Treatment of children with otitis media with effusion continues to plague the practicing pediatrician. One treatment option is the use of steroids, either nasally or orally. Butler and van der Voort conducted a systematic review of the world's literature on this topic. The 10 randomized trials that have examined this found an overall 68% reduction in persistent effusion following a course of antibiotics and oral steroids. However, there was no evidence for a long-term benefit on hearing.
Since sexually transmitted diseases (STDs) are relatively common and can result in significant morbidity, routine screening of all sexually active adolescent girls has been advocated. Smith and colleagues found that 100% of 512 adolescent girls choose self-obtained vaginal swabs over pelvic examination in screening for STDs. More than a quarter of the study population was found to have 1 or more treatable STDs. The use of self-obtained swabs, combined with newer tests, has potential to be significantly effective in controlling STDs in adolescents.
Adequate sedation for children in the emergency department undergoing procedures such as computed tomography scans is necessary but difficult to consistently achieve. Many of the current medications are associated with long periods of onset or recovery and are not ideal for short procedures. This study of 55 patients in an urban pediatric emergency department found that the administration of intravenous methohexital resulted in an onset of sedation within 1 minute, lasted only an average of 14 minutes, and was effective in all but 2 patients. Intravenous methohexital may represent an appropriate choice for short-duration sedation in pediatric emergency departments.
Parents and pediatricians alike are concerned about injuries caused by firearms. One potential method to decrease such tragedies is safe storage of firearms kept in the home. Coyne-Beasley and colleagues conducted a community-based intervention with parents to change storage practices. The program was dramatically successful in increasing trigger lock use, storing guns in locked compartments, and storing guns unloaded. The intervention demonstrates that the hazards associated with guns can be reduced.
There are currently no recommendations from the Centers for Disease Control on postexposure prophylaxis for human immunodeficiency virus in children and adolescents. Babl and colleagues surveyed the directors of all pediatric infectious disease programs and pediatric emergency departments in the United States to identify recommended practices. Pediatric infectious disease experts were more likely than pediatric emergency medicine physicians to recommend postexposure prophylaxis for the scenarios of a 5-year-old with an accidental needlestick injury from a needle found in a park, and for a 15-year-old after sexual assault. There was a great deal of variability on the drugs and therapy duration recommended. This study points out the need for a national consensus and guidelines for postexposure human immunodeficiency virus prophylaxis in children and adolescents.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2001;155(6):635. doi:10.1001/archpedi.155.6.635