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This Month in Archives of Pediatrics and Adolescent Medicine
August 2010

This Month in Archives of Pediatrics & Adolescent Medicine

Author Affiliations

Copyright 2010 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2010

Arch Pediatr Adolesc Med. 2010;164(8):693. doi:10.1001/archpediatrics.2010.134
Child Hunger Has Long-term Adverse Consequences for Health

Financial challenges in accessing adequate food, termed food insecurity, is an increasing problem in North America, affecting as many as 1 in 7 households in the United States in 2008. This longitudinal study of 5809 children and 3333 adolescents assessed whether the experience of hunger during childhood is associated with poorer subsequent health outcomes. Both ever being hungry and multiple episodes of hunger were associated with poorer health status among children. Youth with repeated episodes of hunger exhibited higher odds of chronic conditions and asthma. Severe food insecurity is an identifiable marker of vulnerability to longer-term poor health.

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Effects of Unilateral Clefts on Brain Structure

Nonsyndromic or isolated cleft lip and/or palate (ICLP) is one of the most common congenital disorders today, and it affects 10 to 11 infants per 10 000 births. Prior studies suggest that cognitive and behavioral abnormalities in ICLP are directly related to structural abnormalities in the brain. This study examined the association between side of unilateral clefts, including both cleft lip only and cleft lip and palate, and brain development in 33 boys aged 7 to 17 years. Cerebral and cerebellar white matter volume was significantly reduced in boys with right clefts compared with boys with left clefts and healthy boys. Within the cerebrum, reduced white matter volumes were evident in the frontal lobes and the occipital lobes. These findings are the first to suggest that laterality of clefts does have a differential effect on brain structure and related behavior.

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Intranasal Midazolam vs Rectal Diazepam for the Home Treatment of Seizures

In the United States, rectal diazepam is the most common “rescue medication” given to families for home treatment of seizures. Disadvantages of rectal diazepam include the social awkwardness for patients and providers, potential for rejection, and its short half-life. In this randomized controlled trial of 358 children with epilepsy, the median time from medication administration to seizure cessation was 1.3 minutes shorter for intranasal midazolam than for rectal diazepam. Caretakers were more satisfied and report that intranasal midazolam was easier to administer than rectal diazepam.

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Time from medication use to seizure cessation (difference, 1.3 minutes; 95% confidence interval, 0.0-3.5; P = .09).

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Randomized Trial of the Palatability of Oral Rehydration Solutions in School-aged Children

Oral rehydration solutions may not be appealing to children owing to poor palatability, and consequently many mild to moderately dehydrated children may refuse to consume these solutions. This randomized crossover trial was conducted to determine whether 5- to 11-year-old children report taste differences between 3 oral rehydration solutions. There were significant differences regarding the best-tasting solution, with Pedialyte selected by 53%, Pediatric Electrolyte by 39%, and Enfalyte by 8% of the participants. Children were least willing to drink the Enfalyte again. Sucralose-sweetened solutions such as Pedialyte and Pediatric Electrolyte are significantly more palatable than the rice-based preparation Enfalyte. Given the similar content of the solutions evaluated and that the sucralose solutions are less expensive, perhaps they should be recommended as initial therapy.

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Box plot of the taste scores, unadjusted, for each of the 3 solutions—Enfalyte (Mead Johnson Nutritionals, Evansville, Indiana), Pedialyte (Abbott Laboratories, Abbott Park, Illinois), and Pediatric Electrolyte (PendoPharm, Mont-Royal, Quebec, Canada).

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