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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
header with photos of various children
October 5, 2022 | Volume 13 | Issue 40
Heath Advisory: Melatonin use in children and adolescents
Melatonin is a hormone produced by the brain in response to darkness and assists in the timing of circadian rhythms and sleep.

Though supplemental melatonin (the second most popular “natural” dietary supplement given to children after multivitamins, and not under the oversight of the FDA) is used to enhance “falling asleep”, “staying asleep” or both, to enhance sleep in children whose “body clocks” are “off schedule” and in children with developmental problems having sleep difficulty, evidence for its efficacy and safety is not sufficiently robust to be recommended by either the American Academy of Sleep medicine or the American College of Physicians.

The number of reports to US Poison Control Centers for children( <19 years of age) who took melatonin has increased from 8,337 (2012) to 52,563 over 10 years, with hospitalizations and serious outcomes (particularly in children <5 years of age) increasing significantly.

A Health Advisory from the American Academy of Sleep Medicine (AASM) suggests that parents consult with their pediatrician prior to giving melatonin (or any supplement!) to their child, and strongly advises that should melatonin be used, parents select a product with a USP Verified Mark.
Read the full article at American Academy of Sleep Medicine
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Association of early oseltamivir in children hospitalized with Influenza
Oseltamivir (Tamiflu) is an oral antiviral drug (neuraminidase inhibitor) approved for the treatment or prevention (children >1 year of age) of acute, uncomplicated influenza in infants >2 weeks of age and older whose flu symptoms have not lasted >2 days. It improves clinical symptoms and shortens recovery time by 1-2 days and is usually considered for children at high risk of developing complications (e.g., those children with heart and/or lung disease, are immunocompromised and/or have other chronic illnesses) or for those with severe symptoms.

“Oseltamivir is recommended for all children hospitalized with influenza despite limited evidence supporting its use in the inpatient setting”.
 
From a multicenter retrospective cohort study of 55,799 children <18 years of age hospitalized with influenza which examined whether early (hospital day 0 or 1) use of oseltamivir is associated with improved outcomes, it appears that the antiviral treatment is associated with a shorter hospital stay, lower hospital mortality and a decreased risk of readmission, transfer to an intensive Care Unit, or use of extracorporeal membrane oxygenation (ECMO).

 
 
Transient synovitis (TS) of the hip: Current practice and risk of misdiagnosis
Transient synovitis (“irritable hip”) an inflammation of the hip joint that occurs in prepubescent children (2-8 years of age) is the most common cause of hip pain/limping in children. While the etiology is unknown, it most commonly occurs in children following a viral infection (boys 2-5 times more frequently than girls and often upper respiratory), is benign, lasts 1-2 weeks and causes no long-term problems. TS must however be distinguished from more serious hip conditions like septic arthritis, osteomyelitis and pyomyositis.
 
A cohort study (using the Pediatric Health Inflammation System of children 1-10 years diagnosed with TS seen in an Emergency Department) analyzed 6,419 encounters, and found only 62 (1%) of children had missed bacterial musculoskeletal infections (mostly occurring in younger children, mean age 2.6 years).

“The optimal combination of blood work and radiographic testing to distinguish TS from more serious disease remains unclear”.


 
Association of post-partum maternal mood with infant speech perception at 2 and 6.5 months of age
“Language development builds on speech perception, with early disruptions increasing the risk for later language development”.  
Major post-partum depression is associated with later language development in infants. Whether a depressed mothers’ mood at subclinical levels (a common phenomenon after birth), is associated with early speech perception trajectories from age 2-6.5 months is unknown.
 
From a longitudinal cohort study of 46 health mother-infant dyads assessed at 2 months, and 36 mother-infant dyads seen at 6 months follow-up, which examined whether a mother’s reported post-partum mood affects her infant’s speech perception, it appears that a subclinically depressed mood in a post-partum mother is significantly associated with weaker infant speech perception and potentially delayed language development. (Whether early post-partum maternal support will improve infant outcomes remains to be tested).
 
 
Pumpkin carving-knife injuries 
From the National Electronic Injury Surveillance System, 20,579 pumpkin related knife injuries were identified between 2012-2021. Patient demographics and injury data was analyzed to describe trends in incidence and injury patterns.
 
Pumpkin related knife injures have remained stable over time. Hand injuries (87.6%) are most frequent with the thumb (33.5%) and index finger (25.0%) most commonly affected. Demographic data indicates that injuries occur mostly in 10–19-year-olds (31.5%) followed by children <10 years of age (19.5%) and are seen primarily on Saturdays and Sundays in October/November.
“Public safety initiatives and education on safe pumpkin carving techniques could prevent serious injuries in the future”.
 
Detection of Messenger RNA (mRNA) COVID-19 vaccine in human breast milk
The cornerstone of fighting COVID-19 is vaccination. mRNA vaccine clinical trials however excluded young children and lactating mothers with the result that the US Food and Drug Administration (FDA) deferred the decision to authorize mRNA vaccines for infants <6 months of age.
 
In a small study of 11 lactating mothers trace amounts of mRNA COVID-19 vaccine was detected in the breast milk of some lactating women. Caution is warranted regarding breastfeeding infants <6 months of age particularly in the first 2 days after maternal vaccination
 
Injury rates per mile of travel for electric scooters (e-Scooters) vs. motor vehicles
From a secondary analysis of existing data of stand-up, dock-less e-scooter injuries presenting to an Emergency Department (vs. comparative injury data of motor vehicle-miles-traveled; VMT) it appears that the VMT-based e-scooter injury rate is approximately 175-200 times higher than Statewide or County-specific injury rates for motor vehicle travel.
 
 
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Pediatric & Adolescent Scoliosis: Evaluation & Basic Principles of Treatment

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