Here is the latest of my more or less monthly newsletter on pediatric topics. In it I highlight and comment on new research, news stories, or anything else about children’s health that I think will interest parents. If you want to subscribe to it and get it in the form of an email each month there is a sign-up form at the very bottom of my home page.
Coming soon: A smartphone app to see if your baby is too jaundiced
This bit of news is pretty interesting, although the product is still in development. These days babies typically go home from the hospital when they’re a day old or even less.Newborn jaundice is very common, especially in breast-fed babies. Nearly all the time it means nothing and passes without treatment. Once in a while, though, the blood bilirubin, which causes the jaundice, gets dangerously high. We treat it with phototherapy. It takes a blood test to measure the blood level, although we’ve used devices for years in the hospital that estimate it from the skin color, identifying those babies that need the blood test. Now it looks as if there will be a way to screen your baby at home using your cell phone and then sending the results to you doctor. I think it’s a cool concept.
Let them sleep in more: American Academy of Pediatrics recommends delaying school start for adolescents
Every parent with a teenager knows they like to sleep more. To no one’s surprise, this is because they need more sleep to be healthy and sharp for school. Research has shown real benefits for mental and physical health. Starting school at 7:30 in the morning, or even earlier, is particularly hard for adolescents. Recognizing this, the AAP has come out with new recommendations for middle and high school start times, suggesting 8:30 am as more appropriate.
Who knows if this will go anywhere because the logistics of getting kids to school and parents to work on time can make it tough to change things. After school activities, such as sports, would also be affected if practice times are pushed back. But it seems pretty clear that a later start would be better for teenagers.
Children who use digital media a lot may be less able to read actual human emotions
This one is interesting. All of us, especially children, are spending a lot more time staring at digital screens — computers, smart phones, video games. A research report coming out next month suggests this may not be a good thing for emotional development. Children, who have not yet fully developed human interaction skills, may be less able to read emotions on actual human faces if they spend a large amount of time with screens.
The researchers found that children whose access to electronic devices was limited were better able to read other people’s emotions. The authors concluded: “Decreased sensitivity to emotional cues – losing the ability to understand the emotions of other people – is one of the costs. The displacement of in-person social interaction by screen interaction seems to be reducing social skills.
“I’m not surprised by this, really, and I find it concerning. It’s one of several reasons my wife and I monitor and limit our son’s computer and smart phone time.
High levels of physical activity linked to early academic achievement
Every parent knows that physical activity is good for children. Among other things, being active and not parking in front of the TV is linked to a lower level of obesity. A new study from Finland suggests that a higher than average level of physical activity is also linked to improved academic performance in elementary students, particularly among boys.
The authors observed 186 children during recess for the first 3 years of schooling and also collected other information on physical activity, such as riding a bike to school: “The improvements in academic attainment were most striking in male participants, especially with reading skills. Boys with higher levers of physical activity, and in particular walking or cycling to school, had better reading skills than the less active boys.
“I was interested to see this research but it seems to me to be confirming common sense. What it is really saying is that if you encourage children, especially boys, to run around a lot and work out their energy, they concentrate better in the classroom. It reminds us that old-fashioned recess is getting rarer and rarer. A half-hour of unstructured play time used to be common; it no longer is.
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.
Those noise machines to make your baby sleep may loud enough to affect their hearing
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.
The American Academy of Pediatrics recently published its guidelines for how hospitals, and systems of hospitals, should care for injured children. The recommendations have also been endorsed by the relevant organizations of surgeons, emergency physicians, critical care physicians, and children’s hospitals.
Traumatic injuries in children are a huge issue. They are the number one killer of children, accounting for 60% of all deaths up to the age of 18. Thus injuries kill more children than all other causes combined. There is also a large burden of disability later in life for injured children, particularly those with traumatic brain injury. One study from a decade ago estimated this financial burden — initial medical costs, lifetime medical costs, and lost income — at nearly 100 billion dollars.
In spite of the importance of injuries to children’s health care needs, pediatric trauma systems have lagged behind those of adults. There are several reasons for this. For one thing, all the pediatric specialists needed to provide optimal care in fully-equipped PICUs are not available in many places. This is not so much of a problem for adolescents, but it is a major problem for pre-schoolers and infants. Another reason is that, from my perspective, children often seem to be off the radar of governmental and institutional planners. One clear purpose of the AAP publishing these guidelines is to try to change that.