PedSPAM September 1998

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

In the News

Flu season lasts from October until March. Influenza is expected to be in the news this fall and winter. There have been recent outbreaks in Alaska and Washington state. The vaccine supply is already very low, and shortages are projected for the rest of the flu season. You should get your flu shot and flu shots for your kids as soon as you can. Remember that flu shots are now approved for use as early as six months old, and seem to be especially helpful for children with excessive numbers of ear infections (otitis media) or who are in day care.

Surgeons have long believed that if an infant or child develops an inguinal (groin) hernia on one side of the body, the other side should be explored and repaired if an early defect is found. A large study in Japan reported in the Journal of Pediatric Surgery in July refutes this idea. The low (11.7%) eventual incidence of subsequent hernia on the other side contrasted with the fairly significant risk of damage to reproductive structures on the side of exploration is high enough to lead the researchers to recommend: leave the apparently normal side alone.

A study of tympanic (infrared ear reading) thermometers in adults led a group of researchers to conclude that they are not reliable enough to use routinely. This is not the first such study. I admit to being an early adopter of tympanic thermometers years ago, and my personal opinion is that the significant advantages outweigh the reliability questions. Rectal temperatures are the standard of accuracy, but also the standard of discomfort and fearful screaming on the part of our little patients! The whole question of how accurate the temperature has to be taken to give truly useful information I will leave to doctors to argue. If your doctor uses the ear thermometer, he or she is aware of these questions, trains the staff to use the instruments properly, and takes possible inaccuracy into account when evaluating your child's total clinical picture.

In a study of milk and food allergies in children, researchers at the University of Palermo have found that cow's milk protein allergy (true milk allergy rather than lactose intolerance) can persist past the age of 2 years. They report that a family history of allergic diseases such as eczema, asthma and multiple food allergies is associated with longer-term intolerance. The investigators found that gastrointestinal complaints such as diarrhea and vomiting were the most frequent symptoms in younger subjects, whereas respiratory problems - for example wheezing, runny nose - were most frequent in older children. They found that over time, allergic patients seemed to develop some degree of tolerance to the allergens and could often tolerate smaller amounts of the foods. Reported in the July issue of Clinical and Experimental Allergy.

According to a study from researchers at the CDC in the August issue of Obstetrics and Gynecology, use of alcohol among pregnant women in the United States is increasing. According to the researchers. "Among pregnant women, alcohol use decreased from 1988 to 1992 and then increased to 1995," and that "...frequent alcohol use decreased from 1988 to 1991 and then increased to 1995." In light of the known deleterious effects of alcohol consumption on the fetus, including fetal alcohol syndrome, this is discouraging. This report is especially depressing in light of the report that the percentage of college students who drink specifically to get drunk has increased from 30% to 50%.

Researchers report in the August issue of the Journal of Asthma that oral corticosteroids appears not to increase asthmatic children's risk of infections requiring outpatient antibiotic treatment. While high doses of steroids given for long periods of time increase the risk of infections, the use of short courses of oral steroids for asthma flareups do not increase the chance that a child will need an antibiotic in the following month.

When preparing naturally uncooperative children for colonoscopy, whether to anesthetize or sedate has been debated. Both anesthesia and deep sedation carry some risk; how to choose between them has been the question in pediatric gastroenterology circles. According to researchers in Ireland, children requiring colonoscopy can have it done very safely under general anesthesia, rather than deep sedation, with less anxiety for the child. Anesthesia additionally offers the elimination of sedation-related repiratory depression. From Pediatrics 1998;102:381-383.

Researchers in Canada report that the standard treatment of intramuscular dexamethasone (a potent steroid) injection is significantly better than nebulized budesonide, a recently advocated treatment. They once again demonstrated the effectiveness of dexamethasone treatment for croup (a question that was hotly debated in years past). New England Journal of Medicine 1998;339:498-503.

A long term study of the natural history of Tourette syndrome show the average age of onset as about five to six years old. Tic severity peaks around 10 years of age, with a range between 8 and 12 years. About one fifth of patients with Tourette syndrome will have such severe problems that school is interfered with or impossible. Almost all patients get better with time, and by age 18, half of affected children are tic-free, and nine of ten have only mild or no tics. (Pediatrics, July 1998)

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