Aug. 3, 2016
Volume VII | Issue No. 31

Bullying and Suicide Risk 
"Bullying is unwanted, aggressive behavior among school-aged children that involves a real or perceived power imbalance... and can occur in-person or through technology. Bullying has serious and lasting negative effects on the mental health and overall well-being of youths". It even negatively effects children who have observed but not participated in bullying behavior.

A study of 524 Emergency Department (ED) patients (mean age 15.2 years) who presented with medical/surgical or psychiatric complaints and completed a structured interview to develop a screening suicide risk instrument, indicates an elevated suicide risk for the 11.5% of pediatric ED patients who were recent victims of bullying and who present with medical complaints. (ED identification based suicide prevention intervention protocols would be valuable, Ed).

Gross disturbance of the distal tibia in patients with idiopathic clubfeet
"Clubfoot is 3-dimensional deformity; in adduction, equinus and supination". Most cases (80-90%) are considered "idiopathic". It may be associated with a wide variety of other malformations/syndromes.

A retrospective follow-up evaluation on deformities of the distal tibia in 35 patients at least 10 years of age who had undergone surgical treatment after unsuccessful casting indicates a high incidence of distal tibial deformity strongly suggesting the need for follow-up evaluations of patients with idiopathic clubfoot.
Management of acute appendicitis in children
From two recent articles it appears that:

1.   Transitioning children with perforated appendicitis from intravenous to oral antibiotics at discharge is safe, cost effective, reduces ultrasound imaging, PICC placement and allows for early discharge from hospital with no increase in intraabdominal abscess formation.

2.   "Non-operative management of acute appendicitis in children with an appendicolith results in an unacceptable high failure rate".
Play it Safe in the Sun 
INFORMATION BONUS!  Newly Updated... 

Download, print and pin this information on your office wall.


-This is a "Must Have" (Ed.) 

More on Electronic Cigarettes (e-cigarettes) 

The debate continues as to whether e-cigarette use increases or decreases the use of conventional cigarette smoking.

Data from a questionnaire complete by 1,694 11th/12th grade students evaluated the cross-sectional association between e-cigarette use, the social environment and susceptibility to future cigarette use among "never cigarette smokers".

1.     31.4-34.6% of "never used cigarettes" and past "e-cigarette users" indicates susceptibility to cigarette use (c/f 21% of "never e-cigarette users").
2.     Current e-cigarette users appear 2 times more likely to smoke cigarettes compared to "never users".
3.     Friends' use and a positive attitude to e-cigarette use are also associated with a greater susceptibility to cigarette smoking.

Pediatricians are concerned about the possible deleterious health effects of e-cigarettes but appear uninformed about them and/or how to guide patients and families.
Video Feature 
Electronic cigarettes health risks?
Electronic cigarettes health risks?
Feeding at the breast and expressed milk feeding; association with otitis media and diarrhea in infants

It appears that longer duration of expressed breast milk (>6 months - bottle fed) feeding is associated with an increased likelihood of infant otitis media (compared to breast feeding) while breast milk fed infants (independent of mode) experience less diarrhea than those formula fed.

Psychological factors associated with delayed symptom resolution in children with concussion
Delayed symptom resolution (>3 new or worse symptoms than preinjury 1 month after concussion) occurs in 21% of patients 8-18 years of age.

It appears that delayed symptom resolution following concussion is associated with previous somatization symptomatology (a tendency to experience and communicate psychological distress in the form of clinical symptoms).

Other variables include:

  1. Female sex
  2. Continued activity participation
  3. Loss of consciousness
  4. Worsening symptoms from the day of concussion
Gestational exposure to Selective Serotonin reuptake inhibitors (SSRI) and offspring psychiatric disorders
"SSIRs are a class of drug that are typically used as anti-depressants in the treatment of major depressive disorders and anxiety disorders". Their exact mechanism of action is unknown.

A large cohort study using National register data in Finland in pregnant women exposed or unexposed to SSRIs indicates that at 14.9 years prenatal SSRI exposure is associated with increased rates of childhood depression ("these findings must be balanced against the substantial adverse consequences of untreated maternal depression").
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