Lisa Hack

	The American Academy of Pediatrics, the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists recently approved the 

 for childhood and adolescent immunizations.

 reviews the immunization recommendations for children and adolescents aged to 18 years. This year’s schedule follows the same format as last year’s, providing a single schedule for the entire age range. The guidelines also indicate the recommended dose number by age, recommended catch-up ages, and ages when a vaccine is not routinely recommended.

	Changes from last year’s schedule include a tetanus, diphtheria, and acellular pertussis footnote on vaccinating persons aged 7 years and older with a single lifetime dose, unless they are pregnant. Pregnant adolescents should be vaccinated with each pregnancy, preferably during week 27 through week 36 of gestation.

	Other changes include a footnote to the 

 type b vaccine section clarifying vaccination of children aged 1 to 5 years who are at increased risk; a footnote regarding pneumococcal vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23) itemizing recommendations for PCV13 and PPSV23 use in children and adolescents at increased risk; a footnote regarding influenza vaccine describing dosing for children aged 6 months to 8 years and for those aged 9 years and older for the current season; a footnote in the hepatitis A vaccine section outlining persons at increased risk for hepatitis A disease; a footnote for human papillomavirus vaccine clarifying the intervals between vaccine doses; and a footnote for the meningococcal vaccine including guidance for use of Menveo (Novartis, Cambridge, Massachusetts) starting at 2 months of age for certain persons at increased risk. 

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Articles

The American Academy of Pediatrics, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists recently approved the 2014 recommended schedules for childhood and adolescent immunizations.

Child and adolescent vaccination schedule updated

	Making the appropriate diagnosis is critical to the optimal use of antibiotics in children who have upper respiratory tract infections (URIs), according to a new clinical 

	The report was issued by the Committee on Infectious Diseases of the American Academy of Pediatrics (AAP) and the Centers for Disease Control and Prevention (CDC) in conjunction with 

Titled “Principles of judicious antibiotic prescribing for bacterial upper respiratory tract infections in pediatrics,” the committee outlines when antibiotics are appropriate for otitis media, sinusitis, and pharyngitis, with emphasis on first determining the likelihood that an infection is bacterial, rather than viral, in nature.

	With acute otitis media, the researchers say that those children with more severe symptoms, bilateral involvement, and younger age are more likely to benefit from antibiotics.

	With acute sinusitis, the investigators emphasize that bacterial forms are diagnosed on the basis of symptoms that are persistent and not improving (eg, a cough lasting 10 days); worsening (eg, new onset of fever, daytime cough, or nasal discharge after improvement of a typical viral URI); or severe (eg, persistent fever ≥39°C or purulent nasal discharge for at least 3 days).

	And with pharyngitis, the committee notes that the most important diagnostic consideration is whether ß-hemolytic group A 

 is the cause. Children with 2 or more of the following features should undergo testing: absence of cough, presence of tonsillar exudates or swelling, history of fever, presence of swollen or tender anterior cervical lymph nodes, and age younger than 15 years. Children with cough, nasal congestion, conjunctivitis, hoarseness, diarrhea, or otopharyngeal lesions are more likely to have viral illness.

 reports that each year as many as 10 million children risk side effects and antibiotic resistance by taking antibiotics that are unlikely to do anything for their upper respiratory conditions.

Making the appropriate diagnosis is critical to the optimal use of antibiotics in children who have upper respiratory tract infections (URIs), according to a new clinical report.

New guide for antibiotic use for pediatric URIs

	You may not need to operate on every child with acute appendicitis. New research suggests that antibiotics and inpatient observation may be all that are required.

	For decades we’ve believed that surgery is the only appropriate management of acute appendicitis in children. Now interim results from an ongoing 

 indicate that nonoperative management, including a combination of intravenous (IV) and then oral antibiotics and in-hospital observation, may suffice for many children.

	The researchers from Nationwide Children’s Hospital in Columbus, Ohio, conducted a prospective, nonrandomized, single-center study involving children aged between 7 and 17 years. To participate, the children had to have symptoms for 48 hours or less, no generalized peritonitis, a white blood cell count ≤18,000, and imaging studies indicating acute appendicitis without evidence of rupture or appendicolith.

	The researchers then gave caregivers the choice to pursue surgical or nonsurgical treatment. The nonoperative route consisted of at least 24 hours of IV antibiotics; hospitalization until symptoms resolved and a regular diet resumed; and a 10-day course of oral antibiotics upon hospital discharge.

	Of the 30 participants, 13 pursued nonoperative management and 17 chose surgery. The mean age of the participants was 12 years.

	The investigators reported the success rate of the nonsurgical approach to be 77%. One child in the nonoperative group required appendectomy prior to discharge for failure to resume a regular diet despite improvement in symptoms, and 2 children returned with abdominal pain after discharge and underwent appendectomy. One had acute appendicitis, but the other had a normal appendix.

	None of the nonsurgical group progressed to rupture or gangrene. Although they had almost twice as long of a hospital stay as those in the surgical group (44 hours vs 28 hours), they resumed normal activities far faster (4 days vs 18 days).

	The investigators presented their findings during the recent annual 

 of the American Academy of Pediatrics held in Orlando, Florida, October 26 to 29.

You may not need to operate on every child with acute appendicitis. New research suggests that antibiotics and inpatient observation may be all that are required.

No surgery for acute appendicitis?

 shows that children who survive cancer may face another battle-heart disease.

	Researchers have known for some time that childhood cancer survivors can face heart and other health problems decades after cancer treatment, but this is the first study to look at cardiovascular changes while the survivors are still children.

	It seems that cancer treatments change children’s arteries in a way that may increase the risk of early heart disease and atherosclerosis, according to research presented in November at the annual meeting of the American Heart Association in Dallas, Texas.

	In a poster session titled “Signs of early subclinical atherosclerosis in childhood cancer survivors,” researchers revealed findings from a study involving 319 boys and girls in the United States aged between 9 and 18 years who survived for at least 5 years following treatment for leukemia or some type of cancerous tumor. The researchers measured artery stiffness, thickness, and function.

	Compared with 208 siblings who were never diagnosed with cancer, the survivors demonstrated poorer arterial function. The leukemia survivors, for example, demonstrated a 9% decrease in arterial health.

	As a result, the investigators say that monitoring these children and managing lifestyle and other risk factors is critical following cancer treatment, especially with the number of childhood cancer survivors growing. According to the 

, the 5-year survival rate in 1975 to 1977 was slightly more than half (58.1%). Today, according to the 

, the 5-year survival rate is around 80%. 

A new study shows that children who survive cancer may face another battle-heart disease.

Surviving cancer takes a toll on the heart

	Fewer than half of all adolescents with psychiatric disorders receive treatment, and many that do receive treatment in a setting where specialist mental health training is unlikely to exist.

 recently found that a mere 45% of adolescents with a diagnosable psychiatric disorder received some form of service within the previous 12 months, and that the most common service providers were schools.

	The findings come from data on approximately 6,500 teenagers aged 13 to 17 years from the 

National Comorbidity Survey: Adolescent Supplement (NCS-A)

, a survey of the prevalence, course, onset, and comorbidity of 

Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV

 mental, emotional, and behavioral disorders and use of treatment services. The survey was conducted from 2001 to 2004, which is the most recent data available on the topic.

	The investigators found that the conditions most likely to have received treatment in the previous year were attention-deficit/hyperactivity disorder, conduct disorder, and oppositional defiant disorder. Least likely to have received treatment were adolescents with specific phobias and any anxiety disorder.

	Treatment settings included schools (23.6%), specialty mental health settings (22.8%), general medical settings (10.1%), juvenile justice settings (4.5%), and complementary and alternative medicine settings (5.3%).

	White participants were significantly more likely than blacks to receive treatment in a specialty mental health or general medical settings. Girls were less likely to receive treatment than boys.

, approximately 21% of 9- to 17-year-olds have a diagnosable mental or addictive disorder that causes at least minimal impairment at home, at school, or with peers. Consequences of untreated disorders include suicide, school failure, juvenile and criminal justice involvement, and higher health care utilization.

Fewer than half of all adolescents with psychiatric disorders receive treatment, and many that do receive treatment in a setting where specialist mental health training is unlikely to exist.

Teens not getting treatment for psych disorders

 raises a question about whether too many antireflux procedures (ARP) are performed on children during a period of infancy when frequent regurgitation is normal and when already ambiguous measures of gastroesophageal reflux disease (GERD) are difficult to interpret at best.

	According to the investigators, although GERD is a common diagnosis in infants and young children, “no objective criteria exist to guide the diagnosis and treatment of this disease” in these populations.

	Researchers from Seattle and New Orleans conducted a retrospective cohort study using inpatient data from 41 US children’s hospitals. To be included, the children had to be younger than 18 years of age and discharged between 2002 and 2010 with a diagnosis of GERD.

	The investigators found that of the nearly 150,000 children included in the research, a little over 8% underwent an ARP during the study period, with half of those undergoing the procedure when aged 6 months or younger. Although almost two-thirds of those in the ARP group received preoperative upper gastrointestinal tract fluoroscopy, all of them did not receive a uniform workup.

	Performance of an ARP was significantly less likely in those aged 7 months to 4 years and in those aged 5 to 17 years than in those aged younger than 2 months and those 2 to 6 months of age. ARP procedures were much more likely in those who also had failure to thrive, neurodevelopmental delay, cardiopulmonary anomalies, cerebral palsy, or aspiration pneumonia, and in those with tracheoesophageal fistula or diaphragmatic hernia.

 recently issued guidelines emphasizing that not all cases of gastroesophageal reflux are gastroesophageal reflux disease, and that all opportunities to correct symptoms with lifestyle changes should be exhausted before attempting more intensive or invasive strategies.

A new study raises a question about whether too many antireflux procedures (ARP) are performed on children during a period of infancy when frequent regurgitation is normal and when already ambiguous measures of gastroesophageal reflux disease (GERD) are difficult to interpret at best.