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

Daily Treatment Report

Cognitive Therapy-CBT-Psychotherapy

Task Force Finds Cognitive Behavioral Therapy Effective for Children and Adolescents Exposed to Trauma “The review concluded that, for both individual and group CBT, there was strong evidence, demonstrated in published studies, that the use of these interventions in children exposed to trauma reduced overall psychological harm.”

Psychotherapy Reduces OCD Symptoms In Young Children, Helps Some Achieve Clinical Remission

Device Therapy

Drug Side-Effects and Interactions

Baby Acetaminophen Tied to Asthma: 46% Increased Risk of Asthma With Baby Acetaminophen Use “Babies who get acetaminophen -- Tylenol is one brand -- have an increased risk of childhood asthma. Acetaminophen, often given to treat fevers in the first year of life, also upped the risk of eczema and having a runny nose and itchy eyes. The finding, from an international study of 205,487 children in 31 countries, does not prove acetaminophen causes asthma, eczema, or nose/eye problems. But it raises important safety concerns about the most commonly used drug in the U.S.: the fever-reducing painkiller acetaminophen (also known as paracetamol), the main ingredient in Tylenol. People should think twice about using acetaminophen, but nobody should stop taking it or giving it to children with high fevers, says study leader Richard Beasley, DSc, a professor at the Medical Research Institute of New Zealand.“

Long-Term Steroid Asthma Therapy Increases Fracture Risk in Children, Teens

Neonatal Antibiotic Treatment Is a Risk Factor for Early Wheezing (PEDIATRICS 2008) “CONCLUSIONS. Treatment with antibiotics in the neonatal period was an independent risk factor for wheezing that was treated with inhaled corticosteroids at 12 months of age. These results indirectly support the hypothesis that an alteration in the intestinal flora can increase the risk of subsequent wheezing.”

Drugs

Drug companies: No cold meds for kids under 4 “Children under 4 should not be given over-the-counter cough and cold remedies, drug companies said Tuesday in a concession to pediatricians who doubt the drugs work in kids and worry about their safety. The voluntary changes came less than a week after federal health officials said they also saw little evidence that the drugs work, but feared that parents would give kids adult medicines if the products were taken off store shelves.”

Cholesterol Drugs for Kids?

Cholesterol Drugs for 8-Year-Olds “We were appalled when we first heard that the American Academy of Pediatrics has recommended that some children as young as 8 be given drugs to reduce their cholesterol levels — and that they could end up taking these drugs for the rest of their lives. After reading the academy’s report, we are now more dismayed about what this recommendation says about children’s health. … The recommendation has provoked furious debate among pediatricians, as Tara Parker-Pope reported in Science Times on Tuesday. Critics complain that there is no evidence that giving statins to children will prevent heart attacks later in life and that there is no data on the potential side effects of taking the drugs for decades. … The academy did urge that good diets and physical exercise be tried first, but the drug recommendation has attracted the most attention. We do fear that it will open the way for drug companies to bombard anxious parents with ads promoting these and other products and increase the number of parents insisting on prescriptions for their children.”

Cholesterol Drugs Recommended for Some 8-Year-Olds

Corticosteroids and Mortality in Children With Bacterial Meningitis (JAMA. 2008) “Conclusion In this multicenter observational study of children with bacterial meningitis, adjuvant corticosteroid therapy was not associated with time to death or time to hospital discharge.“

Valuing Reduced Antibiotic Use for Pediatric Acute Otitis Media (PEDIATRICS 2008)

Exercise

Aerobic Exercise Program Is Beneficial in Children With Fibromyalgia

Amount of exercise, not intensity, important for BP lowering in kids

General Information

Grommets (ventilation tubes) for recurrent acute otitis media in children. (Cochrane Database Syst Rev. 2008)

Storm over Statins — The Controversy Surrounding Pharmacologic Treatment of Children

Early, Aggressive Treatment Warranted in Pediatric Status Epilepticus

Ice or Heat - "Which Should I Apply?"

Does Honey Relieve Cough in Children?

Reviewers Say Children Should Not Take Antihistamines For Chronic Cough

Trends in Otitis Media Treatment Failure and Relapse (PEDIATRICS 2008)

Antidepressants for children

Management of the critically ill children with traumatic brain injury. (Paediatr Anaesth. 2008)

Bariatric surgery in morbidly obese adolescents: A 4-year follow-up of ten patients. (Int J Pediatr Obes. 2008) "From a psychological perspective, the actual psychological condition was measured by five different psychological tests, e.g., 80% had a high score for depression, and 40% had negative self-acceptance. Discussion. The laparascopic gastric banding operation was not as effective in weight reduction as expected. We have to turn our attention to compliance, postoperative treatment and the psychological component."

Comparison Of Antipsychotic Treatments In Adolescents With Schizophrenia "The researchers discovered that clozapine was approximately twice as likely to produce a treatment response as olanzapine. Both positive symptoms (psychosis) and negative symptoms (blunted emotional response, reduced motivation) responded better to clozapine. John H. Krystal, M.D., Editor of Biological Psychiatry and affiliated with both Yale University School of Medicine and the VA Connecticut Healthcare System, comments on the findings: "Olanzapine is among the most effective antipsychotic medications, so the distinctive effectiveness of clozapine in this study could be very important." Dr. Kumra discusses this patient population: "The majority of these youth had histories of multiple hospitalizations, extreme violence, suicidality and trauma prior to study enrollment. Without appropriate intervention it is likely that many would have ended up in long-term care institutions, psychiatric prison settings, and/or experienced early death from drug use, violence, or suicide." So, this preliminary data is hopeful, indicating that proper and effective treatment may be available for these adolescents, although there are also concerns. Both medications produced significant weight gain and associated metabolic abnormalities."

Antibiotics Do Not Prevent Fluid Buildup In Children's Ear Infections

Antibiotic Therapy to Prevent the Development of Asymptomatic Middle Ear Effusion in Children With Acute Otitis Media (Arch Otolaryngol Head Neck Surg. 2008) "Conclusion Because of a marginal effect of antibiotic therapy on the development of asymptomatic MEE and the known negative effects of prescribing antibiotics, including the development of antibiotic resistance and adverse effects, we do not recommend prescribing antibiotics to prevent MEE."

FDA to declare cold medicines too risky for babies, toddlers "Parents should not give sniffling babies and toddlers over-the-counter cough and cold medicines -- they're too risky for tots so small, the government will declare Thursday."

Guidelines

Guidelines Issued for Prevention and Treatment of Stroke in Children “Acute management of ischemic stroke from SCD should include optimal hydration and correction of hypoxemia and systemic hypotension. Periodic transfusions to reduce the percentage of sickle hemoglobin are recommended to lower stroke risk in children 2 to 16 years of age with abnormal TCD. For children with stroke and heart disease, treatment of congestive heart failure is recommended and may lower the risk for cardiogenic embolism. Congenital heart lesions should be repaired when feasible, especially complex heart lesions with high risk for stroke. Atrial myxoma should be resected. • Children with nontraumatic brain hemorrhage should undergo a thorough risk factor evaluation, including standard CA, when noninvasive tests are not diagnostic. Stabilizing measures should include optimizing respiratory effort, controlling systemic hypertension and epileptic seizures, and managing increased intracranial pressure. Appropriate factor replacement therapy is indicated for children with a severe coagulation factor deficiency, and those with less severe factor deficiency should undergo factor replacement after trauma. Congenital vascular anomalies should be identified and corrected whenever clinically feasible, as should other treatable risk factors for hemorrhage. “

Guidelines Issued on Pertussis, Tetanus, Diphtheria Prevention in Pregnant Women and Newborns

NGC - Diagnosis and treatment of otitis media in children. (2008)

Age Inconsistency in the American Academy of Pediatrics Guidelines for Acute Otitis Media (PEDIATRICS 2008)

NGC - Otitis media. (2007)

NGC - Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. (2007)

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

Efficacy of allergy immunotherapy as a treatment for patients with chronic otitis media with effusion. (Int J Pediatr Otorhinolaryngol. 2008)

Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. (Arch Otolaryngol Head Neck Surg. 2008) "CONCLUSION: Children in the saline group showed faster resolution of some nasal symptoms during acute illness and less frequent reappearance of rhinitis subsequently."

Experimental

Radiotherapy

Supplements-Vitamins-CAM

Zinc Supplements Help With Diarrhea in Children "Zinc use cut the average duration of both acute and persistent diarrhea, lead author Dr. Marek Lukacik, from the Medical College of Georgia in Augusta, and colleagues report. In addition, zinc therapy reduced the average stool frequency by 18.8% and 12.5% in children with acute and persistent diarrhea, respectively. The findings also show that zinc use helped prevent diarrhea. Treatment with zinc supplements reduced the occurrence of both types of diarrhea by roughly 18% relative to placebo. On the downside, in most of the studies, zinc was more likely than placebo to cause vomiting. In this regard, zinc gluconate was more problematic than zinc sulfate/acetate. "On the basis of these findings, which now add to the large body of previously published clinical data and update previous meta-analyses and systematic reviews, zinc therapy is useful for treating both acute and persistent diarrhea and for their prophylaxis," the authors conclude."

Surgery

Bariatric surgery for extreme adolescent obesity: Indications, outcomes, and physiologic effects on the gut-brain axis. (Pathophysiology. 2008)

Tonsillectomy Significantly Improves Quality Of Life In Adult And Pediatric Patients "Among the study's findings were significant decreases in number of sore throats, antibiotic courses, days missed from daycare/school, doctor visits, and persistent halitosis."

Transplantation

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