Miami, FL
August 7, 2019 
Volume X | Issue No. 32
Health-related Quality of Life (HRQL) in children with Sickle Cell Disease (SCD) undergoing chronic red cell transfusion therapy (CRCT) 
CRCT not only decreases primary and secondary strokes, but also decreases the risk of acute chest syndrome and pain-related hospitalization.

Genetic and early-life environmental influences on dental caries; a twin study 
A study on 250 twin pregnancies explored the relative contributions of genetic and environmental influences on dental caries risk and investigated fetal and developmental risk factors.
Environmental (lack of water fluoridation, hypo-mineralized second primary molars, dichorionic placenta and maternal obesity) rather than genetic factors are important in increasing the risk of dental caries.
See related video HERE
Risky driving and Attention Deficit/Hyperactivity Disorder (ADHD) 
Two recent publications report/comment on "risky driving... shown to be consistently elevated in those with ADHD." Skills critical in driving (including executive functioning) are frequently impaired in adolescents with ADHD.
A study identified children born between 1987 and 1997 and who were as adolescents diagnosed with ADHD. All obtained an "initial" divers license (minimum age 17 years) during the study period, and all had at least 1 month post-licensure follow-up. Per-driver rates of crashes (at fault, alcohol related, nighttime and with peers), violations and suspensions were calculated.
Crash rates (plus violations for speeding, seatbelt nonuse and electronic equipment usage) are higher for drivers with ADHD regardless of licensing age, particularly during the first month of licensure. In the first year of driving the rates of alcohol and/or drug valuations are 3.6 times higher for adolescents with ADHD.
Comprehensive targeted preventive programs that focus on skills training, and shared decision making strategies plus promotion of healthy behaviors are essential to reduce risk.  
See related video HERE, HERE & HERE
Childhood Obesity Facts 
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Persistent isolated metacarpal swelling and pain in adolescence - consider osteochondritis  

Osteochondritis encompasses a family of joint diseases (disorders of endochondral ossification) that occur in rapidly growing children (10-14 years of age) characterized by interruption of blood supply to the bone (particularly the epiphysis), of unknown origin (but perhaps genetic and repetitive trauma are important factors) followed by localized bony necrosis and regrowth.
Osteochondritis of the metacarpal head is rare, with the second and third digits being most frequently involved. Clinical
Johns Hopkins All Children's Sports Medicine - Osteochondritis Dissecans
presentations vary from asymptomatic to pain/swelling/tenderness and loss of mobility.
An interesting case report of a 13 year old right handed girl who presented with a 5-month history of isolated pain, swelling and restrictive mobility to her left second digit reminds us that a child presenting with long-lasting pain of a finger joint (and even with a negative initial radiograph) requires repeated radiological examination plus avoidance of repetitive traumatic activity.
Journal of Pediatrics 
Proadrenomedullin as a diagnostic or prognostic biomarker for acute appendicitis in children
Adrenomedullin (ADM) is a peptide hormone encoded by a single gene on chromosome 11. It belongs in the same family as calcitonin and procalcitonin and is widely synthesized by many tissues. It has many biological effects. Proadrenomedullin (pro-ADM) is cleaved from ADM and has been found to be a useful biomarker to identify patients with bacterial infection and to guide diagnosis and treatment of septic patients.
A prospective, analytical, observational and multicenter study investigated the utility of pro-ADM to diagnose acute appendicitis (AA) in 285 children.
Children with acute appendicitis have higher pro-ADM levels than children with abdominal pain from other causes and with a C-reactive protein level is a reliable indicator for the presence or absence of AA.
A six-minute screening test to assess the skills needed for childhood reading and cognitive ability 

Reading is one of the most important skills that allow for learning and involves acquiring a number of different attributes that relate not only to word recognition, decoding words and spelling, etc. but also important executive functions (like working memory, ability to filter information, attention, speed of processing and others).
Failure to diagnose early poor reading skills may have life-long negative effects.
An excellent (and long) article discusses in depth the assessment of reading difficulties and describes Zippy 6, a 6-minute screening test whose results correlate well with traditional testing (with the major advantage of avoiding unnecessary and costly evaluations). (An article well-worth reading, Ed.)
Acta Paediatrica
Video Feature
How To Parent A Child With ADHD
How To Parent A Child With ADHD
Neurodevelopmental outcomes at 4-10 years in children born at 22-25 weeks gestation 
From a review of multiple sources a study evaluated neurodevelopmental disability of children 4-10 years of age born between 22-25 weeks gestation.
Rates of moderate-to-severe neurodevelopmental disability in very preterm infants are as follows:
                22 weeks gestation - 42%
                23 weeks gestation - 41%
                24 weeks gestation - 32%
                25 weeks gestation - 23%
This data is of value to physicians and parents during decision-making discussions.
Diabetes in children (1 of 9): Your child's diabetes team
Diabetes in children: Your child's diabetes team
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