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Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP
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November 17, 2021 | Volume 12 | Issue 46 |
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Association of Attention Deficit/Hyperactivity Disorders (ADHD) diagnosis with Pediatric Traumatic Brain Injury (TBI) |
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“TBI is the leading cause of acquired disability in children and ADHD is one of the most common neurodevelopmental sources of disability”. The association between the two is unresolved at present.
A meta-analysis of 24 studies (including 12,374 children with TBI and 43,491 unique controls, aged 4-18 years) assessed whether traumatic brain injury (concussion and mild, moderate, or severe TBI) are associated with an increased risk for ADHD.
The odds for ADHD are not significantly increased following concussion, mild or moderate TBI. Following severe TBI there is a 4.81 fold increase in the likelihood of ADHD (compared to children with other injuries) with 35.5% having ADHD >1 year post injury (it is of interest that the 16.0% rate of pre-TBI ADHD found is significantly higher than the 10.8% incidence of ADHD found in the general population – ADHD symptoms may predate injury).
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Read full article at JAMA Pediatrics
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Association between prenatal exposure to metals and atopic dermatitis in children aged 4 years |
There are multiple adverse intrauterine and postnatal consequences of metal exposure (e.g. nickel, arsenic, lead, mercury, cobalt) during pregnancy through disruption of maternal hormones, fetal cellular growth and development and alterations in the immune system, with increases in miscarriages, stillbirths, birth defects, neurodevelopmental disorders and potentially increased infant asthma (allergic airway inflammation), eczema (atopic dermatitis) and food allergy.
A cohort study of 370 mother and child pairs examined the prenatal exposure to arsenic and other metals against the occurrence of atopic dermatitis in offspring at 4 years of age.
29.7% of children born to pregnant mothers exposed to inorganic arsenic and cadmium have atopic dermatitis and other allergic disease (2.42 times greater risk for every doubled increase in inorganic arsenic).
Videos
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How much opioid do kids actually need? |
A prospective cohort study of 87 children (mean age 10.1 years) with operative fractures examined post-discharge opioid and other analgesic use (days 1, 3 and 5) and pain over the preceding 2 days. Complications, pain control and opioid refills were recorded.
“Pain is consistently well-controlled after operative pediatric fractures”. Acetaminophen/non-steroidal anti-inflammatory drugs (NSIDS) are given 82% of the time (inconsistently) before opioids. For 97% of children prescribing <8 opioid doses is adequate for pain control. Opioids are given 4-5 times the amount needed. (“Poorly controlled pain should prompt early evaluation for possible complications”).
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Prevalence of detection of Clostridioides difficile (C. diff) among asymptomatic children |
“C. diff is an in important cause of antibiotic-associated diarrhea and one of the most common healthcare-associated pathogens”, with a wide range of clinical presentations from asymptomatic colonization, mild diarrhea to fulminant disease (characterized by lieus, toxic megacolon, hypotension and/or shock). Often a stool is tested for C. diff. when a child presents with diarrhea lasting several days with or without a previous history of antibiotic exposure during the previous month.
A systematic review and meta-analysis of multiple databases utilized 95 studies with 19,186 participants to assess the prevalence of C. diff. (Toxigenic and non-toxigenic) detection among asymptomatic children across the age spectrum. C. diff. colonization is detected in 41% of asymptomatic infants aged 6-12 months (14% toxigenic) and 12% (lowest) among children 5-18 years.
“C.diff test result interpretation should include consideration of the high likelihood of C. diff. colonization in young children”.
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Comparison of minimally invasive loop drainage and standard incision drainage of cutaneous abscesses in children |
“Subcutaneous abscesses are common in children and incision and drainage remains the gold standard of treatment”. The loop technique (using a Penrose drain or vessiloop) is a minimally invasive treatment of abscesses that allows for continuous drainage and eliminates the need for packing changes.
A prospective control trial randomized 81 children seen in a Pediatric Emergency Department (ED) with skin abscesses to receive standardized or vessel loop drainage and assessed, before discharge, at 24-48 hours and 14 day follow-up, treatment failure (re-instrumentation or admission for intravenous antibiotic), satisfaction score, wound appearance and visit frequency.
Abscess drainage with a vessel loop in the pediatric ED gives similarly favorable results to standard incision and drainage, with less intervention needed.
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A longitudinal study of Assisted Infant Toilet Training (AITT) during the first year of life |
“Potty training success hinges on physical, developmental and behavioral milestones not age” and the perfect age to begin potty training may be different for every child. It takes 3-12 months from the onset of training (usually around 18 months of age) to daytime toilet independence and most children are successfully trained by 2.5 years-4 years of age (98% by age 4 years). Earlier AITT has been utilized in non-Western settings.
A longitudinal cohort study (utilizing standardized caregiver interviews at 1-2 months intervals) of 85 participating families with 87 children recruited to start AITT before 4 months of age (mean age 2.5 months) describes the practice of AITT and caregiver satisfaction in a Western setting during the first year of life.
88%-94% of Western infant caregivers can identify infant’s elimination signals which results in the number of toileting attempts decreasing from 3-4 months of age. Use of “trainers” and “underwear” increases significantly with high caregiver satisfaction (and a positive association with daytime and nighttime dryness).
“Early AITT (during the first year of life) is a worthy viable alternative to the use of diapers even in the Western setting.
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Hydrocarbon intoxication in children |
Hydrocarbon intoxication occurs primarily on 3 settings:
- Childhood accidental ingestion of kerosene, paraffin, etc. mostly seen in low-middle income countries.
- Adolescents/young adults intentionally abusing volatile hydrocarbons by inhalation (e.g. glues, solvents, paints, gasoline, etc.).
- Adolescents/adult workers with dermal or inhalation occupational exposure (e.g. naphtha, paint thinners, etc.).
Many body systems may be deleteriously affected (depending on the methodology of exposure and hydrocarbon utilized). Frequently the lungs, central nervous system, cardiovascular system, skin, liver and immune systems may be damaged. In children most complications seen are associated with pulmonary aspiration following kerosene ingestion (low viscosity and surface tension).
A study of 172 hospitalized children following ingestion of kerosene indicates that most occur in boys, frequently from a crowded home, and the kerosene is usually stored in bottles or other easily accessible containers. Children often present with mild/moderate symptoms – cough, vomiting, and decrease in level of consciousness followed by fever and dyspnea from chemical pneumonitis. Occasional deaths do occur. Most cases of kerosene poisoning in children are preventable.
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