Clinical Pediatrics

Oral health is a prevalent health issue for children. Pediatricians have an important role in screening, educating, and making referrals during well-child visits. Advice must be age-specific to be effective. Topics to be covered include hygiene, diet, habits, fluoride, and referrals to dentists. Other members of the office can play a role in educating care givers. Special needs children and literacy issues demand extra attention in oral health management. There are many oral health resources available for pediatricians and parents.

Although the incidence of acute mastoiditis has been substantially reduced since the introduction of antibiotic therapy, mastoiditis complications are still commonly seen in the pediatric population. Many of these cases require lengthy hospitalizations and extensive medical and surgical interventions. Accordingly, a safe, effective, and resourceful diagnostic and therapeutic plan must be executed for the workup and treatment of each patient suspected of having acute mastoiditis. With thorough clinical evaluations, early diagnosis, and close follow-up, a large proportion of children with severe acute otitis media or early stage mastoiditis can be managed in the primary care setting without immediate surgical specialty involvement. This review presents an overview of the anatomical and pathophysiological considerations in acute mastoiditis and offers pediatricians a practical, evidence-based algorithm for the diagnostic and therapeutic approach to this disease.

Although there are many published studies on factors associated with medical student career choice, few are specific to pediatric careers, and even fewer address the choice between general and subspecialty pediatric training. Fourth-year medical students surveyed at 2 schools reported their demographics, anticipated future income, the factors influencing their career choice, and their anticipated career. This study included the subset of 337 students planning pediatric careers. Results indicated that marital status, anticipated income, and career values are associated with pediatric career plans. Specifically, married students were more likely than unmarried students to pursue general pediatric careers (P < .01). Compared with students planning subspecialties, those intending to pursue general pediatric careers anticipated lower incomes ($110 906 vs $135 984; P < .001) and rated lifestyle, comprehensive patient care, and working with the poor as more important (P < .05) when choosing a career. Students planning subspecialty pediatric careers placed more value (P < .05) on prestige, income, and research opportunities.

Objective. The objective was to evaluate the feasibility of delivering a pediatric weight management intervention adapted for low-income families.Academic researchers, a Medicaid health plan, a State Medicaid agency, and community pediatric providers partnered in the project. Methods. Participants were 48 families with 52 overweight/obese children aged 4 to 12 recruited from Medicaid health plan and providers’ offices. Elements of efficacious pediatric obesity interventions were modified for low literacy and implemented in person and telephonically with parents. Results. Families report ents in food shopping and preparation, and child eating and activity habits. The retention rate was 88%. Children grew significantly taller (F = 7.1; P = .012) but did not gain significant weight (F = 0.91; P = .35), with a trend toward decreased BMI ( F = 3.2; P = .08). Conclusions. The authors demonstrate the feasibility of delivering an adapted pediatric obesity intervention with low-income families. They also discuss implications for public—private partnerships among key stakeholders to address pediatric obesity in this high-risk population.

Through a questionnaire, the authors sought to elicit information about initial attitudes concerning circumcision after reading a summary of the American Academy of Pediatrics (AAP) Policy Statement and, again, after reading a description of recent HIV/HPV studies. Predictors of increased support for circumcision included having a prior circumcised boy and being US born. Predictors of decreased support included being of Hispanic ethnicity and believing that the uncircumcised penis was more culturally normal. After reading the AAP statement, 86% of respondents remained favorable of elective circumcision, whereas 13% viewed it less favorably. After reading the passage about the HIV/HPV studies, the majority maintained their initial level of support. Certain characteristics were associated with an individual’s desire to perform circumcision on his/her infant. Despite a slight decrease in support to perform circumcision after reading the AAP policy summary, respondents’ initial attitudes toward circumcision were unchanged after subsequent review of recent HIV/HPV research.

To describe pediatric clinicians’ adherence to practice recommendations for obesity prevention and treatment, we conducted a cross-sectional analysis of 227 medical records of 3- to 18-year-old patients (seen from September 2003 to April 2004) and a longitudinal analysis of data from 632 overweight and obese patients (followed through March 2006). The cross-sectional analysis showed that early practice adopters (n = 3) more frequently recorded BMI (91% of patients), a diagnosis (89%), and counseling (82%) compared with late adopters (n = 9; 34%, 51%, and 48% of patients, respectively; P < .001). The longitudinal analysis showed that among overweight and obese patients, documentation of BMI dropped from 96% at the first clinic visit to 27% by the fifth visit; documentation of individual risk behaviors fell from ≥72% at the first visit to ≤23% at the fifth visit. Despite initial adoption of screening and assessment practices, clinicians’ attention to weight management diminished over time.

Backgound. Today it is known that celiac disease (CD) may be silent or present with atypical extraintestinal symptoms (silent/atypical CD). Case report. The authors report the case of a 3-year-old child in whom the diagnosis of CD was made after several admissions to hospital for recurrent febrile infections and persistently moderate neutropenia. After the beginning of a gluten-free diet, we observed a remission of febrile infections and an increase in neutrophil count until it reached normal ranges. Conclusions. We suggest that recurrent febrile infections and moderate neutropenia be included in the diagnostic workup for atypical/silent CD in the general population.

Objective. To determine the information needs of parents of children with attention-deficit/hyperactivity disorder (ADHD). Method. A cross-sectional survey of parents recruited from pediatric hospital clinics, support groups, and newspaper advertisements in Victoria, Australia, was undertaken. Parents completed a questionnaire covering information sources accessed, the quality of this information, the information content they considered important and their preferred information modes. Results. Survey data were collected from 99 parents. Parents most frequently accessed information from pediatricians (89%), books (78%), general practitioners (65%), and schools (61%). Pediatricians were rated highest as a useful, trusted, easy-to-understand, and up-to-date information source. Parents placed most importance on causes and symptoms at the time of diagnosis. Parents preferred to receive verbal information from a professional (69%). Conclusion. Information provision for parents of children with ADHD is a continuous process. Although they access a range of sources and modes, parents prefer verbal information delivery.

Background. Although the negative impact of maternal stress during pregnancy on stress reactivity in offspring is well documented in nonhuman animals, we know little about these relations in humans and their lasting effects. Aim. The authors examined the relation between perceived maternal stress during pregnancy and stability of infant stress reactivity across the first year of postnatal life in humans. Study design. Perceived maternal stress during pregnancy was measured in the immediate postpartum period and again at 10 months after delivery in 84 mothers and examined in relation to behavioral and neuroendocrine stress reactivity measures in their healthy, full-term infants. Outcome measures. Salivary cortisol was collected between 24 to 48 hours of postnatal life in response to a heel stick and again at 10 months of age in response to a toy removal task in the same sample of infants. Behavioral reactivity was coded from direct observation during the toy removal task. Results . Perceived maternal stress during pregnancy and neonatal cortisol reactivity each remained stable across the first 10 months of postnatal life. Maternal stress during pregnancy predicted infant cortisol reactivity at 2 days and 10 months after birth as well as behavioral reactivity at 10 months. Neonatal cortisol reactivity predicted 10-month behavioral reactivity. Conclusion . These preliminary findings suggest that maternal stress during pregnancy may negatively affect neonatal stress reactivity within 24 to 48 hours after birth, and these influences may persist through the first year of postnatal life.

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency of the neonate. Previous information about this disease has largely been gathered from limited series. We analyzed 13 years of the National Inpatient Sample (NIS) and 3 years of the Kids’ Inpatient Database (KID; 1997, 2000, 2003) to generate the most comprehensive profile of outcomes to date of medically versus surgically treated NEC. We identified 20 822 infants with NEC, of whom 15 419 (74.1%) and 5403 (25.9%) were undergoing medical and surgical management, respectively. Overall, surgical patients had greater length of stay, total hospital charges, and mortality. Among infants dying during admission, there was no significant difference in length of stay or charges between the medical and surgical groups. These findings highlight the need for developing a clinically relevant risk stratification tool to identify NEC patients at high risk for death.

Background. The purpose of our study was to compare caregiver perceptions of fever between ethnicities in a population with a large percentage of Hispanics. Methods. A 20-item, cross-sectional survey was collected from English- and Spanish-speaking parents of children. Questions addressed level of parental worry, parental definition of fever and high fever, and other items related to fever and its potential outcomes and treatments. Results. Responses indicated 57% of all parents report being “very worried” when their child is febrile. Results also indicated that parental fear of fever varies by race. Worry was also significantly higher in parents of younger children, and in parents with fewer years of education. However, Hispanic ethnicity was the single most predictive factor for fever worry. Conclusions. Fever phobia continues to exist. The prevalence appears to differ by ethnicity, making it important for physicians to use every patient encounter for culturally sensitive fever education.

Duchenne muscular dystrophy (DMD) is among the most common lethal genetic diseases. It has been proposed that genetic counseling and prenatal diagnosis have begun to lower the incidence. We reviewed the records of all patients with confirmed DMD who were born between 1969 and 2008. Statistics Canada data on annual male births in Nova Scotia were obtained for each year.The overall incidence of 1 per 4700 male births remained stable during the 30-year period of the study. Similarly, the age at diagnosis did not change during that time.