Stories about: Pediatric Dose September 2015

Clinical Consult: Celiac and other gluten-related disorders


Interest in gluten—and in particular, avoiding it — continues to be on the rise. The gluten-free market has become a billion dollar business as more and more adults and children trial this restrictive diet. Many go gluten-free as a lifestyle choice.

However, many turn to a gluten-free diet for medical reasons and for relief of specific symptoms. It is estimated that roughly 10 percent of the population have gluten-related disorders. Figuring out whether an individual needs to be gluten-free and where she lies on the spectrum of gluten-related disorders can be hard, but is an important endeavor. …Read More

Clinical Consult: Dizziness, vertigo and balance disorders

dizziness vertigo vestibular disorders

Imagine that you wake up one morning and the world around you is spinning rapidly as if you were on a merry-go-round. You try to walk but the floor seems to be moving and you fall to the ground. You begin to feel nauseous. You lie down hoping the feeling will disappear, but it does not.

It can be a terrifying experience for a child to experience dizziness. Moreover, it can often be very difficult for them to articulate to their parents and doctors exactly what they are experiencing.

Most pediatric health care providers do not learn about the evaluation and management of dizziness in children during the course of their training. A child complaining of dizziness may appear normal and may not have any obvious abnormalities on physical exam, but the differential diagnosis of dizziness in children is expansive, ranging anywhere from simple dehydration to a vestibular or balance disorder to a brain tumor. For these reasons, the evaluation of a child with dizziness can often be an intimidating and time-consuming task. …Read More

Expert’s Corner: What to do about incidental imaging findings?

CT scan incidental finding imaging thyroid
Radiologists Edward Lee, MD, MPH, and Sarah Bixby, MD

The surge in computed tomography (CT) imaging in the last two decades has spurred an unintended consequence (apart from increasing patients’ radiation exposure)—an increase in the number of incidental findings, or incidentalomas. These worrisome, unanticipated spots on a scan might indicate malignancy or, as is more often the case, point to a benign finding.

Incidentalomas can be particularly troublesome for pediatric clinicians, says Edward Lee, MD, MPH, from Boston Children’s Hospital Department of Radiology. Lee and his colleagues Sara Vargas, MD, from Boston Children’s Department of Pathology, and Juan Baez, MD, from radiology, recently published the first research on pediatric incidentalomas, focusing on how to manage incidentally detected thyroid nodules on CT exams. …Read More

Narrow networks: Don’t let children get shut out

narrow insurance

Narrow networks—health insurance plans that sharply limit the providers a patient can see—have been winning the popularity contest among consumers, especially on the Affordable Care Act’s (ACA) insurance exchanges. Limited choices can equal cheaper premiums, which is why about 70 percent of plans sold on the exchanges last year featured a limited network, with premiums that were up to 17 percent cheaper than less restrictive plans (according to McKinsey & Company).

A telling new study examining physician networks for plans sold on the ACA’s online insurance exchanges revealed that 11 percent of plans are “extra small,” covering fewer than 10 percent of physicians in a plan’s region. Another 30 percent were “small,” covering between 10 and 25 percent of physicians. Just 11 percent earned “extra large” status by covering at least 60 percent of physicians in the area.

While limiting consumer choice in order to control costs rightly continues to be a hot-button topic, there’s a piece of the conversation that’s rarely voiced: how this affects children, and in particular, children who are extremely sick and require specialized care. …Read More