Below are news releases and briefs on statements appearing in the December issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP).

For Release: December 3, 2007, 12:01 am (ET)

MOST U.S. EMERGENCY ROOMS NOT FULLY PREPARED TO TREAT CHILDREN

Just 6 percent of U.S. emergency departments (EDs) have all of the recommended equipment and supplies recommended in 2001 AAP and American College of Emergency Physicians (ACEP) joint policy statement, "Care of Children in the Emergency Department: Guidelines for Preparedness." In the new study, "Pediatric Preparedness of US Emergency Departments: A 2003 Survey," researchers created a survey, based on the AAP/ACEP recommendations, and mailed it to more than 5,100 ED medical and nursing directors throughout the U.S. Among the reported missed items were child laryngeal mask airways, and neonatal and infant equipment. Fifty-nine percent of the hospitals were aware of the AAP/ACEP guidelines, and those that were received higher preparedness scores. The study authors recommend that hospital EDs continue to strive to improve pediatric preparedness and care quality.

INFANTS MORE LIKELY TO EAT FRUITS AND VEGETABLES AFTER REPEATED EXPOSURE

Both breast and formula-fed infants who were repeatedly exposed to green beans were more likely to eat and eventually enjoy the food, according to the study: "Early Determinants of Fruit and Vegetable Acceptance." In the study, 45 infants, of whom 44 percent were breastfed, were assigned randomly to one of two groups: one fed green beans, and the other green beans and peaches at the same time, for eight consecutive days. Initially, the breastfed infants ate more peaches than green beans, as did their mothers. For both breastfed and formula-fed infants, repeated exposure to green beans, with or without peaches, resulted in more green-bean consumption (93.6 grams versus 56.8 grams). The study authors recommend that caregivers offer repeated opportunities to taste a given fruit or vegetables so that infants can learn to like these foods. They also suggest focusing not only on infants' facial expressions but also on their willingness to continue eating.

ALLERGIC PEANUT REACTIONS OCCURRING AT AN EARLIER AGE

Despite AAP recommendations that very young children, especially those with a family history of allergies, avoid peanut exposure during the first three years of life, the age that children are first exposed to peanuts and subsequently have an allergic reaction has fallen over the past decade. In the study, "Clinical Characteristics of Peanut-Allergic Children: Recent Changes," researchers compared the medical data of peanut-allergic patients at a Duke University clinic between July 2000 and April 2006 with those of a similar population between 1995 and 1997. The median age of first peanut exposure and reaction were 14 and 18 months, respectively, between 2000 and 2006. Between 1995 and 1997, the first exposure and reaction were 22 and 24 months. Most of the children in both patient groups had other food allergies, including eggs, cow's milk, nuts, fish, soy, wheat and sesame seeds. The study authors recommend more research on the cause of early allergic reactions to peanuts, as well as successful prevention efforts.

EARLY LANGUAGE INTERVENTION BOOSTS SKILLS AT AGE 8

Early screening and treatment for language delays reduced the number of children who required special education, and improved language performance at age 8, according to a new study from the Netherlands. In "A Cluster-Randomized Trial of Screening for Language Delay in Toddlers: Effects on School Performance and Language Development at Age 8," more than 3,100 children were assessed for language development at age 15 and 24 months by a systematic screening instrument, and compared to a control group of more than 2200 children who received usual care. At age 8, 3.7 percent of the children who did not have early screening and intervention were attending a special education school, compared to 2.7 percent of the children who received early language screening and intervention. Of the control group, 6.1 percent had repeated a grade by age 8 (compared to 4.9 percent in the intervention group), and 9.7 had deficient language skills (compared to 8.8 percent). The study authors recommend mandatory early screening and intervention for all children.

FEVER MAY IMPROVE BEHAVIOR OF CHILDREN WITH AUTISM SPECTRUM DISORDERS

The behavior of children with autism spectrum disorder may improve with fever, according to a new study, "Behaviors Associated With Fever in Children With Autism Spectrum Disorders." Researchers studied 30 children, ages 2 to 18, with autism spectrum disorders during and after an illness with fever. Parent responses to the Aberrant Behavior Checklist - a common behavior assessment for children with autism - were collected during a fever of at least 100.4ºF, immediately after the fever had abated, and when the child had been fever-free for seven days. The results were compared with those collected from parents of 30 children with autism spectrum disorders without fevers, at similar time intervals. Fewer aberrant behaviors - irritability, hyperactivity, stereotypy (repeated, ritualistic movements) and inappropriate speech - were recorded for the children during and immediately after a fever, and the behavior improvement occurred regardless of the severity of the fever and possibly also of the illness. More research is needed to confirm the link between behavior and fever, and to determine the biological cause of the behavior change.

SURGE IN DIARRHEA CASES LINKED TO UNTREATED SEWAGE

A new study links significant increases in diarrhea cases at a suburban Milwaukee pediatric emergency department with the release of untreated sewage into the area's water system. In "Pediatric Emergency Department Visits for Diarrheal Illness Increased After Release of Under treated Sewage," researchers collected data between 2002 to 2004 at Children's Hospital of Wisconsin on the daily number of emergency department (ED) visits for children (under age 19) for diarrheal illness. Data was collected both on children living in zip codes with Lake Michigan drinking water, as well as those living in other areas. During the study period, ED visits for diarrhea increased approximately 50 percent for patients living in Lake Michigan drinking water areas after the two largest "sewage-bypass" events. The results, according to the study authors, suggest a link between the release of partially treated sewage into a drinking water system and subsequent surge in child ED visits for diarrheal illness. Additional research is needed to affect future policy debate.

AAP POLICY OUTLINES EMERGENCY DEPARTMENT SAFETY STANDARDS

A new AAP policy statement outlines recommendations for improving safety for pediatric patients in emergency departments (EDs). While the release of two landmark reports by the Institute of Medicine (IOM) Committee on Quality of Health Care in America in 1999 and 2001 placed greater focus on patient safety, there is still much room for improvement in reducing the number of medical errors and harm. Safety should be a priority for ED staff and health care organization governing boards, according to the new policy statement, "Patient Safety in the Pediatric Emergency Care Setting." Staff should be encouraged to report medical errors, use clinical tools to aid in medication dosing and administration, and recognize staff fatigue as an important safety risk. Other recommendations include defining pediatric emergency care-competencies for all ED disciplines, and integrating patient- and family-centered care into all aspects of pediatric care.

NEW RECOMMENDATIONS FOR PEDIATRIC HEALTH

The AAP and Bright Futures have released the "2008 Recommendations for Pediatric Health," also known as the Periodicity Schedule, outlining the guidelines and priorities - including measurements, screenings, tests, immunizations, developmental/behavioral assessments, oral health and anticipatory guidance (preventative care) - at each of the 31 age-based health supervision visits from birth to age 21. Children and adolescents with developmental, psychosocial, and chronic diseases may require frequent counseling and treatment visits separate from preventive care visits. The recommendations help ensure continuity of care for all children throughout the U.S. Bright Futures is a project of the AAP funded by the Health Resources and Services Administration's (HRSA) Maternal and Child Health Bureau (MCHB). More information on Bright Futures is available at http://brightfutures.aap.org/web/

REPORT OUTLINES OBESITY INTERVENTION STRATEGIES

A new supplemental report from the AAP and partner organizations recommends a series of interventions for children to help prevent obesity, and a 15-minute approach in the medical office for quickly assessing childhood Body Mass Index (BMI) and establishing a plan for behavior change when warranted. As obesity threatens the health of today's children, "Recommendations for Prevention of Childhood Obesity" outlines the behaviors and risk factors associated with obesity, and recommends that all physicians and health care providers counsel children, age 2 to 18 with a BMI in the 5th to 84th percentile, about diet and behavior. Specifically, they should counsel patients to limit intake of sugar-sweetened beverages (soda pop and sweetened juices); eat greater quantities of fruits and vegetables, calcium and fiber; limit television and computer use; increase physical activity, eat meals as a family; and limit portion size. The 15-minute obesity prevention strategy includes assessing diet, activity level, and determining possible behaviors that can be changed; outlining next steps for patient and family change; and making plans to follow-up on planned changes in behaviors.

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.