DC Child Accident & Safety Blog

Why the Pacifier Shouldn’t Be Too ‘Clean’

Fri, 17 May 2013 09:04:41 -0500

It’s a Pavlovian response—you lick your thumb to clean the pureed peas off your baby’s face. But licking her pacifier clean after she knocked it onto the floor? Ewwww.

Get over it. According to a new study in the journal Pediatrics, that’s exactly what you should do. Parents who perform this protective act might be reducing the kid’s risk of developing allergies.

As explained on MedPageToday.com, the study suggests that transferring the microbes in your mouth to your baby’s mouth could modify its population of bacteria and cultivate a broader immune response to future invaders.

The researchers looked at kids who were 18 months and 36 months. In the younger group, children born to parents who said they cleaned their child's pacifier with their mouths were less likely than those born to parents who cleaned it with water to have asthma and eczema. At 36 months, the association remained for eczema, but not for asthma.

The benefit of this “oral hygiene,” the researchers suggest, might extend to a kid’s nether regions—because the baby swallows the newly transferred parental bacteria, they could affect the microbiology in the intestines, which could improve general gut tolerance.

Infants with less diversity among their gut microbes, according to MedPage Today, are more likely to develop allergies. That suggests that exposing youngsters to a wider variety of microbes could promote immune system function.

As Dr. Amal Assa'ad of Cincinnati Children's Hospital Medical Center told MedPageToday, "[W]e have to let nature play out a little bit and not be too clean and not be forming artificial barriers in the connection between the mother and the infant and the parents and the infant."

"We have to at some point reach a balance where we're making sure we're not predisposing [infants] to infections at the same time [we're making] sure we're giving them what they were naturally expected to get from the parents ... so we end up with a balanced body that doesn't veer towards allergies and doesn't veer towards serious infections and harm."

It’s interesting that, according to the study, the method of birth (cesarean or vaginal) was related to the likelihood of a parent sucking on the pacifier. Vaginal delivery and parental pacifier sucking independently were associated with a reduced likelihood of developing eczema; babies delivered vaginally and whose parents licked their pacifiers had a lower incidence of eczema.

The theory is that vaginal delivery, which also transfers bacteria from mother to infant, has a beneficial effect on allergy resistance.

Regarding the “ick” factor, and the concern that transferring a pacifier from a parent's
mouth to a child's could spread respiratory infection, the study showed no difference in the rate of such infections based on pacifier cleaning practices.

Keep in mind that this study had a relatively small sample size (184 kids), and that it’s relatively difficult to diagnose asthma in early childhood. So a larger study also involving older children is necessary to replicate—and confirm—these results.

But, for now, if you think it’s better to wash your kid’s pacifier under the tap than in your saliva, it’s probably time to think again.

When to Call the Doctor

Fri, 10 May 2013 09:08:57 -0500

Claire McCarthy gets it. The primary care physician and medical director of Boston Children’s Hospital’s Martha Eliot Health Center knows that when your kid is sick, it can be difficult to know when you can treat him or her on your own, and when it’s time to call the doctor.

Writing on KevinMd.com, she confides, “Sometimes, when a parent tells me about something that happened with their child, I think (and say, as nicely as I can): Why didn’t they call right away?”

“And sometimes, when I’m talking to a parent or seeing their child in the office, I think (but don’t say): Why did they call about this?”

Sometimes you have no idea what’s ailing your child. You don’t know if the problem has peaked, or is getting worse. You don’t want to believe there’s something really wrong, you don’t want to miss something and you don’t want to worry the kid—or anyone—unnecessarily by being overprotective.

As the old TV ad used to say, “What’s a mother to do?”

According to McCarthy, call the doctor if:

The symptoms are bad. “Bad anything," says McCarthy. “Bad pain. Bad trouble breathing. Bad bleeding. Bad vomiting. I know, bad is subjective. But if in your head the word ‘bad’ seems to apply, better to get advice than wait and watch.”

The symptoms aren’t going away. Even if it’s a little thing … a slight limp, a nagging headache, a rash that the cream isn’t resolving, the diarrhea that’s mild but doesn’t end …

Your gut is telling you something is wrong. “I can’t tell you how much I’ve come to respect and rely on parental instinct,” McCarthy says. “The parents are nearly always right."

You can’t say: “I know what to do,” and really mean it. Be honest with yourself. Nobody knows what to do in every situation.

And, finally, says McCarthy, “[R]ead the list—but if what’s going on isn’t on the list and you’re worried, call.”

Cold Medicines Are Dangerous for Very Young Children

Fri, 03 May 2013 14:07:19 -0500

All parents of children old enough to spend time around other children know that their offspring are little cold factories. Data from the University of Michigan’s C.S. Mott Children’s Hospital indicate that kids get 5 to 10 colds a year.

To relieve their symptoms, their parents often give wee ones over-the-counter (OTC) cough and cold products. In many cases, that’s bad medicine.

According to a national poll on children’s health by the Mott Children’s Hospital, more than 4 in 10 parents give their children younger than 4 cough medicine or multi-symptom cough and cold medicine. One in 4 gives them decongestants.

In 2008, the FDA issued an advisory that these OTC meds should not be given to infants and children younger than 2. Not only are they not proved to be effective for young children, they can cause serious side effects that might include:

convulsions

allergic reactions

elevated or uneven heart rate

drowsiness or sleeplessness

slow and shallow breathing

confusion or hallucinations

nausea and constipation.

A couple of years ago, we wrote about the dangers of Tylenol and dosing information for children younger than 2.

After the FDA warning, manufacturers of OTC cough and cold products rewrote their labels to read that the medicines should not be given to children younger than 4.

Although parents might feel as though they should give their ailing children something, anything, these products “don’t reduce the time the infection will last and misuse could lead to serious harm,” said Dr. Matthew M. Davis, director of the poll, in a University of Michigan news release.

“What can be confusing,” Davis said, “is that often these products are labeled prominently as ‘children’s’ medications. The details are often on the back of the box, in small print. That’s where parents and caregivers can find instructions that they should not be used in children under 4 years old. … [W]hat’s good for adults is not always good for children.”

As with any medication, prescription or OTC, you should always read the labels and patient information that comes with it. Contact your doctor if you’re uncertain about how, or to whom, it should be given.

To learn more about the difficulty in adjusting adult medicine for pediatric use, see our blog, “Drug Labels Still Leave Pediatricians Playing a Guessing Game.”

Nursing Shortages in NICUs Promote Infection in Babies

Fri, 26 Apr 2013 07:10:51 -0500

Any parent whose newborn has spent time in the neonatal intensive care unit (NICU) has felt helpless and frightened seeing their tiny baby swathed in more medical paraphernalia than you’d think he or she could withstand. They’ve probably also felt grateful and in awe of the medical army charged with nurturing delicate new life into viability.

Neonatal nurses are truly on the front lines of their babies’ survival. And a recent study published in JAMA Pediatrics concludes that the warriors fighting for your kid are under serious attack from a lack of numbers. Depleted staffs raise the risk of infection in critically ill babies.

The study, as interpreted on MedPageToday, shows that infection rates for very low birth weight infants were 40% higher in NICUs that were understaffed with nurses.

The problem seems to be widespread: The researchers found that hospitals understaffed nearly 1 in 3 of their NICU infants and more than 9 in 10 of their high-acuity NICU infants, relative to staffing guidelines. (“High-acuity” patients are seriously ill and require medical interventions of an emergency and/or specialized or complex nature.)

National guidelines spell out optimal nurse-to-patient ratios. They’re based on acuity. Staffing for low-acuity infants is supposed to be one nurse per three or four babies; levels for the highest-acuity patients are at least 1 to 1.

When these levels aren’t maintained, studies show, the patients have a higher rate of nosocomial infections, especially infants with very low birth weights. “Nosocomial” means the infection was contracted as a result of the hospital setting—from a treatment or other exposure.

The study examined data from 67 NICUs from the Vermont Oxford Network, a nonprofit collaboration of health-care professionals working in more than 900 NICUs around the world. Measured by the national guidelines, hospitals understaffed nearly 1 in 3 NICUs infants in 2009 and nearly 5 in 10 in 2008, but the levels varied by acuity. Hospitals understaffed more than 8 in 10 high-acuity infants in 2008 and more than 9 in 10 in 2009.

The study did have limitations—it might not represent all hospitals with a NICU or consider other factors that might be important in NICU staffing decisions, including non-nursing personnel.

But the researchers’ conclusion was unequivocal: The "most vulnerable hospitalized patients, unstable newborns requiring complex critical care, do not receive recommended levels of nursing care."

Usually, parents don’t choose the NICU in which their ailing babies are assigned. So if yours is a NICU patient, find out if your child is considered a low- or high-acuity patient, and let the staff know you’re aware of the staffing recommendation for each. If the facility is understaffed, be extra vigilant about monitoring its infection-control measures. Find out more on our blog, “Controlling Infections in Pediatric ICUs.”

Hospitals Show Progress in Clamping Down on Early Elective Deliveries

Fri, 19 Apr 2013 14:11:23 -0500

A few months ago, we recalled a case in which Patrick Malone represented a family who sued a group of obstetricians when their baby was delivered early and suffered brain damage. As we noted in that blog, except when there are real medical complications, the American College of Obstetricians and Gynecologists recommends against delivering babies or inducing labor before 39 weeks of gestation.

Earlier this month, a study published in the journal Obstetrics & Gynecology not only confirms the wisdom of waiting to full-term before delivering the baby, but shows that hospitals that promote full-term delivery can realize excellent results.

As described by KaiserHealthNews.org, the study profiled 25 hospitals in five states that were able to cut their rates of elective early deliveries from nearly 28 in 100 to fewer than 5 in 100 in one year.

Such efforts are critical to lowering the rates of deliveries, which can put babies at risk of serious health issues including feeding, breathing and developmental problems. The latter often turn out to be long-term problems—one study by researchers at Emory University found that babies born before 38 weeks had lower scores on standardized tests in first grade.

Because 10 to 15 of 100 U.S. babies are delivered early without a medical reason, the value of full-term gestation needs to have wider appreciation among both parents and doctors. It is not uncommon for either party to opt for early delivery not because it’s optimal for the wee ones, but simply because it’s more convenient. That is, too often early delivery is a matter of scheduling preference than medical need.

Hospitals are starting to accept that they are on the frontlines of preventing the long-term negative effects of early delivery, and so must the rest of us. As the lead author in the hospital survey said, “This quality improvement program demonstrates that we can create a change in medical culture to prevent unneeded early deliveries and give many more babies a healthy start in life.”

Boom in ADHD Diagnoses Can Lead to Overmedicating and Drug Abuse

Fri, 12 Apr 2013 13:48:42 -0500

The news last month from the Centers for Disease Control and Prevention (CDC) was widely reported: Nearly 1 in 5 high-school age U.S. boys and more than 1 in 10 of all school-age children have been diagnosed with attention deficit hyperactivity disorder (ADHD).

ADHD generally is thought to result from abnormal chemical levels in the brain that impair the ability to pay attention and compromise impulse control.

The New York Times was among the media outlets that reported the significant increase of the diagnosis, and the concern about overprescribing the drugs used to treat it. We, too, have questioned the practice.

More than 6 million children 4 to 17 have been diagnosed with ADHD; their numbers have increased 16 percent since 2007, and more than doubled in a decade. More than 2 in 3 currently diagnosed take Ritalin or Adderall, stimulants that certainly help the afflicted, but, according to the The Times, also can cause addiction, anxiety and even psychosis.

Sales of stimulants to treat ADHD, The Times says, have more than doubled to $9 billion in 2012 from $4 billion in 2007.

Some people legitimately need these drugs, but experts estimate that only 3 to 7 in 100 children suffer from ADHD, and that the meds are being given to people with mild symptoms who shouldn’t be taking them.

As The Times puts it, “While some doctors and patient advocates have welcomed rising diagnosis rates as evidence that the disorder is being better recognized and accepted, others said the new rates suggest that millions of children may be taking medication merely to calm behavior or to do better in school.”

Kids often share or sell their meds to classmates, so the boom in ADHD opens the door to drug abuse and its consequent health risks. CDC Director Thomas R. Frieden compared the rising rates of stimulant prescriptions among children to the overuse of pain medications and antibiotics in adults.

One heartbreaking illustration of this scenario was presented last week in a commentary in the New York Times. The writer, Ted Gup, told the story of his son David, who was diagnosed with ADHD as a first-grader and told by one psychiatrist that he wouldn’t even see the child until he was medicated.

Gup resisted, but after a year of David’s “rambunctious” behavior, he started taking Ritalin, then Adderall.

As a 21-year-old college senior, he was found on the floor of his room, dead from a fatal mix of alcohol and drugs. The date was Oct. 18, 2011.
No one made him take the heroin and alcohol, and yet I cannot help but hold myself and others to account. I had unknowingly colluded with a system that devalues talking therapy and rushes to medicate, inadvertently sending a message that self-medication, too, is perfectly acceptable.

My son … was known to trade in Adderall, to create a submarket in the drug among his classmates who were themselves all too eager to get their hands on it. What he did cannot be excused, but it should be understood. What he did was to create a market that perfectly mirrored the society in which he grew up, a culture where Big Pharma itself prospers from the off-label uses of drugs, often not tested in children and not approved for the many uses to which they are put.

Stories like David’s are likely to repeat. As The Times points out, the American Psychiatric Association is planning to broaden the definition of ADHD in the upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders (see our blog, “Controversy Swirls as Psychiatry Manual Gets an Update.”)

That invites more people to be diagnosed and be medicated, possibly many for whom other treatments are more appropriate.

Pharmaceutical company marketing enables any parent seeking to help a kid who’s misbehaving and whose grades are falling. The Times noted that the brochure for Vyvanse, an ADHD drug, shows a parent looking at her son and saying, “I want to do all I can to help him succeed.”

Dr. Jerome Groopman, professor of medicine at Harvard Medical School, told The Times, “There’s a tremendous push where if the kid’s behavior is thought to be quote-unquote abnormal — if they’re not sitting quietly at their desk — that’s pathological, instead of just childhood.”

Diagnosing ADHD is a difficult judgment call. As The Times notes, there’s no definitive test for it—it’s determined only by extensive communication with patients, parents and teachers, and by ruling out other possible causes for its behavioral symptoms. The process is subjective and made more difficult when parents pressure doctors for a diagnosis. ADHD is a chronic condition that often endures in adulthood.

More than twice as many boys as girls have been diagnosed with ADHD—15 in 100 versus 7 in 100. The rates were highest among high-schoolers—1 in 10 girls, and nearly twice as many boys. About 1 in 10 high-school boys takes ADHD medication.

Before yours becomes one of them, find out if your kid truly is suffering from a mental disorder. Explore other treatment options, such as counseling, and causes for unacceptable behavior that might be social (bullying?) instead of chemical. Drugs can be lifesavers, but they also can harm.

More Proof that Vaccines Have Nothing to Do With Autism

Fri, 05 Apr 2013 14:56:46 -0500

A new, large study by the Centers for Disease Control and Prevention (CDC) should help redirect the concern of parents who still wonder if vaccines have a role in children developing autism.

The science-based medical establishment has not wavered from the position that children should be vaccinated against a variety of diseases (See our blog, “Feds Say Childhood Vaccine Schedule Is Safe and Effective”), but a campaign devoid of science and juiced by quackery keeps planting the seeds of skepticism about whether vaccines do more harm than good.

As reported last week on NPR, the answer, again, is a categorical “no.” The CDC study found no connection between the number of vaccines a child received and his or her risk of autism spectrum disorder. And even though kids get more vaccines than they used to, they’re far less able to provoke an immune response than older versions.

That’s because newer vaccines have fewer antigens. Those substances cause the body to produce antibodies, which are proteins that fight infection. Our bodies are experienced antibody-producers because we’re routinely exposed to microbes, whether they’re the bacteria responsible for a sinus infection or a virus that results in a cold sore. In other words, antibody production is a natural, vital part of human life. To believe it’s responsible for causing a mental disorder is nonsensical.

The CDC study compared the vaccine histories of about 250 children diagnosed with autism spectrum disorder with the histories of 750 kids who weren’t. Researchers compared medical records to see how many antigens each child received and whether that affected the risk of autism. The results, published in The Journal of Pediatrics, were clear.

"The amount of antigens from vaccines received on one day of vaccination or in total during the first two years of life is not related to the development of autism spectrum disorder in children," said lead author Frank DeStefano, director of the Immunization Safety Office of the CDC. Because kids, like everyone else, are constantly exposed to antigens from bacteria and viruses, "It's not really clear why a few more antigens from vaccines would be something that the immune system could not handle," he said.

The the number of vaccines a kid is supposed to get has increased, but the number of antigens in vaccines has decreased. A lot. In the late 1990s, vaccinations exposed children to several thousand antigens, the study said. By 2012, that number was 315.

That’s because the science of vaccination has improved; it’s more precise in how antibodies kick-start the immune system.

The problem with supporters of quack science is not only that they leave their children and others in their community vulnerable to the problems vaccines address, they also divert resources into worthless pursuits that otherwise would contribute to the body of science, not waste time trying to overcome it.

"I certainly hope that a carefully conducted study like this will get a lot of play, and that some people will find this convincing," Ellen Wright Clayton told NPR. She’s a professor at Vanderbilt University who contributed to a report on vaccine safety for the Institute of Medicine. “That would let researchers pursue more important questions.

"The sad part is, by focusing on the question of whether vaccines cause autism spectrum disorders, they're missing the opportunity to look at what the real causes are," she said. "It's not vaccines."

Getting Back Into the Game After Suffering a Concussion

Fri, 29 Mar 2013 15:20:49 -0500

When we wrote about kids and concussions a while ago, the discussion concerned the rising awareness of how getting your head banged during an athletic competition can lead to traumatic brain injury, and that sports equipment manufacturers were responding by designing more protective gear.

How quaint. As of last week, the guidelines for treating kids who suffer a head injury on the field of play have become more stringent. At least that’s what the American Academy of Neurology advises.

As reported by the Associated Press, when athletes are suspected of having a concussion, they should be taken out of action immediately and shouldn't resume playing until they've been fully evaluated and cleared by a doctor or other professional with concussion expertise.

The academy’s recommendations support a position paper it issued in 2010, but the new guidelines are a more complete document for evaluating and managing a head injury based on a comprehensive review of scientific research.

The guidelines replace those published 15 years ago that advised grading the severity of a concussion at the time of injury as a way to measure when the player could return to the game. The new recommendations emphasize individual player assessment and management of the injury when it occurs, and are not flexible about returning to play: Don’t do it.

Athletes should not be allowed back into the game if they show any symptoms, such as dizziness, muddled thinking, blurry vision, headaches or nausea. The guidelines also say players of high school age or younger with a diagnosed concussion should wait much longer to return to action than older athletes.

AP pointed out that the research showed that the grading system didn't provide useful information about outcomes, and that recovery from concussion is not predictable—some people recover faster than others. But the first 10 days after a concussion, according to the guidelines, are when a player is at the highest risk of getting a second concussion

And getting that concussion before the first one is healed can lead to longer periods of disabling symptoms. Sometimes the damage, including mental impairment, memory loss, headaches and mood disorders, can be permanent.

So, parents, coaches and trainers, if a child of yours bangs his or her head in the course of the game and is seeing stars, having trouble with balance, unable to focus or complaining of headache, that child does not belong in the contest that day and for days to come. At least.

If your child’s coach (or any other authority) encourages him or her to just shake it off and get back into the game, it’s time to find another place to play.

To learn more about concussions, link here on website of the American Academy of Neurology.

EPA Continues to Ignore the Dangers of Lead for Children

Fri, 22 Mar 2013 02:56:50 -0500

In 2001, the Environmental Protection Agency (EPA) set hazard standards for levels of lead, the measure of which is critical to children’s health. Despite calls from the agency’s science advisors, says USA Today, the federal body has no plans to revise those outdated standards.

As we have written, the Advisory Committee on Childhood Lead Poisoning Prevention says no amount of lead in a child’s body is safe. Children’s developing organs are especially vulnerable to lead; it can compromise intelligence, and cause behavioral problems, impaired hearing, coma, convulsions and death.

Older and/or deteriorating houses pose a heightened exposure risk, as do homes undergoing renovation, thanks to the lead content of paint chips, dust and soil contaminated by leaded gasoline.

In response to the EPA’s sloth, Howard Mielke, a soil contamination expert at Tulane University’s medical school told USA Today, “It's outrageous we aren't acting on what we know.”

A year ago, the EPA's Children's Health Protection Advisory Committee asked then-administrator Lisa Jackson for “immediate and urgent attention” to several recommendations about lead poisoning, including revising the lead dust standards.

Yet its lead standard for house dust remains under review, and, says USA Today, seems to be years away. The agency told the paper earlier this month that no action is being taken to revise hazard standards for soil either. Compare with a California health model, the federal standard allows five times more lead in play areas than what’s required to protect children from losing one IQ point.

The standards are applied in home inspections for lead paint residues and when yard and playground soil is tested for contamination from paint, industrial sources or particles from when vehicles burned leaded gasoline.

“We have thousands of risk assessors around the country determining whether you have risks and using clearance standards that are outdated," Rebecca Morley, executive director of the National Center for Healthy Housing, told USA Today. “They matter to consumers as a right-to-know issue: If you're told your home is safe and in fact it's not.”

Last year, the Centers for Disease Control and Prevention revised its standard for children’s lead blood levels. It cut by half the amount that should trigger public health actions.

According to USA Today, some 500,000 U.S. children have a blood-lead level of at least 5, the CDC's new standard, although the agency and its scientific advisers emphasized that there is no safe level.

In 2009, the EPA received a petition from several consumer and children’s health organizations to lower the lead standards. The agency doesn't expect to change anything until September 2014.

And nothing’s happening in terms of soil contamination. The EPA's hazard standard for bare soil where children play, says USA Today, is 400 parts per million (ppm) of lead. The California model’s standard is 80 ppm.

Only a tiny amount of ingested lead dust can poison a child. A packet of artificial sweetener contains 1 gram of powder. A microgram is one-millionth of that amount, and swallowing just 6 micrograms of lead particles a day over about three months can raise a child's blood-lead level by up to 1 point and affect cognitive function.

Bruce Lanphear, a medical researcher who studies sources of lead in children's bodies and has served on EPA advisory panels told USA Today, "In every instance, the [EPA] standards are based less on science and more on what the feds though was feasible."

If you want to pressure the EPA to accept the science, tighten the standards and protect children from the insidious effects of lead poisoning, contact your congressional representatives. Find there here.

Read more about protecting children from lead paint poisoning, and watch a video, on the Patrick Malone law firm website.

Monster Beverage Gets Monstrous with a Nutritionist

Wed, 20 Mar 2013 11:02:48 -0500

Monster Beverage wants a pediatric nutritionist to back off her warnings about the dangers to children of consuming high-caffeine "energy" drinks, or else.

Monster threatened a defamation lawsuit against Connecticut nutritionist Deborah Kennedy. She responded by contacting her U.S. Senator, Richard Blumenthal, who got Monster to back down, a teeny bit. Imminent litigation is no longer threatened, but Monster issued a statement saying Ms. Kennedy's comments about its products are still defamatory.

Which caused her mind to reel, inasmuch as the newsletter she sent to schools who are her clients hadn't even mentioned Monster by name. Plus, her warnings about the dangers of these beverages are backed up by the American Academy of Pediatrics, which issued its own warnings about energy drinks and sports drinks two years ago.

The saber-rattling by Monster was reported by the New York Times' Barry Meier, who describes Monster's new strategy to insinuate its products into kids' lives, by rebranding them into "beverages," instead of "nutritional supplements" as they had been for years.

Not coincidentally, the beverage label gets the manufacturer off the legal hook of having to report to the Food and Drug Administration when consumers experience adverse reactions.

Bottom line is that high-caffeine energy drinks should not be consumed by children.

Rethinking the Use of Antibiotics for Ear Infections

Fri, 15 Mar 2013 14:15:13 -0500

It’s a simple equation: child + ear infection = antibiotic treatment. Except that the formula is being reworked.

In an effort to limit the unnecessary use of antibiotics, the American Academy of Pediatrics has issued new guidelines for diagnosing and treating children’s ear infections.

As reported by NPR, ear infections are among the most commons reasons parents bring their children to the pediatrician, and the primary reason kids get antibiotics. When your kid is screaming all night, and tugging at his ear, you will do anything to make the hurt go away.

But about 7 in 10 kids will improve within a couple of days without drug intervention; about 8 in 10 get better within a week to 10 days, said one of the doctors involved in writing the new guidelines.

In addition to helping bacteria develop resistance to drugs, taking antibiotics when they’re not necessary can cause stomach problems and allergic reactions.

According to the new guidelines, the first thing parents should do if their child is having ear discomfort is to ensure it’s really an infection instead of another problem that also causes pain. Infections can be diagnosed only by having a doctor view the eardrum to see if it’s bulging. Infection causes that structure to push outward, as if it wants to pop.

Even then, however, that doesn’t mean an antibiotic is in order. If the immediate need is to relieve pain, other drugs can do that without the side effects or bacteria-boosting consequences.

If a child clearly has a severe infection—intense pain, high fever, bulging eardrum—antibiotics are indicated. Also, any child 6 months to 2 years old who has infection in both ears should take antibiotics, as should a kid whose eardrum has ruptured.

Doctors have options they didn’t used to have, and they should consider whether it’s best to offer parents the safety net of antibiotics, or to adopt a wait-and-see approach, and treat only the pain for a day or two. If they opt for “watchful waiting,” a prescription for antibiotics can still be given, and filled only if the child isn’t better in a couple of days.

Breast-feeding seems to help a child resist ear infections in the first place, as does keeping the kids away from cigarette smoke.

The Perils of Underage Use of Social Media

Fri, 08 Mar 2013 06:36:04 -0500

It’s a techno world, we just live in it. As much as parents want to give their children everything they need for learning and having fun, the adoration many kids have for social media poses important boundary issues.

Writing on KevinMd.com, pediatrician Natasha Burgert recalls a visit from a 10-year-old patient who had a completely age-appropriate love for dancing, gymnastics and horseback riding, and, as Burgert saw it, a wholly unacceptable involvement in Pinterest, a photo-sharing website where users create and manage thematic posts based on their interests and events.

Burgert was discomfitted to learn that not only was the child active on Pinterest, but that her mother had helped her set up the account. Said mom: “[T]he stuff she looks at is OK. She likes arts and crafts, and looking at hairstyles. Sometimes she shares ideas with me.”

Burgert clearly believes it is not OK for a 10-year-old to be surfing the web alone. She said there’s a common misconception by parents that social media sites are suggested for children older than 13, based on the network’s content, like a PG-13 movie.

By federal law, users of social media sites must be at least 13 years old.

The long-term consequences of a 10-year-old’s online activity are unknown. Do you really want to risk your child’s future?

Here are Burgert’s reasons for encouraging parents to enforce the age limit on social media:

1. A child younger than 13 (U13) is protected by the Children’s Online Privacy Protect Act (COPPA). Essentially, COPPA protects a child’s personal information from being collected and shared. Such protection is being updated to include online data tracking, location, photos, videos, and information available to third-party advertising networks.

Creating an account for a child U13 using a false date of birth circumvents the federal law. That means the social networks, and all the information your child shares, are completely out of your control.

(Some people believe that COPPA laws decrease a child’s protection online, arguing that without COPPA, fewer children would lie about their age, which would enable better online protection based on their true age. But it’s still the law.)

2. Kids know the U13 rule. If you, as a parent, falsify your child’s age to create an account, you are saying that it’s OK to lie on the Internet. You are saying that the rules don’t apply to your kid. Is that really what you want to do?

“Teaching appropriate boundaries and limitations on the Internet are of paramount importance,” Burgert writes. “Parents should be providing an example of ethical and responsible internet citizenship. This means enforcing the rules.”

3. Children U13 do not have the intellectual or emotional maturity to handle many social media themes. Pre-teens have enough trouble with real-life social interaction. Their reasoning skills are developing, and they’re vulnerable to online harassment, solicitation and cyber-bullying. “Allowing a child U13 on a major social site,” says Burgert, “is only prematurely increasing this risk.”

4. There are safer alternatives for children U13. Learning how to navigate and interact on social media sites is an important skill, and kids need to learn responsible Internet behavior. But some pre-teen social networks enable this education, they’re fun and they provide legal protection. For guidance in this realm, and a list of such sites, link to Common Sense Media.

How Parents Choose a Pediatrician in the Internet Age

Thu, 28 Feb 2013 22:51:08 -0500

For most people, the Internet is a primary resource for a range of services from restaurant reviews to insurance policy comparisons. Medical/health apps are popular (and varied in quality and usefulness—see our blog ), as are hospital and doctor rating services.

But when it comes to how parents choose doctors for their children, online resources are a decidedly generational preference. Gender, too, plays a role in how much a parent consults the Internet.

So says a recent survey by the Mott Children’s Hospital National Poll on Children’s Health, a project of the University of Michigan (UM). Only 1 in 4 parents, it says, consider doctor rating sites very important in choosing a practitioner for their children.

Parents younger than 30 (44 in 100) and mothers (30 in 100) were more likely to say that online doctor ratings were very important than older parents (21 in 100) and fathers (19 in 100).

Other results of the poll include:

More than 9 in 10 parents rated “accepts my health insurance” as very important.

About 65 in 100 parents rated a convenient office location as very important.

More than 50 in 100 parents rated a doctor’s years of experience as very important.

Nearly 1 in 3 parents who have gone online to view doctors’ ratings said that they have selected a doctor for their children because of good ratings or reviews. Nearly 1 in 3 said they avoided a doctor for their children because of bad ratings or reviews.

Very few adults (5 in 100) said they have ever posted ratings or reviews of doctors.

In a UM news release, Dr. David A. Hanauer, a professor of pediatrics at the university who was involved in the polling project, said, “The small percentage of people who actually post reviews suggests that people who depend on online ratings may not be getting an accurate picture of a pediatrician’s care.”

So how much should you rely on online ratings? Dr. Matthew M. Davis, director of the poll, offered this perspective: “[T] here is currently no oversight or regulation for rating websites that collect ‘crowd-sourced’ information about doctors. It is hard to verify the reliability of the ratings or whether they are subject to manipulation.”

But he also pointed out in the news release that word-of-mouth isn’t exactly an objective measure of quality either. And that a personal source of information might be perceived as more directly accountable, and therefore more trustworthy.

Fast Food Diet Shows Link to Breathing Problems

Fri, 22 Feb 2013 13:09:31 -0500

Parents generally don’t need a reason to limit their children’s consumption of fast food—everybody knows chicken nuggets, fries and bacon burgers are load with saturated and trans fats, which have been shown to compromise immunity. Now, a new study in the respiratory journal Thorax seems to show a direct cause-and-effect for specific harms of eating too much junk food.

As reported on ScienceDaily.com, the study results show that eating three or more servings of fast food each week is associated with a higher severity of allergic asthma, eczema (skin inflammation) and rhinitis (inflammation of nasal passages) for children in developed nations.

We’ve blogged about the respiratory signs of allergy.

Dietary data was collected from more than 319,000 13- and 14-year-old teens in 51 countries, and more than181,000 6- and 7-year-olds from 31 countries. All of the study’s subjects were involved in the International Study of Asthma and Allergies in Childhood (ISAAC), a collaborative research project involving more than 100 countries and nearly 2 million kids. ScienceDaily says it’s the largest study of its kind.

Parents of the kids were asked about symptoms of asthma (wheezing), rhinoconjunctivitis (runny or blocked nose accompanied by itchy and watery eyes) and eczema (patchy, itchy skin, bleeding blisters), and their weekly diet. They focused on the severity of symptoms over the last 12 months, including frequency and interference with daily life and/or sleep patterns. They also asked about certain foods linked to protective or damaging effects on health.

They included meat, fish, fruits and vegetables; cereals, bread, pasta and rice; butter and margarine; nuts; potatoes; milk; eggs; and fast food/burgers. They asked how often the children ate these foods—never, occasionally, once or twice a week and three or more times a week.

The analysis showed that fast food was the only food category to show the same associations across both age groups. So the authors suggested that "such consistency adds some weight to the possible causality of the relationship."

The study had limitations—relying on one’s memory isn’t the best way to collect objective data—but because the sample was so large and included so many regions, the patterns can’t be ignored.

The relationship between fast food and severity of symptoms for the three conditions was consistent among the teens in all the participating countries, irrespective of gender or family affluence.

The pattern among children was less clear-cut, but except for eczema, a fast food diet still was associated with symptoms across all regions and poorer countries, except for current/severe symptoms of asthma. (See our blog about the quality of hospital care for children with asthma.)

This difference, the authors speculated, might have to do with the fact that children have fewer options about their food choices.

Three or more weekly fast food servings were linked to an increase of severe asthma of more than one-third for teens and more than one-quarter for younger children.

But fruit seemed to be protective for both age groups in all regions for all three conditions among younger children, and for current and severe wheezing and rhinitis among the teens. Eating three or more servings of fruit each week was linked to decreased severity of symptoms for both teens and younger children.

Parents who eat healthfully model this habit for children, who will benefit from it their whole life. The occasional fast food meal is not a problem for most people, but if your child has respiratory problems, he or she might be more vulnerable to its negative effects.

Hospital Readmission Rates for Children Mirror Those of Adults

Fri, 15 Feb 2013 08:33:05 -0500

Hospital readmissions—patients who have to check back into the hospital unexpectedly within 30 days of going home—have become an important factor in determining the quality of health care, particularly since Medicare is using that data to compensate and penalize hospital performance in its Hospital Readmissions Reduction Program.

But not much attention has been paid to hospital readmissions for children.

A new study, however, has found that trends seen in adult hospital readmissions also apply to pediatric readmissions. Published in the Journal of the American Medical Association (JAMA), the study found that 1 in 15 children discharged from a pediatric hospital is readmitted.

Researchers at Boston Children’s Hospital examined data from the National Association of Children’s Hospitals and Related Institutions for 72 large acute-care children’s hospitals between July 2009 and June 2010.

As reported on MedCityNews.com, the most common problems that returned young patients to the hospital were anemia/neutropenia (low white blood cell count), ventricular shunt procedures (to drain fluid around the brain) and sickle-cell crises. The incidence of readmission for those complications was comparable to the rate for adults readmitted for heart attack, heart failure and pneumonia.

So, many readmission trends seen in adults also are seen in children—similar rates related to certain conditions. Just like with adults, most pediatric patients are readmitted because they suffer from chronic diseases.

As noted in an editorial accompanying the JAMA study, most children are hospitalized only once in their lives—when they are born. Excluding newborns, every year about 3.6 million people are hospitalized, almost one-third of whom are children. But only a small percentage of children account for the majority of hospital admissions and costs—the ones with complicated medical problems.

Their larger use of health-care resources mirrors that of people on Medicare, whose chronic, complicated problems require more resources, and result in more readmissions.

Rates varied among the hospitals surveyed, and ranged from 4.6 to 8.5 in 100, depending on factors such as differences in hospital and follow-up care and family or community influences on health, the researchers said. Bottom line: There’s room for improvement, but it’s not just about hospitals doing a better job of treating inpatients and communicating with them on discharge, which is known as transition care.

“Community clinicians and organizations have a role to play as well,” said Dr. Mark Schuster, chief of general pediatrics at Boston Children’s Hospital in a statement released with the study. “Parents also need support in being able to stay home with their recuperating children.”

As noted by MedCityNews, this study found results similar to one that examined readmissions in VA hospitals in that a shorter hospital stay was associated with lower rates of readmission. And as you might expect, readmissions are higher for children with no insurance or with public coverage.

Critics of the Hospital Readmission Reductions Program say that you can’t use numbers alone to determine why some hospitals have higher readmission rates than others—some serve populations that lack primary care that might have addressed problems before they became serious enough to require hospitalization, so they’re treating a sicker patient population. Some are located in areas with higher trauma and crime rates, which mean they see more people with critical care issues.

The JAMA editorial acknowledged these complications as they apply to pediatric readmissions. “Until research can demonstrate that hospitals that have high pediatric readmissions are delivering suboptimal quality as opposed to caring for more children with complex social environments that contribute to readmission,” the authors wrote, “physicians and policy makers should not consider pediatric readmissions as a quality indicator: current research only supports it as a marker of health care utilization.”

“Are pediatric readmissions ready to debut as a showcase hospital quality measure?” the writers ask. “At this point, the answer is no. Or at least not yet.”

But that doesn’t mean that you can’t help your child get the best possible hospital care. Mindful of the factors that can skew pure numbers, you can find out how many hospitals rate on Medicare’s Hospital Compare site.

Another method of hospital review is described in our previous blog about performance ratings. Also, read my two-part newsletter about how to keep a loved one safe during hospitalization here and here.