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Obesity With Necrotizing Gallstone Pancreatitis

Herman, T. E., Siegel, M. J. — Thu, 10 Sep 2009 10:53:13 PDT

Type 2 Diabetes in the Pediatric Population: Are We Meeting ADA Clinical Guidelines in Ohio?

Valent, D., Pestak, K., Otis, M., Shubrook, J. — Thu, 10 Sep 2009 10:53:15 PDT

Several studies have demonstrated the importance of achieving the American Diabetes Association (ADA) clinical guidelines in adults. However, research is limited on adherence to these guidelines in the pediatric population. This retrospective chart review examined 56 charts from 6 physician offices and 1 multispecialty health care system in Ohio. Variables of interest included recommendations from the 2007 ADA Standards of Medical Care in Diabetes. HgA1c was measured every 3 months in 44.6% of patients, while 55% achieved A1c goal. Blood pressure was monitored in all patients, with 57% meeting goal. Lipids and urine microalbumin were tested annually in 51.7% and 26.7% of patients, respectively. Dilated eye and foot exams were performed on 53.5% and 37.5% of patients, respectively. Adherence to ADA clinical guidelines for pediatric patients with type 2 diabetes is suboptimal. The authors recommend that specific evidence-based guidelines be evaluated for children with type 2 diabetes.

Parent Perception of Healthy Infant and Toddler Growth

Laraway, K. A., Birch, L. L., Shaffer, M. L., Paul, I. M. — Thu, 10 Sep 2009 10:53:15 PDT

We hypothesized that parents of infants prefer growth at higher percentiles and are averse to growth at lower percentiles. Of 279 participating parents, only 10% desired their child’s weight to be in the lowest quartile. For children weighing in the lowest quartile, 57% of parents thought their child’s weight was "too low." In contrast, 66% of parents whose child’s weight was in the top quartile preferred their child weigh that much.When viewing hypothetical infant growth trajectories, 47% ranked a growth chart demonstrating growth along the 10th percentile for weight as "least healthy" of 6 growth patterns, and 29% chose charts showing an infant at the 90th percentile for weight at age 1 as "healthiest." In conclusion, parents are averse to growth at the bottom of the weight growth chart but are much less likely to feel negatively about growth at higher percentiles.This is troubling given the childhood obesity epidemic.

Provider Compliance With the Food and Drug Administration Recommendation to Avoid the Use of Over-the-Counter (Nonprescription) Cough and Cold Medications in Children Younger Than 2 Years

Goo, R., Miller, M., McArthur, T. — Thu, 10 Sep 2009 10:53:15 PDT

Hematemesis and Pyloric Stenosis

Kaila, R., Kannikeswaran, N., Kamat, D. — Thu, 10 Sep 2009 10:53:14 PDT

Pediatrician's Role in Children's Oral Health: An Indiana Survey

Ditto, M. R., Jones, J. E., Sanders, B., Weddell, J. A., Jackson, R., Tomlin, A. — Thu, 10 Sep 2009 10:53:13 PDT

Objectives. To evaluate Indiana pediatricians’ current practices related to oral health, knowledge of oral health prevention, and opinions on anticipatory guidance integration into their practices. Background. The American Academy of Pediatrics (AAP) May 2003 policy statement on oral health risk assessment timing and establishment of a dental home has provided pediatricians with guidelines to assess patients’ oral health and caries risk status. Methods. A survey of 31 questions was distributed via mail to all active Indiana pediatricians (300) registered in the Indiana State Medical Association to evaluate current practices relating to oral health prevention and guidance. Results. Of the 300 distributed surveys, 138 were returned (46%).The authors found that 15% of pediatricians recognize the AAP-recommended age for a dental home as 12 months and practice this recommendation.Among the respondents, 7% believe application of fluoride should be part of a well-child visit.The majority (89%) of respondents reported interest in obtaining further knowledge on oral health.

Agitation During Procedural Sedation and Analgesia in Children

Tue, 08 Sep 2009 13:26:20 PDT

Background. Agitation that occurs in children receiving standard procedural sedation regimens may indicate inadequate patient comfort and compromise procedural success. Although agitation in uninterrupted pediatric procedures is recognized to occur,it is not generally tracked as an adverse event,and there have been no formal studies to determine its rate of incidence. Methods. We identified intraprocedural agitation in a large cohort of children undergoing standardized sedation regimens in a tertiary care pediatric hospital over a calendar year and compared it with rates of well-accepted quality measures of sedation using odds ratio analysis,with 95% confidence intervals (CIs).All analyses excluded those patients who were documented to fail to sedate or to wake before the procedure was over—2 tracked adverse events that involve agitation and aborted, interrupted, or incomplete procedures. Results. Agitation occurred in 433 of 5045 (8.6%) procedures during the study period, including 306 (6.1%) who had an uninterrupted, complete procedure. In contrast, severe adverse events during sedation, including cardiovascular resuscitation and allergic reactions, were exceedingly rare (0.9 %).When excluding patients who woke during the procedure or who failed to sedate,we found that the odds ratio for the association between agitation and tracked adverse events was 2.9 (95% CI = 1.7-4.8; P < .001). Discussion. A clinically significant number of children appear agitated during standard procedural sedation and analgesia. In addition, agitation in children undergoing uninterrupted procedures was associated with other adverse events. Identifying risk factors for agitation is fundamental to improving the quality of procedural sedation in children.

Recurrent Febrile Infections and Neutropenia in a Child With Silent Celiac Disease

Leonardi, S., Vitaliti, G., La Rosa, M. — Tue, 08 Sep 2009 13:26:20 PDT

Backgound. Today it is known that celiac disease (CD) may be silent or present with atypical extraintestinal symptoms (silent/atypical CD). Case report. The authors report the case of a 3-year-old child in whom the diagnosis of CD was made after several admissions to hospital for recurrent febrile infections and persistently moderate neutropenia.After the beginning of a gluten-free diet, we observed a remission of febrile infections and an increase in neutrophil count until it reached normal ranges. Conclusions. We suggest that recurrent febrile infections and moderate neutropenia be included in the diagnostic workup for atypical/silent CD in the general population.

Making the Case for Early Treatment of Acne

Zaenglein, A. L. — Tue, 08 Sep 2009 13:26:19 PDT

Early acne can be defined as the occurrence of acne at its onset, primarily in preteens, or as acne at its earliest severity (ie, mild to moderate).Although the majority of patients with acne are treated by dermatologists, most, particularly mild to moderate cases, could be successfully managed by primary care physicians.Therefore, it is important for physicians to understand the benefits of treating all types of acne,not just the most severe.Awareness of the emotional impact of acne, particularly in adolescence,as well as recognition of possible scarring are important considerations.To achieve optimal results, physicians should be familiar with classification and severity grading of acne.Also, in-depth knowledge of available acne medications will streamline and optimize treatment regimens. Recognizing, treating, and monitoring the progress of early acne may lead to quicker, better clinical outcomes and improved quality of life.

Clinical Strategies for the Management of Acute Mastoiditis in the Pediatric Population

Lin, H. W., Shargorodsky, J., Gopen, Q. — Fri, 04 Sep 2009 10:36:30 PDT

Although the incidence of acute mastoiditis has been substantially reduced since the introduction of antibiotic therapy, mastoiditis complications are still commonly seen in the pediatric population. Many of these cases require lengthy hospitalizations and extensive medical and surgical interventions.Accordingly,a safe,effective,and resourceful diagnostic and therapeutic plan must be executed for the workup and treatment of each patient suspected of having acute mastoiditis. With thorough clinical evaluations, early diagnosis, and close follow-up, a large proportion of children with severe acute otitis media or early stage mastoiditis can be managed in the primary care setting without immediate surgical specialty involvement.This review presents an overview of the anatomical and pathophysiological considerations in acute mastoiditis and offers pediatricians a practical, evidence-based algorithm for the diagnostic and therapeutic approach to this disease.

Commentary on "Breastfeeding Does Not Protect Against Urinary Tract Infection in the First 3 Months of Life, but Vitamin D Supplementation Increases the Risk by 76%"

Linday, L. A., Shindledecker, R. D., Greer, F. R., Holick, M. F. — Fri, 04 Sep 2009 10:36:31 PDT

Acanthosis Nigricans and Oral Glucose Tolerance in Obese Children

Tue, 25 Aug 2009 13:23:37 PDT

Fulminant Herpes Simplex Hepatitis Following a Short Course of Corticotherapy in a Child

Barreira, E. R., Bousso, A., Shieh, H. H., Goes, P. F. — Tue, 11 Aug 2009 11:50:45 PDT

Prescribing Errors in a Pediatric Clinic

Condren, M., Studebaker, I. J., John, B. M. — Thu, 30 Jul 2009 09:19:49 PDT

Objective:This project was completed to determine the frequency and type of prescribing errors occuring in a pediatric clinic. Study design: Records for all patient encounters in the pediatric acute care clinic from February through April 2007 were reviewed. Prescriptions entered into the electronic medical records (EMR) were reviewed the day after they were written. Results: A total of 3523 records containing 1802 new prescriptions were reviewed. Prescribing errors were found in 175 prescriptions (9.7%).The most common type of error was an incomplete prescription (42%), followed by dosing errors (34%).Anti-infectives were most commonly written in error followed by anti-inflammatories. Conclusions: Prescribing errors were commonly identified in a pediatric clinic utilizing electronic medical records. Incomplete prescriptions and dosing errors were the most commonly occurring errors. Recognizing the types of errors has been beneficial for developing educational programs intended to decrease prescribing errors and recommending improvements to the EMR system and its utilization.

Preterm Premature Rupture of Membranes: Clinical Outcomes of Late-Preterm Infants

Mateus, J., Fox, K., Jain, S., Jain, S., Latta, R., Cohen, J. — Thu, 30 Jul 2009 09:19:49 PDT

Objective: To determine gestational age-specific neonatal outcomes of late preterm infants delivered as a consequence of premature rupture of membranes (PROM). Methods: Retrospective cohort study of infants born to women delivered electively due to preterm PROM between 34^0/7 and 36^6/7 weeks of gestation. Neonatal outcomes were compared between those delivered at 34^0/7 to 34^6/7 weeks, at 35^0/7 to 35^6/7 weeks, and at 36^0/7 to 36^6/7 weeks. Results: 192 infants were identified.The 34^0/7 to 34^6/7 week infants had significantly higher neonatal intensive care admission rate (72.5%) compared to those at 35^0/7 to 35^6/7 weeks (22.8%) and at 36 to 36^6/7 weeks (17.8%) (P < .05). Neonatal respiratory distress syndrome was significantly higher at 34^0/7 to 34^6/7 weeks (35.4%) compared with 35^0/7 to 35^6/7 week and 36^0/7 to 36^6/7 week infants (10.5% and 4.1%; P < .05).The longest hospitalization occurred in the 34^0/7 to 34^6/7 week infants (248.5 ± 20.0 hours). Conclusion: Substantial short-term morbidity occurred in late preterm infants.The greatest number of complications affected infants born at 34^0/7 to 34^6/7 weeks.

Variations in Costs for the Care of Low-Birth-Weight Infants Among Academic Hospitals

Herrod, H. G., Chang, C. F., Steinberg, S. S. — Thu, 30 Jul 2009 09:19:49 PDT

Objectives: To determine the relative role that academic hospitals (AHs) play in providing neonatal care for low-birthweight infants within a single state and to determine if there are variations in inpatient costs for neonatal services among AHs. Design: Retrospective analysis of hospital costs for low-birth-weight infants. Setting: Cases were identified using 2003-2005 data from the Tennessee Hospital Discharge Data System.A specific focus was discharge data from the 5 AHs that support obstetrical residencies and have a neonatal intensive care unit. Participants: Cases included all discharged infants with a birth weight of <2500 grams. Results: The 5 AHs discharged 18% of the total normal-birth-weight infants and 30% of the low-birth-weight infants for the entire state.AHs had higher costs associated with these infants than did other hospitals, with a single exception The difference in costs at this hospital was consistent with the finding of lower utilization rates of hospital services, a shorter average length of stay, and lower costs for infants insured by the state Medicaid program. Conclusion: Academic obstetrical hospitals discharged a disproportionately high percentage of low-birth-weight infants compared with other Tennessee hospitals.The lower costs observed in the Shelby County hospital indicates that other hospitals could potentially lower their costs for the care of low-birth-weight infants.

Back Pain as the Only Presenting Symptom of Intussusception: A Case Report

DeGoff, W., Anderson, J. E., Chen, T. — Wed, 29 Jul 2009 09:03:29 PDT

Intussusception can often be a difficult diagnosis as many children do not present with the typical findings of abdominal pain, vomiting, and hematochezia.The authors report the case of a young child who presented with back pain as the only symptom of intussusception.We encourage pediatricians to consider this diagnosis in any child with episodes of intermittent abdominal or back pain.

Methicillin-Resistant Staphylococcus aureus in Middle Ear Fluid of Children

Klein, J., Chan, S. — Thu, 23 Jul 2009 11:53:23 PDT

Background: Methicillin-resistant Staphylococcus aureus (MRSA) infections and colonization in children have increased in recent years. Objective: This study examined the possible effect of this increase on MRSA isolation from middle ear fluid (MEF) of children. Method: A retrospective descriptive study was performed using the electronic medical records of children cared for at the Alfred I. duPont Hospital for Children from 2003 to 2007. All MEF isolates obtained at tympanostomy tube placement for recurrent or chronic otitis media or from spontaneous drainage were tabulated and analyzed. Records of children who’s MEF grew S aureus comprised our database. Results: A total of 920 MEF isolates were reviewed, of which 121 patients with S aureus in the MEF were identified.Twenty were excluded per protocol.In the cohort of 101 patients, 76 had methicillin-sensitive Staphylococcus aureus (MSSA; 75.3%) and 25 had MRSA (24.7%). Conclusion: In this retrospective study, the authors demonstrated that among children with S aureus in the MEF, younger children (<3 years) were more likely to have MRSA.

The Pace of Signs and Symptoms of Blunt Abdominal Trauma to Children

Pariset, J. M., Feldman, K. W., Paris, C. — Thu, 23 Jul 2009 11:53:23 PDT

The authors describe the types, signs, and symptoms of blunt abdominal injury. Record reviews of children <5 years old were carried out at a regional children’s hospital or level 1 trauma center between 1994 and 1999. Recognized cases of child abuse, penetrating trauma, or children with an unavailable chart were excluded.The mean age was 38 months (n = 42;range 11-59).Motor vehicle trauma caused most of the injuries (72%);64% had isolated solid organ,14% isolated hollow viscous, and 21% both organ injuries. Multisystem trauma included closed head injury (29%) and fractures (43%). Scene reports documented that 80% of those assessed immediately had abdominal pain.Average time taken to arrive at the emergency department was 66 minutes (range 15-420). Hollow viscous perforations were symptomatic from onset. The overall mortality rate was 12%,related to multitrauma.Most children suffering unintentional blunt abdominal trauma have immediate and ongoing injury.Caretakers promptly seek emergency care,and solid organ injuries predominate.The series mortality was low compared with that for abusive abdominal injuries.

Isolated Low HDL Cholesterol Emerges as the Most Common Lipid Abnormality Among Obese Adolescents

Harel, Z., Riggs, S., Vaz, R., Flanagan, P., Harel, D. — Thu, 23 Jul 2009 11:53:22 PDT

A 12-hour fasting lipid profile was obtained from 88 otherwise healthy obese (BMI ≥ 95%) adolescents (age 16 ± 1 years, BMI 36 ± 1 kg/m², 55 males, 33 females, 57% Hispanic, 23% African American, 19% Caucasian, 1% Asian American). About 56% of the obese adolescents exhibited lipid abnormalities based on cutoff points established by American Heart Association (AHA) guidelines, and about 57% exhibited lipid abnormalities based on percentile values established by the Lipid Research Clinic Pediatric Prevalence Study. Isolated low high-density lipoprotein–cholesterol (HDL-C) was the most common abnormality (43% based on AHA, 36% based on the Lipid Research Clinic Pediatric Prevalence Study) among the obese adolescents with lipid disorders. While there was no significant statistical difference (SSD) between genders in the levels of total cholesterol and low-density lipoprotein–cholesterol (LDL-C), triglyceride (TG) levels were significantly higher (P = .003) in males (120 ± 11 mg/ dL) than in females (81 ± 7 mg/dL), and levels of HDL-C were significantly higher (P = .006) in females (42 ± 2 mg/dL) than in males (35 ± 1 mg/dL). There was no SSD between races in total cholesterol and LDL-C levels. TG levels were significantly lower in African-American participants (81 ± 9 mg/dL) compared with levels in Caucasian participants (117 ± 15 mg/dL, P ≤ .05) and with levels in Hispanic participants (112 ± 11 mg/dL, P = .03). HDL-C levels were significantly higher in African-American participants (43 ± 3 mg/dL) compared with levels in Hispanic participants (36 ± 1 mg/dL, P = .03), but there was no SSD when compared with HDL-C levels in Caucasian participants (37 ± 2 mg/dL).

Unethical Prescriptions: Alternative Therapies for Children With Cerebral Palsy

Weisleder, P. — Thu, 23 Jul 2009 11:53:23 PDT

The US National Center for Complementary and Alternative Medicine (CAM) defines CAM as "a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine." The problem with said therapies is that, for the most part, their effectiveness is questionable and their side effect profile is essentially unknown. Furthermore, as stated by Rosenbaum, many CAM treatments are based on "at best, anecdotal evidence and at times rather unusual ideas about the biology of the conditions to which they are being applied." In spite of the data shortage, Americans are forecasted to spend more than $42 billion on CAM during 2009. Using a patient for illustration purposes, the author presents 3 CAM treatments that have been advocated for children with cerebral palsy. The current scientific literature on these remedies and their purported benefit is reviewed. The article ends with a discussion on the reasons why prescribing said therapies is contrary to the concept of evidence-based medicine and the tenets of medical ethics.

Mullerian Dygenesis, Renal Agenesis, Endometriosis, and Ascites

Herman, T. E., Siegel, M. J. — Thu, 23 Jul 2009 11:53:23 PDT

A Child With Lacrimal Gland Swelling

Karia, V. R., Shah, N., Espinoza, L. R., Gedalia, A. — Wed, 15 Jul 2009 15:01:10 PDT

Accuracy of Perception of Body Size Among Overweight Latino Preadolescents and Their Parents After a 6-Month Physical Activity Skills Building Intervention

Gesell, S. B., Scott, T. A., Barkin, S. L. — Wed, 15 Jul 2009 15:01:09 PDT

Background. Previous research has shown that overweight Latino children underestimate their body size. Erroneous perception of body size may have important health and behavioral implications and serve as a significant barrier to weight control. Objective. The aim of this study was to determine whether children’s perceptions of their body size became more accurate following a pediatric obesity intervention focused on increasing physical activity. Design/methods. This analysis includes 61 overweight (body mass index ≥85%) Latino children (aged 8-11 years) parent–child dyads who completed a pilot randomized control trial. Results. After the intervention, 40.7% (11/27) of children in the intervention group rated their body size accurately compared with 21.2% (7/33) in the control group. The difference indicates a trend toward significance (P = .09). Conclusions. Participating in monthly physical activity skill building sessions may increase children’s accuracy in body size perception. This may be an important first step toward behavior modification.

The Choking Game and YouTube: A Dangerous Combination

Linkletter, M., Gordon, K., Dooley, J. — Mon, 13 Jul 2009 10:25:33 PDT

Purpose. To study postings of partial asphyxiation by adolescents on YouTube and to increase awareness of this dangerous activity as well as the value of YouTube as a research tool. Methods.Videos were searched on YouTube using many terms for recreational partial asphyxiation. Data were gathered on the participants and on the occurrence of hypoxic seizure. Results. Sixty-five videos of the asphyxiation game were identified. Most (90%) participants were male. A variety of techniques were used. Hypoxic seizures were witnessed in 55% of videos, but occurred in 88% of videos that employed the "sleeper hold" technique. The videos were collectively viewed 173 550 times on YouTube. Conclusions. YouTube has enabled millions of young people to watch videos of the "choking game" and other dangerous activities. Seeing videos may normalize the behavior among adolescents. Increased awareness of this activity may prevent some youths from participating and potentially harming themselves or others.

Office-Based Interventions for Recognizing Abnormal Pediatric Blood Pressures

McLaughlin, D., Hayes, J. R., Kelleher, K. — Thu, 09 Jul 2009 08:46:19 PDT

Interventions to improve pediatric blood pressure (BP) screening have not been well studied. The authors measured staff acceptance of 2 simple in-office interventions and measured the effect on physician recognition of elevated BP measurements. Group 1 used simplified normative pediatric BP tables affixed to the growth chart, group 2 used a personal digital assistant program (PDA) to calculate BP percentiles as part of the vital signs, and group 3 served as the control. Group detection rates by compliant (C) and noncompliant (NC) with the intervention were: (1) (BP table) C = 18%, NC = 12%; (2) (PDA) C = 33%, NC = 26%; and (3) (control) 18%. There was no statistically significant intervention effect with documented compliance (P = .27) nor was there an effect in the noncompliant records (P = .12). Although the interventions were used inconsistently, their presence in the medical record did not improve performance. Future education and interventions are needed to reduce barriers to elevated pediatric BP recognition.

Teenage Boy With a 60-Pound Weight Loss

Banas, D. A., Lazebnik, R. — Wed, 01 Jul 2009 16:15:11 PDT

Practice Patterns of Pediatric Emergency Medicine Physicians Caring for Young Febrile Infants

Ferguson, C. C., Roosevelt, G., Bajaj, L. — Mon, 29 Jun 2009 11:22:03 PDT

The authors conducted a chart review of all febrile infants between 28 and 90 days of age who presented to the emergency department (ED) between December 1 and March 31 during 2004-2006. The objectives of the study were to describe the practice patterns of pediatric ED physicians caring for these infants and to determine whether the evaluation and management of these infants differed based on their age at presentation. Two groups were compared—infants aged 28 to 59 days (n = 79) and infants aged 60 to 90 days (n = 88). As compared with the younger age group, infants in the older age group had fewer complete blood cell counts (relative risk, RR = 3.57; 95% confidence interval [CI], 2.15-5.95), fewer blood cultures (RR = 3.38; 95% CI, 1.99-5.74), fewer urine cultures (RR = 3.83; 95% CI, 1.81-8.13), and fewer cerebrospinal fluid cultures (RR = 2.56; 95% CI, 1.94-3.40). Overall, there was poor adherence to current guidelines for the diagnostic evaluation of young febrile infants.

Thrombotic Thrombocytopenic Purpura and Multiorgan System Failure in a Child With Sickle Cell-Hemoglobin C Disease

Majjiga, V. S., Tripathy, A., Viswanathan, K., Shukla, M. — Fri, 12 Jun 2009 16:06:14 PDT

Facial Asymmetry Involving the Parotid Gland of an Infant

Hicks, C. W., Krakovitz, P. R., Reid, J. R., Rome, E. S. — Thu, 04 Jun 2009 15:00:52 PDT

Lymphatic malformation (LM) is a benign congenital disorder that consists of vesicles or large cysts filled with lymphatic fluid. Here we describe the clinical, pathologic, and imaging features of a facial LM that extends from just below the dermis through the left parotid gland in a young child whom we have followed from age 7 weeks through 6 years. Imaging studies of the lesion show a microcystic lymphatic malformation of the left parotid region that is prone to infection and is gradually enlarging. The current management dilemma involves the choice between surgical excision, with the risks of cosmetic disfigurement and/or facial nerve injury, versus intermittent antibiotic therapy for recurrent infection. The role of steroids in treatment of a large facial LM is also discussed.

Tinea Capitis: Predictive Value of Symptoms and Time to Cure With Griseofulvin Treatment

Lorch Dauk, K. C., Comrov, E., Blumer, J. L., O'Riordan, M. A., Furman, L. M. — Mon, 01 Jun 2009 16:17:40 PDT

Objectives. To describe (a) the predictive value of symptoms for diagnosis of tinea capitis and (b) the rate and timing of cure with high-dose griseofulvin treatment. Methods. This prospective open-label study enrolled children aged 1 to 12 years with clinical tinea capitis. Participants with a positive dermatophyte culture received oral griseofulvin (20-25 mg/kg/ day) and topical selenium sulfide shampoo for 6 weeks. Main outcome measures. The rate of symptoms of tinea capitis, and rates of mycologic and clinical cure. Results. The positive predictive values of any 1, 2, 3, or 4 symptoms for a positive culture were 88%, 82%, 78%, and 77%, respectively. The observed rates of mycologic, clinical, and complete cure were 89%, 66%, and 49%, respectively. Conclusion. In a high-risk population it is reasonable to diagnose tinea capitis using one or more cardinal symptoms. Oral griseofulvin at 20 to 25 mg/kg/day with adjunctive shampooing for 6 weeks is moderately successful as treatment.

A Girl With Bilateral Temporomandibular Joint Pain, Generalized Arthralgias, and Inability to Walk

Sklirou, E., Mavrikou, M., Voudris, K. A., Stamoyannou, L. — Mon, 01 Jun 2009 16:17:39 PDT

The authors present the case of a 6.5-year-old girl with bilateral temporomandibular joint (TMJ) pain, generalized arthralgias, inability to walk, and absence of deep tendon reflexes in the context of Guillain–Barrè syndrome. TMJ pain was the sole manifestation for 3 days, before other typical symptoms appeared, an issue that initially led to an improper diagnosis. A thorough clinical examination along with laboratory and radiographic evaluation excluded other possible causes of TMJ pain. To the best of the authors’ knowledge, this is the first case of Guillain–Barrè syndrome in the pediatric population initially presenting with bilateral TMJ pain. Guillain–Barrè syndrome may be quite atypical in its expression, especially in young children, with pain being a common presenting symptom, and pediatricians should be alert to avoid misdiagnosis.

Parent Involvement Is Associated With Early Success in Obesity Treatment

Mon, 01 Jun 2009 16:17:41 PDT

Objective: The study examined the influence of parent involvement and family factors on body mass index (BMI) change in a pediatric obesity treatment program. Methods: A total of 104 children and their caregivers were examined during a 12-week obesity intervention. Participants (mean age = 11.42 years; SD = 2.83) and their caregivers completed measures of family environment and depression prior to enrollment. Children’s BMI and parental involvement were rated weekly during the intervention. Logistic regressions were conducted to examine the role of sociodemographic factors, family characteristics, and parent involvement on weight. Results: Children with the lowest parent involvement were less likely to lose any weight or have clinically significant (≥2 kg) weight loss. Demographics and family factors did not predict BMI change. Parent involvement related to ethnicity, absences and physical activity. Conclusions: Parental involvement may be helpful in identifying who is likely to do well in a weight loss program.

Clinical and Laboratory Assessment of Dehydration Severity in Children With Acute Gastroenteritis

Parkin, P. C., Macarthur, C., Khambalia, A., Goldman, R. D., Friedman, J. N. — Mon, 01 Jun 2009 16:17:42 PDT

Objective. To evaluate clinical and laboratory assessment of dehydration severity in children, 1 to 36 months, with acute gastroenteritis. Study design. Clinical and laboratory measures and weight change following rehydration were collected for enrolled children. Setting. Pediatric emergency department. Results. Likelihood ratio (LR+) and 95% confidence interval (CI): for a clinical score of 0, the LR+ was 2.2 (95% CI = 0.9-5.3); for a clinical score of 1 to 4, the LR+ was 1.3 (95% CI = 0.90-1.74); for a clinical score of 5 to 8, the LR+ was 5.2 (95% CI = 2.2-12.8); for a venous pH <7.32, the LR+ was 7.2 (95% CI = 2.4-21.9); and for serum bicarbonate <18 mmol/L, the LR+ was 11.6 (95% CI = 3.5-38.0). Conclusion. Clinicians may find it useful to incorporate the Clinical Dehydration Scale and laboratory measures into clinical decision-making algorithms to assess dehydration severity in children with acute gastroenteritis.

Petechia and Seizure in an Infant With Acute Kawasaki Disease

Ho, C.-L., Jan, S.-L., Fu, Y.-C., Lin, M.-C., Lin, S.-J. — Fri, 29 May 2009 13:57:17 PDT

Feminizing Changes in a Prematurely Born Infant

Marinkovic, M., Rasmussen, M., Jones, K. — Fri, 29 May 2009 13:57:19 PDT

Hypoglycemic Seizure

Freedman, B. D., Hughan, K., Garibaldi, L. — Fri, 29 May 2009 13:57:18 PDT

Does Picky Eating Affect Weight-for-Length Measurements in Young Children?

Ekstein, S., Laniado, D., Glick, B. — Fri, 29 May 2009 13:57:16 PDT

Objectives: Picky eating is a major source of parental concern, and children with picky eating habits are potentially at risk for nutritional deficits. This research aimed to determine whether picky eating is related to being underweight in young children. Methods: Participants included 34 children with picky eating behavior who were referred to the Pediatric Feeding and Nutrition Clinic for evaluation and 136 healthy controls. Weight and height measurements were obtained, and weight-tolength data were calculated for each child. Results: In all, 7 of 34 children (20.6%) in the picky eaters group and 9 of 136 children (6.6%) in the control group were underweight (P = .02). Underweight was found in 15 children (14.2%) at or under 36 months and in 1 child (1.6%) older than 36 months (P = .002). Conclusions: Children with picky eating habits, especially those younger than 3 years of age, are at increased risk of being underweight.

Antibiotic Use in Premature Infants After Discharge From the Neonatal Intensive Care Unit

Fri, 15 May 2009 10:58:00 PDT

Using a retrospective cohort of premature infants, we constructed multivariable Poisson models to determine factors associated with the receipt of antibiotics during the first year after discharge, N = 891. Black race (incidence rate ratio 1.80 compared with White infants, P = .008), male gender (incidence rate ratio 1.44; P = .007), bronchopulmonary dysplasia (incidence rate ratio 1.47; P = .04), and each additional child at home (incidence rate ratio 1.21, P = .002) increased the receipt of antibiotics for any reason. Male gender and additional children at home increased the receipt of nonrecommended antibiotics, while Black infants received care at facilities that prescribed more nonrecommended antibiotics. Even in a high-risk population of children, factors other than the medical history and presentation of the child may alter antibiotic prescription patterns and result in variations in care.

A Comparison of Perceptions of Fever and Fever Phobia by Ethnicity

Rupe, A., Alhers-Schmidt, C. R., Wittler, R. — Fri, 15 May 2009 10:58:00 PDT

Background. The purpose of our study was to compare caregiver perceptions of fever between ethnicities in a population with a large percentage of Hispanics. Methods. A 20-item, cross-sectional survey was collected from English- and Spanish-speaking parents of children. Questions addressed level of parental worry, parental definition of fever and high fever, and other items related to fever and its potential outcomes and treatments. Results. Responses indicated 57% of all parents report being "very worried" when their child is febrile. Results also indicated that parental fear of fever varies by race. Worry was also significantly higher in parents of younger children, and in parents with fewer years of education. However, Hispanic ethnicity was the single most predictive factor for fever worry. Conclusions. Fever phobia continues to exist. The prevalence appears to differ by ethnicity, making it important for physicians to use every patient encounter for culturally sensitive fever education.

Ethnic Differences in Parental Perceptions and Management of Childhood Fever

Cohee, L. M. S., Crocetti, M. T., Sabath, B., Kapoor, S., Serwint, J. R. — Fri, 15 May 2009 10:57:59 PDT

To explore knowledge and management of childhood fever among ethnically diverse parents and identify opportunities for educational intervention, we administered a cross-sectional survey to a convenience sample of 487 parents of children enrolled in 2 urban hospital-based pediatric clinics. Outcomes included parental definition of fever, level of concern, and management of fever. Latino parents were least likely to identify a temperature as nonfebrile from 97-100.3°F (adjusted odds ratios [aOR] 0.06) or identify a fever as a temperature from 100.4-107°F (aOR 0.52). african americans were least likely to believe that fever can cause death or brain damage (aOR 0.4). african americans were more likely to dose ibuprofen more frequently than recommended (aOR 1.97). all ethnicities are equally likely to treat normal temperatures and dose acetaminophen too frequently. Therefore continued education of all families about fever is necessary, and there are opportunities to develop ethnically sensitive strategies to target educational interventions.

Underestimation of Children's Weight Status: Views of Parents in an Urban Community

Tschamler, J. M., Conn, K. M., Cook, S. R., Halterman, J. S. — Fri, 15 May 2009 10:58:01 PDT

Objective. To examine the relationship between parents’ underestimation of their child’s weight status and concerns about their child’s weight and health. Methods. We conducted interviews with parents in an urban pediatric clinic (January through June 2006). Children’s height and weight were measured at the visit using standard techniques. Results. 193 children were included (response rate 87%, 18 months-9 years, 70% black); 31% of parents underestimated their child’s weight status (46% of overweight children, 24% of normal weight). Parents of normal-weight children who underestimated were more likely to be concerned about their child’s weight (39% vs 2.9%, P < .001) than those who did not underestimate. Parents of overweight children who underestimated were less likely to be concerned about their child’s weight (7.7% vs 59%, P < .001) than those who recognized their children as overweight. Conclusions. Many parents continue to underestimate their child’s weight status. These perceptions may present a barrier to the prevention of childhood obesity.

Bone Marrow Suppression in the Setting of Normal Thiopurine Methyltransferase Phenotype Testing

Best, C., Sudel, B. — Fri, 15 May 2009 10:58:01 PDT

Effects of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) at Age 8 Years: Preliminary Data

Fri, 15 May 2009 10:58:01 PDT

The current study reports the effects of NIDCAP (Newborn Individualized Developmental Care and Assessment Program) at 8 years of age for a randomized controlled trial of 38 very early born (≤29 weeks postmenstrual age), high-risk preterm infants. It was hypothesized that the experimental group at school age in comparison with the control group would perform significantly better neuropsychologically and neuroelectrophysiologically. Twenty-two (11 control, 11 experimental) children of the original 38 (18 control, 20 experimental) participants were studied at school age with a detailed neuropsychological battery and with eeG spectral coherence measures. Results indicated significantly better right hemisphere and frontal lobe function in the experimental group than the control group, both neuropsychologically and neurophysiologically. Neurobehavioral and physiological results in the newborn period successfully predicted the beneficial brain function effects at age 8 years. Results support the conclusion that the NIDCAP intervention has lasting effects into school age.

10-Year-Old Male With Fever and Headache

Berry, S. J.-B., Smith, R. — Sun, 03 May 2009 21:31:07 PDT

An 18-Month-Old With Progressive Vomiting and Leg Pain

Campagna, J., Crete, R., Rooks, V., Kratovil, T. — Mon, 20 Apr 2009 14:56:33 PDT

A Lethargic Neonate and an Infant With Seizure

Narayanaswamy, V., Rettig, K. R., Bhowmick, S. K. — Mon, 20 Apr 2009 14:56:33 PDT

Association of Substance Use Discussion by Pediatric Providers With the Parent-Provider Relationship and Maternal Behavior Change

Garg, A., Nelson, C. S., Burrell, L., Sia, C., Duggan, A. K. — Fri, 10 Apr 2009 10:44:52 PDT

A cross-sectional study of data from a randomized, controlled trial was conducted to determine (1) provider and parent attributes associated with discussion of maternal substance use, (2) how substance use discussion related to the parent–provider relationship, and (3) whether discussion was associated with maternal attempts at behavior change. Of the 482 mothers, 34% reported discussing all 3 substance use items (smoking, alcohol, and drug use) with their child’s provider. Mothers who discussed smoking were more likely to report discussing alcohol and other drug use (P < .001). Parent–provider relationship scores, measured by a modified version of the Primary Care Assessment Survey, were positively associated with discussion of each substance (P < .001). Discussion of smoking and drug use were significantly associated with attempted behavior change. Our findings suggest that discussion of parental substance use by pediatricians is positively associated with the parent– provider relationship and may lead to behavior change.

Painful Swallowing After Herpes Stomatitis

Goldsmith, B., Pohl, J. F., Jatla, M. — Thu, 12 Mar 2009 13:28:31 PDT

The Relationship of Maternal Depression to Parental Monitoring of Adolescents: Reports From Mother-Adolescent Dyads

Dawlett, M. F., Auslander, B. A., Rosenthal, S. L. — Wed, 04 Mar 2009 16:42:30 PST

Asymptomatic, Transient Complete Heart Block in a Pediatric Patient With Lyme Disease

Heckler, A. K., Shmorhun, D. — Tue, 03 Feb 2009 10:23:16 PST

Lyme Disease, caused by the spirochete Borrellia burgdorferi, is the most common vector-borne disease in the United States. Clinically, it primarily affects the skin, joints, nervous system, and heart. Lyme carditis occurs in 4%-10% of adults with Lyme disease. Transient variable-level atrioventricular blocks, occurring in 77% of adults with Lyme carditis, are the most common cardiac manifestation. Up to 50% of Lyme carditis patients may develop complete heart block. The incidence of Lyme carditis in the pediatric population is not well established. We present a pediatric patient with a transient asymptomatic complete heart block resulting from Lyme carditis, an under-recognized complication of Lyme disease in the pediatric population.

Refractory Pneumonia in a Mexican American Infant

Sharma, D., Hilinski, J. A. — Thu, 02 Oct 2008 09:26:18 PDT

Recurrent Pancreatitis in a Child

Shah, A. P., Sahai, S., Sugawa, C., Macha, S., Kamat, D. — Fri, 29 Aug 2008 16:13:11 PDT

A Child With Severe Joint Pain

Mallepalli, J., Gedalia, A. — Mon, 14 Jul 2008 16:22:46 PDT