Miami, FL
May 29, 2019
Volume X | Issue No. 22
Bowel movement characteristics of exclusively breast fed infant during the first 3 months of life 
Parents are frequently told that their breast fed infant should have at least 3 soft stools daily during the first 4-6 weeks of life. Some breast fed infants however may have no bowel movement (or infrequent stools) for many days or longer. Little research data is available on stool patterns (number and consistency) of exclusively breast fed infants over the first few months of life.
A study which examined daily stool frequency and consistency of infants fed exclusively by breast vs. those exclusively formula fed indicates that breast fed infants' daily stool frequency is significantly higher (4.9 vs. 2.3) and is more liquid during the first and second months of life. Infrequent stools occur in 28% of breast fed infants and are 3.5 times more likely to occur than in those infants fed formula.   
Acta Paediatrica 

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Ovarian masses in the child and adolescent: an American Pediatric Surgical Association Outcomes Evidence Based Practice Committee systematic review
A critical review of recent literature outlines the approach to the treatment of ovarian masses in pediatric patients balancing appropriate surgical management with preservation of future reproductive capability.
Malignant potential of ovarian tumors can be estimated preoperatively using tumor markers, ultrasound malignancy indices and other imaging studies with frozen sectioning and surgical staging playing a role.
The use of fertility-sparing techniques for preservation of future reproduction requires preoperative assessment of tumor risk.  
Journal of Pediatric Surgery
Traffic-related air pollution and risk of childhood leukemia 
As the association between traffic-related air pollution and the risk of childhood leukemia remains controversial with inconsistent results, a multi-database (21) case-control meta-analysis study was undertaken.
"Current evidence suggests (not statistically significant) that childhood leukemia is associated with traffic density, and moderate exposure to NO2 and benzene."
Journal of Pediatric Hematology Oncology  
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Childhood Obesity Facts 
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Attention-deficit/Hyperactivity Disorders (ADHD), school performance and effect of medication  
ADHD significantly (and in multiple and different domains, e.g. language more than mathematics) impairs academic performance. While Central Nervous System (CNS) stimulants appear to decrease problematic behaviors (particularly in the absence of psychosocial interventions) and improve standardized test results, it remains unclear whether ADHD medication improves the capacity to learn new material.
A Swedish study of 657,730 students graduating from year 9 examined school performance, ADHD medication, potentially confounding factors and the ability to be promoted to a higher secondary school/grade point average.
Pharmacological treatment of ADHD for 3 months is associated with improvement in a number of measures of school performance.  
Journal of the American Academy of Child and Adolescent Psychiatry 
Video Feature
Signs, Symptoms, and Treatment of ADHD in Children
Signs, Symptoms, and Treatment of ADHD in Children
The ketogenic diet for children with refractory epilepsy of genetic origin 
"The ketogenic diet is an accepted treatment modality in refractory childhood epilepsy."
A study of 59 children with a genetic etiology and refractory epilepsy were treated (at median age 2.2 years) with a traditional ketogenic diet. 95%, 86%, 69%, 64% and 47% remained on the diet, with responses of 63%, 61%, 54%, 53% and 41% at 1, 3, 6, 12 and 24 months respectively.
"The ketogenic diet is an effective treatment modality in children with refractory epilepsy of genetic etiology."
Pediatric Neurology 
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Treatment of resistant congenital torticollis (CT) 
CT is an abnormal positioning of the head (tilted to the side affected; chin pointing to the opposite side with poor rotation of the head) noticed around birth, that results from a shortening of the sternocleidomastoid (SCM) neck muscle from a number of etiologies. It is the most common congenital musculoskeletal abnormality of the newborn (occurring in up to 16%). Early treatment with stretching and strengthening exercises by parents (under the guidance of physical therapist) is often (54%-70%) successful. Approximately 36% of infants however have such rigid and persistently (>1 year) contracted SCM that historically surgery was the treatment of choice.  
The medical records of a cohort of 39 infants with treatment resistant congenital muscular torticollis treated with multiple Botulinum toxin type A (BTX) (a focal muscle relaxant) injections into the SCM muscle (followed by physical therapy) and observed for 2 years indicates that BTX injection into SCM is a minimally invasive technique without adverse effects that removes the need for surgery in most infants with severe CT.
Journal of Pediatric Orthopaedics 
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Deep vein thrombosis (DVT) in the young 
DVTs are not infrequently seen in hospitalized pediatric patients and can have devastating consequences including pulmonary embolisms, postthrombotic syndrome and death. Causes are multifactorial (congenital and acquired) and risk factors include the use of central intravenous catheters and underlying chronic conditions like cardiovascular and neuromuscular disease and malignancy.
"Young healthy athletes can present with unique risk factors for DVT that can be overlooked."
An interesting case report of a healthy 18 year old boy who presented with a 1-week history of pain and altered sensation of the right leg, and calf swelling illustrates that this young athlete's DVT appears to have been directly related to a combination of recent, frequent and long standing (over several days) squatting as a baseball catcher in the face of recovery from a pro-inflammatory state (streptococcal pharyngitis). (Full hematological investigation was normal.)
Journal of Pediatric Hematology Oncology 
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How Does Nicklaus Children's Treat Eating Disorders? - Dr. Metee Comkornruecha Explains
How Does Nicklaus Children's Treat Eating Disorders? - Dr. Metee Comkornruecha Explains
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