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The Informed Parent

What’s Up!

by John H. Samson, M.D., F.A.A.P.
Published on Nov. 02, 2009

Keeping up with the medical literature is hard for physicians and impossible for parents. The volume of articles in news media and medical literature is staggering. There are only so many hours in a day.

I hope to provide our readers with a regular collection of synopses of meaningful articles that appear in print. Some emanate from medical journals. Others will come from news media. Yes, the fourth estate does contribute good reviews of medical issues.

The Los Angeles TIMES Health section had a very useful piece on various types of “milk”. It was short and to the point, appearing in the October 19, 2009 edition. It indicates that cow’s milk, goat’s milk and soy milk are reasonable nutrition sources. Hemp milk, rice milk and almond milk are less desirable substitutes. Read it!

PEDIATRICS, July 2009 Vol. 124 yielded many good papers.

Page 30:  An article entitled “Influenza Virus Infection and the Risk of Serious Bacterial Infections in Young Febrile Infants” was written by William L. Krief, M.D., et. al.  The informative article points out that young infants with fevers who are positive for influenza can have other associated bacterial infections. The most common was a urinary tract infection (UTI, kidney/bladder) and because of this such infections should not be overlooked. This can be done with urinalysis and urine culture.

COMMENT: There is no question in my mind that the pediatrician must be ever alert in thinking of a UTI in the infant with a fever. The ONLY symptom of a UTI can be fever.

Page 71:  “Do Stimulants Protect Against Psychiatric Disorders in Youth With ADHD? A 10-year Follow-up Study.“ The authors, Joseph Biederman, M.D., et. al. from New York Upstate Medical University point out that the use of stimulant medication for attention deficit disorder decreased the risk of subsequent psychiatric disorders while protecting against academic failure.

COMMENT: My own experience certainly supports this.

Page 342:  An article entitled ”Teaching by Listening: the Importance of Adult-Child Conversations to Language Development” by F.J. Zimmerman, Ph.D., et. al. This clearly shows that reading to or with your child is not enough. Parents should also engage their children in two-sided conversations. They must learn to express themselves.

COMMENT: This tells us that language development is both receptive and expressive. Conversation with our children fosters expressive language development. Read to your children, but also let them express their thoughts to you in attentive conversation. Unfortunately adults frequently ask small children questions only to ignore their answers instead of developing on-going dialogue on the subject.

Page 365: An abstract entitled “Headache in Young Children in the Emergency Department: Use of Computed Tomography” by Tarannum M. Lateef, M.D., et. al. addresses headaches in young children presenting to an emergency department with a normal neurological examination and benign history. Seldom does a CT scan of the brain lead to a diagnosis or contribute to immediate management intervention.

COMMENT: This has been the pediatricians’ experience. But I must stress that the neurological examination must be complete, including looking in the eye for signs of increased intracranial pressure (funduscopic examination), and an absolutely thorough history. The radiation exposure to a brain CT scan is staggering, and the study should not be ordered cavalierly.

Page 366: “Clinical Predictors of Pneumonia Among Children with Wheezing”. An abstract by Bonnie Mathews, M.D., et. al. tells us of a study of 526 patients. Wheezing in a child without a fever does not automatically mean a chest x-ray is needed. In fact,  radiographs are discouraged with such patents.

COMMENT: This, of course, is predicated on a normal examination except for wheezing. Respiratory distress or findings on examination suggestive of pneumonia make an x-ray valuable. The practice of getting a chest film on all wheezers has been more of an emergency department approach, rather than that seen in a pediatric out  patient facility.

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