Diagnoses of overweight children and adolescents seen in a pediatric endocrinology clinic.

The prevalence of overweight is rising in the pediatric population. The aims of this study were to determine prevalence and diagnostic characteristics of overweight patients referred for endocrine evaluation. BMI was calculated and diagnosis codes were assigned for patients seen for endocrine evaluation. Odds ratio calculation and logistic regression were used to evaluate overweight patients. Rising odds of overweight was seen as age increased. Referring diagnoses associated with a significant (p <0.05) proportion of overweight patients included excessive growth, other pubertal disorders, and menstrual disorders. Endocrinologist diagnosis of overweight had a significantly higher proportion of overweight patients. Concordance between referring and endocrinologist diagnosis decreased as BMI category rose. A low percentage of records of overweight patients documented discussion of weight management. Certain referring diagnoses have higher proportion of overweight individuals representing clinical findings associated with being overweight. Opportunities are missed to diagnose overweight individuals as well as to begin weight management counseling.

Risk factors associated with glucocorticoid-induced adverse effects in children with severe asthma.

BACKGROUND: Although high-dose inhaled glucocorticoids (GCs) with or without chronically administered oral GCs are often used in children with severe persistent asthma, the adverse effects associated with their use have not been well-described in this patient population. OBJECTIVE: We sought to determine the GC-induced adverse effects profile of older children with severe persistent asthma. METHODS: A chart review of 163 consecutive children 9 years of age or older admitted to National Jewish for difficult to control asthma was done. RESULTS: The population studied consisted mostly of adolescents (mean +/- SD age, 14.4 +/- 2.1 years) with severe asthma receiving high-dose inhaled GC therapy (1675 +/- 94 microg/d) and averaging 6 systemic GC bursts per year. 50% required chronic oral GC therapy. GC-associated adverse effects were common and included hypertension (88%), cushingoid features (66%), adrenal suppression (56%), myopathy (50%), osteopenia (46%), growth suppression (39%), obesity and hypercholesterolemia (30%), and cataracts (14%). Height standard deviation scores of -0.44, -1.22, and -0.93 for those receiving intermittent, alternate day, and daily oral GCs, respectively, were smaller (less suppressed) than published values from the same institution before inhaled GC therapy (standard deviation scores of -1.26, -1.91, and -1.95, respectively). Osteopenia was strongly associated with growth suppression (odds ratio, 5.6; confidence interval, 2.7-11.8; P <.0001) and was found to be more common in female than male subjects, even after correcting for short stature (42% vs 18%, P <.006). CONCLUSIONS: GC-associated adverse effects are still unacceptably common among children with severe asthma, even in those not receiving chronically administered oral GC therapy yet receiving high-dose inhaled GCs. Therefore close monitoring and proper intervention are warranted, especially in female subjects, who appear to be at greater risk for osteopenia. There is clearly a need to consider alternative therapy or earlier intervention. The magnitude of growth suppression, while still a problem, appeared to be less severe with the addition of inhaled GC therapy. This observation suggests that high-dose inhaled GC therapy, by affording better asthma control and allowing less use of systemic therapy, has attenuated the growth-suppressive effects of poorly controlled asthma.

Childhood fever education in a military population: is education enough?

PURPOSE: Parental knowledge of childhood fever and clinic and emergency room utilization were studied in a military pediatric clinic population to determine if intervention would improve parental understanding and management of childhood fever. METHODS: Multiple choice tests evaluating childhood fever knowledge were given to control and intervention groups. Clinic and emergency room utilization were tracked for appropriateness of visits based on criteria used in previous similar studies. RESULTS: Initial test scores showed no difference between the two groups. Subsequent test scores revealed a difference between the two groups as reflected by improved test scores. Evaluation of clinic and emergency room utilization of the groups did not show an overall improvement except in one subgroup analyzed. CONCLUSION: Intervention improved parental knowledge; however, intervention did not translate into anticipated improvement in clinic and emergency room utilization patterns. Emphasis on education and preventative services are important in both civilian and military pediatric practice. Results of this study highlight the need to discuss and reinforce fever education as a topic in pediatric preventive health care visits.