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| Monday, December 12, 2011 |
| Bilingualism in Young Children: Confusing? |
| by Pediatric Perspectives at 01:33 PM |
Wendy Burdo-Hartman, MD, Neurodevelopmental Pediatrics
Spectrum Health Medical Group
Helen DeVos Children’s Hospital
I don’t know if you saw the article in The New York Times a few weeks ago about how babies sort out language, but it got me thinking. The article, by pediatrician and writer Perri Klass, highlighted the growing propensity (particularly among high-income families) to start bilingual language development in children earlier, as well as the growing number of bilingual households immigrant families bring to this country. Could children exposed to more than one language early develop “language confusion?”
I don’t think so. In my experience, normally developing children will learn both languages just fine, something that is supported by the research. For instance, Klass highlighted an EEG study that found infants exposed to two languages in the first year are able to discriminate between sounds in each language by 10 to 12 months.1 Other research suggests that language recognition even occurs prenatally, with babies born to bilingual mothers preferring the languages heard in utero over other languages, and registering differences between the two languages. There is even some suggestion that bilingual children may have an advantage when it comes to early executive control.2
However, children with other developmental delays, or language delays in general, should not be pushed to learn a new language. For these families, you should gently recommend letting the child focus on one language at a time.
Do you see more children learning a second language earlier?
1. Adrian Garcia-Sierra, Maritza Rivera-Gaxiola, Cherie R. Percaccio, et al. Bilingual language learning: An ERP study relating early brain responses to speech, language input, and later word production. J Phonetics. 2011.
2. Byers-Heinlein K, Burns TC, Werker JF. The roots of bilingualism in newborns. Psychol Sci. 2010;21(3):343-8. |
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| Friday, December 09, 2011 |
| New Guidelines for Urinary Tract Infections in Infants |
| by Pediatric Perspectives at 11:31 AM |
Alejandro Quiroga, MD, Pediatric Nephrologist
Spectrum Health Medical Group
Helen DeVos Children’s Hospital
In late August, the American Academy of Pediatrics released the first update in more than a decade to its guidelines for  the treatment of pediatric urinary tract infections (UTI) in children 2 to 24 months and the changes are significant.1 I’ve highlighted the key changes in the table below.
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1999 Guidelines
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2011 Guidelines
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Urine testing
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For all children 2 months to 2 years with unexplained fever
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Selective urine testing based on the probability of UTI1
Antimicrobial therapy given only after obtaining urine specimen for culture and urinalysis1
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Imaging
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Renal/bladder ultrasound (RBUS) after first UTI to rule out anatomic abnormalities
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Renal/bladder ultrasound after first UTI to rule out anatomic abnormalities1
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Voiding cystourethrograms (VCUG)
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Perform after first febrile UTI
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No VCUG required after first febrile UTI. Indicated only if RBUS reveals
“hydronephrosis, scarring, or other findings that would suggest either high-grade VUR or obstructive uropathy, as well as in other atypical or complex clinical circumstances.”1
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The most significant change is that you no longer need to order a VCUG after a first UTI to rule out vesicoureteral reflux (VUR). There are several reasons for this change. The first is how we have traditionally treated VUR: with low-dose, prophylactic antibiotics. Yet, just as prophylactic antibiotics replaced surgical ureteral reimplantation as the primary treatment for VUR after we recognized the surgery was not effective, today we find little-to-no evidence demonstrating the effectiveness of prophylactic antibiotics to prevent UTIs and renal scarring in patients with VUR.2-6 In addition, it appears that pyelonephritis can occur without the presence of VUR by VCUG.1
Second, an analysis of recent studies on VCUG found that it would require 100 infants with febrile UTIs to identify 1 infant with grade V VUR. After a second UTI, however, just 10 infants would need to undergo the procedure to identify the 1 with the VUR, and that one child might have already been identified after the RBUS.1
Finally, a VUR is not a benign procedure. It is invasive; most centers, including ours, sedate children; and it creates a significant amount of parental anxiety, as well.
The new guidelines do raise one interesting question: What do you do if you are treating a child who is taking prophylactic antibiotics? I recommend referring them back to the pediatric nephrologist for assessment.
Questions about the new guidelines? Post them here and I will respond.
References
1. Committee On Quality Improvement And Management and Subcommittee On Urinary Tract Infection. Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics. 2011. 128(3): 595-610.
2. Montini G, Rigon L, Zucchetta P, et al. Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics. 2008;122(5):1064 –1071
3. Roussey-Kesler G, Gadjos V, Idres N, et al. Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol. 2008;179(2):674–679
4. Craig J, Simpson J, Williams G. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med. 2009; 361(18):1748 –1759
5. Pennesi M, Travan L, Peratoner L, et al. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics. 2008; 121(6). Available at: www.pediatrics.org/cgi/content/full/121/6/e1489
6. Garin EH, Olavarria F, Garcia Nieto V, Valenciano B, Campos A, Young L. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics. 2006;117(3):626–63 |
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