Pediatric Newsletter #5
Welcome to my more or less monthly newsletter for parents about pediatric topics. In it I highlight and comment on new research, news stories, or anything else about children’s health I think will interest parents. I have 30 years of experience practicing pediatrics, pediatric critical care (intensive care), and pediatric emergency room care. So sometimes I’ll use examples from that experience to make a point I think is worth talking about. If you want to get the newsletter regularly you can sign up for it here, on my home page (down at the bottom).
The bad effects of bullying are cumulative
We’ve known for eons that bullying can be hard on children. Not surprisingly, bullying is also hard on children’s health. A new longitudinal study over time is useful in showing this. It studied over 4,000 children serially (that is, the same kids) when they were in the 5th, 7th, and 10th grades. The authors found that bullied children were far more likely to have poorer health overall; both chronic and current bullying are associated with substantially worse health. They conclude: “Clinicians who recognize bullying when it first starts could intervene to reverse the downward health trajectory experienced by youth who are repeated targets.”
One caveat is that children with chronic health problems are more likely to be bullied, so the cause and effect relationship is not totally straightforward. Still, it’s a useful study to have: bullying isn’t just mean.
Should you use retail clinics for your children?
The American Academy of Pediatrics has recently put out a policy statement about retail clinics — those free-standing places sometimes called “doc in a box.” Should you bring your child to one? In a nutshell, the AAP doesn’t like them. Of course you should not be surprised by that because in some ways they represent the competition. But the policy statement makes some good points that you should consider if you are thinking about taking your child with something simple like a sore throat or an ear ache to one.
These places won’t know your child; all they will know about her past medical history is what you tell them. Sometimes that matters, sometimes not, but it is a reality.
I’ve had some experience seeing children who have been to a retail clinic, and my experience tells me the training and skill sets of the providers working there are pretty uneven. Many seem to have poor pediatric knowledge and less than standard practice habits. It seems to me that the default for many of them is that the patient should leave with something, generally a prescription. So in my experience they over-diagnosis ear infections, strep infections, and urinary tract infections. This makes for a lot of overprescription of oral antibiotics. They also tend to give antibiotics for what are clearly viral upper respiratory infections, a big no-no.
I’m not saying never use them if your child has an ear ache in the evening. But bear in mind the care you get may well be less than optimal. As I wrote above — sometimes that matters a lot, sometimes not so much.
Old foe, old remedy
We have a lot of antibiotics to choose from when treating children with pneumonia. There is always the temptation to use the newest and fanciest of them, but that can cause problems. For one thing, using the latest antibiotic on an uncomplicated case of what we call community-acquired pneumonia (that is, not caught while already in the hospital) leads to the scourge of developing bacteria resistant to most antibiotics; so when we really need the fancy ones they may not be effective. The newest ones are also typically the most expensive.
Recently the Pediatric Infectious Diseases Society has put out a recommendation that the older, cheaper, and more “narrow spectrum” antibiotics are preferred in ordinary pediatric pneumonia. So if your child has pneumonia, it would be entirely appropriate for you to bring this up with your doctor if he is ready to prescribe $150.00 worth of antibiotics.
I’ve raised a couple of kids of my own so I know how frustrating it can be when they just won’t go to sleep. Like many parents, I found that for several months my daughter just wouldn’t go to sleep unless I drove her around in the car. Then she was such a heavy sleeper I could bring her into the house and put her in her bed. These baby noise machines work on that principle.
These machines make various sounds — gurgling water, a heart beat, or just “white noise.” That’s all fine, but be aware that a recent study suggested that some of them make noises loud enough to affect a baby’s hearing, which is quite delicate.
The authors measured sound levels in 14 machines at various distances from a child’s ear. They found that all of the machines were capable of producing levels of sound hazardous to hearing. The authors don’t specify the brands, but my reading of the study is that all of them can be too loud even when used according to the directions.
My take home on this is that if you use one of these machine, use the lowest settings. Nobody has the sophisticated equipment that the authors of the study used to measure the sound intensity to make sure things are safe.