They Always Wanted to Marry a Doctor

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Morning Report: Not Your Typical Medical Newsletter

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Updated CDC/AAP Developmental Milestone Checklist

PEDIATRIC PERSPECTIVES

We’ve waited 18 years for this. No, we’re not talking about a sequel to Napoleon Dynamite. We’ll still have to wonder if Kip’s cage fighting-career ever takes off. Instead, we’re talking about the update to the Centers for Disease Control and Prevention’s (CDC) 2004 developmental surveillance checklist that informs clinicians and families when a child (2 months to 5 years old) misses a developmental milestone. The CDC funded the American Academy of Pediatrics (AAP) to revise the checklist to allow earlier detection of developmental delays, when interventions play the strongest role.

Major shift in the 2022 checklist

One shortcoming of the previous checklist was its reliance on a median age as the benchmark for achieving a milestone. With that measurement, only 50% of children would reach a milestone at a designated age, leaving clinicians and parents of the remaining 50% to take a wait-and-see approach. This type of approach may work for Napoleon’s Uncle Ricco as he waits to see if time travel is possible (meanwhile, keeping his throwing arm loose), but it’s far from ideal when determining a developmental delay. To remove this ambiguity, the new checklist bases its milestones on the age when 75% of children can complete a task. This shift aims to identify children in need of further testing while preventing unnecessary concern for those who may not.

Other key updates

The research behind the updated checklist led to sweeping changes, including removing 26% of the milestones (crawling being one), shifting 33% of the milestones to a different age, and adding 41% more milestones. Additional changes include the following:

  • Adding checklists for ages 15 and 30 months
  • Using patient-friendly language and omitting vague words, such as “may” or “begins”
  • Offering new, open-ended questions to promote conversations with families
  • Revising and expanding the list of tips and activities for developmental growth

Key takeaway

The CDC recommends that clinicians use this revised developmental checklist for earlier identification of delays in their pediatric patients. Clinicians may also want to share the CDC’s helpful Milestone Tracker app with families to engage them in their child’s care. Of note, child development experts caution that while this checklist may help identify delays, it is not all-encompassing. Clinicians should remind parents not to discount their own observations and intuitions and to raise any questions with their child’s clinician.

Does a Jog After the Jab Amp Immunity?

IMMUNIZATION IMPROVEMENTS

According to a new study, vaccination and exercise go together like Bill Belichick and PB&J sandwiches. In a small, randomized, controlled trial, researchers examined the effect of post-vaccine exercise on antibody levels in patients receiving the 2009 pandemic influenza H1N1, seasonal influenza, or COVID-19 vaccine.

Researchers drew participants’ blood before vaccination and again two and four weeks after vaccination. In all three vaccine groups, participants who engaged in 90 minutes of mild-to-moderate exercise (brisk walking/jogging or stationary cycling) immediately after getting the jab experienced a greater increase in antibody response at one month than did those in the non-exercise control groups. Vaccine side effects were similar in the intervention and control groups. The bump in antibodies was modest but statistically significant.

You may be thinking, “Yikes, 90 minutes may be a lot for many of my patients; surely exercising for half that time will get the job done.” Unfortunately, no. A small subgroup of older adults who exercised for 45 minutes did not experience an increased antibody response. Researchers have yet to study the effect of 60 minutes.

Key takeaway

These findings suggest that coupling exercise with vaccination for influenza or COVID-19 induces a stronger immune response than does vaccination alone. You may want to advise patients that 90 minutes of exercise after receiving their vaccination will do more for them than resting and bingeing on TV (unless the show is as educational as Belichick’s PB&J tutorial—that’s not wasted time).

Did You Know?

A robot designed by a team at Johns Hopkins University recently performed the first laparoscopic surgery on pigs without human assistance. The robot, named Smart Tissue Autonomous Robot (STAR), completed intestinal anastomosis on four animals with results significantly superior to those demonstrated by his human counterparts. STAR, whose name has already gone to his head, was recently armed with specialized suturing tools and state-of-the art imaging systems that allowed him to confidently tell his fellow surgeons, “Move over, guys, I’ve got this.” And he did. STAR was successfully able to “plan, adapt, and execute a surgical plan.” He’s already requesting Johnny 5 to play him in the story of his life.

What makes this feat more amazing is that this type of soft-tissue surgery calls for precision, adaptability, and steady hands. “Check, check, and check,” says STAR. This robotic accomplishment opens the door to future advancements in the field of surgical automation and potentially “more predictable and consistent patient outcomes.” We’re excited for the future! Who says the ‘80s was the best decade for robots?

As for STAR, he’s taking a break to recharge his batteries. Since the successful surgeries, his friendship circle now includes R2-D2 and WALL-E, and he’s considering a marriage proposal from Paulie’s robot in Rocky IV. Rumor has it she always wanted to marry a doctor.

Rapid-Fire COVID-19 Updates

COVID QUICK HITS

Predicting Longevity After Dietary Changes—There’s an App for That

LONGEVITY LEARNINGS

You counsel your patients that a healthy diet is a key to longevity, but we all know that dieting can be frustrating and may elicit more ups and downs than a season with a Kardashian—any Kardashian. One way to help motivate patients to stay on the leafy green road to health is to drive home the benefits of dietary changes in a visual, meaningful, and personalized way. Scientists just made that easier.

They developed a model from existing meta-analyses and data from the Global Burden of Diseases study that demonstrates the longevity gains of switching from a typical Western diet to an optimal Mediterranean one. The model showed that replacing processed foods, red meats, and sugary beverages with legumes, whole grains, fish, fruits, vegetables, and nuts conferred a remarkable increase in life expectancy:

  • Patients who make this dietary shift at age 20 could add 10 years to their lives.
  • Patients who make the shift at age 60 could add eight years.
  • Patients who make the shift at age 80 could add three years.

You may be thinking, “These calculations are based on the extremes of the spectrum. Few patients will jump from three square meals of fast food to dining on kale and carrots.” It’s a fair point. That’s why the researchers also estimated a shift from a typical American diet to a feasible (aka a more sustainable, happy-medium) diet. Such a shift still gives a 20-year-old patient a chance at an additional six-plus years of life.

The best part

This model is customizable to each of your patients. The researchers developed the Food4HealthyLife calculator, which predicts each patient’s life expectancy gains based on their current diet, goal diet, age, and gender. (The Help tab of this app explains everything.)

Key takeaway

Naturally, this dietary study comes with the usual caveats of individual variations and risk factors, but the results are impressive and may motivate patients to strive for those extra 10 years of life. With an additional decade, patients could meet a new grandchild, attend another wedding, or simply keep up with the next generation of the Kardashians.

Interested in more healthcare news? Here are some other articles we don’t want you to miss:

Morning Report is written by:

  • Alissa Scott, Lead Author
  • Aylin Madore, MD, MEd, Author and Editor
  • Shira Page, RN, NP, Author and Editor

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Please note that the summaries in Morning Report are intended to provide clinicians with a brief overview of an article, and while we do our best to select the most salient points, we ask that you please read the full article linked in each summary for clarification before making any practice-changing decisions.

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