July 26, 2017
Volume VIII |  Issue No. 30

External ear pathology and earphone use in children
Children and adolescents have grown up in a world of greater exposure to technology than ever before, as is the use of headphones. Now instead of sitting around or placed on top of the ear, an intrusive earphone design in which separate left and right speakers rest within the ear, are becoming commonplace. These may partially or fully occlude the ear canal.
A presentation of two children (12 and 15 years old) documents the first cases of trauma or infection related to the use of earphones. Preventive measures require evaluation.
Low back pain (LBP) in adolescents
A national insurance database from 2007-2010 was utilized to identify 215,592 patients aged 10-19 years with back pain. At 1-year follow-up post diagnosis (including imaging studies), over 80% have no identifiable diagnosis.

LBP is common in adolescents and serious underlying pathology is rare (diagnoses include lumbar strain/spasm - 8.9%, scoliosis - 4.7%, lumbar degenerative disk disease - 1.7%. All other diagnosis <1%).
Domperidone: The Forbidden Fruit
The FDA has not approved Domperidone (a selective dopamine D2 receptor antagonist) for use in the USA. In spite of this, between 2009 - 2015 7,500-11,600 prescriptions were dispensed annually in the USA primarily to women; 60% by gastroenterologists (for gastroparesis) and 6% by OB/Gyns (presumably as a galactagogue).

"Domperidone is a mildly effective galactagogue with rare BUT SERIOUS ADVERSE REACTION RISKS (cardiac arrhythmias secondary to a prolonged QTc interval); is not FDA approved in the USA and it should not be prescribed to enhance maternal milk production.

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Pediatric Lyme arthritis of the hip: "The Great Imitator"
Lyme disease is the most common tick-borne disease in the USA. Caused by a bacterium (Borrelia burgdorferi) found in small animals like mice and deer, the ticks (Ixodes ticks, i.e. black-legged or deer ticks) feed on these animals then spread the bacterium by biting. Ticks are hard to find (adults are about the size of a sesame seed) and bites are easy to overlook. Signs and symptoms include flu-like symptoms with different organs/systems being affected (e.g. Skin, joints, nervous system and heart). Treatment usually involves a four-week course of antibiotics.
Lyme arthritis (LA) presents similarly to septic arthritis (SA) and transient synovitis (TS). A retrospective study of 93 children who presented with hip pain in an endemic Lyme area reviewed and compared hip aspiration, and clinical/laboratory variables between those diagnosed with LA, SA and TS. 
Children in an endemic Lyme area presenting with an isolated hip effusion/pain with no fever, and elevated ESR and decreased peripheral white blood count are more likely to have Lyme arthritis than SA or TS.
Video Feature
Understanding the Dangers of Lyme Disease | UMass Memorial Healthcare
Understanding the Dangers of Lyme Disease UMass Memorial Health Care

See also What to Know about Lyme Disease
Children's Hospital of Pittsburgh
Treatment of functional abdominal pain (FAP) with antidepressants
Pediatric functional abdominal pain is often treated with tricyclic anti-depressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs).
A retrospective review of 531 children (5-21 years of age) with FAP treated with either TCA's or SSRI's indicates that SSRI's are significantly better (though 25% of patients report adverse effects; only 14% of whom however required discontinuation of therapy).
The influence of maternal pragmatics on the language skills of children with autism (ASD)

"Language does not only consist of words and phrases. Different types of expression are embedded in our language most of which we use without even thinking". Pragmatics is a branch of linguistics which focuses on conversations where the speaker "implies" and the listener "infers", without the meaning being explicitly stated; "pragmatics studies how words can be interpreted in different ways based on the situation". (e.g. when someone asks "how do you feel" most people understand that reciting all your ailments is not the required response; rather "fine" is the usual answer).

A study of 20 matched mother-toddler (aged 24-28 months) dyads (with and without ASD) evaluated mothers' pragmatic violations during a structured interview in relationship to the childs' language development.
Parental pragmatics contribute to early language learning and parent-mediated language interventions may improve language fields in children with ASD (e.g. parallel talk, maternal language expansion which completes a child's incomplete sentences, etc.).

Journal of Developmental Behavioral Pediatrics
Cotton-tip applicators (CTAs) - related ear injury

It appears that approximately 13,000 children per year are seen in USA Emergency Departments for CTA-related injuries (73.2% are due to ear cleaning and many due to children cleaning their ears themselves). Foreign body sensation and/or the presence of bleeding and ear drum perforation are common presentations.

Journal of Pediatrics

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