Most severely obese children have cardiovascular risk

A new study published in Archives of Disease in Childhood suggested that two thirds of severely obese children have at least one cardiovascular risk factor.

The findings were based on data from the Dutch Paediatric Surveillance Unit on children aged 2-18 between 2005 an d 2007. Paediatricians were asked to report information on children's cardiovascular risk factors - high blood pressure, fasting blood glucose levels and blood fats.

The study found that 307 out of 363 children were correctly classified severely obese, 52% were boys and they tended to be more severely obese at younger age but girls were obese at older age. Nearly 1 in 3 severely obese children came from single parent family. 67% had at least 1 cardiovascular risk factor, 56% had hypertension and 54% had high levels of bad cholesterol, 14% had high fasting blood glucose, and 1% already had type 2 diabetes.  The authors said "high prevalence of hypertension and abnormal lipids may lead to cardiovascular disease in young adulthood.” 

Critics noted some limitatons to the study, eg,  a  lack of internationally agreed criteria for diagnosing severe obesity in children, the difficulty of generalising the study results to other populations due to the small size of the study, the ethnicities of the children might also have an effect on the results.

Source: Van Emmerik NMA, Renders CM, van de Veer M, et al. High cardiovascular risk in severely obese young children and adolescents. Archives of Disease in Childhood. Published online July 23, 2012
(full text via Athens)

Current fever management in children is challenged

A new clinical report prepared by the American Academy of Pediatrics (AAP) and published in Pediatrics highlights the need to educate patients and families about fever in children.


It is not a new research but an expert commentary with the aim to challenge current practice on fever management in children, ie fever reduction.

They said that fever is a physiological mechanism in fighting infection, there is no evidence that fever causes long-term neurological complications. The report emphasizes improving the child’s overall comfort rather than concentrating in normalizing the body temperature.


Paracetamol and ibuprofen are the most commonly used antipyretics, but there are adverse effects and toxicity. The report said that it is critical to administer a safe dosage of these drugs and the correct dosage is based on the child's weight. However, many parents do not understand dosing instructions resulting in potential inaccurate or overdosing.


The authors call for better information for parents and concluded that in fever management, fever reduction should not be the primary aim but parents and healthcare professionals should be more vigilant for signs of serious illnesses.


Source: Sullivan JE, Farrar HC and the Section on Clinical Pharmacology and Clinical Report. Fever and Antipyretic Use in Children. Pediatrics 2011 , published online Feb 28

Concerns raised on high prescription errors in children

A study, carried out in 2005 by the Univeristy of London involving a children's hospital, 3 general teaching hospital and 1 non-teaching hospital in London, looked at prescription errors given to children in hospital. The study was published in Archives of Disease in Childhood.


During the study, pharmacists found 391 prescription errors and 429 administration errors in the 3000 prescriptions they exmined over a 2-week period. Errors included incomplete prescriptions, wrong dose, how the drugs should be prepared or how they should given to the patients. One mistake was picked up by the nurse, on 5 occasions, the researchers intervened to prevent the patient suffering the harm.

The researchers believe that their findings show a general picture across Britain and still stand today. The author said prescribing for children is very difficult because most drugs are formualted for adults, doctors have to calculate the dose for children. Much more needs to be done to improve prescribing to children.


They call for better education for doctors on prescription skills and electronic prescribing to be introduced in hospitals. See also post on GMC study on prescription errors in hospitals.

Source: "Minimising medication errors in children”Archives of Disease in Childhood 2009 ;94:161-164

Paracetamol weakens children's response to vacciantion

Paracetamol is sometimes given to infants to reduce their risk of developing fever or a fit caused by fever. In the UK, paracetamol (acetaminophen) is sold over the counter, also present in brands such as Panadol and Calpol. In the US it is more commonly available as Tylenol.

A study published in The Lancet, funded by GlaxoSmithKline Biologicals of Belgium, investigated the effect of giving paracetamol to infants during and immediate after vaccination.

459 healthy infants aged between 9 and 16 weeks were recruited from 10 centres in the Czech Republic and randomised to receive either paracetamol administered every 6 to 8 hrs during the 24 hrs following vaccination or to receive no paracetamol. The parents knew the treatment assigned to their babies.

Researchers found that in both groups, fever above 39.5 degrees C was uncommon, however lower proportion of babies in the paracetamol group had temperature above 38 degrees C. After the primary vaccine doses, more paracetamol doses had to be given to the babies in the control group than the treatment group. They also found that the antibody concentrations following the primary immunisations were significantly lower in the paracetamol group than in the control group and the response varied depending on the vaccination type given.

They concluded that "Although febrile reactions significantly decreased, prophylactic administration of antipyretic drugs at the time of vaccination should not be routinely recommended since antibody responses to several vaccine antigens were reduced."

Critics say this is an important study because there was very few published studies on this issue but further study is needed to demonstrate whether the immunity offered by flu vaccination might be reduced by paracetamol. It may be wise not to give paracetamol routinely to babies as a preventive measure.

Source: "Effect of prophylactic paracetamol administration at time of vaccination on febrile reactions and antibody responses in children: two open-label, randomised controlled trials" The Lancet 2009; 374: 1339-1350 (press release or f/t via Athens)

Free drug samples to children

Researchers analysed the data on more than 10,000 US children under 18 years old from a 2004 national survey that included questions on receipt of free drug samples.


They found that 1 in 10 children who take prescription medications received free samples and 1 in 20 children overall got free samples. The study showed that wealthy and insured American children who had access to medical care and saw doctors in private offices rather than in hospitals or clinics were more likely to get free drug samples although drug companies argue that free samples help uninsured and low-income people get the medications they need.


The author said that most free samples were new and expensive drugs, in her previous study on free samples for adults, Vioxx topped the list but was later withdrawn from the market due to dangerous side effects. She concluded that "Poor and uninsured children are not the main recipients of free drug samples. Free samples do not target the neediest children selectively and they have significant safety considerations."


Source: "Free Drug Samples in the United States: Characteristics of Pediatric Recipients and Safety Concerns" ( Published online October 1, 2008) Pediatrics Vol. 122 No. 4 October 2008, pp. 736-742

Does common cold cause asthma?

US researchers studied more than 250 newborns at high risk for asthma and followed them from birth to 6 years old to investigate the relationship between specific childhood illnesses and early development of asthma. Samples of mucus from their nose and throat were taken and analysed and they were tested for specific viruses during wheezing illnesses.

Researchers found that nearly 90% of the children wheezing with common cold virus, rhinovirus (RV) at age 3 subsequently developed asthma at age 6. The lead author wrote in the Americam Journal of Respiratory and Critical Care Medicine that rhinovirus which causes wheezing in childhood was the most significant predictor of the subsequent development of asthma at age six.

Critics say that athough the study demontrated an association between wheezing during childhood colds and later asthma, it does not mean that cold is the casue of asthma. Asthma is a very difficult condition to diagnose but asthma at age six does not necessarily mean that the it will persist into later childhood.

Source: "Jackson DJ, Gangnon RE, Evans MD, et al. Wheezing Rhinovirus Illnesses in Early Life Predict Asthma Development in High-Risk Children." Am J Respir Crit Care Med 2008: 178; 667–672 ( abstract only)

Children with cancer suffer less at the end of life

A study found that children dying of cancer in the US are currently suffering less with improved palliative care and hospice care that focus more on easing the pain at the end of their life.

The study found that in those cases, hospice care was discussed earlier and more often, do-not-resuscitate orders were put in place earlier, deaths in the intensive care unit decreased. Parents reported less child suffering from pain and breathing problems and they felt prepared in the child's last month of life.

Source :"Easing of suffering in children with cancer at the end of life:is care changing?" Journal of Clinical Oncology, 2008:26(10); 1717-1723

Arthritis drug could reduce psoriasis in children

The Telegraph reported that an arthritis drug, Etanercept (Enbrel), could significantly improve the signs and symptoms of psoriasis in children.

The report is based on a double-blind randomised controlled trial published in New England Journal of Medicine, involving 211 children with psoriasis. The patients received weekly injections of etanercept or placebo for 12 weeks, followed by a 24-week period when all patients received etanercept and a 12-week period when patients were randomised to etanercept or placebo. The author concluded that Etanercept significantly reduced disease severity in children and adolescents with moderate to severe plaque psoriasis

Source: "Etanercept Treatment for Children and Adolescents with Plaque Psoriasis" NEJM 2008 358(3):241-251

Honey is better than children's cough medicine

In a US study to compare the effects of a single dose of buckwheat honey or honey-flavored dextromethorphan with no treatment on nocturnal cough and sleep difficulty associated with childhood upper respiratory tract infections, 130 children were randomly assigned to receive buckwheat honey or honey-flavoured dextromethorphan or no treatment before bedtime.

Parents were asked to answer questions about the child's cough and sleep difficulty and compared with the previous night when no treatment was given at all. They rated honey the most favorable relief of symptoms of their child's nocturnal cough and sleep difficulty. The study concluded that honey may be a preferable treatment for children's cough and sleep difficulty.

Source : "Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents" Archives of Pediatrics & Adolescent Medicine. 2007;161(12):1140-1146 ( full text with Athens)

Childhood obesity has lifelong effects

According to 2 studies published in this week's NEJM, children worldwide are gaining excessive weight that causes serious health problems in their adulthood.

The studies found that high body mass index in childhood increases the risk of coronary heart disease in adulthood. The authors said that healthy food and physical activities are the keys to prevent this health problem, but a national strategy involving parents to help these children to maintain an appropraite weight to reduce the future risk of heart disease is urgently needed.

Source:"Childhood Body-Mass Index and the Risk of Coronary Heart Disease in Adulthood" NEJM 357(23):2329-2337 (free full text)


"Adolescent Overweight and Future Adult Coronary Heart Disease" NEJM 357(23):2371-2379
(free full text)

Lung transplants may bring more harm than good to children with CF

According to a new study that looked at lung transplants in children with cystic fibrosis (CF) in US, children rarely benefited from such transplants and there were significant risk of harm associated with the transplant. The lead author said it is important to develop criteria to identify the children who would benefit most from transpalnts.

An editorial in the same issue of the NEJM commented that the report's conclusion was shocking, the transplant rules in the US have chanaged since the study was done and the researchers put together data of children and adult patients who have a different success rate.

Source: "Lung Transplantation and Survival in Children with Cystic Fibrosis". NEJM 2007 357(21): 2143-2152 (abstract only)

ADHD drugs have no long term benefits

A research referred to in the BBC programme Panorama : What Next for Craig? raised questions about the long -term benefit of the drugs used to treat children with ADHD.

The 3 year Multimodal Treatment study of children with ADHD (MTA) found that ADHD drugs may work well in the short term. By 36 months, there was no apparent improvement in children's behaviour. The study also found the drugs could stunt children's growth.

Source: "3-Year Follow-up of the NIMH MTA Study". Journal of the American Academy of Child & Adolescent Psychiatry. 46(8):989-1002, August 2007.

Statin delays artery damage in FH children

According to a randomised, double-blinded, placebo-controlled study in the Netherlands, statin therapy is safe and effective in treating children with familial hypercholesterolemia ( FH ), researchers found that early initiation of statin treatment in FH children as young as 8 delays the early artery damage.

214 children of 8 - 18 were randomised to receive treatment with pravastatin 20 or 40 mg depending on their age or placebo for 2 years.

Follow-up data for 186 children with an average of treatment period of 4.5 years showed that earlier initiation of statin treatment results in a smaller carotid artery intima-media thickness (IMT) at a later age. Furthermore, no serious clinical or laboratory adverse events were reported.

The results showed that the age of statin initiation was a strong, independent predictor for the increased thickening between the intima and media, however, the researchers suggested further clinical trials will be required to determine the optimal age for beginning statin therapy in FH children.

The study "Statin Treatment in Children With Familial Hypercholesterolemia: The Younger, the Better" is published in the journal Circulation. 2007; 116: 664-668

Does this child have appendicitis?

Appendicitis is a common cause of pediatric abdominal pain, but the evaluation of abdominal pain in children can be quite difficult because the symptoms are very vague.

According to a new study led by the Johns Hopkins Children's Center, many American children suffer a ruptured appendix, a life-threatening complication because younger children have fewer classic symptoms of nausea, vomiting and pain in the abdomen making it easy to miss the diagnosis.

The researchers reviewed the frequency of the most common symptoms of actual appendicitis in children by analysing 25 studies and identified some of the most telltale signs that will help doctors to narrow down the diagnosis and prompt them to refer the child to a surgeon for evaluation.

These include "rebound" tenderness or pain that occurs after pressure is removed abruptly from the lower right abdomen; abdominal pain that starts around the belly button and migrates down to the right and an elevated white blood cell count. They also suggested that CT scans should be avoided if possible.

The study is published in the July 25 issue of JAMA. 2007;298:438-451. Read the abstract.

Antibiotics won't prevent urinary tract infections in children

It is estimated that 70,000 to 180,000 children born in a given year will have urinary tract infection (UTI) by the age of 6.

According to a new study in the July 11 issue of the JAMA, "Recurrent urinary tract infection: risk factors and effectiveness of prophylaxis in a primary care cohort", researchers found 611 children had a first UTI and 83 had a recurent UTI, daily antibiotics may not prevent UTI from recuring in children and may increase the risk of drug resistance. A child's age and race may paly a role in the risk of UTI and being resistant to antibiotics.

This is the first large study of children diagnosed with UTI to estimate the effectiveness of antibiotices in a primary care setting. The researchers suggested that it is appropriate for physicians to discuss with parents the risks and unclear benefits of daily antibiotic treatment after a child has had a first UTI. Read the press release at Medical News Today.

Some pediatricians said the findings may change the practice for the better.