Despite the effectiveness of oral rehydration therapy, many emergency medicine and primary care physicians continue to preferentially use intravenous fluids for treatment of dehydrated children. In this randomized controlled trial of patients with moderate dehydration from acute gastroenteritis, patients treated with oral rehydration stayed in the emergency department 2 hours less, required less staff time, and were less likely to be admitted than patients treated with intravenous fluids. Parents of children who had received oral fluids were more satisfied with their care than those receiving intravenous fluids. This study did not address the barriers to the use of oral rehydration fluids as reported in the past, and indicates that oral rehydration should be much more widely used.
Counseling and reassuring parents is an important element in the pediatrician's management of infantile colic. This prospective study of 547 infants and their mothers found that 86% of infants with colic at age 6 weeks had resolution of their symptoms by 3 months of age. By this age, the mean amount of crying was about 1 hour per day. This study found little lasting effect of colic on maternal anxiety or depression.
Nurse home visitation has been found to have significant effects on parenting skills, risk of child abuse, and long-term outcome of mother and child interaction. Home visitation using volunteers has not been subject to rigorous evaluation. This randomized controlled trial evaluated the effect of home visitation by volunteer community mentors on teenage mothers, until the child was 15 months of age. The visited group had somewhat better parenting behavior scores, but there were no differences in parenting stress or mental health at age 15 months. Combined with other recent data, this study indicates that nonprofessional home visitors do not have as great an effect as do home visitors who are nurses.
A great deal of data indicate that air pollution increases the risk of respiratory illness in children; however, its effects on functional areas such as school attendance have not been well characterized. This study examined the effect of daily levels of air pollution on the school attendance of more than 1200 elementary school students in Seoul, Korea, throughout a 3-year period. Exposure to air pollutants such as particulate matter measuring 10 µm or smaller, sulfur dioxide, and ozone, was associated with a linear increase in the proportion of students absent from school because of illness.
Some have advocated wide-scale school-based asthma screening as a way to improve the health status and health care of children. However, no prior studies have evaluated the effectiveness of such programs on the number of new asthma diagnoses. This study reports a controlled trial of the effectiveness and feasibility of asthma screening using a mailed parent survey. Symptoms suggestive of possible undiagnosed asthma were reported for 7.6% of children; however, only 11.6% of children referred for possible asthma made a visit to a physician. Among the screened children, the proportion of children who had new physician diagnoses of asthma in the subsequent 6 months was similar to that found in a control group of nonscreened children. Asthma screening programs may not be useful.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2002;156(12):1170. doi:10.1001/archpedi.156.12.1170