ABSTRACT
Our objective was to evaluate the risk of short stature in children with attention-deficit/hyperactivity disorder (ADHD) and the effect of ADHD and its treatment on height-for-age z score (HAZ) and body mass index-for-age z score (BMIZ) in early childhood. We evaluated 7603 children from the Early Childhood Longitudinal Study-Kindergarten Cohort 2011 and found that children with ADHD had lower HAZ at second and fourth grades and lower BMIZ at K to fourth grade. Children with ADHD at fourth grade had almost 4 times higher odds of short stature. Children with ADHD at K grew at a slower rate from K to fourth grade (difference in ΔHAZ = 0.23, 95% confidence interval = 0.04-0.42) and had less gain in BMI (difference in ΔBMIZ = 0.16, 95% confidence interval = 0.03-0.29). Longer duration of ADHD medication use was associated with lower HAZ at fourth grade and slower growth from K to fourth grade. These data may assist pediatricians in considering risk of poor growth in children with ADHD.
Subject(s)
Attention Deficit Disorder with Hyperactivity/complications , Body Height , Growth Disorders/etiology , Attention Deficit Disorder with Hyperactivity/drug therapy , Body Mass Index , Central Nervous System Stimulants/therapeutic use , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Longitudinal Studies , Male , RiskABSTRACT
Our objective was to assess the risk of adrenal insufficiency (AI) with short-term use of low- to moderate-potency topical corticosteroids (TCS) for treatment of atopic dermatitis. Our systematic literature search revealed 9 studies (n = 371) that evaluated AI using adrenocorticotropic hormone stimulation testing, with measures of serum cortisol levels at baseline and following at least 2 weeks of TCS application. Biochemical AI was defined by a stimulated cortisol level of ≤18.0 µg/dL (~500 nmol/L). The overall proportion of AI with low-to-moderate TCS use was 2.7% (95% confidence interval = 1.47% to 4.89%). None of the children showed any clinical evidence of AI or adrenal crisis. Short-term use of low- to moderate-potency TCS for the treatment of atopic dermatitis is associated with a low risk of adrenal suppression. General practitioners do not need to test these patients for adrenal suppression in the absence of concerning signs and symptoms of AI.
Subject(s)
Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/adverse effects , Adrenal Insufficiency/chemically induced , Dermatitis, Atopic/drug therapy , Administration, Topical , Adolescent , Child , Child, Preschool , Humans , InfantABSTRACT
AIM: To evaluate for environmental and birth characteristic predictors of short stature in a large nationally representative sample. METHODS: We evaluated 10 127 children from the Early Childhood Longitudinal Study-Kindergarten 2011 cohort, using univariate and multivariable linear and logistic regression to evaluate factors associated with short stature (height <3rd percentile) at kindergarten through second grade. Predictors included birthweight, preterm status, sex, parental education, parental income and race/ethnicity. RESULTS: Lower birthweight was associated with short stature, with each decreasing kilogram having a 2.45 adjusted odds ratio (aOR; 95% confidence interval [CI] 1.81, 3.33) of short stature for term children in second grade. Preterm children (compared to term children) had an aOR of 2.23 (CI 1.32, 3.78) for short stature. Other predictors of short stature included female sex and lower parental income. African American children had a lower risk of short stature (aOR 0.34, CI 0.14, 0.82) compared to white children. CONCLUSION: Predictors of short stature include lower birthweight, preterm status, female sex and parental income. Socio-economic disparities and race/ethnicity further influenced height. These data may assist paediatricians in considering contributors to stature outcomes by early school age.
Subject(s)
Body Height , Age Factors , Birth Weight , Child, Preschool , Cohort Studies , Female , Humans , Male , Odds Ratio , Risk Factors , Sex Factors , Socioeconomic FactorsABSTRACT
BACKGROUND/AIMS: A meta-analysis was performed to determine the likelihood of hypothalamic-pituitary-adrenal (HPA) axis suppression following short-term cutaneous treatment of atopic dermatitis with topical corticosteroids (TCS) in pediatric patients. METHODS: All published pediatric clinical trials evaluating TCS use with pre- and post-treatment HPA axis assessment by cosyntropin stimulation testing were included. RESULTS: Of 128 eligible trials, 12 were selected for meta-analysis with a total of 522 participants. There were 20 observed cases of HPA axis suppression (3.8%, 95% CI 2.4-5.8). The percentage of HPA axis suppression with low- (classes 6-7), medium- (classes 3-5) and high-potency (classes 1-2) TCS use was 2% (3 of 148 patients, 95% CI 0.7-5.8), 3.1% (7 of 223 patients, 95% CI 1.5-6.3), and 6.6% (10 of 151 patients, 95% CI 3.6-11.8), respectively. CONCLUSION: There is a low rate of reversible HPA axis suppression with the use of mid- to low-potency TCS compared to more potent formulations. In pediatric clinical practice, the limited use of mid- to low-potency TCS is rarely associated with clinically significant adrenal insufficiency or adrenal crisis. In the absence of signs and symptoms of adrenal insufficiency, there is little need to test the HPA axis of these patients.
