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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
header with photos of various children
September 29, 2021 | Volume 12 | Issue 39
Long-term symptoms after SARS-CoV-2 infection in children and adolescents
A longitudinal cohort questionnaire study which examined and compared symptoms lasting 4-12 weeks in non-hospitalized children/adolescents, who test positive for SARS-CoV-2 antibodies (vs. those who are seronegative) indicates that 40% (vs. 2% of controls) complain of tiredness, headache, a congested nose, abdominal pain and difficulty concentrating.

By 6 months post-seroconversion there is a low prevalence of symptoms compatible with long-COVID, and most children are reported as being in “excellent health”.
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Living arrangements after parental separation: Impact on child’s mental health at age 7 years

From an extensive study of 39,661 children from the Danish National Birth Cohort living in a nuclear family at age 6 months which compared the mental health after separation in 7-year-old children living either in joint physical custody or with a sole physical custody family arrangement, it appears that living arrangements after parental separation minimally influences a child’s mental health at age 7 years.
Preparedness for Pediatric office Emergencies: A multicenter simulation-based study
Children who need emergency care may first present to a pediatric primary care office (incidence varies, with respiratory distress and seizure management being most common). The American Academy of Pediatrics (AAP) has a Policy Statement on Preparation for Emergencies in Pediatric offices and provides recommendations on personnel, equipment, medication, education, policies and protocols to optimize preparedness.

A multicenter observational study over a 15-month period which involved measurements of adherence to AAP Policy and Quality of care utilizing 2 simulated pediatric patients with emergencies, found that only non-independent practices with a larger staff size are adequately prepared for a pediatric emergency (while overall 82% have essential equipment and supplies; 82% of offices do not have an infant bag-valve mask).

Many offices (particularly smaller independent practices) do not have adequate emergency policies /procedures or appropriate equipment to address an acute pediatric emergency (an opportunity for a partnership with a larger practice offers an option for greater improvement. Ed).
Cardiac performance in the first year of life among preterm infants fed maternal breast milk
“There is a beneficial association between human breast milk exposure in the neonatal period and cardiac mechanics in adults who are born preterm”.

A cross-sectional cardiac and nutritional study of 80 individuals born preterm – median gestational age 27.0 weeks; median birth weight 960gm (vs. a control group born full-term) examined (cardiac function and pulmonary vascular resistance by echocardiography) whether this human milk beneficial effect is seen during the first year of life.

Higher exposure to mothers’ own milk in preterm infants enhances cardiac function and morphology on echocardiographic examination at age 1 year (approaching that of full-term infants).
 
Fluoride varnish application rates in young children
“Fluoride varnish is an important tool to reduce tooth decay which occurs in nearly 25% of children aged 2-5 years and over 50% of children aged 6-8 years”. The American Dental Association (ADA) recommends for children at risk for developing caries a 2.26% fluoride varnish or 1.23% fluoride (APF) gel applied every 3-6 months (or a prescription-strength house-use gel/paste or rinse for children 6 years or older).

89% of children <5 years of age see a pediatrician for routine preventive care while few privately insured children see a dentist during this time.

A study involving 328,661 medical well-child visits (in 4 States) in children < 5 yrs. of age, examined fluoride varnish application rates during pediatric well-child visits (a covered service since 2015) and identified characteristics associated with fluoride varnish receipt.

<5% of children < 5 years of age who routinely visit their pediatrician receive a recommended fluoride varnish application during their visit (despite mandatory insurance coverage in medical settings) . Substantial expansion of this service by pediatricians is critical to improving children’s oral health.
 
Medical disimpaction for children with an organic esophageal foreign body in the era of eosinophilic esophagitis (EoE)
“Esophageal foreign body impaction (EFBI) is a common presentation in pediatric emergency medicine”, with treatments including endoscopic and medical disimpaction methodologies (e.g., glucagon injections or carbonated beverages). Limited information on medical disimpaction for an esophageal impaction is available for children.

A retrospective chart review of 317 children (January 2010 – December 2014) who presented with an EFBI examined age, object ingested, medical agent used, EoE status, complications and outcomes.

Overall, 71% of esophageal impactions in children respond to medical disimpaction. Organic EFBI occurs in 31.9% of impactions. Children with EoE and impaction respond poorly to medical disimpaction attempts.
Clinical results of corrective cast and brace treatment for Early-Onset Scoliosis (EOS)
Scoliosis is an abnormal side-to-side “S” or “C” shaped curve of the spine. Early-onset scoliosis (as compared to Adolescent idiopathic scoliosis which is diagnosed at 10+ years) includes:

  • a. Congenital scoliosis – diagnosed at or shortly after birth.
  • b. Infantile idiopathic scoliosis – diagnosed before age 5 years.
  • c. Juvenile idiopathic scoliosis – diagnosed between ages 6 and 9 years.

Causes of EOS vary and treatments depend on the age, size and severity of the spinal curvature.
Cast and brace treatment is a conservative management approach for EOS.

A study of 22 children (mean age: 4.9 years) with EOS who underwent alternatively repetitive cast and brace treatments, analyzed (after 8.3 years) its clinical outcome when it is extended into school years.
41% children with EOS treated with prolonged cast and bracing will eventually require surgery. Those with an “idiopathic” cause of scoliosis require surgery after 9 years of age; among infants/children with “syndromic scoliosis” growth friendly surgery occurs at mean 9.2 years while those with “neuromuscular scoliosis” generally require surgery at 11.3 years.

Long-term alternatively repetitive cast and brace treatments extending into the school years appears beneficial for the management of Early-Onset Idiopathic Scoliosis.
 
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Contact the Editor | jackwolfsdorf@gmail.com