Posts Tagged ‘CDC’
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.
About those physician rating sites: do parents use them to find a physician for their child?
There are now a multitude of web sites on the internet that allow consumers, that is patients and their families, to rate physicians. And why not? There are rating sites for many other products and services. But these sites can strike fear into the hearts of doctors because, when you look at them, the number of ratings for a particular physician is usually quite low. In my own case, for example, a popular rating site only lists one for me even though I’ve been practicing for 30 years. So there is the fear that one disgruntled patient can tank your rating. But these sites are here to stay, I think. A big question is if parents use them to find a doctor for their child: or, if they haven’t used them, would they? A recent survey asked that question and found that parents are beginning to use the information on the sites. My concern is that, if this is the future, they be run a little better. For example, Angie’s List, a popular one, has contacted me several times to ask me to rate myself. I assume it was a computer glitch, but the potential to cook the books is always a concern with anonymous rating sites.
Long term treatment of ADHD with stimulant medications does not affect growth
Pediatricians are always concerned that long term treatment with any medication could affect a child’s growth. This is true for any medication, but it is a particular concern for attention deficit/hyperactivity disorder (ADHD) because there are so many children taking these medications and they often take them for many years. A recent study in the journal Pediatrics is reassuring on that point. The authors studied a large group of children through childhood and on into adulthood and found no effect on growth.
A related, and important point, is how common is ADHD? A recent report from the Centers for Disease Control (the CDC) used surveys of parents to assess that issue. What they found is that 11% of all children between the ages of 4 and 17 had at one time or another been given the diagnosis of ADHD, and 83% of those still carried that label. And 69% of the total were currently taking ADHD medication. That represents a whopping 43% increase over the past decade. For myself, I find it hard to believe ADHD is increasing at that rate; it’s more likely increased awareness of the condition, but there also may be a component of you find what you look for.
What is my advice to parents about this? I’m not an ADHD expert, I’m a critical care pediatrician, but it seems to me to be a stretch to categorize 11% of all children as abnormal — that even defies the definition of what the word normal means. If your child’s teacher wants you to get ADHD medications for your child, I would first carefully look into the details of the concerning behavior. How troublesome is it really? Could there be other explanations? Could more structure help? Then see a physician or psychologist with experience with ADHD. If the recommendation is for medication, for myself I’d seek another opinion and see if they agree. This is an area in which parents should be the ones driving the bus.
Most parents don’t know how to use a car seat when they leave the hospital with their newborn infants
There is no question that car seats save lives. Since their use has been mandated by law, the death and injury rates of children involved in motor vehicle accidents have fallen dramatically (40-50%). But the seats need to be used correctly. A recent report suggests that new parents need more help in figuring out how to install and use them. In fact, 93% of new parents made at least 1 critical error in using the seat. So if you’re not entirely sure if you’re doing it right, have someone check. Our hospital, like all hospitals delivering babies, has specially trained nurses that can look at your seat, your car, and make sure the seat is installed right. There are also quite a few good online sites (like this one) telling you about different kinds of seats, which children need which ones, and how to install them.
Lower vitamin D levels found in children who drink non-cow’s milk
Many children do not drink cow’s milk. This may be because of a sensitivity to cow’s milk protein, a common condition, or because of parental preference. Parents of children in this situation should know that this brings a risk of reduced vitamin D levels in the blood. Commercial cow’s milk is fortified with vitamin D, as are infant formulas that don’t contain cow’s milk. A recent studymeasured vitamin D levels in children who don’t drink commercial cow’s milk and found that many of these children had low vitamin D levels.
Vitamin D has long been known to be crucial for bone growth. Rickets, a once common bone disease in children caused by low vitamin D, is now extremely rare since milk has been fortified with the vitamin. We also know now that vitamin D has many other functions, such as in cardiovascular health. Our body can make vitamin D if exposed to sufficient sunshine, but this is not a reliable source. Of note, the above study comes from Toronto, and rickets was once much more common in climates where children get less sunshine exposure.
The bottom line is that if your child does not drink fortified cow’s milk he or she is at risk for low vitamin D. Your child’s doctor can help you with identifying the best way to supplement this key nutrient.
Many patients in intensive care units, children included, require what we call a central venous catheter (line) or CVL. This is a plastic tube that enters the skin at one of several places — the neck, upper chest, arm, groin — and has its tip end up in one of what are called the central veins. Here’s what such a line looks like. The pointy end goes into the patient. This particular one only has one tube, called a lumen. But we often use lines with several lumens, all contained within the same overall size tube. It’s like having two or three CVLs simultaneously.
Then central veins are inside the chest just outside the heart. Here’s an illustration of what they look like and shows the various approaches we can use to insert a CVL. The picture shows a subclavian approach — the vein under the collar bone. But we can use the veins in the arms or in the neck as well. Or, as is common in children, we can use the vein in the groin and approach the heart from below.
CVLs allow us to do several things. We can take blood samples without sticking the patient with a needle. This not only spares the patient a painful stick, it allows us to sample the blood in the central vein, which is often important. We can make useful measurements of the pressures inside the central veins, a key thing to know when caring for many patients. Because of the high blood flow inside the central veins, CVLs allow us to give medications that would burn or damage the inside of smaller veins like those in the hands and arm.
CVLs are important tools for managing ICU patients. But they are not without risk. Their tips can wander into places they should not go. More commonly, the CVL can provide a highway for bacteria living on the skin to gain access to the inner organs of the body. These bloodstream infections can be very serious, even lethal.
Some years ago research suggested very simple measures can reduce the chances of a patient with a CVL getting such a serious bloodstream infection. The measures are decidedly low-tech and common sense. Even though you are wearing sterile surgical gloves when you place a CVL, wash your hands before you start. Wear a full-sized sterile gown. Clean the patient’s skin off thoroughly. Use sterile drapes and barriers so that bacteria from the area outside the immediate CVL site don’t crawl into the sterile field. Finally, use a checklist to make sure the person putting in the CVL follows all the steps. This is all very simple stuff. Yet the effect of adhering to the protocol is to reduce the rate of infection. The Centers for Disease Control (CDC) recently documented a nationwide reduction in CVL-associated infections.
The take-home message is that in modern ICU medicine, high-tech as it is, low-tech, simple stuff can have profound effects. My grandmother, a nurse who was always after us kids to wash our hands, would not be surprised,
Influenza, the flu virus, has arrived. It can be a serious infection, and it’s too soon to tell if this year’s epidemic will be as severe as last year’s was.
When I first started in medicine, influenza vaccine was generally only recommended for the elderly or those with some serious underlying condition involving their hearts or their lungs. That’s changed now, and for good reason: the higher the rate of vaccination in the population, the better the degree of herd immunity. For some infections, such as pertussis, a key to reducing the rate of infection is to stop its transmission among those who may only get mild cases, because that interrupts the chain of infection. Influenza is like that. The recommendation now is that nearly everybody should be vaccinated against it.
We also discovered last winter that the new so-called H1N1 strain of influenza could cause severe disease in otherwise normal people. For example, I cared for several children who required several weeks in the PICU on a mechanical ventilator before they improved.
The influenza vaccine is far from an ideal one. This is largely because the virus changes every year and the vaccine mixture needs to be tweaked annually to account for this. We have two types of vaccine — a shot in the arm and a mist blown up the nose. Depending upon you (or your child’s) age, the recommendations differ for which one you should get.
The national Centers for Disease Control (the CDC) explains the basis for their recommendation for near universal influenza vaccination here. It’s a bit heavy reading in spots, but it is the best expert opinion available on the matter.
My child is sick all the time. If you are a parent of a preschool child, have you ever thought that? And, if you have, did you worry all those frequent illnesses meant there was something seriously wrong, some significant, underlying illness? Pediatricians and family doctors often hear this worry from parents.
Preschool children have a lot of infections, especially upper respiratory ones, called URIs. Children under three average five to six URIs per year, although the range of normal is quite broad — as many as ten in a year is not necessarily abnormal. One large survey from the Centers for Disease Control polled nearly three thousand households and asked the parents if their children had experienced URI symptoms during the preceding two weeks — a third of children under three had, as did a quarter of children three to five years old.
Where children are during the day matters in determining how many URIs they get, and the youngest preschoolers spending their day with six or more other children of similar age, such as in a daycare setting, get the most. In the CDC sample, for example, about half the children spent time in daycare, and those children had, on average, a fifty percent higher rate of infection. Considering how toddlers share hugs, toys, and crackers with each other, this is not surprising. But for a parent whose child is in daycare, does this increased number of infections mean anything? Is it worse for your child?
Various studies help answer this key question, and the answer is reassuring. In fact, although children under three attending daycare have more URIs than do their stay-at-home compatriots, there is evidence they have less URIs later on, during their early grade-school years. So things appear to even out; the children who are not exposed to as many respiratory viruses as preschoolers meet those viruses later.
Can all these URIs lead to further problems? The answer is generally no, but once in a while they are a problem for certain children, especially those under two. The principal complication of a URI is a middle ear infection, termed otitis media. The inflammation from the URI blocks the normal function of the eustachian tube, the connection between the back of the nasal passages and the middle ear, allowing bacteria normally present in the area to infect the ear. Children vary in their propensity for this to happen. However, the younger they are when they have their first ear infection, the more likely they are to have more of them. Susceptibility to ear infections also runs in families. Another complication of URIs among some children is wheezing whenever they get one. If your child has problems with repeated bouts of either otitis or wheezing, reducing the number of URIs by reducing exposure to sick children is a good way to help control the situation.
Even though experiencing many URIs is common among preschoolers, there are times when a doctor worries about the situation. For example, if the child is having recurrent high fevers, severe rashes, or diarrhea, this could mean there are problems with the immune system. A key red flag is if the child is not thriving — failing to gain weight or even losing weight, or is not keeping up with normal developmental milestones.
If you are concerned your child is too sick too often, discuss the situation with your child’s doctor. But for nearly all preschoolers, having lots of URIs is just part of growing up.