Houston Area Pediatric Specialists

Independent pediatric specialists aim to serve our community. We want to share news and analysis regarding our specialties and our practices.

Thursday, June 28, 2012

Untreated Sleep Apnea and Behavioral Problems in Kids

Parents, don't ignore this association.  There is a convincing connection between sleep apnea and behavioral problems in some children, according to data presented at the 2012 SLEEP conference.  The pertinent question is: Can we prevent this?  Dr S

Sleep Apnea Causes Behavioral Problems in Children that 

Persists Even in Teenage Years

Children with obstructive sleep apnea that remains untreated in teenage years, suffer from long-term behavioral problems.

Children with obstructive sleep apnea (OSA) that remains untreated in teenage years, suffer from long-term behavioral problems, said a new study.
"If left untreated, OSA negatively impacts a youth's ability to regulate their behaviors, emotions and social interactions. These behaviors can interfere with their ability to care for themselves and engage in socially appropriate behaviors – skills that are needed to be successful in school," said Michelle Perfect, lead author of the study.
For the study, researchers studied 263 children who had obstructive sleep apnea. They found that children who had OSA during their teenage years were more likely to suffer from aggression, hyperactivity, difficulty in controlling their behavior and many other social and behavioral problems.
The study was presented at SLEEP 2012.
Obstructive sleep apnea is common in children. According to many studies around 3 to 12 percent of all children snore in their pre-teen years while around 1 to 10 percent of children have obstructive sleep apnea syndrome.
Sleep apnea is characterized by a distinctive "snorting" or gasping noises while sleeping, CDC says.
Disturbed sleep at night makes people tired and restless during daytime.
Previous studies have shown that obese kids are more likely to suffer from breathing disorders. However the latest research has not found any co-relation between BMI, age, sex or race.
According to a study published in the journal Pediatrics, sleep-disordered breathing adversely affects learning performances. The study also says that children who have behavioral problems may have disturbed sleep.
Experts say that any sleep-related disorder must be treated as soon as possible to avoid any long-term health complications.

Animal Lovers Do Not Despair If You Have Asthma or Allergies

It's overly simplistic if not wrong to say that animals cause or are responsible for poor asthma control in children.  While pet dander may truly exacerbate symptoms in some children, having pets alone does not necessarily increase asthma risk or risk of poor control.  In fact, pets may be helpful.  Dr S

Why Having a Dog Helps Keep Kids Asthma-Free
If you’re a dog person, your kids might be in luck. Research suggests that children who grow up in homes with pets are less likely to develop allergies, and now a recent study by researchers from the University of California, San Francisco, sheds some light on why.
Working with mice, the scientists found that exposure to house dust from homes with a pet appeared to protect the mice against a common virus called respiratory syncytial virus (RSV), which infects the lungs and breathing passages and is a major cause of respiratory illness in young children. (In adults, it usually causes run-of-the-mill cold symptoms.) Severe infections in infancy are linked with an increased risk of developing respiratory problems like asthma later on.
Lead researcher Kei Fujimura and her team looked at three groups of mice. One group was fed house dust from homes with dogs, and then exposed to RSV; a second group was infected with RSV without exposure to dust; and a control group of mice was not exposed to RSV or dust.
The study found that the mice that ingested house dust and were exposed to RSV didn’t develop the telltale symptoms of infection, such as lung inflammation and mucus production — these animals looked just like the controls. The researchers then examined the microbes living in the protected animals’ guts, and found that the types of bacteria they harbored were different and more diverse than the bugs in the RSV-infected animals guts.
What do gut bugs have to do with asthma? Potentially a lot. Researchers are discovering that the microbiome, as it’s known — the vast community of good bacteria and viruses that live in and on the human body, including in the intestines — not only play a vital role in basic bodily functions like digesting food, producing vitamins and fending off infection, but may also contribute to the development of chronic conditions and diseases like obesity, cancer and asthma.
Our bodies begin to acquire these crucial microbes at birth, during our journey through the birth canal. From that point, exposure to everything — from grandparents to pets — influences the makeup of the microbiome. It’s theorized that microbial exposure in infancy, when the immune system is maturing, may help protect children against later allergies and asthma.
In earlier work, Fujimura found that house dust from homes with cats and dogs had significantly different types of bacteria than dust from homes without pets. And previous studies have suggested that early life pet exposure and ownership is associated with reduced risk of asthma. “This led us to speculate that microbes within dog-associated house dust may colonize the GI tract, modulate immune responses and protect the host against an asthmagenic pathogen, RSV,” she said in statement about the study, which was presented at the annual meeting of the American Society for Microbiology in San Francisco.
The findings support the hygiene hypothesis of allergy and asthma development, which posits that exposure to germs in childhood helps strengthen the immune system, reducing the risk of childhood respiratory and allergic diseases. Studies have shown, for instance, that kids who grow up on farms and around livestock are less likely to develop asthma and allergies than those who live in more sterile urban environments.
“Everybody appreciates the fact that we’re all missing something big in asthma,” Dr. Robert Mellins, a pediatric pulmonologist at Columbia University, told ABC News. “People have appreciated that viral infections clearly have an association, and this kind of experiment is interesting because it suggests a mechanism of how that could come about.”
Fujimura concludes that identifying the specific species of microbes and the precise mechanisms that underlie the protective effect of dog-associated house dust could help researchers better understand and treat allergies and asthma.

Monday, June 18, 2012

10 Signs Your Child Might Have Migraines

This infographic highlights some of the most important signs that a child might be suffering from migraines, including family history, symptoms, & latest study findings.
Almost 9 percent of American children 5 to 13 years old suffer from migraines. However, because migraines can be difficult to diagnose, it’s estimated that only 20 percent of children with migraine are diagnosed by a doctor.

More here

Wednesday, June 13, 2012

CPAP for Sleep Apnea Reverses Neurobehavioral Problems in Children

Thanks to Dr. Susarla for posting this article! Dr. Rotenberg

Sleep apnea in children results in problems in the way kids function during the day.  For children that need it, this study confirms that CPAP use can REVERSE issues of daytime sleepiness, behavioral problems, and attention deficits.  A CPAP desensitization service that addresses the difficulties of getting started can make the process easier.  Dr. S 

Effects of Positive Airway Pressure Therapy on Neurobehavioral Outcomes in Children with Obstructive Sleep Apnea

Abstract (summary)

Rationale: Positive airway pressure therapy is frequently used to treat obstructive sleep apnea in children. However, it is not known whether positive airway pressure therapy results in improvements in the neurobehavioral abnormalities associated with childhood sleep apnea. Objectives: We hypothesized that positive airway pressure therapy would be associated with improvements in attention, sleepiness, behavior, and quality of life, and that changes would be associated with therapy adherence. Methods: Neurobehavioral assessments were performed at baseline and after 3 months of positive airway pressure therapy in a heterogeneous group of 52 children and adolescents. Measurements and Main Results: Adherence varied widely (mean use, 170 ± 145 [SD] minutes per night). Positive airway pressure therapy was associated with significant improvements in attention deficits (P < 0.001); sleepiness on the Epworth Sleepiness Scale (P < 0.001); behavior (P < 0.001); and caregiver- (P = 0.005) and child- (P < 0.001) reported quality of life. There was a significant correlation between the decrease in Epworth Sleepiness Scale at 3 months and adherence (r = 0.411; P = 0.006), but not between other behavioral outcomes and adherence. Behavioral factors also improved in the subset of children with developmental delays. Conclusions: These results indicate that, despite suboptimal adherence use, there was significant improvement in neurobehavioral function in children after 3 months of positive airway pressure therapy, even in developmentally delayed children. The implications for improved family, social, and school function are substantial. Clinical trial registered with www.clinicaltrials.gov (NCT 00458406).

Tuesday, June 12, 2012

Infantile Spasms: Treatment Challenges

Treat early and aggressively in idiopathic IS. This requires early identification and rapid referral. JR

 2012 May 13. [Epub ahead of print]

Infantile Spasms: Treatment Challenges.


Child Neurology Unit and Child Development Center, Meir Medical Center, Tel Aviv University, Kfar Saba, Israel, nathan.watemberg@clalit.org.il.
Infantile spasms (IS) represent a major therapeutic challenge, as cessation of spasms and normalization of the electroencephalogram (elimination of hypsarrhythmia) are mandatory to prevent cognitive deterioration in previously healthy infants, or to preserve neurocognitive function among those neurologically affected prior to onset of IS. Traditionally, this epilepsy syndrome has been considered a “catastrophic” epilepsy, not only for its frequent refractoriness, but mostly due to its effect on cognition. Nevertheless, a change of attitude among pediatric epileptologists is probably warranted, as enough evidence and clinical experience demonstrate that early, aggressive therapy, especially with adrenocorticotropic hormone (ACTH), may not only lead to cessation of spasms, but often leads to the cure of infants with idiopathic/cryptogenic IS. Some ACTH protocols such as that prescribed in Israel (tetracosactide ACTH) appear to be highly efficacious in guarantying a good or even excellent prognosis in idiopathic IS. Moreover, oral prednisolone is a promising and much less expensive alternative to IM ACTH. Vigabatrin does have a role as a first-line agent, especially for tuberous sclerosis patients, but evidence supports hormonal therapy as the initial treatment. The role of pyridoxine and the ketogenic diet still needs to be established; given the efficacy of a much shorter tetracosactide ACTH protocol, there may be no need for the long-term diet, despite its efficacy. Finally, a very promising drug has been developed (CP-115) that may altogether replace the current therapeutic regimens in the near future.
Keywords  Infantile spasms – Treatment – Challenges – West’s syndrome – Adrenocorticotropic hormone – ACTH – Vigabatrin – CP-115 – Ketogenic diet – Idiopathic – Cryptogenic – Tetracosactide – Corticosteroids – Topiramate – Zonisamide – Surgery

Monday, June 11, 2012

Have Asthma? Don't Say No To Exercise

There is a lot of confusion about asthma and its relationship to exercise.  Most athletes I treat DO NOT require any restrictions when it comes to sports.  Dr S.

Asthma doesn't have to mean game over for athletes

Sixteen-year-old basketball standout Larry Austin Jr. is doing what a doctor thought unlikely, given his asthma.
“Actually, my doctor told me awhile ago that I’d never play a sport,” says Austin, who has college basketball scholarship offers and plans to compete for a spot on the USA Basketball under-17 team that will play in the World Championships this summer.
Austin, who will be a junior this fall at Lanphier High School, said his asthma symptoms include a lot of sneezing and a nose that is “stopped up.” He’s battled asthma since he was 3 months old.
Time with a nebulizer and sometimes an inhaler helps Austin before basketball games. He says he hasn’t had any problems with asthma this year.
“I started to grow out of it, slowly,” he says.
A chronic lung disease that makes air movement in and out of lungs difficult, asthma can be managed but not cured. In asthma, the lungs’ airways (bronchi) become inflamed and can spasm, causing shortness of breath and wheezing. The exact cause isn’t known, but certain “triggers” (a condition, thing or activity) can make asthma worse.
Some refer to asthma that worsens with exercise as “exercise-induced” asthma. But that term can be misleading, say local medical doctors.
“Usually, the term ‘exercise-induced’ asthma is used. Potentially, it’s just episodic bronchial constriction, which follows exercising patients who have asthma,” says Dr. Anwar Shafi, assistant professor of pediatrics, specializing in pediatric pulmonology, at the Southern Illinois University School of Medicine.
“I think ‘exercise-induced asthma’ is potentially misleading because exercise is not an independent risk for asthma. It’s just a trigger for bronchial constriction in patients who have underlying asthma.”
Initially, it was thought that Austin’s asthma was exercise-induced, but it was later learned that allergens are his triggers.
“It took a lot of trips going to the hospital, being admitted into the hospital before they identified what was really causing it,” said Larry’s mother, Christa Austin, who adds that her son receives allergy shots every 20 days for maintenance.
Other side of the coin
Shafi says exercise can be a trigger for some of his asthmatic patients.
“When we see patients, we take a careful history ... we try to determine if the child has asthma ... (with) typical symptoms of asthma: cough, wheezing, shortness of breath, chest tightness,” Shafi says.
“Then we try to ascertain what can be the triggers. It depends on the age. Usually in children, viral infections are the most common cause for triggering asthma symptoms. If they do have significant allergies, then allergens can be a trigger for their asthma as well.”

Wednesday, June 6, 2012

New Smartphone App Helps Patients With Asthma

Patients and parents: try this. Isonea has devised an innovative way to assist patients with monitoring and treating their asthma... all from the convenience of your smart phone.  Dr S

iSonea Unveils AsthmaSense App for iOS and Android

Medical technology company, iSonea Ltd. recently unveiled a new asthma management smartphone app, called the AsthmaSense. The app reiterates the growing popularity of the mHealth segment and is available for iPhone, iPad and Android users. As the name suggests, AsthmaSense is been targeted to asthma patients and has been designed specifically to help improve the way people live with and manage asthma.
Providing all-encompassing functionality, the AsthmaSense app allows one to record and track their symptoms, lung function tests, asthma events and medications. All one has to do is program their asthma action plan and then the app starts sending reminders and active alerts. It also delivers interactive medication and testing reminders, information which is crucial to anyone who suffers from asthma.
“Managing asthma is crucial to controlling the disease and improving health; however regular, diligent monitoring of symptoms, triggers and medications can be challenging for patients, caregivers and parents alike," said Lynn M. Taussig, M.D., chairman of iSonea's Medical Advisory Board, special advisor to the Provost for the Life Sciences at the University of Denver and the retired president and CEO of National Jewish Medical and Research Center. "AsthmaSense smartphone app is an easy and convenient way to monitor and track asthma and keep your doctor informed of your condition and progress. This ultimately leads to better health, avoids emergency visits and provides peace of mind for patients and their families."
"iSonea is dedicated to developing innovative, easy-to-use devices and mobile apps that help improve asthma monitoring and management," said Michael Thomas, CEO of iSonea Ltd. "We built the AsthmaSense app with the user in mind. We understand how critical it is to track your asthma, and so we built an app with key features that help you better manage your asthma anywhere, anytime."
Some other features found on the AsthmaSense app include; journal functionality which records peak flow, wheeze, medication use, ability to set tone and time for medication and testing reminders, easy access to emergency contact information and the ability to review and share your AsthmaSense data up to two months of medication use.
AsthmaSense is available for purchase at the Apple App Store (for iPhone and iPad users), Google Play and Amazon App Stores (for Android users) and has a one-time cost of $3.99.

Tuesday, June 5, 2012

The Facts About Asthma (in kids)

Parents, please check out my article in this month's issue of Houston Family Magazine in the "Talk to the Doc" section.  It features some fundamentals of childhood asthma I feel every parent should know. Dr S

The Facts About Asthma

by Sarat Susarla, MD

Board Certified in Pediatric Pulmonology, Sleep Medicine, and Pediatrics
Why worry if your child has a cough? Many self-limiting infections can trigger a cough, which will usually resolve within 7-10 days.
But when respiratory symptoms like cough are chronic or become associated with other problems like wheezing and shortness of breath, it’s time to consider asthma.
Asthma is a chronic lung condition associated with inflammation of the airways, making it hard to breathe. It often starts in childhood, although it affects people of all ages.
According to the American Academy of Pediatrics, between 80 and 90 percent of children develop symptoms by age 4 or 5.
And according to a 2010 National Health Interview Survey by the Centers for Disease Control, 7 million U.S. children (10%) aged 17 years and under have asthma.
Asthma seems to be on the rise, although the medical community isn’t sure if this is simply because we’re better at diagnosing the disease or whether it’s due to changes in our environment. Asthma is often confused with infections like bronchitis, which often present in a similar way.
Remarkably, rates of hospitalization and emergency room visits in children have not decreased in the past 10 years, despite the availability of highly effective preventative medication.
Asthma can be difficult to diagnose, especially in children. A combination of symptoms; family history (due to genetic factors); and lung function testing are helpful in reaching a diagnosis.
There is no cure for asthma, but it can be managed with medication.

Monday, June 4, 2012

Study Shows Asthma Medications Prevent Hospitalization When Used Properly

The ICU is one place you don't want to be if you have asthma.  Research shows that available medications for asthma are highly effective in reducing hospitalizations.  SS

Inhaled Steroids Lead to Big Drop in Asthma Deaths at Texas Hospital: Study

They reduce inflammation in the lungs, improving control of asthma symptoms

TUESDAY, May 15 (HealthDay News) -- Patient education and medication compliance contributed to a 74 percent drop in the number of patients with life-threatening asthma admitted to the intensive care unit at University Hospital in San Antonio, Texas, researchers report.

Their review of 30 years of hospital data focused on patients with severe asthma who didn't respond to standard inhalers.
They found that there were 227 patients admitted to the intensive care unit (ICU) with 280 episodes of life-threatening asthma between 1980 and 2010. One patient died, but the death was from a different cause after the patient's asthma improved, according to the team at the University of Texas Health Science Center at San Antonio.
"The main reason for the decline in cases is that more of our patients are taking their controller medications, such as inhaled corticosteroids, which reduce the amount of inflammation in the airways," lead author Dr. Jay Peters, chief of pulmonary diseases at the Health Science Center, said in a university news release.
The researchers also found that insertion of a breathing tube, called intubation, when patients arrived in the emergency department did not lead to longer hospital stays.
"I think our methods of treating patients in the emergency department have improved so much that previous studies of issues with intubation don't hold up anymore," Peters said.
The study appears in the journal Respiratory Medicine.
"On the front end, this study reinforces the importance of staying on controller medications," he said. "On the back end, it shows low mortality for patients in the medical ICU and that we don't need to be afraid to intubate patients and place them on mechanical ventilation if necessary."

Exercise intolerance in obese children--is it asthma? Yes in 47%!

Exercise intolerance in obese children--is it asthma?

W V Med J. 2010 Sep-Oct;106(6):12-5.

Exercise intolerance in obese children--is it asthma?

Yes in 47%! 


Pediatric Pulmonary Division, Baystate Children's Hospital, Springfield, MA, USA.


This is a pilot study designed to examine the frequency of asthma in obese children who have exertional dyspnea. Obese children who complained of breathlessness with exercise and who denied asthma were invited to enroll. If there was evidence of airflow limitation on spirometry, nebulized albuterol was administered and spirometry was repeated. If there was no significant improvement or if the baseline spirometry was normal, exercise testing was performed. A total of 20 patients (ages from 8 to 16 years) with BMI from 22 to 61 were enrolled. 

Of the 19 who completed the study, 9 (47.3%) met criteria for asthma.

Recognizing and treating asthma may lead to improved exercisetolerance and improved weight status in these obese individuals.