Miami, FL
Sept. 12, 2018
Volume IX | Issue No. 37
Proton pump inhibitors (PPIs) and infant pneumonia 
(CAP)/other lower respiratory tract infections (LRTIs)
A cohort case-controlled, nested study of 21,991 infants (<12 months of age) with a history of CAP or LRTI who were dispensed PPI's on at least one occasion prior to their first birthday, estimated the risk of CAP and all LRTI's resulting in hospitalization or death.
It appears in otherwise healthy community-dwelling infants, that the use of a PPI does not increase the risk of CAP or other LRTI's.

See related video HERE & HERE.
Red meat consumption and serum lipids/fatty acids in toddlers  
From a 20-week randomized control trial in healthy 12-20 month old infants fed, in addition to their usual diets, red meat (56g/day of lean red meat) or not (with total and high density lipoprotein-HDL cholesterol and serum fatty acids being measured at baseline, week 4 and week 20) it appears that an approximate 3 fold increase in lean red meat intake/day does not change serum lipid concentrations or fatty acid composition in healthy toddlers, and can be recommended in high resource communities to improve their iron intake and status, with no adverse effects.
Ataxia telangiectasia (A-T) and cancer predisposition
A-T is a rare inherited genetic disease that affects the nervous system and weakens the immune and other body systems. It presents in younger children (usually <5 years of age) with small clusters of enlarged blood vessels which can be found in the eyes and on the surface of the skin, difficulties with walking, balance (ataxia), hand coordination, involuntary jerking movements (chorea), muscle twitches (myoclonus) and disturbances in nerve function (neuropathy) with an increased risk of cancer. In addition these children exhibit increased toxicity to conventional anti-cancer drugs.
A report of three children with Ataxia Telangiectasia and cancer describes the challenges inherent in managing cancer in these children.
Journal of Pediatric Hematology/Oncology 
See related video HERE
Childhood Obesity Facts 
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A.  Etiology

While clubfoot is a common congenital anomaly with multiple potential risk factors, a multi-database systematic search suggests that there is an increase of clubfoot with a family history of clubfoot, maternal obesity, maternal and paternal smoking, amniocentesis and exposure to selective serotonin reuptake inhibitors (SSRIs).

B.  Treatment
Idiopathic clubfoot is treated by manipulation and casting using the Ponseti technique. This may be painful.

A double-blind controlled trial randomized infants with clubfoot undergoing manipulation and casting to receive oral 20% sucrose solution (S), water (W) or milk (M) in a bottle, and assessed neonatal pain.

Sucrose solution and milk are both equally effective in reducing pain during the manipulation and casting associated with the Ponseti treatment of clubfoot.

American Academy of Pediatrics (AAP) recommendations for prevention and control of influenza in children, 2018-2019 

An update from the AAP (Committee on Infectious Diseases) on the routine use of influenza vaccine and antiviral medications for the upcoming 2018-2019 influenza season includes:
  1. Annual flu vaccine immunization is recommended for everyone six months or older.
  2. An inactivated influenza vaccine (IIV) trivalent or quadrivalent is recommended.
  3. A live attenuated influenza vaccine may be used for those who refuse IIV, are older than 2 years of age and who are healthy with no underlying chronic medical conditions.
  4. All 2018-2019 seasonal influenza vaccines contain an influenza A (H1N1) strain similar to last year's vaccine, however the influenza A (H3N2) and influenza B strains differ.
  5. "All children with egg allergy of any severity can receive an influenza vaccine without any additional precautions beyond those recommended for all vaccines."
Other important relevant points and issues for the 2018-2019 influenza season can be accessed at the attached reference.

Video Feature
July 2018 - CDC & AAP Recommendations for FluMist® (2018-2019)
July 2018 - CDC & AAP Recommendations for FluMist® (2018-2019)
Childhood exposure to violent contexts and risky adolescent behaviors

Children being exposed to violence is common. The US Attorney General's Defending Childhood Initiative defines children's exposure to violence as being the witness or direct victim of bullying, child abuse, sexual assault, community and school violence, dating violence and/or exposure to adult or parental domestic violence.
A cohort study involving 2,684 adolescents born between 1998 and 2000 in 20 large American cities examined the effects of exposure to community and family violence at ages 5 and 9 years and risky sexual behavior, substance abuse and obesity subsequently in adolescence (aged 15 years).
Childhood exposure to violence is associated with risky adolescent health behaviors - the associations however are context and behavior specific.
Exposure to community violence increases the likelihood of risky sexual behavior; exposure to family violence results in higher odds of substance abuse.
See related video HERE
Birth month as a risk factor for the diagnosis of Celiac Disease (CD) later in life 
"CD is an autoimmune disorder precipitated by exposure to gluten in genetically susceptible subjects." Environmental factors such as infections associated with seasonal changes have been suggested to play a role (there does not appear to be an association between CD and breast feeding patterns nor the age of gluten introduction).
A study retrieved data from a National database of more than 2 million Israeli adolescents, identified 10,566 CD cases (0.53%) and analyzed the data for CD development later in life, and month and season of birth.  
Infants born in May/June are at increased risk for CD while being born in winter (December to February) show a reduced risk. Perinatal environmental factors appears to play a role in the risk of developing CD in a genetically susceptible population.
Meet Sandeep Davé, MD - The Division of Otolaryngology (ENT) at Nicklaus Children's Hospital
Meet Sandeep Davé, MD - The Division of Otolaryngology (ENT) at Nicklaus Children's Hospital
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