatr Neurol. 2008)

Epidemiology of pediatric obstructive sleep apnea. (Proc Am Thorac Soc. 2008)

EVALUATION OF CHRONIC COUGH IN CHILDREN. (Chest. 2008)

Executive dysfunction in Turkish children at high risk for schizophrenia. (Eur Child Adolesc Psychiatry. 2008) “CONCLUSION: Children of parents with schizophrenia displayed significantly greater number of difficulties in several areas of executive function, such as sequencing, set shifting, and mental flexibility, when compared to their controls.”

Fish allergy in childhood. (Pediatr Allergy Immunol. 2008)

Incidence and Characteristics of Arthritis in Norwegian Children: A Population-Based Study. (Pediatrics. 2008)

Longitudinal progression of movement abnormalities in relation to psychotic symptoms in adolescents at high risk of schizophrenia. (Arch Gen Psychiatry. 2008) “CONCLUSIONS: The results are consistent with the hypothesis of shared neural circuitry for movement abnormalities and psychotic symptoms and suggest the potential value of including an assessment of motor signs in screening for psychosis risk.”

Pathogens Causing Recurrent and Difficult-to-Treat Acute Otitis Media, 2003-2006. (Clin Pediatr (Phila). 2008)

Pediatric allergic rhinitis: Physical and mental complications. (Allergy Asthma Proc. 2008)

Pediatric Hypertension: Does It Have an Impact on Cognition? (Medscape Cardiology. 2008)

Persistence and change in symptoms of insomnia among adolescents. (Sleep. 2008) “CONCLUSIONS: These results document further the public health burden of insomnia among adolescents. Prevalence of insomnia is comparable to that of other major psychiatric disorders such as mood, anxiety, disruptive, and substance use disorders. Incidence over one year also is high. Insomnia represents a chronic condition, further enhancing burden.”

Prevalence of Allergies in Children With Complex Medical Problems. (Clin Pediatr (Phila). 2008)

Progression of Brain Volume Changes in Adolescent-Onset Psychosis. (Schizophr Bull. 2008)

[Schizophrenia in a seven year-old boy.] (Ugeskr Laeger. 2008)

Severe Life Events and Chronic Adversities as Antecedents to Anxiety in Children: A Matched Control Study. (J Abnorm Child Psychol. 2008)

Sinusitis in children and adolescents with chronic or recurrent headache: a case-control study. (J Headache Pain. 2008) “Approximately 40% of the patients with migraine and 60% of the patients with tension-type headache had been misdiagnosed as "sinus headache". Children with chronic or recurrent headaches are frequently misdiagnosed as sinus headache and receive unnecessary sinusitis treatment and sinus graphy.”

Sleep-related problems in pediatric obsessive-compulsive disorder (Journal of Anxiety Disorders 2008)

The role of chronic infection in children with otitis media with effusion: Evidence for intracellular persistence of bacteria. (Otolaryngol Head Neck Surg. 2008)

The role of extraesophageal reflux in otitis media in infants and children. (Laryngoscope. 2008)

Viral Upper Respiratory Tract Infection and Otitis Media Complication in Young Children (Clinical Infectious Diseases 2008) “The common cold or upper respiratory infection (URI), a disease caused by a variety of viruses, is a universal illness. Particularly susceptible to URI are young children, especially those who attend day care centers [1–3]. URI in young children is often complicated by otitis media (OM) [4, 5]. The high prevalence of URI has made OM one of the most common diseases seen in pediatric practice and the emergency department [6, 7]. OM leads to widespread use of antibiotics and performance of otologic surgical procedures [8–10], thus draining public health resources worldwide [11–13]. Efforts to identify means to prevent OM are clearly needed. OM is classified in 2 forms: acute OM (AOM), an acute symptomatic disease, and OM with effusion (OME), an asymptomatic disease involving fluid collection in the middle ear [14]. URI and AOM are closely linked; 29%–50% of all cases of URI develop into AOM [5, 15, 16], and a variety of viruses have been detected in nasopharynx and middle ear effusion specimens obtained from children with AOM [17, 18]. Data on URI that directly leads to new-onset OME are lacking. One way to prevent OM is to prevent URI in children. Because specific viruses may differ in their ability to induce OM, understanding the relative importance of URI-associated viruses will be useful in designing appropriate viral vaccines for OM prevention. Therefore, we performed a prospective study of young children to obtain epidemiologic information on URI and to determine the specific virus types associated with URI and their ability to induce AOM and OME. … Our data emphasize the close relationship between viral URI and OM and suggest that one strategy to reduce OM incidence is to prevent viral URI in young children. … In conclusion, we found a high prevalence of symptomatic viral URI among young children, and >60% of cases were complicated by AOM and/or OME. The risk of AOM development was associated with young age, specific URI-associated viruses, and conventional methods of viral detection.”

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