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| Medical education |
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Patient education |
| Current medical news |
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Information for Ambulatory Pediatrics |
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AAP E-Breaking News on May 28, 2008 : AAP Statement on ECGs in ADHD/Stimulants
“The American Academy of Pediatrics is responding to the American Heart Association's recent recommendation that children taking stimulant medications for ADHD receive an ECG. The Academy does not recommend screening ECGs unless the patient's history, family history or the physical examination raises concerns.” The full statement: http://www.aap.org/new/ecg-adhd.htm
May,2008 Pediatrics 2008;121:1281-1286
Febrile Seizure: Clinical Practice Guideline for the Long-term management of the Child With Simple Febrile Seizure
Long-term therapy is not recommended
Intermittent oral diazepam at the onset of febrile illness (0.33mg/kg, q8h for 48 hours) may be effective in preventing recurrence if parental anxiety associated with febrile seizures is severe.
Antipyretics can comfort the child, will not prevent febrile seizures.
AHA Recommends Cardiac Screening Before ADHD Drugs: Wide use of ECGS may be controversial
Initial assessment for higher risk:
PHx: fainting, dizziness, esp. with exercise; seizures, theumatic fever, chest pain or SOB with exercise, exercise intolerance, palpitations, increased heart rate, skipped heartbeats, hypertension...
FHx: sudden or unexplained death of someone young, sudden cardiac death or MI before age 35, sudden death during exercise, cardiac arrhythmias, and etc.
PE: HR, hypertension, heart murmur, irregular or rapid heart rhythm, signs of Marfan syndrome
Subsequent visit: new potential cardiac symptoms, new FHx, pluse and BP
Refer patient with significant findings to a pediatric cardiologist for further evaluation.
Selective ECG will increase the likelihood of identifying significant cardiac conditions such as hypertrophic cardiomyopathy, long QT syndrome, and Wolff-Parkinson-White syndrome.
The most types of congenital heart disease are not identified as significant risk for sudden cardiac death with ADHD medications. But cardiovascular monitoring should be provided. |
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| Feb. 2008 Infectious Diseases in Children 21(2) Feb.2008 |
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According to a recent Public Health Advisory issued by the FDA, OTC cough, cold medications no longer recommended for children <2years old, because of the potential for serious adverse enents.
"Camphor use entails unique safety concerns" Camphor is a volatile oil with a strong aromatic odor, which is approved by the FDA as a topical antitussive only for children 2 years of age and older. "More published data on the potentioal for significant adverse effects and toxicity of camphor exists than for its clinical efficacy. Antitussive products with camphor: Vicks VapoRub Ointment/cream (4.8%/5.2%); Vicks VapoSteam (6.2%); Mentholatum Ointment (9%); Tom's of Maine Natural Cough and Cold Rub (4.8%).
"Oral dexamethasone: A multipurpose treatment in the ambulatory setting"
Laryngotracheitis:fFrom a large double blind trial of 720 children, effective with single dose of "0.6mg/kg (maximum dose, 20mg)"
Atopic dermatitis: two to three dose with high-potency topical steroid can be effective for severe flare.
Urticaria and IGE reactions: daily dose of up to 0.3mg/kg; limited information now, think about benifit and potential adverse effects.
Rhus dermatitis (Poison ivy dermatitis) if last too long, if the area involved is extensive, and the reaction is severe.
Half life: nearly 36 hours, tablets may be crused adn mixed with almost any food; Tablets come in 0.25, 0.5, 0.75, 1.5, 4, and 6mg
Screening for autism: AAP issues new recommendations "Also, for the first time, the AP recommends formally using an autism screening measure at 18 and 24 months.
"Timely diagnosis of Kawasaki diseas (KD)a challenge" Because there is no definitive diagnostic lab tests, the need to maintain a high index of suspicion of KD in young kids, esp. the infants < 6 months with prolonged fever.
"AAAAI warns coughing at night not a symptom to be taken lightly"
Variety of causes for cough: viral URI, asthma, nasal and sinus disease, GER, habit or enviromental ittitants.
"Have a cough that lasts three to eight weeks or more, coexists with asthma; chronic cough with nasal symptoms or tobacco use or exposure"
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| August-, 2007 |
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Terbinafine Granules benefit tinea capitis- Pediatric News Aug., 2007 The new terninafine coated granules can be sprinkled on food, and for children aged 4-12yo.
Risperdal , the only one is approved for irritabioity associated with autism | | |
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| June-July, 2007 News from AAP |
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Benefits of ADHD drugs may trump concerns over potential risks AAP News June, 2007
Botulinum Toxin for Spasticity in Children With Cerebral Palsy: The safety profile of 12 U/kg of botulinum toxin A is excellent. Functional improvement at 6 months.
Adolescent patients with chronic fatigue syndrome have abnormal catecholaminergic-dependent thermoregulatory responses both at rest and during local skin cooling which support a hypothesis of sympathetic dysfunction and possibly explaining important clinical symptoms.
Benefits of ADHD Drugs May Trump Concerns Over Potential Risks. | |
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Infectious Diseases in Children Feb. 2007
Probiotics may play a role in colic treatment
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Contemp.Peds Dec. 2006 |
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"New Light on SIDS" -According to a new study reported in Jama 2006;296:2124, a brain stem abnormality makes infants vulnerable to the known risk factors sudden infant death syndrome (SIDS) |
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Risk factors for SIDS: Side or prone sleeping, face down sleeping, and bed sharing. |
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Pediatric News Nov.,2006 "Skin Barrier Function Repair is the Next Advance in Atopic Dermatitis Tx" |
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Nonphysiologic moisturizers- petrolatum
Sit on the skin to prevent further water loss. |
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Physiologic moisturizers- MimyX, Atopiclair, and EpiCeram
Incorporated into the skin. |
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Daily bath in lukewarm water is recommended. |
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Pediatric News Nov., 2006 |
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FDA approves first agent for treating autism symptoms |
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Risperidone treats irritability, aggression associated with autism. The medication is approved only for associated symptoms. |
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Mumps outbreak continues in many states. |
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Guillain-Barre syndrome - MCV4 link still unclear. |
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Pediatric News Dec., 2006 |
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Home Nebulizer Misuse Cited in Asthma Deaths |
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The widespread prescription and use of home nebulizers in asthma may lead to an over-reliance on bronchodilators and under-use of steroids. This may lead to subsequent delay in seeking medical care during an acute exacerbation, or to poor chronic of asthma.”. |
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Abnormal Behavior May Be Side Effect of Taking Tamiflu. |
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Infant Deaths Associated with Cough and Cold Medications- Three Cases in Two States, 2005 MMWR |
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AAP on line news on Jun 9, 2006
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FDA Approves Licensure of HPV Vaccine on June 8, 2006
- HPV Vaccine is the first cervical cancer vaccine (Gardasil, manufactured by Merck & Co. Inc.) in the United States.
- “Licensure was granted for 9-to 26-year-old females to receive a three-dose series. The target age for routine immunization will be 11 to 12 years of age”.
- Check the FDA press at http://www.fda.gov/bbs/topics/NEWS/2006/NEW01385.html
- The recommendations of routine immunization of HPV in teens and adults by the ACIP, the CDC, and the COID will be forthcoming in the near future.
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Iron Fortification Reduces Blood Lead Levels in Children in Bangalore, India
Zimmermann et al. Pediatrics. 2006;117:2014
- A randomized, double-blind, controlled school-based feeding trial.
- 5 to 13 year-old iron deficient children (n=186).
- The finding suggests providing iron in a fortified food to lead-exposed children may reduce chronic lead intoxication.
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Orthopedic Complications of Overweight in Children and Adolescents
Taylor ED, MS-III et al. Pediatrics. 2006;117:2167-2173
- Review medical charts from 227 overweight and 128 non-overweight children and adolescents who were enrolled in pediatric clinical studies at the NIH from 1996 to 2004.
- “Reported fractures, musculoskeletal discomfort, impaired mobility, and lower extremity misalignment are more prevalent in overweight than non-overweight children and adolescents.”
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Recurrent Wheeze in Early Childhood and Asthma among Children at Risk for Atopy (Abstract)
Ngoc P., et al. Pediatrics. 2006; 117:2257-58.
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Information on wheeze was collected bimonthly from birth to age 24 months and every 6 months until 7 years old. “At 7 years old, asthma was defined as physician-diagnosed asthma and wheezing in the previous year.”
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The children with parental history of asthma or allergies, who have frequent early wheeze, are at greatly increased risk of asthma.
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Clinical Genetic Evaluation of the Child With Mental Retardation or Developmental delay (Guidance for the Clinician in Rendering Pediatric Care)
The Clinical Report of the AAP Committee on Genetics
Pediatrics. 2006; 117:2304-2316.
- The purpose of this report is to describe the optimal clinical genetics evaluation of the child with developmental delays or mental retardation (DD/MR).
- An algorithm is designed proposed for approach to the clinical genetics evaluation for DD?MR at www.pediatrics.org/cgi/doi/10.1542/peds.2006-1006
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Update of Newborn Screening and Therapy for Congenital Hypothyroidism (Guidance for the Clinician in Rendering Pediatric Care)
American Academy of Pediatrics
American Thyroid Association
Lawson Wilkins Pediatric Endocrine Society
Pediatrics. 2006; 117:2290-2302.
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Unrecognized congenital hypothyroidism leads to mental retardation.
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Newborn screening and early thyroid therapy can normalize cognitive development.
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Initial dosage of 10-15mcg/kg levothyroxine is recommended during the first 3 years of life. The dosages need to be adjusted to maintain total thyroxine or free thyroxine in the upper half of the reference range and to normalize the serum thyroid-stimulating hormone (TSH) concentration.
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“Hypothyroidism can be acquired after the newborn screening. When clinical symptoms and signs suggest hypothyroids, regardless of newborn screening results, serum free thyroxine and TSH determinations should be performed”.
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FDA issues label change for Promethazine HCI (Phenergan)
AAP News June 2006:8
The label change stated that “medications containing promethazine HCL should not be used in any forms (syrups, suppositories, tablets or injectable) for children less than 2 years of age because of the potential for fatal respiratory depression. See http://aapnews.aappublications.org/cgi/content/full/e2005166v1
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New Swimmer’s Ear Guidelines
Pediatric News. May 2006:16
Coming soon
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