MCH Updates in Pediatrics Masthead  

                       Volume IV
                        Issue 19
                                                           South Florida's  only licensed  free-standing
                                                             specialty hospital  exclusively for children ...                                                      May 8, 2013 
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Prenatal exposure to nicotine and impaired reading performance

5,119 normal school aged children (7-9 years) who were exposed prenatally at 8-42 weeks gestation (adjusted for comorbidities, mediators, and cofounders) to nicotine (high: >17mg per day, low: <17 mg per day: 1 pack of 20 average strength cigarettes) were investigated to quantify reading speed, single word identification, spelling accuracy, real and  

non-word reading and  reading comprehension.


Prenatal Nicotine exposure is associated with moderate to large underperformance of 6 of 7 specific reading outcomes at 7-9 years of age. Environmental factors may ameliorate the nicotine response.


Hypnotherapy (HT) for functional abdominal pain or irritable bowel syndrome

Functional abdominal pain is characterized by abdominal; pain which cannot be explained by history, physical examination and/or appropriate testing. Approximately 25% children/adolescents seen by a pediatric gastroenterologist for GIT complaints have functional abdominal pain. This diagnosis includes several types of chronic abdominal pain including irritable bowel syndrome.


James Braid (1795-1860), a surgeon, coined the term "hypnosis". Since then the technique has gone in and out of fashion and while during the past 25 years many studies have indicated in adults its value to relieve symptoms of irritable bowel syndrome, skepticism remains.


A retrospective review of randomized control trials in children with functional abdominal pain or irritable bowel syndrome treated with HT indicates not only significant improvement in abdominal pain, but also improvement of quality of life and reduction in school absenteeism.


Source:  Archives of Disease in Childhood 


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Abdominal complaints as a first presentation of cardiac failure (CHF) in adolescents  


The records of 98 patients < 18 years of age, hospitalized with a diagnosis of dilated cardiomyopathy were retrospectively reviewed to categorize presenting symptoms.


Gastrointestinal complaints (abdominal pain, nausea, anorexia, and  weight loss) and respiratory symptoms, are common in all age groups presenting in CHF, however in adolescents abdominal complaints are more common than any other presenting symptom. (Unlike adults who frequently present with chest pain, arrhythmias, or cardiac arrest).


"Trigger Thumb" in children    


Trigger thumb is frequently a painful condition of unknown etiology which causes the thumb to catch or lock in a bent position aimed at the palm of the hand.


A prospective ultrasound analysis of 35 trigger thumbs initially treated with splinting was undertaken to categorize the underlying cause and potential factors involved for its resolution. Ultrasonography of the A1 pulley of the flexor pollicis longus (FPL) tendon at presentation and at follow up for tendon gliding, texture, cross sectional area and anatomical variation was reviewed.


35% of pediatric trigger thumbs appear to resolve spontaneously and 25% require surgical release. No evidence of FPL inflammation or trauma is evident.


It appears that pediatric trigger thumb is a "development" condition which occurs when the cross-sectional area of the FPL exceeds the cress-sectional area of the pulley. Bilateral triggering is not uncommon.


Risk factors for coronary artery abnormalities in children with Kawasaki syndrome (mucocutaneous lymph node syndrome)

Kawasaki disease is an autoimmune illness in which medium sized blood vessels are inflamed. Clinically it presents with involvement of the skin, mouth and lymph nodes, occurring most commonly in children < 5 years of age. While affecting all ethnic groups, it is more common in children of Japanese and Korean descent.


Typical symptoms (and Atypical presentation occurs in approximately 2% of patients) include a persistent recurring high fever frequently lasting > 5 days, red eyes, crack dry lips, swollen "strawberry" tongue, irritated throat, swollen purple/red palms of hands and soles of the feet, and lymphadenopathy. It is rare, but a more serious complication is its effect on the heart where it can cause coronary heart aneurisms in untreated children.


Approximately 10% of Kawasaki syndrome patients may be diagnosed with coronary artery abnormalities. Not receiving intravenous immunoglobulin before the 10th day of illness, young age, male sex, and atypical presentation are increased risk factors for coronary artery abnormalities.


Acta Paediatrica

Socio demographic risk factors for shaft fractures of the femur in children  


Demographic, socioeconomic and injury data from 1,874 Swedish children (0-14 years of age) with a femur shaft fracture were analyzed and compared with matched controls.


Young parents/low income households are risk factors associated with fractures of the shaft of the femur in boys 7-14 years of age and similar aged girls retrospectively. (Lack of supervision and the weight of the child appear to play a role in "major" limb fractures of young children).


Journal of Pediatric Orthopaedics

Acta Paediatrica

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