Healthy isn?t something you are or aren?t. It?s a hundred little things: eating a banana, walking in the park, putting a bandage on a boo-boo, playing tag, reading up on ways to keep you and your family well and safe. It?s a balance between living well and taking care, and you can start right where you are.
A blog by Christina Elston
Healthy isn't something you are or aren't. It's a hundred little things: eating a banana, walking in the park, putting a bandage on a boo-boo, playing tag, reading up on ways to keep you and your family well and safe. It's a balance between living well and taking care, and you can start right where you are.


Archive for the ‘Children’s Health’ Category

Health Gaps Based On Race, Income and Education Start Early

Wednesday, August 22nd, 2012

Black and Latino fifth-graders are much more likely than whites to witness gun violence, be obese and ride in a car without a seatbelt. These kinds of health gaps have gotten plenty of attention among teens, but attempts to fix them need to begin much earlier – especially in schools.

That’s the message Boston Children’s Hospital researchers are trying to get out on the heels of an extensive look at health disparities among elementary school children in various regions across the U.S. They also note that health gaps narrowed across all races when children had the advantages of educated parents with higher income, or attended certain kinds of schools.

In interviews with 5,000 children ages 10 and 11 and their parents, researchers asked about several health-related measures. Gaps they found included:

• Black children were four times more likely and Latino children and two times more likely than whites to have seen someone threatened or injured with a gun.

• Black fifth-graders were more likely to smoke cigarettes and drink alcohol than Latino and white fifth-graders.

• Obesity rates were nearly twice and high among Latino and black children as among white children, and these children reported less vigorous exercise than white children did.

• Black and Latino children were less likely than white children to wear a seatbelt or bike helmet.

The interviews were conducted between 2004 and 2006 among families living in and near Birmingham, AL; Houston, TX; and Los Angeles, CA. Because the behaviors detailed can have serious long-term impact on health (patterns of seatbelt use and violence, for instance, are known to persist into adulthood), the authors believe intervention efforts should begin before the teen years.

“We should be thinking about these issues when children are young enough to prevent bad outcomes before they occur,” says lead author Mark A. Schuster, M.D., Chief of General Pediatrics at Boston Children’s Hospital. And because schools seemed to have a major impact on narrowing health gaps, they should be a key focus. “Is it a visionary principal, committed teachers, a strong commitment to health education, an engaged PTA?” asks Schuster. “We need to learn more.”

The study appears in the Aug. 23 issue of the New England Journal of Medicine.

Study Says Declining Circumcision Rates Could Cost U.S. Billions

Monday, August 20th, 2012

Circumcision was once standard procedure for baby boys in the U.S. But as parents began to question whether it was really necessary, rates began to fall. And the practice continues to be controversial.

National and international studies point to the health benefits of circumcision – removal of the foreskin at the tip of the penis – finding it holds back buildup of bacteria and viruses in the penis’ skin folds. But the American Academy of Pediatrics (AAP) has stopped short of recommending it for all. In a post on their website dated July 30, the AAP says that while the organization believes circumcision has potential medical benefits, as well as risks, “the existing scientific evidence is not sufficient to recommend routine circumcision.” They suggest leaving the decision to individual parents and pediatricians.

Today just 55 % of the 2 million boys born yearly in the U.S. are circumcised, down from 79% in the 1970s and 1980s.

But Johns Hopkins disease experts and health economists warn that if parents continue to opt out, pushing circumcision rates down toward the 10% level that exists in Europe, rates of disease could climb – along with health care costs. The team constructed an economic model to predict the costs of not circumcising a male newborn, drawing on information from multiple studies and databases tracking the number of infections and numbers of new people infected.

If circumcision rates in the U.S. dropped to European levels, the model predicted:

• A 12% increase in men infected with HIV

• A 29% increase in men and 18% increase in women infected with human papillomavirus (HPV), which is closely associated with cervical cancer

• A 19% increase in men infected with herpes

• A 211% increase in male urinary tract infections

• A 50% increase in cases of female bacterial vaginal infections.

The researchers calculated that every infant boy not circumcised leads to $313 in illness-related costs that wouldn’t have been sustained if the circumcision had been performed. This would add up to $4.4 billion in avoidable costs if the circumcision rate in the U.S. dropped to 10%.

“There are health benefits to infant male circumcision in guarding against illness and disease, and declining male circumcision rates come at a severe price, not just in human suffering, but in billions of health care dollars as well,” said senior investigator Aaron Tobian, M.D., a Johns Hopkins epidemiologist.

The study was published online today in the Archives of Pediatrics & Adolescent Medicine.

Brain Food Begins At Birth

Wednesday, August 8th, 2012

Kids who eat a healthy diet from an early age have a slightly higher IQ than those who don’t. That’s the finding from a study out this week in the European Journal of Epidemiology.

Scientists from the University of Adelaide in Australia reviewed the diets of more than 7,000 children at ages 6 months, 15 months and 2 years and recorded their IQs at age 8. They found that children who were breastfed at 6 months and then fed a healthy diet rich in legumes (peas, beans, nuts), cheese, fruits and vegetables had IQs two full points higher than those whose diet regularly included sweets, soft drinks, chips and other junk foods during the first two years.

“While the differences in IQ are not huge, this study provides some of the strongest evidence to date that dietary patterns from 6 to 24 months have a small but significant effect on IQ at 8 years of age,” lead study author Lisa Smithers, Ph.D., said in a statement. “It is important that we consider the longer-term impact of the foods we feed our children.”

Whooping Cough Vaccine May Leave Some Unprotected

Monday, August 6th, 2012

The switch to a whooping cough vaccine with fewer side effects more than a decade ago may have left children slightly more vulnerable to the illness – a highly contagious respiratory infection where thick mucus in the windpipe can make it difficult to eat, drink and breathe.

That’s the finding in an Australian study published last month July 31 in the Journal of the American Medical Association (JAMA). Researchers looked at data on 40,000 Queensland children born in 1998 who had been vaccinated against whooping cough, also known as pertussis. Those receiving the newer vaccine – made with just a few pieces of killed pertussis bacteria – were three times more likely to develop whooping cough than those treated with the older vaccine made from whole, killed pertussis cells.

In the mid-1990s, the vaccine, then known as DTwP (diphtheria-tetanus-whole cell-pertussis), was changed to the DTaP (diphtheria-tetanus-acellular pertussis) vaccine currently available. The newer vaccine was found to cause far fewer side effects – including pain and swelling at the injection site, fever and prolonged crying – than the DTwP vaccine.

Though this new study found the newer vaccine to be less effective, researchers are stressing the importance of several messages for doctors and parents:

• Vaccination still offers the best protection against whooping cough.

• The increased risk of developing whooping cough is small, leading to just one extra case per year for every 500 vaccinated children.

• Doctors need to consider whooping cough as a diagnosis, even in children who have been vaccinated.

Whooping cough cases in the United States are on track to reach record highs this year, according to the national Centers for Disease Control (CDC). There have been approximately 18,000 cases reported as of this summer, more than twice the number reported up to this time last year.

CDC attributes the upward trend primarily to the fact that potency of the DTaP vaccine begins to fade after about 10 years, and the agency is urging booster shots for teens and adults. While whooping cough isn’t generally fatal in teens and adults, it can be deadly in infants. The CDC reports that nine babies in the U.S. have already died from the disease this year.

Typical Toddler Behavior or ADHD? 10 Signs To Watch For

Monday, July 30th, 2012

When kids are 3 or 4 years old they often have trouble paying attention, but for some, this could be an early indication of trouble down the road. Around one in 11 school-aged children are now diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD), but as many as 40% show warning signs much sooner – as early as age 4.

Mark Mahone, Ph.D., director of neuropsychology at the Kennedy Krieger Institute in Baltimore, encourages parents to watch their young children’s behavior closely, as kids whose symptoms of ADHD begin in early childhood are at the highest risk for academic problems, including grade repetition.

Take note if your 3- to 4-year-old:

1. dislikes or avoids activities that require paying attention for more than one or two minutes;

2. loses interest and starts doing something else after engaging in an activity for a few moments;

3. talks a lot more and makes more noise than other children of the same age;

4. climbs on things when instructed not to do so;

5. cannot hop on one foot by age 4;

6. is nearly always restless, wanting to constantly kick or jiggle feet or twist around in his or her seat, or insists that he or she “must” get up after being seated more than a few minutes;

7. gets into dangerous situations because of fearlessness;

8. warms up too quickly to strangers;

9. is frequently aggressive with playmates, or has been removed from preschool or daycare because of aggression;

10. has been injured (received stitches or needed medical attention) because of moving too fast or running when instructed not to do so.

All of these signs have been associated with diagnoses of ADHD at school age, and parents who notice them in their child should consult their pediatrician or another developmental expert.

Cancer Risk Greater For Kids Abused By Their Parents

Wednesday, July 25th, 2012

New Purdue research shows that frequent child abuse by a parent can increase a child's cancer risk in adulthood, and the effects are especially significant when mothers abuse their daughters and fathers abuse their sons. The research was conducted by Kenneth Ferraro, distinguished professor of sociology and director of Purdue's Center on Aging and the Life Course, and sociology and gerontology graduate student Patricia Morton. Their work was funded by the National Institute on Aging and is published online by the Journal of Aging and Health. (Purdue University photo/Mark Simons)

Parents who swear at, hit, shove, or otherwise abuse their children are doing more than just immediate harm. They are also increasing the children’s risk of developing cancer later in life, say Purdue University researchers.

Looking at data from more than 2,100 adults who answered questions in the mid-1990s, the study found a link between abuse by parents – especially mothers abusing daughters and fathers abusing sons – and increased risk of cancer later in life.

Rather than asking participants directly about “abuse,” the survey included questions about how frequently a parent insulted or swore at them, refused to talk to them, threatened to hit them, threw something at them, pushed, grabbed, shoved, kicked, bit, punched, burned or scalded them as a child – and how often this happened. The more frequent and intense the abuse, the greater the cancer risk the study found.

“People often say that children are resilient and they’ll bounce back,” said lead author Kenneth Ferraro, a sociologist with Purdue’s Center on Aging and the Life Course, “but we found that there are events that can have long-term consequences on adult health.”

The authors aren’t certain why abuse by the same-sex parent had a greater effect on cancer risk, though they theorize the greater social bond between same-sex children and parents could be at work. “Other studies have shown that if a mother smokes, the daughter is more likely to smoke, and the same relationship is found when sons mirror their fathers’ behavior. More research is needed, but another possibility is that men may be more likely to physically abuse their sons, and mothers are more likely to physically abuse their daughters,” says co-author Patricia Morton, a gerontology graduate student at Purdue.

The study was funded by the National Institute on Aging and published online July 4 in the Journal of Aging and Health.

Ready-For-School Allergy-Asthma Update

Monday, July 23rd, 2012

Every year, more than 15 million school days are lost to asthma and allergies, making back-to-school time a great time for a few reminders for parents:

• Have a plan. If your child has asthma or allergies of any kind, your child’s school needs to know. Make sure you have contacted the school and filled out paperwork that will make everyone aware of your child’s condition and give your child access to needed medications on campus.

• Have medications on hand. If your child needs an inhaler for asthma, or an EpiPen or antihistamines for allergies, make sure those are always available at the school. “They should have it with them. It shouldn’t be across campus with a nurse,” says pediatric allergist Roger Katz, M.D., a clinical professor at UCLA School of Medicine with a private practice in Santa Monica. He says that delays in getting these medicines could be life threatening.

• Remind kids and school personnel about food allergies. Even children who know what they aren’t supposed to eat might be tempted by food offered by a classmate.

While fall means the start of gym classes that could aggravate exercise-induced asthma, and Santa Ana winds that bring extra pollen from the high deserts to torment allergy sufferers, there are also new tests and treatments on the horizon.

One, called FENO (fractional exhaled nitric oxide), allows doctors to easily gauge inflammation in the airways. Patients exhale into a machine that measures the amount of nitric oxide (NO) they exhale, which goes up when inflammation is present. Becoming more widespread, FENO is best for ages 6 and up, is covered by some insurance companies (and costs around $50 without coverage), and Katz says his Santa Monica practice has had it available for about 18 months.

For children with allergies, identifying the sources of their suffering is now also much easier, as skin testing for allergy has become more accurate. Experts have now identified the exact antigens for things like cat, dust mite, grass, pollen bee venom and other allergies, allowing for quicker and more accurate diagnosis. “All of these are better today than they were five years ago,” Katz says.

Easier treatment of some of these allergies is also on the way. Instead of allergy shots to help kids become less sensitive to allergens like dust mites and grasses, doctors will be able to provide “oral desensitization,” placing small, controlled amounts of the allergen under the tongue to build tolerance. Katz expects these therapies to be approved by the U.S. Food and Drug Administration and on the market in the next six months.

In a study published July 19 in the New England Journal of Medicine, researchers from Johns Hopkins Children’s Center reported that this type of therapy also showed promise in children with egg allergies (which as many as 3% of children have by age 3). During their study, funded by the National Institutes of Health, they found that 11 of 35 patients treated with egg immunotherapy experienced complete, long-term elimination of allergic reactions, and the remaining 24 were able to tolerate higher doses of egg with mild or no symptoms – offering a protection against serious allergic reactions from accidental exposure.

They note, however, that the treatment is still considered experimental, and should yet be used outside medical research studies.

 

 

‘Early Full Term’ Birth Linked With Lower Reading and Math Scores

Wednesday, July 11th, 2012

The link between preterm birth and risk of lower academic achievement has been established in a number of studies. But new research suggests that – when it comes to brain development – even for full-term babies, every week counts. Scientists have now found that babies born at the earlier end of the “full-term” range are more likely to have lower reading and math scores in third grade than those born just a few weeks later.

Researchers from Columbia University, Morgan Stanley Children’s Hospital and Mount Sinai School of Medicine started with birth records for all singleton babies born to mothers residing in New York City from 1988 to 1992. They then matched the records for those born between 37 and 41 weeks’ gestation (the range considered “full term”) with those same children’s third grade reading and math scores on standardized tests administered in New York City public schools.

In all, they matched records for more than 128,000 children, a group large enough to add significance to their findings. In general, test scores in both reading and math improved for each additional week babies spent in the womb. The most significant deficits were found in children born at 37 and 38 weeks.

Children born at 37 weeks’ gestation had a 14% greater risk of having mild reading impairment, 23% greater risk of having moderate reading impairment and 33% greater risk of having severe reading impairment than those born at 41 weeks. They also had a 16% greater risk of mild and 19% greater risk of moderate math impairment.

This was true even when researchers took a host of other factors that could hamper academic achievement – from the number of years a mother spent in school to lack of prenatal care, substance abuse, history of smoking, race/ethnicity and characteristics of the neighborhood where the mother resided – into account.

The study’s authors note that babies’ brains are growing rapidly between 37 and 41 weeks’ gestation, increasing their gray matter 50% and their white matter threefold. Being in the uterus, they say, likely supports this development. “Early term birth,” as the authors call it, could disrupt this growth. Based on their findings, the authors have two take-home messages for parents and doctors.

First, women and doctors planning early deliveries for nonmedical reasons should consider the potential impact of their decisions – which, as this study shows, lasts at least into elementary school. And second, pediatricians and parents should watch “early term” children in case they need extra educational support.

The study was published online July 2, and in the August issue of Pediatrics.

With Kids’ Prescriptions, Ask and Tell

Wednesday, June 27th, 2012

When your child is prescribed medication, ask questions and report problems. That’s the take-home message from U.S. Food and Drug Administration (FDA) experts on the heels of the latest report examining trends in pediatric prescription medications.

Diane Murphy, M.D., of FDA’s Office of Pediatric Therapeutics, explains that the report is part of the agency’s effort to increase the number of medications that have been studied in children by targeting areas for further research.

The report, published June 18 in Pediatrics, noted that the number of prescriptions for antibiotics had fallen, while prescriptions for ADHD drugs were on the rise. Murphy, one of the authors, says experts were delighted at the antibiotics trend. “Ever since I have been practicing medicine we have been trying to convince parents not to request antibiotics for viral illnesses,” she explains. And the increase in ADHD prescriptions was not a particular surprise. “We expected that some classes of drugs would go up, because they finally have been studied in children,” she says.

Because clinical trials in children are more complicated than those in adults, and there is less profit to be made on drugs targeted to kids, drug companies have been reluctant to study their products in children. Legislation is turning the situation around, but many medications commonly prescribed in children still have never been formally studied. “Even though we’ve made great strides, we’re about half way,” Murphy says.

One example mentioned in the report is lansoprazole (brand name Prevacid), an anti-reflux drug prescribed 350,000 times to infants in 2010, despite the fact that no studies have been conducted in infants to show its safety and effectiveness. Ann McMahon, M.D., also of the Office of Pediatric Therapeutics and another author of the report, is heading up a study on use of lansoprazole in infants – a complicated undertaking that won’t likely yield any results before 2013.

Meanwhile, Murphy and McMahon have this advice for any parent whose child has been prescribed medication.

Be aware that many medications still have not been studied for use in children. Because of this, doctors often have to prescribe drugs “off label,” and many medications have been used this way in kids for years.

• Ask whether the medication has been studied for treatment of your child’s condition in children your child’s age. If it has not, ask whether there is an alternative medicine that has been studied in children, and why your doctor wants to use this one instead. The “off label” medication could be safer to use with other drugs your child is taking, or a better fit for some other reason. Or there may be no alternative.

• Ask whether there are any side-effects you should look out for. Some could be minor, such as interfering with appetite or sleep. Others could be serious.

• Make sure your doctor reports any side-effects or “adverse events” your child experiences to FDA. Even when a drug has been studied for use in children, these reports help shape labeling of drugs and help keep doctors informed about potential problems. “These studies [in children] are often small, and they don’t pick up some of the more unusual things,” McMahon says. In the case of one ADHD medication, “hallucinations” was listed among possible side-effects, but not featured prominently on the label. Once FDA began receiving reports, the labeling was changed to make sure parents were aware that if children taking the medication began to hallucinate, reducing the dosage or discontinuing the medication would correct the problem.

And, of course, don’t hesitate to contact your doctor if you are worried about symptoms your child experiences while taking medication.

Burbank 10-year-old Speaks Up About ‘Adult’ Lung Disease That Affects Kids

Tuesday, June 12th, 2012

When 4-year-old Lucas Van Wormer didn’t have the energy to play like other kids his age, his parents took him to one doctor after another. He had been on a “downward trajectory” for the better part of a year, and no one seemed to have any answers. “We just noticed that he was sluggish and not feeling well,” says Lucas’ father, Steve Van Wormer. “He was basically being misdiagnosed with asthma.”

And the Burbank preschooler’s symptoms looked like asthma – shortness of breath, fatigue and fainting. It was a stroke of luck that provided the Van Wormers with a true diagnosis. A pediatrician filling in for Lucas’ regular doctor ordered a chest X-ray to check for pneumonia, and instead found that the right side of Lucas’ heart was enlarged.

A few referrals later, the mystery was solved. In November 2006 doctors discovered Lucas has pulmonary hypertension (PH), a disease that’s rarely diagnosed in kids.

How PH Works

The lungs are delicate, like a sponge, and can only handle so much blood pressure. If pressure within the lungs gets too high – as it does in people with PH – “it’s like having a high-velocity garden hose shooting blood into the sponge,” explains Juan Alejos, M.D., director of the pediatric pulmonary hypertension program at Mattel Children’s Hospital UCLA. Under pressure, the blood vessels in the lungs thicken, decreasing blood flow to the lungs and oxygen flow to the body. “It’s as if the blood vessel was working out,” says Alejos.

You can be born with PH, or it can be brought on by small defects in the heart. Alejos, who has been treating Lucas since his diagnosis in 2006, believes that PH isn’t necessarily less common in kids than in adults. It’s just more difficult to spot in children.

PH can only be cured through lung or heart-lung transplant (and survival rates aren’t high), but medications that relax the blood vessels can help keep symptoms at bay and keep damage to the lungs from getting worse. Because these medications have only been tested and approved for use in adults, doctors have to use them “off label.” Lucas is currently on a very low dose of one of these medications, and doing great. “It was literally overnight that we had a different kid once he started his therapy,” says Van Wormer.

A PH PSA

To help raise awareness about PH in kids, Lucas, who’s now 10, is using his lungs – more specifically, his voice. He teamed up with his dad, who does professional voice-over work, to create a 30-second Public Service Announcement to help educate the public about how the disease affects kids.

In the video, Lucas makes the following points.

• Before 1995 there were no treatments for pulmonary hypertension.

• Today there are nine PH medications approved to treat adults, but no approved medications for kids.

• The Pulmonary Hypertension Association (www.phassociation.org) is dedicated to funding research into treatments for both adults and kids, and gifts to the association support this effort.

Steve Van Wormer says there is an especially big push to support the Robin Barst Fund (www.phassociation.org/barstfund), created by pioneering PH researcher Robin Barst, M.D. When the goal to raise $1 million is reached, an initiative for pediatric-specific PH research will be created.

Many people with PH, he says, take as long as three years to get diagnosed. And the lack of treatment can take a serious toll on their health. “We were very lucky and got flagged and found out very early,” he says. “For other parents and other patients, I wish that for them as well.” Because while Van Wormer feels that with ongoing research time is now on Lucas’ side, it is running out for others with PH. “I still get daily, weekly email updates on kids that lost their battle, that weren’t as lucky,” says Van Wormer.

Lucas, meanwhile, has finished fourth grade and is enjoying his summer break. On his schedule are a trip to Florida to attend a big PHA conference, and a session of summer camp on Catalina Island for kids with heart conditions, run by Alejos. Eventually, he would like to become a voice over actor.

Click here to see Lucas’ PSA.

Click here for information on the upcoming Swing4theCure golf tournament July 9 in Aliso Viejo. The event, organized by a woman who lost her husband and two sons to PH, has raised more than $160,000 for PH research since 2006.