♦ Alves PM, et al. Pediatr Emerg Care. Dec. 9,
Babies younger than 2 who sit on someone’s lap
during an airline flight are at risk of injury as are chil-
dren in an aisle seat, according to a review of in-flight
medical events over a five-year period.
In 2015, more than 3. 4 billion people flew on com-
mercial airlines worldwide, according to the World
Bank. Studies have detailed in-flight medical events
involving adults, but research on children is lacking.
This study described in-flight injuries that involved
children ages 0-18 years. Data were collected from
the electronic records of all in-flight medical events
reported from 2009-’ 14 to a ground-based medical
support center serving about one-third of the commercial airline passenger traffic worldwide. The center
is staffed by emergency physicians at a U.S. Level I
The center received 114,222 medical event calls
during the study period of which 12,226 involved
children; 400 of the pediatric medical events were
The most common injuries were burns (39%), contusions (30%), lacerations (21%) and closed head injuries (8%). The most frequent causes of injury were
hot soup or beverages that were spilled on a child
(36%), particularly those sitting in an aisle seat, and
falls from the seat by unrestrained or lap children
The authors noted that while children younger than
2 made up only 1% of passengers, they sustained 35%
of pediatric injuries.
The Academy has called for a federal requirement
for restraint use for children on aircraft, including
those younger than 2. The authors agreed that restraints may have prevented injuries from falls detailed
in the study.
“By law, in the United States, an infant must be
secured to a properly positioned safety seat with a
5-point restraint to ride in an automobile at 50 mph
but is free to ride unrestrained on the lap of an adult
inside an aircraft moving at speeds greater than 500
mph on a tridimensional trajectory and subjected to
unexpected turbulence,” they wrote.
by Carla Kemp • Senior Editor
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Many youths with
food allergies don’t
auto-injectors to camp
♦ Schellpfeffer MR, et al. J Allergy Clin
Immunol Pract. Dec. 5, 2016, http://
Nearly 3% of youths attending summer
camp have food allergies, but only 40% of
them have a prescribed epinephrine auto-injector with them, data from 170 camps in
the U.S. and Canada showed.
An estimated 11 million children attend
summer camps each year, according to the
American Camp Association. While cases
of anaphylaxis-related deaths of children at
camps have been reported, no large-scale
studies of food-allergic children in camp
settings have been done.
This study aimed to determine the prevalence of food allergies among campers;
identify campers with co-morbid asthma,
which puts them at higher risk of life-threatening anaphylaxis; and ascertain how many
food-allergic children bring epinephrine auto-injectors with them to camp.
Researchers used de-identified data from
a camp-specific electronic health record system used by 184 overnight and day camps in
2014. Of those, 170 camps collected allergy
information for 122,424 campers.
Data analysis was limited to campers with
a history of allergic reaction that required
intervention or a camp prescription for an
Results showed that 2.5% of campers
( 3,055) had food allergies reported by a parent.
Median age of food-allergic campers was 11
years, and 52% were female. The vast majority
were allergic to peanuts or tree nuts (81%),
followed by seafood (18%), egg ( 8.5%), fruits/
vegetables ( 8.1%) and seeds ( 7.2%). Nearly
23% had multiple food allergies, and 44% also
were diagnosed with asthma.
Data also showed that 60% of campers
with food allergies did not bring an epineph-
rine auto-injector to camp.
“Given our study finding that many campers with food allergies did not have available
epinephrine, future legislation or national
guidelines should strongly consider having
stock unassigned epinephrine autoinjectors
available for emergency use for any camper,”
the authors wrote. “Legislators and public
health officials should also consider how to
best financially support such legislation for
summer camps because these private or not-for-profit camps, unlike public schools, do
not receive state or federal funding.”
In-flight injuries often involve children sitting
on laps or in aisle seats
Cognitive behavior therapy eases pain in children with migraines
♦ Ng QX, et al. Headache. Dec. 28, 2016, http://
Cognitive behavior therapy is effective for reducing
pain in children with migraine headaches, according to
a meta-analysis of 14 randomized, controlled studies.
Pharmacotherapy is the main treatment for migraine and includes nonsteroidal anti-inflammatory
drugs, triptans and dopamine antagonists as well as
preventive agents. However, many of these drugs have
not been studied in children. They also can have side
effects that preclude long-term use.
Behavior and lifestyle factors are thought to play a
role in migraines. Therefore, nonpharmacological options, such as cognitive behavior therapy (CBT), may
be effective treatments. Studies in adults have shown
CBT helps manage migraines, but no meta-analysis
of CBT use in children has been done.
The authors searched PubMed and Ovid databases
for studies comparing CBT with placebo, wait-list
control or standard medication in patients younger
than 20 years with a clinical diagnosis of migraine.
Fourteen studies were included in the analysis.
Pooled odds ratios of clinically significant improve-
ment (defined as 50% or greater headache activity
reduction) after treatment and at follow-up of three
months or later were OR 9. 11 (95% CI: 5.01 to
16.58, P<.001) and OR 9. 18 (95% CI: 5.69 to 14.81,
The authors said CBT has several advantages over
medications. It is noninvasive and has no known side
effects. However, therapy is time-consuming and can be
costly. They noted that several studies included in the
analysis used CD-ROM or online programs to deliver
therapy and were effective in managing migraines.
“There is good evidence that CBT is viable in the
management of pediatric migraine, and it should thus
be routinely offered as a first-line treatment and not
only as an add-on if medications prove ineffective,”
The Academy has called for mandatory restraint use
for children on aircraft, which could have prevented
many of the injuries described in a recent study.