MCH Updates in Pediatrics Masthead  

                 Volume IV
                  Issue 41
                                                           South Florida's  only licensed  free-standing
                                                             specialty hospital  exclusively for children ...                                                      October 9,  2013 
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Dollars & Sense


by Jason Biro 


Today's tip:  Use what you have now to save for retirement.


Does one expense after another keep you from saving for retirement? To make up for this gap, pre-load your retirement and investment accounts with your practice's real estate equity. With a newly-announced program, you can contribute to your retirement plan yearly, without sacrificing the growth of your practice.

Bank of America Practice Solutions  

Pill swallowing in childhood

It appears that there is wide range of ages at which children will, or can be taught to, take pills as medications. In the USA it is most commonly thought to be around 10 years of age, however this varies quite widely. 46% of 6-11 year olds have been reported to be able to swallow pills on their own, while an additional 37% can be easily taught to do so, some as early as 4-5 years of age, particularly among children with chronic illness.


An interesting study of Dutch children, aged 1-4 years indicates that even at this early age many children may accept swallowing a small (4mm) pill. (As ages of tablet acceptability vary widely, the risk of choking particularly in toddlers and preschool children should always be considered. Ed.)


Archives of Disease in Childhood 

Long-term seroprotection after adolescent booster of meningococcal serogroup group C (Men C) vaccination

Serum bactericidal antibody levels after routine Men C vaccine at age 9-12 years followed by a booster Men C or bivalant meningococcal serogroups A/C poylaccharide vaccine at 13-15 years of age, indicates at age 22 years sustained protection against MC disease.


Archives of Disease in Childhood

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Gastroesophogeal reflux (GER) & gastroesophogeal reflux disease (GERD) in children- management guidance  


An excellent extensive (and "must read" Ed.) "Clinical Report" from the AAP "Section on Gastroenterology, Hepatology and Nutrition" outlines the latest evidence based approach to the diagnosis and management of childhood GER and GERD. Differentiating between GER and GERD is fundamental to management approaches.


GER is considered a normal physiological process that occurs with the passage of food between stomach and esophagus, several times a day in healthy infants, children and adults. This non-pathologic reflux may commonly be associated with vomiting and/or regurgitation, with no other history and physical examination abnormality. Life-style conservative treatment (without medications) is usually all that is required and resolution generally occurs by 18 months of age (in the infant).


GERD includes symptoms and complications associated with GER and are classified as either:

1.    Esophageal including: vomiting, poor weight gain, dysphagia, epigastric or substernal/retro-sternal pain (heartburn) and esophagitis and "sour burps".

2.    Extraesophageal including: Respiratory symptoms, dental erosions, pharyngitis, sinusitis and recurring otitis media.


Diagnostic studies, life-style changes, medications (acid suppressants and prokinetic agents) and surgery (for children with intractable symptoms) are fully discussed.



Video Feature  
Tips from a Pediatrician : How to Help Children to Swallow Pills 
Tips from a Pediatrician : How to Help Children to Swallow Pills
ehowhealth via YouTube

C-reactive protein (CRP) as a diagnostic tool to differentiate heatstroke (HS) from central nervous system (CNS) infection


A child who spends too much time and activity in the hot sun without intermittent shaded times and/or ingesting enough cold liquids is at risk or hyperthermia (heat exhaustion, heat cramps, or heat stroke). Heat stroke is a life-threatening condition manifested by systemic inflammation and organ failure.


A study of 36 adult patients with significant hypothermia (>105F) admitted to an intensive care unit has serum CRP levels drawn on admission (plus other studies) and 24-48 hours later. Serum CRP levels are significantly and substantially lower in HS than in those patients with CNS infection.  


American Journal of Emergency Medicine 

Mechanical chest compression devices (MCCD) & survival following out-of-hospital cardiac arrest


Short and long-term survival of patients following out-of-hospital cardiac arrest remains poor in spite of improved standard cardiopulmonary resuscitation and other modalities of care.


A study of 2,401 Swedish out-of-hospital cardiac arrest adult patients who either did or did not receive MCCD indicates that while one month survival improves somewhat, overall survival remains low (no place yet for routine use. (Ed).


American Journal of Emergency Medicine

Hydrocortisone (HC) treatment for Bronchopulmonary Dysplasia (PD) in preterm infants & brain growth  


73 infants (mean gestational age 26.7 weeks, birth weight 906gms) received HC for the treatment of BPD (and matched for sex and gestational age to a similar untreated group) underwent brain magnetic resonance imaging at term-equivalent ages to assess brain volumes (infants with overt parenchymal pathology were excluded).


HC does not appear to affect total brain tissue or cerebellar volumes in treated preterm infants. 


Journal of Pediatrics 

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