Deviations from Typical Developmental Trajectories Detectable at 9 Months of Age in Low Risk Children Later Diagnosed with Autism Spectrum Disorder.

This study was designed to track the developmental trajectory, during the first 24 months of life, of 335 low-risk infants later diagnosed with Autism Spectrum Disorder and identify early deviations observed in routine Well Care checkups. We compared their achievements to typically developing children and to children later diagnosed with non-autistic developmental impairments. The results show that in the first 6 months, the children with autism showed normal acquisition of milestones, whereas by 9 months of age they began to fail the language/communication, as well as motor items when compared to typical and delayed non-autistic children. Regular check-up visits may be useful in detecting early failure in achieving milestones, leading to earlier referral for further evaluation and treatment.

Impact of follow-up calls from the pediatric emergency department on return visits within 72 hours: a randomized controlled trial.

OBJECTIVES: We compare the rate of return to the emergency department (ED) within 72 hours between families of children receiving a follow-up telephone call by a non-health care provider asking about the child's well-being 12 hours after their visit to the ED and families not receiving a follow-up call. METHODS: This was a prospective, randomized study in which we conducted a follow-up call starting at 12 hours after discharge from the ED versus no call for follow-up. At 96 hours after discharge, we contacted all recruited families. We recorded the rate of return to the ED within 72 hours of discharge. RESULTS: Of 371 families in the data analysis, 46% were in the study group, and 55.5% were male patients. Mean age was 5.7 years. The outcome measure was found to be in contrary to our hypothesis. We found return visits to the ED in 24 (14%) of the children in the study group compared with only 14 (7%) in the control group (P < 0.03). All other parameters were not statistically different between the groups. CONCLUSIONS: Emergency departments practicing follow-up calls by non-health care providers should consider a forecasted increase in return rates.

Use of botulinum toxin A in management of children with cerebral palsy.

QUESTION: What is the role of intramuscular botulinum toxin injections in the management of spasticity and related morbidity in children with cerebral palsy? ANSWER: When botulinum toxin A is injected into the limbs of children with spastic paresis, it induces temporary reduction in muscle tone. It also promotes better motor function when used in combination with conservative treatments such as physiotherapy. Although there is a growing body of evidence for its effective and safe treatment, there is still a lack of consensus on dose, treatment regimens, and the best integration with other clinical modalities.

Anti-inflammatory therapy for obstructive sleep apnea in children.

QUESTION: A 4-year-old child was diagnosed by polysomnography as experiencing mild obstructive sleep apnea (OSA). Despite the child being inattentive and distracted during the day at school, his parents prefer to avoid surgical treatment (adenotonsillectomy). Are there any non-surgical treatments for mild OSA in young children? ANSWER: Obstructive sleep apnea in children is caused mainly by adenotonsillar hypertrophy and can lead to considerable morbidities, including neurocognitive and behavioural disturbances. Surgical removal of the tonsils and adenoids is the treatment of choice. In recent years, however, a new understanding of the inflammatory components of OSA has led to the assumption that anti-inflammatory treatment can reduce adenotonsillar size and improve OSA symptoms. Evidence from a few studies suggests that intranasal steroids and oral leukotriene receptor antagonists have beneficial effects, but data from randomized controlled trials are still lacking.

Oxybutynin for treatment of nocturnal enuresis in children.

QUESTION: A 7-year-old child and his parents visit my clinic owing to the child's frequent bed-wetting. During the day, he has no problem controlling his urination. The family has tried behavioural methods but has failed to achieve dryness during the night. They ask to begin medical treatment. Is oxybutynin a safe and effective drug for treating nocturnal enuresis? ANSWER: Oxybutynin is an anticholinergic drug that has not been proven to be effective for treatment of nocturnal enuresis not accompanied by daytime symptoms, such as urgency. It can be added as a second-line drug and is effective for treating children with both daytime and nighttime wetting. Nevertheless, its common adverse effects, which can involve the central nervous system, should be considered when deciding whether or not to use it, especially in young children.

Anti-staphylococcal treatment in dermatitis.

QUESTION: A 10-year-old boy with atopic dermatitis (AD) came for consultation with an exacerbation. He suffered from pruritus and multiple erythematous skin lesions, identified as inflamed but not infected. Because skin colonization with Staphylococcus aureus is very common in AD and can worsen the skin condition, is it reasonable to add topical antibiotic treatment to the anti-inflammatory treatment in this case? ANSWER: Skin colonization with S aureus is prevalent in children and adults with AD, and can aggravate skin inflammation. Although topical combination creams with steroids and antibiotics are widely used for AD flare-ups, their superiority over anti-inflammatory treatment alone is not well established. Antibiotic treatment, whether systemic or topical, should be reserved for cases in which explicit signs of infection are present.

Reducing inappropriate antibiotic use among children with influenza infection.

QUESTION: With the influenza season reaching a peak, I see numerous children in my clinic with fever and influenza-like illnesses. Parents are concerned and at times ask for antibiotic treatment in hopes that the treatment will shorten the duration of illness. What strategies can I use in order to minimize inappropriate prescription of antibiotics during the influenza season? ANSWER: Use of antibiotics for treatment of viral infections such as influenza contributes to the emergence of resistant bacteria strains. Misuse and overuse of antibiotics can be reduced by preventing the infection and its complications through vaccination, point-of-care rapid influenza testing, and early antiviral treatment when appropriate, as well as constantly increasing the knowledge of both physicians and families regarding the appropriate use of antibiotics.

Influenza vaccination for children with asthma.

QUESTION: Parents of children with asthma are encouraged by many health organizations to vaccinate their children against seasonal influenza viruses. Is the influenza vaccine efficient in preventing asthma exacerbation? Are current vaccinations safe to administer to children with asthma? ANSWER: Infection with influenza viruses can cause substantial respiratory morbidity in children with underlying chronic disease such as asthma. Although vaccination against influenza does not reduce or shorten asthma exacerbations, the intramuscular trivalent vaccine is safe and has a beneficial effect on the quality of life of children with asthma.

Incidence and clinical manifestations of adenoviral infection among children undergoing allogeneic stem cell transplantation.

BACKGROUND: Adenoviral infection in children undergoing stem cell transplantation is associated with significant morbidity and mortality. Identification of adenoviral infection by polymerase chain reaction from blood facilitates accurate and rapid diagnosis and surveillance. The incidence of adenoviral infection among children undergoing SCT in Israel is not known. OBJECTIVE: To estimate the incidence of adenoviral infection in pediatric SCT patients and to characterize the morbidity associated with proven infection. METHODS: Blood samples obtained weekly from children who underwent allogeneic SCT were retrospectively tested for adenovirus using standard PCR. A total of 657 samples collected from 32 patients were examined. Correlation was made between the presence of adenovirus in samples and clinical records. RESULTS: Of the 32 patients 4 had adenoviral infection by PCR (12.5%). Clinical disease was present in all four patients concurrent with positive PCR. Gastrointestinal complaints and abnormal hepatocellular enzymes were uniformly present. One patient died due to disseminated disease. T cell depletion was a significant risk factor for adenoviral infection (P = 0.03). CONCLUSIONS: In the patient population studied, the incidence of adenoviral infection in children undergoing SCT was 12.5%. The combination of gastrointestinal symptoms and abnormal hepatocellular enzymes should raise the suspicion of adenoviral infection, especially when occurring during the first few months after SCT.

Adenotonsillectomy improves neurocognitive function in children with obstructive sleep apnea syndrome.

OBJECTIVE: To evaluate neurocognitive functions of children with obstructive sleep apnea syndrome (OSAS), before and after adenotonsillectomy, compared with healthy controls. DESIGN: Prospective study. PATIENTS AND METHODS: Thirty-nine children with OSAS aged 5 to 9 years (mean age, 6.8 +/- 0.2 years) and 20 healthy children (mean age, 7.4 +/- 1.4 years) who served as controls, underwent a battery of neurocognitive tests containing process-oriented intelligence scales. Twenty-seven children in the OSAS group underwent follow-up neurocognitive testing 6 to 10 months after adenotonsillectomy. Fourteen children in the control group were also reevaluated 6 to 10 months after the first evaluation. RESULTS: Children with OSAS had lower scores compared with healthy children in some Kaufman Assessment Battery for Children (K-ABC) subtests and in the general scale Mental Processing Composite, indicating impaired neurocognitive function. No correlation was found between neurocognitive performance and OSAS severity. Six to 10 months after adenotonsillectomy, the children with OSAS demonstrated significant improvement in sleep characteristics, as well as in daytime behavior. Their neurocognitive performance improved considerably, reaching the level of the control group in the subtests Gestalt Closure, Triangles, Word Order, and the Matrix analogies, as well as in the K-ABC general scales, Sequential and Simultaneous Processing scales, and the Mental Processing Composite scale. The magnitude of the change expressed as effect sizes showed medium and large improvements in all 3 general scales of the K-ABC tests. CONCLUSIONS: Neurocognitive function is impaired in otherwise healthy children with OSAS. Most functions improve to the level of the control group, indicating that the impaired neurocognitive functions are mostly reversible, at least 3 to 10 months following adenotonsillectomy.