April 20, 2016
Volume VII | Issue No. 16

A successful school intervention weight program to enhance water drinking vs. sugar-sweetened beverages.
A new study from a NY City public elementary and middle school program which banned all artificial flavors, colors or sweeteners in all beverage vending machines and instead provided water jets in cafeterias, found a reduction in student BMI's and the likelihood of being overweight (availability of beverages at home should only be as an occasional treat).
E-cigarette use in adolescents.
E-cigarette use has increased significantly over the past few years not unrelated to the fact that they are marketed as a tool to reduce cigarette smoking.

The prevalence of e-cigarette and cigarette experimentation are similar; both are associated with higher age, socio economic status and parental smoking of standard cigarette. E-cigarette use does NOT appear to be associated with attempts to quit smoking.

Cyproheptadine (Periactin) use in children with Functional Gastrointestinal Disorders (FGID).
From a retrospective analysis of the efficacy and safety of cyproheptadine in 307 children (median age 9 years) for Rome III-defined FGIDs, it appears that the drug is effective (72.8%) in improving symptoms (also for abdominal migraine - 72%; IBS - 100%; cyclic vomiting - 75%) with minimal side-effects.

Journal of Pediatric Gastroenterology and Nutrition



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Patients diagnosed with Celiac Disease (CD) - "The tip of the iceberg"!

"CD is the most common autoimmune disease in childhood", with most individuals carrying the human leukocytes antigen (HLA) DQ2 or DQ8 haplotype, the presence of which while necessary, is not sufficient for the development of the disease (twin/sibling studies suggest the HLA contribution to be 50-70%). Environmental factors (probably post-natal) play a role.

The small intestine enteropathy which develops on a gluten diet results in malabsorption, however the clinical expression ranges widely from significant symptoms to no symptoms at all. "It appears that 2 of 3 individuals with CD have an undiagnosed disease".

The true prevalence of CD (thought to be about 1% pf the general population in the Western world) is much higher with many cases undiagnosed (symptomology may only be recognized retrospectively when on a gluten free diet).

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Undiagnosed Celiac Disease
Undiagnosed Celiac Disease
Gastric electrical stimulation in children with gastroparesis (GP).

"Gastroparesis is characterized by delayed gastric emptying of fluids and/or solids without evidence of gastric outlet obstruction". Clinically gastric dysmotility is suspected when abdominal pain, nausea, vomiting, early satiety, post prandial fullness, failure to
thrive etc. is persistently present. Causes vary. Comorbidities (38.5%) include, seizure disorder, cerebral palsy, developmental delay, etc. as well as psychiatric disorders (28.4%).

Management of gastroparesis includes diagnosing and management of an underlying condition, correction of fluid and electrolyte imbalances, alleviation of symptoms and improving nutrition. Gastric-electrical stimulation has been used successfully in adults and appears a safe and effective long-term therapy for children with intractable GP.

School experiences at age 9 years as a determinant of mental health problems at 12 years of age.

A prospective Swedish population based study which examined in 592 school children the association between school experiences and mental health in middle childhood indicates that children who have problematic school experiences at age 9 years have approximately two fold higher odds for concurrent total, internalized, externalized, attention-hyperactivity and social problems at 12 years of age.

Diagnostic outcomes following childhood non-specific abdominal pain (NSAP).
"NSAP is the most common diagnosis on discharge following an admission for abdominal pain in childhood".

A comparative study of 268,623 children age 0-16 years and a cohort hospitalized with unrelated conditions examined the risk of subsequent hospitalization for organic or functional gastroenterological conditions.

Only a small proportion (5.8%) of NSAP children are later hospitalized with bowel pathology and 5% with a specific functional disorder. The increased risk of underlying bowel pathology appears to continue to 10 years of age.

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