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Pediatricians tackle controversial issues in new point-counterpoint sessions at AAP conference

ORLANDO, Fla. -- Pediatric experts will debate the pros and cons of the most contentious issues pediatricians face in their daily practice during the new point-counterpoint sessions at the American Academy of Pediatrics (AAP) National Conference & Exhibition in Orlando Oct. 26-29.

For the "Controversies in Pediatrics" series, a new topic will be debated each day by some of the most influential pediatricians in the fields of sports medicine, infectious disease, children with disabilities, and breastfeeding. Reporters interested in covering any of these sessions should check in at the press room, W203B.

The schedule includes:

ECG Screening Prior to Competitive Sports: Should it be Mandatory in the US?
4-5 p.m. Saturday, Oct. 26
Pro: Victoria Vetter, MD
Con: Reginald Washington, MD, FAAP

When a seemingly young, healthy athlete dies suddenly while competing in a sporting event, people want to know how, why, and more importantly, what could have be done to prevent it?

Research has found that mandatory electrocardiograms (ECGs) for student athletes can save more lives, but nationally, it would cost more than $2 billion a year to cover everyone. Estimates from the American Heart Association have shown that the false-positive rate can range from 10 percent to 40 percent because athletes can undergo changes while training that can alter test results. In Italy, all student athletes are required to have a physical exam and ECG, at no cost to the child or parent. In the U.S., not everyone can afford the test, and it is not always covered by insurance. The controversy remains: if even one life can be saved, should cost be an issue?

Kung Fu PANDAS: Stealth Attacks of Streptococci?
4-5 p.m. Sunday, Oct. 27
Pro: Susan Swedo, MD, FAAP
Con: Donald Gilbert, MD, FAAP

For the past 15 years, there has been conflicting research results regarding PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections) being etiologically associated with some cases of obsessive-compulsive disorder (OCD) and tics. Highlights of this session will involve discussion of the controversies about appropriate testing and treatment.

Dr. Swedo will present the pro-PANDAS case, that Strep is a trigger for acute-onset OCD and other neuropsychiatric symptoms. She will argue that pediatricians should obtain a throat culture from any child who suddenly develops obsessions, compulsions, separation anxiety or other signs of PANDAS. If the strep infection isn't recognized and appropriately treated, symptoms can worsen. Repeated episodes may result in chronic, treatment-resistant OCD or other debilitating mental illness.

Dr. Gilbert will debate that if a child presents with new onset OCD or other neuropsychiatric symptoms, the child should be managed with standard-of-care behavioral or pharmacological treatments, and pediatricians should rarely be testing for Strep with throat cultures or blood tests. These approaches are validated in longstanding practice and published evidence.

Preschoolers with ADHD: To Medicate or Not?
4-5 p.m. Monday, Oct. 28
Pro: Mark Wolraich, MD, FAAP
Con: William Barbaresi, MD, FAAP

Is it appropriate or necessary to treat children 4 to 5 years of age with stimulant medications? In 2011, the AAP published a clinical practice guideline recommending behavioral therapy as the first line of treatment for preschool-age children.

Dr. Wolraich will present evidence why stimulant medication should be considered if behavior therapy is not successful for preschoolers diagnosed with ADHD. Dr. Barbaresi will make his case against using medication as treatment in the primary care setting.

What's Wrong with Just One Bottle? Pros and Cons of Choosing to Supplement Breastfed Babies
8:30-9:30 a.m. Tuesday, Oct. 29
Pro: Mandy Brown Belfort, MD, FAAP
Con: Susan Landers, MD, FAAP

It has been longstanding AAP recommendation for babies to be exclusively breastfed for about 6 months, followed by continued breastfeeding as complementary foods are introduced. However, a recent study has shown that small amounts of formula can be used to supplement breastfeeding with positive results. Experts will present both sides of this debate, as well as review the factors that lead breastfeeding mothers to use formula and stop breastfeeding.


Contact: Debbie Jacobson
American Academy of Pediatrics

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