Pediatric Updates from Covenant Care Pediatrics

Experts Recommend Cholesterol Screening for All Children

Patrick N. Pulliam, MD, FAAP — Tue, 15 Nov 2011 08:00:00 GMT

Cardiovascular disease is the leading cause of death in adults in America. Research has shown that the damage to the heart and blood vessels often beings in childhood. In order to prevent and to lessen cardiovascular disease, an expert panel has developed guidelines based on the latest research. It is a comprehensive plan aimed at reducing the risk of disease during childhood. One of the recommendations is that all children have their cholesterol levels checked between the ages of 9 and 11 years, and again at age 18 to 21.

Over the past few years, the recommendation has been to test children who are at risk of having high cholesterol levels, either due to family history of high cholesterol or early heart disease, or due to being overweight or obese. One of the problems with this approach is that the family history is often unknown or inaccurate. Universal screening will hopefully detect all children with elevated cholesterol, since it has been clearly shown that elevated cholesterol during childhood does start the process of cardiovascular damage during childhood as well.

Some disagree with screening every child, feeling that it is unnecessary or not cost-effective. However, given the ease of screening, and the threat to long-term health, it seems like a wise thing to do.

The media is focusing on the cholesterol screening aspect of the guidelines. However, it is a comprehensive set of recommendations, and universal cholesterol screening is only a small part of it. It is a definite change and perhaps some feel that the other recommendations are already being followed. However, that has not been my experience. While my practice already follows most of the other recommendations in this report, many do not. The report is really an effort to start attacking the problem of adult cardiovascular disease during childhood, and that kind of prevention and life-long perspective on health is exactly the kind of thing pediatricians ought to be doing.

Graphic Mashup Showing Antibiotic Resistance Patterns

Patrick N. Pulliam, MD, FAAP — Mon, 31 Oct 2011 07:00:00 GMT

This site provides an excellent and interesting visual representation of the problem of antibiotic resistance. It shows resistance patterns for various bacterial germs both worldwide and in geographic areas of the United States. You can see how common the growing problem of drug-resistant Staph (MRSA) infections has become, or how often S. pneumoniae (the most common bacterial germ in kids) is resistant to macrolides (like Zithromax): 52%. One has to wonder, then, why so many doctors in this area prescribe this antibiotic for ear infections and the like since chances are the germ is resistant to the antibiotic.

Antibiotic-resistant germs have become a major problem. They are due in large part to overuse of antibiotics, both in medicine where they are given for common viral infections like colds, and in agriculture where they are used in livestock to make flocks and herds healthier. We are now starting to see drug-resistant germs causing common infections in the communnity, instead of just in hospitals or long-term care facilities. Hopefully, reducing inappropriate use of antibiotics will help; however, efforts to do so have not been very successful. Too many doctors prescribe antibiotics for viral infections (I see it all the time in our community), and too many patients want or expect it from their doctors. Maybe educating both will turn the tide.

HPV Vaccine Now Recommended for All Boys

Patrick N. Pulliam, MD, FAAP — Fri, 28 Oct 2011 07:00:00 GMT

The human papilloma virus (HPV) vaccine, also known as the cervical cancer vaccine, has been recommended for all pre-teen and teenage girls and young women since 2006. The virus causes genital warts and cancer and is transmitted sexually; therefore, the vaccine has been somewhat controversial and many parents have chosen not to give it to their daughters. The vaccine has been approved for use in boys since 2009 but was not recommended for all boys. Now the expert panel that makes vaccine recommendations for the United States has voted unanimously to recommend that all boys receive the vaccine as well.

The vaccine panel gives several reasons for changing their recommendation. In addition to genital warts in boys, the virus does cause anal and penile cancer as well as cervical cancer. It can also cause cancers of the head and neck. Anal and head and neck cancers due to this virus have been rising in recent years, even as cervical cancers have declined. It is hoped that by giving the vaccine to all children, including boys, it will protect against all forms of cancer caused by this virus.

They also state that the vaccine has not been widely used in females, and it is hoped that by giving it to males it will help protect more females as well as males. One has to wonder, though, that if it has not been widely accepted in females to prevent cervical cancer, which is relatively common, will it not be even less accepted in males to prevent a much rarer form of cancer?

They state that they considered cost effectiveness (as they always do); however, their data is not available at this time. They did say that it is more cost effective to give it to males when the female immunization rate is very low, as it is now. This is the second case in which they use the fact that females are not getting the vaccine to justify recommending it in boys.

I have not been very enthusiastic about giving the vaccine to all girls; abstinence is a far better way to prevent HPV infection. (I do believe that the vaccine should be considered for girls who decide against abstinence or who marry someone who has not been abstinent). I am even less enthusiastic about recommending the vaccine in boys, for whom the risk of disease is much, much smaller. I think the response from the general public will be very similar.

Head Injuries Increasing in Children

Patrick N. Pulliam, MD, FAAP — Fri, 07 Oct 2011 07:00:00 GMT

A report from the CDC shows that the number of head injuries in children increased by 62% between 2001 and 2009, and the rate (number of visits per 100,000 children) rose by 57%. However, most of this increase is likely due to increased recognition of the seriousness of head injuries and a higher percentage of children seeking medical care when injured. The most common activities resulting in ER visits for head injury were football, basketball, soccer, playground injuries and bicycling. These were simply the most common, not the highest risk activities; in other words, injuries from these could be more common simply because more children do these activities. The activities where an injury was more likely to be a head injury compared with other injuries were horseback riding, ice skating, golf (including golf carts), ATV riding, and sledding. The highest rates of injury were among males 10-19 years of age.

Guidelines on Sports and Energy Drinks in Children

Patrick N. Pulliam, MD, FAAP — Tue, 31 May 2011 07:01:00 GMT

The American Academy of Pediatrics has issued new guidelines on the use of sports and energy drinks in children. The guidelines do not seem to me to be anything new; however, they do highlight some very important facts that we try to tell our patients.

Energy drinks are not safe in children due primarily to the stimulants in them and should never be used, even in adolescents.
Sports drinks may be useful in sports and other vigorous physical activity when used properly along with water; however, they should not be used by children in general. They contain too many calories and can lead to overweight and obesity. They are also not good for the teeth. They should not be consumed on a regular basis.
Parents and children need to understand the difference between energy and sports drinks and the potential health risks to each.

I tell my patients and their parents that drinking sports drinks is really no different than drinking sodas in terms of sugar and calories, and they are just as unhealthy. Sports drinks are not a healthy alternative to water, milk, and other liquids. I have not routinely advised my adolescent patients to avoid energy drinks, but perhaps I should. I do not know how often they are used by teens in my practice; the report notes that in one (very small) study, about 40% of teens had used energy drinks in the past two weeks. It may be time to add it to my list of advice to teens and their parents.

As an aside, the report also suggests that pediatricians counsel and educate parents and children about this issue as part of the yearly checkup. There are already an overwhelming number of things that it is recommended we cover during the yearly physical. The list is very long now and covering everything would turn into a rather lengthy lecture. It is unlikely that children and parents have the attention span or desire to endure a lecture about all the things that pertain to their health in one sitting. All of the information could not be absorbed at one time anyway. Furthermore, the way insurance companies pay doctors limits the amount of time doctors can spend with each patient, and there is not enough time anymore at annual physicals to cover all of the information. Children, especially teens, and their parents have to and should take an active role in their health and find health information from reputable sources. We strive to provide information like this advice on energy and sports drinks on our website and in our handouts and booklets. Hopefully, this will be effective in improving the lives and health of children.