Symptoms associated with infant teething: a prospective study.

CONTEXT: Studies of infant teething have been retrospective, small, or conducted on institutionalized infants. OBJECTIVES: To conduct a large, prospective study of healthy infants to determine which symptoms may be attributed to teething and to attempt to predict tooth emergence from an infant's symptoms. DESIGN: Prospective cohort. Setting. Clinic-based pediatric group practice. PATIENTS: One hundred twenty-five consecutive well children of consenting Cleveland Clinic employees. OUTCOME MEASURES: Parents daily recorded 2 tympanic temperatures, presence or absence of 18 symptoms, and all tooth eruptions in their infants, from the 4-month well-child visit until the child turned 1 year old. RESULTS: Daily symptom data were available for 19 422 child-days and 475 tooth eruptions. Symptoms were only significantly more frequent in the 4 days before a tooth emergence, the day of the emergence, and 3 days after it, so this 8-day window was defined as the teething period. Increased biting, drooling, gum-rubbing, sucking, irritability, wakefulness, ear-rubbing, facial rash, decreased appetite for solid foods, and mild temperature elevation were all statistically associated with teething. Congestion, sleep disturbance, stool looseness, increased stool number, decreased appetite for liquids, cough, rashes other than facial rashes, fever over 102 degrees F, and vomiting were not significantly associated with tooth emergence. Although many symptoms were associated with teething, no symptom occurred in >35% of teething infants, and no symptom occurred >20% more often in teething than in nonteething infants. No teething child had a fever of 104 degrees F and none had a life-threatening illness. CONCLUSIONS: Many mild symptoms previously thought to be associated with teething were found in this study to be temporally associated with teething. However, no symptom cluster could reliably predict the imminent emergence of a tooth. Before caregivers attribute any infants' signs or symptoms of a potentially serious illness to teething, other possible causes must be ruled out.teething, tooth eruption, teeth, deciduous dentition.

Zinc lozenges for the common cold.

The scientific basis for zinc treatment of the common cold is debatable, and clinical trials of zinc cold therapy have produced conflicting results. This review summarizes the current basic and clinical knowledge of zinc for the common cold, and suggests the present role of zinc therapy and future research needs.

Zinc gluconate lozenges for treating the common cold in children: a randomized controlled trial.

CONTEXT: The common cold is one of the most frequently occurring illnesses and is responsible for substantial morbidity and economic loss. Biochemical evidence suggests that zinc may be an effective treatment, and zinc gluconate glycine (ZGG) lozenges have been shown to reduce the duration of cold symptoms in adults. OBJECTIVE: To determine the efficacy of ZGG treatment of colds in children and adolescents. DESIGN: A randomized, double-masked, placebo-controlled study. SETTING: Two suburban school districts in Cleveland, Ohio. PATIENTS: A total of 249 students in grades 1 through 12 were enrolled within the first 24 hours of experiencing at least 2 of 9 symptoms of the common cold. INTERVENTION: Zinc lozenges, 10 mg, orally dissolved, 5 times a day (in grades 1-6) or 6 times a day (in grades 7-12). MAIN OUTCOME MEASURES: Time to resolution of cold symptoms based on subjective daily symptom scores for cough, headache, hoarseness, muscle ache, nasal congestion, nasal drainage, scratchy throat, sore throat, and sneezing. RESULTS: Time to resolution of all cold symptoms did not differ significantly between students receiving zinc (n = 124) and those receiving placebo (n = 125) (median, 9 days; 95% confidence interval [CI], 8-9 days; median, 9 days, 95% CI, 7-10 days, respectively; P=.71). There were no significant differences in the time to resolution of any of the 9 symptoms studied. Compared with controls, more students in the zinc group reported adverse effects (88.6% vs 79.8%; P=.06); bad taste (60.2% vs 37.9%; P=.001); nausea (29.3% vs 16.1%; P=.01); mouth, tongue, or throat discomfort (36.6% vs 24.2%; P=.03); and diarrhea (10.6% vs 4.0%; P=.05). CONCLUSIONS: In this community-based, randomized controlled trial, ZGG lozenges were not effective in treating cold symptoms in children and adolescents. Further studies with virologic testing are needed to clarify what role, if any, zinc may play in treating cold symptoms.

Zinc gluconate lozenges for treating the common cold. A randomized, double-blind, placebo-controlled study.

BACKGROUND: The common cold is one of the most frequent human illnesses and is responsible for substantial morbidity and economic loss. No consistently effective therapy for the common cold has been well documented, but evidence suggests that several possible mechanisms may make zinc an effective treatment. OBJECTIVE: To test the efficacy of zinc gluconate lozenges in reducing the duration of symptoms caused by the common cold. DESIGN: Randomized, double-blind, placebo-controlled study. SETTING: Outpatient department of a large tertiary care center. PATIENTS: 100 employees of the Cleveland Clinic who developed symptoms of the common cold within 24 hours before enrollment. INTERVENTION: Patients in the zinc group (n = 50) received lozenges (one lozenge every 2 hours while awake) containing 13.3 mg of zinc from zinc gluconate as long as they had cold symptoms. Patients in the placebo group (n = 50) received similarly administered lozenges that contained 5% calcium lactate pentahydrate instead of zinc gluconate. MAIN OUTCOME MEASURES: Subjective daily symptom scores for cough, headache, hoarseness, muscle ache, nasal drainage, nasal congestion, scratchy throat, sore throat, sneezing, and fever (assessed by oral temperature). RESULTS: The time to complete resolution of symptoms was significantly shorter in the zinc group than in the placebo group (median, 4.4 days compared with 7.6 days; P < 0.001). The zinc group had significantly fewer days with coughing (median, 2.0 days compared with 4.5 days; P = 0.04), headache (2.0 days and 3.0 days; P = 0.02), hoarseness (2.0 days and 3.0 days; P = 0.02), nasal congestion (4.0 days and 6.0 days; P = 0.002), nasal drainage (4.0 days and 7.0 days; P < 0.001), and sore throat (1.0 day and 3.0 days; P < 0.001). The groups did not differ significantly in the resolution of fever, muscle ache, scratchy throat, or sneezing. More patients in the zinc group than in the placebo group had side effects (90% compared with 62%; P < 0.001), nausea (20% compared with 4%; P = 0.02), and bad-taste reactions (80% compared with 30%; P < 0.001), CONCLUSION: Zinc gluconate in the form and dosage studied significantly reduced the duration of symptoms of the common cold. The mechanism of action of this substance in treating the common cold remains unknown. Individual patients must decide whether the possible beneficial effects of zinc gluconate on cold symptoms outweigh the possible adverse effects.

The Ohio Bicycle Injury Study.

To understand bicycle injuries and determine how to prevent them, we designed prospectively a descriptive study of bicycle-crash-related admissions in July 1993 to 10 major Ohio hospitals that admit child trauma patients. All patients studied were under the age of 16. In the 52 cases (38 male, 73%), impact with another vehicle accounted for 23 (44%) crashes. Of these crashes, only three (13%) were caused by definite motor vehicle operator error, and all 20 (87%) of the remaining motor vehicle-bicycle collisions were caused by bicyclist error, including 10 (43%) caused by bicyclists failing to yield properly at an intersection. Head injuries were the primary cause of morbidity in 29 (56%) cases. No child was wearing a bicycle helmet at the time of the crash. Efforts to reduce childhood morbidity from bicycle-related crashes should focus on helmet education and safe riding skills.

The effect of prolonged tourniquet application on serum bicarbonate.

BACKGROUND: Many clinicians believe that prolonged tourniquet application lowers the serum bicarbonate concentration in samples drawn from that limb, but this effect has never been examined prospectively. OBJECTIVE: To test the effect of prolonged tourniquet application before phlebotomy on serum bicarbonate concentration in healthy adults. METHODS: We drew blood samples from 27 healthy adult volunteers without a tourniquet and again 1, 3, and 5 minutes after applying a blood pressure cuff and inflating it to the mean arterial pressure. RESULTS: The mean bicarbonate concentration was 27.3 +/- 2.26 mmol/L (standard deviation) at baseline, 27.7 +/- 2.39 mmol/L at 1 minute, 27.7 +/- 2.05 mmol/L at 3 minutes, and 27.7 +/- 1.96 mmol/L at 5 minutes. The mean change in bicarbonate concentration from baseline was -0.04 +/- 1.02 mmol/L at 1 minute, 0.44 +/- 1.05 mmol/L at 3 minutes, and 0.44 +/- 1.31 mmol/L at 5 minutes. The mean lactate concentration was 1.1 +/- 0.28 mmol/L at baseline, 1.3 +/- 0.65 mmol/L at 1 minute, 1.2 +/- 0.52 mmol/L at 3 minutes, and 1.2 +/- 0.36 mmol/L at 5 minutes. The mean change in lactate concentration from baseline was 0.15 +/- 0.67 mmol/L at 1 minute, 0.11 +/- 0.11 mmol/L at 3 minutes, and 0.12 +/- 0.37 mmol/L at 5 minutes. CONCLUSIONS: Prolonged tourniquet application before phlebotomy does not lower the serum bicarbonate concentration in healthy adults.

Effect of inhaling heated vapor on symptoms of the common cold.

OBJECTIVE: To test the efficacy of steam inhalation in treating common cold symptoms. DESIGN: An in vitro study determined the temperature that inactivated rhinovirus: a temperature of 43 degrees C lasting at least 1 hour was needed. We then conducted a double-blind, placebo-controlled, randomized in vivo study. SETTING: The virology laboratory and the outpatient department of the Cleveland (Ohio) Clinic Foundation. PATIENTS: Sixty-eight Cleveland Clinic employee volunteers with symptoms of the common cold at the time of enrollment. INTERVENTION: A single 60-minute treatment was given to the volunteers. The steam treatment group (n = 32) received 40 L/min of heated saturated air that raised the intranasal temperature to 43 degrees C. The placebo group (n = 36) received 2 L/min of ambient air at 20 degrees C to 24 degrees C. MAIN OUTCOME MEASURES: Subjective symptom scores for nasal congestion, nasal drainage, and sneezing and objective measures of nasal resistance were studied during a 7-day follow-up observation period. RESULTS: There were no significant differences in daily symptom scores between the groups (P = .59 to .83). The only statistically significant differences between the groups were lower nasal resistances at baseline in the steam group (P = .04) and percent improvement in nasal resistance favoring the placebo group on day 7 (P = .01). However, these differences were of questionable clinical significance. CONCLUSION: We conclude that steam inhalation treatment had no beneficial effect on the cold symptoms of our volunteers.

Association between bicycle helmet legislation, bicycle safety education, and use of bicycle helmets in children.

OBJECTIVE: To determine the association between bicycle helmet legislation and bicycle safety education and the use of bicycle helmets by children under age 16 years. DESIGN: Anonymous questionnaire and direct observations of bicycle helmet use. SETTING: Four predominantly white, upper-middle class suburbs of Cleveland, Ohio. PARTICIPANTS: All students in grades 1 through 7 attending public school on the day of the survey and children riding bicycles in a direct observational study. INTERVENTIONS: Beachwood had bicycle helmet legislation and safety education. Orange had only bicycle helmet legislation. Pepper Pike and Moreland Hills did not have bicycle helmet legislation or safety education. RESULTS: In Beachwood, 416 (67.6%) of 615 children who owned a bicycle reported always wearing their helmets, and 72 (85%) of 85 children directly observed were wearing bicycle helmets. In Orange, 103 (37.2%) of 277 children who owned bicycles reported always wearing helmets, whereas 41 (17.9%) of 229 children in Moreland Hills and 78 (21.5%) of 362 children in Pepper Pike reported always wearing helmets. Helmet use was significantly (P < .001) higher in Beachwood, with legislation and education, than in the other communities; helmet use was significantly (P < .001) higher in Orange, with legislation alone, than in Moreland Hills and Pepper Pike, with no programs. CONCLUSIONS: There was a dramatic association between reports of increased helmet use and bicycle helmet legislation plus education; the association was stronger than that found with legislation only.

Effect of cotton-tipped swab use on ear-wax occlusion.

We studied parents' and patients' approach to earwax (cerumen) removal, patients' level of cerumen occlusion, and the association between the use of cotton-tipped swabs (CTS) and cerumen occlusion. Six hundred fifty-one consecutive patients from the general pediatric practice of the Cleveland Clinic aged 2 weeks to 20 years (57% males) answered a questionnaire with their parents' help. Of the 651, 401 (62%) had used CTS during the 2 months before the study. Examiners unaware of the questionnaire results found that 46 (7%) of both right and left ear canals were at least 75% occluded by cerumen. Cerumen occlusion of at least 75% was associated with CTS use on the left side (P = .02), but not on the right side (P = .27). We conclude that cotton-tipped swab use may be associated with cerumen accumulation.

Respiratory infections in children. What helps and what doesn't?

Respiratory disorders are common in children. Upper respiratory infection is particularly common in children who receive day care or group care. Frequently used methods of treating the common cold (eg, heated vapor, over-the-counter antihistamines and decongestants) have not been proven objectively to be beneficial in young children. Sinusitis is usually diagnosed through history taking (eg, complaints of more than 9 days of non-improving nasal congestion and/or cough), but radiographs may be necessary. Antibiotics effective against specific causative agents are the treatment of choice. Data do not support routine use of myringotomy to treat acute otitis media, but combined with tube placement, this method is useful for recurrent infection. Antibiotic prophylaxis may help prevent recurrent episodes of acute otitis media. Before tonsillectomy is considered for pharyngitis, a history of recurrent episodes must be documented. Epiglottitis, although increasingly rare, should still be considered when certain specific clinical signs are present.

Pediatric wandering spleen: case report and review of literature.

Wandering spleen is a rare diagnosis, especially in the pediatric population. We reviewed the English literature from 1900 through April 1991 for all cases of wandering spleen in patients from birth through age 10. There are 50 case reports prior to the one presented here. The goals of this article are to summarize the histories, findings, and treatment of the 51 patients, describe diagnostic and treatment modalities, and increase the clinician's suspicion for wandering spleen. This condition is probably underdiagnosed and potentially treatable by splenopexy if suspected and diagnosed early in the course of disease.

Tympanic membrane temperatures compared to rectal and oral temperatures.

One hundred thirty-seven children at the Cleveland Clinic Foundation were enrolled in a study comparing the accuracy and acceptability of tympanic membrane temperatures taken with Thermoscan to rectal or oral temperatures taken by IVAC electronic thermometers. The mean age of the rectal/ear group was 1.2 +/- 0.86 years (range 0.08-5.0 years) with 22 females and 21 males. The mean age of the oral and ear group was 9.0 +/- 4.24 years (range 3-18 years) with 44 females and 50 males. Significantly large (p less than 0.01) correlation coefficients were present between temperatures in the left ear and right ear (0.92), rectal and mean ear (0.77) and oral and mean ear (0.68). The temperature difference between mean ear and rectal measurements was -1.1 degree +/- 0.51 degree C and the temperature difference between the mean ear and oral measurements was -0.20 degrees +/- 0.59 degrees C. A relative lack of correlation between ear and oral temperatures was noted with flat tympanograms, otoscopically diagnosed middle ear effusion, and with red-white or red tympanic membranes. However, small subgroup sizes (6-16) may have contributed to this lack of correlation. Parents and physicians were impressed by the 2.5 second speed of the new technique. However, younger children were nearly as likely to resist and cry with ear as with rectal temperatures. Parents were comfortable with the ease, cleanliness and safety of ear temperatures. While these data indicate a strong correspondence of ear temperatures with oral and rectal temperatures, parents were not as confident of ear temperatures' accuracy.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of inhaling heated vapor on symptoms of the common cold.

A double-blind, randomized study tested the efficacy of steam (technically, heated, humidified air) inhalation in the treatment of common cold symptoms. Two 20-minute treatments spaced 60 to 90 minutes apart were given at the time of enrollment. The active device (Rhinotherm, Netzer-Sereni, Beer Yaacov, Israel) delivered 40 L/min of saturated air at 40 degrees C to 42 degrees C, while the identical-appearing placebo delivered 2 L/min of ambient air at 20 degrees C to 24 degrees C. There were 34 patients in the placebo group and 32 in the active group. Significant improvements in the placebo-treated group were obtained on subjective symptom scores for nasal congestion, nasal drainage, and sneezing on isolated days during the treatment period (40%, vs 25% on day 3, 71% vs 60% on day 6, and 100% vs 67% on day 7). Improvement in nasal resistance as measured by rhinomanography was better in the placebo group than in the active group on day 7 (11% vs -6%). Our study demonstrated no beneficial effects of steam inhalation on common cold symptoms.

Infant sleep and bedtime cereal.

We studied whether feeding infants rice cereal before bedtime promotes their sleeping through the night. One hundred six infants were randomly assigned to begin bedtime cereal feeding (1 tablespoon per ounce in a bottle) at 5 weeks or at 4 months of age. Caretakers recorded the infant's sleep from age 4 to 21 weeks for one 24-hour period per week. Sleeping through the night was defined as sleeping at least 8 consecutive hours, with the majority of time being between the hours of midnight and 6 AM. The results were also reviewed changing the requirement from 8 hours to 6 hours. There was no statistically significant trend or a consistent tendency of one group to have a higher proportion of sleepers than the other. Therefore, feeding infants rice cereal in the bottle before bedtime does not appear to make much difference in their sleeping through the night.

Office education by pediatricians to increase seat belt use.

We studied promoting seat belt use by school-aged children through discussions with their pediatricians. The study population consisted of 242 well children observed coming to and leaving from a private pediatric practice. Only four (5%) of 73 control patients who did not wear their seat belts coming in wore them going out. For intervention patients, this figure was 29 (38%) of 77. At one-year follow-up by questionnaire, there were no statistical differences between the percentage of seat belt use in control (67%) vs intervention (62%) patients. However, pediatricians' reported percentage of patients routinely counseled about seat belt use prior to the start of the study was highly correlated with patients' observed prestudy seat belt use. Pediatricians should include education about automobile safety as a part of all well-child visits.