Clinical Pediatrics

Objective: To investigate the epidemiology of player—player contact injuries in a nationally representative sample of US high school student-athletes. Methods: Data from the National High School Sports—Related Injury Surveillance Study were analyzed to calculate rates, describe patterns, and evaluate potential risk factors for player—player contact injuries. Results: Player—player contact injuries represented 46.4% of all high school sports injuries and occurred at a rate of 11.6 per 10 000 athlete exposures (AEs). Player—player contact injury rates (per 10 000 AEs) were highest in football (26.0), wrestling (10.8), and girls’ soccer (9.8). Body sites most commonly injured were the ankle/foot (21.9%), head/face (18.9%), and knee (16.9%). Most common diagnoses were ligament sprains (32.5%). Conclusions: Player—player contact is the most common mechanism of injury among high school athletes. The epidemiology of such injuries varies by gender and sport. Developing effective preventive measures depends on increasing our knowledge of player—player contact injury rates, patterns, and risk factors.

Juvenile scleroderma is a rare connective tissue disease that involves the skin and subcutaneous tissue. Among all presentations of juvenile scleroderma, localized scleroderma (JLSc) is the most frequent, followed by systemic disease (JSSc) and eosinophilic fasciitis (EF). In posttransplantation chronic graft-versus-host disease (GvHD), scleroderma-like skin involvement can occur. Systemic forms of juvenile scleroderma and GvHD can affect the internal organs, such as the lungs, the gastrointestinal tract, the heart, and kidneys and cause disability and severe, sometimes lethal, complications. Here, the authors give an overview of different presentations of juvenile scleroderma. They report their experience with the different forms and presentations of scleroderma, diagnostic workups, treatment, and outcome of all forms of childhood scleroderma in the context of the existing literature.

Objective. This study examined the efficacy of 2 computer-based training systems to teach children with attention deficit/hyperactivity disorder (ADHD) to attend more effectively. Design/methods. A total of 41 children with ADHD from 2 middle schools were randomly assigned to receive 2 sessions a week at school of either neurofeedback (NF) or attention training through a standard computer format (SCF), either immediately or after a 6-month wait (waitlist control group). Parents, children, and teachers completed questionnaires pre- and postintervention. Results. Primary parents in the NF condition reported significant (P < .05) change on Conners’s Rating Scales—Revised (CRS-R) and Behavior Assessment Scales for Children (BASC) subscales; and in the SCF condition, they reported significant (P < .05) change on the CRS-R Inattention scale and ADHD index, the BASC Attention Problems Scale, and on the Behavioral Rating Inventory of Executive Functioning (BRIEF). Conclusion. This randomized control trial provides preliminary evidence of the effectiveness of computer-based interventions for ADHD and supports the feasibility of offering them in a school setting.

Objective. To evaluate an easy to use 10-point scoring system in clinical assessment of acute otitis media (AOM). Study design. Symptoms of AOM observed by validated otoscopists were tabulated and scored with a 10-point and a 30-point system at acute onset of illness and at the test-of-cure (TOC) 3 weeks later. Results. A total of 330 children (mean age = 13.1 months) with AOM were studied. At AOM onset, the mean 10-point and 30-point scores; were highly correlated (P < .001). At TOC, 256 children were cured, 69 failed, and 5 were lost to follow-up. The 10-point scores were 0.5 and 4.4 for children with cure and failure. The 10-point score had a sensitivity of 87%, specificity of 98%, positive predictive value of 91%, and negative predictive value of 97% compared with the diagnosis by validated otoscopists. Conclusion. A simple, easy-to-use 10-point AOM scoring system was shown to discriminate AOM cure and failure at TOC.

This pilot study is an innovative approach to addressing the issue of childhood obesity that starts with the primary care physician and involves group education with peers. The primary care physician assesses the child’s well-being at each interaction, whether for a scheduled well-child visit or for an acute illness. At each office visit the vital signs are taken, including the height, weight, and the calculated body mass index (BMI). The BMI is a tool that helps the provider identify children who are overweight or obese. Using the patient empowerment readiness model, the provider addresses obesity with the patient and the parent to determine if they are ready to implement behavioral changes. During a 10-month period, 68 patients were enrolled in the pilot program. The initial results after the 10 months showed that when the provider identified the issue of obesity and the child was assessed for readiness and integrated in the behavioral modification program the outcome was 63% of the group reduced their BMI. It was also noted that asthma was the most frequent comorbidity in the overweight/obese children. Whereas BMI increased in a matched control group, participants in the pilot program succeeded in reducing BMI.

The aim of this study was to determine the French norms and examine the validity of a parent-report inventory: the Child Development Inventory (CDI), called “Inventaire du Développement de l’Enfant (IDE)” in French. This assesses the general level of a child’s development in 8 developmental domains. The norms were determined for a community sample of 1287 children, aged 15 to 72 months. The score for the CDI general development scale correlates closely with chronological age (r = .89). The intra- and interobserver (mother vs teacher) agreements were .97 and .76. The 1-year stability coefficient between the developmental quotient (DQ) values was .81. Correlation between the DQ (CDI) and the IQ of psychometric individual test was high (r = .84). The sensitivity and specificity for detecting borderline children (IQ < 86) were 84% (95% CI = 72% to 92%) and 92% (95% CI = 84% to 97%), respectively. Therefore, the French version of the CDI, like the English one, provides a useful tool for measuring children’s development.

Recent routine screening revealed multiple cases of unexplained lead poisoning among children of Burmese refugees living in Fort Wayne, Indiana. A cross-sectional study was conducted to determine (a) the prevalence of elevated blood lead levels (BLLs) among Burmese children and (b) potential sources of lead exposure. A case was defined as an elevated venous BLL (≥10 µg/dL); prevalence was compared with all Indiana children screened during 2008. Environmental and product samples were tested for lead. In all, 14 of 197 (7.1%) children had elevated BLLs (prevalence ratio: 10.7) that ranged from 10.2 to 29.0 µg/dL. Six cases were newly identified; 4 were among US-born children. Laboratory testing identified a traditional ethnic digestive remedy, Daw Tway, containing a median 520 ppm lead. A multilevel linear regression model identified daily use of thanakha, an ethnic cosmetic, and Daw Tway use were related to elevated BLLs (P < .05). Routine monitoring of BLLs among this population should remain a priority.

Objective. Studies have shown that platelets play an important role in the pathophysiology of vaso-occlusive crises (VOC) in sickle cell disease. This study investigates whether changes in platelet indices from baseline can be predictive of complications during acute pain crisis. Methods. Data were obtained from pediatric sickle cell patients in the well-clinic setting and compared with data gathered during VOC (n = 67). Primary outcome was complicated (admission, acute chest syndrome, transfusion, etc) versus uncomplicated (discharge from emergency department without subsequent return) course. Results. Patients with uncomplicated courses had larger platelet declines (53.7) than those with complicated courses (14.8, P = .005). Conclusions. The study suggests that patients with uncomplicated VOC are more likely to experience a larger decline in platelets. The predictive value is limited by the need to have preexisting steady-state data and relatively small decline. Ongoing studies are needed to identify useful laboratory data to help predict severity of VOC.