Interest in using piracetam to improve the cognitive function of children with Down syndrome dramatically increased following a nationally broadcast television program in 1995 and follow-up national television news programs in 1996 and 1997. Despite its the widespread use, there are no well-designed studies in the peer-review literature. This double-blind, randomized controlled trial tested piracetam in 18 children with Down syndrome. It had no effect on cognitive performance compared with placebo but was associated with adverse central nervous system stimulatory effects in 7 of the 18. The results are strikingly different from the testimonials presented in the popular press.
What happens when only a portion of children in day care centers is immunized against varicella? In 11 day care centers (N = 4064), of vaccine coverage increased from 4.4% in 1995 to 63% in 1999. Rates of varicella decreased by 81% in the vaccinated group and 91% in the unvaccinated. Despite substantial herd immunity, some children will be susceptible and at risk for complications if varicella is contracted at a later age.
The use of complementary and alternative medical (CAM) therapies is common and increasing in pediatric populations. However, little is known about pediatric inpatients' need for and interest in receiving consultation regarding CAM services. Kemper and Wornham describe their experience in providing CAM consultation at a tertiary center, (Boston Children's Hospital). Of the 70 patients seen, 61% were from the oncology unit. The most common goal for the consultation was to help manage symptoms, such as nausea, pain, and anxiety, followed by assistance in building up the child's strength and resilience. Most families were interested in information about herbs or dietary supplements. This study indicates the desire of many patients and families for CAM and the need to integrate CAM into regular care.
Pain control in children and adolescents coming to the emergency department with vaso-occlusive pain continues to be challenging. Ketoralac is a potent nonnarcotic analgesic with few adverse effects and known narcotic-sparing properties. Beiter and colleagues evaluated intravenous (IV) ketoralac as first-line therapy in the treatment of patients with sickle cell disease with moderate to severe pain. Of 70 episodes, 53% responded to IV ketoralac and IV fluids without requiring opoids. Patients who required narcotics were more likely to have more sites of pain and higher initial pain scores. First-line therapy with IV ketoralac seems to be successful in at least half of patients with acute vaso-occlusive pain.
It is well known that children in child care have higher rates of common communicable infections than children cared for at home. The effect of this higher rate of illness on children's development is unknown. This study prospectively followed more than 1200 children from birth to age 3 years. While the rates of illness were higher in children attending child care than in children reared exclusively at home during the first 2 years of life, these differences disappeared by age 3. There was no evidence that increased rates of illness had a negative effect on school readiness or language competence.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2001;155(4):437. doi:10-1001/pubs.Pediatr Adolesc Med.-ISSN-1072-4710-155-4-ptm0401