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Un enfant qui fréquente ma clinique s'est récemment fait une entorse à la cheville et il éprouve de la douleur et de la difficulté à supporter son poids sur la jambe affectée. Sa mère lui donne de l'acétaminophène parce qu'on lui a dit de ne jamais utiliser d'anti-inflammatoires non stéroïdiens (AINS) en raison de son asthme contrôlé par pharmacologie. L'asthme chez un enfant est-il une contre-indication à l'administration d'AINS? La maladie respiratoire exacerbée par les AINS existe-t-elle comme entité réelle? RÉPONSE: Les AINS sont des médicaments analgésiques et antipyrétiques efficaces. La maladie respiratoire exacerbée par des AINS a été décrite chez des adultes ayant certains facteurs de prédisposition, mais n'a pas été clairement identifiée chez un grand nombre d'enfants. Les AINS peuvent donc être recommandés aux enfants ayant une sibilance connue qui n'ont pas d'antécédents de maladie respiratoire déclenchée par des AINS.

I frequently suggest to parents to use acetaminophen to treat their children's fever and pain. Recently, I had a child in my office who presented with a target-lesion skin rash a day after receiving acetaminophen. The rash resolved after 3 days and after stopping administration of acetaminophen. Does acetaminophen carry a risk of adverse events such as this?Like any other medication or active substance, acetaminophen preparations might carry a risk of adverse events. In recent years a potential association between acetaminophen and asthma was investigated, and the US Food and Drug Administration recently published a warning about potential severe but rare skin reactions associated with acetaminophen. Although acetaminophen is mostly a safe medication, health care providers should be alert and advise parents about the possibility of rare but severe adverse events.

Despite the widespread use of over-the-counter (OTC) cough and cold medications (CCMs), the effectiveness of most CCMs has not been proven in children. A meta-analysis summarizing trials using OTC CCMs for viral-induced cough found no evidence for or against the use of OTC medicines in both paediatric and adult populations when cough frequency and severity, as well as physician assessments, were compared. Furthermore, North American data suggest that OTC CCMs may be associated with medication errors and adverse events, resulting in visits to emergency departments and even leading to death. The present article provides information on current evidence for cough and cold therapies, including fluid intake, humidified air, antihistamines, echinacea, zinc, honey and vitamin C, for caregivers of children and youth.

A 4-year-old girl was playing with her neighbour's dog. The dog became excited and bit the girl on the forearm, leaving a puncture wound. As a result of the injury, she has presented to my office. Should she be treated with antibiotics? If so, which antibiotic should be used and for how long?Initiation of prophylactic antibiotics is indicated if the dog bite has undergone primary closure; if there is a moderate or severe bite wound; for puncture wounds (especially if penetration of bone, tendon sheath, or joint), facial bites, bites to the hands or feet, or genital area bites; or wounds sustained by victims who are immunocompromised or asplenic. The first-line choice of antibiotic is amoxicillin-clavulanate. Appropriate tetanus and rabies prophylaxis as indicated should also be a part of caring for a patient who has sustained a dog bite, as well as local debridement and thorough cleaning of the wound.

Owing to Health Canada's recent recommendations to avoid the use of over-the-counter cough and cold medications in preschool children, I was looking at other antitussive medications for acute cough. Codeine was recommended in the past for this indication. What is the evidence for its use and how effective and safe is it?Cough is one of the most common symptoms in children, and the opioid codeine has known antitussive qualities mediated by a central nervous system pathway. However, current evidence finds codeine to be no more effective than placebo for acute cough in children. Its safety profile and recent advances in understanding codeine's variable effectiveness prohibit recommending codeine for cough in children.

Pediatric emergency medicine (PEM) is a mature discipline in North America, although it does not exist, or is still in its infancy, in many regions of the world. Maturity arrives with expectations, which, if unfulfilled, are likely to result in unrealized potential and indeed early senility. PEM practitioners need to consider what is expected of the discipline to achieve full potential. A myopic outlook leads one to believe that PEM entails taking care of children in the pediatric emergency department (PED). Working in a PED has its challenges, with limited resources and increased demands. Inpatient bed shortages, curtailed laboratory services, inadequate staff and large patient volumes place tremendous stress on the PED in its role of triaging, treating and ensuring that every child gets appropriate care. Yet the PED is an integral part of the hospital system and works closely with the pediatric intensive care unit (ICU), pediatric inpatient wards and operating rooms to ensure a seamless interface to other pediatric subspecialties. Many of the procedures that were once the realm of specialty services are now performed in the emergency department (ED). Procedures such as endotracheal intubation and procedural sedation that were facilitated by anesthesiologists are now an integral part of the PED capability. Stabilization and skilled resuscitation, once the domain of specialized intensivists, are now managed equally well in the ED by PEM-trained physicians. Suturing lacerations and reducing closed fractures are now routine for pediatric emergentologists. The importance of having the PED work closely with the pediatric ICU and the rest of the hospital has been previously emphasized. 1