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Kim D.,BC Childrens Hospital | Butterworth S.A.,BC Childrens Hospital | Goldman R.D.,PRETx program
Canadian Family Physician | Year: 2016

Question While the diagnosis of acute appendicitis is relatively straightforward, chronic appendicitis is an entity that can be controversial and is often misdiagnosed. How and when should clinicians be investigating chronic appendicitis as a cause of chronic and recurrent abdominal pain in the pediatric population? Answer Chronic appendicitis is a long-standing inflammation or fibrosis of the appendix that presents clinically as prolonged or intermittent abdominal pain. It is often a challenging diagnosis and might result in complications such as intra-abdominal infections or bowel obstruction or perforation. Clinical presentation, along with imaging studies, can help the clinician rule out other conditions, and among those who are diagnosed, for many children, appendectomy results in partial or complete resolution of pain symptoms.


Bonney A.G.,PRETx Program | Goldman R.D.,PRETx Program | Goldman R.D.,BC Childrens Hospital
Canadian Family Physician | Year: 2014

Question Otitis media is a very common condition in pediatrics and can be quite distressing for children and their parents. Is there a role for antihistamines and decongestants in the management of acute otitis media or otitis media with effusion in children? Answer Traditionally, antihistamines and decongestants have been used in the treatment of otitis media; however, recent guidelines, which are based on study findings with negative results, recommend against routine use. No antihistamine-decongestant combination has been shown to be of clinically significant benefit, and there are potential adverse events that need to be taken into account.


McWilliams C.J.,BC Childrens Hospital | Smith C.H.,BC Childrens Hospital | Goldman R.D.,PRETx Program
Canadian Family Physician | Year: 2012

Question: In the summer months I see many children with uncomplicated acute otitis externa (AOE). I am aware of the multiple ototopical preparations. Which is the best first-line agent to treat AOE, and is there a role for an oral antibiotic? Answer: There are no specific Canadian guidelines for the management of AOE. However, current American guidelines promote initial ototopical therapy without systemic antibiotics for uncomplicated AOE; suggest there is little difference between the various ototopical preparations; and recommend the choice of treatment be based on the specific clinical situation. In practice, this often results in prescribing an antibiotic-steroid formulation for 7 to 10 days. This ototopical treatment option is supported by a recent Cochrane review that has documented the superiority of an antibiotic-steroid combination when compared with placebo or acetic acid in providing clinical resolution of AOE.


Chin B.,University of British Columbia | Chan E.S.,PRETx Program | Goldman R.D.,Childrens Hospital
Canadian Family Physician | Year: 2014

Question: I have been under the impression that infants should avoid potential allergenic foods such as nuts, cow's milk, and eggs in order to avoid developing allergic reactions. What advice should I give parents regarding the introduction of food in infancy and the development of food allergy? Answer: There is no evidence that delaying the introduction of any specific food beyond 6 months of age helps to prevent allergy. A recent Canadian Paediatric Society statement recommends no delay in the introduction of food in infancy. Recent research also appears to suggest that early introduction of potentially allergenic foods (at 4 to 6 months of age) might actually provide a form of protection and help prevent allergy, but more research is needed.


Arane K.,PRETx program | Goldman R.D.,PRETx program
Canadian Family Physician | Year: 2016

Question: A 2-year-old patient in my practice with acute otitis media that has progressed to mastoiditis with a high fever returns with positive culture results for Fusobacterium. What should I do next? Answer: Fusobacterium is a genus of anaerobic bacteria. Although Fusobacterium infections are rare, they can become severe if not treated promptly. Appropriate treatment is combination antibiotic therapy consisting of β-lactam (penicillin, cephalosporin) and an anaerobic antimicrobial agent (metronidazole, clindamycin). At times surgical involvement is required for mastoiditis such as drainage of abscesses or insertion of a ventilation tube. Delayed treatment of an infection caused by Fusobacterium can lead to serious complications, including Lemierre syndrome. Children should be seen in a hospital for close monitoring.


Janjua I.,PRETx Program | Goldman R.D.,PRETx Program
Canadian Family Physician | Year: 2016

Question A mother brought her 12-year-old son into my office because she is concerned that he has difficulty falling asleep almost every night. Her job involves shift work and she uses melatonin herself to help her fall asleep. She asked if her son could take melatonin. What are the recommendations and considerations for using melatonin in otherwise healthy children and adolescents? Answer Insomnia is reported in up to a quarter of healthy children and in three-quarters of children with neurodevelopmental and psychiatric conditions, resulting in negative consequences. For children with delayed sleep phase syndrome, melatonin can be a useful treatment together with insomnia evaluation and regular follow-up. For children with otherwise undiagnosed insomnia and healthy sleep hygiene, melatonin use should be considered. While melatonin seems to be safe, there is a lack of evidence for its routine use among healthy children.


Teoh T.,PRETx program | Chan E.S.,PRETx program | Avinashi V.,PRETx program | Ko H.H.,PRETx program | Goldman R.D.,PRETx program
Canadian Family Physician | Year: 2015

Question After a few years of difficulty swallowing solids and feeling like food was getting stuck, a 13-yearold boy in my practice with peanut allergy and asthma was recently diagnosed with eosinophilic esophagitis (EoE). What is EoE and how is it diagnosed and managed? Answer Eosinophilic esophagitis is an immune-mediated disease resulting in inflammation of the esophagus. It is increasing in prevalence and incidence in countries like Canada, and frequently occurs in children with other allergic conditions. Unexplained feeding difficulties, vomiting, and solid-food dysphagia, especially in boys with atopy, supports the possibility of having EoE. A formal diagnosis is obtained by reviewing esophageal biopsies obtained through upper endoscopy performed while the patient is taking a proton pump inhibitor. Once EoE has been established, management should involve working collaboratively with gastroenterology and allergy specialists. Medical or dietary treatments are acceptable therapeutic approaches.


Friedman B.-C.,PRETx Program | Friedman B.,PRETx Program | Goldman R.D.,PRETx Program
Canadian Family Physician | Year: 2011

Question: A 7-year-old child and his parents visit my clinic owing to the child's frequent bed-wetting. During the day, he has no problem controlling his urination. The family has tried behavioural methods but has failed to achieve dryness during the night. They ask to begin medical treatment. Is oxybutynin a safe and effective drug for treating nocturnal enuresis? Answer: Oxybutynin is an anticholinergic drug that has not been proven to be effective for treatment of nocturnal enuresis not accompanied by daytime symptoms, such as urgency. It can be added as a second-line drug and is effective for treating children with both daytime and nighttime wetting. Nevertheless, its common adverse effects, which can involve the central nervous system, should be considered when deciding whether or not to use it, especially in young children.


Zelcer M.,PRETx program | Goldman R.D.,PRETx program
Canadian Family Physician | Year: 2015

Question: In light of the increase in the number of school-aged children diagnosed with dyslexia, what is the role of omega-3 supplements in the management of this condition? Answer: Dyslexia is the most common learning disability and is known to have multifactorial causes. Recent evidence suggests that there is a connection between defects in highly unsaturated fatty acid metabolism and neurodevelopmental disorders such as dyslexia. While the benefit of omega-3 supplementation for children with dyslexia has been studied, evidence remains limited. Unified diagnostic criteria for dyslexia, objective measures of fatty acid deficiency, and close monitoring of dietary intake are some of the factors that would improve the quality of research in the field. © 2015 Canadian Family Physician.

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