Cochrane Briefs

Am Fam Physician. 2004 Jun 15;69(12):2823-2824.

Therapy for Speech and Language Delay

Clinical Question

Which therapies are effective in children with primary speech and language delay?

Evidence-Based Answer

Speech and language therapy is effective in children who have problems with expressive vocabulary and pronunciation. There is insufficient evidence regarding interventions for receptive disorders and mixed results for interventions to improve expressive grammar and sentence structure.

Practice Pointers

Primary speech disorder is defined as a speech and language delay in a child without behavior, hearing, or neurologic impairment. Children with primary speech disorder have a variety of deficits. In adolescence, about one half of children with primary speech disorder have long-term problems with reading and spelling. Speech and language difficulties are common, and there is a range of presentations and etiologies. Some patients have transient, isolated difficulties. Others have more persistent problems with disordered speech and expressive or receptive language.

To evaluate treatments, Law and colleagues searched for randomized, controlled trials on speech and language therapies for children and adolescents with primary speech and language disorders. They found 25 studies of children younger than 15 years that met their selection criteria. Results varied considerably among studies and had wide confidence intervals, but the authors were able to reach some tentative conclusions.

There is some evidence to support speech and language therapy in children with difficulty producing clear speech and expressive vocabulary if difficulties with receptive language are not present. Limited evidence suggests that children with receptive language difficulties may receive less benefit from such therapy. Trained parents and clinicians achieved similar results. Limited data show that group and individual phonology therapy achieved similar results. Interventions lasting more than eight weeks seem to be the most effective. Using peers with normal language as models in intervention is beneficial.

The American Academy of Child and Adolescent Psychiatry1 has published practice parameters for patients with language and learning disorders. For children ages six to 12, the group recommends a clinical diagnostic assessment, including a parent interview, child interview, medical and psychiatric histories, school evaluation, and family history. In the face of limited evidence regarding effective speech and language therapy, these guidelines can help physicians pursue a reasonable diagnostic and treatment plan.

Law J, et al. Speech and language therapy interventions for children with primary speech and language delay or disorder. Cochrane Database Syst Rev. 2003;3:CD004110.

REFERENCES

1. Practice parameters for the assessment and treatment of children and adolescents with language and learning disorders. AACAP. J Am Acad Child Adolesc Psychiatry. 1998;37(10 suppl):46S–62S.

Neuraminidase Inhibitors for Treatment of Influenza

Clinical Question

How safe, effective, and tolerable are oseltamivir and zanamivir in the treatment of children with influenza?

Evidence-Based Answer

Oseltamivir and zanamivir reduce the duration of illness by up to one day if taken within 36 hours of symptom onset. Oseltamivir (and, probably, zanamivir) also reduces the likelihood of otitis media as a complication of influenza (number needed to treat, approximately 10). There were no data on the medications’ efficacy in preventing influenza. Both medications are well tolerated and safe.

Practice Pointers

Two neuraminidase inhibitors, oseltamivir and zanamivir, are approved for use in children. Oseltamivir, which is approved for use in children older then one year, is taken twice daily for five days in dosages of 30 mg (in children weighing less than 15 kg), 45 mg (in children 15 to 22 kg), 60 mg (in children 23 to 40 kg) or 75 mg (in children more than 40 kg). Oseltamivir costs $33 to $67 per treatment course, depending on the dosage. (Prices represent estimated cost to the pharmacist based on average wholesale prices in Red book. Montvale, N.J.: Medical Economics Data, 2004. Cost to the patient will be higher, depending on prescription filling fee.)

Zanamivir, an inhaled agent approved for use in children older than seven years, is taken as two puffs every 12 hours for five days and costs $50 per course. Patients must begin taking oseltamivir or zanamivir within 36 hours of symptom onset.

Matheson and colleagues identified three double-blinded, randomized, placebo-controlled trials of 1,500 children with a clinical diagnosis of influenza (i.e., fever and at least two of the following symptoms: cough, headache, myalgia, sore throat, fatigue). In approximately 53 percent of the children, influenza was eventually confirmed by laboratory tests.

In the 1,500 children with clinically diagnosed influenza, oseltamivir reduced symptoms by a mean of 21 hours, and zanamivir reduced symptoms by a mean of 12 hours. In children with laboratory-confirmed influenza, oseltamivir and zanamivir reduced symptoms by 36 and 30 hours, respectively. In children with asthma and laboratory-confirmed influenza, the duration of illness was reduced by only 10 hours (P = NS).

Oseltamivir reduced the likelihood of acute otitis media from 28 to 17 percent (P = .005) and of bronchitis from 21 to 12 percent (P < .05). Zanamivir use was associated with a nonsignificant reduction in the likelihood of otitis media (23 to 16 percent, P = NS).

Although vomiting was more common in children taking zanamivir (15 percent versus 9 percent in children taking oseltamivir), both drugs were well tolerated, with pooled withdrawal rates similar to those of placebo.

Matheson NJ, et al. Neuraminidase inhibitors for preventing and treating influenza in children. Cochrane Database Syst Rev. 2003;3:CD002744.


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