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Health of Infants and Children
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Medical Concerns in Children

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Erythromycin and Pyloric Stenosis

A study published in the July 2002 issue of the Archives of Pediatrics and Adolescent Medicine confirms suspicions that a common antibiotic can cause a serious condition in very young infants.

Infantile hypertrophic pyloric stenosis (IHPS) occurs when the muscle surrounding the outlet from the stomach becomes overgrown and obstructs the passage of food into the intestines. The condition, which usually arises in the first three to five weeks of life, causes projectile vomiting. This can lead to dehydration, weight loss, and electrolyte imbalances that affect kidney function. Physicians have long believed that exposure to the antibiotic erythromycin is related to the condition.

To investigate the link, researchers tracked the antibiotic use and IHPS occurrence in over 314,000 infants between 1985 and 1997. Of the 7,138 infants given prescriptions for erythromycin within the first 90 days of life, 804 were diagnosed with pyloric stenosis. Further analysis showed that while infants younger than two weeks old were rarely given erythromycin, those who were exposed within the first two weeks of life were eight times as likely to develop IHPS as an infant who had not received the drug during this time. Babies who received erythromycin after the first two weeks did not appear to have an increased risk for the condition.

Physicians commonly use erythromycin to treat infants with illnesses such as respiratory and ear infections, whooping cough, and conjunctivitis. The results of this study suggest the risks and benefits of erythromycin need to be carefully weighed — and perhaps other antibiotics tried — before it is prescribed for use in infants younger than two weeks.

October 2002 Update

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"Heading" in Soccer and Concussions

Soccer players frequently use their heads to pass or shoot the ball — a practice that some experts think can cause brain injuries. In October 2001, the Institute of Medicine brought together experts in head injury, sports medicine, pediatrics, and bioengineering for a workshop. Those taking part in "Youth Soccer: Neuropsychological Consequences of Head Impact in Sports," presented the scientific evidence for long-term consequences of head injury from youth sports, especially soccer, and possible approaches to reduce the risks.

Recent research reveals that a concussion unleashes a cascade of reactions in the brain that can last for weeks. In fact, there are many examples of previously proficient students struggling to pass high school after experiencing concussions on the soccer or football field.

There is also evidence that youths who experience concussions may be at more risk for brain damage than adults because their brains are still developing and may be more susceptible to long-lasting brain damage following just one concussion.

But if heading is done properly, the ball's impact is not usually strong enough to cause a concussion. The proper technique involves contracting the neck muscles so the head is more rigidly fixed to the trunk of the body and hitting the ball squarely with the forehead near the hairline.

Concussions do not always cause visible symptoms, making them hard to identify. Contrary to popular belief, concussion does not necessarily involve loss of consciousness. And because any loss of consciousness frequently lasts only seconds to minutes, it is often not even detected because of the time it takes to stop a game and assess the condition of a player following a head injury. Other signs of a concussion include delayed responses, slurred speech, memory problems, and a vacant stare.

Many speakers at the conference strongly recommended that the people on the playing field and the sidelines need to become educated about the signs and symptoms of a concussion.

Thus far no published study has provided direct evidence that heading a soccer ball causes long-term deficits in mental functions. However, none of the available data are based on pre-adolescent children. As a result, the American Youth Soccer Organization recommends that children under 10 should not head the ball, but it continues to support the practice of heading for older soccer players.

June 2002 Update

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Asthma Education Leads to Improvement in Children

Managing your child's asthma should include meeting with an asthma educator a few times, according to a follow-up study. Presented at the meeting of the American Academy of Allergy, Asthma, and Immunology, the study reports that after attending an interactive training program three times patients felt less worried about their asthma and had fewer asthma-induced awakenings during the night. Both patients and their caregivers, who also took part in the program, made better decisions about asthma care.

The 30 subjects, asthmatic children ages 6–12, underwent ACE IT! (Asthma Care Education: Intensive Training), an interactive, small-group education program. The sessions included a motivational talk by a teenage athlete with asthma and a pharmacist's discussion of medications. A nurse and asthma specialist also taught the participants about the clinical nature of asthma, environmental controls, relaxation techniques, and asthma action plans.

Researchers evaluated the children at the beginning and end of the training, after six months, and again a year later. After the courses, the number of patients reporting two or more nocturnal awakenings per month dropped from 9 to 5, and the number of symptom-free days also improved, from an average of 20 days per month to over 25 days per month.
The patients were more willing to use the tools available to them, such as medications and peak flow meters, devises that asthmatics breath into to help detect airway changes. They also worked harder to avoid things that triggered their asthma, such as pets or dust.

The researchers plan to continue tracking these 30 children to study the long-term effects on quality of life, morbidity, and cost of treatment. A previous study published in the Journal of Allergy and Clinical Immunology in 2000, found that the training program was much more effective than simply handing out educational materials.

May 2002 Update

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Immunizations for 2002

Vaccinations against childhood illnesses are arguably one of the most significant medical achievements of the twentieth century. One hundred years ago, approximately half of all children born in the United States died before the age of 5, many of them from diseases that today can be prevented by vaccines. With proper immunization, the number of cases of these diseases has been reduced dramatically.

Although no new vaccines have been added to the 2002 recommended childhood immunization schedule, this year's schedule highlights vaccines for pre-adolescents and "catch-up" vaccines for children who have fallen behind the currently recommended schedule.

In addition, due to unusual national shortages of the pneumococcal and diphtheria/tetanus/pertussis vaccines, the 2002 immunization schedule also includes a link to information from the Centers for Disease Control (CDC), which explains the necessary modifications to the recommended schedule for these vaccines. These vaccine shortages will hopefully only be temporary.

Please discuss your child's immunization history with the doctor to insure that his or her immunizations are up to date in accordance with the current 2002 Recommended Childhood Immunization Schedule, approved annually by the CDC, the American Academy of Pediatrics, and the American Academy of Family Physicians. For additional reliable and up-to-date information about vaccines and their importance, visit the National Immunization Program website at or the American Academy of Pediatrics website at
April 2002 Update

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Obesity in Children is on the Rise

A recent study published in the Journal of the American Medical Association showed that American children are heavier now than ever before. In 1998, 12%, 21%, and 22% of Caucasion, African American, and Hispanic children, respectively, were classified as overweight. In fact, between 1986 and 1998, the prevalence of overweight children rose steadily among these groups.

The reason behind childhood obesity — that kids are taking in more calories than they're expending — is easy to understand. But diagnosing obesity is more complicated. It cannot be diagnosed simply by looking at someone because ideal body images differ among individuals, and different body shapes carry weight differently.

And changing lifestyles that create obesity may be even harder. Children are spending more time than ever watching television, playing video games, and surfing the Internet instead of being active. Their parents are busier than ever, too, making it harder to cook nutritious meals.

This is all problematic, as obesity is a risk factor for many health problems, both in childhood and later in life. Children who are overweight are more likely to develop high blood pressure, high cholesterol, and heart disease as adults than kids of normal weight. Long-term obesity also increases the risk of arthritis, heart disease, diabetes, and certain kinds of cancer.

So what can you do? First, talk with your child's doctor. Objective standards have been developed for defining and measuring obesity. He or she will use the body mass index (BMI), calculated from your child's weight and height, and compare it with national growth charts.

There are also tangible things parents can do to help prevent (and treat) obesity in their children as well as in themselves. Begin by establishing healthier eating habits and promoting a more active lifestyle. For example, you can plan daily family activities that involve exercise; limit television, computer, and video game use; eat meals together as a family whenever possible; and when eating out, choose lower fat items on the menu.
March 2002 Update

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New Information on Sudden Infant Death Syndrome

Sudden Infant Death Syndrome (SIDS) is the most common cause of death in infants from one to six months of age, peaking between ages two and four months. For a number of years, pediatricians have recommended putting babies to sleep on their backs to prevent SIDS, and studies have proven that this position reduces babies' risk. The "Back to Sleep" campaign has led to changes in infant sleep position — specifically, a decrease in the amount of prone (on the tummy) sleeping and, subsequently, a statistically significant decrease in the incidence of SIDS. Unfortunately, doctors still don't know for sure what causes SIDS and how best to prevent it entirely.

A new study from the University of Washington, published in the December 2001 Journal of Pediatrics, has found additional risk factors for SIDS. Researchers found the risk of SIDS was increased for infants weighing less than 5 ½ pounds, infants born to mothers who smoked, infants born to unmarried mothers, black infants, and infants who received limited prenatal care.

While research on the causes of SIDS continues, these findings can help doctors advise parents about reducing their baby's risk. Similarly, this information should help doctors increase public awareness about the importance of prenatal care.

If you have an infant at home, do all that you can to prevent SIDS.

  • Put your baby on his or her back to sleep.
  • Use a firm, snug-fitting mattress, and a crib that meets federal safety standards.
  • Do not put soft bedding (pillows, comforters, sheepskins, and bumpers) or stuffed animals in your baby's crib.
  • Dress your baby and adjust the room temperature so that he or she is warm, but not hot.
  • Never smoke around your baby (or during pregnancy).

March 2002 Update

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Bicycle Helmets Save Lives

Although bicycling is one of the most popular sports, injuries associated with bicycling are the leading cause of emergency room visits for children and adolescents. Unfortunately, many of these injuries include head trauma.

Previous studies have shown helmets can sharply reduce the serious head injuries that can occur with cycling. But the majority of children (and their parents) still don't use helmets regularly. Why? Reasons suggested include discomfort, lack of style, peer pressure, and not recognizing the importance of helmets on short rides.

The American Academy of Pediatrics recently published a statement emphasizing the importance of correct bicycle helmet use. In these recommendations, all bicyclists (children and parents alike) should wear proper helmets every time they ride. A helmet made after March 1999 should be used. These newer helmets meet US Consumer Product Safety Commissions standards.

Children should be properly fitted because helmets come in several sizes. Keep in mind that:

  • In its correct position, the helmet should sit low on the forehead and be parallel to the ground.
  • Velcro pads should be placed in, or removed from, the inside of the helmet as needed to make the helmet fit snugly.
  • The chinstrap should be adjusted so that no more than two fingers can be placed between the strap and the chin.
  • The helmet should not shift or come off when the child shakes his head.
  • All helmets should be replaced every five years.

February 2002 Update

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Injuries From Infant Walkers

The American Academy of Pediatrics is recommending a ban on mobile baby walkers after recent studies have shown serious injury associated with their use.

Baby walkers are made for infants who are sitting up, but not yet walking on their own. Most of them are designed with a rigid base set on wheels. The infant sits in a cloth seat that supports his weight, yet allows his feet to be in contact with the floor. This design lets the child move around quickly and independently, without adult help.

Unfortunately, problems have developed. Infant walkers were responsible for 34 deaths from 1973 to 1998. Moreover, 8,800 children under 15 months of age were treated in emergency rooms in the United States in 1999 for injuries associated with walkers. About one quarter of these injuries resulted in fractures and head injuries. Injury rates related to infant walkers are higher than those associated with any other type of baby equipment.

Many dangers can arise while your baby is strapped into an infant walker. Walkers can tip over, tumble down the stairs, gain speed quickly, knock over baby gates, and make hazardous or poisonous items easier to reach. Studies have shown that injuries occur even with close adult supervision.

Some parents think the walkers will help their child learn to walk sooner, but this has not been proven true. In fact, some studies suggest babies who use walkers actually learn to crawl and walk later than those without walker experience.

If you do choose to use an infant walker, despite this recent recommendation of the American Academy of Pediatrics, never leave your child unattended, even for a moment. Be sure to block off stairs in your home with gates. Remember, though, infants in walkers can travel at high enough speeds to knock gates over, so gates do not guarantee your baby's safety.

To be safe, avoid mobile infant walkers altogether. Stationary activity centers (such as exercise saucers or bouncer seats) which do not roll on wheels provide a safer environment in which your baby can develop and thrive.
November 2001 Update

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The Benefits of Surgery for Ear Infection are Unclear

Every year thousands of young children undergo surgery to alleviate chronic middle ear infections (otitis media). The demand for these procedures is driven by the concern that persistent bouts of ear infection will cause hearing loss and long-term effects on their child's speech and language development. However, the benefits of surgery are unclear — even after two recent new studies.

The most common operation involves inserting tubes through the eardrums to drain fluid that collects in the middle ear. Whether or not prompt implementation of this surgery actually protects against the development of infection was the subject of the first study in which 6,350 children were checked regularly for ear infections. By the age of 3, 429 of them were diagnosed with chronic ear infections. About half received the surgery as soon as possible, while the others waited up to nine months. The researchers found the children who had the surgery promptly had fewer subsequent ear problems than those who waited. But there was no significant difference in their speech, language, cognition or psychosocial development as measured by standardized tests and parental assessments. In fact the mean scores for all of the children fell with the average range for that age.

The second study examined hospital discharge records for children in Ontario to determine whether removing adenoids and/or tonsils at the same time as the insertion of tubes helped reduce the likelihood of subsequent ear problems. Of the 37,316 cases who received tubes, 28% also involved the removal of adenoids and/or tonsils. About one quarter of those who didn't undergo adjuvant surgery were re- hospitalized within two years after their initial surgery for subsequent ear problems. But those who did nearly halved their risk of re-hospitalization. Having both adenoids and tonsils out provided additional benefit.

So should children with chronic ear infections have tubes inserted, and should they also have their adenoids and tonsils taken out? Because of limitations in these and previous studies, we still don't know. More research is needed to weigh the long-term risks of hypothetical development impairment verses the not fully understood risk of the different surgeries.
August 2001 Update

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Home Monitors and SIDS

Sudden Infant Death Syndrome devastates some 3,000 families each year in the United States. To prevent such tragedies, many babies are sent home with expensive monitors. But a new study, the Collaborative Home Infant Monitoring Evaluation (CHIME), suggests the cardiorespiratory events these machine track are common and may not necessarily be signs of impending SIDS.

Although researchers aren't certain what causes SIDS, some think prolonged apnea (periodic cessation of breathing) and bradycardia (slower heart rate) may precede the fatal event. So it's become customary for parents to use home monitors with the hope they'd be alerted of such problems before it's too late. The devices are traditionally recommended for preterm infants (£ 34 weeks gestation), siblings of SIDS, and for infants who've previously experienced an apparent life-threatening event requiring mouth-to-mouth resuscitation. To investigate whether these infants are actually at an increased risk for apnea and bradycardia, CHIME monitored 1,079 children during their first 6months.

During the 718,358 hours of home monitoring, no deaths occurred, but at least one bout of apnea and/or bradycardia occurred in 41% of the children, including healthy full-term babies. Only preterm infants were at an increased risk of extreme events that lasted longer than conventional alarm standards. But this added risk vanished before they reached the age when SIDS is most common.

The results suggest these cardiorespiratory events are common and aren't immediate precursors to SIDS. The researchers also noted that conventional devices might have missed many of the events recorded using the highly sensitive monitors used in the study. While the effectiveness of home monitors remains unproven for preventing SIDS, there's no doubt they can provide the peace of mind many parents need. But the best advice to avoid putting infants to sleep on their stomachs, using soft bedding, and exposing them to cigarette smoke.
August 2001 Update

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Early Childcare and Communicable Illnesses

All kids get sick, but young children in day care are at increased risk for infection.

The National Institute of Child Health and Human Development recently examined rates of ear infections, gastrointestinal tract illnesses, and upper respiratory tract infections in children participating in the Institute's Study of Early Child Care. The study is following 1200 children from birth to age three in ten locations across the county. The researchers found the rates for each illness were higher for children in day care than for those reared exclusively at home during the first two years of life. But this difference disappeared by the time they were three years old.

The number of hours per week children spent in day care generally had little to do with their likelihood of getting sick. Instead, the great the number of children enrolled in a facility, the greater a child's risk of illness. But being sick more frequently didn't have developmental consequences. Some parents felt that sickly children had increased behavioral problems, but this was likely the result of increased stress.
July 2001 Update

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Childhood Depression and Postpartum Psychiatric Depressive

In the United States, more than 2 million adults suffer from bipolar manic depressive disorder, an illness of extreme moods. It is characterized by deep depression followed by periods of hyperactivity and elation, referred to as mania, with periods of normal mood in between. Bipolar disorder often leads to substance abuse and one in four people with the condition attempt suicide.

In a recent study published in the American Journal of Psychiatry, researchers set out to determine how often major childhood depression turns into bipolar disorder. The researchers followed up on 72 subjects who, at an average age of 10.3 years, had been treated for major depressive disorder with the tricyclic antidepressant drug nortriptyline. They also studied 28 normal subjects.

At the time of follow-up, the average age of the subjects who had had prepubertal major depressive disorder was 20.7 years. Of these subjects, 33.3% now had bipolar disorder, compared to none of the normal comparison subjects.

These results may, in part, be due to heredity. A large portion of the prepubertal children who had been diagnosed with a major depressive disorder had family histories of bipolar disorder. Because bipolar disorder tends to run in families, these children may have been more vulnerable to developing the condition. Another possibility is that the children who were originally treated with nortriptyline already had bipolar disorder, but had not yet experienced their first manic episode.

Clinicians treating children with antidepressants should be aware of the risk that children with major depressive disorder may develop adult bipolar manic depressive disease.

Another study, published in Psychology and Medicine, sought to determine the long-term prognosis of women with postpartum psychiatric disorders. 50-80% of women experience some degree of postpartum depression within one month of delivering a child. Postpartum psychiatric disorders are more extreme.

The study authors used standardized questionnaires to determine the long-term outcome of 64 women who had been hospitalized with postpartum psychiatric disorders 23 years earlier, and who had been interviewed for a 1982 study of women with diagnoses of schizophrenia, schizo-affective, bipolar, or unipolar affective disorders.

The researchers found that 75% of the women had recurrent psychiatric illness, and 37% of the women had at least three subsequent episodes. However, only 29% of the 34 women who gave birth after the initial postpartum psychiatric disorder had additional episodes of maternal psychiatric illness. In addition, a majority of the 64 women were functioning well in society; 71-73% were employed and in stable relationships.

The women with the best outcomes were those who had an initial diagnosis of unipolar disorder, those who experienced psychiatric illness after a first pregnancy, and those whose psychiatric illness started within one month of delivery.
July 2001 Update

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Children and Peanut Allergies

Children usually outgrow allergies to milk and eggs, but not to peanuts. In a recent study, researchers found that the majority of children with peanut allergies will have adverse reactions to accidental peanut exposure within five years. In addition, allergic reactions are likely to worsen over the years.

Researchers followed 83 children who were diagnosed with a peanut allergy before their 4th birthday. Of these children, 61 had initial non-life-threatening reactions, while 22 had potentially life-threatening reactions. After 5.9 years, they found that 50 of the 83 children had experienced a total of 115 adverse reactions to peanuts.

Most of the reactions increased in severity after the initial reaction. Of the children with initial non-life-threatening reactions who had additional reactions, 44% had at least one potentially life-threatening subsequent reaction. And of the 22 children who had initial life-threatening reactions followed by additional reactions, 71% had at least one additional life-threatening reaction.

In 12 of the original 83 children, the initial reaction occurred after touching, (not eating) peanuts, and they experienced only skin symptoms. Eight of these 12 had subsequent reactions, and all eight had at least one occurrence of respiratory or gastrointestinal symptoms. Children with only skin symptoms had significantly lower serum peanut-specific antibodies than those with other initial symptoms, but there was no "safe" antibody level below which subsequent reactions were only skin-specific.

Most children with peanut allergies accidentally ingest peanuts and this study showed that allergic reactions are likely to get progressively worse with each exposure. Children must be educated to avoid peanuts and foods containing peanuts. In addition, children should always have access to a self-injectable epinephrine kit that both parents and children should know how to use if the need arises.
February 2001 Update

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Pet Reptiles and Salmonella

Between 1996 and 1998, approximately 16 state health departments reported salmonella infections in persons who had direct or indirect contact with reptiles (i.e., lizards, snakes, or turtles) to the Centers for Disease Control and Prevention.

Salmonella infection can result in severe illness and even death, particularly in infants, young children, and anyone with a compromised immune system. The CDC issued the following recommendations to reduce the chances of anyone in your family contracting this potentially deadly infection from these increasingly popular exotic pets:

  • Pet store owners, veterinarians, and pediatricians should provide information to owners and potential purchasers of reptiles about the risk of acquiring salmonellosis from reptiles.
  • People should always wash their hands thoroughly with soap and water after handling reptiles or reptile cages.
  • People at increased risk for infection or serious complications of salmonellosis (e.g., children younger than age 5 and immunocompromised persons) should avoid contact with reptiles.
  • Pet reptiles should be kept out of households where children younger than age 5 and immunocompromised persons live. Families expecting a new child should remove the pet reptile from the home before the infant arrives.
  • Pet reptiles should not be kept in childcare centers.
  • Pet reptiles should not be allowed to roam freely throughout the home or living area.
  • Pet reptiles should be kept out of kitchens and other food-preparation areas to prevent contamination.
  • Kitchen sinks should not be used to bathe reptiles or to wash their dishes, cages, or aquariums. If bathtubs are used for these purposes, they should be cleaned thoroughly and disinfected with bleach.

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Study Stresses Need for Parental Education About Firearm Safety and Storage

Parents should keep guns unloaded and locked up, according to the American Academy of Pediatrics. But in response to a recent questionnaire, half of gun-owning parents said they didn't follow these guidelines.

Researchers surveyed more than 400 parents whose children had visited pediatric ambulatory care centers in Atlanta during fall 1997. Of the parents who responded (94%), 113 reported keeping a firearm in the home. Of these, 52% kept their firearms loaded or unlocked.

The majority of gun-owning parents believed their 4- to 12-year-old children would be able to distinguish between a toy gun and a real one, and 23% thought their children could be trusted with a loaded gun.

These results reveal how many parents underestimate the risks involved in leaving a child in a home with an unlocked and loaded gun. Five hundred children are killed unintentionally by guns each year in the United States. Estimates suggest the number of nonfatal cases of unintentional gunshot injuries could be as high as 70 times that amount. The best way to prevent an accident is to not store guns in your home, but if you must keep a gun, it should be kept unloaded and locked up.

For other ways to prevent injuries to your child, see page 990 of the Family Health Guide.

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Adderall vs. Methylphenidate (Ritalin) for Attention Deficit Hyperactivity Disorder

The most commonly prescribed medication for children with attention deficit hyperactivity disorder (ADHD) is methylphenidate (for example, Ritalin). However, its effects may be short-lived and some children do not respond to it at all. Researchers at the State University of New York at Buffalo recently compared the effectiveness (and effects of) methylphenidate (MPH) with another drug, Adderall, in 21 children with ADHD between the ages of 6 and 12 years old. The results from this small study showed that a single morning dose of Adderall resulted in the same changes in behavior throughout the school day as MPH taken twice a day. A single dose of MPH in the morning appeared less effective than taking MPH twice a day or taking one dose of Adderall, and its effects wore off by early to mid-afternoon.

Adderall may offer a good alternative for children when a two-dose per day regimen is a problem. This study was conducted in the context of an intensive summer treatment program that included behavioral elements as well. More research is needed to compare these medications and dosing options in a regular school setting.

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Guidelines for Diagnosis and Evaluation of Children with ADHD

Attention deficit hyperactivity disorder (ADHD) affects 7–10% of children, making it the most common neurobehavioral disorder among children. Over the past decade, the number of prescriptions for stimulant medication to treat ADHD in children has ballooned, creating fears of over-diagnosis. Surveys show a lack of uniform criteria for diagnosis of ADHD and variations in the amount of stimulants prescribed by physicians. In an effort to develop a standard national framework for diagnosis and evaluation of ADHD in children of 6 to 12 years of age, the American Academy of Pediatrics formed a committee to review the existing literature and develop consistent guidelines.

The committee recommends that primary care clinicians evaluate for ADHD children who are inattentive, hyperactive, impulsive, academic underachievers, and those who have behavioral problems. Because these symptoms are rarely obvious in a clinical setting, parents or other caregivers who notice these problems should inform the child’s physician. When parents don’t bring up these concerns, physicians should inquire about the symptoms of ADHD.

According to the guidelines, a diagnosis of ADHD requires that a child meet the specific criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. These involve displaying numerous symptoms of inattention, hyperactivity, and impulsivity in at least two settings. By completing ADHD-specific questionnaires, parents or caregivers and classroom teachers must provide evidence of the core symptoms of the disorder, duration of symptoms, the degree of functional impairment, and associated conditions. According to the guidelines, nonspecific questionnaires are not adequate for the diagnosis of children with ADHD. The guidelines recommend that evaluation for ADHD also include an assessment for coexisting conditions such as conduct and oppositional defiant disorder, mood disorders, anxiety disorders, and learning disabilities. Coexisting conditions affect roughly one-third of children with ADHD. Recommendations do not include the use of brain imaging, EEG, and thyroid hormone screens as diagnostic tests for ADHD.

These guidelines provide a starting point for clinicians in the assessment of ADHD in children of 6 to 12 years of age. Further research is necessary to develop guidelines for other age ranges.

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Screening Children for Type 2 Diabetes

As obesity in the United States reaches epidemic proportions, the number of children diagnosed with type 2 diabetes has been increasing dramatically. Until recently, yype 1, or juvenile-onset, diabetes was the most common form of the disease in this age group, so many children with type 2 diabetes have been either undiagnosed or misdiagnosed as having type 1 diabetes. Research suggests that a child age 10 (or younger if puberty begins before age 10) should be screened every two years for type 2 diabetes if he or she is 120% or more of his or her ideal weight and has one or more of the following risk factors:

  • a family history of type 2 diabetes in first- or second-degree relatives (that is, in a sibling, parent, grandparent, cousin, blood aunt or uncle)
  • is American Indian, African-American, Hispanic, Asian, South Pacific Islander
  • has signs of insulin resistance (for example, excess sugar in the urine) or conditions associated with insulin resistance (for example, dark, velvety patches on the skin or high blood pressure)

Because a decrease in physical activity and an increase in the intake of calories and fat are major causes of obesity, personal preventive measure can be taken against the onset of type 2 diabetes in children. When a child's blood glucose levels are still normal, or even if they are elevated but not enough for a diagnosis of diabetes to be made, taking action can have long-term benefits in all children at high risk for type 2 diabetes. Overweight or obese children with any of the bulleted risk factors mentioned above should be strongly encouraged to maintain a healthy diet (high in fruits and vegetables and low in fat) and to exercise at least 30 minutes per day.
October 2000 Update

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Wet Combing More Effective for Detecting Head Lice than Traditional Visual Inspection

Head lice are minute, parasitic insects that live in hair. They easily spread from person to person, especially among children at school or in day care, and they are responsible for many school absences. Because lice are barely visible, finding lice eggs, called nits, is the easier way to detect an infestation. These tiny, white flecks cling to hair shafts. Researchers at Belgium’s Ghent University recently found that carefully sweeping a fine-toothed comb through wet, conditioned hair is more effective for detecting lice than the traditional, dry-scalp visual inspection.

The study, published in the British Medical Journal, compared the two methods on 224 school children. Two trained teams independently examined the students: one using the wet comb technique, the other using the visual test. Wet combing found lice in 49 children, while the visual test only detected 32 of these cases. In addition, the traditional inspection mistakenly identified 14 uninfected children as having lice.

The results suggest that compared to traditional, visual inspection, wet combing would allow for more accurate head lice detection, meaning more infestations detected before they can spread, and fewer non-infested children receiving unnecessary treatment with insecticides.

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