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, September 26, 2013

Winter Viruses, Not Asthma, Culprit Behind Sleep-Disordered Breathing in Children

Pediatric sleep medicine includes the practice of evaluating and treating children with sleep related breathing disorders like obstructive sleep apnea.  This disorder, according to new research, may have a seasonal variation that worsens significantly during the virus season.  Dr. Susarla

Winter Viruses, Not Asthma, Culprit Behind Sleep-Disordered Breathing in Children

A new study reveals that during the winter and spring months, viruses alone — not allergies or asthma — can lead to an increased risk for sleepbreathing disorders in children that can impair their mental and physical development.
Over time, sleep-disordered breathing in children can cause stunted growth, heart disease, and neurocognitive problems associated with poor academic performance, impaired language development, and behavioral problems.
Until now, researchers believed that asthma, allergies, and viral respiratory infections, such as the flu, contributed to disorders that affect children’s breathing during sleep.  Now, however, they have found that viruses alone contribute to these breathing problems.
Lead researcher Dr. Riva Tauman and her colleagues at Tel Aviv University say the study has broad implications for the treatment of sleep-breathing disorders in children.
“We knew from research and clinical practice that sleep-disordered breathing in children gets worse during the colder months,” Tauman said. “What we didn’t expect is that the trend has nothing to do with asthma or allergies.”
During the study, researchers statistically analyzed data of more than 2,000 children and adolescents who were referred to the sleep center to be tested for suspected sleep-disordered breathing between 2008 and 2010.
The researchers found that pediatric sleep-disordered breathing is worse in the winter months than in the summer. The seasonal variability is most apparent in children less than five years old, they found.
The researchers also found that wheezing and asthma do not contribute to these problems.  Based on their findings, the researchers speculate that viral respiratory infections — which are more common in younger children during colder months — are the main reason behind the seasonal variability found in pediatric sleep-disordered breathing.
The researchers estimate that seven percent fewer children would have been diagnosed with sleep-disordered breathing if all the tests had been done in the summer.
“Our study suggests that if a child comes into the sleep laboratory in the winter with a mild case, I may consider not treating him. I can assume he will be better in the summer,” said Tauman.
“But if he has only mild symptoms in the summer, I can assume they are more severe in the winter.”

Monday, September 16, 2013

Autism resources


Wrightslaw -- Special Education law website
The Council of Parent Attorneys and Advocates
Disability Rights Texas
The Autism Society of America
The Brain Connection -- Excellent autism resource
Families for Early Autism Treatment
Tony Attwood site -- Excellent information on Asperger's Syndrome.
Future Horizons -- World leader in Autism/Asperger's Syndrome Publications
The National Learning Disabilities Association
The International Dyslexia Association
The Williams Syndrome Association
Children and Adults with Attention Deficit/Hyperactivity Disorder
The Texas Education Agency Special Education Website
The Office of Special Education and Rehabilitative Services
PBIS website. Information on Positive Behavioral Supports
American Music Therapy Association
Travel Training Information
The Texas Organization of Parent Attorneys and Advocates
The law offices of Purcell and Saucedo
The law offices of Dorene Philpot
Focus Initiative:  Assisting individual’s with ASD’S, with social cognitive differences
ASPIE of Houston: Asperger's Syndrome parent-Professional Information exchange

Infant Wheezing Episodes Impact Lungs Later

Having bronchiolitis in infancy, a wheezy illness associated with viral infections, seems to leave its footprint in the lungs for years to come including adulthood.  Dr Susarla

Infant Wheezing Episodes Impact Lungs Later

BARCELONA -- Children who suffer through a bout of bronchiolitis can end up with lungs early in adulthood that look like those of patients with chronic obstructive pulmonary disease (COPD), researchers reported here.
Thirty years after being hospitalized for bronchiolitis when they were younger than 2 years of age, 11% of the patients exhibited lung function that fell below the 0.7 FEV (forced expiratory volume in one second)/FCV (forced vital capacity) ratio that is threshold for the definition of COPD, said Katri Backman, MD, a researcher in pediatrics at Kuopio University Hospital in Finland.
"We found that [about] 30 years after first being hospitalized for bronchiolitis, many of these patients exhibited irreversible airway obstruction -- even though [they] were 28 to 31 years of age," Backman told MedPage Today. She reported her results in a late-breaking poster abstract session at the annual meeting of the European Respiratory Society.
"Irreversible airway obstruction is present 30 years after infantile bronchiolitis for more than 20% of former bronchiolitis patients, suggesting permanent structural changes in airways," Backman said.
Backman and colleagues determined that these patients' airways had been permanently damaged by performing lung function tests before and after administration of bronchodilating medications. But there were no differences in lung function among the bronchiolitis patients, compared with controls or with patients who had been hospitalized with pneumonia in childhood.
"The lack of effect among the bronchiolitis patients of these medicines leads us to believe that the disease has irreversibly damaged their lungs," she said.
In the study, Backman and colleagues identified 83 children hospitalized for bronchiolitis and 44 who were hospitalized for pneumonia at Kuopio University Hospital in 1981-82. All the children in the study were under 2 years of age. "All these children had viral infections in their lungs," she said. "What differentiates bronchiolitis and pneumonia is that the bronchiolitis children have their illness accompanied by this wheezing."
In 2010, the researchers tracked down 47 of the bronchiolitis patients and 22 of the pneumonia patients and compared them with controls who had avoided hospitals as youths. The researchers also recruited 138 healthy, matched controls. All the subjects then underwent multiple lung function tests, such as forced vital capacity, FEV1, the FVC-FEV-1ratio and the FVC/FEV1-ratio % of predicted (FEV%).
They found irreversible airway obstruction that could be considered COPD in five of the bronchiolitis patients (P=0.012); in one of the pneumonia patients (P=0.360), and in two of the controls. "I think that if we had more pneumonia patients, then that number would be statistically significant too. These are both serious diseases in infancy."
Irreversible airway obstruction -- defined as an FEV % of less than 88% -- was observed in 21% of bronchiolitis patients (P=0.001); in 9% of pneumonia patients (P=0.247), and in 4% of controls.
Backman said making comparisons between the bronchiolitis patients and pneumonia patients was difficult because there were few pneumonia patients.
"These findings are similar to what we are finding in our children," Guilia Cangiano, MD, resident in pediatrics at Sapienza University in Rome, told MedPage Today. "Our children have reached the age of 6 and we are seeing these kinds of long-term problems." She did not participate in Backman's study.

Saturday, September 7, 2013

Non-pharmacological sleep interventions for youth with chronic health conditions

In children with chronic health problems, sleep problems are common, UNRECOGNIZED by most professionals and have a negative IMPACT on recovery.

Many sleep problems can  treatable with non-pharmacologic means. 

Bottom line: If your child has a sleep problem, parents should seek the help of a SPECIALIST (e.g neurologist or pulmonologist) who is knowledgeable in sleep disorders to maximize treatment and recovery. 


Non-pharmacological sleep interventions for youth with chronic health conditions: A critical review of the methodological quality of the evidence
July 2013, Vol. 35, No. 15 , Pages 1221-1255 (doi:10.3109/09638288.2012.723788)

1Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta,
Edmonton, Alberta
2Department of Public Health, Faculty of Professional Education, Concordia University College of Alberta
Correspondence: Cary A. Brown, FHEA, PhD, Associate Professor, Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta,
Edmonton, Alberta
Canada. T6G 2G4. Tel: (780) 492–9545. Fax: (780) 492–4628. E-mail: 

Purpose: Restorative sleep is clearly linked with well-being in youth with chronic health conditions. This review addresses the methodological quality of non-pharmacological sleep intervention (NPSI) research for youth with chronic health conditions. Method: The Guidelines for Critical Review (GCR) and the Effective Public Health Practice Project Quality Assessment Tool (EPHPP) were used in the review. Results: The search yielded 31 behavioural and 10 non-behavioural NPSI for review. Most studies had less than 10 participants. Autism spectrum disorders, attention deficit/hyperactivity disorders, down syndrome, intellectual disabilities, and visual impairments were the conditions that most studies focused upon. The global EPHPP scores indicated most reviewed studies were of weak quality. Only 7 studies were rated as moderate, none were strong. Studies rated as weak quality frequently had recruitment issues; non-blinded participants/parents and/or researchers; and used outcome measures without sound psychometric properties. Conclusions: Little conclusive evidence exists for NPSIs in this population. However, NPSIs are widely used and these preliminary studies demonstrate promising outcomes. There have not been any published reports of negative outcomes that would preclude application of the different NPSIs on a case-by-case basis guided by clinical judgement. These findings support the need for more rigorous, applied research.
Implications for Rehabilitation
  • Methodological Quality of Sleep Research
  • Disordered sleep (DS) in youth with chronic health conditions is pervasive and is important to rehabilitation therapists because DS contributes to significant functional problems across psychological, physical and emotional domains.
  • Rehabilitation therapists and other healthcare providers receive little education about disordered sleep and are largely unaware of the range of assessment and non-pharmacological intervention strategies that exist. 
    An evidence-based website of pediatric sleep resources can be found at http://www.SleepRight.ualberta.ca
The current research on non-pharmacological sleep interventions (NPSI) for youth with health conditions is methodologically weak. 

However, consistently positive outcomes reported in the literature demonstrate that pragmatic interventions such as:
  •  bright light therapy, 
  • activity, 
  • massage and 
  • behavioral interventions are promising areas. 

  • No studies found reasons that a trail of a NPSI matched to the youth’s context and condition should not attempted. More rigorous clinically relevant study of pragmatic non-pharmacological interventions appropriate for therapists’ and parents’ needs is required.

Read More: http://informahealthcare.com/doi/abs/10.3109/09638288.2012.723788