March 25, 2015   Vol. VI, Issue 12
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Treatment of femur fractures in young children aged 2-6 years: flexible intramedullary nail or Spica cast. 

Spica casting appears to be the "standard" of care for femur fractures in children up to the age of 6 years.


A retrospective study of 215 children with femur fractures compared immediate Spica casting to the surgical placement of a flexible intramedullary (titanium elastic nailing-TEN) nail. Time to fracture union appears similar, with the TEN treated group returning more quickly to ambulation and full activity. TEN treatment appears especially appropriate for high-energy causes of femur fracture.


Journal of Pediatric Orthopedics

Effects of acute exercise on markers of inflammation in pediatric chronic kidney disease (CKD): A pilot study. 

"Children/adolescents with CKD are chronically exposed to high levels of inflammation placing them at an increased risk for secondary health complications.


It appears that acute exercise may create an anti-inflammatory environment in children and adolescents with chronic kidney disease (stages III-V).


Journal of Pediatric Nephrology

Risk and protective factors for falls from furniture in young children (0-4 years). 

A multicenter case-control study of approximately 224 children with falls from furniture (and matched controls) indicates that parents of injured children:

  1. Are less likely to have safety gates at home.
  2. Have not taught their children rules about climbing kitchen objects.
  3. More likely to leave children, change their diapers and/or put them in car/bouncing seats on raised surfaces.
  4. More likely allow children to play or climb in/on furniture.

While there appears to be multiple causes of children injuring themselves on furniture, many may be prevented by parental education.


JAMA Pediatrics 



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A practical approach to classifying and managing feeding disorders (or "avoidant/restrictive food intake disorders").


"Many young children are thought by their parents to eat poorly" many parents however have difficulty differentiating normal children from those with milder forms of disease. On reviewing the most recent DSM-V classification it appears that feeding disorders could be classified into three abnormal feeding patterns:


1.    Children eating too little.

2.    Selective intake-"restricted number of foods".

3.    Fear of eating.


"Feeding difficulties must be conceptualized as a relationship disorder between the feeder and the child" and caregiver feeding styles must be recognized as an issue to be taken into consideration in the management of these problems.


This excellent "State-of-the-Art" review article which outlines diagnostic and treatment approaches should be read, printed and kept by all, caring for children (Ed.).



Video Feature 

(via YouTube)
Avoidant/Restrictive Food Intake Disorder (ARFID)
Avoidant/Restrictive Food Intake Disorder (ARFID)

Management of pediatric post-traumatic headache. 


"Post-traumatic headache is one of the most common symptoms occurring after mild traumatic brain injury". Most are migraine or tension type and standard medications e.g. triptans (for migrainous) or non-steroidal anti-inflammatories (for the other types of headaches) are recommended. Medication overuse should be avoided. Nerve blocks, nutraceuticals (e.g. melatonin) and behavioral therapies may be useful, as is attention to sleep hygiene and the management of anxiety. It appears that recommending strict rest for adolescents after acute concussion may be of no benefit.


Pediatric Neurology



Effects of magnesium alginate plus simethicone on gastro intestinal reflux (GER) in infants.   


A randomized control trial utilizing 64 infants (median age 5 months) with GER compared one month of treatment using magnesium alginate plus simethicone vs. a rice-starch-

Gastroesophageal Reflux (GER)
Gastroesophageal Reflux (GER)

thickened formula or reassurance alone with lifestyle changes, indicates that magnesium alginate/simethicone is significantly better in reducing GER symptoms that the other treatment options (though all improve symptoms).


Journal of Gastroenterology and Nutrition 

Cognitive outcome in adolescents born preterm.


It appears from a study of 134 adolescents born preterm with a birth weight <1,500 grams (divided into three groups: Extremely preterm, 23 to 27 weeks gestation, very preterm 28 to 31 weeks gestation, moderate preterm 32 to 36 weeks gestation) and studied comprehensively at 18 years, that those born at 28 to 31 weeks gestation perform similarly to term-born controls; extremely preterm infants' cognitive function is much poorer, while those born between 32-36 weeks gestation function less well that either very preterm or full-term born adolescents (primarily because they are mostly small-for-gestational age).


Adolescents born at 28 weeks gestation or later, of appropriate birth weight/ gestation and having had no perinatal complication, function like their term-born peers at 18 years of age.   


Acta Paediatrica 

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