PedSPAM September 2001

Welcome to the PedSPAM archive for September. Here are the month's daily SPAMlets from my update reading that you might have missed:

In the News

Tuesday, September 4: A study in the New England Journal of Medicine confirms that while febrile seizures are slightly more likely after immunization with the diphtheria, tetanus, and pertussis (DTP) or measles, mumps, and rubella (MMR) vaccines, these simple seizures do not appear to have any long-term effects. The researchers found that DTP immunization was associated with febrile seizures on the day of vaccination. Seizures were actually four times more likely after a MMR shot than after a DPT (the rate is still very low), but these seizures typically occurred 8 to 14 days after the shot. New England Journal of Medicine 2001;345:656-661.
Wednesday, September 5: Iron drops - ferrous sulfate - to correct anemia work as well when given once a day as when given three times a day, find Canadian researchers. Kids hate these drops - they taste awful. Parents do not particularly like them either, because they can temporarily stain the baby teeth. Pediatrics 2001;108:613-616.
Just by-the-by: ferrous sulfate can stain the plaque on a child's teeth, but does not permanently stain the enamel. This is best avoided or reduced by giving the drops mixed in some fruit juice, letting the child sip the mixture through a straw, and then rinsing the mouth with some water or plain juice right after the medicine is taken.

Thursday, September 6: Premature infants going home from the hospital are at risk for respiratory problems - apnea, bradycardia (slow heart rate) while in the semi-upright position of their car seats. A new recommendation from the American Academy of Pediatrics cautions doctors to test for respiratory stability in the car seat before discharging babies born earlier than 37 weeks gestation home in the car seat. They are also warned to check for proper fit in the car seat before discharge, because a significant proportion of small babies do not have a secure fit in the seat without adjustments and padding. Pediatrics 2001;108:647-652
I lost a tiny infant patient years ago who was riding in a car seat in the back seat (as is currently recommended); she slid down, apparently choked and aspirated milk, and arrested. She died several days later. I have warned about this in my own practice ever since. Very sad.

Friday, September 7: Children with developmental disabilities may have disturbances of normal sleep rhythms, and chronic sleep problems. Two neurologists report that these children can be helped to fall asleep more quickly when they are given melatonin at bedtime. Five milligrams of melatonin given at bedtime helped the test subjects fall asleep more readily at bedtime, with no significant side effects. Specifically, there was no increased incidence of seizures noted in those children with seizure disorders. Journal of Child Neurology 2001;16:581-584.
Monday, September 10: A new material that can be applied to teeth to prevent or even help to heal small existing cavities has been discovered. Called "amorphous calcium phosphate" (ACP), it is applied directly to the tooth surface. The substance releases calcium and phosphate ion in the right proportions to form the natural mineral of teeth and bones. It would perhaps be applied to teeth when fillings are done to prevent further decay; it is not expected to replace fillings for repair of any but the tiniest cavities. Reuters Health
Tuesday, September 11: The longer a child's typanostomy (PE) tubes remain in the eardrums, the greater the incidence and length of suffering with otorrhea (pus draining from the ear tube). If tubes remain in the eardrum for at least 18 months, there was an 83% incidence of otorrhea in this study. Three fourths of children who had tube insertion developed at least one episode of otorrhea in the first 12 months after the operation. Pediatrics 2001;107(6):1251-1258.
I note as interesting: Children in this study were treated with oral antibiotics; I have found these to be nearly worthless for runny ears. If oral antibiotics failed, 6 out of a total of 184 children in the study were admitted to the hospital for intravenous antibiotics. That I have never seen nor even heard of. Parents were instructed to "clean" the ears three times a day; I teach my patients' mothers to insert a cotton wick (a small amount of cotton spun onto the bare end of a wooden or plastic single-ended cotton swab, and slid off into the ear canal with the thumbnail). The newer generation antibiotic ear drops (e.g. Floxin®) combined with wicking usually cleans up runny ears in a few days.

Wednesday, September 12: An educational campaign has been launched by the National Heart, Lung, and Blood Institute to emphasize to parents the importance of adequate sleep for children. The NHLBI warns that most children do not receive the recommended 9 hours of sleep. This relative sleep deprivation can cause attention problems in school, crankiness and fatigue - mimicking hyperactivity and attention deficit syndrome. NHLBI experts recommend
Thursday, September 13: Singulair® (montelukast) is safe and effective for the treatment of asthma in children as young as age two, finds this study. The once-daily drug blocks the action of inflammatory hormones known as leukotrienes. It is available in a chewable tablet - a big plus when dealing with young children. The drug has a fast onset of action, with improvement seen in as little as a day. It has had a very incidence of side effects as well. The 4 mg tablet is approved for use in children as young as two years old. Pediatrics 2001;108:e48.
The cherry flavored chewable has a very high kid acceptance factor, too.

Friday, September 14 The use of the injectable inactivated poliovirus vaccine (IPV) in children has not reduced immunization rates. Concern was expressed by some public health authorities and physicians when the switch to an all-injectable polio vaccine schedule was made that parents would be less likely to follow through with full immunization of their children. A nationwide survey showed that immunization rates did not fall after the switch, in fact, were slightly better. Pediatrics 2001;107(6):e90.
Monday, September 17: Findings presented at annual meeting of the American Academy of Otolaryngology Head and Neck Surgery Foundation in Denver showed that cochlear implants are effective and safe for both short and long-term use in children. Children with implants improved significantly over time in their ability to recognize speech. The greatest improvements were made in those children who were mainstreamed in school and used speech only rather than signing or speech and signing. No ill effects were observed in any of the children studied. Reuters Health
Tuesday, September 18: Children with pale breath holding spells associated with slow heart rate (bradycardia) not only can be helped by permanent pacemaker placement, but should have this therapy, according to these authors. Simple breath holding spells are often precipitated in susceptible toddlers by a sudden fright or a tantrum with hyperventilation. Children quickly recover from this sort of spell without harm. A more complex pattern of breath holding spells associated with seizures, bradycardia or even total stopping of the heart (asystole - "ay-SIS-toe-lee") occurs rarely in children, and is often unresponsive to medication. These children, the doctors feel, should have pacemaker intervention. Pediatrics 2001;108:698-702.
Wednesday, September 19: It has long been suspected that diabetes was often triggered by viral infections. Researchers in Finland found that infections with viruses in the enterovirus family are much more common in children who develop diabetes. Children who develop diabetes are twice as likely to have had an enterovirus infection in the six months before the onset of symptoms of the disease. This strong association does not directly prove that the virus directly causes diabetes, but does imply some as yet undetermined role. These and similar findings lead to some hope that a vaccine might ultimately be developed to prevent the disease. Reuters Health
Thursday, September 20: British researchers find that even infants under one year of age can benefit significantly from treatment with an inhaled steroid (fluticasone, Flovent®). They selected infants with wheezing who had either evidence of allergic diseases such as eczema or a parent or sibling with allergies. These infants received either fluticasone or a placebo; the treatment group had significantly better outcomes. They cautioned against indiscriminate use of inhaled steroids because of concerns about possible effects on lung development. Archives of Disease in Childhood 2001;85:143-148.
Friday, September 21: It has been reported in the past that sunburn in childhood increases the risk of melanoma skin cancer in adulthood. This theory has received experimental support in an animal model. Scientists report that mice with similar susceptibility to ultraviolet light exposure as humans develop skin tumors in early adulthood after just one sunburn-inducing exposure to UV light in infancy. The researchers outline possible mechanisms for this effect and predict that this experimental model will enable us to eventually understand how melanomas arise, how to improve sunscreens, and possible immune therapies for melanoma. Nature 2001;413:271-272.
Tuesday, September 25: The General Accounting Office (GAO) of the United States Government finds that increases in the use of stimulants to treat attention-deficit/hyperactivity disorder (ADHD) have not led to major increases in stimulant abuse in schools. Some have viewed the increase in the use of methylphenidate (Ritalin®) and other stimulants in school aged children with alarm; the possible diversion of the pills to other children for abusive use has been one argument against stimulant use. It turns out that this is a rare problem. Reuters Health
Of more interest to me is the extent to which laymen think they must meddle in issues they often do not understand and for which they certainly have no direct responsibility. My personal opinion is that there is at least as much undertreatment of ADHD and needless suffering by defenseless children as there is overtreatment. The NIH has rigorously investigated what works for attention deficit disorder and found that indeed, only stimulants have any real and positive effect.

Wednesday, September 26: Researchers found significant differences between blood lead levels in British children with developmental or behavioral problems as compared with normal controls. These differences could not be accounted for by differences in age, sex or socioeconomic status. Since testing is simple and environmental control measures can significantly reduce lead levels in children, the investigators suggest that doctors caring for children with such problems consider routinely testing them for lead intoxication. Archives of Disease in Childhood 2001;85:286-288.
Thursday, September 27: It will be flu season soon. Aventis Pasteur, Inc., the major supplier of influenza vaccine in the US, will be able to ship at least a partial order of flu vaccine to all of its customers by the end of September. This will allow the administration of the vaccine to those patients who have the greatest risk on schedule. All orders for flu vaccine should be filled by October and November, so that immunization against influenza will likely proceed on schedule this year. Reuters Health
Remember that flu shots can be given to, and are beneficial for healthy children as young as 6 months of age, and that all children with diabetes, heart lesions, or certain other chronic health problems should definitely be vaccinated each fall.

Friday, September 28: A mother who had difficulty successfully breastfeeding her first child because of inadequate milk supply should not give up on breastfeeding her second. Women who had trouble with nursing their first babies make significantly more breast milk for the second baby, researchers have found. Lancet 2001;358:986-987.

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