Respite needs of families receiving palliative care.

Aim: The care of a child with a life-limiting condition proves an emotional, physical and financial strain on the family that provides care for their child. Respite care is one way which allows carers to receive some relief and support in the context of this burden of care. The provision of and the requirements for respite in this context is poorly understood.

Antidepressants for functional gastrointestinal disorders in children.

Question: Functional gastrointestinal disorders (FGIDs) are complex conditions I see in some of my pediatric patients. The indications for antidepressants such as selective serotonin reuptake inhibitors (SSRIs) do not include treatment of FGIDs; however, some children are prescribed SSRIs for this condition. Are antidepressants effective and safe to use for treating FGIDs in children and adolescents?

Answer: The pathogenesis of FGIDs is largely idiopathic, and although theories exist to explain why SSRIs might be used to treat FGIDs, there is no conclusive evidence of their effectiveness.

Proton pump inhibitors for irritable infants.

Question: Crying is common in infants; however, caring for infants with inconsolable crying, previously also known as colic or reflux, is often extremely distressing for parents. Is there a benefit to using gastric acid suppression (eg, proton pump inhibitors [PPIs]) in these infants?

Answer: The use of PPIs in infants and children has increased in recent years. The efficacy of proton pump inhibitors has not been demonstrated in the treatment of irritability and excessive crying in otherwise healthy infants younger than 3 months of age.

Staphylococcus aureus decolonization for recurrent skin and soft tissue infections in children.

Question: I see otherwise healthy children in my practice with recurrent staphylococcal skin infections. While I am comfortable with managing each acute infection, what can be done to eradicate Staphylococcus aureus and reduce the chance of recurrent infections?

Answer: Staphylococcus aureus skin and soft tissue infections (SSTIs) are common in children and are increasing in frequency. Risk factors for the development of staphylococcal SSTIs are colonization with S aureus and recent diagnosis of SSTI in a household member.

Acute otitis externa in children.

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.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections.

Question: I have heard about children who have tic disorders that seem to be exacerbated by group A β-hemolytic streptococcal infection. Should children presenting with this phenomenon receive treatment with antibiotics, receive prophylactic treatment, or use immunomodulators to treat the symptoms?

Answer: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) constitute a condition that includes neuropsychiatric symptoms, mainly obsessive-compulsive disorder or tic disorders, temporally associated with an immune-mediated response to streptococcal infections. The actual existence of PANDAS as a unique clinical entity is still up for debate, as a temporal association between group A β-hemolytic streptococcal infections and symptom exacerbations has been difficult to prove thus far.

An incurable itch: head lice.

Question: Head lice infestations continue to be seen frequently in many communities. Some of these children require multiple treatments before eradication. What are the current treatment recommendations for head lice?

Answer: Head lice (Pediculus humanus capitis) infestations are common, particularly among school-aged children.

Topical nonsteroidal anti-inflammatory drugs for corneal abrasions in children.

Question: Corneal abrasion from minor injury to the eye is common in both adults and children. Some of my colleagues prescribe topical nonsteroidal anti-inflammatory drugs (NSAIDs) for analgesia. How safe is this practice?

Answer: Topical ophthalmic NSAIDs are a short-term effective treatment of the pain associated with corneal abrasions in children.