2009 Pediatric-Related News

Special Issue of Pediatrics Devoted to Analyses from the 2005-2006 National Survey of Children with Special Health Care Needs (12/03/2009)

A special issue of Pediatrics contains 15 articles whose new findings result from closer examination of data collected by the 2005-2006 National Survey of Children with Special Health Care Needs. The articles focus on timely epidemiologic and public health issues at the national and state levels that highlight elements affecting this population.

The 2005-2006 National Survey of Children with Special Health Care Needs is the largest health survey ever completed on this population, with a sample size of parents or guardians of more than 40,000 children in all 50 states and the District of Columbia. The Health Resources and Services Administration’s Maternal and Child Health Bureau and the National Center for Health Statistics at the Centers for Disease Control and Prevention funded and oversaw the development of the survey. A limited number of paper copies of the journal supplement will be available through the online HRSA Information Center or by phone at 1-888-Ask-HRSA. Paper copies are also available by e-mailing Steph Toomer.

AHRQ Study Finds Telemedicine Reduces Children’s Emergency Department Visits (12/03/2009)

The Agency for Healthcare Research and Quality (AHRQ) has published information from the study “Acute Illness Care Patterns Change with Use of Telemedicine," which finds that when telemedicine is available in child care centers and schools for urban children with acute illnesses, the use of emergency departments (EDs) decreases substantially. In their study, researchers from the University of Rochester examined use of telemedicine access at 22 child care and school sites, office visits, and ED care. Children at telemedicine access sites had 22.2 percent fewer visits to EDs than those without access.

AHRQ Highlights Adverse Events in Pediatric ICUs (10/30/2009)

The Agency for Healthcare Research and Quality (AHRQ) has released highlights from the study, “Pediatric Safety Incidents from an Intensive Care Reporting System,” which focuses on adverse events (AEs) in pediatric intensive care units (ICUs). It found that one-third of such incidents result in physical injury to children, while two-thirds harm children in other ways. The study’s data was collected over a two-year period describing safety incidents taking place in pediatric ICUs around the country. To improve safety in pediatric ICUs, the researchers recommend developing protocols for high-risk procedures involving lines and tubes and improved patient monitoring, as well as improve staffing, training, and communication initiatives.

National Commission on Children and Disasters Releases "Final" Interim Report (10/16/2009)

The National Commission on Children and Disasters has submitted their Interim Report to Congress and the White House. It identifies several shortcomings in disaster preparedness, response, and recovery, and is designed to make children an immediate priority in disaster planning. The report includes recommendations that mention the EMSC Program, including providing additional funding to meet EMSC performance measures (see “Emergency Medical Services and Transport” section on pages 25-27). The final report will be developed over the next year. The next public meeting is scheduled for Tuesday, November 10, 2009.

CDC Publishes Report on Common Co-infections in H1N1 Fatalities (10/05/2009)

Many people who have died from 2009 H1N1 influenza in the United States had co-infections with a common bacteria (Streptococcus pneumoniae, or pneumococcus) which likely contributed to their death, according to a report published in this week’s edition of the Centers for Disease Control and Prevention′s (CDC) Morbidity and Mortality Weekly Report. CDC is reminding people of the importance of being vaccinated against this common bacterium.

HRSA Posts New Toolbox on Health IT for Children (10/02/2009)

The Health Resources and Services Administration (HRSA) has developed a new toolbox designed to provide concrete health information technology (IT) tools to families, public and private organizations, and clinicians who provide services to children and their families. The toolbox addresses many issues, ranging from pediatric electronic medical records to enrollment in children’s health insurance coverage.

CDC Publishes Report on H1N1 Pediatric Deaths (9/11/2009)

The Centers for Disease Control and Prevention (CDC) recently published the report “Surveillance for Pediatric Deaths Associated with 2009 Pandemic Influenza A (H1N1) Virus Infection—United States, April—August 2009” describing trends in pediatric deaths associated with H1N1. As of August 8, 2009, 36 deaths among children younger than 18 years of age were reported. Of the 36 deaths, 19% were in children younger than 5 years of age and 67% had one or more high risk medical conditions. The duration of the patient’s illnesses lasted from 1 to 28 days, with the median infection lasting 6 days.

National Commission on Children and Disasters Releases "Draft" Interim Report  (9/11/2009)

The National Commission on Children and Disasters recently released their draft interim report for public review and comment. The report contains the Commission’s findings and recommendations on a range of subjects, including emergency management, mental health, child physical health and trauma, transportation, and child care. The report will be discussed at the next public meeting of the Commission on September 15, 2009, in Washington, DC. Comments are encouraged and should be submitted by Friday, September 11, 2009 to Vicki Johnson at Victoria.Johnson@acf.hhs.gov.

Ten Year Study Reviews Delayed Diagnosis of Pediatric Trauma  (9/11/2009)

The article “Ten-Year Retrospective Study of Delayed Diagnosis of Injury in Pediatric Trauma Patients at a Level II Trauma Facility,” which appeared in the August issue of Pediatric Emergency Care, reviewed the delayed diagnosis of injury (DDI) in pediatric trauma with the purpose of determining the long-term trends and risk factors associated with DDI. The 10-year retrospective study involved patients 14 years old or younger admitted to the hospital from 1997-2006.

The study revealed 47 delayed diagnoses or a rate of 4.0%. That rate remained constant over the 10 years, with a greater number of missed injuries in the more severely injured patients. The study suggests special attention be given to the lower extremities of younger trauma patients.

FEMA Announces Creation of Children's Working Group (8/28/2009)

The Federal Emergency Management Agency (FEMA) announced the creation of a “Children's Working Group" at a subcommittee hearing on disaster recovery. The working group will allow FEMA and its partners to explore and implement planning and response strategies specific to children throughout the agency. It will also ensure that during a disaster the unique needs of children are fully integrated into how FEMA administers support to states and the public. The Children's Working Group will be composed of FEMA employees across multiple directorates and offices to ensure coordination and action, and will report directly to the Office of the Administrator.

CDC Issues Updated Guidance for School Response to H1N1 (8/21/2009)

The Centers for Disease Control and Prevention (CDC) has issued new guidance relating to how schools should respond to H1N1 during the upcoming 2009-2010 school year. They recommended:

  • staff and students stay home when sick to separate ill students and staff
  • focus on hand hygiene and respiratory etiquette
  • routine cleaning
  • early treatment for those at high risk
  • consideration of selective school dismissal

About 55 million students and 7 million staff attend the more than 130,000 public and private schools in the United States each day. By implementing these recommendations, schools and health officials can help protect one-fifth of the country’s population from the flu.

NIAID to Begin H1N1 Vaccine Trials in Children (8/21/2009)

The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, announced this week that an independent monitoring committee recommended that trials of the H1N1 vaccine begin in children. The committee reviewed data from 500 healthy adult and elderly volunteers enrolled in vaccine trials and concluded that there were no safety concerns that precluded trials from taking place in children. As a result two vaccine trials will begin shortly and will be conducted through NIAID’s nationwide network.

Study Evaluates Recognition of Strokes in Children (8/07/2009)

The study “Delayed Recognition of Initial Stroke in Children: Need for Increased Awareness,” appearing in the journal Pediatrics, evaluates medical personnel’s ability to detect stroke symptoms in children. The study involved 107 patients 28 days of age or older who were diagnosed with arterial ischemic stroke (AIS). It found that there were considerable delays in diagnosing pediatric AIS due to lack of awareness of stroke among medical staff members despite risk factors and focal signs at presentation.

CDC Article Identifies Potential H1N1 Complications in Children (7/31/2009)

The Centers for Disease Control and Prevention (CDC) has published the article, “Neurologic Complications Associated with Novel Influenza A (H1N1) Virus Infection in Children” in the Morbidity and Mortality Weekly Report. This article highlights four cases of children experiencing neurological complications with the H1N1 virus in Dallas. It suggests that physicians caring for children hospitalized with influenza-like illnesses and unexplained seizures or mental status changes consider that the neurological symptoms may be related to influenza.

ISMP Highlights Potential Error in Broselow Tapes (7/29/2009)

The Institute for Safe Medication Practices (ISMP) has indicated that there is a mistake in the 2007 Edition A Broselow Tape. This edition lists the incorrect dosage for glucagon as 0.5 mg/kg/dose and 1 mg/kg/dose, rather than the correct standard doses of 0.5 mg or 1 mg, respectively. More information is available in a recent issue of ISMP's Safety Brief.

AAP Releases Policy Statement on Pedestrian Safety (7/27/2009)

The American Academy of Pediatrics (AAP) recently released the policy statement, “Pedestrian Safety”. It presents several suggestions, including: parents and caregivers should learn about the developmental limitations that prevent young children from being able to navigate traffic, and child pedestrians should not be unsupervised before 10 years of age. Children in the 10- to 15-year and 15- to 19-year age groups have the highest rates of nonfatal injuries in recent years. Each year approximately 900 pedestrians younger than 19 years of age are killed and 51,000 children are injured as pedestrians.

Study Examines Treatment of Traumatic Brain Injury in Children (7/20/2009)

The recently published article, “Early Resuscitation of Children with Moderate-to-Severe Traumatic Brain Injury” in the journal Pediatrics examines prehospital and emergency department care in relation to health outcomes for children with traumatic brain injuries (TBI). The study involved 299 children treated at level one pediatric trauma centers and indicated that one-third of children were not properly monitored in the early phases of TBI management. Additionally, the study noted that attempts to treat hypotension and hypoxia significantly improved outcomes.

Joint Commission Conference to Focus on Pediatric Safety (6/19/2009)

The Joint Commission will hold the Pediatric Safety Conference: Safe Care, Quality Care, We Care on Wednesday, July 22 and Thursday, July 23, 2009, in Oakbrook Terrace, IL. The conference will focus on assessment tools for pediatric health services, checklists to improve patient safety, emergency preparedness, and the benefits of animal therapy for children. This conference is targeted towards all healthcare providers who serve children in general or pediatric specialty hospitals.

Study Highlights the Effect of Family Presence on Pediatric Resuscitations (6/16/2009)

A new study, The Effect of Family Presence on the Efficiency of Pediatric Trauma Resuscitations, by the University of Utah, suggests that the presence of family does not prolong time to computed tomographic (CT scan) or the pediatric trauma team. The study also showed that families believed that the presence of family was helpful to the entire family, including the child. The study, comprised of 705 patients, measured the amount of time from an emergency department arrival to receiving a CT scan, and ultimately resuscitation completion.

ARRA Stimulus Funds Available for EMS (6/12/2009)

A provision of the American Recovery and Reinvestment Act (ARRA) has set aside $19 million that will be divided between 280 communities in 39 states. Among other things, these funds will be used for programs in healthcare, public safety, and educational services. In addition, other sources will be utilized to generate $6.9 million for the purchase of emergency services and systems and fire and rescue equipment. These additional funds will help local communities purchase more than 120 fire, medical, and police vehicles. This portion of the stimulus effort is expected to help rural communities maintain essential functions and create or save more than 1,350 jobs.

AAP Report Examines Children’s Health and Safety Legislation (5/29/2009)

The American Academy of Pediatrics (AAP) has released the 2008 State Legislation Report outlining activities relating to 11 issues affecting children’s health and safety. The narrative for each issue explains the state activity that occurred during the 2008 state legislative sessions. State-by-state legislation charts are also included and provide information from 2008 as well as previous years to provide a national perspective on state action.

CDC Releases Interim Guidance for H1N1 in Children (5/15/2009)

The Centers for Disease Control and Prevention (CDC) released interim guidance on May 11, regarding the prevention and treatment of H1N1 (swine flu) in infants and young children. While little is known about the H1N1 virus, past influenza epidemics have provided key information. Young children, especially those younger than five years of age and who have high risk medical conditions, are at increased risk of influenza-related complications. Additionally, the risk for severe complications from seasonal influenza is the highest among children less than two years old.

AHRQ Highlights Innovative Approach to Pediatric Emergency Care (5/08/2009)

The Agency for Healthcare Research and Quality (AHRQ) is highlighting an innovative program that seeks to connect pediatric emergency and critical care physicians at the University of California at Davis Children’s Hospital to rural and underserved emergency departments in northern California. The program also provides these remote emergency departments with a standardized triage protocol with laminated reference cards and monthly pediatric critical care training in an effort to increase physician knowledge and improve consistency and quality of care.

Preliminary unpublished findings from eight telemedicine sites and two control sites using traditional telephone consultations found that the program improves the diagnostic and treatment process and parent satisfaction. A more comprehensive evaluation of the program’s impact on quality of care is currently underway.

AHRQ to Host Children’s Public Health Emergency Preparedness Webcast (4/22/2009)

The Agency for Healthcare Research and Quality (AHRQ) will host the webcast Planning and Preparedness for Children's Needs in Public Health Emergencies on Tuesday, May 12, 2009 at 1:00pm ET. The event will feature a panel discussion of preparedness initiatives and insights from pediatric emergency preparedness planners. During the webcast, participants will learn about AHRQ's resources for emergency preparedness involving children, including:

  • School-Based Emergency Preparedness: A National Analysis and Recommended Protocol
  • Pediatric Hospital Surge Capacity in Public Health Emergencies.

    The webcast is targeted at emergency preparedness planners, as well as federal, State, and local community health planners, providers, first responders, and school district personnel.

    DHHS Establishes New Emergency Care Coordination Center(4/22/2009)

    The Department of Health and Human Services (DHHS) has created the Emergency Care Coordination Center (ECCC). This new branch of will work primarily to improve the government’s coordination of hospital emergency medical care. ECCC will also be responsible for leading efforts to promote and fund emergency and trauma medicine research; promote more effective emergency medical systems; and promote local, regional, and state emergency preparedness.

    Also, within the ECCC’s scope, is the establishment of the Council on Emergency Medical Care (CEMC), designed to improve collaboration and coordination with other federal agencies. The council will also provide policy guidance regarding the nation’s emergency medical care. The CEMC contains emergency medical system experts as well as government representatives.

    AAP Publishes News Article Promoting Revised Field Treatment Guidelines(4/10/2009)

    The American Academy of Pediatrics (AAP) has published the article “Emergency Treatment Streamlined with Revised Field Triage Guidelines”. The article discusses the Academy’s endorsement of the re-released Field Triage Decision Scheme, which is a set of guidelines designed to ensure that trauma victims receive quick and appropriate care. Under these guidelines, EMS workers classify a patient by using an Injury Severity Score. Injured patients are evaluated then sent to an appropriate emergency department. The revised guidelines are key to addressing important pediatric issues.

    ODHPHP Seeks Comments for Healthy People 2020(4/03/2009)

    The Office of Disease Prevention and Health Promotion (ODPHP) has published recommendations on the Healthy People 2010 objectives. As ODPHP creates the draft objectives for Healthy People 2020, they would like to consider feedback submitted through the Health People 2020 website. All comments should be received by April 24, 2009. A more extensive public comment period on the draft Healthy People 2020 objectives will be conducted at a future date. Additionally, the ODPHP plans to convene three public meetings across the country in late summer, early fall to garner additional stakeholder input on the draft Healthy People 2020 objectives. Details on the meetings will be posted on the Healthy People web site as they become available.

    IOM Seeks Recommendations for Comparative Effectiveness Research Priorities(3/27/2009)

    The Institute of Medicine (IOM) has been asked to recommend priorities regarding comparative effectiveness research to be conducted or supported with funds from the Economic Stimulus Bill (American Recovery and Reinvestment Act of 2009). Input from stakeholders and the public is invited and will be considered by the IOM Committee. Individuals interested in participating are encouraged to visit the IOM website.

    NASEMSO Releases EMS Education Information (3/27/2009)

    The National Association of State EMS Officials (NASEMSO) has announced the availability of two new documents intended to support the national implementation of the EMS Education Agenda for the Future: A Systems Approach (Education Agenda). These documents, “Talking Points” and “Frequently Asked Questions” (FAQs) were developed to support state implementation activities and describe greater understanding about the individual components of the Education Agenda. For more information about each or to download, visit NASEMSO website.

    AHRQ Issues Recommendations for Safeguarding Children In Emergencies (3/20/2009)

    The Agency for Healthcare Research and Quality (AHRQ) has released two new tools designed to protect and care for children who are in a hospital or a school during a public health emergency.

    The first tool, Pediatric Hospital Surge Capacity in Public Health Emergencies, consists of guidelines to assist pediatric hospitals in converting from standard operating capacity to surge capacity and help community hospital emergency departments provide care for large numbers of critically ill children. Steps address needs such as communications, staff responsibilities, triaging, stress management, and security concerns when handling mass numbers of children with either communicable respiratory diseases or communicable food borne or waterborne illnesses.

    The second tool, School-Based Emergency Preparedness: A National Analysis and Recommended Protocol, is a national model for school-based emergency response planning. It provides guidance on the recommended steps for both creating and implementing a school-based emergency response plan. Steps outlined include performing needs assessments, conducting site surveys, developing training modules for school staff, and informing parents of the plan, as well as steps relating to building security and safety, preparation for large-scale emergencies, sheltering-in-place and lockdown, evacuation, relocation, and communications. Included with the guidance is a model school-based emergency response plan developed by the Brookline, Massachusetts, school district in cooperation with the Center for Biopreparedness, the division of Harvard Medical School that prepared both sets of guidelines under contract to AHRQ.

    Reduced Air Pollution Leads to Improved Breathing in Asthmatic Children (3/06/2009)

    According to a study appearing in a recent issue of Pediatrics, better air quality is associated with a significant reduction of airway inflammation in allergic asthmatic children. The study, “Less Air Pollution Leads to Rapid Reduction of Airway Inflammation and Improved Airway Function in Asthmatic Children,” is the first of its kind to adopt a real-life experimental approach to analyze the impact of outdoor air pollution on respiratory health in childhood. Study authors conclude that children with chronic respiratory problems may require little or no pharmacological intervention if they breathe cleaner air, and new strategies to further reduce emissions need to be developed to minimize the impact of air pollution on asthma morbidity in children.

    Study Indicates Lead Poisoning in Children Decreasing (3/06/2009)

    A new study in the journal of Pediatrics, titled “Trends in Blood Lead Levels and Blood Lead Testing Among US Children Aged 1 to 5 Years, 1988-2004,” indicates that elevated blood lead levels among children from 1988 to 2004 has declined by 84 percent. However, the major risk factors for higher blood lead levels continue to be living in housing built before 1950, poverty, age, and being non-Hispanic black. The study notes that children can be exposed to lead from multiple sources, and health care providers must continue to test children at high risk for lead poisoning.

    Study Indicates Cell Phones May Distract Child Pedestrians (2/20/2009)

    For the first time, a study examines how cell phone usage distracts pre-adolescent children while crossing the street. In “Effects of Cell Phone Distraction on Pediatric Pedestrian Injury Risk,” researchers from the University of Alabama at Birmingham used data from children aged 10 to 11 years in simulated road crossings in an interactive, virtual pedestrian environment. Results indicate that when distracted, children were less attentive to traffic, left less time between themselves and the next oncoming vehicle, and were involved in more collisions and near misses. The article appears in the February issue of Pediatrics.

    Study Finds Psychotic Symptoms in Children Associated with ADHD Medication (2/06/2009)

    A recently released study in the journal of Pediatrics, “Hallucinations and Other Psychotic Symptoms Associated with the Use of Attention-Deficit/Hyperactivity Disorder Drugs in Children,” indicates that some children on medication for ADHD may develop symptoms of psychosis or mania. Researchers analyzed data from 49 randomized, controlled clinical trials as well as post-marketing surveillance data on ADHD drugs. The data show that some people can develop drug-related symptoms of psychosis or mania at usual doses. Hallucinations involving visual or tile sensations of insects, snakes or worms were reported in pediatric post-marketing cases. Patients and physicians should be aware that these symptoms may represent adverse drug reactions.

    Study Suggests Parental Support Reduces Risk of Child Maltreatment (2/13/2009)

    An article published in the January 22, 2009, online edition of Prevention Science finds that parents who have access to parenting information and support may reduce child maltreatment. The study, funded by the Centers for Disease Control and Prevention (CDC), evaluated the effect of a variety of parental support programs -- including public seminars and assistance available through specially trained providers -- across nine counties in South Carolina. It found lower confirmed cases of child abuse, child out-of-home placements, hospitalizations, and emergency room visits for children in counties with the services. Researchers estimated that these parental services could translate into 688 fewer incidences of child maltreatment annually. More information about “Population-Based Prevention of Child Maltreatment: The U.S. Triple P System Population Trial” is available online.

    National EMS Education Standards Now Available (2/06/2009)

    The National EMS Education Standards and corresponding Instructional Guidelines are now available. The National EMS Education Standards outline the minimal terminal objectives for entry-level EMS personnel to achieve within the parameters outlined in the National EMS Scope of Practice Model.

    HRSA Releases New CYSHCN Grant (2/06/2009)

    The Health Resources and Services Administration (HRSA) has released HRSA-09-159 (State Implementation Grants for Integrated Community Systems for CSHCN) to help support statewide implementation of the “Presidents New Freedom Initiative.” The New Freedom initiative is designed to create inclusive community-based systems of services for children and youth with special health care needs (CYSHCN). Approximately $1.8 million is available to fund six awards. The grant application deadline is March 6, 2009.

    Georgetown University Posts New Webpage on Unexpected Infant/Child Death for First Responders (1/29/2009)

    The National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University has posted a new page on its website providing up-to-date information for first responders. The webpage includes roles of emergency medical technicians, firefighters, the emergency room personnel, coroners, and medical examiners who investigate and determine the cause of death for an infant who has died unexpectedly. It also includes links to standards and protocols, training resources, and other information at the national and state level.

    Children Lacking a Usual Source of Health Care Face Unmet Needs (1/29/2009)

    The proportion of uninsured children who did not have a usual source of care has grown in recent years, according to the study “Usual Source of Care and Unmet Need Among Vulnerable Children: 1998-2006.” Children who have a usual source of medical care have higher rates of preventive care, and require fewer acute care visits (those for illness or injury) and hospitalizations. Although there were fewer uninsured children in 2006 than in 1998, the number of uninsured children without a usual source of care was higher. Children with private or public insurance who had no usual source of care were two to three times more likely to have unmet medical needs in most study years.

    CDC Study Links Childhood Trauma to Chronic Fatigue Syndrome (1/22/2009)

    A study conducted by researchers from the Centers for Disease Control and Prevention (CDC) and Emory University School of Medicine has identified childhood trauma as a significant risk factor for the development of chronic fatigue syndrome (CFS). The results of the study, published in Archives of General Psychiatry, confirm that childhood trauma is associated with a six-fold increased risk for CFS. More information about the study is located on the CDC website.

    New York DOH Releases Pediatric/Obstetrical Emergency Planning Guide (1/15/2009)

    The New York Department of Health (DOH) recently released the tool kit "A Guide for Pediatric and Obstetrical Emergency Planning." The guide is designed for those hospitals that do not have pediatric intensive care services or obstetrical or newborn services and must prepare for such patients during time of a disaster.

    Updated Recommendations Increases the Number of Children to be Vaccinated (1/08/2009)

    The Centers for Disease Control and Prevention (CDC), The American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) have released a joint update on immunization recommendations. The “2009 Childhood and Adolescent Immunization Schedules” contains new recommendations on the influenza vaccination indicating that children age 6 months to 18 years should be vaccinated. Previously, the influenza vaccination was recommended for children age 6 months to 59 months. The change in recommendations increases the number of children to be vaccinated by approximately 30 million.

    HHS Issues Guidance for Use and Stockpiling of Drugs to Combat Pandemic Influenza (1/08/2009)

    A recently released guidance from the U.S. Department of Health and Human Services (HHS) recommends that health care workers and emergency services personnel be protected with antiviral drugs throughout an influenza pandemic, regardless of whether workers are exposed to or become sick themselves. HHS assigns the responsibility of stockpiling the antiviral drugs and planning for their use as an employer’s obligation.