1.
Disorders of childhood growth and development: screening and evaluation of the child who misses developmental milestones.
Grissom, M
FP essentials. 2013;:32-44; quiz 45-50
Abstract
The family physician is one of the few individuals from whom families receive feedback about their children's development; this makes early identification of potential delays an important responsibility. The American Academy of Pediatrics recommends formal developmental screening for all children at the 9-, 18-, and 24- and/or 30-month well-child visits as well as developmental surveillance at every office visit through age 5 years. A formal screening measure is recommended, taking into account administration time and cost, characteristics of the patient population (eg, availability of screening tool in numerous languages), and psychometrics (eg, reliability, sensitivity, specificity). In the case of abnormal screening results, family physicians must determine the need for further medical evaluation (eg, by a developmental pediatric subspecialist or a pediatric neurology, genetics, or physiatry subspecialist) and/or further developmental evaluation (eg, by a physical therapy [PT], occupational therapy [OT], speech/language pathology, psychology, or audiology subspecialist). Knowledge of early intervention and early childhood programs is necessary for directing parents to evaluation and treatment sources. In treating patients with developmental delays, family physicians must possess knowledge regarding traditional modalities (eg, speech/language therapy, OT, PT) as well as newer treatments with less research support (eg, gluten-free/casein-free diet, hyperbaric oxygen therapy, neurodevelopmental treatment) that families may consider.
2.
Acute febrile neutrophilic dermatosis (Sweet's syndrome) in childhood and adolescence: two new patients and review of the literature on associated diseases.
Hospach, T, von den Driesch, P, Dannecker, GE
European journal of pediatrics. 2009;(1):1-9
Abstract
OBJECTIVES The objectives of this study were to analyse the literature on Sweet's syndrome in childhood focussing on associated diseases and to suggest possible screening procedures for this group of patients. Furthermore, two new patients with Sweet's syndrome are reported. METHODS A literature search was performed on Pub med using search terms "sweet* syndrome*" and neutrophil* dermatos*. Patients were subdivided into the following groups: classic/idiopathic, paraneoplastic, and parainflammatory Sweet's syndrome. RESULTS The literature search revealed 64 patients (including our two patients) who were diagnosed with Sweet's syndrome in childhood and adolescence; 27 (42%) patients were categorized as "classic/idiopathic Sweet's syndrome". In 37 patients (58%) chronic associated diseases were reported. Out of these, 21 (33%) patients were categorized as "parainflammatory Sweet's syndrome" including chronic recurrent multifocal osteomyelitis, vasculitis with aortitis, recurrent infections due to immunodeficiencies, arthritis, and systemic lupus erythematosus. Sixteen (25%) patients were categorized as "paraneoplastic Sweet's syndrome" comprising both malignant and premalignant diseases like leukemia, aplastic anaemia, and Fanconi anaemia. As all five (8%) patients treated with drugs (granulocyte-colony stimulating factor, retinoid acid) suffered from malignant, premalignant, or parainflammatory diseases, these patients were categorized according to the underlying disease. Two new children with Sweet's syndrome and associated diseases are presented here, one of them suffering from recurrent infections and trisomy 21, while the other was diagnosed with CNS vasculitis 5(1/2) years after the primary diagnosis. CONCLUSIONS Sweet's syndrome should be considered in differential diagnosis of prolonged fever with cutaneous involvement. As most cases of pediatric Sweet's syndrome are associated with other diseases we suggest careful screening and monitoring of these patients especially concerning malignant/premalignant diseases, immunodeficiencies, cardiovascular involvement, autoimmune diseases, and drug associations.
3.
Screening for hypoglycemia in healthy term neonates: effects on breastfeeding.
Haninger, NC, Farley, CL
Journal of midwifery & women's health. 2001;(5):292-301
Abstract
Transient hypoglycemia in the early neonatal period is a common adaptive phenomenon as the newborn changes from the fetal state of continuous transplacental glucose consumption to intermittent nutrient supply following cessation of maternal nutrition at birth. Research has demonstrated that in the term, healthy newborn, this dynamic process is self-limiting and is not considered pathologic. The American Academy of Pediatrics and the World Health Organization recommend that neonatal blood glucose screening be reserved for newborns who are at risk or symptomatic and conclude that universal hypoglycemia screening is inappropriate, unnecessary, and potentially harmful. Nevertheless, many hospital nurseries continue the clinical practice of routine early glucose screening on healthy, term newborns. This results in the misidentification of neonates captured while experiencing the normal, self-correcting physiologic blood glucose nadir who are then diagnosed with pathologic neonatal hypoglycemia. Subsequent to this misdiagnosis, further surveillance and unnecessary, aggressive treatment interventions will follow that are potentially harmful to the successful establishment of positive maternal-infant interactions and the breastfeeding experience. Research studies indicate that routine hypoglycemia screens, treatments, and interventions in the healthy infant are not evidence-based and result in a serious disruption of the initiation process and duration patterns of lactation. Using the perspective of the theory of technology dependency, this inquiry explores the potential adverse sequelae of inappropriate glucose screening in the healthy breastfeeding newborn and describes selected outcome variables including: 1) the consequences of early maternal-infant separation, 2) the influence of early formula supplementation on breastfeeding discontinuance rates, 3) the effect of separation and supplementation on the onset of lactogenesis, and 4) the impact of hospital staff and provider recommendations of formula supplementation on maternal confidence to independently nurture her baby.