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Healthy Children

with Steven Parker, MD

This blog is now retired. Dr. P passed away on Monday, April 13, 2009. The WebMD Community will dearly miss his kind, caring, and often humorous manner.

Monday, January 5, 2009

Dr. P’s Top 10 Pediatric Stories of 2008

Is it possible another year has passed? Here, in no particular order, are 10 pediatrics stories that caught my eye in 2008:

1. New recommendations for lipid screening and treatment in kids.
Perhaps in response to the epidemic of childhood obesity, the American Academy of Pediatrics has significantly revised its recommendations on the screening and treatment of kids for high cholesterol and blood lipid (fat) levels.

Basically they are recommending that your pediatric provider order blood tests for these levels starting at age 2 years, and then every 3-5 years thereafter if you have a positive family history for high lipid levels or early heart disease, or if such history is unknown, or if your child is overweight. That turns out to be a majority of kids!

However, what has generated a lot of controvery was their recommendation that – if diet and exercise fail to lower the levels to an acceptable range – cholesterol and lipid-lowering medications be used in children, as early as age 8 years. As you might guess, I have an opinion on this New Cholesterol Guidelines for Kids. Stay tuned for where all this goes in the next few years.

2. Cough and cold medicines get the axe for infants and toddlers.
I’ve long contended that cough medicine is essentially useless and cold medications are not much better. What I wasn’t aware of until this year were the numerous incidents of these over the counter cough and cold preparations causing harm to infants and toddlers (often due to giving too high a dose. After all, “If a little is good, a lot is better”, right?). Here are my appreciative comments on this change: The FDA and OTC Cold Medications for Infants.

So it’s now no longer recommended to use any of these medications for children under two years of age. Stick to old stand-bys: a humidifier/vaporizer, elevating the head of the bed, honey after age one year for cough and, of course, chicken soup and TLC.

3. New ways to lower the risk of SIDS
Earlier in the year I alerted you to a study showing that pacifier use seems to significantly cut the risk of Sudden Infant Death Syndrome (SIDS). Now comes another potential low-tech way to decrease the risk even more: running a fan in the bedroom. In this study, a fan in the bedroom seemed to also cut the risk of SIDS by 70% (perhaps because it prevents the baby from sleeping too deeply).

So now the list on how to decrease the risk of SIDS includes “back to sleep”, pacifiers, a fan in the bedroom, not too soft mattresses, no dolls in the crib, not too hot a temperature in the bedroom, and, I’m sure, more to come. I so would love to see the last of SIDS in the world. It is such a cruel event.

4. Probiotic “friendly” bacteria safe in pregnancy and for infants
It’s always nice when research confirms what you have been preaching. In 2007, despite scant evidence, I came out for giving infants and kids “friendly” probiotic bacteria under certain circumstances.

This year another study showed that feeding normal infants these bacteria was safe and also seemed to increase resistance to respiratory infections during the first 2 years of life! During the 6-month intervention, antibiotics were prescribed less often than in the placebo group (23% vs 28%) and respiratory infections occurred less frequently in the friendly bacteria group.

5. Honey is the best cough medicine.
OK, if cough medicine is useless, does anything help? A neat little study this year showed that good old buckwheat honey did help in children over 1 year of age. Try it.

6. Eating breakfast reduces weight gain in adolescents
Could my (and everyone else’s) mother have been right? Is breakfast the “most important meal of the day”? I don’t know about that, but a recent study did show that adolescents who eat breakfast aren’t nearly as overweight as those who skip breakfast. The reasons for this association are not clear.

Given this study and others showing children who have breakfast are better able to concentrate at school, let’s go with mom on this one: have a good breakfast! (Timlin MT et al. Breakfast eating and weight change in a 5-year prospective analysis of adolescents: Project EAT (Eating Among Teens). Pediatrics 2008 Mar; 121:e638.

7. On the road to a malaria vaccine
I hate mosquitoes, but for the wrong reasons No doubt, so do you. The most important reason to loathe mosquitoes is their transmission of malaria, arguably the worst disease on the planet. Every year over 500 million people contract malaria and 1-3 million die, the majority of whom are children in sub-Saharan Africa.

But just a few weeks ago, a vaccine with about 50% efficacy to prevent malaria (not great but much better than anything else) was reported. You know how much I love vaccines. Now it looks like we may soon be getting the upper hand on banishing this horrid disease from the lives of the world’s poorest children.

8. Stem cells created from normal skin cells
2008 was a great year for stem cell research. Two research teams were able to take skin cells from patients suffering from a variety of diseases and reprogram them into stem cells. This may avoid the need to use the controversial embryonic stem cells all together.

The newly created stem cells can hopefully then be induced to assume new identities and serve as major tools for understanding how diseases arise and develop. Eventually, when scientists master cellular reprogramming so that it is more finely controlled, efficient and safe, patients may someday be treated with healthy versions of their own cells.

9. Five-in-one vaccine developed
The first “five in one” vaccine (“Pentacel” – diphtheria, tetanus, pertussis, polio, hemophilus influenza) has been developed. This means fewer shots and less cost. And, yes, combination vaccines have been shown to be just as effective and no more prone to serious side effects than the single, double or triple vaccines were.

Pentacel still has to be administered in four separate doses, three times between the ages of 2 and 6 months, then
again between 15 and 18 months – but it cuts down by 30% on the 23 injections toddlers under 18 months normally receive.

10. Prenatal maternal blood test for Down Syndrome
A new genetic test may be able to pick up Down syndrome in the fetus with a simple blood sample from the mom-to-be. Because small amounts of fetal DNA enter the mother’s blood stream, the test is designed to detect abnormally elevated levels of chromosome 21 in the mother’s blood, which would indicate a baby with the syndrome. This would be a far less invasive and safer way to diagnose this common parental concern.

11. Enjoy your kids! All the best from Dr. P for a happy and fulfilling 2009 for you and your family!
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Posted by: Steven Parker MD at 10:00 am

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