Abstract
BACKGROUND:
METHODS:
CONCLUSIONS:
Paediatr Perinat Epidemiol. 2016 Mar;30(2):160-70. doi: 10.1111/ppe.12268. Epub 2015 Dec 8.
Thursday
Body Mass Index, Waist Circumference, and the Clustering of Cardiometabolic Risk Factors in Early Childhood
Paediatr Perinat Epidemiol. 2016 Mar;30(2):160-70. doi: 10.1111/ppe.12268. Epub 2015 Dec 8.
Monday
Myeloperoxidase: a front-line defender against phagocytosed microorganisms
Abstract
Successful immune defense requires integration of multiple effector systems to match the diverse virulence properties that members of the microbial world might express as they initiate and promote infection. Human neutrophils—the first cellular responders to invading microbes—exert most of their antimicrobial activity in phagosomes, specialized membrane-bound intracellular compartments formed by ingestion of microorganisms. The toxins generated de novo by the phagocyte NADPH oxidase and delivered by fusion of neutrophil granules with nascent phagosomes create conditions that kill and degrade ingested microbes. Antimicrobial activity reflects multiple and complex synergies among the phagosomal contents, and optimal action relies on oxidants generated in the presence of MPO. The absence of life-threatening infectious complications in individuals with MPO deficiency is frequently offered as evidence that the MPO oxidant system is ancillary rather than essential for neutrophil-mediated antimicrobial activity. However, that argument fails to consider observations from humans and KO mice that demonstrate that microbial killing by MPO-deficient cells is less efficient than that of normal neutrophils. We present evidence in support of MYELOPEROXIDASE as a major arm of oxidative killing by neutrophils and propose that the essential contribution of MPO to normal innate host defense is manifest only when exposure to pathogens overwhelms the capacity of other host defense mechanisms.
- Seymour J. Klebanoff*,
- Anthony J. Kettle†,
- Henry Rosen*,
- Christine C. Winterbourn† and
- William M. Nauseef‡,1
+ Author Affiliations
- ↵1.Correspondence: Iowa Inflammation Program and Dept. of Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, D160 MTF, 2501 Crosspark Rd., Coralville, IA 52231, USA. E-mail: william-nauseef@uiowa.edu
Tuesday
Iron, Vitamins Linked to Teens' Fitness Levels
BETHESDA, MD—European researchers discovered a possible link between vitamins and adolescent physical fitness. In a newly released study in the Journal of Applied Physiology online edition, scientists found adolescents’ blood levels of various micronutrients are correlated with how well they performed in physical fitness tests (J Appl Physiol. 2012 Jun 21.).
The researchers studied European children ages 12 to 17. The adolescents performed a standing long jump test, which assesses lower-body muscular strength, and a 20-meter shuttle run test, which assesses cardiovascular fitness through maximal oxygen consumption (VO2max). The scientists took blood samples from more than 1,000 of the participants, and looked for various micronutrients, including hemoglobin, indicative of iron intake, soluble transferrin receptor, serum ferritin, retinol, vitamin C, beta-carotene, alpha-tocopherol, vitamin B6 and vitamin D.
The study found connections between physical fitness and micronutrients, particularly iron. In the shuttle run, concentrations of hemoglobin, retinol, and vitamin C in males and beta-carotene and vitamin D in females were associated with VO2max. Similarly, better performance in the muscular fitness test pointed toward concentrations of hemoglobin, beta-carotene, retinol, and alpha-tocopherol in males and beta-carotene and vitamin D in females.
Iron's importance has long been touted. In July, a study published in the Canadian Medical Association found iron supplementation decreased fatigue in women who had ferritin levels below 50 µg/L. However, the Centers for Disease Control and Prevention released its Nutrition Report in April, indicating that the U.S. population has good levels of vitamins A and D, and folate in the body, but some groups still need to increase their levels of vitamin D and iron.
Monday
Fetal, developmental, and parental influences on cystatin C in childhood: the Uppsala Family Study.
Nitsch D, Sandling JK, Byberg L, Larsson A, Tuvemo T, Syvänen AC, Koupil I, Leon DA.
SourceFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK. dorothea.nitsch@lshtm.ac.uk
Abstract
BACKGROUND: The aim was to identify determinants (biomedical and social characteristics of children and their parents) of cystatin C levels in healthy children drawn from a population sample.
STUDY DESIGN: Cross-sectional study.
SETTING & PARTICIPANTS: 425 pairs of consecutive full siblings born 1987-1995 in Uppsala were identified using the Swedish Medical Birth Registry and invited with their parents for examination in 2000-2001.
OUTCOME: Serum cystatin C level was log-transformed and analyzed using random-effects models.
MEASUREMENTS: The examination in parents and children consisted of a nonfasting blood sample, anthropometry, and questionnaires about lifestyle and socioeconomic position. Tanner stage was used for assessment of pubertal status.
RESULTS: In age-, height-, and body mass index-adjusted analyses, cystatin C level increased by 2.6% (95% CI, 0.3%-4.8%) higher in Tanner stage 2 vs 1 girls, and 1.6% (95%CI, 0.2%-3.1%) lower in boys than girls. For every 10% increase in maternal cystatin C level, offspring cystatin C level increased by 3.0% (95% CI, 2.2%-3.8%); the equivalent effect for paternal cystatin C level was 2.1% (95% CI, 1.3%-2.9%). Lower maternal education was associated with a 2.4% (95% CI, 0.3%-4.6%) higher cystatin C level in their offspring.
LIMITATIONS: Cross-sectional study design, missing cystatin C values for subset of parents, lack of urinary measurements, no gold-standard measurement of glomerular filtration rate.
CONCLUSIONS: There are intergenerational associations of cystatin C level in families in line with previous reports of heritability of kidney disease. Lower maternal education is associated with higher cystatin C levels in their children. Further studies of healthy children are needed to explore the biological mechanisms for these findings. If cystatin C is measured, these studies will need to record pubertal stages.
SourceFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK. dorothea.nitsch@lshtm.ac.uk
Abstract
BACKGROUND: The aim was to identify determinants (biomedical and social characteristics of children and their parents) of cystatin C levels in healthy children drawn from a population sample.
STUDY DESIGN: Cross-sectional study.
SETTING & PARTICIPANTS: 425 pairs of consecutive full siblings born 1987-1995 in Uppsala were identified using the Swedish Medical Birth Registry and invited with their parents for examination in 2000-2001.
OUTCOME: Serum cystatin C level was log-transformed and analyzed using random-effects models.
MEASUREMENTS: The examination in parents and children consisted of a nonfasting blood sample, anthropometry, and questionnaires about lifestyle and socioeconomic position. Tanner stage was used for assessment of pubertal status.
RESULTS: In age-, height-, and body mass index-adjusted analyses, cystatin C level increased by 2.6% (95% CI, 0.3%-4.8%) higher in Tanner stage 2 vs 1 girls, and 1.6% (95%CI, 0.2%-3.1%) lower in boys than girls. For every 10% increase in maternal cystatin C level, offspring cystatin C level increased by 3.0% (95% CI, 2.2%-3.8%); the equivalent effect for paternal cystatin C level was 2.1% (95% CI, 1.3%-2.9%). Lower maternal education was associated with a 2.4% (95% CI, 0.3%-4.6%) higher cystatin C level in their offspring.
LIMITATIONS: Cross-sectional study design, missing cystatin C values for subset of parents, lack of urinary measurements, no gold-standard measurement of glomerular filtration rate.
CONCLUSIONS: There are intergenerational associations of cystatin C level in families in line with previous reports of heritability of kidney disease. Lower maternal education is associated with higher cystatin C levels in their children. Further studies of healthy children are needed to explore the biological mechanisms for these findings. If cystatin C is measured, these studies will need to record pubertal stages.
Sunday
Prospective study of growth and development in older girls and risk of benign breast disease in young women
Abstract
BACKGROUND:
In adult women with retrospective data, childhood adiposity, pubertal growth and development were associated with benign breast disease (BBD) and/or breast cancer. The authors prospectively evaluated these childhood/adolescent characteristics and BBD risk.
METHODS:
The Growing Up Today Study (GUTS) included females, aged 9-15 years in 1996, who completed annual questionnaires through 2001, then 2003, 2005, and 2007. Participants annually/biennially provided information on menarche, height, and weight, from which the authors derived body mass index (BMI in kg/m2). Peak height growth velocity (PHV in cm/year) was estimated from longitudinal data. On 2005-2007 surveys, 6899 females (18-27 years of age) reported whether a healthcare provider ever diagnosed BBD (n = 147), and whether it was confirmed by biopsy (n = 67). Logistic models investigated risk factors adjusted for age, alcohol, pregnancy, and maternal history.
RESULTS:
More childhood adiposity (odds ratio [OR], 0.91/[kg/m2]; P = .04) and shorter adult height (OR, 0.93/inch shorter; P = .07) were associated with lower risk of biopsy-confirmed BBD. Girls with most rapid height growth were at increased risk (OR, 2.12; P = .09) relative to those with the slowest growth. Age at menarche was not associated (OR, 1.11/year; P = .32) nor was adult BMI (adjusted for childhood BMI: OR, 1.01/[kg/m2]; P = .98); larger BMI increases (childhood to adulthood) were not protective (OR + 1.04/[kg/m2]; P = .37). Among girls with maternal breast cancer, those with more rapid growth had higher risk (OR, 1.47/[cm/year]; P = .02). All estimates were age-adjusted.
CONCLUSIONS:
Increased BBD risk (likely evolving to elevated breast cancer risk) was observed in thinner girls, girls with the most rapid growth, and taller women. Contrary to expectations, later menarche age was not protective against BBD, consistent with studies that found BBD patients are not protected against breast cancer by later menarche. Cancer 2011;. © 2011 American Cancer Society
Catherine S. Berkey ScD, MA1,*,†, Walter C. Willett MD, DrPH2, A. Lindsay Frazier MD, ScM1,3, Bernard Rosner PhD1, Rulla M. Tamimi ScD1, Graham A. Colditz MD, DrPH4
BACKGROUND:
In adult women with retrospective data, childhood adiposity, pubertal growth and development were associated with benign breast disease (BBD) and/or breast cancer. The authors prospectively evaluated these childhood/adolescent characteristics and BBD risk.
METHODS:
The Growing Up Today Study (GUTS) included females, aged 9-15 years in 1996, who completed annual questionnaires through 2001, then 2003, 2005, and 2007. Participants annually/biennially provided information on menarche, height, and weight, from which the authors derived body mass index (BMI in kg/m2). Peak height growth velocity (PHV in cm/year) was estimated from longitudinal data. On 2005-2007 surveys, 6899 females (18-27 years of age) reported whether a healthcare provider ever diagnosed BBD (n = 147), and whether it was confirmed by biopsy (n = 67). Logistic models investigated risk factors adjusted for age, alcohol, pregnancy, and maternal history.
RESULTS:
More childhood adiposity (odds ratio [OR], 0.91/[kg/m2]; P = .04) and shorter adult height (OR, 0.93/inch shorter; P = .07) were associated with lower risk of biopsy-confirmed BBD. Girls with most rapid height growth were at increased risk (OR, 2.12; P = .09) relative to those with the slowest growth. Age at menarche was not associated (OR, 1.11/year; P = .32) nor was adult BMI (adjusted for childhood BMI: OR, 1.01/[kg/m2]; P = .98); larger BMI increases (childhood to adulthood) were not protective (OR + 1.04/[kg/m2]; P = .37). Among girls with maternal breast cancer, those with more rapid growth had higher risk (OR, 1.47/[cm/year]; P = .02). All estimates were age-adjusted.
CONCLUSIONS:
Increased BBD risk (likely evolving to elevated breast cancer risk) was observed in thinner girls, girls with the most rapid growth, and taller women. Contrary to expectations, later menarche age was not protective against BBD, consistent with studies that found BBD patients are not protected against breast cancer by later menarche. Cancer 2011;. © 2011 American Cancer Society
Catherine S. Berkey ScD, MA1,*,†, Walter C. Willett MD, DrPH2, A. Lindsay Frazier MD, ScM1,3, Bernard Rosner PhD1, Rulla M. Tamimi ScD1, Graham A. Colditz MD, DrPH4
Wednesday
How to Handle Scary-Sounding Childhood Diseases
By Colleen Cappon & Karlie Pouliot
Hand, foot and mouth disease; fifth disease; scarlet fever; whooping cough – all of these conditions sound pretty scary, and the truth is, any kid can get them, especially with school back in session.
But the good news is these ailments are all pretty manageable if you take the proper precautions. We talked to a pediatrician who specializes in infectious disease to run down the facts.
Hand, Foot and Mouth Disease
“Hand, foot and mouth is caused by a virus that is usually a benign and common virus,” Dr. Frank Esper from Rainbow Babies & Children's Hospital in Cleveland, Ohio told FoxNews.com. “But this virus is often unrecognized because it’s so mild. A child may have a blister in their mouth and that’s it.”
Esper said for the most part, this virus, most commonly caused by coxsackievirus A16, is spread from child to child due to direct contact with other children that have the virus.
“And these kids can be infectious for weeks – again because it’s so mild,” he said.
Symptoms include a slight fever, sluggishness, sore throat as well as blisters and rash that appear on the hands, feet and mouth.
The encouraging news is, the virus goes away within three to five days on its own – no medication required.
Still, Esper said, it’s always a good idea to call your pediatrician if you’re concerned about your child, especially if they become dehydrated. And make sure you practice frequent hand washing to keep the virus contained.
Whooping Cough
“Whooping cough is the most significant - the one we’re most concerned about,” Esper said.
And this is especially true in light of the recent epidemic in California that has resulted in the deaths of nine infants. Earlier this month, state health officials concluded that at least eight of those cases were not diagnosed early enough, with doctors treating the infants for the common cold or nasal congestion instead.
As a result, the California Department of Public Health recently sent a letter to doctors urging them to treat anyone younger than 6 months old who has trouble breathing as a whooping cough case until proven otherwise.
Some 3,600 whooping cough infections have been reported in California so far this year - a sevenfold jump from the same period last year and the most cases since 1958. All of the children who died were less than 3 months old.
“Infants can’t get the first whooping cough vaccine before 2 months of life… so they are very vulnerable,” Esper said. “The best thing to do is to ensure that everyone is vaccinated in the house - especially if you have a new infant.”
Whooping cough, also called pertussis, is a bacterial infection that causes severe coughing spells and is spread when an infected person sneezes or coughs, sending the bacteria into the air. It can be tough to diagnose because early symptoms are mild and resemble a cold. Since whooping cough can progress rapidly in infants, delayed treatment can increase the risk of death.
Esper said there are also new guidelines being put in place, with California leading the way, to make sure all pregnant women get vaccinated against whooping cough.
“This is a vaccine that has been long overdue for the adult population, and now, we’re ramping it up,” Esper said. “The reality is, antibodies go away overtime, and people need to get boosters to keep up their immunity. The CDC is seriously looking at developing an adult series of vaccines like we do for children.”
RELATED: 9th Infant in California Dies From Whooping Cough
Scarlet Fever
Scarlet fever sounds like a disease out of the Middle Ages, but it’s actually one form of a common bacterial infection we all know as strep throat. The condition is caused by group A strep bacteria, which is very common in hospitals. Esper said scarlet fever is one of the least severe diseases caused by strep.
”It is exactly just as the name describes. So your child will have a fever and the skin will have a rash that will start in the face and trunk and then will spread to the rest of the body. There will also have a ‘sand paper-like’ rash,” he said.
In the early stages of scarlet fever, the tongue can look red and bumpy like a strawberry with a white coating in some spots.
Esper recommends that parents call their doctor, and in most cases, they will prescribe the pink bubble gum-flavored amoxicillin, that a child will take for about 10 days.
But it’s important to note, that if left untreated, scarlet fever can cause vomiting, ear infections, or even pneumonia in extreme cases, according to the Mayo Clinic website.
Fifth Disease
“Fifth disease has always been around,” Esper said.
Also known as slapped cheek syndrome, because the main symptom is a lacy red rash on the face and other parts of the body, fifth disease is a very common childhood illness. It’s caused by the human parovirus B19 and is spread by coughing and sneezing.
There is no vaccine, but an average healthy child who contracts it will have nothing more than a rash and a fever. However, when children who have other conditions get fifth disease, it could be cause for concern.
“If it gets in the right host, especially [a child with] sickle cell anemia - that’s when it causes severe disease and sometimes death. We have to give blood transfusions a lot to kids with sickle cell,” Esper said.
That’s because fifth disease causes the decrease of red blood cells.
“And kids with sickle cell don’t have enough to begin with,” Esper added.
What to Keep in Mind
When you send you kids back to school, it’s not only their brains that are learning – their immune systems are learning as well, Esper pointed out.
“You have to understand, these viruses and bacteria are a part of the world, and we have to deal with them,” he said. “Our body has its own line of defense – the immune system – and once these kids are back in school, they are being exposed to these viruses, and being exposed is how the immune system learns to combat.”
Another simple and easy way to combat these illnesses is to wash your hands. It’s that simple. So teach your kids to get in between their digits with soap and water, for at least the duration of singing happy birthday once to themselves.
“And remember, some of these diseases are so mild that you can give them fluids and their immune systems will take care of the rest,” Esper said.
Hand, foot and mouth disease; fifth disease; scarlet fever; whooping cough – all of these conditions sound pretty scary, and the truth is, any kid can get them, especially with school back in session.
But the good news is these ailments are all pretty manageable if you take the proper precautions. We talked to a pediatrician who specializes in infectious disease to run down the facts.
Hand, Foot and Mouth Disease
“Hand, foot and mouth is caused by a virus that is usually a benign and common virus,” Dr. Frank Esper from Rainbow Babies & Children's Hospital in Cleveland, Ohio told FoxNews.com. “But this virus is often unrecognized because it’s so mild. A child may have a blister in their mouth and that’s it.”
Esper said for the most part, this virus, most commonly caused by coxsackievirus A16, is spread from child to child due to direct contact with other children that have the virus.
“And these kids can be infectious for weeks – again because it’s so mild,” he said.
Symptoms include a slight fever, sluggishness, sore throat as well as blisters and rash that appear on the hands, feet and mouth.
The encouraging news is, the virus goes away within three to five days on its own – no medication required.
Still, Esper said, it’s always a good idea to call your pediatrician if you’re concerned about your child, especially if they become dehydrated. And make sure you practice frequent hand washing to keep the virus contained.
Whooping Cough
“Whooping cough is the most significant - the one we’re most concerned about,” Esper said.
And this is especially true in light of the recent epidemic in California that has resulted in the deaths of nine infants. Earlier this month, state health officials concluded that at least eight of those cases were not diagnosed early enough, with doctors treating the infants for the common cold or nasal congestion instead.
As a result, the California Department of Public Health recently sent a letter to doctors urging them to treat anyone younger than 6 months old who has trouble breathing as a whooping cough case until proven otherwise.
Some 3,600 whooping cough infections have been reported in California so far this year - a sevenfold jump from the same period last year and the most cases since 1958. All of the children who died were less than 3 months old.
“Infants can’t get the first whooping cough vaccine before 2 months of life… so they are very vulnerable,” Esper said. “The best thing to do is to ensure that everyone is vaccinated in the house - especially if you have a new infant.”
Whooping cough, also called pertussis, is a bacterial infection that causes severe coughing spells and is spread when an infected person sneezes or coughs, sending the bacteria into the air. It can be tough to diagnose because early symptoms are mild and resemble a cold. Since whooping cough can progress rapidly in infants, delayed treatment can increase the risk of death.
Esper said there are also new guidelines being put in place, with California leading the way, to make sure all pregnant women get vaccinated against whooping cough.
“This is a vaccine that has been long overdue for the adult population, and now, we’re ramping it up,” Esper said. “The reality is, antibodies go away overtime, and people need to get boosters to keep up their immunity. The CDC is seriously looking at developing an adult series of vaccines like we do for children.”
RELATED: 9th Infant in California Dies From Whooping Cough
Scarlet Fever
Scarlet fever sounds like a disease out of the Middle Ages, but it’s actually one form of a common bacterial infection we all know as strep throat. The condition is caused by group A strep bacteria, which is very common in hospitals. Esper said scarlet fever is one of the least severe diseases caused by strep.
”It is exactly just as the name describes. So your child will have a fever and the skin will have a rash that will start in the face and trunk and then will spread to the rest of the body. There will also have a ‘sand paper-like’ rash,” he said.
In the early stages of scarlet fever, the tongue can look red and bumpy like a strawberry with a white coating in some spots.
Esper recommends that parents call their doctor, and in most cases, they will prescribe the pink bubble gum-flavored amoxicillin, that a child will take for about 10 days.
But it’s important to note, that if left untreated, scarlet fever can cause vomiting, ear infections, or even pneumonia in extreme cases, according to the Mayo Clinic website.
Fifth Disease
“Fifth disease has always been around,” Esper said.
Also known as slapped cheek syndrome, because the main symptom is a lacy red rash on the face and other parts of the body, fifth disease is a very common childhood illness. It’s caused by the human parovirus B19 and is spread by coughing and sneezing.
There is no vaccine, but an average healthy child who contracts it will have nothing more than a rash and a fever. However, when children who have other conditions get fifth disease, it could be cause for concern.
“If it gets in the right host, especially [a child with] sickle cell anemia - that’s when it causes severe disease and sometimes death. We have to give blood transfusions a lot to kids with sickle cell,” Esper said.
That’s because fifth disease causes the decrease of red blood cells.
“And kids with sickle cell don’t have enough to begin with,” Esper added.
What to Keep in Mind
When you send you kids back to school, it’s not only their brains that are learning – their immune systems are learning as well, Esper pointed out.
“You have to understand, these viruses and bacteria are a part of the world, and we have to deal with them,” he said. “Our body has its own line of defense – the immune system – and once these kids are back in school, they are being exposed to these viruses, and being exposed is how the immune system learns to combat.”
Another simple and easy way to combat these illnesses is to wash your hands. It’s that simple. So teach your kids to get in between their digits with soap and water, for at least the duration of singing happy birthday once to themselves.
“And remember, some of these diseases are so mild that you can give them fluids and their immune systems will take care of the rest,” Esper said.
Thursday
The Choking Game: Physician Perspectives
OBJECTIVE: The goal was to assess awareness of the choking game among physicians who care for adolescents and to explore their opinions regarding its inclusion in anticipatory guidance.
METHODS: We surveyed 865 pediatricians and family practitioners.The survey was designed to assess physicians’ awareness of the choking game and its warning signs, the suspected prevalence of patients participation in the activity, and the willingness of physicians to include the choking game in adolescent anticipatory guidance. Information on the general use of anticipatory guidance also was collected.
RESULTS: The survey was completed by 163 physicians (response rate: 21.8%). One-hundred eleven (68.1%) had heard of the choking game, 68 of them (61.3%) through sources in the popular media. General pediatricians were significantly more likely to report being aware of the choking game than were family practitioners or pediatric subspecialists (P.004). Of physicians who were aware of the choking game,
75.7% identified 1 warning sign and 52.3% identified 3. Only 7.6% of physicians who were aware of the choking game reported that they cared for a patient they suspected was participating in the activity, and 2 (1.9%) reported that they include the choking game in anticipatory guidance for adolescents. However, 64.9% of all res ondents agreed that the choking game should be included in anticipatory guidance.
CONCLUSIONS: Close to one third of physicians surveyed were unaware of the choking game, a potentially life-threatening activity practiced by adolescents. Despite acknowledging that the choking game should be included in adolescent anticipatory guidance, few physicians reported actually discussing it. To provide better care for their adolescent patients, pediatricians and family practitioners should be knowledgable about risky behaviors encountered by their patients, including
the choking game, and provide timely guidance about its dangers.Pediatrics 2010;125:82–87
AUTHORS: Julie L. McClave, MD,a Patricia J. Russell, MD,b
Anne Lyren, MD, MSc,c,d Mary Ann O’Riordan, MS,e and
Nancy E. Bass, MDf
aSchool of Medicine, and dDepartment of Bioethics, Case
Western Reserve University, Cleveland, Ohio; bMultiCare Health
System, Tacoma, Washington; and Divisions of cGeneral
Academic Pediatrics, ePediatric Pharmacology and Critical Care,
and fChild Neurology, Department of Pediatrics, Rainbow Babies
and Children’s Hospital, Cleveland, Ohio
METHODS: We surveyed 865 pediatricians and family practitioners.The survey was designed to assess physicians’ awareness of the choking game and its warning signs, the suspected prevalence of patients participation in the activity, and the willingness of physicians to include the choking game in adolescent anticipatory guidance. Information on the general use of anticipatory guidance also was collected.
RESULTS: The survey was completed by 163 physicians (response rate: 21.8%). One-hundred eleven (68.1%) had heard of the choking game, 68 of them (61.3%) through sources in the popular media. General pediatricians were significantly more likely to report being aware of the choking game than were family practitioners or pediatric subspecialists (P.004). Of physicians who were aware of the choking game,
75.7% identified 1 warning sign and 52.3% identified 3. Only 7.6% of physicians who were aware of the choking game reported that they cared for a patient they suspected was participating in the activity, and 2 (1.9%) reported that they include the choking game in anticipatory guidance for adolescents. However, 64.9% of all res ondents agreed that the choking game should be included in anticipatory guidance.
CONCLUSIONS: Close to one third of physicians surveyed were unaware of the choking game, a potentially life-threatening activity practiced by adolescents. Despite acknowledging that the choking game should be included in adolescent anticipatory guidance, few physicians reported actually discussing it. To provide better care for their adolescent patients, pediatricians and family practitioners should be knowledgable about risky behaviors encountered by their patients, including
the choking game, and provide timely guidance about its dangers.Pediatrics 2010;125:82–87
AUTHORS: Julie L. McClave, MD,a Patricia J. Russell, MD,b
Anne Lyren, MD, MSc,c,d Mary Ann O’Riordan, MS,e and
Nancy E. Bass, MDf
aSchool of Medicine, and dDepartment of Bioethics, Case
Western Reserve University, Cleveland, Ohio; bMultiCare Health
System, Tacoma, Washington; and Divisions of cGeneral
Academic Pediatrics, ePediatric Pharmacology and Critical Care,
and fChild Neurology, Department of Pediatrics, Rainbow Babies
and Children’s Hospital, Cleveland, Ohio
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