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Children in hospitals: a disturbing trend.

In my practice of inpatient pediatrics and pediatric critical care, I have experienced a trend that worries me. In the last two or three months, we have had three teenagers admitted with clotting disorders. These have presented in the form of pulmonary embolus in two kids and a deep venous thrombosis in the third child.

The first child was 14 years old. She is overweight, was on oral contraceptive pills to regulate her periods, and was sedentary. In fact before she presented to the ER with shortness of breath, chest pain and low oxygen saturations, she had been sitting at her desk for long periods, studying for final exams.

The ER doc was impressed with the severity of her symptoms and ordered a CT angiogram that demonstrated a very large clot in the right pulmonary artery. She was evaluated by our pulmonologist and hematologist, was started on shots of Lovenox (anti-coagulant or "blood thinner") and discharged home to close follow-up by these specialists. A work-up is also underway to determine if she has a genetic predisposition to abnormal blood clotting.

The second child was a 16-year-old boy, a high school football player who weighs nearly three hundred pounds. He had had recent knee surgery to repair a football injury to his cartilage, and because of the post-op pain and lack of mobility, he also had an extended period of immobility.

He, too, presented to the ER with shortness of breath and chest pain. His oxygen level was acceptable, but a CT angiogram revealed a clot in the pulmonary artery. His situation was complicated by a blood clot in one of the leg veins as well (the leg upon which he had the knee surgery). He also was seen by pulmonologists and hematologists and he also was started on Lovenox and is in the process of undergoing a work-up for blood clotting abnormalities, which thus far has been normal.

The third child was a 17-year-old girl who was just admitted to our service a couple days ago. She presented with leg pain and swelling. She also had a period of inactivity following a horse riding accident and a bout with mononucleosis. She is overweight and takes oral contraceptive pills. She, luckily, did not have respiratory problems.

She was found to have a large blood clot in the deep veins of the leg that extended all the way up to the veins in the abdomen. She was treated with heparin and then taken to interventional radiology where the clot was identified and removed. She should have an excellent prognosis, providing no clotting abnormalities are found with her. She also will be managed with blood thinner shots for weeks to months and followed up closely with the hematologist.

Clotting disorders in the form of deep venous thrombosis and/or pulmonary embolus are issues we used to never see in pediatrics. If you didn't notice in my description of the three cases, these patients have several things in common and that are endemic in our present culture. One, they were all overweight and, for different reasons, sedentary. Obesity and inactivity definitely place all patients, even kids, at risk for clot formation. The two girls had been on birth control pills, which have also been associated with clot formation in some cases. None of the kids smoked cigarettes, thankfully, but this would have put them at even higher risk, and we all know that smoking has not disappeared in our young people!

For years, I have stated that lifestyle issues and our current culture is robbing kids of their childhood. These cases are simply another example of how we now are seeing "adult" issues and problems in children, and the age of presentation of these problems is getting increasingly younger. The solution? Increased awareness and prevention. Help get our kids moving, to maintain healthy weights and habits, and to claim their childhoods again!

By John E. Monaco, MD

John E. Monaco, MD practices pediatric critical care and inpatient pediatrics in Tampa, FL. In addition, he has published three books. In his latest, Too Small to Be Big, co-authored with actress Ricki Lake, they take on the childhood obesity crisis and introduce their program, Allstride. Read more at www.allstride.com.
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Author:Monaco, John E.
Publication:Pediatrics for Parents
Geographic Code:1USA
Date:Jan 1, 2013
Words:705
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