Screening Teens for Drugs, Alcohol

Bruce Goldman, LCSW

All adolescents should be screened for alcohol, tobacco and other drugs every time they visit the doctor, according to a new recommendation in the journal published by the American Academy of Pediatrics.

This is an excellent and timely recommendation. It is no secret that adolescents experiment with alcohol and drugs. In fact 41.2 percent of high school seniors report past month use of alcohol with 22.3 percent reporting binge drinking in the prior month (more than 5 drinks in a row). Marijuana use among high school seniors is now more prevalent than tobacco use (21.4 percent vs. 19.2 percent). Additionally, we cannot read a newspaper or listen to a news report without hearing about the Full Post - to Detail View

ADHD Medicine Doesn’t Increase Kids’ Heart Risk

Andrew Adesman, MD

Stimulant medications are generally viewed as the safest and most effective medications for the treatment of attention deficit hyperactivity disorder (ADHD). Several years ago, concerns were raised about the possibility of a small but increased risk of sudden cardiac death among children and adolescents treated with stimulant medication for ADHD. Although subsequent analyses suggested that there is no increased risk, patients and clinicians have remained cautious about these medications from a cardiac standpoint.

In this week’s New England Journal of Medicine, a team of researchers present findings from their analysis of an extraordinarily large sample (1.2 million children and young adults) with respect to ADHD drugs and serious cardiovascular events. This new study once again fails to find an association between treatment with stimulant medication and sudden cardiac death, myocardial infarction or stroke. Although the authors acknowledge that they cannot rule out a modest increase in risk, the data are overall quite reassuring, especially considering that they did not exclude children with congenital heart disease--a group presumed to be at increased cardiovascular risk--from the analyses.

In short, this study provides additional reassurance to families and clinical practitioners that stimulant medications like Concerta, Full Post - to Detail View

Proper Backpack Use for Kids

Shaheda Quraishi, MD

During back-to-school time, parents are frequently concerned about the heavy backpacks kids use to carry books. If not used properly, these backpacks can cause significant back pain.

Most backpacks have two straps--one over each shoulder. This design is the most ergonomic compared to a single-strap design. Two straps allow the weight of the backpack to be evenly distributed over each side, thus reducing the load on each individual shoulder. Bags with only one strap cause disproportionate amounts of weight on one side, resulting in abnormalities in posture.

The amount of weight within the backpack is the most important factor. If there are textbooks that can be left at home or are not needed daily, leave them out. Furthermore, maintaining correct posture is critical to allowing the body to successfully bear the weight of the backpack. The majority of the weight is felt by the lower back and therefore, it is a common site of problems.

To protect your child from injury due to a heavy backpack:

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Newborn Screening for Congenital Heart Disease Gains Prominence

Dennis Davidson, MD

The November issue of Pediatrics reports a strategy for screening for congenital heart disease via a test called pulse oximetry, which measures blood oxygen. The report—published online August 22—is endorsed by the American Academy of Pediatrics, the American College of Cardiology Foundation and the American Heart Association.

I support these recommendations. In fact, the neonatal service at Cohen Children’s Medical Center of New York has been using pulse oximetry screening since 2003, when neonatologist Robert Koppel, MD, published an early study demonstrating its usefulness in detecting critical congenital heart malformations before a baby could be discharged from the regular newborn nursery.

Pulse oximetry is a rapid, easy crib-side test that is noninvasive, extremely inexpensive, and completely safe way to detect a newborn’s oxygen saturation. The test is done just before the routine blood test taken from the baby’s heel to test for a variety of treatable newborn conditions that may be extremely harmful.

Pulse oximetry is not a perfect test, but it is much better than the current standards of practice, especially since hospital discharges of the mother and baby occur sometimes as early as 24 to 36 hours after birth. Pulse oximetry screening can help prevent the newly born with an undiagnosed heart malformation from going home and developing shock that can lead to death or permanent brain and other organ injury, when there could have been corrective cardiovascular surgery shortly after birth.

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The Recurrence Risk for Autism Between Siblings

Andrew Adesman, MD

About one in 110 US children has been diagnosed with an autism spectrum disorder (ASD), and children who have an older sibling diagnosed with ASD are more likely to receive that diagnosis, according to a study just published online by the journal Pediatrics.

Using data from 12 different sites internationally, this large, well-designed study of families with an older child with an autism spectrum disorder employed a systematic and rigorous approach to evaluating the recurrence risk for an autism spectrum disorder in subsequent children when evaluated at age 3.

This study found a higher than expected recurrence rate for an ASD. Whereas prior research has suggested that the recurrence rate for another child with an autism spectrum disorder ranges from 3 percent to 10 percent, this study suggests the overall recurrence rate is 18.7 percent. Recurrence risks were found to be especially high for boys and in families with more than one affected child. In this study, there was almost a three-fold greater risk for an ASD in later male children compared to female children (26.2 percent vs. 9.1 percent, respectively). In families with two or more older children, there was a much higher risk of recurrence if two older children had an ASD compared to households with only one affected older child (32.2 percent vs. 20.1 percent).

To the extent that recurrence risks were found to be higher than previously reported, these new findings must be rather sobering and disconcerting for parents who have one or more children with an ASD and who are considering having another child. Full Post - to Detail View