Tulsa Family Health Shorts
Compiled by Richard J. Sagall, md
Tongue Piercing and Infection
The Question: Does the composition of the tongue-piercing stud affect the oral bacteria?
The Study: Eighty-five people who were going to have their tongues pierced agreed to have a pre-piercing dental examination. Cultures were taken to determine each participant’s normal oral bacteria. Each participant underwent the tongue piercing and a stud made of one of four materials was used: steel, titanium, polytetrafluoroethylene or polypropylene.Two weeks after the piercing, each participant had another dental exam with cultures taken.
The Results: Nearly 30 percent of the participants had one or more lingual recessions (61 total recssions). In addition, 5 percent of the participants reported a chipped tooth from the stud. The participants with the metal studs were much more likely to have abnormal bacteria in their mouths compared to those with the plastic studs.
Comment: If you or your child is planning to get a tongue piercing, use plastic studs. And be prepared for chipped teeth and other possible complications.
Read More: Journal of Adolescent Health, 07/11
The Question: What adverse events occur when children are treated with acupuncture?
The Study: In this meta analysis (a study of studies), the researchers found 37 studies that met their criteria. The adverse events from each study were pooled, for a total of 249 events.
The Results: The adverse events ranged from mild (pain, bruising, bleeding and mild worsening of symptoms) to severe (thumb deformity, infections, heart rupture, lung puncture, nerve impairment, coughing up blood, coma and more). The incidence of mild adverse events was over 11 percent.
Comment: The authors conclude that the majority of adverse events are mild and that acupuncture is safe. I wouldn’t call a procedure with a 11 percent mild adverse event incidence rate “safe,” particularly when there’s the possibility of severe complications.
What isn’t addressed is the effectiveness—or lack effectiveness—of acupuncture.
Read More: Pediatrics, 12/11
Varicella in Infants
The Question: Does the varicella (chickenpox) vaccination program also protect infants too young to be vaccinated from this disease?
The Study: The incidence of varicella (chickenpox) in infants under one year of age was measured before and after the varicella vaccine program was introduced in 1995. The vaccine is approved for administration in children 1 year and older.
The Results: The incidence of chickenpox in this age group declined by almost 90 percent from 1995 to 2008. Those infants who did suffer from varicella had few symptoms, their symptoms were milder, and they had fewer complications.
Comment: Too many parents think of chickenpox as a benign disease. They are severely misinformed. For some children chickenpox is just an unpleasant experience, while others suffer significant complications including skin infections, ear infections, pneumonia, inflammation of the testicles, convulsions and more.
The reason for the decline in chickenpox in infants too young to be immunized is a phenomenon called “herd immunity.” If enough of the herd (surrounding children and adults) is protected, then the unimmunized are also likely to be protected.
Read More: Pediatrics, 12/11
C-Section and Illness
The Question: Are babies delivered by cesarean more susceptible to common infectious diseases?
The Study: The health history of 522 children (72.4 percent were born vaginally) was recorded for six years.
The Results: The children born by cesarean were more susceptible to common childhood infectious diseases, pneumonia, and cough than children born vaginally.
Comment: This study supports the movement towards fewer cesarean deliveries. The reason for the relationship, if it truly exists, needs to be determined.
Read More: Clinical Pediatrics, 10/11
New Foods in the Diet
The Question: Does delaying the introduction of certain foods into an infant’s diet lessen the chances for developing eczema and wheezing?
The Study: Nearly 7,000 Dutch children were enrolled in the study. The date each was first given cow’s milk, hen’s egg, peanuts, tree nuts and gluten was recorded. Each child was evaluated at 2, 3, and 4 years of age for allergies.
The Results: The incidence of wheezing (31 percent at age 2 years, 14 percent at 3 and 4 years) and eczema (38 precent, 20 percent and 18 percent, respectively) was the same for all the children who first tasted the above foods at 6 months or 12 months. A history of cow’s milk allergy or parental allergies didn’t affect the results.
Comment: The authors conclude that their data “doesn’t support the recommendation for delayed introduction of allergenic foods after age 6 months for the prevention of eczema and wheezing.”
Too Much of a Good Thing
The Question: Does use of iron-fortified formula affect long-term developmental outcome?
The Study: Eight-hundred-thirty-five healthy, full-term Chilean infants were enrolled into a study. Half were fed iron-fortified formula from 6 to 12 months of age; the other half were given a low-iron formula. The development of 473 of the children was evaluated when they were 10 years old. Measurements included IQ, spatial memory, arithmetic achievement, visual-motor integration, visual perception and motor function. (The other children were “lost to follow-up.”)
The Results: The children who received the low-iron formula showed better scores on all the tests than the children who received the iron-fortified formula.
Comment: It’s hard to know what conclusions to draw from this one study. The authors caution that “...long-term development may be adversely affected in infants with high hemoglobin levels who receive... iron fortified formula.” More studies are needed before feeding practice recommendations will change. However, it does support the idea that just because a little of something is good doesn’t mean a lot of it is better.
Read More: Archives of Pediatrics and Adolescent Medicine, 11/11
Vitamin A and Asthma
The Question: Does vitamin A supplementation early in a child’s life lessen his risk of developing asthma later in childhood?
The Study: Nearly 6,500 Nepalese children were randomly assigned to receive either vitamin A supplements or to receive a placebo. The supplements were given to their mothers when pregnant and breastfeeding or to the children during their preschool years. When the children were teens or young adults they were asked about asthma symptoms and were given a spirometry test that evaluates lung function.
The Results: There was no difference in the reported asthma symptoms or in the spirometry results between the two groups.
Comment: Before accepting the conclusion that vitamin A supplementation has no effect on the risk of developing asthma, a few questions need to be answered. Why do the study in Nepal? Because it’s an area where vitamin A deficiency in children is chronic. Are the results reliable? Most likely, since the researchers are from Johns Hopkins University and it was published in a reputable journal.
Read More: European Respiratory Journal, 12/11
The Flu and Cigarette Smoke Exposure
The Question: Does passive tobacco smoke exposure increase the severity of flu symptoms in children who catch the flu?
The Study: The hospital records of 113 children 3 to 11 years old admitted for the flu were evaluated for a number of factors including asthma, chronic health problems, prematurity and passive tobacco smoke exposure.
The Results: Forty-one percent of the children were routinely exposed to tobacco smoke at home. A quarter had a history of asthma, a quarter had an underlying chronic disease, and 14 percent were born prematurely. The children exposed to tobacco smoke were three times more likely to require treatment in the intensive care unit and six times more likely to require a ventilator than the children with no smoke exposure. Their hospital stays were almost 1.5 days longer than the children with no secondhand smoke exposure (3.5 days compared to 2.1 days). The other factors taken into consideration had little effect on the length of hospital stay or the treatments required.
Comment: Many health professionals consider exposing children to passive tobacco smoke a type of child abuse. In many states it’s illegal to smoke in a car when children are passengers. The same law should apply in any closed space, especially and including homes.
Read More: Pediatric News, 06/11
Egg Allergy and Flu Vaccine
The Question: Should children with a known egg allergy receive the flu vaccine?
The Study: One hundred and one children with proven egg allergy were given a flu vaccination. Before receiving the immunization all the children were give a skin prick test with full strength vaccine to determine if they reacted to the vaccine.
The Results: None of the children developed a systemic reaction after receiving the vaccination. One child had a local reaction and the other developed a localized infection.
Comment: Every child should receive the flu vaccine. This study demonstrates that even a skin-prick-proven egg allergy is not a reason to defer the vaccination. These children were observed in the office for 30 minutes to ensure they had no system allergic reaction. If your child has an egg allergy you should discuss the risks and benefits of the flu vaccination with your child’s doctor.
Read More: Pediatric News, 06/11
Pneumococcal vaccine and ear infections
The Question: Does heptavalent conjugated pneumococcal vaccine (PCV7) immunization offer children protection against ear infections?
The Study: The researchers followed 96 children who had at least one ear infection before age 6 months. All were followed until reaching 2 years of age. Forty-six received the PCV7 vaccine and 50 didn’t.
The Results: The 96 children had a total of 363 ear infections. The incidence for the children who received the PCV7 vaccine was 26 percent less than in the children who were unimmunized. The immunized children also had 36 percent fewer emergency visits and half the rate of ear tube insertions.
Comment: Fewer ear infections are an added benefit to the PCV7 vaccine. Since the same bacteria that cause respiratory infections cause many ear infections, this finding is not all that surprising.
Read More: ACTA Paediatrica, 10/11
The Question: How do the outcomes of laparoscopic appendectomies (LA) compare to those of traditional open appendectomies (OA)?
The Study: The charts of 7,650 children who underwent an appendectomy (3551 LAs and 4099 OAs) were reviewed. The researchers looked for any complications during the 30 days after the surgery (wound infection, abscess and readmission) and length of hospital stay.
The Results: Laparoscopic appendectomies resulted in a significantly decreased risk of wound infection, abscess formation and total length of hospitalization.
Comment: The rate of LA increased from 22 percent of all childhood appendectomies in 1988 to 70 percent in 2007—and it’s probably higher now. It’s a quick procedure that’s less traumatic to the patient and the procedure of choice unless there are extenuating circumstances.
Read More: Archives of Surgery, 10/11