Stories about: Pediatric Dose July 2015

Expert’s Corner: Neurosurgical approaches for spastic cerebral palsy

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(Jaren Jai Wicklund/Shutterstock)

The brain injuries that cause cerebral palsy also commonly cause muscle spasticity, which can limit patients’ mobility and control over their movements. Spasticity that is mild or limited in scope may respond to conservative treatments such as physical therapy, oral medications or injections of botulinum toxin (botox).

But children with severe spasticity, or spasticity that does not respond to these treatments, should be considered for neurosurgery.

In properly selected patients, therapy directed at the underlying nervous system abnormalities can markedly improve function and quality of life. According to Boston Children’s Hospital’s Shenandoah Robinson, MD, neurosurgery can also reduce bone deformation and joint damage, decreasing the need for orthopedic surgery.

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Matching children in chronic pain with the right treatment

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(Giovanni Cancemi/Shutterstock)

Chronic pain ranks with ADHD and asthma among the most costly chronic pediatric conditions in the United States. To some extent, the cost—roughly $19.5 billion annually—stems from the large number of children—an estimated 1.9 million—seen for pain every year.

However, in large part the problem may also be one of matching children and adolescents in pain to the appropriate treatments. As psychologist and pain specialist Laura Simons, PhD, and collaborators recently noted in PAIN, pediatrician surveys reveal a lack of consensus when it comes to diagnosing pain, making treatment planning a challenge and potentially putting children at risk for chronic pain problems as adults.

“We’re not catching pain problems early enough,” says Simons, who works in Boston Children’s Hospital’s Department of Anesthesia, Perioperative and Pain Medicine. “Patients may undergo multiple medical procedures, or see several specialists before a diagnosis is given or an appropriate treatment plan is put into place.”

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Clinical Consult: Tonsils and Adenoids

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(Ilya Andriyanov/Shutterstock)

It’s a common scenario in every pediatrician’s office: A mother brings in her otherwise healthy 7-year-old for a well visit, and you look in the mouth and see markedly enlarged tonsils. Does the child snore? Yes. Does the child mouth breathe? Yes. Does the child experience respiratory pauses? Not sure. But over the last year there have been two episodes of strep-positive tonsillitis, with a few days of missed school. …Read More

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