*"It doesn't matter if the cat is black or white as long as it catches
mice."*

Deng Hsaio P'ing 1904-1997

This a page for sharing "what works" as seen in the published literature
as well as what is done at sites that care for American Indian/Alaskan
Native children. If you have any suggestions, comments or questions
please contact Steve Holve, MD, Chief Clinical Consultant in Pediatrics
at sholve@tcimc.ihs.gov

IHS Child Health Notes

December 2004

# Quote of the month

" *When so many hours have been spent in convincing myself that I am
right, is there not some reason to fear I may be wrong?."*

Jane Austen

**Articles of Interest**

Oral prednisolone in the acute management of children age 6 to 35 months
with viral respiratory infection-induced lower airway disease: a
randomized, placebo-controlled trial. J Pediatr. 2003
Dec;143(6):725-30.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14657816&itool=iconabstr>

-   A 2 mg/kg dose of oral prednisolone given in the emergency
    department did not decrease the need for admission to the hospital
    for young children with viral respiratory infection induced
    wheezing.

-   However, the above dose at emergency department presentation and
    continued for three days did decrease the severity and duration of
    symptoms and decreased the length of hospital stay.

-   An accompanying editorial suggest that for steroids to be effective
    in bronchiolitis they need to be given early in the onset of disease
    to prevent airway inflammation.

A randomized trial of a single dose of oral dexamethasone for mild
croup.\
N Engl J Med. 2004 Sep 23;351(13):1306-13.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15385657

-   It is known that dexamethasone is beneficial in severe croup. This
    study showed that oral dexamethasone was beneficial even in mild
    croup.

-   Dexamethasone treated patients were only half as likely to need to
    be seen for a follow-up visit (7% versus 15%).

-   The authors admit that the benefits per patient were small. However,
    they point out that the benefits may not be "small" to parents who
    had to make less return trips to the emergency room and whose
    children slept better.

# Editorial Comment

When I was in residency the faculty spent a lot of energy making sure we
didn't overuse steroids. Only patients who really had documented asthma
should receive them. Perhaps we were trying too hard to convince
ourselves. If only Jane Austen had been an attending.

The debate about how to best treat bronchiolitis is unlikely to end
anytime soon. For hospitalized patients hydration and oxygen are the
most important. Nebulized albuterol or epinephrine may benefit some
subset of patients. Should all wheezing infants be treated with
prednisolone? I don't think this paper definitively answers that
question. It does raise the issue that if patients are to be treated
perhaps they need treatment early in the course of illness. Once there
has been significant airway inflammation and desquamation steroids may
not have much benefit.

However, the second paper extends the use of steroids for treating
croup. There is good evidence to treat all patients with croup, mild to
severe with steroids. In addition, the steroid may be given by mouth or
by injection with equal results.

**Recent literature on American Indian/Alaskan Native Health**

Prevalence of dental caries among 7- and 13-year-old First Nations
children, District of Manitoulin, Ontario. J Can Dent Assoc. 2004
Jun;70(6):382.\
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15175117

Prevalence of early childhood caries among First Nations children,
District of Manitoulin, Ontario. Int J Paediatr Dent. 2004
Mar;14(2):101-10.\
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15005698>

# 

-   Two dental studies from First Nation children in Canada show that
    the caries rate is higher in Aboriginal children compared to the
    overall caries prevalence in Canadian children. This is similar to
    the finding in the U.S. in which American Indian and Alaskan Native
    children had a higher caries rate than the overall population.

-   This raises the question of what factors make the caries rate higher
    in both of these populations? We know that caries are an infectious
    disease: We know from multiple studies that crowding, poverty and
    *Strep mutans* carriage rates in mothers are all risk factors. How
    much is diet a factor? Is there a genetic component?

-   Despite the increase in caries in First Nations children the rates
    in Canada were not nearly as high in American Indian children. The
    average number of decayed, missing and filled surfaces (dmfs) in
    three year old Canadian Aboriginals was 7.5. In many tribes in the
    U.S. American Indian young children have a dmfs rate of 20. What
    factors make early childhood caries an even greater problem in U.S.
    native children compared with Canada?

# Meetings of Interest for Child Health

Annual Midwinter Maternal Child Health Conference

February 25 -- 27, 2005; Telluride, CO

A meeting for those who care for Native American women and children with
a chance to ski in Telluride. For more information contact Alan Waxman
at <awaxman@salud.unm.edu> or go to

<http://www.ihs.gov/MedicalPrograms/MCH/M/ConfDnlds/TellurideagendaI0-2004.doc>

April 29-May 1, 2005\
Seattle, WA

Join the American Academy of Pediatrics and the Canadian Paediatric
Society, in cooperation with the Indian Health Service, for the first
International Meeting on Inuit and Native American Child Health.
Pediatricians, family physicians, residents, other health care
professionals, clinical researchers, state and federal public health
employees, child advocates, and other professionals and family
representatives dedicated to working with First Nations, Inuit, and
American Indian/Alaska Native (AI/AN) children should attend.
Participants will have the opportunity to share ideas on culturally
effective health care delivery models, present research findings, and
dialogue about strategies to improve the health of First Nations, Inuit,
and AI/AN children and communities.

http://www.aap.org/nach/InternationalMeeting.htm

This is the first international meeting on Indian/Inuit health with
sponsorship by both countries pediatric societies. It should be an
excellent forum for education and sharing of ideas.