*"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

March 2005

# Quote of the month

*" The first step to wisdom is getting things by their right names"*

Chinese Proverb

**Articles of Interest**

Diagnosis and Management of Acute Otitis Media: Clinical Practice
Guideline of the American Academy of Pediatrics and American Academy of
Family Physicians. Pediatrics: 113;5: May 2004: pages 1451-1465

[www.aap/org/policy/aomfinal.pdf](http://www.aap/org/policy/aomfinal.pdf)

**Editorial Comment**

The key to management of acute otitis media (AOM) is accurate diagnosis.
Numerous studies show that at least 50% of the diagnoses of AOM are
incorrect. The most common error is mistaking otitis media with
effusion, which is sterile, for AOM that is an acute infection. The
driving force behind this guideline is an effort is to decrease the
prescription of unneeded antibiotics by making diagnostic criteria more
explicit and stringent.

The study acknowledges that history alone is not sufficient. A complaint
of fever, crying and earache is present in infants with AOM but also up
to 70% of infants who only have URI. An accurate diagnosis of AOM
requires:

1\. Acute onset of symptoms in the past 48 hours

2\. Presence of middle ear effusion as confirmed by bulging or limited
mobility of the eardrum

3\. Signs or symptoms of middle ear inflammation such as erythema of the
eardrum or distinct otalgia.

The recommendations also addressed treatment suggestions. This portion
of the guideline received a lot of attention in the medical and lay
press because it was the first U.S. policy guideline to give the option
of withholding antibiotic treatment for AOM. The committee endorsed the
option to withhold initial antibiotic treatment in well appearing
children over two years of age. This was based on the observation that
the vast majority of AOM will improve spontaneously in 48 hours and the
risk of invasive disease approaches zero in this age group. Each
practitioner will have to make his/her own decision on treatment but
everyone who treats children should read this practice guideline.

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

This isn't literature but it is from a library.

The National Library of Medicine has a series of on-line exhibitions on
the history of medicine. The exhibits rotate every 3 to 4 months and
past exhibits are stored in on-line archives immediately accessible. The
exhibits are terrific and cover a wide array of subjects from Islamic
medicine to the history of the cesarean section to scientific
biographies. Visit the site at

<http://www.nlm.nih.gov/exhibition/exhibition.html>

The reason I found this site is the 1994 on-line exhibit "*If You Knew
the Conditions"...Healthcare to Native Americans.* The exhibit has text
and pictures that cover AI/AN health issues from the 19^th^ century to
the present. It helps to put present day issues in the proper historical
context. The recurrent theme of neglect and lack of funds for Indian
health is a reminder that "the more things change, the more they remain
the same". I recommend a visit:

<http://www.nlm.nih.gov/exhibition/exhibition.html>

Lastly, there is a History of Medicine homepage that can direct you to
an archive of original texts and photos about medicine. The site is:

<http://www.nlm.nih.gov/hmd/>

# Meetings of Interest for Child Health

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.