May 11, 2016
Volume VII | Issue No. 19

"Same-sex" and "different-sex" parents and child health outcomes
A study utilizing the National Survey of Children's Health (NSCH) data from 2005 for family configuration (95,677 US households with children, of which 95 were female same-sex parents. Male headed families were too small in number to consider). finds, that though these couples report more parenting stress, their children are no different in general health, emotional well-being, coping ability and learning behaviors from those reared in different-sex parent households.
Age of onset of Functional constipation (FC)
From a review of 538 children with FC where age of onset, symptom duration and behavior/development was examined, it appears that onset occurs predominantly in infants and toddlers, older children have the shortest symptom duration and are more likely to have behavioral/developmental issues.

Journal of Pediatric Gastroenterology and Nutrition
Risk and protective factors for late talking
A prospective longitudinal pregnancy cohort of 1023 mother-infant pairs was followed before 25 weeks, between 34-36 weeks gestation and at 4, 12, and 24 months postpartum to assess risk and protective factors for late talkers (defined by scoring < 10th percentile on an appropriated Communication skill tool between 24 and 30 months of age).

It appears that the prevalence of late talking is 12.6%; being a male and/or having a family history of late talking are risk factors, while exposing the infant/toddler to a language-rich environment (in formal play, being read to or shown picture books daily) has a protective effect.



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What pediatricians should know about the Zika virus 

This recent excellent article outlines the virology, epidemiology, clinical manifestations, prevention and diagnosis of the Zika virus.

In summary:
  1. Zika virus was first isolated in 1947 in the Zika forest of Uganda. Sporadic infections have occurred subsequently.
  2. Zika virus in a member of the Flavivirus family similar to those viruses causing yellow fever etc.
  3. The current presentation started in Brazil in May 2015 and has subsequently spread to 26 countries (to date the USA has only seen patients infected outside the country).
  4. Usually transmission occurs through the bite of an infected Aedes mosquito (though both blood and sexual transmissions have been reported).
  5. The incubation period is probably up to seven days. 80% of infections are asymptomatic. Signs/symptoms include: fever, rash, arthralgia/myalgia, conjunctivitis and headache.
  6. A link between Zika infection and microcephaly, Guillain-Barré syndrome and other autoimmune diseases has been reported.
  7. Mosquito control and avoidance are the mechanisms for prevention.
  8. Reverse transcription-polymerase chain reaction within two weeks of exposure facilitates diagnosis
Video Feature
Cyclic Vomiting Syndrome (CVS) in infants and children - outcomes

CVS presents as sudden, repeated episodes of nausea, vomiting, and exhaustion often starting between that ages of 3 and 7 years (but can occur at any age), lasting a few hours to days (each episode occurring at similar times of the day with similar severity and length of occurrence) with no apparent cause, followed by symptom-free periods. Males and females are equally affected. While the cause is unknown migraine headaches occur in up to 80%. Abnormalities in cellular mitochondrial function may be present with increased adrenocorticotropic and antidiuretic hormone levels being found during an attack. Diagnosis is by exclusion.

A study of 25 children with CVS for 66 months (median) and followed for at least 5 years indicates that:
  1. 44% develop migraines.
  2. Valproic acid with/without phenobarbital, and amitriptyline are effective in some patients.
  3. Most children recover completely over time.
Recovery following sport-related Concussion in children

Following concussion, it appears that most children will return to learning in 2.5-4 days, be symptom free in 12-14 days and return to play in 14-19.5 days.

While most clinical practice guidelines advise cognitive and physical rest after injury, potential harm and worsening outcomes may occur after prolonged activity restriction with resultant persistent physical, cognitive and mental health problems.

Clinical Pediatrics
Acute illness; C-reactive protein (CRP) and Procalcitonin (PCT)
A retrospective study of 635 simultaneous pairs of CRP and PCR levels done in acutely ill children indicates discrepancies in 29%. While both can increase without bacterial infection (e.g. inflammatory conflictions - hypoxia, post-operative, etc.) PCT is better in the diagnosis of bacteremia.

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