Against decongestants: This week’s pediatrics briefing

I’m always delighted to find medical literature that corresponds with the seasons, and with cold season here, it’s worth reminding parents that there’s no good evidence for giving OTC cold medicines to children. Check out Single-Sentence Summary #1 — it’s like a pumpkin spice latte for your mind.


Dr. Joshua Landy Co-founder, Figure 1

Single-Sentence Summaries

1. Decongestants and antihistamines are not recommended for children under 6 with the common cold, though a saline nasal irrigation may provide some comfort. BMJ, October 10, 2018

2. Hand sanitizer significantly outperformed soap-and-water in reducing respiratory infections and antibiotic prescriptions at a daycare centers in Spain. Pediatrics, October 2018

3.  Early-onset asthma and wheezing may contribute to an increased risk of developing obesity in later childhood. European Respiratory Journal, October 2018

4. The duration of IV antibiotic treatment for uncomplicated, late-onset GBS bacteremia can be shortened from 10 days to 8. Pediatrics, Sept 2018

5. Adolescents with nonheterosexual orientation have a significantly higher risk of attempted suicide compared with their heterosexual peers. JAMA Pediatrics, October 2018

Clinical Quiz

An otherwise healthy 15-year-old male presents to his family physician with a six-month history of progressive bloating, recurrent abdominal pain, bloody diarrhea, and tenesmus. His abdomen is tender to palpation in the right lower quadrant, and rectal examination reveals perianal skin tags and occult blood in his stool. A diagnosis of ulcerative colitis is suspected and a colonoscopy is booked. Which of the following endoscopic findings would be consistent with this diagnosis?

A. Presence of a fistula

B. Discontinuous lesions and skip areas

C. Continuous mucosal involvement

D. Cobblestoning

Answer at the bottom of this email, or click here to see the full case and discussion on Figure 1, a free physician community for viewing medical cases.

Editor’s Pearl

This week’s pearl comes the Brown University Emergency Medicine Residency, which shared a case of a 5-year-old who swallowed a screw on Figure 1. In their accompanying blog post, they presented this information regarding identifying airway foreign bodies in children:

Although commonly used, studies have found that the use of decubitus films actually decreases the specificity of standard chest x-ray without changing the sensitivity, suggesting they may be little diagnostic value with the added risk of increased radiation exposure.

Clinical Quiz Answer:

C. Continuous mucosal involvement

Ulcerative colitis (UC) is one of two forms of inflammatory bowel disease, and can be distinguished by a number of endoscopic features. Involvement of the mucosa is almost always continuous and circumferential, though inflammation is limited to only the mucosa and submucosa. The rectum is typically involved and inflammation may extend proximally to other parts of the colon. Cobblestoning, skip areas, and fistulization are findings associated with a diagnosis of Crohn disease.


This briefing is made by physicians, for physicians.