Stories about: Pediatric Dose August 2015

Clinical Consult: Pediatric sleep disorders

yawning baby childhood sleep disorders

Though highly prevalent, pediatric sleep problems (e.g., snoring, apneas, restless sleep, nighttime awakenings, excessive daytime sleepiness, insomnia, nightmares, night terrors) tend to be under-diagnosed in the primary care setting. Sleep problems may only come to clinical attention if parents notice these symptoms or if these are significant. In addition, beyond the infant and toddler years, many parents don’t think to mention sleep disturbances during office visits.

However, a 2010 study of children 0 to 18 years in a large primary care network found that only 3.7 percent had an ICD-9 diagnosis of a sleep disorder, much lower than the prevalence of sleep disorders suggested by epidemiologic studies. Snoring alone, for example, has a reported prevalence as high as 10 to 15 percent, while insomnia is as high as 5 to 20 percent. …Read More

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Expert’s Corner: A closer look at stress echoes for children

children exercise congenital heart defect echocardiography
(Pan Xunbin/Shutterstock)

Surgery in infancy or childhood can often correct even the most complex congenital heart defects (CHD). But there is no such thing as a complete repair of a defect. Even after surgery, the heart of a child with CHD will never be completely normal; there will always be residual issues.

As patients grow, pediatric cardiologists have to figure out how their uniquely abnormal hearts function differently than anatomically correct hearts. While an echocardiogram works fine while a patient is lying down, children are always active and moving. How do doctors know whether enough blood flow is getting to the heart while their patients are walking to school, doing chores or playing sports?

Invasive tests such as coronary angiography can provide this insight, as can nuclear imaging, which is non-invasive but involves a high dose of radiation (just one nuclear imaging scan has the same amount of radiation as about 500 chest x-rays). There is another alternative, however—one that requires no radiation, is non-invasive, and doesn’t even require the child to be stuck by a needle: exercise stress echocardiography (ESE). …Read More

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Virtual visits: How telemedicine can improve health care


laptop heartbeat telemedicine telehealth

Between June 2013 and June 2014, 11-year-old Carson Domey had 36 doctor’s appointments, most of which were with gastroenterologist Michael Docktor, MD, at Boston Children’s Hospital. Carson, who has a rare form of Crohn’s disease that causes oral inflammation, lives in in Dudley, MA—an hour-and-a half car ride from Boston.

“Sometimes, by the time we can schedule an appointment and drive there, my symptoms are gone,” he says. “Telemedicine would allow me to miss less school and get immediate attention when I need it.”

“The time out of school is huge,” says Carson’s mother, Michelle.

Docktor is equally passionate about this issue. “He can Skype into school!” he adds emphatically. “Why can’t he do that for a doctor’s appointment?”

Well, why can’t he? What is stopping Carson and so many other children like him from receiving follow-up clinical care via video conferences—otherwise known as telemedicine? …Read More

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