Docnotes

Amoxicillin and tooth enamel

Here's another reason not to use too many antibiotics. Published last week (sorry I'm so late on this one!) in the Archives of Pediatrics & Adolescent Medicine.

Is This Child Dehydrated?

JAMA:Is This Child Dehydrated? Here's a pdf of the article .. just for my own personal use ;-)   .. it's an excellent review of a complex yet very common topic.

Mercury not in vaccines

It's hard to miss the posts from Mercola.com on medlogs.com.

Dr Mercola's frequent posts are often enhanced with graphics - so they stand out from the crowd. He does a good job sharing his opinion .. but today's post on mercury in vaccines is quite misleading. He suggests that readers/parents "read more on the link between autism and vaccines before deciding whether to vaccinate your infants." 

Huh?

He may not know that thimerosal is not in any of the commonly used pediatric vaccines - nor has it been for several years. Dr Mercola: please update your weblog to reflect a more accurate picture of pediatric vaccines circa 2004. While there may be reasons for some parents to have questions about vaccines .. thimerosal is not one of them.

Newborn Neurologic Exam

  Figure. Summary of the neurologic examination with respect to gestational age. ATNR = asymmetric tonic neck reflex. From:   Yang: Neurology, Volume 62(7).April 13, 2004.E15-E17

This is a useful table that I often look for when teaching students and residents.  Now I'll never need to look very far.  ;-)

Smoking in pregnancy

Thorax -- Abstracts: Svanes et al. 59 (4): 295 Early exposure to parental smoking appears to influence the development of the airways and predispose to respiratory symptoms. A study was undertaken to determine whether the consequences of parental smoking could be traced in adulthood.

A Treatable Cause of Painful Breastfeeding

Pediatrics -- Abstracts: Anderson et al. 113 (4): e360 A Treatable Cause of Painful Breastfeeding

How Should Parents Protect Their Children From Environmental Tobacco-Smoke Exposure in the Home?

This Pediatrics  Electronic Artice  asks (and answers) the question: How Should Parents Protect Their Children From Environmental Tobacco-Smoke Exposure in the Home?

Sandifer Syndrome

Ok .. so I hadn't heard of this syndrome, but I've now seen a case (or what I think is a case .. we'll see if the specialists agree) .. and I think it's a good one to know about.  Here's an article with a good summary of some typical findings .. and here's a good review article on it.

 

Will Mothers Discuss Parenting Stress and Depressive Symptoms With Their Child’s Pediatrician?

Pediatrics -- Abstracts: Heneghan et al. 113 (3): 460 Conclusion: Mothers are aware that their own emotional health has consequences for their children. Although many mothers experienced lacks in their social support systems, many are reluctant to discuss parenting stress and depressive symptoms with their child's pediatrician because of mistrust and fear of judgment. Mothers are, however, generally receptive to the idea of open communication with their pediatricians and are interested in receiving supportive written communication about parenting stress and depressive symptoms from pediatricians. These qualitative data are valuable in developing an intervention to help pediatricians assist mothers at risk.

This is an interesting paper from many standpoints - and surprises me little.  Comunication between a child's physician and parents is essential to the health of the family.  Pediatricians are ill-positioned for this task relative to family physicians.  I'm occasionally asked by parents why they should bring their child to a family physician rather than a pediatrician.  Because we have a relationship with the parents - family physicians are simply better positioned to build and maintain a relationship with them as separate people (rather than as extensions of the children).  Parents' fear of being judged would, I expect, be less in this scenario. 

Fetal Monitoring

Josh Steinberg (scroll down - he's the Mac-user) e-mailed a question to the NE ALSO faculty listserv a while back . and has now answered his own question:

I inquired about online tutorials for fetal heart monitor strips, and now I
have the answer.

Here's one via the University of Nottingham's ob/gyn site in Britain:
http://www.fetal.freeserve.co.uk/  It's nice because it gives a look at overall issues and approaches to fetal monitoring, including but not limited to continuous EFM, also gives practice questions at the end of the module.

Another I can't get access to but might be of use.  It is proprietary
software for sale developed at Virginia Commonwealth University's med school
called, "Clinical Simulations of Fetal Heart Rate Patterns in Labor".  One
could spend money to purchase the software.  See about a third
of the way down the page:
http://www.cbil.vcu.edu/resources/projects.html

Finally, there is a dynamite, exhaustive Evidence Based review of electronic
fetal monitoring (144 page .pdf)  with tons of details, definitions, decision guides about when to monitor, when not to, how to respond to various results -- all
linked to quality of evidence and strength of recommendation levels -- at
none other than the British site of the Royal College of Obstetricians and
Gynaecologists (however the Brits spell that).  Nice thing about Brit
websites is that they aren't all trying to make a buck off everything, so I
found lots more accessability than at American websites.  As a poignant
example, one can't get into ACOG's website without being a paying
member and journal subscriber.  I am attaching the PDF RCOG evidence linked
guideline, for what it's worth.  It's only weakness is that it contains no
actual examples of fetal heart tracings.

Since we've not yet convinced Josh to begin a weblog .. I've posted his work product here.  Well done, Josh!