by Allan S. Lieberthal M.D., FAAP, and
Shawn L. Ralston M.D., FAAP
A revised AAP clinical practice
guideline on the diagnosis and management of bronchiolitis updates the
2006 guideline with stronger recommendations, addition of new therapies and significantly
revised recommendations on the use of palivizumab.
Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis is published in
the November issue of Pediatrics (2014;134:e1474-
In 2012, a multi-disciplinary committee was formed
to revise the 2006 guideline due to the publication of
a significant amount of new literature on the disease
in the intervening years. The committee reviewed literature published since completion of the 2006 guideline as well as the literature included in the earlier
document. As a result, multiple changes were made.
The new document, from the AAP Subcommittee
on Bronchiolitis, emphasizes that bronchiolitis is a
clinical diagnosis that may be caused by a number of
viruses. Up to 30% of patients may be co-infected
with more than one virus. As a result, testing for respiratory syncytial virus (RSV) or other viruses generally
Imaging of the chest and other laboratory tests, such
as a complete blood count and electrolytes, also are
not needed. Chest radiography most commonly leads
to overdiagnosis of pneumonia, resulting in unnecessary antibiotic therapy.
Whereas the 2006 guideline used the language “…
should not routinely be used…” for bronchodilators,
allow parents to
videotape office visits?
by Robin L. Altman, M.D., FAAP
With the advent of smartphones, people can
videotape anything. It stands to reason that parents may want to use this technology to share
office visits with a parent who cannot be present
or to help them remember the pediatrician’s advice
or treatment instructions.
Whatever the reason, pediatricians should think
carefully about the privacy, security and medical
liability implications of allowing parents to videotape office visits.
Value of recordings
Prior to smartphones, an office visit typically
was shared with an absent parent with a phone
call in the exam room during the visit or after the
visit when the doctor had more time to address
the absent parent’s concerns. The old-fashioned
phone call can enhance communication and
involvement of the absent parent, but it does not
create a real-time recording like a smartphone can.
A 2008 AAP technical report titled
Communicating with Children and Families: From Everyday
Interactions to Skill in Conveying Distressing Information (http://pediatrics.aappublications. org/con
tent/121/5/e1441.full.pdf+html) describes use of
audiotapes during office consultations to allow
parents to re-listen to information provided and
share it with other involved family members who
could not attend the visit. There is evidence that
audiovisual aides, including recording and watching an office visit, can improve parent understanding of and adherence to medical management recommendations, increase patient satisfaction, decrease patient uncertainty, assist with
participant recall, and contribute to a patient-centered environment.
It also has been demonstrated that videotaping
parent-child interactions during an office visit is
an effective tool to teach parents about child devel-
See Law, page 16
Pediatricians and the Law
In this issue
Fighting foodborne illness
Antibiotic-resistant foodborne bacteria remain a significant
cause of infections that no longer respond to antibiotics, but
some progress is being made in the war on drug resistance.
What’s new with pediatric Current Procedural Terminology
coding in 2015? Page 25
Volume 35 • Number 11 • November 2014
See bronchiolitis, page 4
New data prompt update to AAP guideline
on diagnosis, management of bronchiolitis
Hillary Clinton delivers special plenary
on early literacy at AAP national conference
See related article on page 4.