May 24, 2017
Volume VIII |  Issue No. 21

Point of care lung ultrasound (US) of children with acute asthma
 exacerbations in the Pediatric Emergency Department (ED)
From a study of 60 asthmatic children (2-17 years of age) presenting with respiratory distress in an ED who undergo lung ultrasound, it appears that 45% have a positive result. A positive lung US is associated with increased antibiotic usage, ED length of stay and admission rate.

American Journal of Emergency Medicine

US to diagnose lung disease
US to diagnose lung disease
Parental age and risk of psychopathology in offspring
It appears that parental age is associated with offspring psychopathology; younger mothers' offspring is associated with increased behavioral syndrome, increased hyperactivity, conduct problems and psychosis in youth; younger fathers' offspring have increased risks for altered social development. Advanced paternal age is associated with increases in autism spectrum disorder/pervasive developmental delay, bipolar disorder and attention deficit/hyperactivity disorder. Genetic and environmental factors have been implicated.

Management of simple clavicle fractures by primary care physicians
Most clavicle fractures in children are mid-shaft. Traditionally non-surgical treatment has been the modality of choice, though good outcomes are not universal. Children with simple fractures are often referred to orthopedic surgeons to ensure adequate care.

A retrospective chart review of 16 adolescents with simple clavicle fractures treated with a sling by their primary care physician indicates that outcomes (bony union, pain and function) are excellent, with no outcome differences noted compared to those patients treated by an orthopedic surgeon.

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Use of the 5 "A's" for teen alcohol use

What Kids Drink
Alcohol is the most frequently used drug by teenagers in the USA. It appears that about 50% of junior and senior high school students drink regularly and 14% have been intoxicated at least once in the past year. 8% "binge drink". Alcohol decreases a teen's ability to pay attention, and in "post-withdrawal," many tend to have memory difficulties. The negative implications of teen drinking are legion, with many more likely to become problem drinkers as adults.

"Clinical guidelines recommend addressing adolescent alcohol use in primary care". One useful model uses the 5 A's (Ask, Advise, Assess, Assist and Arrange) as a methodology for identification and intervention during pediatric office visits. Almost none use it!

Parental approach to the prevention and management of fever and pain following childhood immunization

Fever is a common symptom associated with immunizations. Many pediatricians and parents routinely use antipyretics prior to, or after vaccination though current practice discourages their use as they may reduce immunologic responses (though this varies depending on the timing, age of infant, vaccine and the drug used).

It appears that 11% of parents give antipyretics prior to vaccination and 64% after to prevent and/treat fever. Parental education is needed to prevent the unnecessary use of routine analgesics around vaccination time.
Clinical Pediatrics
Video Feature

Autism risk could rise with father's age
Autism risk could rise with father's age
Gastric Bezoars

A gastric bezoar is an intestinal foreign body usually composed of ingested food, foreign bodies and mucus and are classified according to their composition: Phytobezoars contain vegetable matter, pharmacobezoars are composed of non-dissolved medication, and trichobezoars are made up of swallowed hair. Bezoars are relatively rare in children and apparently there are no standard guidelines for management.

An interesting report describes a five year old girl who presented with a history of constipation and abdominal pain initially attributed to a urinary tract infection, and who on subsequent abdominal x-ray was found to have a gastric bezoar. Following review of the literature she was give two liters of cola to drink (over 24 hours) which resulted in total radiological resolution with dissolution of the gastric bezoar.  This makes interesting reading and the method may be a safe, effective first-line treatment in the stable child.

Clinical Pediatrics
Lactulose breath test in childhood Irritable Bowel Syndrome (IBS)
Bacterial colonic fermentation results in increased gas production in adults with IBS and correlates with symptom generation, psychosocial stress intestinal transit time and frequency of bowel movement. Whether this is true in childhood IBS is unknown.

A study of 87 children (mean age 13 years) with pediatric Rome III IBS completed a psychosocial questionnaire and 2-week daily diary recording of pain, and stool characteristics, followed by a 3-hour lactulose breath test (total hydrogen and methane production), with intestinal transit time being measure using carmine red.

Hydrogen and methane production in children with IBS following a lactulose load DOES NOT correlate with either abdominal pain frequency/severity or psychosocial distress. Lactulose breath total methane production however may serve as a bio-marker of whole intestinal transit time and bowel movement frequency.

Did You Know?
Advanced Pediatric Care Pavilion | The Beacon Award for Excellence
Advanced Pediatric Care Pavilion | The Beacon Award for Excellence
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