The certified child life specialist: A novel resource in the pediatric primary care clinic for managing children's pain during routine immunizations.

This study evaluated the effect of the Certified Child Life Specialist (CCLS) on pediatric pain and pain management during routine immunization administration in the pediatric primary care clinic. Children 4-12 years of age (n = 125) presenting for a well child physical examination at a rural primary care clinic were selected to receive standard nursing care or standard nursing care plus CCLS support during routine immunization administration. Patient reported pain was measured using the Faces Pain Scale-Revised (FPS-R), and patient behavioral responses were measured during immunization administration using the Children's Emotional Manifestation Scale (CEMS). The performance of psychosocial interventions and administration of topical pain-relieving interventions were measured between both groups. CCLS support was associated with fewer negative emotional behaviors during immunization administration among 7- to 12-year-old children and a significantly higher provision of psychosocial interventions and topical pain-relieving interventions among all ages. This study demonstrates that the presence of a CCLS can increase the provision of psychosocial and pain-relieving interventions and reduce distress during immunization administration in a busy pediatric primary care clinic.

Three Patient Kindred with a Novel Phenotype of Osteogenesis Imperfecta due to a COL1A1 Variant

Osteogenesis imperfecta (OI) is characterized by fractures and progressive bone deformities. Fracture rates peak during the toddler and adolescent years and decline during adulthood but do not stop entirely. We describe a kindred, the affected members of which were the mother and two sons, who presented with an apparently unique phenotype of OI. Our patients demonstrated a pattern of prenatal bone deformities followed by multiple, nontraumatic long bone fractures within the first two years of life and then an absence of nontraumatic fractures thereafter. No extra-skeletal manifestations have been noted to date. The mother did not receive bisphosphonate therapy but had no nontraumatic fractures after the age of five months. Intravenous bisphosphonate therapy was started for both sons within two months of birth, with the most recent infusions at age 18 months and 28 months in Patients 2 and 3, respectively. Two patients harbored a variant of uncertain significance in the COL1A1 gene. This heterozygous variant, c.3548C>T; p.(Pro1183Leu), is listed in the OI Variant Database as affecting only one other individual with osteopenia. We describe three family members with a unique presenting phenotype of OI, characterized by cessation of nontraumatic fractures after the first two years of life.

Impact of Asthma on the Association between Childhood Obesity and Influenza.

BACKGROUND: Despite long-standing recommendations for influenza vaccine in patients with asthma, whether asthma is a risk factor for medically-attended influenza is unclear. Obesity has more recently been found to be a risk factor for severe influenza in adults. Its role in children is less certain. MATERIALS AND METHODS: We conducted a 1:1 matched case-control study of all 185 children 2 to 18 years old with PCR-confirmed influenza at our institution from 2010 to 2013. RESULTS: Having a prior history of asthma was 2 times more common (95% CI, 1.24-3.23) among the influenza cases than the controls. Obesity was not associated with influenza overall (OR 0.94, 95% CI 0.49-1.83). However, among patients with asthma, influenza cases were 4.4 times more likely to be obese compared with subjects without influenza (95% CI, 0.93-20.58). CONCLUSION: In our population, a prior diagnosis of asthma was associated with a two-fold increased risk of medically-attended influenza. In addition, among patients with asthma there was a trend toward obesity increasing the risk of influenza.

Fusobacterium nucleatum Osteomyelitis in 3 Previously Healthy Children: A Case Series and Review of the Literature.

Fusobacterium nucleatum is a rare cause of monomicrobial osteomyelitis in children. We describe the cases of 3 children with F. nucleatum osteomyelitis of the distal femoral epiphysis with concurrent septic arthritis and review 6 other cases reported in the literature. Our report emphasizes the importance of maintaining a high index of suspicion for anaerobic osteomyelitis, given its atypical presentation and the unique growth requirements of anaerobic bacteria.

Implications of the innate immune response to adenovirus and adenoviral vectors.

Adenovirus (AdV) is a common cause of respiratory illness in both children and adults. Respiratory symptoms can range from those of the common cold to severe pneumonia. Infection can also cause significant disease in the immunocompromised and among immunocompetent subjects in close quarters. Fortunately, infection with AdV in the normal host is generally mild. This is one reason why its initial use as a gene-therapy vector appeared to be so promising. Unfortunately, both innate and adaptive responses to the virus have limited the development of AdV vectors as a tool of gene therapy by increasing toxicity and limiting duration of transgene expression. This article will focus on the innate immune response to infection with wild-type AdV and exposure to AdV gene-therapy vectors. As much of the known information relates to the pulmonary inflammatory response, this organ system will be emphasized. This article will also discuss how that understanding has led to the creation of new vectors for use in gene therapy.