Children were more likely to receive an outpatient
prescription for more than five days’ worth of an opioid pain reliever if they were under 9 years old, their
diagnosis did not include an injury or if the medication
was prescribed by a pediatric resident, according to a
retrospective study at a Midwestern pediatric health
With deaths due to prescription opioids at record
levels, efforts to prevent opioid abuse have focused on
developing prescribing guidelines. Some states recommend limiting prescription amounts to a three- to sev-en-day supply.
To describe prescribing practices in a pediatric acute
care setting, researchers analyzed discharge data for children under 19 years treated at two pediatric emergency
departments and two children’s urgent care centers from
June 1, 2012, to May 31, 2013. They sought to identify
factors associated with oral opioid prescriptions written
for more than five days.
Researchers collected data on patient age, sex, race/
ethnicity, insurance, diagnosis, type and amount of
medication prescribed, refills, and prescriber. Diagnoses
were categorized as injury or noninjury.
Results showed prescriptions for opioids were written
for 4,606 visits, and 3,991 had complete data for analysis.
Ninety-three percent of prescriptions were written for
oxycodone or products that contained oxycodone. None
included refills. The median number of days prescribed
was 3. 3, with a range of one to 44. Nearly 20% were
for more than a five-day supply.
Independent associations were found between prescriptions for more than five days and younger patient
age, urgent care visit, written by residents and noninjury
The authors concluded that education on opioid
prescribing should be mandatory in medical schools,
residency and continuing education for all physicians.
“By improving our prescribing practices, we hope to
decrease the amount of opioids available for nonmedical
use and abuse in the home and community,” they wrote.
by Melissa Jenco • News Content Editor and Carla Kemp • Senior Editor
AAP News (ISSN-1073-0397) is published monthly by the American Academy of Pediatrics, 141
Northwest Point Blvd., Elk Grove Village, IL 60007. Printed in the U.S.A. Periodicals class postage
rate is paid at Elk Grove Village, IL, and additional mailing offices.
POSTMASTER: Send address changes to AAP News, P.O. Box 927, Elk Grove Village, IL 60009-0927.
CANADA SUBSCRIPTIONS: Canada Post Agreement Number PM40063731. Send change of
address information and blocks of undeliverable copies to P.O. Box 1051, Fort Erie, ON L2A 6C7.
SUBSCRIPTIONS: Members – price is included in annual AAP membership dues. Nonmembers –
$89 per year; $69 online only. Single copy $10. To subscribe, contact (866) 843-2271.
AAP News © 2017. Views expressed in AAP News are not necessarily endorsed by the Academy.
Reprint permission may be requested from the editor. www.aapnews.org. The American Academy of Pediatrics is an organization of 66,000 members committed to the health, safety and
well-being of infants, children, adolescents and young adults.
American Academy of Pediatrics
P.O. Box 927 • Elk Grove Village, IL 60009-0927
Opioids more likely to be prescribed to younger patients, by residents
Most dietary supplement exposures involve kids under 6
♦ Rao N, et al. J Med Toxicol. 2017;13:227-
The annual rate of exposures to dietary supplements
increased from 2000-’ 12, and most occurred in children under 6 years old, an analysis of data from the
National Poison Data System showed.
In 2011-’ 12, about half of U.S. adults reported taking a dietary supplement in the past month.
Previous studies have focused on emergency department visits due to supplement exposures or specific
supplements. The aim of this study was to describe the
epidemiology of all dietary supplement exposures that
were reported to poison control centers from 2000
Demographic information on those exposed was
collected as well as reason for and route of exposure,
clinical effects, treatment and medical outcome. Those
exposed were divided into two age groups: younger
than 6 years and 6 years and older.
Supplements were categorized as amino acids,
botanicals, cultural medicines, energy products,
hormonal products, miscellaneous supplements and
other dietary supplements.
The analysis showed 274,998 calls were made to
poison control centers regarding dietary supplements
during the study period or about 21,154 per year.
Seventy percent occurred in children under 6, and
nearly all of these were unintentional. Among all age
groups, 94% of exposures were acute, and 98% were
due to ingestion.
Most of the younger children (91%) did not go to
a health care facility but three died. Thirty-one people ages 6 and older also died. Ma huang (ephedra),
which was banned by the Food and Drug Administration (FDA) in 2004, was associated with five deaths,
multi-botanicals without ma huang or Citrus auran-tium with four deaths and cultural medicines with two.
The most common clinical effects included tachycardia, vomiting, nausea, irritability, drowsiness and
Most of the serious medical outcomes were linked
to energy products, botanicals (especially yohimbe
and ma huang) and cultural medicines. Nearly half
the exposures to energy products occurred in children
younger than 6.
The authors noted that ma huang exposures decreased after it was banned, highlighting the effectiveness of the FDA’s action. “Our results demonstrate
the need for FDA regulation of yohimbe and energy
products in the US as was done successfully with ma
huang products in 2004,” they wrote.
Opioids were prescribed to children under 19 years
for a median of 3. 3 days, but nearly 20% of prescriptions were for more than a five-day supply, a
recent study found.
New tool aims to predict
Researchers have created a tool to help determine a child’s risk of having influenza and reduce
the number being treated unnecessarily.
The Suspected Pediatric Influenza Risk-Strat-ification Algorithm “aids clinicians in determining who to test versus who to treat empirically,
saving children from costly viral testing or unnecessary antiviral exposure,” authors wrote.
During peak influenza season, the Centers
for Disease Control and Prevention (CDC)
recommends treating children who may have
the virus and are at high risk for complications.
Physicians also may consider treating previously
healthy children. Because these groups may be
treated before laboratory confirmation of influenza, children may be overtreated, according to
Researchers set out to create an algorithm to
help determine the likelihood a child has influenza. They analyzed medical records for 818
children presenting to an emergency department
with influenza-like symptoms in the 2012-’ 13
Samples were collected from patients meeting
CDC protocol, and patients were given a prescription for oseltamivir, then discharged with
recommendations for supportive care. Later in
the day, families were notified of the test results
and whether to start treatment.
About 35% tested positive for influenza. Researchers determined children younger than 2
years were at high risk for influenza if they were
in contact with someone who had influenza.
They also were more likely to have influenza
during high-incidence periods if they were unimmunized or if they were immunized but had
Children 2 and older were more likely to have
influenza during low-incidence periods if they
were unimmunized. During high-incidence periods, children were more likely to have influenza if they presented with myalgia or if neither
myalgia nor diarrhea were present.
Authors noted the algorithm is not meant to
diagnose flu but to quantify the risk and serve
as a companion to CDC guidelines.
“… we believe that a tool that gives clinicians,
patients, and families more precise information
regarding the likelihood of influenza infection
will help patients and providers to more effectively make testing and treatment decisions,”