PedSPAM June 2000

Welcome to PedSPAM for June. Here are some more things from my update reading that might interest you:

In the News

There is new hope for children with severe eczema (atopic dermatitis). Two large multicenter pediatric trials have shown tacrolimus ointment to be a possible breakthrough drug for this condition. Oral tacrolimus is an immune system modulator used to prevent transplanted organ rejection. The ointment was found to produce rather dramatic improvements in moderate to severe eczema in about three weeks. The drug is said to be very safe, and avoids the side effects of potent topical steroids.

The Centers for Disease Control (CDC) have released revised growth charts for American children. these charts, in Adobe Acrobat® format, are available for download in the Parents Common Sense Encyclopedia. The complete set of new charts, including those for body mass index (used to evaluate and predict obesity) can be obtained at

Sunscreen is safe for children under 6 months, and there is not only no reason to withhold it from them, but good reason to use it, according to a pediatric dermatologist at the recent University of Miami Masters of Pediatrics conference. Sunscreen of at least SPF 15 should be applied to exposed areas of the body 30 minutes before sun exposure. Scientists estimate that two thirds of a person's lifetime sun exposure occurs by age 18. The more sun-caused skin damage that can be prevented in childhood, the more the risk of skin cancer in adulthood can be reduced.

Research holds the promise of new treatment regimens, if not new drugs for Tourette syndrome. The nicotine patch commonly used to help smoking cessation efforts can produce marked improvement in patients with Tourette syndrome. Also, the blood pressure medicine mecamylamine produces improvement in Tourette symptoms when given at low doses (with no effect on blood pressure). Pediatric News, May 2000.

A combination therapy of permethrin 1% rinse with oral trimethoprim/sulfamethoxazole is effective against resistant head lice, according to Dr. Ron Hipolito speaking at the American Federation for Medical Research meeting in Carmel, California this spring.

Only about half of children who appear to have obstructive sleep apnea (OSA) actually do according to Finnish researchers. and that the diagnosis can only be confirmed with overnight polysomnography (multiple measurements of breathing, brainwaves, heart rate, etc.). Archives of Otolaryngology Head and Neck Surgery 2000;126:481-486.

Researchers reporting in this month's Pediatrics warn against alternating acetaminophen and ibuprofen for fever control. They worry about overdosage, and were dismayed to find that a majority of pediatricians surveyed recommended the alternation of the two medications for fever control. They were similarly puzzled that physicians recommended ibuprofen preferentially for higher fevers. Pediatrics 2000;105:1009-1012.

I can answer that one. The research showing that was well detailed to pediatricians when prescription ibuprofen was first introduced (Advil®) on the American market some years ago. Pediatricians at that time had just abandoned aspirin for fever control, a drug that was on occasion given on an alternating schedule with acetaminophen.

The American Academy of Pediatrics (AAP) has issued guidelines for the diagnosis of attention deficit hyperactivity disorder (ADHD) in the primary care setting. The guidelines state:

Pediatrics 2000;105:1158-1170.

In young children the bronchial dilator albuterol given via a metered dose inhaler with a spacer is as effective as a nebulizer treatment for treatment of moderate to severe asthma attacks in the emergency room. Inhaler treatments worked just as well or better than nebulizer treatments, and saved about one third of the cost of a typical emergency room visit in the study, done in New Zealand.Journal of Pediatrics 2000;136:497-502.

Inhaled nebulized budesonide (a steroid drug) significantly reduces hospital stay for infants and toddlers with acute wheezing, find a group in Brazil. The children studied ranged in age from 3 to 24 months. The average hospital stay was reduced from 93 hours to 66 hours. Journal of Allergy and Clinical Immunology 2000;105:699-703.

We are always on the lookout for treatment that will help very small children with wheezing. In the past, steroid use (given by injection or intravenous infusion) for bronchiolitis has been pretty disappointing. If this study is confirmed, early use of inhaled budesonide might conceivably lead to a reduction in the number of children who wheeze later in childhood.

Low levels of antibodies in the fetus against pneumococcus (Streptococcus pneumoniae), a respiratory tract germ, predict a higher rate of ear infections (otitis media) during the first year of life. Dr. Kathleen A. Daly of the University of Minnesota Medical School believes that "testing for antibodies during pregnancy...may help predict which children will be at higher risk for otitis media." She added that "maternal immunization is an area to be explored [which] may hold promise in the future for preventing infant diseases." Reuters.

At least among low income families, parents of obese children usually fail to recognize that their children are overweight. Eight percent of parents of severely obese children even maintain that their child is underweight. This according to a survey of 1,180 families with children 1 to 5 years old who participate in the Supplemental Nutrition Program for Women, Infants and Children (WIC) in New York State, reported at the combined annual meeting of the Pediatric Academic Societies and the American Academy of Pediatrics.

Children who describe acts of sexual abuse are generally reliable in their descriptions, according to a comparison of the confessions of sex offenders and the allegations of their child victims. In fact, researchers find the child's report more reliable than a medical examination. Reuters.

Often there are simply no physical stigmata of abuse; medical examination is either inconclusive or totally useless. It is useful to know that young children really do usually report the truth (as seen through their eyes) of what went on.

Adolescent girls with iron deficiency are twice as likely to score below average on mathematics achievement tests as those girls with normal body iron levels. This effect did not hold for tests of general intelligence or reading ability, however. Researchers who made the findings speculate this phenomenon may account for some of the basis of reported greater disinterest in mathematics among adolescent girls.

A study has reexamined the previously documented relationship of the intake of cola drinks with bone fractures in active adolescent girls. The odds of bone fractures increased almost five fold in girls who were active, and drank cola soft drinks. The proposed mechanism of this effect is a high phosphate content of the cola drinks which produces demineralization of the bones. Archives of Disease in Childhood 2000; 154:610-613.

Just because your child uses a spacer with his metered dose inhaler does not mean he uses the MDI correctly. A study in adults using MDI's with spacer devices found that just using a spacer did not correct poor inhaler technique. They advised careful instruction of proper inhaler technique for all patients on inhalers with spacers.

Final adult height of asthmatic children is not affected by use of steroids in childhood. A Swedish study showed no long term difference in average adult height among those treated with oral or inhaled steroids for asthma, those who had asthma but no steroids, and healthy non-asthmatic patients. Any suppression of growth by heavy steroid use is apparently compensated for later with catch-up growth.

Eighty percent of children who die in drunk-driving accidents were riding with the drinking driver. Thirty percent of these drivers were themselves underage. JAMA 2000;283:2245-2252,2291-2292.

A phonologic (phonics) instruction program for dyslexic boys not only improved their reading scores, but changed brain metabolism to normal levels when measured a year after the course of instruction. American Journal of Radiology 2000;21:916-922.

A screening checklist administered at 18 months of age can identify about a third of children destined to be diagnosed by age seven years as having autism or related disorders. Journal of the American Academy of Child and Adolescent Psychiatry 2000;39:694-702.

A new ultrafast CT scanner allows imaging of children without sedation. The scanner can obtain a scan of the chest in less than half a second. This procedure avoids hospital admission and intravenous sedation with some element of risk as well as the need for post-sedation monitoring for several hours.

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