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Daily Dose

New Iron Recommendations for Children

A new study says many U.S. children are iron deficient. How much iron do children need to stay healthy? New recommendations from the American Academy of Pediatrics.An article released in the journal Pediatrics from the American Academy of Pediatrics committee on nutrition, sets new guidelines for iron intake in infants and children.  The news is not good.  According to Dr. Frank Greer, who is the co-author of the report, “iron deficiency remains common in the United States”.

The effects of being iron deficient not only cause anemia, but may also cause “long term  irreversible effects on children’s cognitive and behavioral development.  Because of these findings it is imperative that adequate iron is provided in infancy and early childhood. Studies have shown that 4 percent of 6 month olds, and 12 percent of 12 month olds are iron deficient.  Children between the ages of 1-3 years of age have rates of iron deficiency between 6-15 percent. Preterm infants, infants who are exclusively breastfed and infants who are at risk for developmental disabilities seem to be at higher risk to develop iron deficiency. The committee recognized that the ideal way to prevent iron deficiency and iron deficiency anemia would be with a diet consisting of foods that are naturally rich in iron, but realized that in some cases “children will still need liquid iron supplements or chewable vitamins to get the iron they need. The AAP guidelines now recommend that: 1.  Term healthy babies that are exclusively breast fed should receive an iron supplement (1 mg per day) beginning at 4 months of age 2.  Whole milk should not be started until 12 months of age 3.  Infants 6–12 months of age need 11 mg of iron per day, which should be met via the use of “complementary” foods.  Red meat and vegetables with high iron content should be introduced early, as well as the use of iron fortified cereals. 4.  Toddlers ages 1-3 years need 7 mg of iron per day, and again this is best if iron comes from foods. 5.  Children should have their hemoglobin checked sometime between 9–12 months of age, and again between 15-18 months of age, and follow-up for iron deficiency treatment and testing is recommended 6.  Children who do not meet their iron needs via foods should receive a daily iron supplement The article contains a table which shows many foods from each food group that are good sources of iron.  Foods like meat, shellfish, beans, iron fortified cereals, and fruits and vegetables that contain vitamin C (which aids in iron absorption) are all encouraged. Thanks to my mother, I have always known that liver is a good source of iron (never my favorite dinner as a child), but who would have known that clams and oysters are also high in iron.  While oatmeal is a good iron source, molasses is also high in iron.  Tofu and wheat germ are also high in iron, as are edema me beans, which many kids love. By getting creative with foods that are high in iron beginning early in a child’s life, iron deficiency may be avoided.  You never know what your child will eat, unless you try it! That's your daily dose for today.  We'll chat again tomorrow. Send your question to Dr. Sue!

Daily Dose

Pay Attention Around The Pool

With summer heat spread across the country, many families seek relief by a pool. The first thing to think of is safety!With the summer heat enveloping the entire country, it certainly is time for trips to the pool.  The first thing that comes to my mind when I think of swimming pools is safety!!

Knowing that over 900 children between the ages of 1–14 years die each year from drowning,  the discussion of water safety is a necessary part of summer.  Astoundingly, reports show that 9 out of 10 of those children who drowned were “under supervision”. The AAP has recently endorsed allowing children between the ages of 1-4 to take swimming lessons. It was previously thought that encouraging swimming lessons for children under the age of 4 years might actually contribute to increased drowning. In fact, recent studies have suggested that children ages 1–4 may be less likely to drown if they have had formal swimming instruction. The AAP has not gone so far as to routinely recommend mandatory swimming lessons for this age group, but does endorse swimming lessons in younger children who are frequently exposed to water and are emotionally and physically able to participate. Just as with any childhood milestone, different children will become more adept swimmers at different ages.  The AAP does not recommend formal “infant survival swimming lessons” for children under the age of 1 year. I have heard many parents discuss infant swimming classes and I believe that parent- child pool time is great, but infant survival swimming has not been proven to be beneficial. The AAP continues to recommend that most children ages 4 and older should learn to swim.  Swimming is a life skill that everyone should attempt to master, just like jumping rope, riding a bike and swinging. When I am discussing water safety with my patients and families, I emphasize that drowning continues to be the second leading cause of death for children ages 1–19.  Because I practice in Texas, many families have a backyard pool of some sort, whether it be in ground, above ground or even a very large portable inflatable pool. All of these pose the risk of drowning. I often have interesting discussions with parents who have a backyard pool who do not believe that it is necessary to have a barrier around the pool. They will say, “we never let our child outside alone” or “he or she is always being supervised by an adult”.  As you might expect, these are usually first time parents who have yet to experience the cunningness of a toddler. Just as our children watch us and learn how to feed themselves, or drink from a cup or climb out of a bed, they too watch us open a door, or take a stool out to reach something. A toddler is more than capable or figuring out how to reach a door handle even with a lock, or climb out a window to go outside and head straight for the pool. Drowning is also SILENT!!  It is not like the movies with screaming and yelling. The child quietly goes beneath the water and sinks.  It only takes minutes and the consequences of drowning are devastating. Even for a child who is found and resuscitated there may be a life-long brain injury and the worst case scenario, death.  All families with a pool should install a 4 sided fence that is at least 4 feet high to limit pool access. It must be difficult to climb and have a self-latching, self-closing gate. The arguments I hear about “landscape aesthetics” fall on deaf ears. Every family should also know CPR. So sign your child up for swimming lessons, and have fun practicing flutter kicks and arm strokes. Just do it with an adult within arm’s reach of all new and novice swimmers and a fence around the pool! That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Hot Dogs: A Choking Hazard

The AAP recommends the food industry change the shape of a hot dog as it causes choking in children. Dr. Sue says other foods are just as hazardous. Did you read the latest AAP (American Academy of Pediatrics) position statement which addressed the issue of choking among children?   Choking is unfortunately a common problem in the pediatric population and prevention of choking is a topic I discuss with all parents as their children begin eating table food.

Children under the age of 3 have the greatest frequency of choking and hot dogs are a major concern for causing choking.  Due to this, the AAP has recommended that food manufacturers “design new food and redesign existing food to minimize choking risk”. They also state that foods that pose a high choking risk (peanuts, hard candy, grapes, apples, popcorn and chewing gum) should also get warning labels. But this may sound crazy, while knowing that choking is a problem in the pediatric population, I cannot understand a recommendation to change the shape of a hot dog.  A hot dog is a hot dog and if flattened it will then be called bologna. Hot dogs are not the issue, as grapes and peanuts cause choking and we cannot advocate changing their shapes.  Rather, it seems to me to be an issue with educating parents and making parents responsible for cutting up their children’s food. Parents need to be parents and take responsibility for protecting their children but not by changing the shape of a hot dog.  Think of all of the different objects that can cause choking, coins, toys, buttons, weird small objects that toddlers find on the floor. We cannot protect our children from all small objects and at the same time, things that we have control over, such as a hot dog or a grape, should be cut into small pieces before giving them to a child.  Lollipops also cause choking and some pediatricians still give lollipops after an office visit.  Hotdogs and lollipops are just what they are, they cannot be changed. We educate parents about using sunscreen (but we did not change the sun) and we are concerned about drowning and advocate fences and pool safety, but we don’t stop going outside or playing in a pool in the summer. Keep talking to parents about the risk of choking, advocate that all parents take infant and child CPR, cut up a child’s food until they are old enough to tell you that they know how to use a knife, but don’t outlaw hot dogs.  I will eat a hotdog at the ballpark or state fair, but not bologna. That's your daily dose for today.  We'll chat again soon.

Your Teen

AAP Updates Position on Marijuana Legalization

1:30

The American Academy of Pediatrics (AAP) has come out in favor of keeping marijuana illegal, but decriminalizing its use.

The AAP says the penalties for being caught with the weed should be reduced because a criminal record can have a lasting impact on someone’s life making it harder to get a job, apply for loans for education and even finding housing.

Decriminalization of marijuana “takes this whole issue out of the criminal justice system and puts it into the health system, where it really should be,” said Dr. Seth Ammerman, the statement’s lead author from Stanford University in California.

While some people feel that marijuana is as benign as alcohol use, Ammerman says that argument isn’t persuasive, especially when applied to adolescents and young adults.

“It’s not benign for youth,” he said. “It may be benign for adults, but the Academy feels strongly that alcohol is not benign for youths either.”

The statement goes on to state that the negative effects of marijuana on teens are well documented including impaired short-term memory and decreased concentration and problem solving.

Because the drug can affect motor control skills, its use may also contribute to deaths and traffic accidents or injuries.

Another concern is whether smoking pot may affect brain development in younger people.

“There has been some interesting brain development research that shows the brain continues to develop into the mid-20s, and there is some research in regular to heavy users that their brain development is not normal,” Ammerman said.

The Academy also opposes the legalization of marijuana for medical uses that haven’t been evaluated through proper regulatory channels, such as the U.S. Food and Drug Administration.

 “These cannabinoids can have therapeutic value, but there have been no studies in children or adolescents.” Ammerman noted.

The Academy does make an exception though "for children with life-limiting or severely debilitating conditions and for whom current therapies are inadequate."

While some medical marijuana advocates said they were pleased with the updated AAP policy, they felt that it was a weak effort.

Source: Andrew W. Seaman, http://www.reuters.com/article/2015/01/26/us-legal-marijuana-pediatricians-idUSKBN0KZ0AK20150126

 

Parenting

AAP Says Lice Shouldn’t Keep Kids Out of School

1:30

Typically, when a student has head lice or nits (the eggs of head lice), the school requires that he or she go home and not return until the lice are gone. The American Academy of Pediatrics (AAP) recently proposed new guidelines that say, "No healthy child should be excluded from school or allowed to miss school time because of head lice or nits."

The AAP says that while head lice may be annoying and cause itching, they don’t actually make people sick or spread disease. Many people believe that the insects are easily spread, but experts say that direct head-to-head contact is required.

The AAP notes that most doctors who care for children agree that school policies requiring children to be free from nits before returning to school should be abandoned.

The AAP also reported that screening kids at school for head lice does not reduce the occurrence in classrooms over time. However, pediatricians advise parents to check their children’s heads for lice and school nurses may check children who are showing symptoms such as repeated head scratching.

To treat lice, the AAP recommends parents start with over-the-counter medications that contain 1 percent permethrin or pyrethrins (types of insect-killing chemicals).

Parents should carefully follow the treatment instructions, and when using permethrin or pyrethrin products, should apply the treatment at least twice (about 9 days apart).

Because these medications do not kill 100 percent of the lice eggs, the treatments should be followed by manual removal of the eggs, the guidelines say. This can be a tedious process, but fine-tooth combs called "nit-combs" can make the process easier.

Some head lice have become resistant to OTC treatment, these cases may benefit from prescription medications such as spinosad or topical ivermectin.

Once a person is diagnosed with head lice, everyone in the family should be checked for the condition. Lice are usually transmitted by direct contact, so it's less likely that people will get lice from touching household items, but it is still wise to clean all hair-care items and bedding used by the person who had lice, the guidelines say.

Children should be taught not to share items such as combs, brushes and hats, although such precautions may not prevent all cases of head lice, they can reduce the risk of transmission.

Source: Rachel Rettner, http://www.livescience.com/50629-head-lice-recommendations.html

Your Child

AAP Supports Flu Shots Instead of Nose Spray for Children

1:30

The American Academy of Pediatrics (AAP) says that health care providers should not use the live attenuated influenza vaccine (LAIV) in the upcoming 2016-’17 flu season due to poor effectiveness. The LAIV is the nasal spray version of the annual flu vaccine.

Instead, the AAP recommends health care providers use the inactivated vaccine given by injection for flu prevention in children.

Academy leaders say they support the interim recommendation released this week, by the CDC’s Advisory Committee on Immunization Practices (ACIP).

“We agree with ACIP’s decision today to recommend health care providers and parents use only the inactivated vaccine for this influenza season,” said AAP President Benard Dreyer, M.D., FAAP.

Health officials reported Wednesday that the spray performed dismally for the third straight year, while the traditional flu shot — the one that stings — worked reasonably well this winter.

“We could find no evidence (the spray) was effective,” said Dr. Joseph Bresee, a flu expert at the U.S. Centers for Disease Control and Prevention (CDC).

The AAP recommends children ages 6 months and older be immunized against influenza every year. Previously, the CDC and AAP had recommended either form of flu vaccine – the inactivated influenza vaccine (IIV) that is given by injection and is approved for all patients older than 6 months, or LAIV which is given by intranasal spray and is approved for healthy patients ages 2 through 49 years.

However, the new data presented to the ACIP showed that currently only IIV provides protection against flu. The ACIP assessed data from the past three influenza seasons and cited evidence of poor effectiveness of LAIV during this time period.

Two years ago, experts suggested health care providers use AstraZeneca’s FluMist nasal spray to protect children against the flu. This week, a federal advisory committee on immunization withdrew its endorsement of the vaccine.

“We do understand this change will be difficult for pediatric practices who were planning to give the intranasal spray to their patients, and to patients who prefer that route of administration,” said AAP CEO/Executive Director Karen Remley, M.D., M.B.A., M.P.H., FAAP. “However the science is compelling that the inactivated vaccine is the best way to protect children from what can be an unpredictable and dangerous virus. The AAP will be working with CDC and vaccine manufacturers to make sure pediatricians and families have access to appropriate vaccines, and to help pediatricians who have already ordered intranasal vaccines.”

During the winter that just ended, flu shots were nearly 50 percent effective against the flu strain that made most people sick. But FluMist didn’t work at all, CDC researchers said, citing preliminary results from a study of about 2,300 U.S. children.

Experts were particularly worried that FluMist hasn’t protected against H1N1, a type of flu that often causes more deaths and hospitalizations among children and young adults.

For now, health officials say that returning to the flu shot, instead of using the nasal spray, is the best option for preventing or minimizing the effects of the flu in children.

Story sources: http://www.aappublications.org/news/2016/06/22/InfluenzaVaccine062216

Mike Stobbe, https://www.washingtonpost.com/national/health-science/ouch-flu-spray-fails-again-flu-shots-work-better/2016/06/22/33e94216-38b5-11e6-af02-1df55f0c77ff_story.html

Daily Dose

Changes in Flu Immunizations for Children

Flu season is fast approaching and that means it is time to get your flu vaccine. Recently the Centers for Disease Control and Prevention and the American Academy of Pediatrics expanded the recommendation for flu vaccination to include all children ages six months to 18 years.

The previous recommended age group was 6 months to 5 years. "Children under nine years of age who have never received a flu vaccine need to have two doses of vaccine separated by at least four weeks, and all other children receive a single dose," says pediatrician Dr. Sue Hubbard. That means the time is now for you to call and schedule a flu shot with your doctor and your child's pediatrician. Many offices block off certain times during the day in which they have "flu shot clinics." According to Dr. William Schaffner, president-elect of the National Foundation for Infectious Diseases there is an ample supply of the flu vaccine this year. He encourages people to start taking it now as there is no reason to wait. "There are two options for children older than two: the injectable flu vaccine or the live attenuated flumist intranasal vaccine. There are some restrictions to intranasal vaccine (children with asthma, immuno-suppressed children) but for many children the idea of sniffing a vaccine is far better than a SHOT. The upside of the nasal vaccine is also that it seems to be more effective," says Dr. Hubbard. "Either way, start thinking about getting on your doctors schedule to get vaccinated before the winter and influenza hits." Dr. Hubbard also recommends that you teach your child to practice good hand and cough hygiene to help prevent the spread of germs. More Information: The American Academy of Pediatrics More Information: Centers for Disease Control and Prevention

Your Baby

Preventing Peanut Allergies with Peanuts

1:45

As the number of U.S. children with peanut allergies continues to grow, researchers are looking for ways to help these youngsters overcome or manage their allergy better.

The American Academy of Pediatrics (AAP) is now endorsing a recommendation that infants at high risk of peanut allergies be given foods containing peanuts before their first birthday.

How can you tell if your infant might be at risk for developing a peanut allergy?  Children are considered at high risk if they've had a previous allergic reaction to eggs or experienced a severe eczema skin rash. Allergy tests are recommended before exposing at-risk infants to peanut-containing foods.

An earlier published allergy study found that exposure to peanuts in infancy seemed to help build tolerance -- contrary to conventional thinking that peanuts should be avoided until children are older.

Here’s how the study was conducted.  Researchers in Britain followed 640 babies, 4 months to 11 months old, who were considered at high risk of developing peanut allergies. One group avoided peanuts; the others ate a small amount of peanut protein or peanut butter every week. After five years, the group that ate peanut products had 81 percent fewer peanut allergies than the group that didn't.

"There is now scientific evidence," the AAP says, "that health care providers should recommend introducing peanut-containing products into the diets of 'high-risk' infants early on in life (between 4 and 11 months of age) in countries where peanut allergy is prevalent because delaying the introduction of peanut can be associated with an increased risk of peanut allergy."

The advice comes in a consensus statement that the American Academy of Pediatrics helped prepare and endorsed in June along with the American Academy of Allergy, Asthma & Immunology and major allergy groups from Canada, Europe, Japan and elsewhere. The recommendations are meant to serve as interim guidance until more extensive guidelines can be prepared for release next year, the consensus statement said.

While getting the exact percentage of children with peanut allergies is difficult, peanut allergy is one of the most common food allergies. The Centers for Disease Control and Prevention states that four out of ten children suffer from a food allergy. It also notes that hospitalizations resulting from severe attacks have been increasing.

Severe cases can cause an allergic child to experience anaphylactic shock, a potentially life-threatening reaction that disrupts breathing and causes a precipitous drop in blood pressure.

Parents who are interested in the idea of treating peanut allergies with peanuts should not attempt to do this themselves. Children, particularly infants, should only be treated under the care of their pediatrician or pediatric allergist.

The AAP’s recommendation on treating peanut allergies with small doses of peanut protein will be published in the August 31 edition of the journal Pediatrics.

Source: http://www.cbsnews.com/news/new-advice-for-parents-on-peanut-allergies/

http://www.cdc.gov/nchs/data/databriefs/db10.htm

Your Child

AAP: Talk to Your Nine-Year-Old About Alcohol

2:00

Many parents might think the right time to talk to their children about the dangers of alcohol abuse would be around 12 or 13 years of age. But a new report from the American Academy of Pediatrics (AAP) says parents should begin having that conversation with their child by age nine to help prevent binge drinking and abuse as they move into adolescence.

Through television, movies and the Internet, children are exposed to alcohol at a much younger age then just a generation ago.  According to the AAP’s latest report, as many as 50 percent of high school students currently drink alcohol; within that group, up to 60 percent binge drink.

And it’s not only high-school children that are over-indulging. Among 12- to 14-year-olds who drink, approximately half binge drink, according to the report. And while the total number of binge drinkers at this age remains very low (the authors cite one survey which revealed 0.8 percent of 12- to 14-year-olds binge drink), parents should still be aware of the consequences.

Dr. Lorena Siqueira, study co-author and clinical professor of pediatrics at Florida International University, says that the reason to start talking to kids about alcohol before they reach middle school is that children are already beginning to develop an impression of alcohol by nine years old. In terms of prevention, it's better for parents to influence children's ideas about alcohol early, rather than trying to change their impressions later, from positive to negative, she said.

"[Alcohol] is the substance most frequently abused by children and adolescents," Siqueira told Live Science. But because it's a legal substance, the consequences are often downplayed. 

"When I have kids in the ICU [intensive care unit], and I tell the parents it’s alcohol, they're relieved," Siqueira said. But they shouldn't feel relief, she added. "Alcohol is a killer.”

Binge drinking in adults refers to five or more drinks for men and four or more for women over a 2-hour period. For teens, the amount of drinks can be lower because they weigh less, researchers said.

For some teens, having even three drinks is considered binge drinking and having fewer drinks than that should not be considered safe.

Part of the problem is how adolescents drink, Siqueira said. They often turn to vodka, and they drink very fast, often directly from the bottle, with the goal of getting drunk — and this can kill them, she noted.

According to the report, nearly a third of fatal car accidents among 15- to 20-year-olds involve alcohol.

Drinking at a younger age can also interrupt brain development and increase the risk of chronic alcohol disorder later.

To warn children about the dangers of alcohol abuse, Siqueira recommends parents use every available opportunity to talk about the issue.

"Alcohol is ubiquitous," she said. And kids see it everywhere - on the sides of buses, on billboards and in movies.

"If you're driving, and you see someone swerving, talk about that. If you see it in a movie, talk to your kids about it then," she said.

One of the best teaching methods is to lead by example. Eighty percent of teenagers say that their parents are the biggest influence on their decision to drink.

That doesn’t mean you should not have a drink in front of your child, but getting drunk or “needing a drink” to handle stress shouldn’t happen, Siqueira said.

The report was published in the journal Pediatrics.

Source: Sara Miller, http://www.livescience.com/52030-parents-talk-about-alcohol-kids-early.html

 

 

 

 

 

 

 

 

 

 

 

 

 

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