Pediatric Annals

Trend Watch 

Trend Watch

Abstract

New guidelines from the Infectious Diseases Society of America advise that although most sore throats are caused by viruses and do not require antibiotics, when group A streptococcal pharyngitis is confirmed by testing, it should be treated with penicillin or amoxicillin and not cephalosporins. Further, the guidelines recommend that children who have recurrent streptococcal pharyngitis should not have their tonsils surgically removed solely to reduce the frequency of infection.

The guidelines note that children and adults do not need to be tested for streptococcal pharyngitis if they have a cough, runny nose, hoarseness, and mouth sores, which typically indicate a viral throat infection. A sore throat is more likely to be caused by streptococcus if the pain comes on suddenly, swallowing hurts, and the sufferer has a fever without the other respiratory symptoms, but it should be confirmed through testing before antibiotics are prescribed.

If streptococcal infection is suspected, the guidelines recommend physicians use the rapid antigen detection test. If that test is negative, a follow-up throat culture is recommended for children and adolescents, but not for adults. Results of the culture can take up to several days, but antibiotics should not be prescribed unless results are positive.

“These guidelines are designed to provide guidance for diagnosis and treatment of strep throat,” said study researcher and Pediatric Annals Editor-in-Chief Stanford T. Shulman, MD. “Another goal is to help reduce unnecessary use of antibiotics for nonstrep pharyngitis and thus reduce pressure for resistant bacteria to develop.”

James H. Brien, DO, an editorial board member of Pediatric Annals’ sister publication, Infectious Diseases in Children, commented on the new guidelines. “This is an outstanding review of this very common, yet inexplicably controversial topic. It is written by the recognized leaders in the field of Group A streptococcal infections, including tonsillopharyngitis.”

Brien, who was an infectious disease fellow in the early 1980’s, studying with renowned streptococcal expert, the late Col. James W. Bass, MD, said the guidelines’ new format, “gives the provider a quick and easy reference when needed. There is also an in-depth explanation of the rationale behind the guidelines with a comprehensive set of references for those who want to pursue the evidence.”

The guidelines will be available in a smartphone format and a pocket-sized quick-reference edition. A podcast interview of Shulman, and the full guidelines are available for free on the IDSA website at www.idsociety.org.

Shulman ST. Clin Infect Dis. 2012;doi:10.1093/cid/cis629. Disclosure: Neither Shulman nor Brien report any relevant financial disclosures.

The number of high school teenagers who drink and drive has decreased 54% over the past 2 decades, according to a Vital Signs study by the Centers for Disease Control and Prevention.

“We are moving in the right direction,” CDC Director, Thomas R. Frieden, MD, MPH, stated in a press release. “But we must keep up the momentum — 1 in 10 high school teens, aged 16 and older, drinks and drives each month, endangering themselves and others.”

CDC. MMWR. 2012;61:1–6

Maternal depressive symptoms experienced 9 months after giving birth were associated with children’s physical growth in early childhood, according to Pediatrics.

“Our study underscores the importance of screening for depressive symptoms among young mothers and women of childbearing age,” the researchers wrote. “Incorporating a maternal mental health component into maternal child health care delivery situations could likely benefit child growth, as well as a range of other child health and development outcomes.”

Pamela J. Surkan, ScD, and colleagues from Johns Hopkins Bloomberg School of Public Health examined data from the Early Childhood Longitudinal Study, Birth Cohort, focusing on approximately 6,550 children whose mothers had depressive symptoms when the children…

Antibiotics not Required for Most Sore Throats

New guidelines from the Infectious Diseases Society of America advise that although most sore throats are caused by viruses and do not require antibiotics, when group A streptococcal pharyngitis is confirmed by testing, it should be treated with penicillin or amoxicillin and not cephalosporins. Further, the guidelines recommend that children who have recurrent streptococcal pharyngitis should not have their tonsils surgically removed solely to reduce the frequency of infection.

The guidelines note that children and adults do not need to be tested for streptococcal pharyngitis if they have a cough, runny nose, hoarseness, and mouth sores, which typically indicate a viral throat infection. A sore throat is more likely to be caused by streptococcus if the pain comes on suddenly, swallowing hurts, and the sufferer has a fever without the other respiratory symptoms, but it should be confirmed through testing before antibiotics are prescribed.

If streptococcal infection is suspected, the guidelines recommend physicians use the rapid antigen detection test. If that test is negative, a follow-up throat culture is recommended for children and adolescents, but not for adults. Results of the culture can take up to several days, but antibiotics should not be prescribed unless results are positive.

“These guidelines are designed to provide guidance for diagnosis and treatment of strep throat,” said study researcher and Pediatric Annals Editor-in-Chief Stanford T. Shulman, MD. “Another goal is to help reduce unnecessary use of antibiotics for nonstrep pharyngitis and thus reduce pressure for resistant bacteria to develop.”

James H. Brien, DO, an editorial board member of Pediatric Annals’ sister publication, Infectious Diseases in Children, commented on the new guidelines. “This is an outstanding review of this very common, yet inexplicably controversial topic. It is written by the recognized leaders in the field of Group A streptococcal infections, including tonsillopharyngitis.”

Brien, who was an infectious disease fellow in the early 1980’s, studying with renowned streptococcal expert, the late Col. James W. Bass, MD, said the guidelines’ new format, “gives the provider a quick and easy reference when needed. There is also an in-depth explanation of the rationale behind the guidelines with a comprehensive set of references for those who want to pursue the evidence.”

The guidelines will be available in a smartphone format and a pocket-sized quick-reference edition. A podcast interview of Shulman, and the full guidelines are available for free on the IDSA website at www.idsociety.org.

Shulman ST. Clin Infect Dis. 2012;doi:10.1093/cid/cis629. Disclosure: Neither Shulman nor Brien report any relevant financial disclosures.

Teens Drink and Drive Half as Much as a Decade Ago

The number of high school teenagers who drink and drive has decreased 54% over the past 2 decades, according to a Vital Signs study by the Centers for Disease Control and Prevention.

“We are moving in the right direction,” CDC Director, Thomas R. Frieden, MD, MPH, stated in a press release. “But we must keep up the momentum — 1 in 10 high school teens, aged 16 and older, drinks and drives each month, endangering themselves and others.”

CDC. MMWR. 2012;61:1–6

Maternal Depression May Affect Physical Growth of Offspring

Maternal depressive symptoms experienced 9 months after giving birth were associated with children’s physical growth in early childhood, according to Pediatrics.

“Our study underscores the importance of screening for depressive symptoms among young mothers and women of childbearing age,” the researchers wrote. “Incorporating a maternal mental health component into maternal child health care delivery situations could likely benefit child growth, as well as a range of other child health and development outcomes.”

Pamela J. Surkan, ScD, and colleagues from Johns Hopkins Bloomberg School of Public Health examined data from the Early Childhood Longitudinal Study, Birth Cohort, focusing on approximately 6,550 children whose mothers had depressive symptoms when the children were infants. The study tracked children’s growth at 9 months, 4 years, and again at 5 to 6 years.

Growth measurements were collected by trained staff during home visits at each study wave. Maternal depression at 9 months was assessed using self-administered questionnaires. Surkan and colleagues used multivariable logistic regression analyses to determine the link between maternal symptoms of depression and child growth outcomes.

Results showed that at 9 months, 24% of mothers reported mild depressive symptoms and 17% reported moderate-to-severe depressive symptoms. Adjusting for factors that included household income, maternal age, and children’s birth weight, the researchers found that children whose mothers had moderate-to-severe depressive symptoms at 9 months postpartum had 40% increased odds of being below the 10th percentile in height at age 4 (OR=1.4; 95% CI, 1.04–1.89); 48% had increased odds of being below the 10th percentile in height at age 5 (OR=1.48; 95% CI, 1.03–2.13) vs. children whose mothers had no or few depressive symptoms. Surkan and colleagues found no significant association between maternal depression at 9 months postpartum and weight deficits.

Maternal depression may be associated with poorer parenting behaviors, such as shorter duration of breast feeding, less responsive feeding practices, and increased stress response in children, which may account for stunted growth.

“Our study does not, however, elucidate mechanisms; thus, additional study is needed to understand the behavioral and physiologic processes that link early caregiving to child growth,” the researchers wrote.

Surkan PJ. Pediatrics. 2012;doi:10.1542/peds.2011–2118. Disclosure: The researchers report no relevant financial disclosures.

Adolescents with Terminal Illness Want Say in Their End-of-Life Care

Adolescents and young adults with terminal illness reported wanting a hand in planning their end-of-life care, even if they found the process stressful.

The November issue of Pediatrics reports that adolescents and young adults facing a terminal diagnosis want a say in the kind of medical treatment they want and do not want; how they would liked to be cared for; information for their family and friends to know; and how they would like to be remembered.

Researchers presented two end-of-life planning documents to 52 participants, age 16 to 28 years, living with metastatic or recurrent cancer or HIV infection. The participants were asked to rank 25 items on several factors, including how likely they would be to complete each statement. Ultimately, the researchers created a third developmentally appropriate end-of-life (EoL) document for use by adolescents and young adults: Voicing My Choices, soon to be available from Aging with Dignity ( www.agingwithdignity.org).

Over 80% of respondents rated anticipating what kind of medical treatment they would like to be the most stressful decision to make while planning their EoL care. Determining who would make those decisions by proxy and what messages they would leave their survivors tied for the second most stressful decision (35% each).

The researchers noted that health professionals may worry that discussing EoL plans or presenting an EoL planning document to patients and their families may send the message that the medical team is withdrawing care, that death is imminent, or that hope is lost.

Lead investigator Lori Weinberg, PhD, a pediatric oncology researcher at the National Cancer Institute, told Pediatric Annals that EoL documents such as Voicing My Choices, “Can help staff start difficult conversations” and allow young patients to “make choices about what nurtures, protects, and affirms their remaining life and how they wish to be remembered in the future.”

The researchers also concluded that, “Knowing what the youth wants can be a great relief to parents.”

Weiner L. Pediatrics. 2012;doi:10.1542/peds.2012-0663. Disclosure: The authors report no relevant financial disclosures.

BP Check for Younger Patients often Neglected

Despite recommendations from the American Academy of Pediatrics that yearly blood pressure screenings should start at age 3 years, clinicians are still not taking these measurements in as many as one-third of preventive visits, according to a recent study.

Anisha I. Patel, MD, of the University of California, San Francisco, and other researchers analyzed data collected between 2000 and 2009 from two annual government surveys of doctors’ practices and emergency departments. They found that although the percentage of pediatricians taking blood pressure (BP) during routine pediatric checks has improved, from 51% to 71%, screening rates should be higher.

“Hypertension screening occurred during 35% of ambulatory pediatric visits, 67% of preventive visits, and 84% of preventive visits in which overweight/obesity was diagnosed,” Patel and colleagues wrote. The rate of hypertension screening was especially low for children aged 3 to 7 years, according to the study findings.

The researchers concluded that although pediatricians seem to understand the importance of screening, “efforts to encourage routine screening, particularly in young children, may be needed.”

Shapiro DJ. Pediatrics. 2012;doi:10.1542/peds.2011–3888. Disclosure: Patel reports no relevant financial disclosures.

Little Evidence to Back Medical Interventions for Autism

Insufficient evidence exists to back medical interventions for adolescents and young adults with autism spectrum disorders, according to the results of a meta-analysis published online.

Dwayne Dove, MD, PhD, and colleagues from Vanderbilt University reviewed 32 studies, published from 1980 to 2011, on therapies for patients aged 13 to 30 years, with autism spectrum disorders (ASD). The researchers focused on outcomes and interventions, including medical, behavioral, educational, and vocational ones.

This research is part of a larger report on ASD interventions for adolescents and young adults that found there is little evidence to support findings, good or bad, for all therapies currently used.

“Published papers suggest that many, if not most, adolescents and young adults with autism spectrum disorders are taking medications for behavioral problems. Our careful review of the literature revealed, however, that there is very little evidence that these medications provide benefit, or evidence that they are free from potential negative effects,” study researcher Jeremy Veenstra-VanderWeele, MD, told Pediatric Annals.

The researchers said although some treatments improved social skills and educational outcomes, the studies were generally too small to draw definitive conclusions. The most consistent findings were identified for the effects of antipsychotic medications on reducing problem behaviors that tend to occur with autism, such as irritability and aggression. Harms associated with medications included sedation and weight gain.

“The evidence on the use of risperidone in this age range is insufficient when considered alone but is consistent with the data in the population of children with autism spectrum disorders,” Dove and colleagues concluded.

“Clinicians and families are left making difficult decisions without the benefit of clear guidance from research studies. More work is clearly needed in this area,” Veenstra-VanderWeele said.

Dove D. Pediatrics. 2012;doi:10.1542/peds.2012-0683. Disclosure: Dove and Veenstra-VanderWeele report no relevant financial disclosures.

Check List ☑

The Centers for Disease Control and Prevention (CDC) has reported in a press release a multi-state outbreak of human Salmonella infections linked to small turtles. Although a ban on the sale of turtles with shells less than 4 inches in length has been enforced by the FDA since 1975, small turtles continue to be linked to Salmonella infections, particularly among children.

In its investigation of more than 160 illnesses in 30 states, the CDC found 64% of the Salmonella infections were in children age 10 years or younger; 27% were in children age 1 year or younger.

The CDC’s Deputy Branch Chief of the Outbreak Response and Prevention Branch, Casey Barton Behravesh, DVM, Dr.PH, said in a press release, “Many people don’t know that turtles and other reptiles can carry harmful germs that cans make people very sick. For this reason, turtles and other reptiles might not be the best pets for your family, especially if there are children 5-years-old and younger or people with weakened immune systems living in your home.”

The CDC recommends:

  • ☑ Do not buy small turtles from street vendors, websites, pet stores, or any other sources.

  • ☑ Keep reptiles out of homes with young children or people with weakened immune systems.

  • ☑ Reptiles should not be kept in child care centers, nursery schools, or other facilities with young children.

  • ☑ Always wash hands thoroughly with soap and warm water, immediately after touching a reptile or anything in the area where they live and roam. Use hand sanitizer if soap and water are not available.

Authors
Trend Watch written by Christi Fox, Whitney McKnight, John Schoen, and Colleen Zacharyczuk.

10.3928/00904481-20121022-02

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