Welcome to the Red Carpet: Pediatric Grand Rounds (1:23)

Red carpet ClooneyBrangelinaJloBjork swan dress

Good evening all, and welcome to the Red Carpet PGR!
Tonight we will be encountering many interesting posts from all over the pediatric blogosphere, dressed in their red carpet best.

However, unlike the Oscars, no actual awards will be given due to the recent report from Stanford psychologist Carol Dweck and colleagues cited in New York Magazine and featured in Treatmentonline.com that certain types of praise can be harmful. Apparently, praising a child for being “smart” or “intelligent” may raise their self-esteem, but makes them hesitant to try new tasks or fail because they are afraid of not being perceived as “smart/ intelligent”. Instead, we should be praising them for trying, for a job well done and for doing specific tasks and developing specific skills. Yikes! have we turned the next generation into “praise junkies”?

Next on the red carpet, we have the dashing Dr. Clark Bartram of Unintelligent Design and the always lovely NICU nurse Judy, from Tiggers Don’t Jump who both had bad experiences with ALTE’s. That’s “Apparent Life Threatening Events” for those of you “not in the know”. Treatment and evaluation of these episodes seem to require some basic equipment: a working brain and a good dose of common sense, both of which Dr. Bartram and Nurse Judy have in abundance.

Speaking of babies with life threatening problems, we have grrlscientist from Scientist, Interrupted with a post about Viagra being used in Newcastle, England to improve circulation in a premature baby, thus saving the child’s life. Leave it to the Brits to find a new market for Viagra. Another example of ingenuity comes from the suave Scot Trauma Queen who tells the tale of a wee lad with a Lego up his noggin.

And what’s a PGR without vaccines? Dr. Sidharth Sethi from Pediatricsinfo online tells us about the cost-effectiveness of pneumococcal vaccines in developing countries. Regarding the reports of intususception associated with the new rotavirus vaccination, we have not one, but two rants from our friends Dr. Sam Blackman at Blog MD and the prolific Dr. Flea. Flea also weighed in on Merck’s recent decision to cease and desist its lobbying for mandatory HPV vaccination of adolescent girls. Nurse Marcia of Ants Marching also objected to Merck’s campaign, which turned what should be a medical/ preventive health issue into a political one.

This might be “so last year” (actually, 6 months ago), but the IOM Report on the future of Emergency Care, pointed out the lack of adequate trained personnel, facilities, resources, and disaster preparedness for pediatric emergency care in this country, has there been any progress since the report came out? Methinks we should continue talking about it till we see some. Docwhisperer just whispered in my ear that in addition to these issues, there is a growing rift in the ER community between the “career” ER physicians and the residency trained docs.

Dr. Sam Blackman of Blog MD deserves an award (although we’re not handing out any), not only for having 2 posts in this edition of PGR, and for riding in the PanMassachusetts Challenge, a 192 mile bike ride to raise money for the Dana Farber Institute, but also for evangelizing and exhorting others to join the good fight versus pediatric cancer. Thanks to Shinga too for introducing me to Lucia, a plucky 17 year old on a soapbox. In this edition, she talks about JimmyTeensTV.com, a videoproject by teens for teens to help them deal with cancer. To complete the triangle, we also hear from Cancer Dad who shares some of the difficult decisions involved in parenting a seriously ill child.

Illness is difficult enough even when parents and physicians agree on treatment, complications multiply exponentially when they don’t. Dr. Steven Novella of Neurologica Blog points out the ethical and legal issues involved when parents and physicians disagree on the therapeutic plan, particularly when unproven or controversial procedures (like psychic healing) are being used.

Preemies have been in the spotlight lately. Aside from the aforementioned Viagra baby, there is Amilla Sonja Taylor, the earliest surviving preemie, born at 22 weeks gestation. NICU Nurse Laura from Adventures in Juggling weighs in on the realities and costs of caring for very early preemies and The Preemie Experiment discusses the ambivalent emotions many parents have and asks whether they are given sufficient information and counseling in making these difficult choices. Tales from the Womb also shares new information on the psychological and neurodevelopmental outlook for these kids.

Since this is a blog dedicated to allergies and asthma, we need at least one post on that topic. My thanks to Shinga from BreathSpa for Kids for submitting an excellent post debunking the increasingly common (and immensely profitable) use of IgG levels to “diagnose” food intolerance or allergy. Brava! You can also check the Food Allergy page on this blog for more information. I’d also like to thank Shinga for trolling the blogosphere and helping me find many of the excellent blogs featured today.

Wait! The orchestra’s starting to play and I haven’t thanked my agent yet! Since it is Oscars night, I’d like to plug three excellent films this year involving children (although not necessarily suitable for children), namely Pan’s Labyrinth, Little Children, and Little Miss Sunshine.
I’m also taking the liberty of pushing my current favorite children’s book: The Secret Science Project That almost Ate the School (click to download the podcast)
My secret science project

I’d also like to thank everyone who contributed to this PGR, and to anonymous black puppy in the cooler, I couldn’t have done it without you!
Darn! There’s that music again, no, wait it’s my current favorite children’s Indie rock band, the Sippy Cups! Before we rock out, don’t forget next PGR is at Blog, MD on March 11, 2007.

Ladies and Gentlemen, the Sippy Cups!

13 thoughts on “Welcome to the Red Carpet: Pediatric Grand Rounds (1:23)

  1. Well, that was a star-studded spectacular and I learned about some good films and a book to boot. I’m reserving judgment on the Sippy Cups for the present as they have a strong resemblance to my last memory of a dental GA (a long time ago).

    Thanks for all of the work that went into this.

    Regards – Shinga


  2. I see a number of patients in the psychiatry service state that they have an allergy to haloperidol (Haldol). Our impression has been that what is being called an allergy was actually an adverse reaction or a common side effect such as dystonia or tremors. If so, there might be no contra indication to the use of Haldol with such patients (using low doses and concomitant use of Cogentin).
    Is this an appropriate presumption? Also, it is being said by some that the JCAHO requires recording self-report of allergy despite the physician’s judgement about it, and to be guided by this record of allergy. Any comments would be appreciated.
    Brian Ladds, M.D.


  3. An allergic reaction or hypersensitivity reaction to drug refers specifically to an IgE mediated immediate reaction involving histamine release, onset of 30 minutes up to 6-12 hours after exposure, and symptoms which include itching, hives, rash, edema, throat closing, abdominal cramps, diarrhea/ vomiting, wheezing, difficulty breathing, and/ or hypotension.

    A lit search on PubMed does not show any “allergic” reactions as described above to haloperidol, but there are reports of frequent injection site reactions. The product info on haloperidol does list “allergic reaction” as an adverse effect, but is not specific as to what symptom.

    The approach I would recommend, which I suggest to anyone who is told by a patient that he/ she is “allergic” to something is:
    1. Inquire what kind of reaction the patient had to the drug, how soon after exposure it happened, and how long ago it occurred.
    2. If the reaction was itching, hives, rash, wheezing, swelling, throat closing, abdominal sx, or dizziness/ hypotension within 30 minutes to a few hours after exposure, then it is possible that the patient may have had an allergic reaction and I would not give him/ her that medication until further evaluation by an allergist.
    Other delayed type hypersensitivity reactions such as serum sickness with hives and joint swelling, and cutaneous rashes can occur several days after exposure, but these are not life-threatening.
    3. If the reaction is not as described above, or occurs a few days after exposure, it is most likely not an allergic reaction.
    4. I would document the patient’s history of allergy, describe the reaction, and the physician’s evaluation of the complaint, regarding whether it is most likely a side effect/ adverse effect of the drug or a true allergy.

    I agree that self report of allergy should be documented as this makes for a more complete history. However, it is up to the physician to assess whether the report is a “true” allergy or a side effect, and whether it requires further evaluation. The patient’s self report should be addressed, but it is the physician’s assessment which should be the basis of further treatment, if needed.

    I am not aware of the JCAHO requirements you mentioned, can you give a reference?


  4. It’s really great and really helpfull for my understanding.

    Sometimes kids need more care regarding the allergy

    Hope that you can provide much more information in the near future.



  5. No, you wouldn’t use haldol with cogentin, that would be like starting a fire and then throwing water on it, just in case….To see dystonic reaction (oculogyric crisis with retrocollis within hours of receiving Haldol) in autistic patient, see “Autistic Patient In Crisis Goes Unnoticed” on you tube. Dystonic reaction in this patient was quickly reversed with ‘cogentin” and ‘benadryl”. Patient was later put on risperdone, and had tremors, where tongue froze (in another video called “shocking patient neglect of autistic person>”) Seroquel and Geodon carry least side effects, but should be reserved as last resort, PRN, not chronic use in autistic patients with epilepsy. All anti-psychotics lower seizure threshold, unless meticulously balanced with anti-convulsants to counter, and there is efficacy of med. stopping behaviors that could also lower seizure threshold. KNOW your patient.


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