Medical Concerns in Children
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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
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
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 http://www.cdc.gov/nip or
the American Academy of Pediatrics website at http://www.aap.org/.
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
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
- 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
- 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
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
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
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
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
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
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
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
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
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
- 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
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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
Attention deficit hyperactivity disorder (ADHD) affects 710% 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
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 childs physician. When parents
dont 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
- 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 Belgiums 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
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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