PedSPAM January 1998

Welcome to this more-or-less January edition of PedSPAM. Things have been busy around the office, as you might imagine for a pediatrician in late December. The real fun usually starts about now; based on patient flow so far this year I am predicting a rough next few months for me and my patients. This month's news is digested from Pediatric News.

An oral vaccine against rotavirus may soon be licensed and recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control in Atlanta. Rotavirus is the number one cause of severe diarrhea in children worldwide, is the leading cause of hospitalization for diarrheal dehydration (50,000 annually in the US), and causes thousands of deaths in young children worldwide every year. The vaccine would be given at 2, 4 and 6 months. This is a real advance and when the vaccine becomes available I will promote it aggressively, especially for children in daycare. Possible sticking points with the vaccine are post-immunization fever and the cost factor. It still sounds like a winner.

In 1994 the "Back to Sleep" program was instituted by the National Institute of Child Health and Human Development in the US to encourage parents to lay infants on the back to sleep to prevent SIDS (Sudden Infant Death Syndrome). The rate of SIDS has dropped significantly in the US - from 1.4 per 1000 live births to 0.74 deaths per 1000 live births over a period from before the new recommendations to about 1997. See sleeping position.

The CDC has changed guidelines for lead screening. Now routine screening is only advised for children who live in areas with known concentrations of older homes with lead-based paint or children on Medicaid (low socioeconomic status) are to be screened for high blood lead levels.

According to the CDC, twenty percent of America's children are exposed to tobacco smoke in the home. Ugh.

Research is proceeding with encouraging data towards a vaccine against Group B streptococcal disease in newborns. This is a potentially devastating illness involving often overwhelming infection, meningitis, brain dameage or death in newborns in the first six weeks or so of life. A vaccine that would be given to pregnant women at 28-32 weeks gestation is under development with encouraging results.

An ordinary chewing gum containing xylitol, a simple sugar, has been shown to be effective in preventing ear infections in children. The gum was studied in Finland in day care centers, and was shown to reduce otitis media attacks by 40 per cent in the treatment group. The sugar works also when given as a syrup or a lozenge, but the gum method produced the greatest reduction in infections. The sugar works by somehow inhibiting the ability of bacteria to attach themselves to the mucous membranes and by directly inhibiting the metabolism of the most common cause of bacterial otitis media. Xylitol gum is already on the market in the US, since it is a food, not a drug. I do not know the trade name of the gum but will post it when I find out.

Helicobacter pylori is the bacterial germ responsible for most ulcer disease in humans. We have treated this infection in the past with two or three weeks of triple or quadruple drug therapy... hard to do reliably in anyone and especially kids. Now a study in Ireland has shown that just 7 days of treatment with plain old Pepto Bismol®, clarithromycin (Biaxin®, an antibiotic), and metronidazole (another antibiotic) is as effective as longer regimens. Beats three weeks, especially with the metronidazole - bitter stuff.

The ACIP has released new guidelines for handling rabies exposure via bats. The CDC recommends rabies prophylaxis (shots) for any obvious wound from a bat, and suggests it be considered at least in any situation where exposure might have occurred. A bat bite may not leave an obvious wound, and the expert quoted in the article felt that "it is wise to vaccinate a child even if no bite is seen." The treatment is very safe and no longer involves as many nor as painful shots, and rabies is uniformly fatal if it develops. If such a situation should arise, remind your doctor to get the latest information.

Powder jet injection may be the future of immunizations. A system has been developed that allows vaccines to be injected directly through the skin in the form of micropowders fired from a gas operated system at high velocity directly through the skin. This method is capable of delivering a dose of vaccine without a needle. I donÍt know if the comfort factor will be any better, though.

Reducing time in front of the TV is the most crucial ingredient in fighting childhood obesity, according to Dr. William Dietz, director of clinical nutrition at Floating and New England Medical Center Hospitals in Boston. Thirty-five per cent of children ages 10-15 who watch TV greater that five hours a day are overweight. Sedentary activity (isn't that an oxymoron?) in front of the television is a double threat because of high calorie snacking encouraged by TV food ads. Weight maintenance alone for a couple of years - no weight gain but no reduction, either - will effectively treat the modestly obese child (20-30 percent overweight). Simply cutting back on the fast food can accomplish this goal, since these children are only eating about 50-100 calories per day in excess of their metabolic needs. He stressed changing eating patterns to encourage healthier foods, increasing activity levels, and reducing sedentary behavior (couch potato syndrome).

The "Reading Checkup Guide" is downloadable from the web. This is meant to help parents and teachers monitor children's reading levels.

Information about calcium consumption for teenagers is also available from the web. This is the website for the "Crash Course on Calcium" program aimed at schools to promote knowlege about proper calcium intake for teens. Teachers can obtain video instructional materials and informational pamphlets.

Home tympanic thermometers now have competition in the technological overkill department. A handheld sonar device used to detect middle ear fluid has hit the market. I suppose this might be occasionally useful for kids with chronic ear disease, but I suspect what really happens is that parents will get these things to try to be their own physicians. "He has fluid in his ear and a fever - just call me in some antibiotic." I can hardly wait.

A paper in the Journal of American Academic Child and Adolescent Psychiatry reports a study showing that children of mothers who consider religion to be important were less likely to develop depression. The authors surmised that a religious upbringing "influences the character of maternal childrearing and shapes the home environment." Surprise, surprise.

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