Stories about: Developmental Medicine

Paper Trail: Challenges for developmental-behavioral workforce, pediatric dentistry trends, implications of herpes zoster and more

Clinical research from Boston Children's

Boston Children’s Hospital is at the forefront of clinical research. Stay connected with Paper Trail — a monthly feature highlighting recently published outcomes data and new approaches to the diagnosis, treatment and prevention of pediatric illnesses.

Implications of herpes zoster in vaccinated children

Researchers including dermatologist Jennifer Huang, MD, describe seven children without a history of primary varicella who presented with herpes zoster that correlated with the original VZV vaccination site and resolved without complications. These cases, published on Feb. 6 in Pediatric Dermatology, highlight the close correlation between the vaccination site and cutaneous eruption.

Trends in pediatric dental care use

Co-authored by Dentist-in-Chief Man Wai Ng and published in the April 2018 issue of Dental Clinics of North America, this article explores trends in three areas of pediatric dental services: access among Medicaid-enrolled children, treatment of oral health conditions, and use of emergency departments for dental needs among U.S. children.

Parents’ perceptions of their child’s health status 

The aim of this study by Nurse Scientists Kristine Maria Ruggiero and Judith A. Vessey, Associate Chief Nurse Patricia Hickey and colleagues, was to examine parents’ perceptions of the health-related quality of life (HRQOL) in their school-age child with congenital heart disease (CHD). The results of this study, published in the Journal for Specialists in Pediatric Nursing, are useful in providing practical recommendations in caring for children with CHDs while informing relevant policies.

Challenges for developmental-behavioral peds

In this Pediatrics paper published Feb. 16, Carolyn Bridgemohan, MD and colleagues surveyed a sample of the developmental-behavioral pediatric workforce and found it struggles to meet current service demands. Clinician burnout was reported with increased patient complexity and female subspecialists spent more time in billable and nonbillable components of clinical care.

For more clinically-actionable insights, bookmark Boston Children’s Notes blog for primary care providers.

More preschoolers with ADHD are taking medication, missing out on behavioral therapy

more-young-kids-with-ADHD-taking-medicationA recent study by the U.S. Centers for Disease Control (CDC) found that in 2015, 75 percent of children aged two to five years with a diagnosis of Attention Deficit-Hyperactivity Disorder (ADHD) were receiving medication-based treatment, and only 50 percent received some form of behavioral therapy. This was true regardless of insurance type; that is, it was equally true for children covered by Medicaid as it was for children on private insurance.

The study raises concerns on many levels.

The data on treating older children are fairly clear regarding the benefits and risks of medication treatment for ADHD. The landmark trial showed better outcomes in those treated with medication and behavioral therapy as opposed to behavioral therapy alone, and side effects were infrequent and readily manageable or reversible. Similar high-quality, multi-center, blinded scientific studies in younger children have not been done.

…Read More

Expert’s Corner: Should we doubt Ritalin?

Ritalin ADHD

The stimulant methylphenidate has been used for decades to treat attention deficit and hyperactivity disorder (ADHD). However, a Cochrane Review last month looked at 185 pediatric clinical trials of methylphenidate (Ritalin, Concerta and other brands) and found that the evidence for benefit has generally been of poor quality.

Collectively, the trials involved more than 12,000 children or adolescents with an ADHD diagnosis. Most compared methylphenidate to placebo, with treatment durations ranging from 1 to 425 days (average, 75). Of the 185 trials, 72 (40 percent) were industry-funded.

While the collective data indicate that the drug reduced hyperactivity and impulsivity and increased children’s ability to concentrate, most trials were small and judged to be low quality. For example, methylphenidate’s side effects may have compromised blinding in many studies. While short-term data indicated no life-threatening harms, the drug was associated with an increased risk of side effects such as sleeping problems and decreased appetite.

So should we now be questioning Ritalin? Notes checked in with Elizabeth Harstad, MD, MPH, of the Developmental Medicine Center at Boston Children’s Hospital, who is involved in an ongoing analysis of practice patterns for ADHD management. …Read More

Read Full Story | Leave a Comment

Clinical Consult: Language and speech delays

empty speech bubble pediatric language delay developmental delay
(Stock Rocket/Shutterstock)

Like all developmental milestones, children learn to communicate at different rates. But delays in speech and language development are important to recognize as early as possible. A child’s early understanding and expression of language will often impact other important developmental milestones such as play skills, social interactions and behavioral regulation.

When should a parent or clinician be concerned about delayed language acquisition, and when is further evaluation by a specialist such as a developmental-behavioral pediatrician or child neurologist warranted? Notes consulted with Carol Wilkinson, MD, PhD, a fellow in Boston Children’s Division of Developmental Medicine, and David Urion, MD, FAAN, of the hospital’s Department of Neurology, for advice and tips on what to watch for. …Read More

Read Full Story | Leave a Comment