Does Pacifier Use in Infancy Decrease the Risk of Obesity?

BACKGROUND: Nonnutritive sucking using a finger or pacifier is a natural reflex for infants. We hypothesized that infants may overfeed if the bottle or breast is constantly offered. Our goal was to determine whether pacifier use in early infancy is associated with lower incidence of obesity at later age. METHODS: Parents of 399 infants, 9 to 15 months old, were interviewed and asked whether a pacifier was used consistently for ≥9 months. Body mass indexes at birth, 6 months, and on the day of interview were calculated. RESULTS: In all, 204 (51%) infants used a pacifier, and 195 (49%) were nonusers. More infants in the nonuser group were either overweight-40 (21%)-or obese-32 (16%)-than in the user group-22 (11%) and 22 (11%), respectively ( P = .003). CONCLUSIONS: Pacifier use in infancy was associated with lower incidence of obesity at 9 to 15 months of age. Offering a pacifier can be protective against infantile obesity.

Possible Impact of Yearly Childhood Vaccination With Trivalent Inactivated Influenza Vaccine (TIV) on the Immune Response to the Pandemic Strain H1N1.

BACKGROUND: Annual vaccination of children against seasonal influenza with trivalent inactivated influenza vaccine (TIV) has shown to be beneficial. However, this yearly practice may have unintended effect. Studies have shown that infection with wild type influenza A viruses can stimulate protective heterotypic immunity against unrelated or new influenza subtypes. We hypothesized that a consequence of yearly TIV vaccination is lack of induction of heterotypic immunity against the recent H1N1 pandemic. METHODS: This was a retrospective case-control study. We reviewed the medical records of polymerase chain reaction-confirmed cases of 2009 H1N1 influenza infection in children 6 months to 18 years and a matched control group seen during the pandemic. RESULTS: We identified 353 polymerase chain reaction-confirmed H1N1 cases and 396 matching control subjects. Among the H1N1 group, 202/353 (57%) cases received a total of 477 doses of seasonal TIV compared with 218/396 (55%) in the control group who received a total of 435 doses. Seasonal TIV uptake was significantly higher in the H1N1 group 477/548 (87%) than in the control group, 435/532 (81%) (P = .017). CONCLUSION: Seasonal TIV uptake was significantly higher in H1N1-infected group. The finding suggests that the practice of yearly vaccination with TIV might have negatively affected the immune response against the novel pandemic H1N1 strain. Given the rarity of pandemic novel influenza viruses, and the high predictability of seasonal influenza occurrence, the practice of yearly influenza vaccination should be continued. However, the use of live attenuated intranasal vaccine, as opposed to TIV, may allow for the desirable development of a vigorous heterotypic immune response against future pandemics.

Bilateral onychodystrophy in a boy with a history of isolated lichen striatus.

Lichen striatus (LS) is a relatively rare and self-limited linear dermatosis of unknown etiology. It primarily affects children, with more than 50% of cases occurring in patients aged 5 to 15 years. The case of a 2-year-old boy who presented for evaluation of a nonpruritic linear rash on the left side of the lower abdomen of 3 weeks' duration is discussed. A diagnosis of lichen striatus (LS) was made and the lesions completely resolved within 6 months. At 5 years of age, the patient returned for evaluation of bluish discoloration and thinning of the nails on the left middle and ring fingers, which ultimately fell off and started to regrow 2 months prior to the second evaluation. The rare diagnosis of isolated onychodystrophy as a late manifestation of LS was made.

Emergence of human rotavirus genotype G9 in metropolitan Detroit between 2007 and 2009.

Between January 2007 and April 2009, rotavirus (RV)-positive stool samples from 238 children with acute gastroenteritis, seen at Children's Hospital of Michigan in Detroit, USA, were collected and RV genotyping was performed. G and P genotypes were determined by RT-PCR and nucleotide sequencing was conducted on selected G9 and P[6] strains. Correlation between the severity of gastroenteritis episode and the infecting G genotype was done using a 14-point scoring system. The predominant G genotype was G9 (39.5 %), followed by G1 (35.3 %) and G4 (15.5 %), while P[8] was the most prevalent P genotype (66.5 %), followed by P[4] (21.9 %) and P[6] (11.2 %). The gene combinations G1P[8] and G9P[8] were the most prevalent (21.4 % and 20.6 %, respectively), followed by G4P[8] (13 %) and G9P[6] (8.8 %). Immunization data showed that only 17/238 (7.1 %) children received ≥one dose of RV vaccine (the pentavalent vaccine RotaTeq or the monovalent vaccine Rotarix) and that 10/17 were infected with G4P[8] strains. Severity of RV gastroenteritis episodes was not related to the infecting G genotype. Our results suggest a high proportion of genotype G9 strains in combination with P[8], P[6] and P[4] specificity circulating in the metropolitan Detroit area. While the protective efficacy of the RV vaccines has been demonstrated against G9P[8] strains, the level of cross-protection offered by the vaccines against G9 strains with P[6] and P[4] genotypes in the Detroit paediatric population remains to be determined.

"Don't call me 'mom'": how parents want to be greeted by their pediatrician.

BACKGROUND: Physician-patient interaction during the medical interview is essential in establishing the rapport necessary for a successful relationship. Physicians are generally encouraged to shake hands with patients, address patients by name, and identify themselves. OBJECTIVE: To define parents expectations for greetings by pediatricians and to determine the frequency with which these expectations are met. Design and methods. A total of 100 parents visiting the General Pediatric Clinic at Children's Hospital of Michigan were recruited. Parents were interviewed at the end of their medical encounter to determine expectations for greeting by their doctor. They were questioned about preferences for shaking hands, the doctors' use of their names, and the way doctors should introduce themselves. They were then asked if the experience at this visit conformed to these expectations. RESULTS: Overall, 81% of the parents were the children's mother and 86% were African-American. Over 80% of parents expected physicians to shake hands; 70% of residents and 66% of attendings did. 88% of parents wanted to be addressed by their names; only 14% of residents and 24% of attending physicians did so. All of the parents wanted the physicians to introduce themselves; 84% of residents and 93% of attendings did so. CONCLUSIONS: Physicians neither shook hands with many parents who expected it, nor did they address parents by their last names. About 90% of physicians introduced themselves. These disappointingly low results may predispose to parent dissatisfaction. Attending physicians need to teach these small, but important features, and to model them as well.

Prurigo nodularis in a 9-year-old girl.

A 9-year-old African-American female with a known history of atopic dermatitis presented for evaluation of an intensely pruritic nodular rash on both upper and lower extremities, buttocks, and lower abdomen for more than 1 year. The patient had been treated with several medium-potency topical steroids and antipruritics without appreciable improvement. After considering and excluding other differential diagnoses, the diagnosis of prurigo nodularis (PN) in association with atopic dermatitis was made. Prurigo nodularis usually occurs in middle-aged and older persons and is rarely seen in the pediatric population. The onset of PN in the case presented is considerably earlier than what has been described in literature. The etiology of the disorder is unknown. The management of prurigo nodularis is usually challenging for both patients and treating physicians. Frequently, combinations of several medications or modalities are used in an attempt to control disease activity. Overall, PN is a benign condition in children, particularly when it is associated with atopic dermatitis. It does not increase mortality; however, it can cause significant morbidity in untreated patients.

The natural history of pityriasis rosea in black American children: how correct is the "classic" description?

OBJECTIVES: To delineate the natural history of pityriasis rosea in black children and to compare our findings with those of the American, European, and African literature on pityriasis rosea. Textbook and journal article descriptions of pityriasis rosea usually offer information about the presentation and clinical course of this condition in white patients. DESIGN: Prospective observational study. SETTING: The general pediatric clinic, adolescent clinic, and emergency department of Children's Hospital of Michigan, Detroit, from June 2003 through May 2005. PATIENTS: We followed up 50 black children with pityriasis rosea from the time of diagnosis through follow-up visits at 1, 2, and 4 weeks. Detailed observations were made and digital photographs taken at each visit. MAIN OUTCOME MEASURES: Duration of illness and pigmentary sequelae. RESULTS: Similarities with the medical literature were found regarding season of onset and prevalence of pruritus and of a herald patch. Our patients had more frequent facial involvement (30%) and more scalp lesions (8%) than usually described in white populations. One third had papular lesions. The disease resolved in nearly one half of patients within 2 weeks. Residual hyperpigmentation was seen in 48% of patients. Hypopigmentation developed in 29% of patients with purely papular or papulovesicular lesions. CONCLUSIONS: Pityriasis rosea in black children differs in several ways from textbook descriptions. Physicians may use this information to better counsel patients about the course and potential sequelae of this condition.

Azithromycin does not cure pityriasis rosea.

OBJECTIVES: Pityriasis rosea (PR) is a common skin disorder in children. Its cause is unknown. A recent publication reported a 73% cure rate in patients with PR after treatment with erythromycin. To duplicate this result using a drug with fewer adverse effects and greater biological half-life, we set out to study the effect of azithromycin on PR. Azithromycin is an azalide antibiotic with a spectrum of antimicrobial activity very similar to that of erythromycin. DESIGN: We randomly assigned 49 children with PR to receive either azithromycin (12 mg/kg per day, up to a maximum of 500 mg/day) for 5 days or a similar-appearing placebo. Study physicians were blinded to patients' treatment type. Two pediatricians had to agree on the diagnosis of PR before patients could be enrolled. Subjects were seen at follow-up visits 1, 2, and 4 weeks after starting treatment. OUTCOME MEASURES: We measured the appearance of new lesions and resolution of lesions. RESULTS: Rates of cure and of partial resolution were similar in the azithromycin and placebo groups. CONCLUSION: Azithromycin does not cure PR.