Below is a release on a study appearing in the December issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP).
For Release: Monday, November 28, 2011 at 12:01 a.m. ET
VACCINATING CHILDREN AGAINST CHICKENPOX ALSO PROTECTS BABIES
Varicella (chickenpox) vaccine given to children 12 months of age and older has resulted in significant protection from the disease for infants as well, according to a study in the December 2011 issue of Pediatrics and published online Nov. 28. Before the U.S. began vaccinating children 12 months of age and older against varicella in 1995, infants were four times more likely to die from a varicella infection compared to children ages 1 to 14 years. In the study, “Varicella in Infants After Implementation of the U.S. Varicella Vaccination Program,” researchers at the U.S. Centers for Disease Control & Prevention tracked cases of varicella in infants from 1995 to 2008. Infant varicella disease in children under 1 year of age declined 89.7 percent during that time period, even though infants are not eligible for the vaccine. Infants ages 0 to 5 months had milder clinical disease compared to those ages 6 to 11 months, possibly because they were protected by maternal antibodies. Authors conclude that the varicella vaccination program has resulted in substantial indirect benefits for infants. Because exposure to the virus continues to occur, improving vaccination coverage in all age groups will further reduce the risk for infants, study authors conclude.
There are conflicting recommendations about whether parents should give their infants acetaminophen prior to and after receiving immunizations to ease discomfort or help infants sleep after vaccination. Sleep is important to facilitate a healthy immune response and increased antibody production. The study, “Infant Sleep Following Immunization: A Randomized Controlled Trial of Prophylactic Acetaminophen,” appearing in the December 2011 Pediatrics (published online Nov. 28), examined two areas that indicate vaccine response: increased sleep duration and increased body temperature. Study authors associated increases in both these areas with increased antibody response. They found that sleep duration in the first 24 hours after immunization increased for all infants, particularly if the immunizations were administered after 1:30 p.m. Most infants also had the expected increase in body temperature. Acetaminophen use was associated with smaller increases in sleep duration, but not when controlling for other factors. The authors conclude that if further research finds a relationship between time of day for vaccine administration, increased sleep duration and elevated body temperature (indicating antibody response), then afternoon immunizations should be recommended to facilitate increased sleep after immunization, regardless of whether or not acetaminophen is used.
The American Academy of Pediatrics (AAP) recommends that infants sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS) and other sleep-related deaths. As a result, pediatricians have seen an increase in the number of children with positional plagiocephaly, or positional skull deformities (flat heads). In the revised AAP clinical report, “Prevention and Management of Positional Skull Deformities in Infants,” in the December 2011 Pediatrics (published online Nov. 28), positional skull deformities are commonly diagnosed as benign, reversible head-shape irregularities that are caused in utero or may develop during the first few months of life, and do not require surgical correction. It is important for pediatricians to be able to differentiate between infants with positional skull deformities and infants with craniosynostosis, a more serious condition that can lead to neurological damage or severe craniofacial deformity. The vast majority of positional plagiocephaly cases can be corrected with physical therapy and noninvasive measures. Helmet therapy is rarely necessary. If the condition appears to be worsening by 6 months, referrals should be made to pediatric neurosurgeons with expertise in caring for this condition to help determine whether a skull-shaping helmet or other interventions are needed.
Updated guidance on the meningococcal conjugate vaccine from the American Academy of Pediatrics includes the recommendation that 16-year-olds receive a booster dose. The policy statement, “Meningococcal Conjugate Vaccines Policy Update: Booster Dose Recommendations,” published in the December 2011 Pediatrics (published online Nov. 28), recommends adolescents be routinely immunized at 11 or 12 years of age, and receive a booster dose at age 16. This booster is reflected in the current 2011 immunization schedule for adolescents; the policy statement provides explicit guidance for the pediatrician. Adolescents who receive their first dose of meningococcal vaccine at or after 16 years of age do not need a booster dose. Additional booster recommendations are included in the policy statement for children who received the vaccine earlier due to certain health conditions and who are at increased risk of disease. The booster dose at age 16 is needed to protect adolescents during their period of high vulnerability.
Because of the many physical, social, and psychological changes adolescent boys experience during puberty, pediatricians are encouraged to discuss age-appropriate sexual and reproductive health issues with adolescent male patients during routine office visits and deliver appropriate sexual and reproductive health care. In the new clinical report, “Male Adolescent Sexual and Reproductive Health Care,” appearing in the December 2011 Pediatrics (published online Nov. 28), addressing male teenage sexual and reproductive health issues should always include taking a sexual history, conducting an examination, administering vaccinations and providing age-appropriate guidance related to sex, relationships, and prevention of sexually transmitted infections/HIV and unintended pregnancy. Sexual or reproductive health services should be provided in a confidential and culturally acceptable manner to help adolescent males feel comfortable and engaged. It is also important for parents to talk with their sons about sexual health and development on a regular basis, and to provide support for them when appropriate.
Youth in the juvenile correctional system are at risk for many health issues, especially those who have had inconsistent or deficient care. According to an updated policy statement by the American Academy of Pediatrics (AAP), “Health Care for Youth in the Juvenile Justice System,” appearing in the December 2011 Pediatrics (published online Nov. 28), incarcerated youth are entitled to the same standards of medical and mental health care as their peers in the community, and clinicians caring for incarcerated youth should have training and/or expertise in pediatrics or adolescent medicine. Youth in the juvenile justice system should receive a comprehensive history and physical exam, dental screening and mental health screening for psychiatric illness, substance abuse and neurological and developmental disorders. Because of high rates of unprotected sexual activity, HIV and sexually transmitted infection testing should be offered, and all pubertal girls should be screened for pregnancy. Incarcerated youth have higher rates of substance abuse and mental health disorders so the AAP recommends advocating for interventional programs that will be linked to continued care for these individuals once they reenter the community.
Some parents ask their pediatricians to consider using an alternative childhood immunization schedule so they can decline or delay recommended childhood vaccines. The study, “Washington State Pediatricians’ Attitudes towards Alternative Childhood Immunization Schedules,” in the December 2011 Pediatrics (published online Nov. 28), surveyed 209 Washington State pediatricians to determine their comfort using an alternative immunization schedule. Overall, 61 percent of those surveyed are comfortable using an alternative schedule if requested by a parent. But there are three vaccines pediatricians would rather not delay: Haemophilus influenzae type b vaccine (Hib), Pneumococcal conjugate vaccine (PCV), and diphtheria, tetanus and acellular pertussis vaccine (DTaP). The authors suggest that reasons may include a desire to protect children from diseases that are still common (e.g. pertussis) or are more likely to result in severe illness in infancy and early childhood. Despite a willingness to consider an alternative schedule, only 4 percent of pediatricians indicated that they would offer an alternative schedule for a child in the absence of parental request. The authors conclude that this study suggests a need for more research into the use of alternative immunization schedules and how they impact safety and efficacy, as well as the consequences of delaying immunization.
Much media attention has been given to pediatric sports-related injuries, but questions still exist as to what happens to a child’s brain after sustaining a sports-related concussion (SRC). According to researchers who authored, “Pediatric Sports-Related Concussion Produces Cerebral Blood Flow Alterations,” in the January 2012 Pediatrics (published online Nov. 30, 2011), most children in this small study demonstrated a significant reduction in cerebral blood flow compared to uninjured controls, with 27 percent having persistent alterations more than a month after the initial injury. The authors also found that an SRC is primarily a physiological injury, without measurable evidence of structural or metabolic damage. This data suggests that there may be significant differences between pediatric and adult neural responses to SCR; these may have important implications for management and treatment in the future.
Sports-related concussions are common among high school athletes, and can have long-term, debilitating effects on memory, school performance and concentration. In the study, “Computerized Neurocognitive Testing for the Management of Sport-Related Concussions,” in the January 2012 Pediatrics (published online on Nov. 30, 2011), 1,056 concussions recorded in the High School Reporting Information Online injury surveillance system during the 2009-2010 school year were examined. Concussions accounted for 15 percent of high school athletic injuries. About 40 percent of U.S. high schools that employ an athletic trainer use computerized neurocognitive tests when assessing sport-related concussions. Students who were assessed with computerized neurocognitive tests were less likely to return to play within 10 days of their injury. Study authors feel that it is important for ATs and physicians to properly manage concussed athletes in order to determine appropriate and safe timing of return to play.
In a policy statement, “Scope of Health Care Benefits for Children From Birth Through Age 26,” in the January 2012 Pediatrics (published online Nov. 30), the American Academy of Pediatrics defines the recommended set of health insurance benefits for children through age 26. The benefit recommendations apply to all public and private health plans.
The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well being of infants, children, adolescents and young adults. For more information, visit www.aap.org.