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This Month in Archives of Pediatrics and Adolescent Medicine
October 2003

This Month in Archives of Pediatrics & Adolescent Medicine

Author Affiliations

Copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2003

Arch Pediatr Adolesc Med. 2003;157(10):951. doi:10.1001/archpedi.157.10.951
Effects and Costs of Requiring Child-Restraint Systems for Young Children Traveling on Commercial Airplanes

The Federal Aviation Administration has been planning a new regulation that would require children younger than 2 years to ride in an approved child-restraint seat on airplanes. This would mean that parents would have to buy separate seats for their young children; parents could no longer carry children on their laps in planes. Newman and colleagues examined the implications of this proposed policy if parents chose to drive to their destinations instead of fly because of the increased cost. Increased deaths from motor vehicle crashes would exceed deaths prevented by restraint use on planes if more than 5% to 10% of families switched from plane to car travel. Moreover, for each $1 increase in the cost of plane travel per family, the cost per death prevented would increase by $64 million.

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Net effect of mandated child-restraint system use as a function of the proportion of families who choose to drive rather than fly and the average number of miles driven per diverted enplanement. The labeled isocontour lines show the specified net change in the annual number of deaths.

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A Meta-analysis of Randomized Controlled Trials Evaluating the Efficacy of Epinephrine for the Treatment of Acute Viral Bronchiolitis

This systematic review examined 14 randomized trials comparing epinephrine with a placebo or other bronchodilators. Among outpatients, epinephrine appeared to be better than the placebo and albuterol for short-term effects. However, there was inadequate evidence to make any conclusions about use of epinephrine in inpatient settings. The frequency of the problem and the costs for care demand that large-scale multicenter randomized trials be conducted.

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Abusive Head Injury as a Cause of Apparent Life-Threatening Events in Infancy

Episodes of apparent life-threatening events involving changes in an infant's breathing pattern, color, and muscle tone are frightening to parents and often perplexing to pediatricians. In this series of 243 infants admitted for these episodes, Altman and colleagues found that the most common causes were reflux and seizures. In 6 infants (2.5%), an abusive head injury was the cause, and 2 of these infants died. While a wide spectrum of mostly benign disorders can cause these apparent life-threatening events, child abuse must be considered, and an appropriate evaluation should be done early in the hospital admission.

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Trends in Psychotropic Medication Costs for Children and Adolescents, 1997-2000

The use of psychotropic medications in children has become a highly visible issue among both the lay and medical press. The cost implications are substantial, since medication costs are the fastest growing part of the health care budget. To provide more information on the factors underlying changes in psychotropic medication costs in children, Martin and Leslie examined insurance claims data from a national, 4-year sample. The largest changes in use were in atypical antipsychotics, atypical antidepressants, and selective serotonin reuptake inhibitors. Costs increased by 18%, more than half of which was due to a change in costlier medications within the same class of drugs. Almost half of the increase in cost was accounted for by 3 drugs.

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