July 5, 2017
Volume VIII |  Issue No. 27


Television (TV) during meals in the first four years of life
A study which analyzed data of meal time TV habits and family characteristics through parent surveys at birth and at six months intervals thereafter to four years of life indicates that most (84%) infants fed watching TV during the first 24 months of life continue to do so at 4 years of age (college educated fathers and families with annual income >$50,000 are associated with less-frequent TV exposure during meal times). Clinicians should counsel parent about mealtime TV.

Bivalved vs. circumferential cast immobilization for displaced forearm fractures
A bivalved cast is one which has been cut into two halves. A randomized study of 202 children (mean age 10 years) with similar displaced/angulation fractures of the radius and/or ulna compared cast immobilization with a bivalved or circumferential long arm cast, on maintenance of reduction and complications after closed reduction.

"Cast immobilization is effective in the majority of patients after closed reduction of displaced forearm fractures" and there appears to be no differences on maintenance of reduction, need for surgery or complication rates between the two long-arm casts.

Condom availability in schools
In spite of educational classes encouraging abstinence adolescents and young adults are frequently sexually active and are thereby exposed to sexually transmitted diseases (STIs) and unplanned pregnancies. School availability of free condoms may increase condom usage.

"The Society for Adolescent Health and Medicine encourages schools to make condoms available to students as part of efforts to decrease rates of STIs and unplanned pregnancies. The Society also encourages healthcare providers to advocate for and support the availability of condoms in local schools."

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Guidelines on enuresis by the Steering Committee of World Bedwetting Day 2017
  • Treatment of enuresis before age 5 years is not recommended
  • At 5 years+ screen patients for bladder dysfunction
  • Treatment by a primary care physician is only advisable if monosymptomatic
  • Patients should drink sufficiently during the day (1L/day for child 10kg; 1.5L/day for a child of 20kg ) with fluid restriction before sleep.
  • Nocturnal enuresis can be treated using desmopressin. If unsuccessful/unresponsive referral is advised
  • Small maximum voiding volumes and arousal problems are treated using a bedwetting alarm
Video Feature: Examining Enuresis
The International Study of Kidney Diseases in Children (ISKDC) classification and a new semi quantitative classification (SQC) for predicting outcomes in Henoch-Schönlein Purpura (HSP) nephritis

"HSP is a systemic vasculitis of small blood vessels characterized by the tissue disposition of immunoglobulin A-containing immune complex". Renal involvement more common in older children, is typically seen a few days to one month after the rash etc. and it is not apparently related to the severity of the systemic symptoms. The clinical course and the renal histopathological findings vary significantly, however children with mild symptoms usually have mild renal disease.

A modified SQC classification of renal findings in HSP nephritis includes activity, chronicity and tubulointerstitial indices.

A study evaluating ISKDC and SQC classification and renal outcomes over 7.3 years indicates that the modified SQC classification is the more sensitive indicator for predicting renal outcomes.

Treatment of ingrown toenails; excision of skinfold (Vandenbos procedure) or toenail?

For severe ingrown toenail a typical surgical approach is a wedge-shaped resection or total removal of the toenail. An alternative approach is to excise the surrounding skinfold and allowing the wound to heal by open secondary wedge closure (Vandenbos procedure).

A study of 59 ingrown toenails (in 39 children; mean age 13.5 years) who underwent the Vandenbos procedure assessed pain, functional status and quality of life prior to and after
Ingrown Toenail
Ingrown Toenail
surgery, and 1, 2 and 6 months postoperatively.

Following skinfold removal for a severe ingrown toenail,  time to return to school is 7 days and 23 days to wearing enclosed shoes. Complications are few and minor with excellent outcomes. 95% of children and 100% of parents would recommend the procedure.

The effects of prenatal maternal stress on early temperament

Following a sudden-onset flood in Queensland Australia a study examined disaster-related prenatal maternal stress on infant temperament at six months post-partum.
Pre-natal Maternal Stress
Prenatal Maternal Stress

Depending on the level of the  maternal assessment  of hardship, mothers' emotional response, timing of the flood during pregnancy and infant sex, infants' responses vary with exposure during early pregnancy with higher perceived levels of hardship resulting in more irritable, and difficult boys.

Did You Know?
Nicklaus Children's Hospital Pediatric Specialty Services Again Ranked Among The Best in The Nation

Eight subspecialty programs of Nicklaus Children's Hospital, part of Miami Children's Health System, are again identified among the best in the nation, according to U.S.News & World Report's 2017-18 "Best Children's Hospitals" rankings.
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Are probiotics beneficial for VLBW  preterm infants in the prevention of severe necrotizing enterocolitis?

Can you name the 10 things Transgender and Gender Non-conforming youths want their doctors to know?

What are the common characteristics of childhood anxiety disorders?

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