PedSPAM June 2002
Welcome to the PedSPAM archive for June. Here are the month's daily SPAMlets from my update reading that you might have missed:
In the News
Monday, June 3: Portable car seats or bouncy chairs present a serious risk of head injury if they are placed on elevated surfaces such as a kitchen counter. In a study of head injuries seen at a London hospital, 13% involved these seats and most of the cases stemmed from placing the child on an elevated surface. A much larger series of cases in the United States found that an estimated 8,700 head injuries occurred in infants less than 6 months of age presenting to emergency departments due to a fall while in a car seat or baby bouncer, and more than one-third occurred when the devices were placed on an elevated surface. Archives of Disease in Childhood 2002;86:168-69.
Tuesday, June 4: Tattoos and/or body piercings in teenagers are indicators of adolescent risk-taking behaviors, this study finds. Teens surveyed in the study who had tattoos and/or body piercings were more likely to have engaged in risk-taking behaviors. Their risk-taking was also more extreme than those adolescents without either. The behaviors included disordered eating behavior, gateway drug use, hard drug use, sexual activity, and suicide.
- males having tattoos and females having body piercings were more likely to be associated with violence
- gateway drug use was associated with younger age of both tattooing and body piercing
- hard drug use was associated with the number of body piercings
- suicide was associated with females having tattoos and younger age of both tattooing and body piercing
- tattoos and body piercings were found to be more common in females than males
Wednesday, June 5: Second infections with chickenpox are not nearly as rare as once believed. A five year long survey of chickenpox infections was designed to find how commonly this occurs. The researchers found that 95% of the reported first infections in children suspected of having more than one episode infection could indeed be linked to exposure to another child with chickenpox, had a classic chickenpox rash, or had physician-diagnosed disease. The yearly incidence rate of repeat infections ranged over the five year span from a low of 4.5% to a high of 13% (an astounding number to me). Pediatrics 2002;109:1068-1073.
Thursday, June 6: Motor vehicle accidents have killed more U.S. teenagers than any other cause. Legal implemenatation in 37 states and the District of Columbia of graduated driver's licensing for young drivers has produced a dramatic drop in accidents and fatalities involving teen drivers. These programs grant young drivers full driving privileges gradually as they mature and develop their driving skills. From 1996 to 1999, accidents involving 16 year old drivers dropped by one fourth in Michigan and North Carolina. The rate of fatal accidents for these drivers dropped by over half in North Carolina.
Model law examples provide for
American Academy of Pediatrics News Vol. 20 No. 6 June 2002, p. 274.
- parental or responsible adult supervision for teen-agers at least during the first six months of driving
- nighttime driving curfews (at least between midnight and 5 a.m.)
- use of safety belts
- zero tolerance for alcohol use, with provisions for administrative license revocation
This is a great idea, and as a parent and father of teenaged sons I wish it were implemented in our state and every other state in the land.
Friday, June 7: Up to 60% of children with asthma are sensitive to cat allergens. Montelukast (Singulair®) is an approved treatment for asthma in children; it is a tablet, and easily taken by even small children. It also now is found to be effective against cat allergen-induced asthma in this age group. Studies showing effectiveness again cat or other specific allergens had been done in adults; this study is the first to show a protective effect from specific allergens triggering asthma. Journal of Allergy and Clinical Immunology 2002;109:794-799.
Monday, June 10: Brief exposure to cows' milk in the newborn period of breast fed infants is not associated with later allergic disease, finds this study. Researchers had suggested previously that brief supplemental exposure to formula in breast fed infants increased the risk of later allergy. There was no difference in the rate of allergic disease in two groups of children, exclusively breast fed and those who received small amounts of formula, evaluated at 1, 2 and 5 years. Archives of Disease in Childhood 2002;86:365-369.
Tuesday, June 11: Among low-income preschool children, the presence of a television in the bedroom is a significant risk factor for overweight. Television viewing has been strongly associated with obesity among school-aged children, adolescents, and adults. Now this relationship has been demonstrated in preschool-aged children. TV viewing is directly related to obesity in itself, and a TV in the childŐs bedroom is an even stronger indicator of increased risk of being overweight. The authors urged pediatricians to begin educating about this risk before the child reaches age two. Pediatrics 2002;109:1028-1035.
Wednesday, June 12: It is almost an article of faith that breastfeeding promotes child intelligence. These studies have been done a number of times, usually with positive results reported. These investigators assembled a number of such studies and examined them using strict epidemiological research standards. Only 2 of 40 studies met strict criteria of higher quality studies to yield statistically significant results. Of these two, one found a positive effect from breast feeding. Pediatrics 2002;109:1044-1053.
Thursday, June 13: A phenomenon known as "publication bias" significantly affects the validity of the conclusions of pediatric research, finds this study. Researchers examined all papers submitted to the Society for Pediatric Research for publication over a period of time. They found that only about half of papers describing the results of randomized controlled trials of new therapies were published. The published studies tended significantly to report positive results; studies with disappointing results were much less likely to be published. The authors point out that when the negative results are not published, they are not factored in when other investigators tabulate outcomes data from many studies. Archives of Pediatric and Adolescent Medicine 2002;156:474-479.
Monday, June 17: High levels of naturally occurring radioactive radon gas in homes not only do not lead to higher levels of childhood cancers and leukemia. On the contrary, a study in Great Britain found that higher levels of radon in the home were associated with slightly lower rates of the six childhood cancer types studied: acute lymphoblastic leukemia, other leukemias, non-Hodgkin's lymphoma, Hodgkin's disease, central nervous system tumors and other solid tumors. Upper income homes had higher radon levels because of better sealing of windows and doors, but had a lower incidence of childhood cancers. British Journal of Cancer 2002;86:1721-1726, 1727-1731.
There at least some scientific suspicion that the concept that there is absolutely no safe level of radiation is not valid. Our bodies probably are adapted to the low level background radiation that has always been here.
Tuesday, June 18: An independent review of medical literature concerning the measles, mumps and rubella vaccine found no link at all between the MMR shot and autism or inflammatory bowel disease "in very reliable research going back a long time," according to Dr. Anna Donald, of Bazian Ltd, a specialist company that conducts independent reviews of medical research. The investigators reviewed 2,000 studies on MMR and single vaccines--including the research by Dr. Andrew Wakefield which sparked the concerns--found nothing to support the safety fears.Reuters Health
Wednesday, June 19: Two new reports published in this month's British Medical Journal find that an innovative pregnancy prevention program did not appear to be very effective in reducing pregnancy rates, delaying the initiation of intercourse, or decreasing risky sexual behaviors. The researchers noted that there is evidence that the most promising programs are those that are long-term and "much broader" than sex education alone--promoting, for example, adolescent community service. British Medical Journal 2002;324:1426-1430,1430-1433.
Thursday, June 20: This study from Canada finds that extremely low birth weight children often have complex learning disabilities, even if their overall intelligence is average and they do not show neurologic abnormalities.
The researchers studied the prevalence of learning disabilities in extremely low birth weight children who were otherwise functioning normallly. They found that over half the children had at least one learning disability, and a third had more than one area of learning affected. Archives of Pediatric and Adolescent Medicine 2002;156:615-620.
This would imply that parents, teachers and physicians should be on the lookout for learning disabilities in children who survived extremely low birth weight apparently neurologically intact. These disabilities may be subtle and may involve more than one area of learning.
Friday, June 21: Harmless bacteria - Lactobacillus rhamnosus and L. reuteri - given orally to children with diarrheal illness reduced the length of their illnesses in this Danish study. Both children with mild intestinal viral and bacterial infections as well as hospitalized children with more severe disease benefited. The beneficial effect of treatment was seen most when the therapy was begun within the first 60 hours of illness. Pediatric Infectious Disease Journal 2002;21:411-419.
These results replicate earlier studies which have established the effectiveness of these so-called probiotic organisms. Your child can get lactobacilli from active culture yogurt, in case you are curious.
Monday, June 24: Irish researchers report that babies regularly placed in baby walkers have delayed development of lower extremity motor milestones and are at increased risk of injury. They found that for each 24 hours of baby walker use, there was an associated 3.3 day delay in walking alone and a 3.7 day delay in standing alone. For this reason, and because of the known risks of injury, use of baby walkers should be discouraged, they say. British Medical Journal 2002;324:1494.
Tuesday, June 25: This study suggests that many children are at subsequent risk of skin cancer because of
Parents have been largely ignoring recommendations promulgated over the last 10 years for improved sun protection and avoidance of tanning beds and sunburning. The authors propose nationally coordinated campaigns in a new effort to prevent future skin cancer in children and adolescents. Pediatrics 2002;109:1009-1014.
- suboptimal sunscreen use
- high rates of sunburning
- tanning bed use
Wednesday, June 26: Babies born prematurely who receive respiratory syncytial virus immune globulin (RSV IG - Respigam®) because of chronic lung disease in infancy have improved lung function and fewer allergies 7 to 10 years later. The authors of the study speculate that this finding could lead to investigation of ways to prevent the development of asthma in children by preventing RSV disease. American Journal of Medicine 2002;112:627-633.
Thursday, June 27: A Canadian team has assessed the association of tic disorders and Tourette's syndrome in children and found that tics are due to underlying attention disorder, not drug treatment. They cite the fact that a recent study found that 5% of non-medicated children with ADHD also had tic disorders, and were 60 times more likely than their peers without the attention disorder to have Tourette's syndrome. In their survey of 800 children and teenagers with ADHD who had never received stimulant medication, they confirmed that at least 5% of the patients had tic disorders of some type. (Presented at Canadian Pediatric Society's annual meeting in Toronto.) Reuters Health
Friday, June 28: Young children aged 6 months to 8 years old can safely and effectively be given nebulized budesonide (Pulmicort®) for moderate persistent asthma. A total of 300 children received either budesonide or placebo by nebulizer inhalation twice a day. The budesonide treated group had significantly better asthma scores and lower bronchodilator use. The safety profile of the budesonide was excellent in the study. Journal of Asthma 2002;39:227-237.
We use a lot of nebulized budesonide in our practice. It is a great advantage for smaller children for whom the metered dose inhaler with spacer device is unworkable.