Stories about: Pediatric Dose January 2016

Clinical Consult: Weighing the risks and benefits of Deflux for reflux

vesicoureteral reflux VUR deflux Dx/HA

It’s estimated that one in three children with recurrent urinary tract infections have vesicoureteral reflux (VUR), a urological condition where urine flows backwards from the bladder to the kidney.

Though the condition’s management has evolved, the question of which treatment is the preferred one — and specifically, whether urologists should continue to turn to endoscopic injections of dextranomer/hyaluronic acid copolymer (Dx/HA, aka Deflux) — remains a source of debate.

Boston Children’s Urologist-in-Chief, David Diamond, MD and colleagues Alan B. Retik, MD and Stuart B. Bauer, MD, researched Dx/HA use, and determined that due to its:

  1. high failure rate
  2. long-term complication rate
  3. high re-treatment rate
  4. high (and rising) cost

the risks of Dx/HA far outweigh its limited benefits in a majority of patients.

Read Boston Children’s “Caution in Employing Deflux for Reflux – The Thinking Behind Our Approach” white paper and find out why our urology experts say Dx/HA should not be considered as a preferred treatment option for children with VUR.

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Dispatch from Liberia: When the doctor’s office is regarded as a last resort

Phebe Hospital Ophelia Adpia Liberia global health
Ophelia Adipa (second from right) with staff from Liberia’s Phebe hospital.

As I reflect on my last few months at Phebe Hospital in Bong County, Liberia, my thoughts are drawn to particular patients who are hard to forget, like:

  • The 6-year-old boy who burned his leg severely falling into a fire during a seizure. His family spent two months seeking care elsewhere; he spent another two months in the hospital recovering from surgery.
  • The developmentally delayed, severely malnourished 1-year-old, who weighed 4 kg (8.8 lbs; the average weight of a 2-week old) when I first met him one Wednesday afternoon.
  • The 4-year-old girl with malaria, treated in the hospital after experiencing fevers and seizures. She was covered in chalk after being treated with herbs in the village.
  • The 6-month-old girl who arrived in the emergency room with a florid full body rash. Her parents had been treating her with a cream of herbs mixed into zinc oxide.

It is amazing how quickly I adjusted to hearing stories like these, which would seem so far-fetched if heard in the Boston Children’s emergency room. However, an overriding theme that seemed to link a lot of my patients’ stories was shopping around for local remedies before coming to Phebe. …Read More

How much screen time is too much screen time for a preteen?

preteen video game Minecraft mediatrician Michael Rich
(Volt Collection/Shutterstock)

How much screen time is too much? That’s the essence of a question one parent sent in to Boston Children’s Hospital’s Mediatrician, Michael Rich, MD, MPH, director of the hospital’s Center on Media and Child Health, about the hours upon hours her preteen daughter spends on the computer playing Minecraft.

Rich notes that as screens have become ever present in society, the pediatric establishment’s view on screen time has evolved:

As technologies continue to develop and screen media become more and more prevalent in all of our lives, experts including the American Academy of Pediatrics (AAP) are moving away from the concept of screen time limits for children.

Before offering advice on how to talk to her daughter about her Minecraft time, Rich adds that families need to view a child’s on- and offline activities in the context of her age and developmental needs:

Remember, your daughter is at a stage in life where one of her key developmental tasks is how to prioritize activities and manage her time. Her academic and social demands are increasing and she is moving out of the nuclear family unit to a much larger universe of peers and the public. Minecraft is just one of many activities she will need to prioritize, put into perspective and ultimately regulate in terms of her time and attention. Ironically, time management and getting enough rest is essential to success within the game of Minecraft.

See the rest of Rich’s response on our sister blog Thriving.



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