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Welcome to The Differential, our weekly pediatrics briefing. Created by physicians for physicians, The Differential is designed to be quick (skim it in just a few minutes) and thorough (all the information you need is in right here). Today’s Differential is edited by Dr. Cherilyn Cecchini.

The Differential for Pediatrics is available as a free weekly email.
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Single-Sentence Summaries

1. Children with autism are much more likely to also have food, respiratory, or skin allergies. JAMA Network Open June 2018

2. If a child is suspected of swallowing a button battery, parents should feed the child honey to help form a protective layer around the object and neutralize its alkalinity. The Laryngoscope June 2018

3. Three-quarters of U.S. pediatricians disapprove of spanking. Journal of Developmental & Behavioral Pediatrics June 2018

4.  One in five youths are seeing unwanted sexual material online—and one in nine are getting unwanted requests for sexual material. Journal of Adolescent Health June 2018

5. For detecting inflammation in pediatric inflammatory bowel disease, ultrasound is just as effective as MR enterography. Hospital Pediatric Radiology June 2018

Clinical Quiz

An 8-year-old male presents with constipation after eating pebbles at school. He has normal vital signs and a normal abdominal examination. A flat plate abdominal X-ray demonstrates innumerable 1-2 cm round opacities overlying the small and large bowel. Which of the following conditions predisposes a patient to pica?

A. Folate deficiency
B. Autism
C. Generalized anxiety disorder
D. Borderline personality disorder

Answer at the bottom of this email, or click here to see the full case and discussion on Figure 1.

Editor’s Pearl

New parents are often concerned their child is constipated. They will report that the infant is straining and appears uncomfortable when passing a bowel movement. It is key to discuss the consistency of the stool here. If the stool is soft, the presentation is inconsistent with constipation. Provide reassurance to the family and explain that stooling for many infants can be a full body workout! It is also normal to see the transit time slow between 4-24 months to about 16 hours, resulting in 1-2 stools daily rather than several in one day. Older children may only stool every other day. If the consistency is firm and the baby has been passing small, round “balls” or “pellets,” you may want to suggest starting with between 12 ounce to 1 ounce of prune or pear juice daily to relieve the constipation. More helpful information on defining and classifying constipation in infants and young children can be found here.

Clinical Quiz Answer:

B. Autism Pica is defined as the consumption of non-food substances over a period of a month or longer. This behavior has increased frequency in patients with an intellectual disability or autism.

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