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The Informed Parent

Scanning The Journals: ADHD; Strep Tests; Trampolines

by John H. Samson, M.D., F.A.A.P.
Published on Jan. 01, 1997
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Equivalent Effects of Stimulant Treatment for Attention-Deficit Hyperactivity Disorder During Childhood and Adolescence, B. Smith, Ph.D., W. Pelham, Ph.D., E. Gnagy, B.S., R. Yudell, B.S. Journal of the American Academy of Child and Adolescent Psychiatry, 37:3, March 1998, p. 314

These authors documented what some physicians have known from clinical experience. Unfortunately, other physicians, parents, caregivers and ill-informed laymen did not seem to know. This lack of knowledge has caused many an A.D.H.D. academically and socially struggling teenager to be deprived of necessary therapy. (refer From the Editor's Desk column in this issue.)

It is also pointed out that before increasing the dosage of a stimulant, one must be sure that the primary A.D.H.D. condition is the cause of the aberrant behavior rather than extrinsic causes. If environmental causes are the main reason for worsening behavior, increasing the dose of the medication may not be beneficial, but actually detrimental.

It is time that we all realize A.D.D. syndromes can extend into adult life and can respond to stimulant medication.

Does Culture Confirmation of High-Sensitivity Rapid Streptococcal Tests Make Sense? A Medical Decision Analysis, Kenneth H. Webb, M.D., e2 electronic abstracts, http://www.pediatrics.org

The advent of rapid streptococcal tests was met with mixed emotions. The original rapid tests demanded rechecking of all negative results with a throat culture. This gave physicians a tool without enough sensitivity to stand alone. The result was the need for two tests. This minimized the advantage of the rapid screening and their cost ineffectiveness.

Some physicians elected to treat according to clinical findings only. This meant many children would receive antibiotics that they did not need. The study shows that the "Strep A 0IA" (Biostar)

high sensitivity antigen test allows taking action upon it's result without a follow-up throat culture.

If your child has a rapid strep test done, be sure it is the type reported in this paper before you accept a negative test alone. If it is another type, request a follow-up culture. If it is this test do not agree to the cost of a throat culture in order to verify a negative result.

Injuries to Children in the United States Related to Trampolines, 1990-1995: A National Epidemic, Gary A. Smith, M.D., DrPH, PEDIATRICS, Vol. 101 No. 3 March 1998, p. 406Another devise that can lead to serious injury in children is presented in Dr. Smith's paper. This time it has no wheels or blades and does not hang by rope or chain. Nevertheless, the stats are significant. His final conclusion is very strong and may be justified.

During the years 1990 to 1995 there were 249,400 trampoline related injuries to patients 18 years old or younger treated in United States emergency rooms. The median age of an injured child was 10 years. 93% of these injuries occurred at home. 1400 children necessitated hospital admission because of their injuries. 83% of these admitted patients suffered fractures or dislocations.

As early as 1977, an American Academy of Pediatrics statement on trampolines revealed that these injuries were second only to football in causing sports related spinal cord injuries with permanent paralysis. The Academy's recommendation then was to abolish trampoline activities as part of physical education programs at all levels of schools. In 1978 the American Alliance for Health, Physical Education and Recreation issued a softer statement which opened the door to increased use of this device. The American Academy of Pediatrics also took a weaker stand which followed the statement mentioned above. Still, they did say, "the trampoline should never by used in home or recreation settings."

The paper by Dr. Smith clearly supports the view that home trampolines can be a serious source of injury to your children. We can't "bubble-wrap" our little ones, but we should also not expose them to potential injury that might lead them to hospitalization or even permanent paralysis. If you have a trampoline in your back yard think before you let your children use it. Absolute caution and supervision is clearly needed. And if the author is correct, that may not be enough.




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