Sept. 16, 2015
Volume VI, Issue No. 37

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Bronchiolitis - "to treat or not to treat with bronchodilators, that is the question?!"
An interesting examination of the data behind the 2014 American Academy of Pediatrics (AAP) 2014 based decision to recommend against the use of bronchodilator therapy in the management of bronchiolitis in infancy raises compelling arguments to reconsider this issue. It appears that the 2014 Cochrane systematic review upon which the AAP decision was primarily based, utilized small sample sizes, no standardized protocols, a non-optimal bronchodilator delivery system, and assessments which were inconsistent.
A trial of bronchodilator therapy in the treatment of bronchiolitis in infancy, with monitoring of clinical response appears worth reconsidering.
Ibuprofen during lactation
Ibuprofen is frequently used as an analgesic during breast feeding to treat pain and inflammatory disorders, with breast fed infants generally receiving 0.2% of the pediatric dose. Maternal use of ibuprofen appears compatible with breast feeding without significant adverse events.

In a confirmatory study of cytochrome P450 enzymes involved in the pharmacodynamics of ibuprofen, breast milk DNA was utilized for genotype analyses for P450 polymorphisms which affect the metabolism of ibuprofen. All genetic profiles which may account for a decreased maternal metabolism result in an infant ibuprofen dose <1% than that usually recommended. Ibuprofen appears safe for all infants during breast feeding.
Too much television and later victimization
It appears now that while total TV time viewing is expanding among 2-11 year olds at a slower rate; time spent on mobile devices is increasing significantly.

In spite of the fact that the American Academy of Pediatrics (AAP) recommends that infants <2 years of age should avoid screening time altogether (and have no TV in their bedroom), infants still appear to be viewing TV for approximately 1 hour/day.

A longitudinal cohort study of 1,997 boys and girls aged 29 months (median) examined the effects of TV time on self-reported victimization at age 12 years.

An approximate 1 hour increase in TV viewing/day at 29 months of age predicts an 11% increased likelihood of victimization by classmates at the end of 6th grade.

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Dietary and lifestyle counseling from birth

Despite of a variety of studies which indicate that intensive diet and physical activity behavioral counseling results in consistent improvement in health outcomes, adults in the USA appear not to be following the advice given.

A study which examined the psychological well-being of 457 young adults who participated in a Coronary Risk Factor Intervention Project from infancy and who received repeated dietary and lifestyle interventions to age 20 years indicates (against a matched non-intervention group) no effect on psychological well being or adverse effects. (Perhaps that lack of improvement in well-being is part of the reason for the failure of individuals to comply. Ed).
Fast food (FF) consumption and academic growth
A study correlating the reading, math and science abilities of 8,544 children followed from kindergarten to 8th grade, against fast food consumption indicates that >66% of children report some FF consumption, 20% report at least 4 FF meals/week and FF consumption in the 5th grade predicts lower levels of academic achievement in all three subjects at 8th grade, independent of a variety of confounding variables.

Video Feature

via YouTube

 Sleep disturbances - parasomnias
Sleep disturbances - parasomnias
Sleep disturbances - parasomnias or seizures?
Parasomnias are a category of sleep disorders characterized by abnormal movements, behaviors, emotions and dreams which occur during transition from wakefulness and sleep. While clinical presentations may differ they occur during both non-rapid eye movement (NREM) and rapid-eye movement (REM) sleep.
Nocturnal frontal lobe epilepsy may present clinically with episodes of nocturnal arousal and/or complex motor and behavioral phenomena seen during sleep mimicking parasomnias. Frontal lobe epilepsy however, is usually of shorter duration, stereotypical and occur multiple times during the night. Video-EEG may be helpful however a good clinical history remains key to diagnosis.
Identifying fecal impaction in childhood functional constipation (CFC)

In order to enhance the diagnosis for CFC at the Secondary hospital level Outpatient Department, medical histories, physical including rectal examination, and ultrasound measurements of rectal diameter was analyzed in 235 children aged 2-16 years diagnosed with CFC (according to Rome III criteria). Fecal impaction was defined as a rectal diameter >3cm.
In the diagnosis of CFC the following information appears significant:
1.   72.3% of patients report painful bowel movements.
2.   39.1% have fecal incontinence.
3.   Rectal examination identifies impaction in 66.2%.
4.   In children with impaction rectal diameter on ultrasound is a reliable alternative indicator to rectal examination.
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