bluuebunny/crossref_metadata_2025 huggingface dataset:
Economic Considerations Associated With Pediculus humanus capitis Infestation
Authors: Hansen Ronald C. , O’Haver Judith
Published: March 2006

An estimated 6 to 12 million head lice infestations occur in the United States annually, with children ages 3 to 12 most likely to be affected. There are significant direct costs associated with treatment and indirect costs due to lost time from school. Anecdotal reports suggest that direct costs of treatment are in the hundreds of millions of dollars annually. Indirect costs are also substantial but more difficult to quantify. Examples of indirect costs include missed days from schools that use a “no nit” policy, lost wages for parents who must stay home with children, and costs of daycare for parents who cannot miss work. Contributors to the expense of treating head lice include misdiagnosis, and, consequently unneeded treatment; treatment failure due to misuse of pediculicides or other agents; and developing resistance, particularly to over-the-counter pyrethroid agents. An overview of direct and indirect costs of infestation are included in this review, along with a discussion of factors that lead to misuse and overuse of pediculicides. More accurate diagnosis of head lice infestation may provide the most effective means of controlling the costs of care and ensuring proper use of pediculicides.
Once-Daily Use of Colchicine in Children with Familial Mediterranean Fever
Authors: Koşan Celalettin , Özkan Behzat
Published: March 2006

Patients with familial Mediterranean fever routinely take daily multiple doses of colchicine to prevent acute attacks and to reduce the risk of amyloidosis. However, although there is no research in this regard in the literature, some clinicians believe that the use of colchicine in children as daily single dose may cause toxic side effects. The efficiency and the side effects of the administration of daily single dose versus daily multiple doses of colchicine were evaluated in the treatment of patients with familial Mediterranean fever. Thirty-nine patients being observed at Atatürk University Medical Faculty Pediatrics outpatient clinic with the diagnosis of familial Mediterranean fever were randomly divided into 2 groups. Group I consisted of 20 patients who continued taking colchicine in 2 or 3 divided doses daily as they did before the study. Group II comprised 19 patients who were given the total daily colchicine dose at 1 time. Patients were re-examined at 30-day intervals and both groups maintained this regimen for an average duration of 8 months. There was no difference between these 2 groups with respect to frequency of side effects, number of attacks, and acute phase response. Therefore, the daily colchicine dose can be given to children once daily.
Frequency of Antinuclear Antibodies in Healthy Children and Adolescents
Authors: Hilário Maria Odete Esteves , Len Claudio Arnaldo , Roja Suzana Campos , Terreri Maria Teresa , Almeida Gastão , Andrade Luis Eduardo Coelho
Published: March 2006

Sera from 214 healthy children and adolescents (108 females [50.4%]) aged 6 months to 20 years (mean 8.7 years) and from 116 patients with rheumatic diseases were assayed for antinuclear antibody (ANA) by indirect immunofluorescence (IIF) by using HEp-2 cells as substrate. Twenty-seven healthy children (12.6%) presented a positive ANA test; there was no difference between genders, and we observed a trend for higher frequency of ANA ≥1/80 among children between 5 years and 10 years. Eight of the 27 healthy children with positive ANA test were reevaluated 36 months later, and none of them had developed any rheumatic disease, though the sera remained positive in 2 of them. ANA was present in 42/116 patients (36.2%). In daily medical practice ANA determination should be required only in individuals with clinical signs and symptoms suggestive of autoimmune disease.
Survey of Parenting Books for Advice on the Common Cold, Diarrhea, and Otitis Media in Infants and Toddlers
Authors: Holland Paul R. , Mau Monica K. , Yamamoto Loren G.
Published: March 2006

Parenting books often provide advice for common medical ailments of infants and toddlers. However, the accuracy of such advice has never been evaluated. The purpose of this study is to survey the informational content of a sample of parenting books. Fifty general parenting books were identified and reviewed for the informational content on the following topics: common colds, diarrhea, and otitis media. When covered by the book, accurate and consistent information was generally provided in the following topic areas: non-medicated nose drops for nasal congestion, upright positioning for children with colds, breastfeeding infants with diarrhea, electrolyte solutions for diarrhea, and feeding practices as they relate to otitis media. The following topic areas displayed significant inconsistency: the use of decongestants, antihistamines, expectorants, cough suppressants, and decongestant nose drops for colds; antidiarrheal medications; soft drinks and juice for diarrhea; home recipes for oral hydration solutions; and the usefulness of pressure equalization tubes for refractory otitis media. Practitioners should be aware that parents may be misinformed by some parenting books and take measures to educate parents.
The Yield of Esophageal pH Monitoring During Polysomnography in Infants with Sleep-Disordered Breathing
Authors: Greenfeld Michal , Tauman Riva , Sivan Yakov
Published: March 2006

This study evaluates the yield of adding simultaneous esophageal pH monitoring to polysomnography (PSG) in 41 infants with unexplained sleep disordered breathing. The relationships of respiratory events to episodes of gastroesophageal reflux (GER) were analyzed. The major causes for referring the infants were cyanotic episodes (22%), apneas (20%), and choking events (15%). PSG was abnormal in 8/41 (20%). Abnormal pH studies were observed in 12/41 (29%) infants. In 4/12 (33%), respiratory events correlated with GER episodes. Adding simultaneous pH monitoring to PSG may identify associated conditions and thus focus treatment.
Preparing Residents to Counsel About Smoking
Authors: Scal Peter , Hennrikus Deborah , Ehrlich Laura , Ireland Marjorie , Borowsky Iris
Published: March 2006

The objective of this study was to evaluate the effects of an innovative, multicomponent, theory-based educational intervention for pediatric residents on prevention of tobacco use counseling for cessation. Before and 3 months after intervention residents in a large urban midwestern pediatric residency program completed a self-assessment of measures of their attitudes and counseling behaviors. The intervention was a 3-hour multicomponent program including presentations, case discussions, role-plays and support material based on concepts from Motivational Interviewing (MI). Participants reported increased confidence in their ability to counsel, as well as greater frequency of counseling (standardized effect size ( d) = 0.57). Residents also reported an increased use of principal components of MI, assessing how important quitting is to patients ( d = .66), and how confident patients are in their ability to quit ( d = .78). This brief educational intervention taught theory-based counseling techniques to pediatric residents. After the study, participants reported significant increases in their frequency of counseling as well as greater use of the MI principles.
Diagnostic Yield of Parathyroid Hormone Testing in Children Evaluated for Hypercalciuria
Authors: Lo Christina , Zucker Yael , Gauthier Bernard G. , Vergara Marcela , Frank Rachel , Vento Suzanne , Trachtman Howard
Published: March 2006

Hypercalciuria is a frequent cause of non-glomerular hematuria in pediatric patients. Because hypercalciuria can be secondary to primary hyperparathyroidism, measurement of serum parathyroid hormone (PTH) levels is often performed in children with this urinary abnormality. A retrospective chart review was performed to determine the diagnostic yield of PTH measurements when performed under these clinical circumstances. Over a 30-month period (January 1, 2001 to September 30, 2003), among 31 children who had a PTH determination, the level was elevated in 1 (3%) patient. Based on these findings and the serious nature of untreated primary hyperparathyroidism, serum PTH level should be measured in pediatric patients with newly diagnosed hypercalciuria.
Healthy Steps: Resident’s Perceptions
Authors: Kinzer Susan L. , Dungy Claibourne I. , Link Ellen A.
Published: March 2006

The objective of this study is to determine pediatric residents’ perception of Healthy Steps for Young Children, Healthy Steps Iowa, and Healthy Steps specialists. Twenty-nine of 37 (78%) pediatric residents participated in this survey. The Healthy Steps specialists facilitated pediatric residents’ learning of anticipatory guidance (69%), and assured the patients received information efficiently (69%). Sixty-two percent reported that the Healthy Steps specialists did not interfere with their relationship as the patient’s primary care provider. Seventy-six percent would consider using Healthy Steps specialists in their future practice. Program improvement areas include improving clinic efficiency with the incorporation of Healthy Steps specialists; increasing the pediatric residents’ awareness of family violence, mental illness, and substance abuse; and improving their method of referral to community contacts.
Diagnosis and Treatment Frequency for Overweight Children and Adolescents at Well Child Visits
Authors: Louthan Miriam V. , Lafferty-Oza Margaret J. , Smith Elizabeth R. , Hornung C. A. , Franco Sofia , Theriot Judy A.
Published: March 2006

Obesity in children is a rapidly growing problem and may be underrecognized by pediatricians. We reviewed 473 consecutive well child visits to assess frequency of correctly identifying overweight children. Of children with a body mass index greater than the 95th percentile for gender and age, only 27 (29%) were diagnosed as overweight by the physician. Our results suggest that the frequency of diagnosing children as overweight at well child visits is critically low.
Assessment of the Effectiveness of Biofeedback in Children with Dyssynergic Defecation and Recalcitrant Constipation/Encopresis: Does Home Biofeedback Improve Long-Term Outcomes
Authors: Croffie Joseph M. , Ammar M. Samer , Pfefferkorn Marian D. , Horn Debra , Klipsch Ann , Fitzgerald Joseph F. , Gupta Sandeep K. , Molleston Jean P. , Corkins Mark R.
Published: March 2006

The purpose of this study was to determine whether biofeedback benefits children with dyssynergic defecation and constipation/encopresis, and whether home biofeedback improves long-term outcomes. Thirty-six patients with chronic constipation who had failed at least 6 months of conventional treatment and demonstrated dyssynergic defecation at anorectal manometry were randomized to biofeedback in the laboratory alone (group 1, n=24) or in the laboratory and at home (group 2, n=12) and followed up at 2, 4, and a mean of 44 months. Thirty patients were available for long-term follow-up. Bowel movements increased in all from a mean of 1.4/week to 5.1, 5.8, and 5.1 per week at 2 months, 4 months, and long-term, respectively (p ≤0.001). Soiling decreased in all from a mean of 5.5/week to 0.6, 0.1, and 1 per week at 2 months, 4 months, and long-term, respectively (p ≤0.001). Laxative use decreased from a mean of 4.1 days/week to 0.6, 0.3, and 0.7 per week at 2 months, 4 months, and long-term, respectively (p ≤0.001). Twenty-seven of 30 parents ranked their satisfaction a mean of 2.2 (range 1-excellent to 3-good). There were no significant differences in outcomes between the laboratory alone group and the laboratory plus home group. Biofeedback is beneficial for some children with chronic constipation and dyssynergic defecation. Supplemental home biofeedback does not improve long-term outcomes.
Psychiatric Symptoms of Adolescents with Physical Complaints Admitted to an Adolescence Unit
Authors: Kışlal Fatih Mehmet , Kutluk Tezer , Çetin Füsun Çuhadaroğlu , Derman Orhan , Kanbur Nuray Öksüz
Published: March 2006

The aim of this study was to evaluate the psychiatric symptoms among adolescents who were seen in the outpatient clinic for their physical complaints. Two hundred and ninety adolescent outpatients (154 males and 136 females) between 13 and 17 years of age (mean 14.3±1.2) are included in this study. Patients with known psychiatric disorders, mental retardation, organic brain diseases, or chronic organic problems were excluded. The Brief Symptom Inventory, which measures the psychiatric symptoms under the categories of anxiety, depression, negative self, somatization, and hostility, was given to all subjects. Symptoms of urinary and cardiovascular systems were related to hostility. Patients with obesity, hirsutism, problems of external genitalia, enuresis nocturna, abdominal pain, chest pain, and lack of weight gain showed psychiatric symptoms at pathological levels. Hostility symptom was found to be high in all groups.
Conservative Approach to the Mediastinitis in Childhood Secondary to Esophageal Perforation
Authors: Demirbag Suzi , Tiryaki Tugrul , Atabek Cuneyt , Surer Ilhami , Ozturk Haluk , Cetinkursun Salih
Published: March 2006

The aim of this study was to evaluate the safety and efficacy of nonoperative treatment of esophageal perforation (EP) in children. Between 1999 and 2004, 13 episodes in 12 patients were evaluated. The treatment program consisted of broad-spectrum antibiotics, nasopharyngeal aspiration, parenteral and/or enteral nutrition by gastrostomy, and pleural effusion or mediastinal abscess drainage when required. Mean age of the patients was 3.75 ± 1.13 (range 3-7 years). Two patients (16.7%) were girls and 10 patients (83.3%) were boys. Chest pain was found 76.9% of all EP episodes (10 of 13 perforations), followed by dyspnea in 69.2% (9 of 13), vomiting in 46.1% (6 of 13), fever in 46.1% (6 of 13), and epigastric pain in 7.6% (1 of 13). No deaths occurred. In children, in contrast with the adults, EP can be treated safely by nonoperative methods.
Physician Knowledge and Management of Children Exposed to Domestic Violence in Ohio: A Comparison of Pediatricians and Family Physicians
Authors: Zink Therese , Siegel Robert , Chen Lei , Levin Linda , Pabst Stephanie , Putnam Frank
Published: March 2006

Active members of the Ohio chapters of American Academy of Family Physicians (FP=1,498) and American Academy of Pediatrics (Ped=1,725) were surveyed about their knowledge and management regarding children exposed to domestic violence (DV). Characteristics of respondents were analyzed by use of Chi-square analysis. Logistic regression was performed to identify predictors of DV knowledge and management. The response rate was 33.3%. Family physicians were more likely to know their local DV agency and recognize the adult symptoms of DV, such as unexplained injury. Pediatricians were more likely to report the child who saw a fight between parents to child protective services. Continuing work to increase physicians’ comfort and ability to assess for DV and manage exposed children is needed.
Variation in Establishing a Diagnosis of Obesity in Children
Authors: Mabry Iris R. , Clark Sarah J. , Kemper Alex , Fraser Kiesha , Kileny Sharon , Cabana Michael D.
Published: March 2006

Consensus guidelines provide recommendations for the diagnosis and management of obesity. We conducted a medical record review of children initially diagnosed with obesity at a general pediatrics visit. The diagnosis was made most often at health maintenance visits (46%). Body mass index was documented in 5% of initial visits; 74% had documentation of obesity-related history; 64% had documentation of counseling. In multivariate analysis, male patients were more likely to have diet history documentation; female patients were more likely to have weight loss program referrals. Future research should assess pediatricians’ perceptions about obesity to better understand clinical practice patterns.
The Incidence, Treatment, and Follow-up of Iron Deficiency in a Tertiary Care Pediatric Clinic
Authors: Traxler Susan Grant , Benjamin John T.
Published: March 2006

To assess the incidence, treatment, and follow-up of iron deficiency in children seen in a tertiary hospital, a retrospective chart review was performed in 2002 of 364 consecutive children screened for iron deficiency with free erythrocyte protoporphyrin and hemoglobin. Sixty-five of the 352 children studied (18.5%) were iron-deficient and 19 patients (5.4%) were anemic. Eighty percent of the affected children were treated with iron, and only 25% had follow-up blood testing done. Iron deficiency is common in children younger than 2 years of age. Whether or not the children had anemia, treatment and follow-up were less than optimal.
Inaccuracy of Stated Versus Measured Parental Heights
Authors: Teitelbaum Jonathan E. , Koreen Susan , Hightower Kimberly , Rajaraman Raj , Jaeger Joseph
Published: March 2006

Routine measurement of children’s height is essential in monitoring for deviations in normal growth velocity. Target adult height of children is estimated by determining an adjusted midparental height. Such determinations are dependent on the accurate acquisition of parental height. Incorrect assessment of parental height will result in inaccurate expectations for the child’s height. To observe the difference between stated and measured parental heights within a United States subspecialty setting, prospective acquisition of parental stated and measured heights during the summer months of 2000 and 2001 was examined. Two hundred and thirty-eight parents, 185 mothers and 53 fathers, were measured. The mean values of the stated heights for mothers and fathers were 163.7 cm ± 6.3 cm and 177.1 cm ± 8.6 cm, respectively. The corresponding measured heights were 163.0 cm ± 5.9 cm and 175.2 cm ± 6.6 cm, respectively. The mean height difference for mothers was 0.69 cm (p<0.001) while the mean height difference for fathers was 1.90 cm (p<0.001). Parents significantly overestimate their height in a clinical setting. Fathers overestimate to a greater degree than mothers. These findings emphasize the need to obtain height measurement of parents along with that of their children in assessing for linear growth delay.
Referral by Pediatricians of Children with Behavioral Health Disorders
Authors: Williams Jane , Palmes Guy , Klinepeter Kurt , Pulley Anita , Foy Jane Meschan
Published: March 2006

A standard interview guide focused on behavioral health referral practices and communication patterns was developed and administered to 47 pediatricians in private practice. Results suggested that the most frequent reasons for referral to a mental health provider were diagnostic uncertainty, failure to respond to treatment, presence of severe affective symptoms, and need for ongoing psychotherapy. Only a third of the providers indicated that their patients frequently followed through with recommendations to receive mental health care. More than half of the pediatricians wanted more information regarding their patients referred for mental health services, and they expressed a strong interest in colocation with a mental health provider.
Near Strangulation as a Result of Hair Tourniquet Syndrome
Authors: Chegwidden Heather J. , Poirier Michael P.
Published: March 2006

Hair tourniquet syndrome has been a recognized clinical entity for many decades. In this syndrome, hair becomes tightly wrapped around an appendage, usually that of an infant. Body parts involved include the finger, toe, penis, clitoris, and uvula. The end result of necrosis is also well documented. In this report, an 11-month-old girl with hair tourniquet syndrome causing signs and symptoms of an acute strangulation is presented.
Paroxysmal Non-Epileptic Events Resembling Seizures in Children with Otitis Media
Authors: Soman Teesta B. , Krishnamoorthy Kalpathy S.
Published: March 2006

Children may frequently present with recurrent spells, which are often thought to be seizures. However, there are several benign non-epileptic conditions that mimic seizures. A group of 8 children is described who were diagnosed with otitis media and presented with recurrent, stereotypic spells suggestive of seizures. A paroxysmal phenomenon, in association with otitis media, resembling seizures, has not been previously described. These paroxysmal phenomena resembling seizures may be related to acute otitis media and should be included in the differential diagnosis of paroxysmal non-epileptic events in infants and young children.
Chronic Sinusitis in Children
Authors: Steele Russell W.
Published: March 2006

Clinical practice guidelines for the management of acute sinusitis in children have been published by the American Academy of Pediatrics. Of note is that in this document, a brief discussion of chronic disease concluded that the pathogenesis and management are essentially unknown. Although there are insufficient data in the literature to develop evidence-based clinical guidelines, a careful review of the literature and clinical experience of experts who manage pediatric chronic sinusitis is presented in an effort to develop specific recommendations and to offer practical treatment options. Factors associated with chronic sinusitis should be addressed individually and include recurrent viral upper respiratory infections, allergic and nonallergic rhinitis, ciliary dyskinesia, cystic fibrosis, immunodeficiency, and anatomic abnormalities. Bacteriology includes the 3 pathogens associated with acute disease i.e., Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis but with chronic sinusitis also includes Staphylococcus aureus, anaerobic bacteria, and fungi. Medical interventions discussed include endoscopic sinus surgery, saline nasal irrigation, intranasal decongestant therapy, intranasal steroids, and oral antibiotics. Clinical ranking without regard to side effects and cost suggests that endoscopic sinus surgery and antral irrigation have the highest probability of substantial symptom improvement. Other issues discussed include identification and management of gastroesophageal reflux disease (GERD), allergy, and immune deficiency.
Complexities in HIV Consent in Adolescents
Authors: Ho Wing Wah , Brandfield Julie , Retkin Randye , Laraque Danielle
Published: March 2006

A large proportion of people infected with the human immunodeficiency virus (HIV) are adolescents. Unfortunately, there is no uniform policy on minors’ rights to consent to HIV testing and treatment. The process of obtaining consent is complex and depends on several factors, including individual state HIV laws and laws relating to a minor’s capacity to consent to general health care. These issues are particularly relevant given the growth of HIV in this population. In this review, the complex laws of informed consent and confidentiality surrounding HIV disease in adolescents are reviewed. Familiarity with these laws by the clinician is essential to halting the HIV epidemic in adolescents and will be underscored.
Adverse Effects Following the Inadvertent Administration of Opioids to Infants and Children
Authors: Meyer David , Tobias Joseph D.
Published: March 2006

Regardless of the clinical scenario in which they are administered, opioids can have adverse effects in infants and children. These adverse effects may be particularly problematic when opioids are inadvertently administered since the clinical signs and symptoms may not be readily attributed to opioids without an appropriate history. The authors present 3 clinical scenarios in which adverse effects occurred related to the inadvertent administration of opioids when: (1) acetaminophen with codeine were administered instead of acetaminophen, (2) a mother was breastfeeding while taking opioids, and (3) a fentanyl patch was placed on a superficial injury. A thorough history and physical examination combined with urine/plasma drug screening resulted in the identification of the problem and its effective therapy.
Relationship Between Cyclic Vomiting Syndrome and Migraine
Authors: Stickler Gunnar B.
Published: March 2006

The strength of the association between cyclic vomiting syndrome (CVS) and migraine was explored by studying the prevalence of migraine in patients with CVS and their relatives versus geographic normal controls. A questionnaire was sent to patients with CVS or their parents and to individuals of the same gender and age living within 1 mile of the home of patients with CVS. Patients with CVS, their mothers, and their grandmothers had a prevalence of migraine almost twice as frequent as that in controls. In a large number of patients, CVS is migraine-related.
Hospital Readmission for Bronchiolitis
Authors: Kemper Alex R. , Kennedy Emily J. , Dechert Ronald E. , Saint Sanjay
Published: March 2006

The objectives of this study were to determine the rate and risk factors for hospital readmission after inpatient treatment for bronchiolitis. We conducted a retrospective cohort study from 2000 to 2002. The readmission rate within 30 days was 3.7% (95% Confidence Interval: 2.1%-6.0%). Readmission was not associated with age, prematurity, respiratory syncytial virus status, receipt of intensive care, or the observation period off supplemental oxygen. Those who required supplemental oxygen had a lower risk of readmission. Identifying children at risk for readmission is challenging. Children who did not require supplemental oxygen may be at greater risk because they are progressing in their illness.
Teaching Children with Attention Deficit Hyperactivity Disorder (ADHD) and Autistic Disorder (AD) How to Swallow Pills
Authors: Beck Melissa H. , Cataldo Marilyn , Slifer Keith J. , Pulbrook Valerie , Guhman Jaswinder K.
Published: March 2006

One barrier to medication adherence in pediatric populations is difficulty swallowing pills. Some children may not have prerequisite skills for pill swallowing, while others may have developed conditioned anxiety from repeated negative experiences. Eight children with attention deficit hyperactivity disorder or autistic disorder participated in behavioral training to increase cooperation with pill swallowing. A pill-swallowing protocol was utilized during practice sessions with placebo “pills” of increasing size to implement systematic desensitization. Seven of the 8 children swallowed medication with a therapist. Six of the 8 children maintained treatment gains over time. Interventions used to succeed with these children are presented along with methods to reduce conditioned behavioral distress.
Hypertension as a Late Sequela of Henoch-Schönlein Purpura
Authors: Nussinovitch Naomi , Elishkevitz Keren , Volovitz Benjamin , Nussinovitch Moshe
Published: March 2006

The development of hypertension was examined several years after an episode of Henoch-Schönlein purpura (HSP) in children with or without urinary abnormalities or hypertension at diagnosis. Medical records of 155 children (mean age 6.8±2.3) with HSP from 1969 to 1997 were reviewed for a specific description of renal involvement, blood pressure, and urinary abnormalities. The study group consisted of 86 boys (55.47%) and 69 girls (44.53%); 30% had renal involvement, 5 among them presented with nephritic-nephrotic syndrome. Hypertension was found in 7 patients with HSP on long-term follow-up including the 5 who had nephritic-nephrotic syndrome at presentation, 1 who had macroscopic hematuria but normal blood pressure, and 1 with normal urine and normal blood pressure. These data emphasize the need for regular monitoring of children with HSP with or without renal findings.
Preferred Antibiotics for Treatment of Acute Otitis Media: Comparison of Practicing Pediatricians, General Practitioners, and Otolaryngologists
Authors: Pichichero Michael E.
Published: March 2006

The antibiotic preferences of 2,190 pediatricians (peds) 360 general practitioners (GPs), and 273 otolaryngologists (ENTs) in the United States and concurrence with treatment guideline recommendations for acute otitis media (AOM) for suspected drug-resistant Streptococcus pneumoniae (DRSP) and beta-lactamase-producing Haemophilus influenzae before and after an educational workshop were compared. Peds and GPs preferred amoxicillin/clavulanate high-dose, whereas ENTs preferred higher generation cephalosporins. Before the workshop, endorsement of guideline-recommended antibiotics for treatment of AOM caused by DRSP by Peds, GPs, and ENTs was 80%, 75%, and 78%, respectively, and for Haemophilus influenzae was 73%, 63%, and 84%, respectively. After the workshop concurrence with AOM guideline recommendations for DRSP increased to 96%, 95%, and 97% and for H. influenzae increased to 93%, 94%, and 96% for Peds, GPs, and ENTs, respectively (p<0.0001 for all comparisons). Peds, GPs, and ENTs select appropriate antibiotics for AOM 63-84% of the time. After instruction that provides the rationale for guideline-recommended agents based on pharmacokinetics/pharmacodynamics and double tympanocentesis trials, endorsement of recommended antibiotics significantly improved to >90%.
Views of Pediatric Health Care Providers on the Use of Herbs and Dietary Supplements in Children
Authors: Woolf Alan D. , Gardiner Paula , Whelan Julia , Alpert Hillel R. , Dvorkin Lana
Published: March 2006

Herbs and dietary supplements (HDS) are widely used by adults for treating illnesses and/or preserving good health, and many parents use HDS for their children as well. Previous reports suggest parents will not divulge HDS use to health care providers for fear of their skepticism or disapproval. Yet the views of pediatric health care providers on HDS use in children are not well known. This study investigated the attitudes and practices of pediatric nurses and physicians regarding HDS use in children, in order to identify those characteristics associated with a high degree of confidence in initiating a dialogue on the topic of HDS with families in their practice. A written survey on attitudes and practices toward HDS was developed, piloted, revised, and then administered to a convenience sample of practitioners attending a regional postgraduate course in general pediatrics. Only 42% of 204 pediatric health care providers sampled felt confident in initiating discussions about the therapeutic use of herbs and dietary supplements with families in their practice. Confidence in discussing HDS with families correlated with both personal use of an HDS (OR 3.22; p=0.033) and length of time in practice less than 10 years (OR 8.26; p=0.007). Less than 18% felt that HDS were safe for children under 6 months of age; and only 35% felt they were safe for use in children < 24 months old. Only 7% felt that parents should be allowed to give their hospitalized child an herb or dietary supplement they had brought with them from home, although this increased to 35% if the herb or dietary supplement had been prescribed by a physician. Ninety-two percent of practitioners thought that HDS should be more closely regulated by the FDA. Only a minority of pediatric community practitioners felt confident in discussing HDS with families of children in their practice. Those who had been in practice for a shorter time and who had used HDS themselves were more likely to report confidence in initiating such discussions. The provision of more postgraduate educational opportunities to learn about herbs and dietary supplements may alleviate some practitioners’ concerns about their own competency in discussing HDS with families in their practice.
Treating Overweight Children and Adolescents in the Clinic
Authors: Young Karen L.
Published: March 2006

The increasing prevalence of pediatric overweight has caused the medical community to begin searching for ways to deal with this new pediatric medical problem. The Centers for Disease Control developed the Body Mass Index (BMI) growth charts, which came into use in 2000. Primary care providers are seeking education on this relatively new topic. This article provides fundamental information based on the medical evidence for pediatricians to learn how to care for their overweight pediatric patients in the office setting.
Difficulty in Defecation in Infants with Gastroesophageal Reflux Treated with Smaller Volume Feeds Thickened with Rice Cereal
Authors: Mascarenhas Ryan , Landry Lisa , Khoshoo Vikram
Published: March 2006

We prospectively evaluated the incidence of difficulty in defecation in infants with gastroesophageal reflux who were treated with smaller volume feeds thickened with rice cereal and also assessed the effect of changing the cereal to oatmeal. We evaluated 53 thriving infants with uncomplicated gastroesophageal reflux who were treated with smaller volume feeds thickened with rice cereal. Parents maintained records of bowel movements for 7 days. Rice was substituted by oatmeal cereal in those infants developing difficulty in defecation and another 7 days’ record was kept. Of the 53 infants enrolled, 34 (64%) reported no difficulty in defecation, 8 (15%) reported mild difficulty, and 11 (21%) reported severe difficulty in defecation during rice-based feedings. In these symptomatic 19 infants, after rice was substituted by oatmeal cereal, 10 infants (52.6%) reported no symptoms, 6 (31.6%) had mild symptoms, and 3 (15.8%) continued to have severe symptoms. We conclude that difficulty in defecation is common during treatment of infants with gastroesophageal reflux with smaller volume feeds thickened with rice cereal. Substitution of rice with oatmeal cereal results in partial or complete resolution of symptoms in most of these infants.
Kawasaki Disease Hospitalizations in a Predominantly African-American Population
Authors: Abuhammour Walid M. , Hasan Rashed A. , Eljamal Ahmed , Asmar Basim
Published: March 2006

This is a descriptive study of the occurrence of Kawasaki disease (KD) in an urban population that was a majority of African Americans. Records of 189 children (mean age, 2.9 ± 2.2 years [range: 2 months to 11.1 years]) hospitalized for KD over 8 years (January 1, 1992 to December 31, 1999) were reviewed and data analyzed. One hundred thirty-six (72%) were African American (AA), 43 (23%) were white, and 9 (5%) children were “others.” The annual frequency was 15 for AA and 7.7 for white per 100,000 5-year-old children. Coronary artery abnormalities (CAA) were reported in 21 (11%) children (18 [13.2%] of 136 AA, and 3 [4.7%] of 43 whites [p=0.095]). AA children with CAA were older than their white counterparts (26 to 24 vs. 5 to 2.8 months, p=0.03). There was a higher occurrence in winter and spring (110 cases [58%] vs. 79 cases [42%]) compared to summer and fall. KD occurrence was positively associated with average monthly snowfall (r=0.35, p=0.004) and inversely associated with average monthly temperature (r= - 0.2, p=0.048). African-American children were more likely to be hospitalized for KD compared to white children. The association of KD with temperature and precipitation suggest that it is influenced by environmental factors.
Tracheomalacia and Bronchomalacia in 34 Children: Clinical and Radiologic Profiles and Associations with Other Diseases
Authors: Yalçın Ebru , Doğru Deniz , Özçelik Uğur , Kiper Nural , Aslan Ayşe Tana , Gözaçan Ahmet
Published: March 2006

We reviewed our experience on tracheomalacia (TM) and bronchomalacia (BM) in children who presented with chronic respiratory problems and evaluated their clinical and radiologic characteristics and their associations with other disorders. There were 26 males and 8 females with a median age of 9 months. The main symptoms were wheezing, persistent or recurrent pneumonia, and chronic cough. Atelectasis on chest radiograph was the most common sign. Of 23 children with TM, 1 had a double aortic arch, 1 had tracheoesophageal fistula, and 1 other had associated laryngomalacia. BM was found in 27 children and was predominantly seen on the right side. TBM was found in 16 cases (in an infant TBM was accompanied by pharyngeal dyskinesia and in another by laryngomalacia). Malacia disorders were associated with gastroesophageal reflux, cardiovascular anomalies, and tracheoeosophageal fistula. TM and BM should be considered in the differential diagnosis of children with chronic and recurrent respiratory symptoms. Early diagnosis of malacia disorders will prevent unnecessary use of antibiotics or antiasthmatic drugs, which are often abused to treat these children. In these patients, treatment for associated diseases should also be considered.
Brain Imaging Findings in Neonatal Hypoglycemia: Case Report and Review of 23 Cases
Authors: Alkalay Arie L. , Flores-Sarnat Laura , Sarnat Harvey B. , Moser Franklin G. , Simmons Charles F.
Published: March 2006

A hypoglycemic infant with secondary occipital brain injury defined by serial computed tomography and magnetic resonance imaging is described. An additional 22 similar cases were previously published in the English language literature. A total of 23 cases (including the present case) were reviewed. Abnormal brain imaging findings are associated with profound hypoglycemia and show involvement of the occipital lobes in 82% of affected newborns. Half of these infants had visual impairment, and their median and range of plasma glucose values, and postnatal age when hypoglycemia was first detected, were 7 mg/dL (range, 2-26 mg/dL) and 48 hours (range, 1-72 hours), respectively.
Intussusception Incidence Relative to Rotavirus Vaccine Use in Honolulu
Authors: Lee Yvonne Y. , Lee Rachel , Yamamoto Loren G.
Published: March 2006

Rotavirus vaccine was in use during the period August 1998 to October 1999. Epidemics of intussusception during this period were allegedly due to rotavirus vaccine, which prompted the vaccine to be withdrawn. Hawaii’s geographic location between Asia and the mainland United States may subject it to infectious disease epidemic periods midway between occurrence in Asia and occurrence in the mainland United States. In contrast, immunization recommendations are temporally identical across all 50 states. The purpose of this study was to determine whether an epidemic of intussusception was experienced in Honolulu during the period of rotavirus vaccine use. This is a retrospective study of data obtained from inpatient and emergency department discharge diagnosis codes of intussusception for children up to 36 months of age. The incidence data were plotted by time periods to identify possible epidemic periods. The data are graphed. The arrows on the graphs indicate the period of time that rotavirus vaccine was in use. These graphs are most consistent with an increase in the cases of intussusception during the period July 2000 to December 2000, and a possible decline of intussusception during the rotavirus vaccine period. These incidence data are inconsistent with a temporal association between rotavirus vaccine and an epidemic of intussusception in Honolulu.
Failure to Thrive: Still a Problem of Definition
Authors: Olsen Else Marie
Published: March 2006

The term ‘failure to thrive’ (FTT) is widely used to describe inadequate growth in early childhood. However, no consensus exists concerning the specific anthropometrical criteria to define this description. The aim of this study was to make an updated assessment concerning the use of FTT definitions and describe possible trends regarding the use of specific criteria. A cross-sectional review was done covering English-language articles published from January 2003 until June 2004, and recent textbooks of general pediatrics. Most of the reviewed literature broadly defined FTT as inadequate growth and total agreement existed to define FTT based solely on anthropometrical parameters. Large differences, however, were seen regarding which growth parameters to use and whether to use attained values or velocities. Weight was the most predominant choice, but many included more than one anthropometrical parameter. Failure to thrive in children is currently described solely based on anthropometrical indicators, with weight gain as the predominant choice of indicator and cut off around the 5th percentile. Discussion is needed as to whether the term ‘failure to thrive’ is still a useful common term for pediatric undernutrition of different types.
Gaps in Pediatricians’ Advice to Parents Regarding Early Childhood Aggression
Authors: Scholer Seth J. , Nix Robert L. , Patterson Barron
Published: March 2006

Persistent early childhood aggression is a strong predictor of violence later in life. To determine how well general pediatricians counsel parents regarding aggression management strategies, responses to open-ended questions and endorsements of specific aggression management strategies, among 27 pediatricians were evaluated. Sixteen (59%) screened regularly for aggression and 23 (85%) counseled (rather than referred) if there were parental concerns. Pediatricians were most likely to spontaneously recommend time-outs (85%) and verbal reprimands (78%) and much less likely to recommend other strategies such as redirecting (26%, p < 0.01) and promoting empathy (22%, p < 0.001). Pediatricians did endorse other aggression management strategies, however, when specifically asked about them. Pediatricians appear to take a limited approach to counseling parents of children with hurtful behavior. To increase health care providers’ role in violence prevention, more systematic efforts are needed to increase rates of screening for early childhood aggression and to broaden the scope of how pediatricians counsel parents.
Nutrient Deficiencies in Tube-fed Children
Authors: Skelton Joseph A. , Havens Peter L. , Werlin Steven L.
Published: March 2006

The charts of children with gastrostomy or jejunostomy tubes followed in the Tube Feeding Clinic at the Children’s Hospital of Wisconsin from January 1999 to June 2002 were reviewed. Prevalence of selected nutrient deficiencies were determined and their association with growth and caloric intake was measured. One hundred fifty patients (60% male) met the inclusion criteria. The mean age of children was 7 years 6 months (SD ± 5 years 4 months). As a proportion of total caloric intake, the mean percentage of calories from formula was 92% (± 15). No deficiencies of vitamins D or E were found. Ferritin concentration below lower limits of the age-appropriate range of normal (LLN) was found in 30 of 122 (25%) and hemoglobin was below LLN in 12 of 139 (9%). One patient each had vitamin A, calcium, phosphorus, and magnesium serum concentrations below LLN. Below normal serum zinc was found in 43 of 142 (30%). Ninety-one of 134 patients (68%) had below normal selenium levels, and 29 of 126 (23%) had both zinc and selenium deficiency. A significant association was found between percentage of recommended daily allowance (RDA) of calories received and selenium concentration below LLN. Patients with selenium deficiency received a mean of 75% (± 21) of the RDA of calories for age, whereas patients without deficiency received a mean of 91% (± 19) of the RDA of calories for age (p < 0.0001). There was a negative association between deficiency and weight for age: patients with selenium deficiency were 33% mean weight for age percentile (± 30), compared to 21% (± 27, p < 0.05) for those without selenium deficiency. There was a negative correlation between the percentage of RDA of calories and height for age, weight for age, and weight for height (p < 0.05).
Incidence of Meatal Stenosis following Neonatal Circumcision in a Primary Care Setting
Authors: Van Howe Robert S.
Published: March 2006

The objective of this study was to prospectively document the incidence of meatal stenosis in boys. The study included a consecutive sample of boys whose visit with the physician included a genital examination in a private primary care pediatric practice in rural northern Wisconsin. Meatal stenosis was diagnosed in boys from 1.94 to 12.34 years of age. The diagnosis was made in 24 of 329 circumcised boys who were Tanner I development and older than 3 years of age (7.29%, 95%CI=4.48-10.10%). Nearly all required meatotomy to resolve their symptoms. All of the boys with meatal stenosis were circumcised neonatally (exact OR=3.54, 95%CI=0.62-∞). The ratio of circumcised boys to noncircumcised boys in this study provided 80% power to demonstrate a 21.4% difference in the incidence of meatal stenosis between circumcised and noncircumcised Tanner I boys 3 years and older. Meatal stenosis may be the most common complication following neonatal circumcision. The frequency of this complication and the need for surgical correction need to be disclosed as part of the informed consent for neonatal circumcision. A careful meatal examination is indicted in any circumcised boy with abdominal or urinary complaints.
A Study of Family Head Shape: Environment Alters Cranial Shape
Authors: Pomatto Jeanne K. , Calcaterra Jennifer , Kelly Kevin M. , Beals Stephen P. , Manwaring Kim H. , Littlefield Timothy R.
Published: March 2006

A change in the type of cranial deformities (plagiocephaly) presenting to certain clinics has occurred. The purpose of this study was to compare infant head shapes against head shapes of their biologic parents to explore the roles of heredity and environment on cranial shape. Standardized family photographs and anthropometric measurements demonstrated that 30% of the infants had cranial widths 2 standard deviations above norm, while 4.6% had widths exceeding 3 standard deviations. Despite a mean age of only 8 months, 11.6% had widths that were already greater than that of 1 parent. These results demonstrate that plagiocephaly has taken on a new configuration, presenting not only with asymmetry, but also with excessive cranial width.
Does a Mother Singing to her Premature Baby Affect Feeding in the Neonatal Intensive Care Unit?
Authors: Blumenfeld Hugh , Eisenfeld Leonard
Published: March 2006

Recent studies suggest that premature neonates exposed to music have reduced symptoms of stress, faster weight gain, and shorter neonatal intensive care unit (NICU) stays. This pilot study attempted to measure contingent effects of mothers’ singing during feedings. Mothers sang to their babies during 2 of 4 feedings on 2 consecutive days, logging songs they sang, and subjectively evaluating each feeding. Infants’ heart and respiration rates were recorded as well as duration of feeding and volume of fluid taken orally; feeding velocity and percent of feeding goal were calculated. In paired t tests, no significant benefits or deterents assignable to the singing were observed.
Safe Removal of Upper Esophageal Coins by Using Magill Forceps: Two Centers’ Experience
Authors: Cetinkursun Salih , Sayan Ali , Demirbag Suzi , Surer Ilhami , Ozdemir Tunc , Arikan Ahmet
Published: March 2006

Coin ingestion with subsequent esophageal coin impaction is common in children. Considerable debate surrounds the choice of technique for the removal of esophageal coins. This study demonstrates a minimally invasive technique for upper esophageal coin extraction. A retrospective review was conducted of 165 children who had upper esophageal coins extracted by using a Magill forceps. One hundred fifty-six coins (96.4%) were successfully removed without any complications. The average time taken to remove the coin was 33 seconds. Use of the Magill forceps technique minimizes instrumentation of the esophagus and is an easy, safe technique for removing coins from the upper end of the esophagus.