What do vapor rub, a probiotic, the “No Child Left Behind Act” and head lice have in common? They were all subjects of a half-dozen articles in the pediatric literature this past year with practice-changing implications, noted pediatrician Michael Burke at Hopkins Children’s annual Pediatrics for the Practitioner Update. “So,” Burke asked the 180-plus pediatricians who attended the two-day conference in mid-September, “just how many of you remember being smeared with vapor rub by a parent or grandparent?”
The answer may be more relevant for patients today, said Burke, chairman of pediatrics at St. Agnes Hospital, pointing to a recent randomized controlled trial showing vapor rub more effective than petroleum jelly and placebo in reducing nighttime cough and cold symptoms (Pediatrics 2010;126(6):1092). “There was a statistically significant improvement in the child’s cough and less disruption of his sleep and, perhaps more importantly, the parents’ sleep,” Burke said. He cautioned, however, that vapor rub should not be used in children under 2 years of age because of the potential toxicity of one of its ingredients, camphor.
The probiotic lactobacillus CG was the subject of another randomized controlled trial looking at its efficacy in treating abdominal pain in children with irritable bowel syndrome, or IBS (Pediatrics 2010:126(6):e1445). Lactobacillus CG, Burke noted, resulted in a statistically significant reduction in both the frequency and severity of abdominal pain in IBS patients, and the improvement persisted after treatment. The authors theorized that the mechanism for improvement was a change in intestinal wall permeability found in IBS patients after treatment, Burke said.
Citing a recent study that looked into the association of aerobic fitness, obesity and standardized test scores in children, Burke noted that many school districts have reduced physical education and recess time due to budget cuts and pressure to perform on core-subject tests mandated by the “No Child Left Behind Act of 2001” (J Pediatrics 2010;156(5):711). Reviewing the data of some 2,000 5th-to-9th graders from 14 Southern California schools, researchers found that children in the 5th to 84th percentile of BMI scored in the 60th percentile of the CAT6 math test, while overweight children scored in the 56th percentile and obese children in the 52nd percentile. The group that was fit or extremely fit – measured by how long it took them to walk or run one mile – scored in the 70th percentile on the standardized math test, while those who were not fit scored in the 58th percentile.
“Their conclusion was children with high BMI and those children who were not fit scored lower on the standardized tests,” Burke said. “This is an article that may help educators who are pressured to have children do well in school, and pediatricians who are advocating for healthy children in the community, to get on the same page.”
In a related study, survey responses from the parents of some 8,550 4-year-olds indicated that how often a family eats dinner together, and how much screen time and sleep the child gets daily is linked to obesity risk (Pediatrics 2010;125(3):420). If a family adopted all three of the recommended behaviors – less than two hours of screen time per day, 10.5 hours of sleep per night, and greater than five family dinners per week – the odds ratio for obesity in the 4-year old was 0.63 percent.
It’s difficult to establish cause and effect in a cross-sectional study like this, said Burke, but he added that there’re lots of good reasons to recommend these behaviors in families: “If you’ve caused decreased obesity, great. If not, there are other benefits. So this is something you could include as part of your anticipatory guidance for pre-school children.”
Last but not least, lice. There’s been a lot of talk on the subject in recent years, Burke noted, and for good reason. Head lice infestation, or pediculosis capitis, is common with 6 to 12 million cases in this country each year, expensive with costs up to $1 billion a year, and disruptive with 12 to 24 million missed school days each year. Also, there’s an increasing resistance to commonly used over-the-counter medications like permethrin and pyrethrins, which has prompted some new treatments.
One new FDA approved therapy is the Lousebuster, which desiccates the lice from eggs via very hot dry air delivered directly to the scalp (Pediatrics 2006;118(5):1962). Benzyl alcohol lotion has also been approved as a safe and effective topical treatment for head lice (Pediatric Dermatology 2010;27(1):19), as has Spinosad (Pediatrics 2009;124(3):e389). For difficult to treat head lice, Burke cited the results of a trial comparing the oral treatment Ivermectin with a malathion lotion (NEJM May 2010;362(10):896). Of patients in the Ivermectin group, 95.2 percent were lice free, compared with 85 percent of patients in the lotion group. Ivermectin is an FDA approved drug, but its use for treatment of head lice is an off-label use.
“I don’t think this is going to be standard first-line treatment for head lice, but it may be something you turn to as you see more resistant head lice,” Burke said. “Also, it may be something your patients may ask about, so it’s good to know about it.”