Effectiveness of oral or nebulized dexamethasone for children with mild croup.

OBJECTIVE: To assess the efficacy of oral dexamethasone or nebulized dexamethasone sodium phosphate in children with mild croup. METHODS: Double-blind, placebo-controlled study of 264 children between 6 months and 6 years of age with symptoms of croup for fewer than 48 hours. Patients were excluded if they received racemic epinephrine or corticosteroid treatment. Other exclusion criteria included corticosteroid treatment during the 14 days prior to enrollment or complicating medical condition. Subjects randomly received oral dexamethasone (0.6 mg/kg), nebulized dexamethasone sodium phosphate (160 microg), or placebo. Telephone follow-up was obtained on days 1, 2, 3, 4, and 7. MAIN OUTCOME MEASURES: The primary outcome measure was treatment failure, defined as receiving corticosteroid or racemic epinephrine treatment during the 7 days after enrollment in the study. Secondary outcome measures included seeking additional care and the parental assessments of the patients' condition obtained during follow-up (worse, same, better, or gone). RESULTS: Eighty-five patients received oral dexamethasone, 91 received nebulized dexamethasone, and 88 received placebo. There were 3 treatment failures in the oral dexamethasone-treated group, 12 in the nebulized dexamethasone-treated group, and 10 in the placebo-treated group (P =.05). Ten children in the oral dexamethasone-treated group sought additional care compared with 27 and 29 in the nebulized dexamethasone-treated and placebo-treated groups, respectively (P =.002). Parents of children in the oral dexamethasone-treated group reported greater improvement on day 1 (P<.001) compared with the nebulized dexamethasone-treated and placebo-treated groups. CONCLUSIONS: Children with mild croup who receive oral dexamethasone treatment are less likely to seek subsequent medical care and demonstrate more rapid symptom resolution compared with children who receive nebulized dexamethasone or placebo treatment.

Is routine heparin lock placement beneficial in the evaluation and treatment of febrile children?

INTRODUCTION: Nurses often use intravenous heparin locks (HL) with pediatric patients while obtaining laboratory studies to evaluate fever without a source. The purpose of the HL is to avoid an intramuscular injection if parenteral antibiotics are subsequently ordered. The objectives of this study were to determine if HL placement in patients undergoing laboratory evaluation for fever without a source (1) results in fewer injections and (2) is associated with increased use of antibiotics. METHODS: A retrospective chart review of ED patients aged 3 to 36 months was performed. Patients included in the review had fever with no identified source of infection, and a complete blood cell count and/or blood culture had been ordered. For analysis, patients who received an HL were compared with patients who did not receive an HL. RESULTS: A total of 439 patients had laboratory studies for fever without a source, with 345 (79%) in the HL group. No statistically significant differences were found in antibiotic administration, number of needle sticks, age, temperature, or white blood cell count between the groups. DISCUSSION: The use of an HL in young febrile ED patients did not change the total number of needle sticks or the likelihood of antibiotic administration.

An evaluation of a safety education program for kindergarten and elementary school children.

OBJECTIVE: To determine the effectiveness of a safety education program, Safety City, that is designed to teach kindergarten and first grade children how to cross the street, call 911 in an emergency, and avoid strangers. PARTICIPANTS/SETTING: Kindergarten students at 10 urban elementary schools. DESIGN: Each school was randomized to either the intervention or control group. An evaluation tool was administered to all participants as a pretest. The Safety City program was then presented to the intervention schools. Afterward, the same evaluation tool was used as a post-test. The posttest was administered to the intervention group 6 months after the Safety City program was presented. The control group took the posttest 6 months after the pretest. MAIN OUTCOME MEASURE: Change in individual test scores. RESULTS: One hundred eighty-one children completed the pretest and posttest evaluations. There was no statistical difference in the change between pretest and posttest scores of children who participated in the Safety City program and those in the control group (crossing the street, P = .29; calling 911, P = .41; stranger avoidance, P = .57). CONCLUSIONS: Exposure to the Safety City program did not achieve the desired changes in safety knowledge among participants. This is most likely owing to the fact that Safety City attempts to convey a large amount of relatively complex information to young children in a brief period. We conclude that programs such as Safety City are not sufficient to teach children these behaviors. This report also emphasizes the importance of building an evaluation component into educational programs.

Babywalker-related injuries continue despite warning labels and public education.

OBJECTIVE: To describe the epidemiology of babywalker-related injuries to children treated in a pediatric emergency department despite current prevention efforts, and to investigate the beliefs of parents regarding babywalker use. DESIGN: A descriptive study of a consecutive series of patients. SETTING: The emergency department of a large, academic children's hospital. PARTICIPANTS: Children treated for babywalker-related injuries during the 3-year period of March 1993 through February 1996. RESULTS: There were 271 children treated for babywalker-related injuries. The mean age was 9.2 months, and 62% of patients were boys. Ninety-six percent of children were injured when they fell down stairs in their babywalker. The number of stairs that a child fell down was significantly associated with skull fracture and admission to the hospital, and a fall down more than 10 stairs had a relative risk (RR) of skull fracture = 3.28 (95% confidence interval, 1.35 < RR < 7.98). There were 159 children with contusions/abrasions (58.6%), 35 concussions/head injuries (12. 9%), 33 lacerations (12.2%), 26 skull fractures (9.6%), 9 epistaxis (3.3%), 4 nonskull fractures (1.5%), 4 avulsed teeth (1.5%), and 1 burn (0.4%). Three of the skull fractures were depressed, and three also had accompanying intracranial hemorrhage. Ten patients (3.7%) were admitted to the hospital, and all had skull fractures resulting from falls down stairs. Supervision was present in 78% of cases, including supervision by an adult in 69% of cases. Forty-five percent of families kept the walker, and 32% used the walker again for the study patient or another child after the injury episode. Fifty-nine percent of parents acknowledged that they were aware of the potential dangers of babywalkers before the injury event. Fifty-six percent of parents favored a national ban on the sale of walkers, and 20% were opposed. CONCLUSION: Despite the currently used prevention strategies, including adult supervision, warning labels, care giver education programs, and stairway gates, serious injuries associated with babywalkers continue to occur to young children. The US Consumer Product Safety Commission should promulgate a rule, similar to the voluntary standard adopted in Canada, regarding design requirements for babywalkers that will prevent their passage through household doorways at the head of stairs. The manufacture and sale of mobile babywalkers that do not meet this new standard should be banned in the US. A recall or trade-in campaign should be conducted nationally to decrease the number of existing babywalkers.