Copyright 2002 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2002
Nutritional anemia is a common problem among adolescent girls around the globe in both industrialized and nonindustrialized countries. Effective treatment is often hindered by lack of compliance. In this randomized controlled trial of anemic adolescent schoolgirls in Nepal, Shah and Gupta found that once-weekly supplementation with iron and folate raised the hematocrit as much as daily supplements with the same dose of iron and folate. Weekly treatment seems to be as effective as daily nutritional supplements and may offer the advantage of lower cost and improved compliance.
Appropriate management of asthma, as with any chronic illness, involves the child and family learning effective self-management skills. This randomized controlled trial evaluated the effect of a computerized interactive asthma self-management and education program, the Health Buddy, in 8-year-old to 16-year-old children with asthma. The program resulted in a 50% reduction in reported limitation of activities and a 30% decrease in reported coughing or wheezing, although there was no effect on health services utilization. Easy-to-use Internet-based devices such as the Health Buddy may be useful tools to empower chronically ill children to care for themselves.
In another illuminating study from the Tucson Children's Respiratory Study, Ball and colleagues found that children who were in large day care centers during the first 3 years of life had more frequent colds at age 2 years but had 60% to 70% fewer colds during ages 6 through 11 years. Children attending large day care centers for more than 2 years also had fewer colds at ages 6, 8, and 11 years than children attending day care for only 12 months or less. Regardless of whether children acquire immunity to viral respiratory infections in preschool or primary school, they seem to have similar levels of protection by 13 years of age. This study provides reassuring information to parents and clinicians as pointed out by Bergman in his accompanying editorial.
Kawasaki disease is now the leading cause of acquired heart disease in childhood, but its long-term prognosis is still unknown. In this study from Japan, 6576 children with Kawasaki disease were followed for a mean time of 12.6 years. Cardiac sequelae occurred in 15.3% of patients. There was an increased mortality during the acute phase of the illness, but overall, the standardized mortality ratio was not elevated following the acute phase. Only among males with cardiac sequelae was there an increased risk of death during the postacute, follow-up period. For the vast majority of patients with Kawasaki disease who do not have cardiac sequelae, there does not seem to be a later increased risk of death.
Reflux is commonly encountered in both the office and hospital settings. Nonpharmacological remedies such as positioning, formula changes, and thickened formula are commonly recommended. In this systematic review, Carroll and colleagues found no evidence to support the use of infant seats, elevating the head of the bed, use of a pacifier, or formula changes on the symptoms of reflux in infants. Thickened formula was the only intervention that reduced the frequency of emesis.
Concerns about early discharge of newborns from the hospital continue. The most common reason for rehospitalization is infant dehydration and failure to gain weight. In this study from Kaiser Permanente, the incidence of rehospitalization for dehydration was 2.1 per 1000 live births. Most rehospitalizations occurred between 24 and 72 hours after initial discharge. Serious sequelae of dehydration were rare. Risk of dehydration requiring rehospitalization was increased among infants born to first-time mothers, infants who were exclusively breastfed, and infants born to older mothers. Adherence to the American Academy of Pediatrics follow-up guidelines did not seem to decrease the risk of dehydration and rehospitalization.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2002;156(2):103. doi:10.1001/archpedi.156.2.103