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Your Child

Preschoolers Should be Examined for Possible Vision Problems

2:00

For very young children, blurry vision may seem normal to them. There’s also a good chance that their parents won’t know their little ones are having difficulty seeing clearly.

That’s why the U.S. Preventive Services Task Force (USPSTF) is recommending that 3 to 5 year olds receive vision screening at least once to detect abnormal visual development or risk factors for it.

A couple of visions problems that first show symptoms at this age are Strabismuc (crossed eyes) and Amblyopia (lazy eye).)

Crossed eyes do not look in the same direction at the same time. Six muscles attach to each eye to control how it moves. The muscles receive signals from the brain that direct their movements. Normally, the eyes work together so they both point at the same place. When problems develop with eye movement control, an eye may turn in, out, up or down.

Infants and young children often develop this condition by the age of three, but older children and adults can also get crossed eyes. People often believe that a child with strabismus will outgrow the condition. However, this is not true. In fact, strabismus may get worse without treatment. An optometrist should examine any child older than 4 months whose eyes do not appear to be straight all the time.

Lazy eye is the loss or lack of development of central vision in one eye that is unrelated to any eye health problem and is not correctable with lenses.

Lazy eye often occurs in people who have crossed eyes (misalignment) or a large difference in the degree of nearsightedness or farsightedness between the two eyes. It usually develops before age 6 and it does not affect side (peripheral) vision.

Treatment for lazy eye may include a combination of prescription lenses, prisms, vision therapy and eye patching. In vision therapy, patients learn how to use the two eyes together, which helps prevent lazy eye from reoccurring.

According to the American Public Health Association, about 10% of preschoolers have eye or vision problems. However, children this age generally will not voice complaints about their eyes.

Parents should watch for signs that may indicate a vision problem, including:

•       Sitting close to the TV or holding a book too close

•       Squinting

•       Tilting their head

•       Frequently rubbing their eyes

•       Short attention span for the child's age

•       Turning of an eye in or out 

•       Sensitivity to light

•       Difficulty with eye-hand-body coordination when playing ball or bike riding

•       Avoiding coloring activities, puzzles and other detailed activities

If you notice any of these signs in your preschooler, arrange for a visit to your doctor of optometry.

While the two may sound similar, there is a difference between a vision screening and an eye exam.

Vision screenings are a limited process and can't be used to diagnose an eye or vision problem, but rather may indicate a potential need for further evaluation. They may miss as many as 60% of children with vision problems. Even if a vision screening does not identify a possible vision problem, a child may still have one.

Sometimes, parents get a false sense that their child doesn’t have a vision problem if he or she passes a vision screening.

A doctor of optometry performs an eye exam. He or she will look for any developmental problems and evidence of disease. If needed, your doctor of optometry can prescribe treatment, including eyeglasses and/or vision therapy, to correct a vision development problem.

When considering an eye exam, parents should:

•       Make an appointment early in the day. Allow about one hour.

•       Talk about the examination in advance and encourage your child's questions.

•       Explain the examination in terms your child can understand, comparing the E chart to a puzzle and the instruments to tiny flashlights and a kaleidoscope.

The preschool years are a time for developing the visual abilities that a child will need in school and throughout his or her life. Steps taken during these years to help ensure vision is developing normally can provide a child with a good "head start" for school.

Story sources:

http://www.aoa.org/patients-and-public/good-vision-throughout-life/childrens-vision/preschool-vision-2-to-5-years-of-age?sso=y

Molly Walker, http://www.medpagetoday.com/ophthalmology/generalophthalmology/63476

 

Your Child

Is MiraLAX Safe for Young Children?

2:30

Constipation is a common problem in kids. It can become a painful elimination process if not treated quickly. Children will sometimes “hold” their poop to avoid the experience, making the situation worse.

Pediatricians often prescribe MiraLax for treatment. MiraLax contains PEG 3350, which is not habit-forming and is easy to give to kids because it has no taste or odor. You can mix it in their beverages, and they typically won't complain.

MiraLax is not a natural product. It does not completely clean a colon out, like an enema does, but it works well enough to unclog a child. Over time, constipation can cause other serious health consequences, so the condition needs to be treated promptly.

While the majority of children do fine when given MiraLax, a group of parents have reported dramatic changes in their child’s personality after being given the laxative.

For the past few years, the Children's Hospital of Philadelphia (CHOP) has quietly been conducting an FDA-grant funded study into parents' reports of devastating side effects from their kids' use of the over-the-counter constipation relief drug.  

But until that study is completed, the hospital won't comment on the experiences of individual families.

A FaceBook page called, Parents Against MiraLax (PEG 3350) has been created, and more than 3,500 people have joined to organize and voice concerns about PEG 3350.

When the FDA grant was awarded to CHOP in early 2014, the federal agency disclosed that MiraLAX powder contains small amounts of Polyethylene glycol 3350 (PEG 3350), which may under certain conditions degrade into ethylene glycol or diethylene glycol — toxic ingredients found in antifreeze.

"The Food and Drug Administration has received a number of reports of adverse events in children taking PEG products," the FDA said in its grant description. "The Agency has conducted a review that documented a number of reports of neurological and psychiatric events associated with chronic PEG use in children. A number of these pediatric patients received an adult dose of PEG (17 grams) for a duration ranging from a few days to a couple of years."

MiraLAX, manufactured by Bayer, is not recommended for patients under the age of 17, but the FDA concluded that it is often suggested to parents in clinical practice.

Bayer has responded in a statement, referencing existing clinical studies confirming the long and short-term safety of PEG 3350 in pediatric patients, though the company acknowledged the product is not labeled for use in the pediatric population.

An article in the New York Times, published in 2015, reported that the FDA had raised questions about the safety of an “an adult laxative routinely given to constipated children, “ sometimes for years.

The article also mentioned that buried in the FDA’s brief to researchers, it had tested eight batches of MiraLax and found tiny amounts of ethylene glycol (EG) and diethylene glycol (DEG), ingredients in antifreeze, in all of them. The agency said the toxins were impurities resulting from the manufacturing process.

Those tests were conducted in 2008, but the results were not disclosed. Jeff Ventura, an F.D.A. spokesman, said batches were tested because “many of the reported adverse events were classic symptoms of ethylene glycol ingestion.”

Psychiatric illnesses like those reported in children taking the laxatives have also been observed in cases in which a child took substantial amounts of ethylene glycol. Some children taking MiraLax chronically (over long periods of time) also have developed acidic blood, according to F.D.A. records, which can be a consequence of ingesting EG.

MiraLAX primarily is recommended for short-term use up to seven days to relieve constipation. The FDA does not approve chronic use, although many use it regularly or even daily to treat severe issues with digestion.

The North American Society of Pediatric Gastroenterology, Hepatology and Nutrition and the American Academy of Pediatrics said in statement after the study began, that they welcome “an investigation into the safety of treatment through data and research in the prolonged use of PEG 3350.”

A timeline for the CHOP study results is not immediately known.

For many children, MiraLax works well as a short-term laxative. However, parents should discuss the dosage and the pros and cons of giving it to the their child with their pediatrician.

Story sources: Michael Tanenbaum, http://www.phillyvoice.com/chop-leading-fda-study-parents-alarming-claims-about-over-counter-drug-miralax/

Catherine Saint Louis, https://www.nytimes.com/2015/01/06/science/scrutiny-for-a-childhood-remedy.html?_r=1

Steve Hodges, MD, http://www.parents.com/blogs/parents-perspective/2015/01/07/health/is-miralax-safe-for-kids-an-expert-weighs-in/

Your Child

Childhood Obesity; It’s a Family Affair

2.00 to read

Although there seems to be non-stop discussion about the influence modern day society has on our children, one fact remains the same. Parents and caregivers have the biggest impact on a child’s life. When it comes to helping obese children lose weight and lead healthier lives, it’s parents who decide what food is purchased, and how much activity a child gets. If parents are not available, then a caregiver makes those importance decisions.

For an obese child to have a real chance at losing weight and living a healthier life, parents, caregivers and other family members should be involved in treatment programs designed to help their children.

The American Heart Association released a scientific statement today on the role of parents, families and caregivers in the treatment of obese kids.

"In many cases, the adults in a family may be the most effective change agents to help obese children attain and maintain a healthier weight," Myles Faith, an associate professor of nutrition at the Gillings School of Global Public Health, University of North Carolina at Chapel Hill, said in an American Heart Association (AHA) news release.

"To do so, the adults may need to modify their own behavior and try some research-based strategies," added Faith, who is the chair of the writing group that published an AHA scientific statement in the Jan. 23 issue of Circulation.

But let’s be honest…. old habits are hard to break. That’s why the more people you have working together the more likely you’ll be successful in making the changes you want.  Most families dealing with obesity really want to help family members lose weight  – they often just need a better game plan to help guide them.

One of the most important messages to parents is that they need to lead by example. It is entirely unrealistic for children to change their food and physical activity behaviors on their own. Too often, during the week, family meals consist of high calorie-high / high-fat fast foods. Then the weekend is an all-you-can-eat buffet style breakfast and dinner.

Lack of exercise only adds to the difficulty in dropping unhealthy pounds.

Technology has gotten a lot of the blame for keeping kids in chairs or on couches, but it can also be beneficial. Computers and smart phones may be beneficial in self-monitoring and goal setting for children and their parents. Games such as “Dance Dance Revolution” along with “Wii Fit” and a host of others get kids and even adults up and moving.  In lieu of blaming technology for being a culprit, perhaps viewing it as an opportunity to reach children and teens in the medium they understand may be the best way to communicate healthful behaviors.

Faith adds “Teaching families to identify how many calories they take in from food, and burn during exercise, is a core component to most family treatment programs that have been studied.  Parents and children become more ‘calorie-literate’ in a sense, so they better understand how many calories are in a burger vs. apple vs. water bottle. This knowledge sets the stage for behavior change, and can be an eye opener for many parents.”

Faith and his colleagues identified a number of strategies that have been linked to better outcomes, including:

  • Working together as a family to identify specific behaviors that need to be changed.
  •  Setting clearly defined goals -- such as limiting TV viewing to no more than two hours per day -- and monitoring progress.
  •  Creating a home environment that encourages healthier choices, such as having fruit in the house instead of high-calorie desserts or snacks.
  •  Making sure parents commend children when they make progress, and don't criticize them if they do backslide. Instead, helping children identify ways to make different decisions if they're faced with the same kind of situation again.
  •  Never using food as a punishment or reward.
  •  Keeping track of progress toward goals.

"While these strategies were implemented by health care professionals in a treatment program, the psychological principles on which they are based provide sound guidance for families of obese children as well," Faith said.

A healthy life starts in infancy. For too many years, people just didn’t know much about the nutritional aspect of eating. You’re hungry-you eat. But now, there is an abundance of information, millions of studies that have been conducted, and a food’s calorie, fat, carbohydrate and sodium count is on every label or at your fingertips on the computer. The result of not paying attention to what we put in our mouths is having a devastating impact on families’ lives.

There are many ways to get up-to-date on your child's health. Pediatricians can be critical in the education of parents and caregivers in the optimum feeding and physical activity behaviors for raising healthy children.  Daycare centers, WIC and even grandparents can play a positive role in influencing health outcomes in children.

Denial and ignorance will not make obesity go away. Overweight and obese children seldom outgrow it and they carry that weight-and all its health consequences-into adulthood. Make health a priority for the entire family, and with education, support and good planning everyone will benefit now and for generations to come.

The American Academy of Pediatrics has more about childhood obesity and treatment at http://news.yahoo.com/parents-may-hold-key-treating-kids-obesity-2104138...

Sources: http://news.yahoo.com/parents-may-hold-key-treating-kids-obesity-2104138...http://www.foxnews.com/health/2012/01/24/aha-childhood-obesity-needs-to-...

Your Child

Are Playgrounds Too Safe?

1.45 to read

It takes a lot to bore a preschooler. They are so inquisitive that just about everything seems interesting. But, believe it or not, playgrounds may have become so “safe” that they bore even preschoolers. A new report suggests that may be one of the reasons these little ones are not getting enough exercise.

Researchers have found that strict safety rules for equipment and low budgets at childcare centers were largely blamed for playgrounds that don't make kids feel like playing,

Kristen Copeland, MD, of Cincinnati Children's Hospital Medical Center, and her colleagues wrote in the February issue of Pediatrics that fixed playground equipment that meets licensing codes is unchallenging and uninteresting to children.

Another reason kids may not be exercising enough is that schools are focusing on academics at the expense of recess and gym.

"Societal priorities for young children -- safety and school readiness -- may be hindering children's physical development," they wrote in the paper.

According to an online article in Medpagetoday.com, three-quarters of U.S. kids, ages 3-5 years, attend childcare and most of their time is spent being sedentary.

"Because children spend long hours in care and many lack a safe place to play near their home, these barriers may limit children's only opportunity to engage in physical activity," Copeland's group explained. "This is particularly concerning because daily physical activity is not only essential for healthy weight maintenance, but also for practicing and learning fundamental gross motor skills."

The investigators conducted nine focus groups with a total of 49 childcare providers taking care of preschool-age children at 34 centers in Cincinnati, which varied from inner-city to suburban locations and included some Head Start and Montessori centers.

The providers interviewed were nearly all women with at least some college education. These providers commonly expressed concern that the children they cared for had little chance of outdoor playtime when they went home, particularly those who were picked up late in the day or whose parents worked multiple jobs.

Many of the parents didn't have a dedicated room indoors where kids could be active during bad weather.

To prepare kids for grade school, an emphasis has been placed on teaching children shapes, colors, and skills that prepare them for reading, but not giving them time for outdoor and active play- both of which have been shown to increase a child’s learning ability.

That pressure came directly from parents -- both upper- and lower-income families -- as well as from state early-learning standards.

Some parents also told providers to keep their children from participating in vigorous activities so that they would not be injured.

Providers felt that the playground equipment was safe to let kids play on because of beefed up state inspections and stricter licensing codes, but all the safety measures sort of back-fired and kids just weren’t interested.

"To keep it challenging, teachers noted that children would start to use equipment in (unsafe) ways for which it was not intended," the researchers wrote.

They quoted one provider who explained that with new equipment fitting the tighter standards, "you see children trying to climb into places they're not supposed to climb in because it's just not challenging. They're walking up the slide much more than they ever did with the other one. You can see they are just trying to find those challenges."

Pediatricians may be able to help address this problem by emphasizing the learning and physical benefits of active outdoor play, encouraging parents to dress their child for it, and not suggesting that physical activity is inherently dangerous when giving injury prevention advice, the researchers noted.

Source: http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/30493

Your Child

Are Kid’s Sack Lunches Healthier?

2:00

For some kids who bring their lunch to school, a new study suggests that as far as nutrition goes, they’d be better off buying their meal at the school cafeteria.

Researchers found that student’s bag lunches typically contained foods that were higher in sodium and sugar with fewer vegetables and whole grains compared with standards set for school cafeterias.

The findings are not necessarily surprising, said the study's senior researcher, Karen Cullen, a professor at Baylor College of Medicine in Houston.

"Parents often pack lunches based on their children's preferences," she noted. Plus, she added, some other recent studies have found a similar pattern.

The study involved 12 elementary and middle schools in one Houston-area school district. Over two months, the researchers observed more than 300 students who brought their lunch from home -- noting what they ate and what they threw away.

On average, bag lunches were low on fruits and whole grains, and especially vegetables and milk.

School guidelines say kids should have three-quarters of a cup of vegetables (which really isn’t much) with every lunch. The average elementary school bag lunch had about one-tenth of that amount, according to the study.

Lunches brought from home also contained way too much sodium. The average bag lunch averaged 1,000 to 1,110 mg, versus a limit of 640 mg in elementary school lunches.

About 90 percent of the home lunches contained a dessert, sugary drink or snack chip. Guess what? Kids ate those items whereas between 20 and 30 percent of vegetables ended up in the garbage, according to the study.

Packing milk and palatable vegetables is tricky, noted Dr. Virginia Stallings, a pediatrician at Children's Hospital of Philadelphia who specializes in nutrition.

Giving your kids money to buy it at school can help solve the milk dilemma, said Stallings, who wrote an editorial published with the study. With vegetables, though, it can be challenging to go beyond carrot sticks, she added.

"I think that's one of the advantages of the school lunch," Stallings said. "Kids can have a hot meal, with cooked vegetables." She added that schools are working on making meals that are tasty without relying on salt, and expanding to include culturally diverse choices.

I don’t really think that kid’s attitudes have changed much about school lunches in the last few decades. As long as I can remember, kids eat what they want, trade foods with others and throw out the rest. They often gripe about their lunch food whether it comes from home or the school cafeteria.. That’s just what kids do.

So, if they are going to complain anyway you might as well fix them a lunch that will help them develop strong bones and hearts. The school systems have finally started paying attention to nutrition after all these years. They’re working on creative recipes that just might temp kids to eat better.

You already know that there are way too many American children that are eating poorly, not exercising and developing diabetes at a young age. It’s important what our children eat. Sometimes a school lunch is best and sometimes a lunch brought from home is best. Many times parents split the difference and do both.

Source: Amy Norton, http://consumer.healthday.com/kids-health-information-23/education-news-745/kids-bag-lunches-not-meeting-nutrition-guidelines-694048.html

Your Child

Pre-teen Cholesterol Check-Up

1.45 to read

Do you know your child’s cholesterol level? Unless you have a family history of high cholesterol, getting your child’s checked probably hasn’t been high on your list of medical exams.

A panel of experts appointed by the National Heart, Lung and Blood Institute and endorsed by the American Academy of Pediatrics, are recommending that children be tested for high cholesterol by age eleven. They also recommend that children who are overweight, be screened every 2 years for diabetes.

Major medical groups already suggest children, with a family history of high cholesterol or diabetes, be screened early. Children without a family history of heart disease or diabetes have traditionally not been screened until their later years. Times have changed though and because of the childhood obesity epidemic many kids are developing heart disease and Type 2 diabetes at a much younger age.

Fats build up in the heart arteries in the first and second decade of life but usually don't start hardening the arteries until people are in their 20s and 30s, said one of the guideline panel members, Dr. Elaine Urbina, director of preventive cardiology at Cincinnati Children's Hospital Medical Center.

"If we screen at age 20, it may be already too late," she said. "To me it's not controversial at all. We should have been doing this for years."

An alarming statistic shows how destructive childhood obesity has become. Autopsy studies show that children already have signs of heart disease, long before they show symptoms. By the fourth grade, 10 percent to 13 percent of U.S. children have high cholesterol, defined as a score of 200 or more.

According to the National Cholesterol Education Program's Expert Panel on Blood Cholesterol in Children and Adolescents, the acceptable level for total cholesterol in kids 2 to 19 years old is less than 170 mg/dL. Their LDL cholesterol should be less than 110 mg/dL, HDL levels should be 35 mg/dL or greater, but preferably over 60, and triglycerides should be 150 mg/dL or less.

Doctors recommend screening between ages 9 and 11 because cholesterol dips during puberty and rises later. They also advise testing again later, between ages 17 and 21.

The rise in Type 2 diabetes, in children, has also increased in the last decade. It is hard to detect type 2 diabetes in children, because it can go undiagnosed for a long time; children may have no symptoms or mild symptoms; and because blood tests are needed for diagnosis. That’s why early screening is so important.

The guidelines also say doctors should:

  • Take yearly blood pressure measurements for children starting at age 3.
  • Start routine anti-smoking advice when kids are ages 5 to 9, and counsel parents of infants not to smoke in the home.
  • Review infants' family history of obesity and start tracking body mass index, or BMI, a measure of obesity, at age 2.

There has been some controversy over doctors using terms like overweight and obese when talking with parents and children about their weight. The panel suggests that these are medically correct terms and should be used so that parents and children understand the importance of the problem.

Children whose BMI is in the 85th to 95th percentile should be called overweight, not "at risk for overweight," and kids whose BMI is in the 95th percentile or higher should be called obese, not "overweight; even kids as young as age 2, the panel said.

"Some might feel that 'obese' is an unacceptable term for children and parents," so doctors should "use descriptive terminology that is appropriate for each child and family," the guidelines recommend.

They were released online by the journal Pediatrics.

Your Child

Why Kids Should Learn Handwriting

1:45

I think it’s fair to say that handwriting is becoming a lost art. Computers, tablets and phone keyboards have made actual writing with a pen and paper almost obsolete.

What was once an integral part of a child’s daily school lessons, today, gets about one-fourth the instruction time. What is surprising is that in the not too far future, some kids may never learn penmanship at all.

If keyboards become the most popular form of communication, is there really a need for printing and cursive skills? Yes, according to some educators. Not only will children lose the personal touch of handwriting but will they also lose the benefits learning penmanship offers the developing brain.

Putting pen to paper stimulates brain circuits involved with memory, attention, motor skills, and language in a way punching a keyboard doesn't.

"There is this assumption that we live in the computer age, and we don't need handwriting anymore. That's wrong," says Virginia Berninger, PhD, a professor of educational psychology at the University of Washington.

Indiana University psychologist Karin James, PhD, recently published a study looking at brain scans of preschoolers before and after they learned to produce letters, either by printing or typing. Before the lesson, the children couldn't decipher between a random shape and a letter, and their brains responded similarly to each. After they learned to hand-draw a letter, brain regions needed for reading lit up at the sight of the letter like they do in a literate adult. Learning to type a letter yielded no such change.

Other studies have shown that preschoolers that practice handwriting read better in elementary school.

Handwriting also requires concentration and teaches brain circuits responsible for motor coordination, vision, and memory to work together. "If in the future we were to take away teaching handwriting altogether, I worry there could be real negative impacts on children's development," James says.

Timed right, cursive also comes with some unique advantages. Berninger's research suggests kids who link their letters via cursive get a better handle on what those words look like and end up being better spellers, she says. Cursive also allows them to compose their thoughts faster than in block handwriting or via typing (at least until about seventh grade, when their brains become mature enough to manage two-handed typing quickly).

Berninger says parents can offer their children extra guidance with learning handwriting even before their child begins school and through their early years. Some children may learn these skills quicker and some may need a little more practice. But on an average:

Preschoolers can strengthen motor skills by playing with clay, stringing beads, working through mazes, and connecting dots with arrows to form letters.

From kindergarten through second grade, children should master block letters.

Third to fourth grade is when kids can begin and master cursive.

By fifth grade, children should continue to write by hand while being introduced to typing by touch (not just hunt and peck.)

As I’ve become more accustomed to using my computer or phone to communicate with others, I’ve noticed that my own handwriting skills are beginning to suffer. Cursive isn’t as fluid and readable as when I handwrote more often and my eye, hand and pen coordination isn’t near as comfortable as it used to be. 

I hope future generations will not lose the art of handwriting, not only because of the developmental benefits it offers, but because each person’s handwriting is unique to them.

Story source: Lisa Marshall, http://www.webmd.com/parenting/features/handwriting-matters-kids#1

Your Child

Should More Kids Have Their Tonsils Removed?

2:00

Two new medical reviews suggest that more kids could benefit from having their tonsils removed if tonsillectomy guidelines were less stringent.

Currently, surgery qualifications require that a child must have many recurring throat infections within a short span of time or severe sleep disturbances, said Dr. Sivakumar Chinnadurai, a co-author of the reviews.

An evaluation of current medical evidence suggests more kids would receive significant short-term improvement in their daily life if the guidelines were relaxed, said Chinnadurai, a pediatric otolaryngologist with Vanderbilt University Medical Center in Nashville.

Chinnadural and his team found that children, who underwent a tonsillectomy even when they did not meet the guidelines, experienced nearly half as many sore throats. They also missed fewer days of school and were less likely to need extra medical care.

The benefits seemed to apply only to the first couple of years following surgery. By the third year, there was no clear benefit in terms of the number of sore throats, said Chinnadural. The benefits after the first couple of years following surgery, however, were impressive.

"The decision about whether those children should have tonsillectomy for that temporary benefit is really tied to what those children need or what they're suffering with," Chinnadurai said. Kids who miss a lot of school or need frequent trips to the doctor due to sore throats could benefit from the surgery, he said.

There's an even clearer benefit for kids whose sleep is disturbed due to inflamed tonsils, Chinnadurai said.

"In a child with a diagnosis of sleep apnea, we can see a benefit in sleep-related quality of life," he said. The kids get better sleep, and thus exhibit better everyday behavior and pay more attention in school.

Better sleep in children with sleep apnea can improve many aspects of their daily

lives.

Guidelines say a tonsillectomy to treat throat infections is justified if a child had seven or more sore throats during the previous year; five or more sore throats two years running, or three or more sore throats for three years in a row, according to the background notes.

The researchers decided to review whether the throat infection guidelines are too stringent, ruling out patients who potentially could benefit but don't meet the high threshold of recurring infections, Chinnadurai said.

There aren't strong guidelines regarding the use of tonsillectomy to treat sleep disorders, so the doctors reviewed the evidence to see whether the surgery outperformed so-called watchful waiting -- monitoring the situation.

The study results showed "there may be new evidence that supports expanding the criteria and opening up the procedure to more individuals," said Dr. Alyssa Hackett, an otolaryngologist with the Icahn School of Medicine at Mount Sinai in New York City.

"In the right child with the right indications, these are really wonderful procedures that can be life-changing for both the child and the family," said Hackett, who wasn't involved with the new research.

Although the findings were positive, Chinnadural and Hackett both warned against automatically choosing a tonsillectomy when a child has a sore throat.

"Though a tonsillectomy is low-risk, it is not risk-free, and those risks need to be weighed against the benefits for each individual child," Chinnadurai said.

"We're talking about a child who has significant sleep-related issues," Hackett said. "We don't want people to say my child snores, they need to have their tonsils out. That's not what this study says at all."

Parents should discuss the risks and benefits of a tonsillectomy with their pediatrician if they are concerned about the amount of sore throats their child has, or if sleep apnea is diagnosed.

The two reports were published online in the journal Pediatrics.

Story source: Dennis Thompson, https://consumer.healthday.com/kids-health-information-23/tonsillitis-news-669/should-more-kids-have-their-tonsils-out-718738.html

Your Child

Using Metric Units for Children’s Medicine

2:00

The American Academy of Pediatrics (AAP) says parents should give their children medicines using metric units instead of teaspoons or tablespoons to avoid overdoses. 

Tens of thousands of kids wind up in emergency rooms after unintentional medicine overdoses each year, and the cause is often badly labeled containers or unclear directions, said Dr. Ian Paul, a pediatrician at Penn State Milton S. Hershey Children's Hospital and lead author of new metric dosing guidelines from the AAP.

"Even though we know metric units are safer and more accurate, too many healthcare providers are still writing that prescription using spoon-based dosing," said Paul. "Some parents use household spoons to administer it, which can lead to dangerous mistakes.”

Paul says it’s just too easy to give the wrong dose using a spoon; sometimes a parent may accidently use a tablespoon instead of a teaspoon. To avoid errors associated with common kitchen spoons, the guidelines urge that liquid medicines being taken by mouth should be dosed using milliliters (abbreviated as "mL").

Also, prescriptions should include so-called leading zeros, such as 0.5 for a half mL dose, and exclude so-called trailing zeroes, such as 0.50, to reduce the potential for parents to misunderstand the dosing.

The AAP has been pushing for more accurate dosing of children's medicines since the 1970s. The new guidelines are the most extensive call for metric dosing to date and are intended to reach drug manufacturers, retailers, pharmacists, prescribers and caregivers.

"For this to be effective, we need not just the parents and families to make the switch to metric, we need providers and pharmacists too," said Paul.

Ideally, the drugs should be dispensed with syringes that have a flow meter because that's the most accurate way to measure liquid, said Robert Poole, director of the pharmacy at Lucile Packard Children's Hospital Stanford.

Parents can put the syringe in the side of the child’s mouth and release the medicine slowly. “It's easier for the child to swallow and you know the dose you get into the child is accurate," said Poole, who wasn't an author of the guidelines. "Those little cups that come with the medicine should really only be used to pour out liquid that you then draw into an oral syringe."

In addition, electronic health records should make it impossible for non-metric doses to be prescribed by clinicians or processed at pharmacies, the guidelines suggest.

Parents of very sick children often struggle keeping up with the medicines, dosages and timing required after their child returns home from the hospital. Using metric units instead of spoonfuls helps parents can get a clearer picture of how much medicine they are actually giving their child.

Among prescription drugs, narcotics present the biggest overdose dangers, said Dr. Brian Smith, a pediatrician at Duke University who wasn't involved in writing the AAP guidelines. He also expresses concerns about over-the-counter drugs, particularly acetaminophen (Tylenol), because overdoses can lead to liver failure. It's also dangerous to give children a wide variety of nonprescription drugs at the same time, because they might accidentally get more than one medicine with the same ingredient, leading to unintended overdoses.

"Kids do get overdosed; it happens in the hospital with all of these safeguards in place and it happens at home," said Smith. "Kids come to the emergency room with unintentional overdoses and they get sick and some kids die. Anything we do to reduce errors by making the dosing clearer will save lives."

Many American parents are not very familiar with the metric system, so they should talk to their pediatrician or family doctor and review dosing instructions and how to use metric labeled syringes or cups. While this system may be a new way of doing things for several of us, it also provides a more reliable way of avoiding overdoses

Source: Lisa Rapaport, http://www.reuters.com/article/2015/03/30/us-kids-medicines-dosing-idUSKBN0MQ09K20150330

 

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