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Cholesterol in Children

High Risk Kids Should Have Cholesterol Screening

According to the American Academy of Pediatrics (AAP), current research shows that the stage for adult heart disease (also known as cardiovascular disease) is set early on in life.

The AAP has published new recommendations, found in the July issue of the journal Pediatrics, for parents and pediatricians to screen high-risk kids for signs that they've already begun to develop heart disease.

The screening test, called a fasting lipid profile, measures a child's levels of "bad" LDL cholesterol, "good" HDL cholesterol, and blood fats (triglycerides).

High-risk kids are those with a family history of high cholesterol or a family history of premature heart disease. Also included are kids who are overweight or who have high blood pressure or diabetes.

Here's an overview of the new AAP recommendations:

1. All children should eat a healthy diet, according to the Dietary Guidelines for Americans, better known as the new food pyramid. This approach includes the use of low-fat dairy products.
   
2. Children at higher risk of heart disease and with high cholesterol levels will have to change their diets. This will require nutritional counseling from a dietitian as well as increased physical activity.
   
3. Screening is advised for kids with a family history of high cholesterol or blood fats, or a family history of premature heart disease (age 55 or younger for men, age 65 or younger for women).
   
4. Screening is also recommended for kids who are overweight (at or above the 85th percentile), who smoke, or who have diabetes or high blood pressure.
   
5. First screening is recommended after age 2, but no later than age 10. Children under 2 should not be screened.
   
6. If the fasting lipid profile is normal, a child should be screened again in three to five years.
   
7. For kids who are overweight or obese and who have a high blood-fat level or low level of "good" HDL cholesterol, weight management is the primary treatment. This means improved diet with nutritional counseling and increased physical exercise.
   
8. For kids aged 8 and older with very high cholesterol levels (or high levels with a family history of early heart disease), drug treatment should be considered.
   

So, if your child is active, eats healthy foods, isn't overweight, and doesn't have a family history of obesity or potential heart problems, you probably don't have to worry too much.

But, whether your child is at risk or not, it's still wise to:

1. Limit cholesterol and saturated and trans fat intake
   
2. Avoid foods that are high in saturated fats (all animal fats and some tropical oils) or trans fats (fats formed when vegetable oils are hardened).
   
3. Choose low-fat dairy products whenever you can.
   
4. Pack healthy school lunches.
   
5. Serve snacks like fruit, raw veggies and low-fat dips, plain popcorn or pretzels, low-fat cheese and whole-grain crackers, or low-fat yogurt.
   
6. Exercise - set a good example for your kids and keep them moving. Any activity is better than no activity.
   

Childhood Safety

Bassinet Safety

Bassinets are one place where babies might be injured or even die as they sleep. Infants can suffocate, strangle, and succumb to sudden infant death syndrome (SIDS) in cribs and even adult beds.

Bassinets are growing in popularity with use almost doubling in the past ten years.  Approximately 45 percent of parents use bassinets today for their babies younger than two months. 

According to a study published in the June issue of the Journal of Pediatrics, 53 babies had died in bassinets from 1990 to 2004 according to the U.S. Consumer Product Safety Commission (CPSC).

Some of the major findings of the study:

1. Most (85%) died when they didn't get enough oxygen (e.g., suffocation and asphyxiation).
2. Half were on their bellies (instead of their backs) when they were found dead.
3. Almost 70% had soft bedding (like blankets and pillows) in their bassinets.
4. Nine infants died in bassinets that were not functioning properly with the malfunctions stemming from either "misuse" or mechanical problems.
5. Six of the 53 infants who died in bassinet accidents were found with their faces wedged against the side of the bassinet.
6. A little more than 10% died in a child-care setting.

Here are some safety tips regarding bassinets to help prevent injury to infants:

1. Check to see if your bassinet is sturdy and meets CPSC guidelines: a strong bottom with a wide base, smooth surfaces without any hardware sticking out, legs that lock, and a mattress that's firm and fitting.
   
2. When shopping for a bassinet, ensure the item has a sticker that indicates the furniture has received certification from the Juvenile Products Manufacturers Association (JPMA).  While a JPMA certification is not a guarantee of safety, it is today’s best assurance to consumers that the bassinet meets the voluntary safety standards set by the American Society for Testing and Materials International (ASTM).  Unfortunately, the standards are voluntary and bassinet manufacturers are not required to conform to such standards.
   
3. Try to choose a bassinet with sides made of material that air can easily pass through, like mesh (since some of the babies in the bassinet study died when their faces were wedged against the bassinet's side).
   
4. Follow the bassinet's weight and height requirements.
   
5. Always place your baby to sleep on the back (never on the belly or the side) on a firm mattress in a crib or bassinet — never on a pillow, waterbed, sheepskin, or other soft surface.
   
6. Never put your baby to bed with blankets, comforters, quilts, plush toys, or pillows. If you use crib bumpers, opt for the kind that are mesh or tie at the top and bottom.
   
7. Remove bumpers once your baby begins to pull up and stand.
   
8. Never smoke or let anyone else smoke around your infant during pregnancy or after your baby is born (smoking boosts babies' risk of SIDS).
   
9. Never prop your baby's head or neck up with pillows or soft items like rolled up towels (unless your doctor says otherwise).
   
10. Never put extra mattresses, cushions, or pillows in playpens or play yards — use only the mattress provided.
    
11. Never use an adult sheet. Use a crib sheet that fits snugly over the mattress but isn't too tight. Crib sheets — both those that are too big or too small — can come off and potentially get wrapped around babies' heads.
    
12. Never use or buy a crib that's old, broken, or has been modified.
    
13. Don't over-bundle your baby. Keep the room at a temperature that feels comfortable for an adult in a short-sleeve shirt.
    
14. Don't put your baby to sleep in a bed. Instead, keep the crib or bassinet in your bedroom next to your bed. Bring your infant to your bed for nursing or comforting, but return your baby to the crib or bassinet to sleep.
    
15. Don't place your baby's sleep area near windows and anything your little one could get tangled in or strangle on (like electrical cords or cords from drapes or window shades). Strings or ribbons on crib mobiles or toys should be no longer than 7 inches.
    
16. Remove mobiles once your baby begins to push up on the hands and knees, or by 5 months — whichever comes first.
    
17. Make sure the mattress fits snugly, with no big gaps around the sides.
    
18. Check the CPSC's website http://www.cpsc.gov/ to make sure your bassinet hasn't been recalled.

Food Safety

Tomato Ban Lifted in Salmonella Investigation (7/18)

The Food and Drug Administration (FDA) on July 17 lifted a warning on tomatoes and repeated a warning on peppers as the possible cause of an outbreak of Salmonella Saintpaul in which more than 1,200 people have reported getting sick.

The FDA repeated its warning that young children, the elderly or people with compromised immune systems should avoid fresh jalapeno and Serrano peppers.

FDA said it removed the tomato warning because there are no longer any tomatoes coming into the market from producers that were being looked at as possible sources of contamination.

Since April, 1220 persons infected with Salmonella Saintpaul with the same genetic fingerprint have been identified in 42 states, the District of Columbia, and Canada.

The FDA is directing consumers to its Web site — http://www.fda.gov — for updated lists of the safe regions.

For up to date information on the outbreak from the CDC, go to http://www.cdc.gov/Salmonella/saintpaul/

What is a Salmonella infection?

A salmonella infection is a foodborne illness caused by the salmonella bacteria carried by some animals, which can be transmitted on kitchen surfaces and in water, soil, animal feces, raw meats, and eggs.

There are many strains of salmonella; the tomato outbreak involves an uncommon strain called Salmonella saintpaul.

What are the signs and symptoms of a Salmonella infection?

Salmonella infection can cause diarrhea (which may be bloody), fever, nausea, vomiting, and abdominal pain. Symptoms typically start 12-72 hours after infection.

How is a Salmonella infection treated?

Most people don't require treatment other than drinking plenty of fluids. People with severe diarrhea may require rehydration with intravenous fluids. Antibiotics are usually not used unless the salmonella infection has spread beyond the intestines.

How can a Salmonella infection be prevented?

Here are the FDA's and U.S. Department of Agriculture (USDA) tips for handling tomatoes, other fruits and vegetables and seafood and meat to prevent food poisoning:

1. Wash hands with soap and warm water before handling tomatoes.
2. Wash each tomato thoroughly under running water.
3. When finished washing a tomato, cut out the scar where the stem was, and throw it away.
4. Cut the tomato on a clean cutting board, using clean utensils.
5. Don't let the tomato come in contact with other raw foods or the surfaces they have touched.
6. Wash cutting boards and utensils in between each different type of food that is cut.
7. Refrigerate fresh, cut tomatoes at 41 degrees Fahrenheit or less if they're not eaten within two hours.
8. Wash hands with soap and warm water after preparing the tomatoes.
   
   
9. Consider using paper towels to clean kitchen surfaces.
   
10. If you use cloth towels, wash them often in the hot cycle of your washing machine.
    
11. Separate raw meat, poultry, and seafood from other foods in your grocery shopping cart and in your refrigerator.
    
12. If possible, use one cutting board for fresh produce and a separate one for raw meat, poultry, and seafood.
    
13. Always wash cutting boards, dishes, countertops, and utensils with hot soapy water after they come in contact with raw meat, poultry, and seafood.
    
14. Never place cooked food on a plate that previously held raw meat, poultry, or seafood.
    

Sports Safety

Dramatic increase in 'Tommy John' surgery in young patients

A recent study noted a trend of more and more young athletes requiring "Tommy John" elbow reconstruction surgery.

"Tommy John" surgery is a procedure where a damaged elbow ligament (Ulnar Collateral Ligament or UCL) is replaced with a tendon from elsewhere in the body. The surgery is named for Hall of Fame pitcher Tommy John, who was the first person to have the surgery in 1974. John returned to the major leagues and went on to win 164 games after the surgery. Prior to this historic surgery, a UCL injury was a career-ending injury.

Eighty-three percent of athletes who had "Tommy John" elbow reconstruction surgery were able to return to the same or better level of play, according to the study released recently at the 2008 American Orthopaedic Society for Sports Medicine Annual Meeting.

In the study, 743 patients who had the Tommy John surgery were contacted for follow-up evaluations and completed a questionnaire about their recovery.

The majority of the patients were baseball players (94.5 percent), the remaining 5.5 percent were involved in track, football or other sports.

The study found that 622 patients (83 percent) returned to the previous level of competition or higher. Of the major league players, 75.5 percent returned to the same level of play. For minor league players 56 percent returned to the same level or higher.

The average time from surgery to full competition was 11.6 months after reconstruction, according to study results. Additionally about 10 percent of the patients had complications, mostly minor.

According to the study author, "before 1997 this surgery was performed on only 12 of 97 patients who were 18 or younger (12 percent). In 2005 alone, 62 of the 188 operations performed, were on high school athletes, a third of the surgical group.

According to the study author, "the increase in the number of UCL reconstructions being done now can be attributed to many things: improved diagnostic techniques, heightened awareness, increased chance of positive outcome with current surgical techniques, but most importantly, the overuse of young throwing arms." 

"In the past 10 years, year-round baseball leagues have proliferated. So the best young pitchers are throwing many more pitches and learning to throw more difficult pitches. It's great that the surgery is successful, but prevention of the injury should be the goal. Kids should be urged to rest and be careful about saving their arms, rather than leading to long-term problems at a young age."

Sports Safety

Concussion Recovery Differs for Girls and Boys

Female soccer players and soccer players who have had a previous concussion recuperate differently from males or players without a history of concussion, new research released today at the 2008 American Orthopaedic Society for Sports Medicine Annual Meeting.

The study found that prior history of concussion and gender account for significant differences in test results following the injury. Because of these differences, the authors urge physicians and coaches to take an individualized approach to treating concussion patients.

The authors chose to examine concussion recovery patterns in soccer players due to the popularity of the sport among both genders. Also, it is a non-helmeted sport with identical rules for all participation levels for both genders.

In the United States, there are between 1 and 4 million estimated sports-related concussions each year. The most common causes of concussion in soccer include, head-to-head contact, head contact with other body parts and head-to-ground contact.

A concussion is an injury to the brain that results in temporary loss of normal brain function, usually caused by a blow to the head. Concussions can affect memory, judgment, reflexes, speech, balance and coordination.

The study had 234 soccer players (61 percent female, 39 percent male) ranging in age from 8 to 24 years old, who were given neuropsychological tests that measured attention, memory, processing speed and reaction time after their concussion.

The results of the tests were analyzed to see if there were group differences in performance between male and female participants and those with a previous history of concussion.

The study found that females performed significantly worse than males on tests of reaction time. Females were also significantly more symptomatic than males. Additionally, there was a trend, although not significant, towards females testing poorly regarding verbal memory and processing speed when compared to males.

Soccer players with a history of concussion performed significantly worse on verbal memory testing after another concussion, the study found.

More studies are needed to determine the reason for differences in recovery between males and females.

For more information on concussions, go to Head Injuries.

Methicillin-resistant Staph aureus (MRSA)

Bone Infections due to MRSA more difficult to treat in children

The emergence of methicillin-resistant Staphylococcus aureus (MRSA) as a major pathogen has led to more complications and longer hospital stays for children with acute bone infections according to a recent study.

Acute osteomyelitis, a bone infection that predominantly occurs in children, is usually caused by the staph bacteria. Treatment has traditionally been straightforward because most S. aureus bacteria can be killed with existing antibiotics.

Recently, however, more children with osteomyelitis have been developing the more severe, antibiotic-resistant, community-associated MRSA, resulting in more complications and prolonged antibiotic therapy and hospital stays.

Osteomyelitis might be more common in children because kids tend to be more accident-prone. Most commonly, the bones get infected when bacteria reach the bone through the blood supply. It is thought that minor trauma to the bone facilitates the start of the infection. 

Published in the July/August issue of the Journal of Pediatric Orthopaedics, the study's researchers reviewed the medical records of 290 children admitted to Children's Medical Center Dallas between January 1999 and December 2003 with acute osteomyelitis.

The researchers divided the patient population into two groups (January 1999 to June 2001 and July 2001 to December 2003) to verify whether MRSA infections were becoming more common and more severe.

They then compared patients with MRSA osteomyelitis to children with non-MRSA osteomyelitis, which included those with methicillin-sensitive S. aureus (MSSA) infections. They also reviewed outcomes, including duration of fever, the type and length of antibiotic therapy, and the frequency of complications, such as muscle inflammation, bone abscesses and the need to drain the bone surgically. 

Study findings include:

1. The average age of those surveyed was 6 years. Sixty percent were male.
   
   
2. Symptoms such as localized pain, fever, tenderness, swelling and limping were observed in more than half the patients.
   
   
3. Though the clinical characteristics of the participants didn't change significantly between the first and second study periods, children who were treated in the latter period for osteomyelitis fared far worse, possibly because MRSA infections were more common.
   
   For example, in the second study period, bone abscesses were observed in 69 percent of the patients with MRSA osteomyelitis versus 26 percent among those with MSSA infections.
   
   
4. Children admitted with MRSA osteomyelitis during the second study period also spent an average of 42 days on antibiotics, almost two weeks longer than those diagnosed with MSSA.
   
   
5. Seventy-eight percent of the patients with MRSA required surgery, compared with 49 percent of those with MSSA.

According to the author of the study, "the key is to treat the infection as early as possible with appropriate antibiotics and if needed, surgical drainage of the bone".

For more information, go to MRSA.

Firework safety

Fireworks Safety Tips

Consumer fireworks cause serious preventable injuries in children, including bystanders.


A study published in the journal of Pediatrics in July 2006 estimated that over 85,000 pediatric fireworks-related injuries were treated in US ERs from 1990-2003.

The following are some of the major findings:

• 80% of the injured children were male with an average age of 11 years.
• One out of 5 of all injuries occurred in a bystander.
• Firecrackers caused 30% of injuries while sparklers/novelty devices caused 20% and aerial devices 17%.
• The most common area of the body injured involved the eye (21%), the face (20%) and the hands (20%).
• Although most of the children were treated and released from hospital ERs, 5% required hospitalization.

For fireworks safety tips, go to Fireworks Safety.

Health Alerts

Jardine Crib Recall

About 320,000 Jardine cribs sold by Toys “R” Us and Babies “R” Us stores were recalled Tuesday because four children became trapped.

The wooden slats and spindles on the crib frames can break, allowing children to get trapped in the remaining gap. The Consumer Product Safety Commission reported 42 incidents of broken slats and spindles. This includes four instances of children getting trapped, two of whom suffered cuts and bruises.

The recalled cribs were manufactured in China and Vietnam by Jardine Enterprises and sold by Toys “R” Us Inc. retailers: KidsWorld stores, Geoffrey stores, Toys “R” Us and Babies “R” Us. KidsWorld and Geoffrey stores are not longer in operation, but sold the recalled cribs when they were open.

The cribs were sold around the country between January 2002 through May 2008.

For more information on the specific Jardine crib styles included in the recall, consumers can call 800-646-4106.

Childhood Safety

Bunk Bed-Related Injuries in Children and Adolescents

Kids love bunk beds but they can be a source of injury, sometimes serious enough to require a trip to the ER.

A study published in the June issue of Pediatrics used national data to examine patterns and trends of bunk bed-related injuries among children and young adults (up to 21 years of age).

Data for the study were obtained from the National Electronic Injury Surveillance System of the United States Consumer Product Safety Commission. The analysis included cases of non-fatal bunk bed-related injuries treated in emergency departments across the U.S. from 1990 through 2005.

There were an estimated 572,580 bunk bed-related injuries during the 16-year study period, resulting in an average of nearly 36,000 cases annually.

Other important findings:

1. Bunk bed-related injuries occurred more frequently among males (60.6%).
   
   
2. Half of the cases analyzed involved children younger than 6 years of age.
   
   
3. Lacerations were the most common type of injury (29.7%), followed by contusions and abrasions (24.0%) and fractures (19.9%).
   
   
4. The body parts most frequently injured were the head and neck (27.3%) in all age groups.
   
   

5. Children less than 3 years of age were 40 percent more likely to sustain head injuries than older children, probably because their higher center of gravity tends to cause them to fall head first.

6. Falls were the most common mechanism of injury (72.5%).
   
   
7. Of the cases for which locale of injury was recorded, 93.5% occurred at home.
   
   
8. Approximately half of the bunk bed-related injuries that occurred at schools involved individuals aged 18 to 21 years (50.9%).
   
   
9. An estimated 2.9% of injuries resulted in hospitalization or transfer to another hospital or required additional observation.
   
   
10. The study also found 18- to 21-year-olds experienced twice as many injuries as adolescents in the 14- to17-year-old age group.

The researchers speculated this may be because the older age group may use bunk beds more frequently due to the greater
likelihood these individuals are in institutional settings, such as college dormitories and the military. The chance of injury from bed
malfunction was also significantly higher for older children, possibly because of their larger size and increased weight.

The study called for better strategies to prevent bunk bed-related injuries, including:

1. Using guardrails on both sides of the upper bunk with guardrail gaps being 3.5 inches or less to prevent entrapment and strangulation
   
2. Checking that the mattress foundation is secure and the mattress is of proper size
   
3. Not allowing children under age 6 to sleep in the top bunk
   
4. Using night lights to help children see in a dark room
   
5. Removing hazardous objects from around the bed
   
6. Placing bunk beds safely away from ceiling fans or other ceiling fixtures

Sports Safety

Golf Cart-related Injuries in Children

It seems like you see golf carts all over the place - and not just on golf courses. They are routinely used at sporting events, airports and national parks for example.

Increased use will ultimately lead to increase accidents and injuries.


A new study conducted by researchers in the Center for Injury Research and Policy of The Research Institute at Nationwide Children's Hospital found that the number of golf cart-related injuries has risen significantly over the past two decades.


According to the study, published in the July issue of the American Journal of Preventive Medicine, there were an estimated 148,000 golf cart-related injuries between 1990 and 2006, ranging from an estimated 5,770 cases in 1990 to approximately 13,411 cases in 2006.

Other findings:

1. More than 30 percent of golf cart-related injuries involved children under the age of 16.
   
   
2. The most common cause of injury for all ages was falling or jumping from the cart - children were more likely than adults to fall from the golf cart, and these falls are associated with higher rates of head and neck injuries and hospitalizations.
   
   
3. While the study found that the majority of golf cart-related injuries (more than 70 percent) took place at sports or recreational facilities, individuals injured in carts on the street had an increased risk of concussions and were more likely to require hospitalization than individuals injured in other locations.

The authors of the study recommend the following to decrease the rate of injuries:

1. Children under the age of 6 years should not be transported in golf carts.
   
   
2. Drivers should be at least 16 years old to operate the cart.
   
   
3. More effective safety features, such as improved passenger restraints and four-wheel brakes, in combination with training programs and safety policies would reduce the overall number of golf cart-related injuries.
   

Headaches

Children with Headaches More Likely to have Sleep Problems

Children with a migraine headache are more likely to have sleep disorders, such as obstructive sleep apnea (OSA) and lack of sleep, than children without a migraine, according to a research abstract on the effects of headaches on children's sleep patterns presented this week at SLEEP 2008, the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).

For this study, 90 children with headache and sleep problems underwent a polysomnogram, a sleep test that monitors the brain, eye movements, muscle activity, heart rhythm, and breathing. Of the participants, 60 had a migraine, 11 had a chronic daily headache, six had a tension headache and 13 had a non-specific headache.

Some of the study findings:

1. Children with a migraine were twice as likely as the other children in the study to have OSA.
   
   
2. A sleep-related breathing disorder (SRBD) was found in 56 percent of the children with a migraine versus 30 percent of the children with a non-migraine headache. A severe migraine was also associated with shorter total sleep time, longer total time to fall asleep, and shorter REM sleep.
   
   
3. 50 percent of children with tension headache grind their teeth at night, compared to 2.4 percent of children with a non-tension headache. In addition, an SRBD was also frequent in children with a non-specific headache and in children who were overweight.

OSA is an SRBD that causes your body to stop breathing during sleep. OSA occurs when the tissue in the back of the throat collapses and blocks the airway. This keeps air from getting into the lungs. OSA occurs in about two percent of young children. It can develop in children at any age, but it is most common in pre-schoolers. OSA often occurs between the ages of three and six years when the tonsils and adenoids are large compared to the throat. OSA appears to occur at the same rate in young boys and girls. OSA also is common in children who are obese, and is more likely to occur in a child who has a family member with OSA.

Sleep-related bruxism involves the grinding or clenching of teeth during sleep. It is common for the jaw to contract while you sleep. When these contractions are too strong, they produce the sound of tooth grinding. This can cause dental damage by wearing the teeth down. In most severe cases, hundreds of events can occur during the night.

The rate of bruxism seems to be highest in children. About 14 to 17 percent of children have it. It can begin as soon as a child's upper and lower teeth have come through the gums. Around one third of children with bruxism will still have it when they are adults.

It can also be caused by stress and anxiety. This may be due to a life event or pressure at school or work.

It is recommended that school-aged children get between 10-11 hours of nightly sleep and children in pre-school between 11-13 hours.

The American Academy of Sleep Medicine (AASM) offers some tips to help your child sleep better:

• Follow a consistent bedtime routine. Set aside 10 to 30 minutes to get your child ready to go to sleep each night.
  
  
• Establish a relaxing setting at bedtime.
  
  
• Interact with your child at bedtime. Don't let the TV, computer or video games take your place.
  
  
• Keep your children from TV programs, movies, and video games that are not right for their age.
  
  
• Do not let your child fall asleep while being held, rocked, fed a bottle, or while nursing.
  
  
• At bedtime, do not allow your child to have foods or drinks that contain caffeine. This includes chocolate and sodas. Try not to give him or her any medicine that has a stimulant at bedtime. This includes cough medicines and decongestants.

If you suspect that your child might be suffering from a sleep disorder you should consult with your child's pediatrician or a sleep specialist.

For more information on headaches, go to Headaches. 

Drowning

SC Child Dies from "Dry Drowning"

The tragic death of a South Carolina 10-year-old more than an hour after he had gone swimming has focused a spotlight on the little-known phenomenon called “dry drowning".

According to the Centers for Disease Control, some 3,600 people drowned in 2005, the most recent year for which there are statistics. Some 10 to 15 percent of those deaths was classified as “dry drowning,” which can occur up to 24 hours after a small amount of water gets into the lungs.

Unlike wet drowning, in which water is aspirated into the lungs, dry drowning results when a child experiences laryngospasms (spasm of the larynx which contains the vocal cords and sits atop the trachea or windpipe), which minimizes the amount of water aspirated into the lungs.

Important signs to recognize in a child that could be suffering from dry drowning include persistent coughing or gagging after swimming, difficulty breathing, extreme tiredness and changes in behavior (combativeness, disorientation). All are the result of reduced oxygen flow to the brain.

For more information via news story on this case and "dry drowning", go to Dry Drownng.

Sports Safety

Knee Injuries in High School Costly

Knee injuries, among the most economically costly sports injuries, are the leading cause of high school sports-related surgeries according to a study conducted at the Center for Injury Research and Policy (CIRP) of the Research Institute at Nationwide Children’s Hospital and published in the June issue of The American Journal of Sports Medicine.


The researchers utilized data from the High School RIOTM online injury surveillance system which collects injury reports for nine high school sports from certified athletic trainers at 100 U.S. high schools selected to achieve a nationally representative sample.

Data are collected for boys’ football, soccer, basketball, baseball and wrestling and girls’ soccer, volleyball, basketball and softball.


Important findings of the study:

The knee was the second most frequently injured body site overall

Boys’ football and wrestling and girls’ soccer and basketball recording the highest rates of knee injury.

The most common knee injuries were incomplete ligament tears, contusions, complete ligament tears, torn cartilage, fractures/dislocations and muscle tears.

Knee injuries accounted for nearly 45% of all sports injury-related surgeries in the study.

While boys had a higher overall rate of knee injury, girls’ knee injuries were more severe. Girls were more likely to miss > 3 weeks of sports activity (as opposed to <1 week for boys) and were twice as likely to require surgery.

Girls were also found to be twice as likely to incur major knee injuries as a result of non-contact mechanisms, often involving landing, jumping or pivoting.

The study authors stressed the following:

Knee surgeries are often costly procedures that can require extensive and expensive post-surgery rehabilitation thus effective interventions are important.

Parents of young female athletes should not overreact to these findings as the long term negative health effects of a sedentary lifestyle far outweigh those of the vast majority of sports injuries.

The further study of knee injury patterns in high school athletics is crucial for the development of targeted injury prevention measures.
For more information, go to Sports Injury and Prevention.

Measles

CDC Warns of Measles Outbreaks in the U.S.

Medication Errors

Drug Errors in Hospitalized Kids

Adverse drug event rates in hospitalized children are substantially higher than previously described according to a study published in the April issue of Pediatrics.

The purpose of the study from Stanford was to develop a pediatric-focused tool for adverse drug event detection and describe the
incidence and characteristics of adverse drug events in children's hospitals identified by this tool.

Review of 960 randomly selected charts from 12 children's hospitals revealed 2388 triggers (2.5 per patient), such as use of specific drug overdose antidotes and suspicious side effects, and 107 unique adverse drug events or approximately 11 "adverse drug events" for every 100 hospitalized kids.

Earlier estimates found that two out of 100 hospitalized children experienced an adverse drug reaction or mistake. The new system for
detecting errors showed a much higher percentage of mistakes than traditional methods such as nonspecific patient chart reviews or voluntary reporting.

Other specific findings:

1. 22% of all adverse drug events were deemed preventable
   
2. 18% could have been identified earlier
   
3. 17% could have been handled better
   
4. 97% of the identified adverse drug events
   resulted in mild, temporary harm
   
5. The most common adverse drug events identified were itching  and nausea
   
6. The most common medication classes causing adverse drug events were opioid analgesics and antibiotics
   
7. the most common stages of the medication management process associated with preventable adverse drug events were monitoring and prescribing/ordering

The Joint Commission, a hospital accreditation group, issued new guidelines days after the release of this study for minimizing pediatric medication errors in hospitals.

The new guidelines, which are partly for hospitals and partly for parents, include these tips:

1. Hospitals should weigh children in kilograms, because that's how pediatric medication doses are calculated.
   
2. Hospitals shouldn't give children any high-risk drugs until the child has been weighed.
   
3. Doctors writing prescriptions for hospitalized children should note the calculations they made to arrive at the prescribed dose. 
   
4. Parents and caregivers are encouraged to seek information and ask questions about their children's medications and
   to repeat instructions about those medications back to the doctor.
   

What can parents do to help prevent these errors from occurring? 

Besides number 4 above, consider these tips:

1. Make sure everyone prescribing or giving your kids medicine knows what other medications they're taking and exactly how much each day and about any allergies to medications or eggs (which are used to make flu vaccines).
   
2. In a kind way, find out what medications your kids are being given or prescribed, how often, why and what side effects (if any) might come with them.
   
3. Take notes so you can remember the doctor's instructions and any medications given or tests scheduled.
   
4. Ask your doctor and/or anesthesiologist what to expect before, during, after surgery — procedures, timelines, recuperation time, and possible symptoms afterward.
   
5. Keep a medical journal or running list of symptoms, medications, tests, and issues to address if you're looking at a
   long hospital stay.
   
6. Build a trusting relationship with your kids' health care providers. Work together as a team to make sure all decisions, diagnoses, and treatments are based on your kids' best interests.
   

Bisphenol A (BPA)

Retailers to Phase Out Baby Bottles with BPA

Wal-Mart, Toys "R" Us , and Babies "R" Us said recently that they will phase out baby bottles containing the chemical bisphenol A (BPA).

A couple of weeks ago it was reported that Canada became the first country to ban the use of bisphenol A (BPA) in everyday consumer products, including some baby bottles.

The Canadian government concluded that bisphenol A exposure for babies up to 18 months of age who are fed through polycarbonate bottles exposed to high temperatures is "below levels that may pose a risk," but "to be prudent," Canada proposed banning bisphenol A in polycarbonate baby bottles.

BPA is used in production of polycarbonate plastic and epoxy linings to add strength and resilience to the products.

Effects of BPA as of this point have been demonstrated in animals (e.g., breast and prostate cancer and reproductive problems) but not in humans, so whether or not this concern applies to human beings remains a point of disagreement among scientists.

Nevertheless, many are taking the approach of rather be safe than sorry.  Wal-Mart Canada began pulling all baby products containing BPA from its shelves two weeks ago and plans to stop selling these products in the US by next year.

For details on how to recognize which plastic products contain BPA and how you can minimize exposure in your child, go top Bisphenol A.
And for a video on this topic, go to BPA video.

Drug abuse

Ingestion of Morning Glory Seeds can lead to Hallucinations

I wanted to share with you a case report from the Long Island Regional Poison Center that was presented at the 2007 North American Congress of Clinical Toxicology Annual Meeting in New Orleans.

Here it goes:

• A 16 yr old male was found hallucinating at school 2 days after ingesting a handful of Morning Glory seeds (MGS).
  
• In the ER, he was found to be making up words and expressing illogical thought patterns.
  
• Psychiatry described his condition as “a compensated psychological disturbance” to to a possible “LSD hallucinogen”. 
  
• Urine tox screen for substances of abuse were negative.
  
• The patient was admitted to a psychiatry unit where his effects continued for 4 days before he was discharged without symptoms.

So, what's the word on Morning Glory Seeds (MGS)?

• Consumption of MGS (Ipomoea species) was popularized in the 1960s by teens who ingested the seeds for their hallucinogenic properties.
  
  
• MGS contain an LSD-like compound
  
  
• Common street names of MGS include: Heavenly Blue, Blue Star and Flying Saucers.
  
  
• These seeds are legally available in many places and appear to have been rediscovered as a hallucinogen by teens in New York. 
  
  
• The seeds must be chewed for absorption of the toxins to occur.
  
  
• Restlessness, increased awareness and socialization followed by relaxation for several hours are typical effects reported with ingestions of 20–40 seeds.
  
  
• A dose of 100–150 seeds has produced effects similar to ingestion of 75–150 ug/kg of LSD. This amount has been associated with spatial distortions, hallucinations, and enhanced imagery and mood elevations for 1–5 days.
  
  
• Ingestions of 200–250 seeds have produced additional effects of nausea, vomiting, abdominal pain, lethargy and paresthesias.
  
  
• For pictures, go to the photos called Morning Glory and Morning Glory seeds.
  

Inhalant Abuse

"Dusting" can be Deadly

We first mentioned "Dusting" to you in a June 2007 news story. The term "dusting" comes from the cleaning brand "Dust Off" and it has become a teenager’s new cheap and easily accessible high, despite a warning on the side of each canister.

These canisters contain freon propellant/refrigerants, usually difluoroethane or tetrafluoroethane. Exposure to them can lead to dysrrhythmias, central nervous system depression (coma), respiratory irritation, low oxygen, frost bite and even death.

I wanted to share with you the results of a case series of “Dust Off”exposures from 2000–2006 from the Long Island Regional Poison Center.

This data was presented at the 2007 North American Congress of Clinical Toxicology Annual Meeting in New Orleans.

According to the abstract, 49 individuals, average age 17½ years, were reported to their poison center between 2000-2006.

Study findings:

• 27 males and 22 females were involved
  
• Ages ranged from 19 mo–48 years (the 19 mo was an unintentional exposure; the rest were intentional)
  
• >33% resulted in moderately severe clinical symptoms: loss of consciousness, seizures, 2nd/3rd degree burns/frostbite, & dysrrhythmias
  
• There was 1 death
  
• 29 were referred to health care facility

"Dusting" can have serious consequences so it is very important that parents can recognize when their child is abusing inhalants. For more information, see Inhalant Use.

Sports Safety

Gymnastics-related Injuries to Children

More than 600,000 US children take part in school-sponsored and club-level gymnastics competitions each year (1).

Increased skill difficulty practiced at younger ages, coupled with maintaining the intensity and hours of training required to be competitive, has led to concern regarding the risk, severity, and long-term effects of injury to young gymnasts (2).

Also, gymnastics has one of the highest injury rates of all girls' sports (3).

In this months issue of Pediatrics, a study is published that describes the epidemiology of gymnastics-related injuries among children in the United States.

A review of data for children 6 - 17 years of age from the
National Electronic Injury Surveillance System of the US Consumer Product Safety Commission for 1990 through 2005 was performed.

The major findings include:

• An estimated 425,900 children 6 - 17 years of age were treated in US hospital emergency departments for gymnastics-related injuries during the 16-year period of 1990–2005.
  
  
• The number of injuries averaged 26,600 annually.
  
  
• The average age of injured participants was 11.5 years; 82.1% were female
  
   
• The number of injuries sustained was 4.8/1000 gymnastics
  participants per year.
  
  
• The number of injuries sustained per 1000
  participants per year was greater for the ages 12 to 17 years (7.4) than for the ages 6 to 11 years (3.6).
  
  
• The place where an injury occurred include school (40.0%), a place of recreation or sports (39.7%), home (14.5%),
  or on other public property (5.8%).
  
  
• The body parts injured were upper extremity (42.3%), lower extremity (33.8%), head/neck (12.9%), trunk (10.4%), and other (0.6%).
  
  
• Injury diagnoses were strain/sprain (44.5%), fracture/dislocation (30.4%), abrasion/contusion (15.6%), laceration/avulsion (3.7%), concussion/closed head injury (1.7%),
  and other (4.2%).
  
  
• Upper extremity fractures/dislocations were most common for children 6 to 11 years of age (50.2%).
  
  
• Lower extremity sprains/strains were most common for children 12 to 17 years of age (51.8%).
  
  
• The gymnastic skills being performed at the time of injury were handsprings/flips (42.3%), cartwheels/round-offs (30.7%), handstands (8.9%), dismounts/landings (5.8%), somersaults (4.9%), backbends/walkovers (3.5%), splits (2.1%), and headstands (1.7%).
  
  
• The majority (97.1%) of patients with gymnastics-related injuries were treated and released from the emergency department.

According to the authors of the study, prevention of gymnastics-related injuries depends on the establishment and universal enforcement of uniform rules and regulations for gymnasts, coaches, and spotters.

At this time, a set of uniform rules and regulations has not been developed or implemented. Whereas some high school gymnastics programs and private gyms require safety training for their gymnasts and coaches, many fail to implement such training programs.

A standardized program, including how to fall correctly, how to land safely, how to advance gymnasts to harder skills, and how to spot correctly, should be required for all coaches and gymnasts to ensure proper safety education.

1. The Gym Sports Resource Center. Gymnastics Injuries. Available at: www.usgyms.net/injuries.htm.

2. Caine DJ, Nassar L. Gymnastics injuries. Med Sport Sci. 2005;48 :18–58.

3. Caine D, Caine C, Maffulli N. Incidence and distribution of pediatric sport-related injuries. Clin J Sport Med. 2006;16 (6):500 –513.

Asthma

Does Singulair Increase the Risk of Suicide? (4/08)

The Food and Drug Administration (FDA) announced last week that it is working with the drug company Merck to investigate a possible link between Merck's asthma and allergy drug Singulair and behavior/mood changes, suicidality (suicidal thinking and behavior), and suicide.

The agency said the review was prompted by three to four suicide reports it received since last October.

The FDA's investigation may take nine months. As of now, the FDA has not established a "causal relationship" between Merck's drug and suicidal behavior.

The FDA notes that over the past year, Merck has updated Singulair's prescribing information and patient information several times to include the following postmarketing adverse events: tremor (March 2007), depression (April 2007), suicidality (October 2007), and anxiousness (February 2008).

In February 2008, the FDA and Merck discussed how best to communicate these labeling changes to prescribers and patients.
 
According to the FDA, Merck plans to highlight the recent changes in the prescribing information in face-to-face interactions with prescribers and to provide prescribers patient information leaflets about Singulair.

In response to inquiries received by the FDA, the FDA has asked Merck to evaluate Singulair study data for more information about suicidality and suicide. The FDA is also reviewing its postmarketing reports of
behavior/mood changes, suicidality, and suicide in patients who took Singulair.

According to Merck, in 40 clinical studies of some 11,000 patients who took Singulair as part of a placebo-controlled trial, there
were no reports of suicide.

And in other studies comparing Singulair to other types of asthma therapies including inhaled corticosteroids and long-acting beta agonists, out of roughly 3,900 patients taking Singulair and 3,400 using other asthma treatments, one patient taking Singulair and three patients taking other asthma treatments attempted suicide.

What should you do as a parent of a child taking Singulair?

• The FDA calls Singulair "effective" and advises patients with questions not to stop taking Singulair before talking to their doctor.
  
  
• The FDA also asks health care professionals and caregivers to monitor patients taking Singulair for suicidality and changes in behavior and mood.
  
  
• The FDA urges health care professionals and patients to report side effects from the use of Singulair and other similar drugs (Accolate, Zyflo, and Zyflo CR) to the FDA's MedWatch Adverse Event Reporting program.
  
  
• To report to Medwatch go to http://www.fda.gov/medwatch/index.html or call 800-332-1088.
  

Toy Safety

MagnaMan Magnetic Action Figures Recalled (3/08)

Toy distributor Mega Brands Inc. recalled about 2.4 million Chinese-made toys last week because small magnets could fall out and if more than one were swallowed by a child, lead to intestinal perforation, infection or blockage.

Mega Brands is recalling 1.1 million Magtastik and Magnetix Jr. preschool toys. The company and the Consumer Product Safety Commission have received 19 reports of magnets falling out of these toys.

The recall also includes about 1.3 million MagnaMan magnetic action figures. The company and commission have received 25 reports of magnets falling out of the figures. No incidents involving magnets from the action figures have been reported.

The recalled MagnaMan magnetic toys are figures that have body parts which attach with magnets. They come in either a "Futuristic Warrior" or "Ancient Warrior" theme and each figure comes with three accessories.

Name | Color | Model #
Alien | Green | 28170
Robotor | Red | 28171
Flame | Orange | 28172
Gigantor | Blue | 28173
Toyoto the Samurai | Purple | 28164
Sir Lancelot the Knight | Gray | 28165
Eric the Viking | Blue | 28166
Brutus the Gladiator | Yellow | 28167
RobotAssortment | 28198
Vac Metal | 28327
4-Pack | 28175
3-Pack | 28393
2-Pack | 28392
Vac Metal Assortment | 28327
Assortment | 28254 or 28199

Monday’s recalled products were sold at toy stores around the country, including Wal-Mart, Target, Toys “R” Us and Kmart between January 2005 and December 2007.

For details on the recall, or on how to return the toys and receive a free replacement, consumers can call 800-779-7122. Information is also available at megabrands.com or cpsc.gov.

Smoking

Secondhand Smoke and Heart Disease in Children (3/08)

Last July, I posted a study on the damage a child's arteries by Secondhand Tobacco Smoke (see review).

In a seperate study, researchers from Nationwide Children's Hospital and Research Institute in Columbus, Ohio reported at the American
Heart Association's 48th Annual Conference on Cardiovascular Disease Epidemiology and Prevention reported a similiar conclusion: 

Secondhand smoke in the home appears to induce inflammatory markers for heart disease as early as the toddler years.

The study included 128 children, 2 to 5 years old and adolescents 9 to 14.

Nicotine levels were measured in the children's hair and the inflammatory markers were measured in the children's blood.

Researchers found that children ages 2 to 5 absorbed six times more nicotine than children 9 to 14 from the same levels of parental smoking.

That exposure resulted in a dramatic increase of markers of inflammation and vascular injury signaling damage to the endothelium, the inner lining of the vessel walls. The vascular endothelium plays a key role in promoting cardiovascular health by maintaining the tone and circulation of the arteries.

One specific marker, ICAM, indicates endothelial cell stress, which contributes to artery clogging and atherosclerosis, raising the risk of heart disease.

Although further study is needed to give a long-term picture of the effects of secondhand smoke on the developing cardiovascular system of children, this is again some scientific evidence that secondhand smoke can possibly affect children's health other than their lungs.

For more info go to Secondhand Smoke.

Urinary Tract Infections

Does Antibiotic Prophylaxis Prevent Urinary Infections in Children with Vesicoureteral Reflux (4/08)

Last October, I posted the results from a large study published in the July 11 issue of the Journal of the American Medical Association (JAMA 2007;298:179-86), in which researchers asked the question, "should antibiotics be prescribed over a long period of time (prophylaxis) for every child with recurrent urinary tract infection (UTI), even when vesicoureteral reflux is present?" See October UTI News.

As part of diagnosis and treatment of A UTI in young children, the American Academy of Pediatrics recommends conducting an imaging study to evaluate the presence and severity or grade of vesicoureteral reflux (VUR, a backflow of urine from the bladder into the ureter). Some 30 - 40% of children with UTI also have this condition.

If the child does have VUR, the AAP guidelines recommend giving daily antibiotic treatment in an attempt to prevent future UTIs (i.e., prophylaxis).

The forementioned JAMA study questions this routine practice, atleast in children with less severe VUR. When the authors compared children who received prophylaxis with those who did not, there was no real difference in rates of recurrent UTIs (i.e., preventive antimicrobial therapy did not lower a child's risk of recurrent UTI).

In a more recent study from France published in the Journal of Urology (2008 Feb;179(2):674-9), the objective was to determine whether antibiotic prophylaxis reduced the incidence of urinary tract infection in young children with low grade vesicoureteral reflux (grades are I - V with V being the most severe).

Children 1 month to 3 years old with grade I to III vesicoureteral reflux were assigned randomly to receive daily cotrimoxazole or no treatment, and followed for 18 months.

A total of 225 children were enrolled in the study. There was no difference of gender, age at inclusion and reflux grade between the 2 groups.

Study Findings:

• Overall, there was no significant difference in the occurrence of urinary tract infection between the 2 groups.
  
  
• However, a significant association was found between treatment and patient gender. Prophylaxis significantly reduced urinary tract infection in boys, most notably in boys with grade III vesicoureteral reflux.
  
  
• These data suggest that antibiotic prophylaxis does not reduce the overall incidence of urinary tract infection in children with low grade vesicoureteral reflux.
  
  
• However, the authors concluded, such a strategy of antibiotic prophylaxis may prevent further urinary tract infection
  in boys with grade III reflux.

After reviewing the JAMA study last October, I wrote, "Until we get more definitive data, we can probably be more selective in deciding which patients with a first UTI should receive antimicrobial prophylaxis without exposing these children to extra risks.

One consideration for pediatricians is to limit prophylaxis to those in whom imaging shows either grade 4 or 5 VUR or other obstructive anatomic abnormalities and simply observe children with less severe reflux for recurrent infections."

This still stands at this point in time with the consideration of treating boys with grade III reflux based on the study in the Journal of Urology.

Again, parents should discuss with their child's pediatrician the risk and unclear benefits of daily preventive antibiotic treatment after a first-time UTI. 

For more information on UTIs, including what increases the risk and signs/symptoms, click on UTI.

Internet Safety

Online Dangers for Kids and Teens

With internet use by our kids and teenagers booming, identifying effective Internet safety messages is a very important children's health issue.

I'll first review two studies from last year and one from this month to help emphasize risk factors for falling victim to an online sexual predator and then post some useful resources, including safety tips. Some common themes are present in these study results.

Study 1: February issue 2007 of Archives of Pediatrics & Adolescent Medicine 

This study found that teens who converse with strangers online in many different ways are more likely to fall prey to online harassment than teens who just share their personal information on the Web.

According to the article, about 9% of children who use the Internet are targets of harassment, and 13% are targets of unwanted sexual solicitation every year.

The study analyzed data from a 2005 telephone survey involving 1500 American children aged 10 to 17. All participants had used the Internet at least once a month for the past six months.

For the study, 9 online behaviors were believed to increase the risk of online victimization, including:

1. putting personal information online
2. sending personal information online
3. harassing or embarrassing someone
4. making rude or nasty comments
5. meeting someone online
6. having people known only online on a buddy list
7. talking about sex with someone known only online
8. purposely visiting an X-rated Web site
9. downloading images from a file-sharing program

Other study results:

• One in 5 (300 [20.0%]) youth reported unwanted interpersonal victimization online in the previous year.
• Potentially risky online behaviors also were reported frequently:
• 1125 (75.0%) teens engaged in at least 1 of the 9 online behaviors assessed.
• One in 4 (422 [28.2%]) teens engaged in 4 or more different types of online behavior in the previous year. 
• The most common behavior was posting personal information online.
• Teens who engaged in four types of behavior were 11 times more likely to have been victimized than those reporting none of the behaviors.
  

Study 2: August edition 2007 of the Journal of Adolescent Health

In a survey of 1,500 U.S. adolescents aged 10-17, 300 kids (20%) reported interpersonal online victimization, defined as unwanted sexual solicitations or other types of harassment, within the past year.

Among the victimized participants, 65 kids said their victimizer had asked them for sexual pictures.

Kids were more likely to be asked for sexual pictures of themselves when they were communicating with an adult they had met online who had sent them a sexual picture of himself or herself and had attempted to contact them by phone or in person.

Study 3: February/March issue 2008 of American Psychologist

The question asked in this study was, "what is the typical online sexual predator"?

The study found that the typical online sexual predator is not someone posing as a teen to lure unsuspecting victims into face-to-face meetings; rather, they tend to be adult males who make their intentions of a sexual encounter known to vulnerable young teens who often believe they are in love with the predator.

The study was based on telephone interviews with 3,000 Internet users between the ages of 10 and 17 done in 2000 and again in 2005. The researchers also conducted more than 600 interviews with federal, state and local law enforcement officials in the United States.

Other findings of the study:

1. Internet offenders pretended to be teenagers in only 5% of the crimes studied.
   
2. Nearly 75% of victims who met their offenders in person did so on more than one occasion.
   
3. Internet predators use instant messages, e-mail and chat rooms to meet and develop intimate relationships with their victims.
   
4. Teens who engaged in risky online behaviors (e.g., having buddy lists that included strangers, discussing sex online with strangers, being rude online) were much more likely to be targeted.

For 10 excellent Internet Safety Tips for Kids, go to http://www.safekids.com/kidsrules.htm

Tools like Family Safety from Windows® Live OneCare^TM can help you create a safer environment for your kids while they surf the Net.

For more information on this valuable tool, safety tips and additional resources, please visit http://safetynet.aap.org/.

Another useful resource is i-SAFE Inc., the worldwide leader in Internet safety education. Founded in 1998 and endorsed by the U.S. Congress, i-SAFE is a non-profit foundation dedicated to protecting the online experiences of youth. Go to http://www.isafe.org/ for more information.

Smoking

Parents' Smoking Boosts Child's Allergy Risk

A study published in the journal Thorax in December concluded that exposure to secondhand smoke in early infancy can boost a child's risk of developing allergies.

Researchers from Stockholm analyzed questionnaires filled out by the parents of more than 4,000 families.

The parents filled out the questionnaires when their children were ages two months, 12 months, 2 years and 4 years.

In addition, the researchers collected blood samples from more than 2,500 children at the age of 4 to check for the presence of immunoglobulin E (IgE), which is released by the immune system in response to allergens.

The most important findings included:

1. About 20% of parents smoked after their baby was born, and about 4% of the children were exposed to secondhand smoke from both parents.
   
   
2. Overall, 25% of the children had high IgE levels by the time they were 4 years old, with 15% allergic to inhaled allergens (e.g., pollen), 16% allergic to food allergens, and 7% allergic to both types of allergens.
   
   
3. Compared to children of nonsmokers, children exposed to secondhand smoke during early infancy were almost twice as likely to be allergic to inhaled allergens, such as pet dander, and about 50% more likely to have food allergies.

For more info go to Secondhand Smoke.

Mercury poisoning

Infants Eliminate Mercury In Vaccines Faster Than Previously Thought

There has certainly been a lot of debate over the past few years on whether or not the accumulation in the body of a mercury-containing preservative in vaccines (thimerosal) is a contributory factor for autism.

I have previously reviewed several large research studies on this topic; none of which have shown a link between thimerosal exposure and autism (for a review of these studies as well as an overview on mercury poisoning and thimerosal, go to Mercury Poisoning).

According to a study published just last month in the journal Pediatrics, mercury is eliminated by infants faster than previously thought. In fact, it seems that the human body eliminates thimerosal 10 times faster than the mercury that may be ingested as a result of eating fish.

The study, which was performed in Argentina, consisted of 216 infants divided in three groups.

The scientists gave each baby a thimerosal-containing vaccine. Most of the babies had their blood mercury, stool mercury and urine mercury levels tested prior to vaccination and then again after vaccination.

They found mercury in all the post-vaccination stool samples. They did not however, find any mercury in the post-vaccination urine tests. This indicated that the mercury was eliminated through the gut. A good sign as mercury at high levels is toxic to kidneys.

The researchers found that the half-life (how long it takes for the chemical concentration to be halved in the body) of ethyl mercury in the blood was 3.7 days, compared to 44 days for mercury found in some foods. In all age groups, the blood mercury levels quickly dropped and the levels in most kids had returned to normal bt 11 days after vaccination.

The scientists found that the 6-month old babies, who had received more thimerosal than the babies in the other two groups, had the same blood-mercury levels as the pre-vaccination two-month old babies. This indicates that the mercury is eliminated between each bout of pediatric vaccines.

This is reassuring information for families in other countries where thimerosal-containing vaccines are still used.

Pediatrics Vol. 121 No. 2 February 2008, pp. e208-e214

Car Safety

Risk Factors for Childhood Death in Car Accidents

In the March edition of Archives of Pediatrics & Adolescent Medicine, a study is published in which researchers examined national data on serious car crashes including those resulting in death between 2000 and 2005.

During that time, 2.5 million children aged 8 to 17 were involved in crashes and 9,807 died. The study outlines some of the most dangerous circumstances for these crashes: riding unbuckled with new teen drivers on high-speed roads.

Specific findings of the study:

• 54 percent were riding with a teen driver.
  
• Drivers younger than 16 were the most dangerous.
  
• More than 3/4 of the fatal crashes occurred on roads with speed limits higher than 45 mph
  
• Nearly 2/3 of the young passengers were not wearing seat belts
  

• The risk of death for kids riding with drivers aged 16 to 19 was at least double that of those riding with drivers aged 25 and older.

• Other dangerous circumstances for young passengers included drivers who’d been drinking alcohol, male teen drivers, and driving on weekends. 

According to the study, no states have all the driving restrictions recommended by State Farm Auto Insurance Company, the American Academy of Pediatrics and the Children's Hospital of Philadelphia. For example:

• The minimum age for a learner’s permits should be 16, but nine states grant them to 14-year-olds and at least 30 others give them to 15-year-olds.
  
• Drivers younger than 18 should not be allowed to have more than one teen passenger without adult supervision, but only 34 states have that restriction.

The message for us parents is simple:

1. Don’t let your teen ride with a teen driver who has less than a year’s experience driving.
2. Insist on seat belts.
3. Encourage your teen to resist peer pressure to ride with other teens. 

Immunizations

Flu Update and CDC Vaccine Committee Recommends Flu Shots to All Children and Teens (3/08)

Every state in the US is seeing a widespread number of flu cases. The Centers for Disease Control and Prevention (CDC) said the current vaccine is a good match for only about 40% of the spreading flu viruses.

The influenza A H3N2/Brisbane-like strain emerged at the end of Australia's influenza season, too late for inclusion in US flu vaccines. The current flu vaccine should provide cross-protection against the new strain; therefore, even if you get the flu, it could be less severe and not last as long.

Just last week, the CDC's Advisory Committee for Immunization Practices (ACIP) recommended that flu shots be administered annually to children six months through 18 years of age beginning in the fall of 2008.

Previously, the recommendation were for all children 6 months to 5 years of age and children with chronic diseases.

The agency said healthy children bear "a significant burden" from flu. In addition, there is evidence that reducing flu transmission in children may limit its spread among their household contacts and in the community by increasing the resistance to the flu.

Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, said the recommendation should reduce children's need for flu-related medical care and school absenteeism.

Last week the CDC reported that 22 children had died of flu so far this season. In the 2006-07 season, 68 children died of flu-related causes, including 39 who were between the ages of 5 and 17, according to CDC data. Of 53 children older than 6 months whose vaccination status was known, 50 had not been vaccinated.

The CDC said ACIP recommendations become official CDC recommendations as soon as they are accepted by the CDC director and the secretary of the Department of Health and Human Services.

In the wake of ACIP's recommendation, MedImmune announced plans to raise production of its nasal-spray flu vaccine, FluMist, to 12 million doses for next season, nearly triple this year's production.

For more information on the flu, go to Influenza.

Health Alerts

Crib Recall and Safety Tips (3/08)

The Consumer Product Safety Commission (CPSC) announced a recall of 24,000 cribs last week and also warned parents against putting their babies to bed with pillows and other soft bedding that could suffocate them.

The 24,000 Indonesian-made cribs were recalled for putting children at risk of falling out. The cribs, imported by Munire Furniture Inc., have improper brackets that don’t allow their mattresses to be fully lowered. This could allow children inside the crib to crawl over the railing and fall.

The recall includes the company’s Majestic Curved Top, Majestic Flat Top, Essex, Brighton/Sussex and Captiva cribs with various model numbers. The cribs were sold at children’s specialty stores between November 2005 and November 2007. 

For more details on the crib recall, call 866-586-9639 or visit the firm’s Web site at www.munirefurniture.com

The CPSC recently published data from 2002-2004 in which 241 children under age 5 died in incidents involving nursery products; about 40% of the deaths involved cribs, with soft bedding cited as the leading contributing factor. Many of the children suffocated when lying face down on pillows or other bedding.

For safety tips from the CPSC, go to Crib Safety Tips.

Childhood Safety

ATV Accidents Killed More Than 100 Kids in 2006

According to the Consumer Product Safety Commission (CPSC), at least 555 people, including more than 100 children, died in all terrain vehicle (ATV) accidents in 2006. And all the numbers are not in yet so these numbers will rise.

The CPSC estimated that an additional 146,600 people were treated in emergency rooms for ATV-related injuries; more than a quarter of them children.

In its annual report released Thursday, the CPSC said Pennsylvania has had the highest number of reported ATV deaths since 1982, followed by California, West Virginia, Texas and Kentucky.

Also, the agency recently announced the recall of about 95,000 Polaris ATVs because they can have defective control panels that could catch fire. The Minnesota-based company has received 372 reports of smoking and or melting control panels since June 2005, when 45,000 of the ATVs were recalled. There have been another 20 reports of fires. No injuries have been reported.

Most of the deaths and injuries to children are the result of kids riding adult-size ATVs. Under a voluntary agreement between the industry and the commission, major ATV distributors require dealers not to sell adult-size ATVs to people who might allow children to ride them, but are they following the rule?

In more than 75% of the incidents where speed could be determined, it appeared that ATVs were going too fast for conditions. In nearly 60% of the fatalities, riders were not wearing helmets.

See Head injury for more information on the consequences of a child not wearing a helment.

Meningitis

Protect Your Adolescents Against Meningitis

We have talked a lot this winter about preventing influenza (the flu) in young children, but we must not overlook prevention of meningitis in adolescents, particularly vaccination against meningococcal disease.

Meningitis is an inflammation and swelling of the tissues that cover the brain and spinal cord. 


Meningococcal disease, one form of meningitis, is a potentially deadly bacterial infection that can strike adolescents and young adults. While meningococcal disease can occur at any point throughout the year, cases peak in the late-winter and early-spring months reinforcing the importance of seeking vaccination this time of year rather than waiting for back-to-school physicals.

Bacterial meningitis is less common than viral meningitis (also called aseptic meningitis) but is usually much more serious and can be life-threatening if not treated promptly.

To help prevent infection, the Centers for Disease Control and Prevention recommends meningococcal vaccination for all adolescents 11 through 18 years of age and college freshmen living in dormitories.

However, according to a recent national consumer awareness survey conducted by the National Meningitis Association (NMA), nearly 1/2 of parents polled were unaware that their adolescent children were recommended for vaccination.

Meningococcal disease is spread through air droplets and direct contact with those who are infected, such as through coughing or kissing. Early symptoms may include high fever, headache, stiff neck, confusion, nausea, vomiting and exhaustion. In later stages, a rash may appear.

Adolescents and young adults are at increased risk for the disease, accounting for nearly 30% of all U.S. cases. Certain lifestyle factors, such as dormitory-style living, prolonged close contact with large groups of other adolescents and irregular sleep patterns are thought to put adolescents at increased risk for the infection.

While there are steps your children can take to help protect themselves, such as getting enough rest and maintaining a healthy lifestyle, vaccination is the best way to prevent meningococcal disease.

For more information on meningitis, go to Meningitis.

For more information about NMA, go to http://www.nmaus.org.

Childhood Safety

CDC Study Warns Of Deaths Due To The Choking Game

At least 82 youth have died as a result of playing what has been called "the choking game," according to a study released by the Centers for Disease Control and Prevention in a recent Morbidity and Mortality Weekly Report.

The choking game involves intentionally trying to choke oneself or another in an effort to obtain a brief euphoric state or "high." Death or serious injury can result if strangulation is prolonged.

Here are some of the stats from this disturbing CDC study:

1. Eighty-seven percent of these deaths were among males
   
2. Most fatalities occurred among those 11 years to 16 years old
   
3. Choking game deaths were identified in 31 states
   
4. Most of the deaths occurred when a child engaged in the choking game alone
   
5. Most parents were unaware of the choking game prior to their child's death

CDC said the study probably underestimates the number of deaths as only media reports of deaths attributed to the choking game were analyzed.

Signs that a child may be engaging in the choking game include:

1. discussion of the game - including other terms used for it, such as "pass-out game" or "space monkey" 
   
2. bloodshot eyes
   
3. marks on the neck
   
4. severe headaches
   
5. disorientation after spending time alone
   
6. ropes, scarves, and belts tied to bedroom furniture or doorknobs or found knotted on the floor
   

If you believe your child is playing the choking game, you should speak to them about the life-threatening dangers associated with the game and seek additional help if necessary through your pediatrician.

Steroid Use

Teens Willing to Risk Their Health Using Steroids

I wanted to review the disturbing results of a study published in the January issue of Medicine & Science in Sports & Exercise to increase awareness about anabolic steroid and nutritional supplement use in our teens.

A confidential self-report survey was administered to over 3000 students representing grades 8-12 in 12 states in the United States by their teachers during homeroom or physical education class.

Here are some of the important findings:

1. Use of at least one supplement was reported by 71% of the adolescents surveyed.
   
   
2. The most popular supplements used were multivitamins and high-energy drinks. 
   
   
3. 17% said they had used supplements such as protein powders, creatine and amino acids to gain body mass.
   
   

4. 35% said they had used supplements such as fat burners, high-energy drinks, ephedra and caffeine pills in an attempt to lose weight. The more supplements kids took, the more likely they were to also use steroids.

5. The use of supplements to increase body mass and strength, and to reduce body fat or mass, increased across grade and was more prevalent in males than females.

6. The number of students that self-reported anabolic steroids use was 1.6% (2.4% males and 0.8% females).

7. Steroid use increased with age, especially in boys, with almost
   6% of 12th grade males reporting steroid use.

8. Adolescents also seemed willing to take more risks with supplements to achieve their fitness or athletic goals, even if these risks reduced health or caused premature death.

9. Among students in grades 8 through 12 who admitted to using anabolic steroids, 57% said professional athletes influenced their decision to use the drugs.

10. 80% of users said they believed steroids could help them achieve their athletic dreams.

11. The survey found that 65% of steroid users versus 6% of non-users said they would be willing to use a pill or powder, including dietary supplements, if it guaranteed they would reach their athletic goals even if it may harm their health

12. 57% of steroid users and 12% of non-users said they believe pro athletes have the right to use steroids.
    
    

13. 60% of users and 29% of non-users actually thought using anabolic steroids for athletic purposes is legal.

Is your child on steroids?

Parents can be on the look-out for the following symptoms of steroid use:

• Rapid, improbable gains in muscle and weight
• Aggressive behavior known as ‘roid rage’
• Mood swings
• Worsening acne, often on the chest and back
• Breast enlargement in boys
• Facial hair growth in girls
• Deepened voice in girls

If you suspect your child is using steroids, consult your pediatrician who can evaluate your child and get him/her help if needed.
 
 

Cold medications

Honey May Help Improve Cough

Since the U.S. Food and Drug Administration's recent recommendation that cough and cold medicines not be given to children under 6 years old, us parents are certainly wondering what to give our kids when they come down with a bad cold. 

According to a study published in the December issue of Archives of Pediatrics & Adolescent Medicine giving a child with a cough a single dose of buckwheat honey just before bedtime may relieve the cough and help him/her sleep better, compared to giving nothing or an OTC (over-the-counter) cough medicine.


The study from Penn State College of Medicine evaluated 105 children aged 2-18 who all were suffering from upper respiratory tract infections.

Thirty five of them were randomly selected to receive a dose of buckwheat honey (a dark variety), another 33 were given dextromethorphan (a cough suppressant), while the other 37 were given nothing. Those receiving treatment got it 30 minutes before bedtime.

Their parents had to fill in a survey assessing their child's cough and sleep difficulty twice - once for the night before treatment, and then again for the night with treatment.

The researchers found that honey decreased the frequency and severity of children's coughs associated with upper respiratory tract infections, thus improving both their sleep and their parents' sleep. Dextromethorphan wasn't any better than no treatment at all in a study comparing the three strategies.

Parents reported mild adverse events such as hyperactivity, nervousness, or insomnia in five children who received honey and two who received dextromethorphan, compared with none of the children in the no-treatment group.

Among the limitations of this study noted by the researchers was that much of the improvement in all groups “can also be attributed to the natural history of [upper respiratory tract infections], which generally improve with time and supportive care."


How does honey work to relieve cough? There may be more than one reason for this: the type of honey used in the study was buckwheat honey, which is a dark honey containing higher levels of phenolic compounds than light honey, and phenolic compounds have antioxidant properties.

On the other hand, the mechanism of action involved with the honey treatment might only be its demulcent properties (soothe irritated mucous membranes and thereby remove the irritation that is fueling the cough reflex).

Further studies would be helpful to confirm these findings, but in the meantime a dose of honey before bed in a child with a cough in general should not be a problem.


Honey is a known source of bacterial spores that produce Clostridium botulinum bacteria, and in children less than 1 year old there is risk of infant botulism. Therefore, do not give honey to a child less than 1 year of age.

Bisphenol A (BPA)

Polycarbonate Plastic Bottles Release Chemical When Boiling Water Added

Bisphenol A (BPA) is a chemical compound used to manufacture polycarbonate plastics. These plastics are used as linings on many consumer products including sports bottles and baby bottles.

BPA may be released from a polycarbonate plastic as a result of routine activities like heating liquids, storing acidic foods, and washing containers; this may cause the chemical to leach directly into food or drinks.

BPA has been shown to cause reproductive effects in animals; it is unknown of its effects in humans. For more information, click on Bisphenol A.

In a laboratory study from the University of Cincinnati College of Medicine which was released recently in the Toxicology Letter, researchers investigated whether BPA would be released from plastic bottles under normal usage during backpacking, mountaineering, and other outdoor activities. 

The researchers used new or used polycarbonate (PC) drinking bottles, or new drinking bottles made of high-density polyethylene (HDPE).  Baby bottles were not studied.

The researchers say that their study has confirmed the findings of previous research that bisphenol-A (BPA) can leach out from polycarbonate plastic bottles when heated water is added (15 to 55 times greater rate when heated).

Although this study did not use babies' bottles, it raises issues about the safety of polycarbonates in general. 

Further study concerning baby bottles and the possible health effects of this chemical in children is certainly needed.

In the meantime, it is probably best to minimize exposure to this chemical when possible. For further details, see Bisphenol A. I will keep you posted on any further developments.

National Health Observances

National Children's Dental Health Month

February is National Children's Dental Health Month. It's sponsored each year by the American Dental Association (ADA) to raise awareness among families and policymakers about the critical importance to children of good practices of oral health.

The ADA recommends regular dental check-ups, including a visit to the dentist within six months of the eruption of the first tooth, and no later than the child's first birthday.

For more information, go to ADA.

Household pests

Bedbugs Making a Comeback

Bedbugs, that pest from the old bedtime rhyme (Sleep tight. Don't let the bedbugs bite), are increasingly becoming a problem within residences of all kinds, including homes, apartments and hotels.

According to the National Pest Management Association (NPMA), their member pest control companies are receiving 50 times more bedbug calls a year over the last 5 years.

So what are these pests, why are they back and how can you keep your kids safe from them?

For a new fact sheet we created on these pesty creatures, go to Bedbugs.

Abdominal pain

Constipation Most Common Cause Of Children's Abdominal Pain

A new study led by a University of Iowa researcher showed that acute and chronic constipation together accounted for nearly half of all cases of acute abdominal pain in children treated at one hospital.

The findings, which were based on medical records of 962 children ages 4 to nearly 18, were published in the December 2007 issue of the Journal of Pediatrics.

According to the authors, "constipation can be overlooked as the cause of severe or intermittent abdominal pain, as a reporting of symptoms
alone does not always establish that a child has constipation."

Constipation signs include fewer than three bowel movements per week, one or more episodes of stool incontinence per week, passing of stools so large that they obstruct the toilet, retentive posturing (withholding behavior) and painful defecation.

The study found that 83 (9 percent) of 962 children who had received at least one "well-child" visit during a six-month period in 2004 reported acute abdominal pain at that visit or another clinic or emergency visit.

Significantly more girls (12 percent of the 962) reported such pain, compared to only 5 percent of boys.

Together, acute constipation (lasting eight or fewer weeks) and chronic constipation (lasting eight or more weeks) accounted for 48 percent of the cases (40 children), making it the most common cause of the pain.

Only 2 percent of the children with pain had a surgical condition such as appendicitis. In addition, doctors could not determine causes for 19 percent of the patients with pain.

Go to Abdominal pain to find out:

What questions should I be prepared to answer by the doctor concerning abdominal pain in my child

and

What signs and symptoms may suggest a serious cause for abdominal pain and require immediate medical treatment

Newborn illness

Clinical Signs that Predict Severe Illness in Children Under Age 2 Months

According to a January article in The Lancet, a checklist of seven clinical signs and symptoms could help identify sick newborns, aged up to 2 months, with possibly severe illness who are brought to health facilities.

Researchers carried out a multicenter study in South Africa, Pakistan, India, Ghana, Bolivia and Bangladesh.

They assessed the performance of 31 simple clinical signs - when alone or in combination. First-line health workers used them to detect infants with severe illness who required hospitalization (excluding jaundice), and compared their accuracy to the judgment made by an expert pediatrician.

They studied over 3,000 newborns aged 0-6 days and over 5,500 infants aged 7-59 days.

12 symptoms or signs predicted severe illness in the first week of life:   

1. history of difficulty feeding 
2. history of seizures 
3. lethargy
4. movement only when stimulated
5. respiratory rate of 60 breaths per minute or more 
6. grunting
7. severe chest indrawing
8. temperature of 37·5°C or more 
9. temperature below 35·5°C 
10. prolonged capillary refill (how fast color comes back after you press on the fingers or toes - should be less than 2 seconds)
11. cyanosis (turning blue)
12. stiff limbs 
    

The researchers then reduced the list to seven signs that were noted most commonly.

1 - history of difficulty feeding
2 - history of seizures
3 - movement only when stimulated
4 - respiratory rate of 60 breaths per minute or more
5 - severe chest indrawing
6 - temperature of 37•5°C (99.4°F) or more
7 - temperature below 35•5°C (< 96°F)

With one exception, any of the 12 signs above warrants a medical evaluation in an infant.

In our country, the standard of care for medical evaluation of neonatal fever, all other signs aside, is 38°C (100.4°F) taken rectally.

Marijuana use

Long-term Marijuana Smoking Significantly Impairs Lung Function

According to research published in the December 2007 edition of Thorax, long-term marijuana smoking significantly impairs lung function.

The researchers studied the lung health of 339 marijuana smokers, some of whom also smoked tobacco.

Marijuana smoking was associated with an increased risk of wheezing and coughing and feelings of tightness in the chest, similar to tobacco smoking.

However, marijuana smokers had twice the risk of chronic bronchitis and a 70 percent increased risk of asthma diagnosed after age 16 years.

Based on observed changes in lung function tests, the investigators calculated that one marijuana joint does as much harm as 2.5 to 5 tobacco cigarettes.

For details on marijuana use in teens, click on Marijuana.

National Health Observances

National Radon Action Month

The Environmental Protection Agency (EPA) has designated January as National Radon Action Month.

The EPA and the U.S. Surgeon General urge all Americans to protect their health by testing their homes for radon. According to the EPA, radon is the leading cause of lung cancer deaths among nonsmokers in America.

If a high radon level is detected in your home, you can take steps to fix the problem to protect yourself and your family.

Check out http://www.epa.gov/radon/nram/public.html to see 5 things you can do to protect your family from radon.

Also, for more information on radon on our website, click on Radon Exposure.

Immunizations

Haemophilus influenza type b Vaccine Recalled

The drug company Merck told the US Centers for Disease Control and Prevention (CDC) on December 12th that it is voluntarily recalling over one million doses of vaccines routinely given to babies and children as a precaution. 

The drug company said it was recalling 10 lots of PedvaxHIB vaccine and 2 lots of Comvax vaccine because they could not assure product sterility.

The Hib (Haemophilus influenzae type b) vaccine is commonly given over three or four doses to infants and toddlers at their 2, 4, 6, and 12 to 15 month checkups to prevent bacterial meningitis, pneumonia, epiglottitis, and other infections. Comvax also protects against hepatitis B.

During a routine standard check on manufacturing equipment used in making the two vaccines, Merck said they found signs of a bacteria called Bacillus cereus. However, when samples of the vaccines were tested before shipment, no such contamination was found.

B. cereus is a common cause of food poisoning, although it can cause other infections too, including skin infections and meningitis.

The CDC said Merck had assured them there were no reports of infection in children who received vaccines from affected lots. The CDC said the Vaccine Adverse Event Reporting System (VAERS) had also not detected any problems in connection with the vaccines affected by this recall.

According to the CDC, if your child has just had a Hib shot that later is found to have been contaminated, this may cause some minor skin irritation around the area. Immunocompromised children may be at the greater risk for these infections. These infections are most likely to occur within one week after vaccination. 

It is unlikely that your child recently got a PedvaxHib shot though, as Merck stopped shipments of the vaccine in mid November because of a "manufacturing problem." The current recall makes it more clear what that problem might have been.

If your child recently received a Hib (Haemophilus influenzae type b) vaccine that was involved in the recall and is showing signs of an infection, such as swelling and redness at the infection site, be sure to see your pediatrician.

Will children who received vaccine from affected lots need to be revaccinated?

No. Children who received Hib vaccine from affected lots do not need to be revaccinated. No potency concerns have been identified for these vaccine lots.

How does this impact the nation’s Hib vaccine supply? Are there other Hib vaccine manufacturers?

As a result of this recall, providers who only use Merck Hib vaccines may have none, some or all of their vaccine recalled, and about half of the Hib vaccine in CDC’s stockpile is being recalled.

CDC realizes that some providers will be faced with the prospect of having children to vaccinate with no vaccine available. There are two U.S. Hib vaccine manufacturers – Merck & Co., Inc. and sanofi pasteur. In the past, each manufacturer has produced about half of the nation’s Hib vaccine supply.

What is CDC doing in response to the shortage of Hib vaccine?

CDC is in contact with the two U.S. Hib vaccine manufacturers – Merck and sanofi pasteur. CDC is assessing availability of Hib vaccine and timing of future supply, and will make appropriate recommendations soon.

Flu (influenza)

Tamiflu News Update 12/02/07

In follow up to last weeks news update, the US Food and Drug Administration (FDA) Pediatric Advisory Committee recommended to the agency last week that makers of the flu drug Tamiflu be urged to change the drug's warning label to include the fact that the psychiatric symptoms experienced by children on the drug could be caused by having the flu.

The committee suggested that doctors and patients should be told that delirium, hallucinations, and other psychiatric reactions can be caused by flu itself, and may or may not be linked to the drug.

Some experts at the FDA do not feel that the current labeling on Tamiflu, and a related drug, Relenza, addresses the safety issues adequately.

The recommendation, in an 8-6 vote, reflects the FDA's own uncertainty about what caused nearly 600 psychiatric episodes since the drug was approved in 1999.

Bottom line: The definitive cause for the neuropsychiatric effects noted in some patients on Tamiflu or Relenza is unknown. A result of the drug, the flu itself, or a combination?

What should us as parents do?

• If your child is receiving Tamiflu for the treatment of influenza and you are concerned that he/she may be experiencing a drug-related adverse event, you should contact your pediatrician for advice and management.
  
• Adverse events should be reported to the FDA through the on-line MedWatch system at http://www.fda.gov/medwatch/ or by phone at 1-800-FDA-1088.
  
• Remember, the most effective way to prevent influenza and its complications is by getting the annual influenza vaccine for your child. 

Children younger than or equal to 8 years of age receiving their first influenza vaccine should receive the vaccine split into 2 doses given one month apart. Children from 6 months to 5 years of age and those with certain underlying medical conditions are considered at high risk for developing complications of influenza and are strongly encouraged to get the vaccine.

For more information on the signs and symptoms of the flu, as well as treatment, click on Influenza.

Flu (influenza)

FDA Recommends Warnings on Flu Drugs for Kids 11/26/07

I would like to update you on some news on the use of Tamiflu for the treatment of influenza, or the flu. If you recall, we reported last November that the Food and Drug Administration (FDA) issued a warning to watch for signs of unusual behavior in children taking Tamiflu and then in December after the FDA reported no link between Tamiflu use and the deaths of 12 Japanese children (see Nov 2006 News and December 2006 News).

Just to review first: Tamiflu is an antiviral drug approved for treatment of uncomplicated influenza A and B in patients 1 year of age or older. It is also approved for prophylaxis (prevention) of influenza in people 13 years or older after household contact or at high risk for exposure during influenza season. Tamiflu is available in both capsule and liquid formulations.

When used as directed (twice daily for 5 days) Tamiflu can reduce the duration of influenza symptoms in otherwise healthy children by 1 to 1 ½ days. It also appears to reduce the severity of common flu symptoms. Consequently, it may allow children to return to school or other normal activities sooner. Tamiflu is most effective when taken within 48 hours after the beginning of flu symptoms and not likely to be effective if patients have already had flu symptoms for several days.

The latest news: The FDA released its safety review of Tamiflu and another related medication, Relenza last Friday and recommended adding label precautions about neuropsychological problems seen in children who have taken these drugs to treat the flu.

Toy Safety

Trouble in Toyland

On November 20, 2007, the 22nd annual Public Interest Research Group (PIRG) survey of toy safety, titled "Trouble in Toyland" was released. This report provides safety guidelines for parents when purchasing toys for small children and provides examples of toys currently on store shelves that may pose potential safety hazards.

We have been bombarded with toy recalls this past year. These have primarily involved lead found in toys and choking hazards. My review of the toy safety report will focus on these two topics but I will also mention Neodymium iron boron (NIB) Magnets, plenty of safety tips and a list of age appropriate toys. 

For full details, go to Toy Safety.

Have a safe holiday season!

Cold medications

Cold Medicine Update 11/5/07

In follow up to last months news on the voluntary recall of over-the-counter infant cough and cold medications for children less than 2 years of age, a joint meeting of the Food and Drug Administration's (FDA) Nonprescription Drugs Advisory Committee and Pediatric Advisory Committee was recently held to review the safety and efficacy of over-the-counter (OTC) cough and cold products marketed for use in children under the age of 6. 

Due to a lack of proven effectiveness and the need for pediatric clinical trials, the committees recommended against the use of these products in children under the age of 6.

The Consumer Healthcare Products Association recently announced that several of the makers of the OTC medications voluntarily pulled their infant formulations from the market over concerns of misuse. The list of withdrawn products is as follows:

Dimetapp Decongestant Infant Drops
Dimetapp Decongestant Plus Cough Infant Drops
Little Colds Decongestant Plus Cough
Little Colds Multi-Symptom Cold Formula
Pediacare Infant Drops Decongestant (containing pseudoephedrine)
Pediacare Infant Drops Decongestant & Cough (containing pseudoephedrine)
Pediacare Infant Dropper Decongestant (containing phenylephrine)
Pediacare Infant Dropper Long-Acting Cough
Pediacare Infant Dropper Decongestant and Cough (containing phenylephrine)
Robitussin Infant Cough DM Drops
Triaminic Infant and Toddler Thin Strips Decongestant
Triaminic Infant and Toddler Thin Strips Decongestant Plus Cough
Tylenol Concentrated Infants&r