Commentary: Atlantoaxial instability in Down syndrome: Reassessment by the Committee on Sports Medicine and Fitness of the American Academy of Pediatrics

1996 ◽  
Vol 26 (10) ◽  
pp. 748-749 ◽  
Author(s):  
J. R. O'Connor ◽  
W. R. Cranley ◽  
K. M. McCarten ◽  
M. Feingold
Keyword(s):  
Down Syndrome ◽  
American Academy ◽  
Sports Medicine ◽  
Atlantoaxial Instability ◽  
American Academy Of Pediatrics

Atlantoaxial Instability in Individuals With Down Syndrome: A Fresh Look at the Evidence

PEDIATRICS ◽  
1988 ◽  
Vol 81 (6) ◽  
pp. 857-865
Author(s):  
Ronald G. Davidson
Keyword(s):  
Down Syndrome ◽  
Sports Medicine ◽  
Cord Compression ◽  
Atlantoaxial Instability ◽  
Careful Attention ◽  
Case Review ◽  
Predisposing Factor ◽  
X Ray ◽  
American Academy Of Pediatrics ◽  
High Incidence

In 1984, the Committee on Sports Medicine of the American Academy of Pediatrics published in this journal a statement on the remarkably high incidence of atlantoaxial instability among individuals with Down syndrome. On the assumption that this instability, demonstrable through a specified series of lateral x-ray films of the neck, constituted a predisposition to cervical spine dislocation with subsequent spinal cord compression, the Academy supported and made more specific a series of recommendations that had originated from the Kennedy Foundation a year previously. In essence, for those persons who are found to have the radiographic sign of instability, participation in sports should be restricted. Because the implementation of these recommendations could deprive tens of thousands of individuals with Down syndrome of activities that are emotionally and physically beneficial and because of the rarity of reported cervical dislocations associated with injury, a case review was done. Included were those cases cited as support for the recommendations along with additional reports that had been omitted and a few cases reported subsequently. Little support for the hypothesis that atlantoaxial "instability" is a predisposing factor to "dislocation" was found, although much was found to indicate an urgent need for carefully designed longitudinal studies. Because nearly all of the cases of actual dislocation were preceded by at least several weeks of readily detectable physical signs, a physical examination with careful attention to neurologic signs prior to participation in sports is more predictive of potential or impending dislocation than the radiologic criteria currently recommended.

Evaluation of Pediatrician Adherence to the American Academy of Pediatrics Health Supervision Guidelines for Down Syndrome

2018 ◽  
Vol 123 (5) ◽  
pp. 387-398 ◽  
Author(s):  
Meghan E. O'Neill ◽  
Alexandra Ryan ◽  
Soyang Kwon ◽  
Helen J. Binns
Keyword(s):  
Primary Care ◽  
Down Syndrome ◽  
American Academy ◽  
Medical Records ◽  
Atlantoaxial Instability ◽  
Anticipatory Guidance ◽  
Comorbid Conditions ◽  
Children With Down Syndrome ◽  
Health Supervision ◽  
American Academy Of Pediatrics

Abstract The American Academy of Pediatrics's guideline on health supervision for children with Down syndrome (DS) offers pediatricians guidance to improve detection of comorbid conditions. Pediatrician adherence has not yet been comprehensively evaluated. Medical records of 31 children with DS who received primary care at two urban academic clinic sites from 2008–2012 were reviewed. Data was extracted on adherence to age-specific individual guideline components for each subject by year-of-life (total 84 years-of-life). Overall adherence across all components was 83% (2001 guideline) and 67% (2011 guideline). Adherence to thyroid, hearing, vision, and developmental components was >85%, and anticipatory guidance regarding atlantoaxial instability and sexuality was <35%. Overall adherence was higher when a subject was younger and when a provider was an attending-level pediatrician.

568 Sleep Evaluation in Down Syndrome: What is the Adherence to American Academy of Pediatrics DS Guidelines?

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A224-A224
Author(s):  
Anne Marie Morse
Keyword(s):  
Obstructive Sleep Apnea ◽  
Down Syndrome ◽  
Sleep Apnea ◽  
American Academy ◽  
Phenotypic Variability ◽  
Sleep Diary ◽  
Poor Correlation ◽  
Sleep Habits ◽  
American Academy Of Pediatrics ◽  
Obstructive Sleep

Abstract Introduction Specialized health care guidelines for children with Down Syndrome (DS) published by the American Academy of Pediatrics (AAP) provided specific recommendations based on the higher risk needs of individuals with DS. Obstructive sleep apnea (OSA) is reported to be present in 50–79% of individuals with DS. According to the AAP guideline, all individuals with DS should have a polysomnography (PSG) evaluating for OSA by 4 years old and then screened by history and physical exam annually thereafter. An interim analysis of an ongoing Down Syndrome Research study was evaluated to determine rate of adherence to these guidelines. Methods The Dimensional, Sleep, and Genomic Analyses of Down Syndrome to Elucidate Phenotypic Variability study enrolled down syndrome patients 30 months and older, as well as first degree relatives to participate. Patients completed a standardized clinical sleep interview, childhood sleep habits questionnaire and was asked to complete 2 week sleep diary, actigraphy and polysomnography. We aimed to characterize the rate of PSG completion by 4 years of age, number of research PSGs completed and rate of OSA identified on research PSG. Results A total of 31 patients were consented. The median patient age was 10 years old with a slight female predominance (15F:12M). 27 patients completed the sleep interview and 19 successfully completed a scorable polysomnography. Only 7 patients had completed a PSG previously by age of 4 years. 11 of 19 studies demonstrated obstructive sleep apnea ranging from mild to severe severity (1.7–42.5/hr). REM AHI (range 1.2–58.2/hr, mean 19/hr and median 12.3/hr) demonstrated increased severity. Conclusion Despite AAP guidelines recommending universal PSG evaluation by the age of 4 years of age, only 26% of patients interviewed has a PSG successfully completed previously. Additional recommendations by AAP include yearly surveillance of symptoms although there is poor correlation between parent report and polysomnogram results. Of the 19 research completed PSGs, 58% demonstrated OSA with the mean and median results consistent with moderate to severe OSA and worsening during REM sleep. Improved effort to successfully obtain PSG in this population is needed. Further study is ongoing to evaluate the relationship to other health and cognitive outcomes. Support (if any) NIMH

Accuracy of Parental Perception of Nighttime Breathing in Children with Down Syndrome

2017 ◽  
Vol 158 (2) ◽  
pp. 364-367 ◽  
Author(s):  
Norman R. Friedman ◽  
Amanda G. Ruiz ◽  
Dexiang Gao ◽  
David G. Ingram
Keyword(s):  
Down Syndrome ◽  
American Academy ◽  
Tertiary Care ◽  
Case Series ◽  
Neck Surgery ◽  
Parental Perception ◽  
Breathing Patterns ◽  
Children With Down Syndrome ◽  
American Academy Of Pediatrics ◽  
Obstructive Sleep

Objective In 2011, the American Academy of Pediatrics published a guideline for children with Down syndrome (DS), recommending a polysomnogram (PSG) by age 4 years regardless of symptoms. Their rationale was based on 2 publications with small cohorts, where at least 50% of the children had no obstructive sleep apnea (OSA) symptoms but their PSG results were abnormal. The American Academy of Otolaryngology—Head and Neck Surgery Foundation published a clinical practice guideline recommending PSG prior to adenotonsillectomy for these children. This study aimed to assess parents’ accuracy of their children’s breathing patterns as compared with PSGs in a larger cohort of children with DS. Study Design Case series with chart review. Setting Tertiary care academic pediatric hospital. Subjects and Methods Sleep intake forms assessing frequency of parent-observed apnea, snoring, and restless sleep were analyzed. None of the children had a previous tonsillectomy. Two groups were analyzed according to symptoms: infrequent (<3 nights per week on all questions answered) and frequent (≥6 nights per week on at least 1 question). OSA severity was categorized as follows: normal, <2 events per hour; mild, 2 to 4.9; moderate, 5 to 9.9; and severe, ≥10. Results A total of 113 children met inclusion criteria: 34% (n = 38) had infrequent symptoms, and 66% (n = 75) had frequent symptoms. Parents were unable to predict the presence or absence of OSA by nighttime symptoms ( P = .60). The risk of OSA for children with frequent symptoms versus those with infrequent symptoms was 1.04 (95% CI, 0.89-1.3). Conclusion Parents of DS children are unable to predict the presence or absence of OSA by nighttime symptoms, nor are they able to determine its severity.

Sports and the Child with Epilepsy

PEDIATRICS ◽  
1984 ◽  
Vol 74 (2) ◽  
pp. 320-320
Author(s):  
WULFRED BERMAN
Keyword(s):  
American Academy ◽  
Head Trauma ◽  
Sports Medicine ◽  
Deleterious Effect ◽  
Body Contact ◽  
American Academy Of Pediatrics ◽  
Epileptic Child ◽  
Do So

To the Editor.— The Committee on Children with Handicaps and the Committee on Sports Medicine of the American Academy of Pediatrics are to be congratulated for their concise statement on Sports and the Child with Epilepsy.1 There is little doubt that the child whose epilepsy is under reasonable control and who desires to participate in sports, whether involving body contact or not, should be allowed to do so. Although it is logical to assume that repetitive head trauma—as might possibly occur in contact or collision sports—could not help but have a deleterious effect on the frequency of seizures in the epileptic child, fortunately, no clinical or statistical proof that this is true has ever been published.

Pinhole Occluder

PEDIATRICS ◽  
1996 ◽  
Vol 98 (2) ◽  
pp. 314-314
Author(s):  
William L. Risser
Keyword(s):  
Visual Acuity ◽  
American Academy ◽  
Sports Medicine ◽  
Policy Statement ◽  
Young Athletes ◽  
American Academy Of Pediatrics ◽  
Protective Eyewear

This issue of Pediatrics includes an American Academy of Pediatrics policy statement titled "Protective Eyewear for Young Athletes." I have begun using these guidelines and have found that one of the requirements-that athletes obtain an eye evaluation before clearance for participation in sports if their visual acuity is worse than 20/40 in either eye-often results in indigent athletes not playing sports because they cannot afford these services. After the policy statement was approved for publication, too late to alter it, the AAP Committee on Sports Medicine and Fitness became aware of a device called a pinhole occluder.

Adherence to Guidelines for Screening Polysomnography in Children with Down Syndrome

2019 ◽  
Vol 161 (1) ◽  
pp. 157-163 ◽  
Author(s):  
Philip D. Knollman ◽  
Christine H. Heubi ◽  
Jareen Meinzen-Derr ◽  
David F. Smith ◽  
Sally R. Shott ◽  
...  
Keyword(s):  
Down Syndrome ◽  
American Academy ◽  
Universal Screening ◽  
Significant Shift ◽  
Adherence To Guidelines ◽  
Children With Down Syndrome ◽  
American Academy Of Pediatrics ◽  
Obstructive Sleep ◽  
Before And After ◽  
The Mean

Objectives To compare the percentage and mean age of children with Down syndrome (DS) who underwent polysomnography (PSG) to evaluate for obstructive sleep apnea (OSA) before and after the introduction of the American Academy of Pediatrics guidelines recommending universal screening by age 4 years. Study Design Retrospective cohort study. Setting Single tertiary pediatric hospital. Methods This study is a review of patients with DS seen in a subspecialty clinic. Children born preguidelines (2000-2006) were compared with children born postguidelines (2007-2012) regarding percentage receiving PSG, age at first PSG, and rate of OSA. Results We included 766 children with DS; 306 (40%) were born preguidelines. Overall, 61% (n = 467) underwent PSG, with a mean ± SD age of 4.2 ± 2.9 years at first PSG; 341 (44.5%) underwent first PSG by age 4 years. The rate of OSA (obstructive index ≥1 event/hour) among children undergoing first PSG was 78.2%. No difference was seen in the percentage receiving PSG preguidelines (63.4%) versus postguidelines (59.4%, P = .26). The mean age at the time of first PSG was 5.3 ± 3.5 years preguidelines versus 3.4 ± 2.0 years postguidelines ( P < .0001). Children in the postguidelines cohort were more likely to undergo first PSG during the ages of 1 through 4 years (67.4% vs 52.1%, P < .0001). There was no difference in rates of OSA between the pre- and postguidelines cohorts (79.8% vs 75.9%, P = .32). Conclusions Nearly two-thirds of children with DS (61%) underwent PSG overall, with a significant shift toward completion of PSG at an earlier age after the introduction of the American Academy of Pediatrics guidelines for universal screening for OSA.

Parents and Steroid Use by Nonathletes

PEDIATRICS ◽  
1989 ◽  
Vol 84 (5) ◽  
pp. 940-941
Author(s):  
PAUL S. SALVA ◽  
GEORGE E. BACON
Keyword(s):  
American Academy ◽  
Anabolic Steroid ◽  
Sports Medicine ◽  
Professional Associations ◽  
Steroid Use ◽  
American Academy Of Pediatrics ◽  
The Subject

Anabolic steroid use has received a great deal of attention lately and was the subject of a recent American Academy of Pediatrics' Committee on Sports Medicine report. Other professional associations have also issued position papers as well. All of these statements addressed steroid use by athletes only, implying that athletes are the only segment of the population using them. This simply is not the case. Several studies have shown that 10% to 20% of those who admit to steroid use are not involved in athletics.

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