Miami, FL
April 17, 2019
     
Volume X | Issue No. 16
Macrocephaly (MC) in infants
Macrocephaly is defined as a head circumference >2 SD above the mean (for age, sex and race) and there are a large number of causes. There are no recommended imaging guidelines outlined by the American Academy of Pediatrics (AAP).
 
A study of 169 macrocephalic infants (<36 months of age) was utilized to identify risk factors for pathologic macrocephaly and to identify those infants who would benefit from imaging studies (magnetic resonance imaging, computed tomography or head ultrasound).
 
7.7% of infants with macrocephaly have an abnormal imaging study; primarily those with developmental delay or neurological symptoms (a positive family history almost always precludes an underlying pathology).
 
Rate of recurrence of adverse events following immunization (AEFI) 
A retrospective study of 1,731 children (between 1998 and 2016 in Quebec, Canada) who had been reported as having a link between receiving immunization and an adverse event and who required additional doses of the vaccine, analyzed recurrences following re-immunization.

AEFI occurs in approximately 16% of infants, of whom 16% will have a recurrence of AEFI with re-immunization (18% of parents rate the adverse effect more serious than the initial reaction). Of patients with seizures following measles, mumps rubella with/without varicella vaccine, none have a recurrence.

"Most patients with a history of mild or moderate AEFI can be safely immunized."

Evaluation of the ability of 5-11 year olds to brush their teeth effectively
A questionnaire completed by caregivers developed from items selected from previously validated social science instruments, and calibrated scores to measure plaque, was used to assess childhood tooth brushing effectiveness (manual and electric) in removing plaque.
 
Certain life skills (like ability to write an address, cut meat with a knife, play a musical instrument and/or wash dishes independently) are indicators of better tooth brushing effectiveness and plaque removal scores. Type of toothbrush used does not appear to have any effect on brushing effectiveness.  
 
 
See related video HERE
Childhood Obesity Facts 
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Attention Deficit-Hyperactivity Disorder (ADHD) and stimulants
 
Stimulants, including methylphenidate (e.g. Ritalin, Concerta, Metadate, etc.) and amphetamines (e.g. Adderall, Dexedrine, etc.) are frequently utilized in the management of this, one of the most common mental health problems seen in children/adolescents. While efficacy to reduce symptoms seems fairly well established, safety continues to be debated particularly since 2007 when the Food and Drug Administration (FDA) mandated changes to drug labels to increase awareness of new-onset psychosis associated with stimulant therapy.
 
A study 337,919 adolescents and young adults who received either methylphenidate or amphetamines for ADHD identified and compared the likelihood of either drug inducing a new-episode of acute psychosis.
 
New-onset psychosis occurs in approximately 1 in 660 patients receiving stimulants for ADHD with amphetamine use being associated with a greater risk.
 
New England Journal of Medicine
Video Feature
My Child Doesn't Need More Stimulation. So Why Treat His ADHD with Stimulants?
My Child Doesn't Need More Stimulation. So Why Treat His ADHD with Stimulants?
Acceleration index to predict therapeutic response to orthostatic Vasovagal Syncope (VVS)
 
VVS ("fainting") is a clinical syndrome in which there is transient loss of consciousness due to inadequate cerebral blood flow (neurocardiogenic syncope) most often associated with an abrupt, brief (8-10 seconds), self-limiting drop in systemic blood pressure from a trigger which causes peripheral vasodilatation and bradycardia followed by rapid recovery. The head-up tilt test is frequently utilized to diagnose suspected or recurrent VVS. In some children orthostatic training has been shown to be effective in improving autonomic control (postural changes) and symptomatology.
 
From a study of 33 children with VVS it appears that measurement of the acceleration index (acceleration capacity of the heart) may predict the therapeutic response of orthostatic training in children with VVS.
 
Early subthreshold aerobic exercise for sports-related concussion (SRC) 
 
From a multicenter, prospective clinical trial of 103 adolescents (aged 13-18 years) presenting within 10 days of SRC randomly assigned to receive either aerobic exercise or placebo-like stretching regimen (for approximately 20 minutes/day) it appears that an individualized, subsymptom threshold exercise treatment program (that does not exacerbate concussion symptoms) prescribed to adolescents with early concussion symptoms induces recovery faster (13 days vs. 17 days) and may reduce the incidence for delayed recovery.
 
See related video HERE & HERE
Recovery of bone mineral mass after upper limb fracture in children and adolescents 
 
"Loss of bone mineral mass and muscle atrophy are predictable consequences of cast-mediated immobilization following wrist and forearm fractures."
 
A study of 50 children and teenagers with cast immobilization following forearm or wrist fractures (paired against appropriately matched healthy controls) had dual-energy x-ray absorptiometry of different skeletal sites, and injured and uninjured forearms at time of fracture, and 6 and 18 months later.
 
Rapid bone mass recovery occurs with activity following immobilization, with full bone recovery occurring 6 months after wrist or forearm fracture.
 
Journal of Pediatric Orthopaedics
Children's Health Chats
Dr. Ann Hyslop Chats About the NeuroCardiac and Develpment Program's Multidisciplinary Approach
Dr. Ann Hyslop Chats About the NeuroCardiac and Develpment Program's Multidisciplinary Approach
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