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This Month in Archives of Pediatrics & Adolescent Medicine
Arch Pediatr Adolesc Med. 2005;159:413.
Although Helicobacter pylori is an extremely common bacterial infection, its role in disease among the pediatric population has been unclear. Kato and Sherman review the involvement of H pylori in pediatric diseases, including chronic gastritis, duodenal ulcers, iron-deficiency anemia, and skin diseases. Noninvasive methods to diagnose H pylori infection are described and compared. Indications for treatment and eradication regimens are described. The review article provides information useful for management of this common infection.
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Despite clear guidelines for management of asthma, many children, especially those living in the inner city, still receive inadequate therapy. Halterman et al conducted a randomized, controlled trial to determine whether school-based screening coupled with primary care provider notification of asthma severity would lead to better compliance with recommendations for preventive therapy. Unfortunately, the addition of the school component did not improve prescription of preventive medication, recommendations for environmental modifications, or referrals to specialty care. Half of the children had no medication changes despite still having persistent symptoms. More powerful interventions appear to be needed to ensure all children with asthma receive appropriate care.
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Provision of well-child care is a major component of pediatric practice, yet provision of anticipatory guidance is limited with most parents wanting more advice from their pediatrician. This practice-based quality improvement intervention sought to improve the content of well-child care visits by coaching office staff in auditing performance and identifying, testing, and implementing new care processes. The intervention increased the number of families receiving age-appropriate anticipatory guidance at 1 and 6 months of age, but this did not result in improvement in parents’ knowledge or changes in self-reported behavior.
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An alternative method to deliver anticipatory guidance during well-child visits is the use of computers and interactive, multimedia programs. In this randomized trial, families receiving access to the computer-based informational program improved their knowledge about safety, oral health, fever management, and infant nutrition. This was accomplished without any increase in provider time and is usable by the majority of parents.
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There is general consensus that pharyngitis should only be treated with antibiotics if there is a documented Streptococcal infection. In this study of over 120 000 children with pharyngitis enrolled in 1 of 5 health plans, 43% were treated with antibiotics. Testing for group A Streptococcal infection varied widely among the health plans, with 59% to 83% of patients treated with antibiotics having been tested. These participating health plans were not testing patients with pharyngitis according to standard of care guidelines.
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