Pediatrics

Is there evidence that suggests corticosteroids used to treat asthma might affect growth? Are growth effects from using inhaled or intranasal steroids to control asthma or allergic rhinitis a significant concern? Dr. David Skoner, professor of pediatrics at the Drexel University College of Medicine, discusses the challenges of evaluating the systemic effects of these medications, and suggests what physicians can do to minimize the risk of growth effects when using corticosteroids. Dr. Ketan Sheth hosts.

Non-alcoholic fatty liver disease (NAFLD) is increasingly common among our young obese patients, a population for which cardiovascular disease and diabetes is a significant concern. Can measured levels of liver fat serve to help us gauge future risk for metabolic consequences in children? Host Dr. Larry Kaskel welcomes pediatric hepatologist, Dr. Miriam Vos, assistant professor in the division of gastroenterology at Emory University School of Medicine, to discuss the challenge of encouraging a young child and their family to develop habits that will promote the decline of the child's NAFLD. Dr. Vos also explores the possibility that body shape may be an important clue in the diagnosis of NAFLD, as well as current efforts to generate more accurate markers to quantify liver fat reduction during treatment.

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In 1888, William Osler wrote in the Lancet the following: "In patients with suspected acute appendicitis, one should urge towards laparotomy. The indications for surgical interference are not always clear, but in my experience I have been taught that the abdomen is much more frequently left untouched than it should be, and that an operation is too often deferred until practically useless." Clearly, diagnosis of acute appendicitis has come a long way since then. But challenges remain in selecting the safest, most timely, and cost-effective diagnostic modalities for this condition. Dr. Andrea Doria, associate professor in the department of medical imaging at the University of Toronto School of Medicine, clarifies the use of ultrasound versus CT for evaluation of acute appendicitis in children. Dr. Jason Birnholz hosts.

Respiratory syncytial virus (RSV) is a well-known cause of hospitalization in infants, but new research suggests the burden of illness may be more substantial than previously recognized in healthy, older children as well. Investigators estimate over two million children under the age of five require medical treatment for RSV each year. Because it can be difficult to prevent and treat RSV infections, is there a role for a vaccine against the illness? Host Dr. Jennifer Shu welcomes Dr. Caroline Hall, professor of pediatrics and medicine at the University of Rochester School of Medicine and Dentistry, to explore these questions. Dr. Hall also explains how the characteristics of the virus and its mechanisms of transmission contribute to its proliferation.

In an issue of the Journal, Boucek et al. reported on three cases of heart transplantation from infants who were pronounced dead on the basis of cardiac criteria. Moderator Atul Gawande, of Harvard Medical School; George Annas, of the Boston University School of Public Health; Arthur Caplan, of the University of Pennsylvania; and Robert Truog, of Harvard Medical School discuss key ethical aspects of organ donation after cardiac death.

Although sudden death in the pediatric population is rare, there has been a great deal of discussion recently over the possibility of an increase in risk of sudden cardiac death among individuals taking stimulant medication for attention-deficit hyperactivity disorder (ADHD). Dr. Patrick Frias, a pediatric cardiologist and electrophysiologist at Sibley Heart Center Cardiology in Atlanta and associate professor of pediatrics at Emory University School of Medicine, explores this discussion with host Dr. Jennifer Shu. How can we best evaluate our patients' risk for sudden death before initiating medical treatment for ADHD, and how often should we monitor their cardiovascular status?

Indoor allergens can exacerbate or trigger allergic or asthmatic responses. What effect do carpeting, cleaning solutions, pets, and humidifiers have on indoor environments? Dr. James Sublett, clinical professor and section chief of pediatric allergy at the University of Louisville School of Medicine, offers tips on creating safer homes for patients with allergies. Dr. Todd Mahr hosts.

Past research tells us that many young lesbian, gay, bisexual and transgender patients are at higher risk for health problems, such as depression, substance abuse, and sexually transmitted diseases. We're also learning that the response of the young person's family can trigger or worsen these conditions. Dr. Sten Vermund, professor of pediatrics, medicine, obstetrics and gynecology, and preventive medicine at Vanderbilt University School of Medicine, joins host Dr. Jennifer Shu to explore how physicians can work with families and patients to create a healthy dynamic as patients begin to express their sexual orientation and gender identity.

Once mostly a condition of childhood, our patients with congenital heart disease are now living well into adulthood: nearly two million American children and adults are living with a congenital heart defect. What are the special medical needs of our cardiac patients as they transition from adolescence to adulthood? Dr. Michael McConnell, co-director of the adult congenital heart disease clinic at Sibley Heart Center Cardiology in Atlanta and associate professor of pediatrics and medicine at Emory University School of Medicine, reflects upon how our medical system can improve our capacity to care for the growing numbers of adult patients with a congenital heart defect. Dr. Jennifer Shu hosts.

When schizophrenia first presents in the teen years, patients often have a particularly poor prognosis. What are the best treatments for adolescents? Which medicine is best? Dr. Robert Findling, the Rocco L. Motto, MD, Chair of Child and Adolescent Psychiatry at Case Western Reserve University School of Medicine, talks with host Dr. Leslie Lundt about the long-term effects of medications and new research into treatment of early-onset schizophrenia.