The role of pediatric primary care providers in parental smoking cessation: assessing and motivating parents to quit.

Children and adolescents who are exposed to smokers in their household are 3 times more likely to initiate smoking themselves (Winickoff, Berkowitz, et al., 2005). If successful in getting parents to quit smoking, pediatric providers will have helped parents and their families improve quality of life standards in a variety of ways, including adding 7 years to the parent's life and eliminating the majority of second-hand smoke exposure in children. The purpose of this clinical article is three-fold; (1) to discuss the role of pediatric primary care providers in parental smoking cessation, (2) to discuss the obstacles faced by parents in smoking cessation and how the primary care provider can help them to surmount them, and (3) to discuss the obstacles faced by pediatric primary care providers in assisting parent smoking cessation and options to surmount them.

Adverse events associated with methimazole therapy of graves' disease in children.

Objective. Graves' disease is the most common cause of hyperthyroidism in the pediatric population. Antithyroid medications used in children and adults include propylthiouracil (PTU) and methimazole (MMI). At our center we have routinely used MMI for Graves' disease therapy. Our goals are to provide insights into adverse events that can be associated with MMI use. Methods. We reviewed the adverse events associated with MMI use in our last one hundred consecutive pediatric patients treated with this medication. Results. The range in the patient age was 3.5 to 18 years. The patients were treated with an average daily dose of MMI of 0.3+/-0.2 mg/kg/day. Adverse events attributed to the use of the medication were seen in 19 patients at 17+/-7 weeks of therapy. The most common side effects included pruritus and hives, which were seen in 8 patients. Three patients developed diffuse arthralgia and joint pain. Two patients developed neutropenia. Three patients developed Stevens-Johnson syndrome, requiring hospitalization in 1 child. Cholestatic jaundice was observed in 1 patient. No specific risk-factors for the development of adverse events were identified. Conclusions. MMI use in children is associated with a low but real risk of minor and major side effects.

Practical aspects of real-time continuous glucose monitors: the experience of the Yale Children's Diabetes Program.

Real-time continuous glucose monitoring (RT-CGM) provides new dimension to diabetes management. However, there are many challenges to using RT-CGM successfully. This article aims to present how RT-CGM is integrated into diabetes clinical practice at the Yale Children's Diabetes Program (YCDP). The authors provide factors to consider when choosing one of the commercially available RT-CGM systems and a discussion of key strategies for successful use of RT-CGM for families. Careful training and troubleshooting strategies will ensure the most positive experience possible for a family using RT-CGM.

Low-dose dexamethasone therapy from infancy of virilizing congenital adrenal hyperplasia.

Objective. To assess the growth and control of adrenal androgen secretion in children with virilizing congenital adrenal hyperplasia (CAH) treated with dexamethasone. Method. We examined doses used, control of adrenal androgen secretion, and growth and skeletal maturation of 8 children with CAH treated with dexamethasone beginning in infancy. Results. 3 boys and 5 girls with classical CAH (17-hydroxyprogesterone at diagnosis >20,000 ng/dL) were treated with dexamethasone beginning at diagnosis (<10 days of age). Patients were also treated with fludrocortisone and sodium chloride. The average initial medication dose was 0.1 mg (0.28 +/- 0.015 mg/m(2)); all doses were given in the morning using a dosing syringe to administer a 0.1 mg/mL elixir. The children were treated for 6.5 +/- 2.0 years over which time the change in bone age to chronological age ratio (DeltaBA/DeltaCA) was 0.9 +/- 0.06. Most recent height Z' scores were +0.5 +/- 0.2, and body mass index (BMI) scores were 18 +/- 0.2. Late afternoon levels of 17-hydroxyprogesterone, androstenedione, and testosterone were 780 +/- 238 ng/dL (23.4 +/- 7 nmol/L), 42 +/- 10 ng/dL (1.4 +/- 0.3 nmol/L), and 11.5 +/- 3 ng/dL; (0.4 +/- 0.1 nmol/L), respectively. Conclusions. These observations show that low doses of dexamethasone can be used to effectively treat CAH beginning in infancy.