Pediatric Annals

Trend Watch 

Trend Watch

Abstract

Despite established relationships with pediatricians, parents are still likely to take their children to retail clinics for care because of convenient access, according to recent study findings.

“In our study population with an established relationship with a [primary care physician] about one in four families had used a [retail clinic] for pediatric care at least once, and many reported multiple visits, double that of prior estimates (10% for children and 19% for adults), likely reflecting increasing use of [retail clinics] by families with children,” Jane M. Garbutt, MBChB, of the Washington University School of Medicine in St. Louis, and colleagues wrote in the study published in JAMA Pediatrics.

The cross-sectional study included 1,484 parents who completed surveys from 19 pediatric practices in a Midwestern practice-based research network.

Researchers found that parents who used retail clinics (RCs) for pediatric care (23.2%) were more likely to report RC care for themselves (OR=7.79; 95% CI, 5.13–11.84), have more than one child (OR=2.16; 95% CI, 1.55–3.02) and be older (OR=1.05; 95% CI, 1.03–1.08). Participants also reported first considering going to the pediatrician (74%) but chose an RC because it had more convenient hours (36.6%); an office appointment was not available (25.2%); they did not want to bother the pediatrician after hours (15.4%); or they did not believe it was serious enough (13%). Forty-seven percent of RC visits occurred between 8 a.m. and 4 p.m. on weekdays and 8 a.m. and noon on weekends.

Acute respiratory tract illnesses (sore throat, 34.3%; ear infection, 26.2%; and colds or influenza, 19.2%), and physicals (13.1%) were common reasons for a visit to an RC. Seven percent of participants said the RC indicated it would inform the pediatrician of the visit and only 41.8% informed the pediatrician themselves, according to the study abstract.

“RC use is common for minor pediatric illnesses,” Garbutt told Pediatric Annals. “If physicians want to care for these illnesses themselves they will need to provide convenient access for their patients and ensure that their patients know such access is available and encouraged.” In an accompanying editorial, Edward L. Schor, MD, of the Lucile Packard Foundation for Children’s Health in Palo Alto, Calif., wrote that RCs reflect “systemic changes occurring within the health care industry to which pediatric practices must adapt.”

“Public and private payers are trying to cut or cap physicians’ payment while increasing 24/7 access, assuring quality, and improving the overall health of the population,” he wrote.

Garbutt JM. JAMA Pediatr. 2013; doi:10.1001/jamapediatrics.2013.352. Schor EL. JAMA Pediatr. 2013; doi:10.1001/jamapediatrics.2013.359.

Disclosure: The study was funded in part by the National Center for Research Resources and National Institutes of Health Roadmap for Medical Research.

Black female adolescents who experienced depression and anxiety as a result of a poor body image were more likely to binge eat, which placed them at greater risk for suicide, according to new data published in Prevention Science.

“Eating problems in general can be a signal for a larger problem and should not be taken lightly,” study researcher Rashelle J. Musci, PhD, told Pediatric Annals. “In turn, I think that developing a prevention program aimed at these tangible eating behaviors may have impacts beyond reducing problem eating behaviors, and may, perhaps, reduce the risk for suicide.”

Musci and colleagues from the Bloomberg School of Public Health, Johns Hopkins University, studied the predictors of binge-eating behaviors and suicide outcomes in 313 black girls aged 6 to 17 years from Baltimore. The participants were followed for 11 years, and the researchers relied on teacher, parent and child interviews to examine self-perceptions of body appearance, internalizing symptoms of depression and anxiety, eating behaviors and suicide…

Convenience Leads Many Parents to Retail Clinics Instead of Primary Care Physicians

Despite established relationships with pediatricians, parents are still likely to take their children to retail clinics for care because of convenient access, according to recent study findings.

“In our study population with an established relationship with a [primary care physician] about one in four families had used a [retail clinic] for pediatric care at least once, and many reported multiple visits, double that of prior estimates (10% for children and 19% for adults), likely reflecting increasing use of [retail clinics] by families with children,” Jane M. Garbutt, MBChB, of the Washington University School of Medicine in St. Louis, and colleagues wrote in the study published in JAMA Pediatrics.

The cross-sectional study included 1,484 parents who completed surveys from 19 pediatric practices in a Midwestern practice-based research network.

Researchers found that parents who used retail clinics (RCs) for pediatric care (23.2%) were more likely to report RC care for themselves (OR=7.79; 95% CI, 5.13–11.84), have more than one child (OR=2.16; 95% CI, 1.55–3.02) and be older (OR=1.05; 95% CI, 1.03–1.08). Participants also reported first considering going to the pediatrician (74%) but chose an RC because it had more convenient hours (36.6%); an office appointment was not available (25.2%); they did not want to bother the pediatrician after hours (15.4%); or they did not believe it was serious enough (13%). Forty-seven percent of RC visits occurred between 8 a.m. and 4 p.m. on weekdays and 8 a.m. and noon on weekends.

Acute respiratory tract illnesses (sore throat, 34.3%; ear infection, 26.2%; and colds or influenza, 19.2%), and physicals (13.1%) were common reasons for a visit to an RC. Seven percent of participants said the RC indicated it would inform the pediatrician of the visit and only 41.8% informed the pediatrician themselves, according to the study abstract.

“RC use is common for minor pediatric illnesses,” Garbutt told Pediatric Annals. “If physicians want to care for these illnesses themselves they will need to provide convenient access for their patients and ensure that their patients know such access is available and encouraged.” In an accompanying editorial, Edward L. Schor, MD, of the Lucile Packard Foundation for Children’s Health in Palo Alto, Calif., wrote that RCs reflect “systemic changes occurring within the health care industry to which pediatric practices must adapt.”

“Public and private payers are trying to cut or cap physicians’ payment while increasing 24/7 access, assuring quality, and improving the overall health of the population,” he wrote.

Garbutt JM. JAMA Pediatr. 2013; doi:10.1001/jamapediatrics.2013.352. Schor EL. JAMA Pediatr. 2013; doi:10.1001/jamapediatrics.2013.359.

Disclosure: The study was funded in part by the National Center for Research Resources and National Institutes of Health Roadmap for Medical Research.

Binge Eating Predicted Suicide in Adolescents

Black female adolescents who experienced depression and anxiety as a result of a poor body image were more likely to binge eat, which placed them at greater risk for suicide, according to new data published in Prevention Science.

“Eating problems in general can be a signal for a larger problem and should not be taken lightly,” study researcher Rashelle J. Musci, PhD, told Pediatric Annals. “In turn, I think that developing a prevention program aimed at these tangible eating behaviors may have impacts beyond reducing problem eating behaviors, and may, perhaps, reduce the risk for suicide.”

Musci and colleagues from the Bloomberg School of Public Health, Johns Hopkins University, studied the predictors of binge-eating behaviors and suicide outcomes in 313 black girls aged 6 to 17 years from Baltimore. The participants were followed for 11 years, and the researchers relied on teacher, parent and child interviews to examine self-perceptions of body appearance, internalizing symptoms of depression and anxiety, eating behaviors and suicide attempts.

Study participants who were dissatisfied with their physical appearance were at the greatest risk for developing symptoms of depression and anxiety (P<.01). Internalizing symptoms as a result of a poor body image, in turn, predicted binge-eating behaviors (P<.05). Those who reported binge-eating behaviors were at a significantly increased risk for suicide (OR=1.64; P<.05).

“The relationships found in the study offer prevention scientists a unique opportunity to target individuals at high risk of psychiatric problems by intervening in the case of binge-eating problems,” the researchers wrote. “Our results also support the importance of developing prevention programs that are culturally relevant to individuals.”

Musci RJ. Prev Sci. 2013;doi:10.1007/s11121-013-0411-9.

Disclosure: The author reports no relevant financial disclosures.

FDA Approves Meningococcal A, C, Y/W-135 Vaccine for Use in Infants as Young as 2 months

FDA officials approved the quadrivalent meningococcal conjugate vaccine to prevent invasive meningococcal disease caused by Neisseria meningitidis serogroups A, C, Y and W-135 in patients aged 2 months through 55 years of age, according to an FDA press release.

The FDA initially approved quadrivalent meningococcal conjugate vaccine A, C, Y /W-135 (Menveo, Novartis) for use in patients aged 11 to 55 years in February 2010 and expanded the approved age range for patients aged 2 to10 years in January 2011. The FDA has now approved an expanded age range for the use of Menveo to include children aged 2 months through 2 years of age.

The manufacturer must complete post-marketing studies that include an open label, descriptive, epidemiological safety surveillance study of the vaccine in children aged 2 months through 23 months of age. The study will include two parts. Part 1 of the study, which will last for 3 years, will begin with the first administration of the vaccine to a child aged 2 through 23 months of age who receives medical care at the site where the study is being conducted. Part 2 of the study will be initiated if there is a recommendation by the Advisory Committee on Immunization Practices for routine use of meningococcal conjugate vaccine in at least one birth cohort within the 2 through 23 months age range, according to the FDA approval letter.

Part 2 will begin with the effective date of the ACIP recommendation, and will continue until 20,000 children are enrolled, or until 1 year has elapsed, whichever occurs last.

Go to FDA.gov to read the complete approval letter.

Pre-adolescent Acne Requires Different Treatment Regimens

Puberty at an earlier age might be the reason a growing number of pre-adolescents experience acne, and treatment strategies for this age group depend on severity, according to a presentation at the American Academy of Dermatology Summer Academy Meeting in New York.

Andrea L. Zaenglein, MD, FAAD, professor of dermatology and pediatrics at Penn State Hershey Medical Center, is co-author of recently published acne guidelines for children of all age groups. Researchers believe earlier puberty onset causes hormones to trigger the start of acne sooner, according to a press release.

Pre-adolescents (aged 7 to 12 years) experience acne that is not typically severe and includes comedones on the forehead, nose and chin, Zaenglein said. Larger, inflammatory lesions are uncommon in the age group.

While therapy can control acne for years, Zaenglein advised physicians to monitor the condition throughout puberty for signs that acne may be worsening, since early onset of comedonal acne can predict more severe acne in teens or adults.

Dermatologists should consider the patient’s age and type of acne when determining treatment, Zaenglein said. Over-the-counter benzoyl peroxide products should be effective for mild acne. If patients are unresponsive, a topical therapy combination of benzoyl peroxide and antibiotic or retinoid might be considered. Isotretinoin can safely be used by pre-adolescents if acne does not respond to topical and oral antibiotic therapy.

“Acne … can be especially distressing for kids and parents when it develops sooner than expected,” Zaenglein said. “It is important for parents not to put off treatment thinking acne will go away on its own, especially if a child has severe acne or scarring. Puberty lasts several years, as does acne, so proper treatment is essential.”

Eichenfield LF, et al. Pediatrics. 2013;doi: 10.1542/peds.2013-0490B.

Disclosure: Dr. Zaenglein has served on advisory boards of Galderma, Valeant and Promius, has been a speaker for Galderma, and has participated in clinical trials for Astellas, Galderma, Medicis, Photocure and Valeant.

Music May Help Distressed Children in Pediatric ED

Music intervention eased distressed children and assisted health care providers during intravenous placement, although overall outcomes including children without distress were not statistically significant, according to the results of a study conducted at the Stollery Children’s Hospital in Edmonton, Canada.

The parallel, randomized trial included 42 children aged 3 to 11 years who underwent IV placement in a pediatric ED. An equal number of children were randomly assigned to the standard care group and the music intervention group. Those in the intervention group listened to music throughout the procedure to assess for management of pain and distress.

Using the Observational Scale of Behavior Distress-Revised, researchers found no difference in primary outcome of patient distress before, during and after the procedure. After adjusting for ethnic minorities, who researchers observed to have less distress (P=.06), the reduction of an increase in distress was of borderline significance between the two groups (P=.05).

When researchers removed the 10 children without distress from the analysis, the median change in distress scores was 2.2 (interquartile range, 1.7–8.7; P<.05) in the standard care group and 1.1 (interquartile range, 0.1–2.4; P<.05) in the music group. The regression analysis indicated that music significantly reduced the increase in distress (coefficient, −3.19; 95% CI, −5.75 to −0.63).

Secondary outcome was change in self-reported pain from before to after the procedure, measured with the Faces Pain Scale-Revised. In the standard care group, the pain score increased from before to immediately after the procedure (median, 2; interquartile range, 0–4; P=.04), whereas it remained the same in the music group (median, 0; interquartile range, −4.1 to 0.5; P=.04).

Health care providers found it easier to perform the IV procedure (76% vs. 38%; P=.03) and were more satisfied with the IV start (86% vs. 48%; P=.02) in the music group. Researchers also measured heart rate and parent satisfaction, and found no statistical significances between the groups.

“Any easy-to-implement and low-cost intervention that also contributed to efficiency of care and provider job satisfaction may have some important but as-of-yet largely unmeasured benefits,” researchers wrote.

Hartling L. JAMA Pediatr. 2013;doi:10.1001/jamapediatrics.2013.200.

Disclosure: Study researchers Lisa Hartling, PhD, and Amanda S. Newton, PhD, are supported by New Investigator Salary Awards from the Canadian Institutes of Health Research.

Increased Problematic Video Game Usage in ASD, ADHD Patients

Video game usage is more likely to be problematic in boys with autism spectrum disorder and attention-deficit/hyperactivity disorder compared with those with typical development, according to recent study findings published in Pediatrics.

“These results suggest that children with ASD and those with ADHD may be at particularly high risk for significant problems related to video game play, including excessive and problematic video game use,” researchers wrote. “Attention problems, in particular, are associated with problematic video game play for children with ASD and ADHD, and role-playing games appear to be related to problematic game use particularly among children with ASD.”

The study included parents of boys aged 8 to 18 years with ASD (n=56), ADHD (n=44) or typical development (n=41). Participants completed questionnaires on hours of video game use, in-room access, genre, problematic use, ASD symptoms, and ADHD symptoms.

Researchers found that the ASD group played video games more compared with the typical development group (P=.01), video game systems were more likely to be in the rooms of ASD and ADHD groups compared with the typical development group (P=.001 and P=.002, respectively). The typical development group was more likely to play role-playing video games compared with the ASD group and more likely to play sports games compared with the ADHD group. Inattentive symptoms also were predictors of problematic game play in the ASD and ADHD groups.

“Although longitudinal research is needed to examine the outcomes of problematic video game use in these special populations, general population studies have shown that problematic game use can have significant detrimental effects,” researchers wrote. “Thus, the current findings indicate a need for heightened awareness and assessment of problematic video game use in clinical care settings for children with ASD and ADHD.”

Mazurek MO. Pediatrics. 2013;doi:10.1542/peds.2012-3956.

Disclosure: The study was funded by the University of Missouri Research Board.

Authors

Trend Watch written by Amber Cox, Cassandra Richards, Katie Kalvaitis, John Schoen, Alexandra Todak, and Megan Gilbride.

10.3928/00904481-20130823-02

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