Didactic and case-based discussion of obesity and new formulas focused on practical pediatric office-based issues.

Obesity Treatment and Management in the Pediatric Office: What Can One Do?
William J. Klish, Baylor College of Medicine, Houston, TX

Obesity Detection and Prevention from Office Pediatrician Perspective
Robert Murray, The Ohio State University, Columbus, OH

Formulas Additives Probiotics to Trace Elements—What Parents and Pediatricians Should Know
Judith O'Connor, University of Colorado, Children's Hospital, Denver, CO

Fatty Acid Supplementation of Formulas: Facts and Fictions
Frank R. Greer, University of Wisconsin, Wisconsin Perinatal Center, Madison, WI

There are approximately 200,000 school-aged children with diabetes in the United States. Pediatricians must be aware of the increasing complexities of the diabetes regimen and strategies that can be implemented in schools to improve management and prevention. This workshop will address how to set up a diabetes health care plan, empower families, improve the nutrition environment and promote physical activity. Numerous tools will be presented, including a guide for school personnel, materials to energize the student body to form nutrition clubs and support materials for families.
 

This mini course will set the stage for several discussions of particular issues of major importance and interest. What is "preparedness" and what are the real risks of continuing terrorism in the United States? What is the current status of preparedness in the U.S. hospital and public health systems? How do children differ from adults in terms of response to weapons of mass destruction (chemical, biological and radiological)? How do these differences matter in disaster planning? Are the needs of children being incorporated in local, state and federal disaster plans? Smallpox, anthrax and other biological threats: Where do we stand? What do we do? Nuclear power plants, nuclear weapons, dirty bombs and potassium iodide: What do we know? The mental health consequences of terrorism: What have we learned since 9/11, how do we prepare children for an increasingly vulnerable world, building resiliency and sustaining a positive vision. The new pediatric agenda: What do we have to teach students, residents and pediatricians about the pediatric aspects of terrorism planning. Children and exposure to weapons of mass destruction: science and the essential research agenda.

Introduction
Paul H. Saenger, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY

Welcome and Context
Irwin Redlener, National Center for Disaster Preparedness, Columbia University Mailman School of Public Health, New York, NY

Pediatric Preparedness for Terrorism and Disasters
David S. Markenson, Columbia University Mailman School of Public Health, New York, NY

Biological Weapons of Terror: What Pediatricians Need to Know
Theodore J. Cieslak, U.S. Army Research Institute of Infectious Diseases, Ft. Detrick, MD

Helping Children and Families Cope with Terrorism
David J. Schonfeld, Yale University School of Medicine, New Haven, CT

Radiologic Terrorism, Children and the Question of Potassium Iodide
Thomas P. Foley, University of Pittsburgh, Children's Hospital of Pittsburgh, Pittsburgh, PA

Pain that is recurrent or persistent can create difficulties in diagnosis and treatment. Since research in pediatric pain is relatively recent but expanding, physicians may not have sufficient state of the art knowledge upon which to evaluate and treat their patients with chronic pain. There have been significant advances in the neurobiology of pain and the many factors that magnify and maintain the pain experience, pain behaviors and pain pathophysiology. The interface between mind, body and the environment, as well as new diagnostic tools, is creating new paradigms in our understanding of pain. For example, barostat and imaging studies have revealed new models for thinking about irritable bowel syndrome (IBS) as a condition of neuroenteric dysfunction. Other conditions, such as juvenile fibromyalgia and myofascial syndromes, are thought to be caused by central neurodysregulation. Many of these conditions are magnified and confounded by co-morbid anxiety disorders, learning disabilities and family system issues, among other factors. Why do some children with chronic pain develop a downward spiral of decreasing function and develop PADS? These conditions are not as difficult to evaluate and treat once they are understood from a biopsychosocial perspective. We will discuss the neurobiology, clinical assessment and approach to treatment of chronic pain and PADS, using IBS, juvenile fibromyalgia and myofascial pain as examples.

Overview of Pain Systems: A Mind–Body Perspective
Lonnie K. Zeltzer, David Geffen School of Medicine at UCLA, Mattel Children's Hospital, Los Angeles, CA

Neurobiology of Chronic Pain: Irritable Bowel Syndrome as a Model
Carlo Di Lorenzo, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA

How Do We Understand Disorders Such as Fibromyalgia and Myofascial Pain?
David D. Sherry, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA

Pain-Associated Disability Syndrome (PADS): What Is It and How To Evaluate and Treat It
Brenda Bursch, David Geffen School of Medicine at UCLA, UCLA Neuropsychiatric Institute & Hospital, Los Angeles, CA

Discussion
 

Micronutrients are essential to normal growth and development in infancy. Preterm and small-for-gestational-age infants are especially vulnerable to deficiencies. This symposium will focus on two fundamental nutrients: zinc and iron. Michael Hambidge will discuss the physiologic and metabolic importance of zinc during the perinatal period and the methods that can be used to assess zinc requirements. Nancy Krebs will discuss recent information about zinc homeostasis and requirements in premature and small-for-gestational-age infants. Stanley Zlotkin will discuss the etiology of iron deficiency in preterm infants during the first year of life and interventions to prevent it.

The Importance of Zinc in the Perinatal Period: An Overview
Kenneth Michael Hambidge, University of Colorado Health Sciences Center, Denver, CO

Zinc Requirements in Premature and Small-for-Gestational-Age Infants
Nancy F. Krebs, University of Colorado Health Sciences Center, Denver, CO

Meeting the Iron Needs of the Preterm Infant Throughout the First Year of Life
Stanley H. Zlotkin, The Hospital for Sick Children, Toronto, Canada

TLRs (Toll-like receptors) are a family of transmembrane germ line coded pattern recognition receptors that bind structural motifs common to pathogenic organisms. These structural motifs include endotoxin, products of gram+ organisms, fungi and mycobacteria, as well as DNA and RNA structures common to bacteria and virus but not mammalian cells. The TLRs are expressed by diverse cell types. TLR signaling initiates the innate immune/inflammatory host response to pathogens and also initiates antigen processing for acquired immunity.

Moshe Arditi will review the recent progress in understanding how children respond to pathogens. Maria Abreau will explore how immune signaling is central to both the maintenance of normal gut function and how chronic GI disease may develop. Christopher Karp will then explore how immune signaling relates to the hygiene hypothesis regarding the striking increase in the prevalence of both allergic and autoimmune diseases in children in Westernized countries over recent decades. The goal is to provide an update about newly described mechanisms signaling inflammation/immunity that are central to multiple homeostatic and disease processes in children.

Toll Like Receptors—Bridging Innate and Adaptive Immunity
Moshe Arditi, Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA

TLR Signaling in the Gut in Health and Disease
Maria Abreu, Cedars-Sinai Medical Center / UCLA School of Medicine, Los Angeles, CA

Signaling the Hygiene Hypothesis
Christopher Karp, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

Children who are victims of violent behavior or merely observers of violence may learn destructive or self-destructive patterns of behavior. Violence is a major public health problem. This symposium will focus on breaking the cycle of violence and will showcase speakers who are working on violence prevention in the pediatric emergency department, school and community. The speakers will demonstrate what can be done by physicians who see the importance of this issue and the ways in which we can make a difference.

Violence Prevention in Primary Care: Moving from Public Health to Private Practice
Robert D. Sege, Tufts-New England Medical Center, Boston, MA

Beyond Treat and Street: Violence Prevention in the Emergency Department
Joel Fein, The Children’s Hospital of Philadelphia, PA

Efforts in the Community
Sheryl A. Ryan, University of Rochester School of Medicine, Rochester, NY

The Nutrition Friendly (NF) school process has been developed to help address the rising rates of childhood overweight. It is an ecological model based on the coordinated school health model, which impacts the entire school environment including students, staff and families to prevent the development of overweight in children. School community stakeholders in collaboration with the UCLA School of Public Health Nutrition Friendly Schools and Communities Group developed the NF school certification process and self-evaluation tool.

The goal of the workshop is to report on the continued development and preliminary results of the NF School pilot study and introduce the NF School model to any new participants. Participants will also gain an understanding of the participatory action research method used to develop the NF School model.
 

Current Topics in Breastfeeding and Pediatric Practice

The session addresses AAP Guidelines on breastfeeding, current research findings and applications to pediatric practice.

The AAP Breastfeeding Policy Statement: The 2004 Version
Lawrence M. Gartner, University of Chicago, Chicago, IL

Breastfeeding: Does it Protect Against Obesity in Childhood?
Kathryn Dewey, University of California at Davis, Davis, CA

Contact for information:
Ardythe L. Morrow, Ph.D.
Cincinnati Children’s Hospital Medical Center
Phone: (513) 636-7626
Email: Ardythe.Morrow@chmcc.org
 

Blood vessels perfuse all tissues in the body and play a vital function in mediating the exchange of metabolites between the tissues and the blood. However, recent experimental evidence indicates that endothelial cells play an important signaling role during embryonic development and cell differentiation. Understanding the nature of the interaction between endothelial cells and the surrounding cells and tissues will provide valuable insight into normal developmental mechanisms and may lead to important therapeutic approaches for a variety of diseases. In this symposium, we will discuss endothelial signaling in early organ development with a particular focus on the interactions that occur between airway and vascular cells during lung organogenesis and how these interactions are perturbed in lung injury and repair. In addition, we will discuss the biology of a molecule critical to development, VEGF, and its role during angiogenesis.

Endothelial Signaling During Embryonic Development
Ondine Cleaver, Harvard University, Cambridge, MA

Impaired Vascular and Alveolar Interactions in the Pathogenesis of Bronchopulmonary Dysplasia
Steven H. Abman, The Children's Hospital, Denver, CO

Extracellular Matrix Imbalance and Abnormal Lung Morphogenesis
Mala Chinoy, Penn State University College of Medicine, Penn State Hershey Medical Center, Hershey, PA

New Insights in the Regulation of Angiogenesis by VEGF and Other Mediators
Napoleone Ferrara, Genentech, Inc., San Francisco, CA
 

The National Children’s Study is a national prospective, longitudinal study of environmental effects, including physical, chemical, biological and psychosocial effects, on child health and development. The goal of the study is to improve the health and well-being of children. The study will examine these environmental effects on the health and development of more than 100,000 children across the United States, following them from before birth until age 21. The study is led by a consortium of federal agency partners: the U.S. Department of Health and Human Services, including the National Institute of Child Health and Human Development (NICHD); the National Institute of Environmental Health Sciences (NIEHS); the Centers for Disease Control and Prevention (CDC); and the U.S. Environmental Protection Agency (EPA). For additional information, visit the website at http://www.nationalchildrensstudy.gov/.

The National Children’s Study—An Overview
Duane Alexander, NICHD, National Institutes of Health, Bethesda, MD

The National Children’s Study—Methods
Peter C. Scheidt, National Institutes of Health, Bethesda, MD

Children’s Health and Environmental Exposures: The Most Important Unanswered but Answerable Questions
Michael Weitzman, The AAP Center for Child Health Research at the University of Rochester, Rochester, NY

The application of imaging technologies to solving questions in biology and medicine is revolutionizing medicine by accelerating analyses in situ and in vivo and providing new perspectives on biological processes as diverse as development, neoplasia and injury repair. In this plenary session, three internationally recognized speakers will focus on developmental processes and discuss how these new imaging technologies are providing dynamic insights into the genetic and epigenetic mechanisms that underpin hematopoiesis and vascular development.

Introduction
Lisa M. Guay-Woodford, University of Alabama at Birmingham, Birmingham, AL

Dynamic Imaging of Fluid Forces in Developing Mouse Vasculature
Mary Dickinson, Beckman Institute–Caltech, Pasadena, CA

Microscopic Imaging of Angiogenesis
Donald M. McDonald, University of California, San Francisco, CA

Watching Hematopoietic Stem Cell Engraftment and Hematopoiesis in Living Animals
Christopher H. Contag, Stanford University School of Medicine, Stanford, CA

Questions from the audience
 

Contact for information:
Jane McGowan, M.D.
The Johns Hopkins Hospital
Phone: (410) 955-4565
Email: jmcgowan@jhmi.edu

Worldwide, more than 1,500 children per day become infected with HIV through mother-to-child transmission. Currently there are 2.7 million children living with HIV infection across the globe, >90% of whom reside in developing countries. While there have been enormous successes in the prevention and treatment of pediatric AIDS in the United States and Europe, it remains an open question as to how effectively these public health gains can be replicated in the poor countries of the world, which bear the greatest burden of disease. Efforts to develop an HIV vaccine appropriate for preventing infection among the world's children and adolescents are finally under way on a global scale. We will discuss these issues and accompanying controversies as they apply to the children of the developing world.

AIDS in Children—A Global Public Health Crisis
David L. Pugatch, Hasbro Children's Hospital and Brown Medical School, Providence, RI

Preventing Mother-to-Child Transmission of HIV in Developing Countries—Successes, Failures and Challenges
Catherine M. Wilfert, Elizabeth Glaser Pediatric AIDS Foundation, Santa Monica, CA and Washington, DC

HIV Treatment for Children—Can the Successes of Rich Countries Be Duplicated in Resource-Poor Settings?
Mark W. Kline, Baylor College of Medicine, Houston, TX

Finding an AIDS Vaccine That Works for the World's Children
Richard A. Koup, Vaccine Research Center, National Institutes of Health, Bethesda, MD

The Teacher's Guide includes Pediatric Nutrition Notes, a 46-page primer written for 3rd year medical students. These Notes were developed to provide the essential language of nutrition as well as a matrix into which subsequent learning can be fit. The second part of the Teacher's Guide is a 8-section set of teaching modules developed to address nutition issues through the life cycle—neonatal, early infancy, later infancy, toddler and pre-school, etc. Each module includes the following elements:

1. An introduction and overview
2. Practical aspects of anticipatory guidance at this stage of development
3. A similar assessment of behavior and diet
4. Assessment of nutritional status in four categories
   1. Under-nutrition—protein energy with growth failure
   2. Under-nutrition—specific nutrient deficiency
   3. Over-nutrition—obesity
   4. Over-nutrition—nutrient imbalance
5. Case Studies and discussion are provided for diseases likely to appear at specific stages of development as identified by abnormalities in the assessment of behavior, diet or nutritional status.

The modules can be used in two ways. First, teachers of residents and students can use the modules to prepare lectures or seminars. Alternatively, individual physicians can use the modules for Continuing Medical Education (CME) credits. The various modules are linked through HyperLink technology so that readers can access specific topics (e.g., acute diarrhea or failure to thrive) to develop lectures or seminars addressing specific diseases through the life cycles.

Correspondence with the editors is welcomed: Robert Karp, Rkarp@downstate.edu; Sandy Hassink, Shassink@nemours.org; Elizabeth Shepard, Shepardwe@aol.com; Steve Bachrach, Sbachrac@nemours.org.
 

Obesity is currently one of the greatest health threats facing the health of our children and youth. Reasons for this epidemic are rooted in the changing lifestyle of Americans: one that embraces little physical activity and the consumption of large amounts of processed, high caloric foods. While problems in our societal fabric may take decades to address, pediatricians need effective ways to treat children who are already obese or are at imminent risk. Despite the significance and magnitude of this problem, most attempts at therapy have not been effective. We will discuss current dietary, pharmacologic and surgical approaches to therapy that are gaining in popularity in pediatric populations and will address what is known about the effectiveness of these approaches and the controversies associated with them. The rationale for different diets, including "popular" ones, their efficacy and safety will be discussed. Data concerning safety and efficacy of approved and experimental drug therapies in children will be presented. Finally, we will discuss when to consider bariatric surgery in children.

Novel Dietary Treatments for Obesity and Related Complications
David S. Ludwig, Children's Hospital, Boston, MA

Pharmacotherapy of Childhood Obesity
Robert H. Lustig, University of California, San Francisco, CA

Surgical Weight Loss in Pediatrics
Victor F. Garcia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH

The potential applications for using regenerated cells and tissues to treat injury and disease are unlimited. Early stem research concentrated on the hematopoietic stem cells of the bone marrow, but stem cells are now known to exist in most organs of the body. Furthermore, it may be possible to return mature, differentiated cells to a undifferentiated, stem-like state. This symposium will first provide an overview of non-hematopoietic stem cells, then focus on two rapidly-progressing areas of research—those of regenerating nervous tissue and liver.

Neural Stem Cells: Developmental Insights May Suggest Therapeutic Options
Evan Y. Snyder

Hepatic Stem Cells and the Potential of Liver Repopulation for Cell Therapy
Sanjeev Gupta, Albert Einstein College of Medicine, Bronx, NY

Hot Topics in General Pediatrics is a potpourri of topics of interest to all pediatricians. The topics include lead poisoning, West Nile Virus infection, sleep disorders and esophagitis. Each of these conditions has varied symptoms, signs and manifestations. For each topic there have been new findings that are in the "need to know" category for all pediatric generalists and subspecialists.

Kawasaki Disease
Jane C. Burns, University of California, San Diego, CA

West Nile Fever
Janak A. Patel, Children's Hospital, University of Texas Medical Branch, Galveston, TX