PedSPAM April 1998

Welcome to PedSPAM for April. Here are some things from my update reading and a few additional topics for the Encyclopedia. This month's news is digested from various sources.

In the News

A pacifier dipped in 24% sucrose (ordinary table sugar) solution proved to be significantly effective in reducing the pain of newborn circumcision in a controlled study. It compared favorably with anesthetic injection (dorsal penile nerve block). The so-called "sugar teat" of the old days is back, with scientific support. I am going to suggest this for our hospital nursery.

The number of children seen in emergency rooms for trampoline injuries has doubled in the past five years. An article in Pediatrics reviewed the nature and frequency of these injuries. Most are to an extremity, although the most frightening are cervical spinal cord injuries. The article recommended that trampolines not be used at home and that their sale for home use be stopped. According to the article, adult supervision should be required and flips and tricks should only be attempted with an experienced trainer present. Since that is not going to happen in real life, I personally advise a strict no trampolines policy for my patients. These things are just too darn dangerous for kids. Period.

A study of high school students showed that mild residual internal tibial torsion with mild intoeing while sprinting enhanced sprinting ability. Parents with toddlers or older children with mild intoeing can take some comfort from the knowledge that this does not necessarily mean their children will have difficulty running; they will probably run faster than their peers, on average.

A report in Contemporary Pediatrics advocated the "big hug" as an alternative for time-out for children who resist time-out type of discipline - specifically the little darlings who kick and scream and refuse to go to time-out. The "big hug" is meant to be used with toddlers 18 months and older who are having problems with temper tantrums, hitting and biting.

The parent sits the child on the parent's lap facing away from the parent, holding the child's legs between the parent's and holding the child's arms crossed in front of the body and pinned to his sides. The child is held in this position until he ceases to cry, kick and struggle, and verbally accepts time-out. At this point, parent offers a gentle pat of endearment and a face-to-face hug.

The author says that children learn that parents are in charge, you don't get everything you want, things go better when you calm down, and you talk over issues and give a little to get what you want. Sounds good to me. Feedback, anyone?

Addendum: Dr. K. K. sent me much appreciated feedback and additional information from someone who actually knows what she is talking about in this area. Please read it!

Children who have emergency department workup for minor head trauma, who have a normal neurological exam and have a normal CT scan do not seem to be at risk for significant complications and can be safely observed at home.

A long term followup study of extremely premature infants who received vaccinations at the normal chronological ages (not corrected for prematurity) showed that these infants developed similar protective immune responses to full term babies immunized on the same schedule. While antibody levels were slightly lower for some vaccines compared when compared with those of term babies, the protective effects of immunization were equal.

Progress continues in the quest for a vaccine against Streptococcus pneumoniae (the "pneumococcus"), the causative agent for the majority of ear infections in children, as well as the predominant organism causing bacterial pneumonia and meningitis. A vaccine against this organism has been available for a number of years and is routinely prescribed for the elderly. Unfortunately, the standard pneumococcal vaccine does not generate a protective antibody response in children under two years old. This new development is particularly important because it is hoped it will reduce serious invasive disease caused by this bacterium by 85% and to reduce ear infections caused by the pneumococcus by perhaps 65%.

A recent report in the adult literature has apparently confirmed that at least in a series of adults, the cat scratch disease organism Bartonella henselae can produce an inflammation of the optic nerve which could cause some vision loss. Antibiotics were used to treat these patients, who largely recovered their visual acuity after some months. To repeat, this is from the adult literature, so I cannot vouch for its validity in children, however, if your child were to seem to have more systemic symptoms, such as fever, malaise, or any hint of decreased vision, I think I would advise ophthalmologic and perhaps infectious disease consultations.

Helicobacter pylori infection (the causative organism of gastritis and ulcer disease) in a large sample of healthy preschool children was usually asymptomatic and is not associated with specific abdominal symptoms. This was a large and well-controlled study in Germany that addressed the question of whether this infection could be identified by symptoms. Answer: the H. pylori positive children had even fewer symptoms than those with no evidence of the germ.

A long term (18 years) study in New Zealand showed that breast feeding for at least eight months was associated with small but detectable increases in cognitive ability and educational achievement. The duration of breast feeding determined the magnitude of the increases in IQ, reading comprehension and mathematical ability, and "scholastic ability." The only caveat I see with the study is the usual one: the breast feeding mothers tended to be older, better educated, and of higher socio-economic status, more likely non-smokers, in two-parent households, with above average income and living standards. Supposedly, these beneficial effects were removed through statistical analysis. This study would have been better had it compared apples to apples rather than apples to oranges with regression analysis to make the apples and oranges equal...

Another long term (average followup age 7 years) study in the UK examined the relationship of infant feeding practices to childhood respiratory illness, growth, blood pressure, and body composition. Children exclusively breast fed for at least 15 weeks had a lower subsequent incidence of respiratory illness than those fed artificial formula either wholly or partially. Children fed solid foods before 15 weeks of age had an increased chance of wheezing during childhood. Early solid feeding was associated as well with increased weight and percentage of body fat. This study found that respiratory disease in childhood is significantly reduced if babies are exclusively breastfed for at least 15 weeks.

Beware of methacrylic acid nail primer solutions used to prepare fingernails for application of artificial fingernails. These products can cause severe skin burns in young children, and they are not sold in child-resistant packaging.

Head lice resistant to the usual treatments can be successfully eradicated with a short course of an oral antibiotic, trimethoprim/sulfa (Septra®, Bactrim®, Sulfatrim®). Three days of treatment in the usual pediatric dose is given, and then repeated in 10 days. The antibiotic in the bloodstream poisons the lice by killing the bacteria in the head louse gut. Unable to synthesize B vitamins or to lay fertile eggs, the lice die. Suggest this to your doctor if your child has a resistant case. I am certainly going to try it.

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