The Year in Pediatrics
ROCHESTER, N.Y. -- Childhood obesity remained a focus of pediatrics during the year, along with concerns about safety, particularly the safety of psychiatric medications.
ROCHESTER, N.Y.-- Childhood obesity remained a focus of pediatrics during the year, along with concerns about safety, particularly the safety of psychiatric medications.
The following summary reviews some of the highlights of the year in pediatrics research. For fuller accounts, links to the individual articles published in MedPage Today have been provided.
Rounder and Rounder
Although pediatricians have been increasingly worried about the effects of the obesity epidemic on children, one of the first studies to report hard numbers on abdominal obesity came out in 2006. Abdominal obesity--a predictor of cardiovascular and type 2 diabetes risk--grew by more than 60% among children from 1988 to 1994, according to National Health and Nutrition Surveys (NHANES) data.
The good news is that clinicians now have some direction on what to do for overweight pediatric patients to head off problems later in life.
Physicians cannot depend on kids to grow out of it but should prescribe exercise and improved diet right from the start, researchers found. In a longitudinal study of more than 1,000 children, kids who remained overweight longer were more likely to carry the heft over into early adolescence.
Other researchers found that getting a daily dose of vigorous exercise in an after school program helped reduce or eliminate snoring and other breathing problems during sleep. But, extra exercise alone is not enough for long-term health benefits, according to another study. Adding 90 minutes of physical activity each week at school for overweight or obese preschoolers did not lower their body mass index or change exercise habits. Diet and other lifestyle changes may be necessary to achieve such changes.
- Exercise Alone Can't Slim Down Overweight Preschoolers
- Exercise Reduces Snoring in Overweight Kids
- America's Kids Getting Rounder and Rounder
- With Young Children, Overweight Should Be Nipped in the Bud
Antidepressants
In January, a study of more than 65,000 children and adults treated for depression over a 10-year period found that suicide risk declines, not rises, once a patient begins taking antidepressants compared with the three months before therapy started. The observational study was published in the American Journal of Psychiatry by the American Psychiatric Association, which has been critical of FDA warnings about possible increased risk of suicide in children and adolescents brought on by treatment with newer antidepressants.
However, the FDA stuck by its warnings. And, in December, FDA advisers recommended extending the suicidality-risk black box warning on antidepressant drugs for children and adolescents to cover adults through about age 25.
- Antidepressants Found Unrelated to Suicide Risk
- FDA Advisers Want Antidepressant Suicidality Black-Box Warning for Young Adults
Still, clinicians should not put off using antidepressants because of the warnings, said pediatric psychiatrist John T. Walkup, M.D., of the Johns Hopkins Medical Institutions in Baltimore. They should reassure parents of children and adolescents with depression that the benefits of antidepressants outweigh the potential suicide risk, he said at the U.S Psychiatric & Mental Health Congress.
For pediatric patients already on antidepressant therapy, a study confirmed what most psychiatrists had suspected--medication should be continued for at least six months past the acute stage of major depressive disorder, as is done for adults.
A total of nine months of Prozac (fluoxetine) treatment significantly reduced the pediatric depression relapse rate compared with placebo, particularly in younger children, though relapse rates were high regardless.
- USPSYCH: Antidepressants Benefit Teens Despite Black Box Warnings
- AACAP: Antidepressant Continuation Reduces Relapse in Kids
ADHD
An FDA pediatric advisory panel also met to discuss a black box warning for attention deficit hyperactivity disorder (ADHD) stimulant drugs. They ended up recommending a notice of potential cardiovascular and psychiatric risks in the new "highlights" section of the label for drugs including Ritalin (methylphenidate), Adderall (mixed salts of a single-entity amphetamine product), and Concerta (extend release methylphenidate).
SUVs and Seatbelts
Researchers found that sports utility vehicles are no safer than passenger cars for children during an accident.
Any potential safety advantage of the SUV's greater size and weight was offset by their increased tendency to roll over in a crash compared with sedans cars, in the study of nearly 4,000 children who had been in crashes recorded in an insurance claims surveillance system. Age-appropriate restraints and putting children in the back seat are critically important for reducing the risk of injury regardless of vehicle type, the researchers concluded.
Lack of seatbelts or other safety restraints in school buses may be partly responsible for the estimated 17,000 bus-related injuries treated in emergency departments each year, according to another research group, which was twice the toll cited previously by the National Highway Traffic Safety Administration.
Sex Education
Likewise, urging teens to exercise restraint in sex education classes is insufficient to protect them, according to a national survey. Across political and religious ideologies, abstinence-only programs received the least support and most opposition from the 1,096 surveyed American adults. Sex education classes that teach about abstinence plus other contraceptive methods was supported by 82% while 68% supported condom instruction and 36% supported abstinence-only programs.
Tonsillectomies
A short stay in the hospital after a tonsillectomy appears to be safe for most pediatric patients, according to a retrospective study of nearly 800 patients. Typical time in the recovery room before discharge was under two hours, but ranged from less than 30 minutes up to about seven hours with a 24-hour complication rate of only 0.0075%.
Phlebotomy
Part of the sea change to outpatient tonsillectomy has been safer anesthetics. But for children getting blood drawn, the ultimate in harmless anesthetics appears to be television, according to Italian researchers. Watching television killed the pain of venipuncture for children better than active distraction by a parent, among the 69 patients in the study.
