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Your Child

Bullied Kids at Risk for Health problems as Adults

2:00

Being teased or humiliated by fellow classmates in school was once just a part of growing up for many kids. No one took it very seriously and children were basically told to either deal with it or physically fight back.

That began to change when bullying tactics changed from one-on-one painful snubs or pushing in the hallways to shaming and hateful social media taunts. All of a sudden everyone was in on the game and there was no where to hide or seek refuge from the never-ending onslaught of mean spirited and sometimes violent threats to a child’s very existence.

Bullying had reached a new stage of hurtfulness and too often the coping mechanism from children who were bullied was and still is suicide. Schools, parents and peers began to take notice and implement strategies to stop the bullying – at least in public environments.

Some of these strategies have been very effective and kids, as well as parents, are much more aware of the dangers that can come from bullying. However, there is always someone who thinks that they have a right to humiliate someone else. While it is more a reflection of the insecurity and abnormal personality of the person doing the bullying, the recipient still feels the pain and harbors the emotional damage to their self-value.

A new study looks at the possible future health hazards for children who have been bullied. Their findings reveal that adults who were bullied in childhood may be at an increased risk for obesity, heart disease and diabetes.

"Our research has already shown a link between childhood bullying and risk of mental health disorders in children, adolescents and adults, but this study is the first to widen the spectrum of adverse outcomes to include risks for cardiovascular disease at mid-life," said senior study author Louise Arseneault. She is a professor from the Institute of Psychiatry, Psychology and Neuroscience at King's College London.

"Evidently, being bullied in childhood does get under your skin," she said in a college news release.

The long-term study involved analyzed data from more than 7,100 people.  Participants in the study included all the children from England, Scotland and Wales that were born during one week in 1958. Their parents provided information on whether the participants were bullied at ages 7 and 11.

By age 45, more than one-quarter of women who were occasionally or frequently bullied during childhood were obese, compared to 19 percent of those who never experienced bullying, the study found. Both men and women who were bullied during childhood were more likely to be overweight.

Compared to those who weren't bullied, men and women who were bullied had higher levels of blood inflammation, putting them at increased risk for heart attack and age-related diseases such as type 2 diabetes, according to the researchers.

Like most studies, results didn’t show an actual cause and effect relationship, only an association or link between being bullied and future health risks.

"Bullying is a part of growing up for many children from all social groups," Arseneault said. "While many important school programs focus on preventing bullying behaviors, we tend to neglect the victims and their suffering. Our study implies that early interventions in support of the bullied children could not only limit psychological distress but also reduce physical health problems in adulthood."

Andrea Danese, a study co-author, pointed out that obesity and high blood inflammation can lead to potentially life-threatening conditions such as type 2 diabetes and cardiovascular disease. Taking steps to prevent these conditions is important, Danese said in the news release.

"The effects of being bullied in childhood on the risk for developing poor health later in life are relatively small compared to other factors," Danese added. "However, because obesity and bullying are quite common these days, tackling these effects may have a real impact."

Counseling coupled with family support for children who have been or are being bullied can offer tremendous value to helping a child disconnect with the hurtful words and actions of others. No one likes to be made fun of or taunted for some slight “imperfection”, but those kinds of things can linger in the mind and wear on one’s self-value. The sooner they are dealt with and put in their true perspective, the quicker one can let them go.

The study was published May 20 in the journal Psychological Medicine.

Source: Robert Preidt, http://consumer.healthday.com/kids-health-information-23/bullying-health-news-718/bullying-heart-disease-psych-med-kcl-release-batch-1756-699576.html

Your Teen

Lithium Safe for Children, Teens with Bipolar Disorder

2:00

A new multicenter study says that lithium, a drug typically given only to adults, is safe and effective for children and adolescents who have bipolar disorder.

The study, led by a researcher at the Johns Hopkins Children's Center and published Oct. 12 in Pediatrics, affirms what clinicians who prescribe this drug have observed for years and suggests that doctors can now more confidently add lithium to the available treatments for this vulnerable population -- at least in the short term, the authors say.

Lithium is one of the oldest drugs for bipolar disorder, a chronic brain condition marked by spontaneous, seesawing bouts of abnormally high moods and depression. The drug's ability to stabilize mood extremes has been well established in adults.

The researchers point out that historically, children and women of childbearing age have generally been excluded from many clinical trials out of an abundance of caution. Some believe that while the intentions may have been good, being excluded in clinical studies may actually harm this population- leaving them without access to more effective treatments.

"Lithium is the grandfather of all treatments for bipolar disorder, but it has never been rigorously studied in children," says Robert Findling, M.D., M.B.A., a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and director of child and adolescent psychiatry at the Johns Hopkins Children's Center.

Findling initiated the work while director of child and adolescent psychiatry at Case Western Reserve University School of Medicine.

Though medications used to treat schizophrenia and other psychoses are prescribed to treat bipolar disorder in children, Findling says, those drugs have been linked to substantial weight gain, a considerable medical and social drawback for young people that causes many to stop taking them.

Results from the study showed that the patients on lithium experienced far more significant improvement in their symptoms over eight weeks compared with those on the placebo. Some 47 percent of those on lithium scored in the range of "very much improved" or "much improved" on the Clinical Global Impressions Scale, a rating system commonly used to assess the efficacy of treatments in patients with mental disorders, compared to 21 percent of those on the placebo.

Unlike antipsychotic agents, such as risperidone or olanzapine, lithium treatment was not associated with significant weight gain, and none of the patients experienced serious side effects due to the lithium treatment.

Findling says the findings provide a scientific and reliable confirmation of lithium's efficacy and safety for children in the short term, offering evidence that doctors can use when deciding what medication to prescribe their pediatric patients with bipolar disorder. Further analyses are currently in progress to examine the long-term implications of lithium use, he adds. Areas of particular focus include evaluation of any potential side effects, such as weight gain, reduced kidney function or diminished thyroid function -- all important considerations, as those with bipolar disorder may need a lifetime of medication and behavioral therapies.

Bipolar disorder affects approximately 1 percent of teens and is the leading cause of disability in adolescence.

Source: Adapted Media Release, http://www.medicalnewstoday.com/releases/300847.php

 

Your Child

Lung Ultrasounds as Effective as Chest X-Rays for Detecting Pneumonia

1:45

Traditionally, when a child shows up at the ER or physician’s office with suspected pneumonia, a chest x-ray is ordered to verify a diagnosis.

A new report says that lung ultrasounds may offer a safer and equally effective alternative for diagnosing pneumonia in children.

"Ultrasound is portable, cost-saving and safer for children than an X-ray because it does not expose them to radiation," explained study leader Dr. James Tsung. He is an associate professor in the departments of emergency medicine and pediatrics at the Icahn School of Medicine at Mount Sinai, in New York City.

Ultrasound, also called sonography, is an imaging method that uses high-frequency sound waves to produce images that lead to diagnosis and treatment of many diseases and medical conditions. Radiation is not used in ultrasound testing, but is used in x-rays and CT scans.

The study looked at 191 emergency department patients, aged 21 and younger, who were randomly assigned to either an investigational group or a control group.

Patients in the investigational group had lung ultrasound and, if additional verification was needed, a follow-up chest X-ray. Those in the control group had a chest X-ray followed by lung ultrasound.

The patients in the investigational group had nearly 39 percent fewer chest X-rays, with no missed cases of pneumonia and no increase in complications. The reduction in chest X-rays led to overall cost savings of $9,200 and an average decrease in time spent in the emergency department of 26 minutes, according to the study published April 12 in the journal Chest.

"Our study could have a profound impact in the developing world where access to radiography is limited," Tsung said in an Icahn news release.

Pneumonia is a leading cause of death among children worldwide. Chest X-ray is considered the best way to diagnose pneumonia in children, but about three-quarters of the world's population does not have access to X-rays, according to the World Health Organization.

Parents in the U.S. may want to request a lung ultrasound instead of a chest x-ray when that option is available, to avoid their child’s exposure to radiation.

Story source: Robert Preidt, http://www.webmd.com/children/news/20160413/lung-ultrasound-may-be-best-to-spot-pneumonia-in-kids-study

Your Baby

Singing to Baby in the Womb Decreases Crying After Birth

2:00

There is no shortage of advice for mothers-to-be about what to do once baby arrives. But, there’s something you can do before baby is born to help bring a calmer child into the world. The key is singing to baby while he or she is still in utero, according to a new study.

Researchers divided about 170 pregnant women into two groups; one group sang lullabies in the months immediately before and after birth. The other group did not sing to their baby at all.

They found that babies from the singing group generally cried 18.5 per cent of the time compared to 28.2 per cent of the time in the group who were not sung to.

Meanwhile for those with colic - excessive or frequent crying where there is no ill health - the babies who had enjoyed prenatal lullabies tended to cry for about a quarter of the time.

How well moms and babies were able to bond was also measured after birth. Researchers used a scientific measurement called the Mother-to-Infant Bonding Scale while they also recorded hours of baby sleep, crying incidences and bouts of colic.

In the weeks following birth, the postnatal bonding measurement was a little higher among the singers - 1.96 against 1.28 on the scale.

The authors concluded that: "Mothers singing lullabies could improve maternal-infant bonding. It could also have positive effects on neonatal behavior and maternal stress.”

Babies cry for many reasons. It’s how they communicate hunger, pain, fear, the need to sleep and more.

The most common reason for crying is hunger. Once you recognize the signs of hunger, you can feed before they start. Some signs to watch for are lip smacking, fussiness, putting their hands to their mouths and pushing their heads into your hand or shoulder.

Colic (tummy troubles) is also a common cause of crying. This may come after feeding, so burping the baby is often helpful. If your baby has colic a lot be sure to talk to your pediatrician.

A dirty diaper will trigger crying. This is an easy one to control; check and change often.

Babies need a lot of sleep. Instead of nodding off easily, babies may fuss and cry – especially when they're overtired.

Creating a quiet and warm (but not too warm or hot) room helps, plus rocking baby will often soothe and send them to dreamland. Also, make sure that their clothing is soft. Scratchy blankets or clothes can irritate their tender skin.

And of course, babies cry when they don’t feel well. Discuss what symptoms to look for and the best way to take your little one’s temperature with your pediatrician.

Sometimes, baby just cry and we’re not really sure why, after all, they can’t tell us. They may just want to be held and cuddled. We all like that.

The research was undertaken by the University of Milan and published in the journal Women and Birth.

Story sources: Henry Bodkin, http://www.telegraph.co.uk/science/2017/03/07/sing-bump-lullabies-babies-womb-decreases-crying/

https://www.babycenter.com/0_12-reasons-babies-cry-and-how-to-soothe-them_9790.bc

 

Daily Dose

Penicillin Allergy

1:30 to read

Has your child ever been labelled “penicillin allergic”?  Interestingly, up to 10% of people (of all ages) report having a penicillin allergy, but only about 1% are truly allergic. I see this often in my own practice, especially when seeing a new patient and inquiring about drug allergies, and the parent replies, “ she is penicillin allergic, and developed a rash when she was younger”.  In many if not most of those cases the child is not allergic to penicillin.

 

Penicillins are a class of antibiotics known as beta-lactams and include not only penicillin but  amoxicillin, augmentin, oxacillin and nafcillin, just to name a few.  If you are incorrectly identified as penicillin allergic, when your doctor needs to prescribe an antibiotic they may resort to another class of antibiotic, which are not only more expensive but often may cause more side effects.  

 

Penicillins are the antibiotic of choice and the first line treatment for many pediatric bacterial illnesses including otitis ( ear infections ), strep throat, and sinus infections. They are not only effective, but they are typically inexpensive and have few side effects….which includes allergic reactions.

 

Penicillin allergy is an immune - mediated reaction which usually causes hives ( raised rash ), face or throat swelling, difficulty breathing and in some cases life threatening anaphylaxis.  Intolerance to penicillin is different than being allergic, and in this case symptoms are more likely nausea, diarrhea, headache or dizziness, which may make you uncomfortable but are not immune mediated. 

 

In pediatrics, many children present with a viral illness that includes several days of fever and upper respiratory symptoms, and are then also found to have an ear infection. They are given a prescription for amoxicillin and several days later develop a rash. Many viral infections in children also cause a rash, which is typically red, flat and covers the trunk, face and extremities and does not cause any other symptoms which are seen with a true penicillin allergy.  This rash is benign, but unfortunately many young children will be seen at an urgent care or even an ER due to the rash. The parents are told that their child is penicillin allergic and the antibiotic is changed…and the label “pen allergic” sticks….for many years or even life.  I even saw this rash occur in one of my own sons while on an antibiotic. He is NOT allergic!

 

The good news is that most children are truly not penicillin allergic, and if possible I try to see all of my patients who report a rash while they are on an antibiotic. At times this is not possible, and now with the advent of “smart phones” I have parents send me a picture of the child and the rash. This often helps in determining if the rash truly appears allergic and to identify if there are other symptoms.  Back to the “get a good history”. 

 

If I see an older patient who has had a rash on amoxil when they were little and had no other adverse effects (get a good history), I will sometimes try using a penicillin again, as most people also “outrgrow” their sensitivity after about 10 years. If it is my patient and I have seen the rash I tell the parents that this is not a “pen allergy” and I will use penicillins again.  Some  patients will report a “pen-allergy” but say I can take “augmentin” which is penicillin derivative, so that makes it easy to know they are not allergic.  If I am unsure if a child has had a true penicillin allergy I will refer them to a pediatric allergist for skin testing.  Skin testing is not painful and is an important method for documenting a true allergy. 

 

 

   

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Your Baby

Antibiotics Not Effective for Mild Eczema in Kids

2:00

As many as 10 percent of all infants have some form of eczema, a condition that usually develops between the ages of 2 and 6 months, and almost always before the age of 5 years old. Kids with eczema usually develop itchy, dry, red skin with small bumps on their cheeks, forehead or scalp. The rash may spread to the arms and legs and the trunk, and red, crusted, or open lesions may appear on any area affected.

They also may have circular, slightly raised, itchy, and scaly rashes in the bends of the elbows, behind the knees, or on the backs of the wrists and ankles.

Eczema is not contagious, so there's no need to keep a baby or child who has it away from siblings, other kids, or anyone else.

Antibiotics are often prescribed as a treatment, but a new study says that they are not effective for milder cases in children.

"This is a good example of a common situation in medicine," said Dr. Michael Grosso. "A particular intervention 'makes sense,' becomes common practice -- and often becomes the so-called 'standard of care' -- only to be proved ineffective when the therapy is subjected to scientific investigation."

Eczema is an immunological condition affecting both children and adults.

Dr. Craig Osleeb explained, "Children with eczema have an overabundance of the bacteria normally found on skin." He is a pediatric allergist at Northern Westchester Hospital in Mount Kisco, N.Y.

"The excessive colonization of bacteria can exacerbate symptoms by causing infection and/or triggering inflammation," Osleeb said. So, "antibiotics have often been used to quell eczema exacerbations."

Doctors are concerned that, over time, bacteria can develop a resistance to antibiotics, opening the door for dangerous drug-resistant “superbug” infections. While once a very popular treatment, doctors are now leaning towards reducing the number of antibiotic prescriptions to treat certain cases.

The new study, led by Nick Francis of Cardiff University in Wales, included 113 children with non-severe, infected eczema who were randomly selected to join one of three groups.

The children received either an antibiotic pill plus a "dummy" placebo cream; a placebo pill and an antibiotic cream; or placebo pill plus placebo cream (the "control" group).

After watching outcomes for two weeks, four weeks and then three months, the British team found no significant differences between the three groups in terms of easing of eczema symptoms.

Researchers found that the children with non-severe eczema, given the antibiotics either in a pill or a cream, did not benefit from the treatment. The study authors added that such use might even promote antibiotic resistance or additional skin sensitization.

Francis and his team noted that the study focused only on kids with a milder form of eczema, so the results may not apply to children with more infected eczema.

Osleeb agreed. For children battling milder eczema outbreaks, "corticosteroid creams alone will suffice," he said, but "this study does not eliminate the potential role of antibiotics in more moderate to severe eczema exacerbations."

Diagnosing eczema can be challenging because each child has a unique combination of symptoms, which can vary in severity. Treatments can consist of topical corticosteroid creams, antihistamines and in some instances, ultraviolet light under the supervision of a dermatologist.

Some children will outgrow eczema and some may continue to have symptoms during their teens and into adulthood.

If you suspect your baby or young child may have eczema, have your child seen by your pediatrician for diagnosis and treatment options.

Story sources: Robert Preidt, https://consumer.healthday.com/diseases-and-conditions-information-37/eczema-news-618/skip-the-antibiotics-for-mild-eczema-in-kids-720482.html

http://kidshealth.org/en/parents/eczema-atopic-dermatitis.html#

Your Child

ATV Accidents Causing Serious Chest Injuries in Kids

1:45

From rural America to the suburbs, you can count on the sound of children and their new ATV buzzing up and down the street on Christmas morning. All-terrain vehicles are a popular gift during the holidays, and more often than not, you’ll see children with a safety helmet on to reduce the risk of head trauma – should they have an accident.

What parents may not know is that these vehicles also pose a high risk for severe chest injuries, according to a new study.

"I believe that many parents are unaware of how serious ATV-related injuries can be," said the study's author, Dr. Kelly Hagedorn, a radiology resident at McGovern Medical School at the University of Texas Health Science Center at Houston.

"Some parents view ATVs as being more similar to bicycles. However, many of the injury patterns are more similar to those sustained in motor vehicle collisions," Hagedorn explained.

ATVs are motorized recreational vehicles with three or four tires, designed for off-road use. Because they can weigh 300 to 400 pounds and travel at speeds of up to 75 miles an hour, ATVs can often be involved in serious accidents, including crashes, rollovers and ejections, the researchers said.

The good news is that ATV-related injuries have declined since 2007. As public safety awareness about ATVs increases, more parents are making sure that helmets, protective clothing and personal oversight safeguard their children.

However, nearly 25,000 children under the age of 16 were treated for ATV-related injuries in hospital emergency rooms nationwide in 2014, according to the U.S. Consumer Product Safety Commission (CPSC).

Researchers suspect that one of the reasons children’s ATV-related chest injuries are becoming more severe and frequent is that the newer vehicles are larger and weigh more than their predecessors. 

"As ATVs have gotten bigger and heavier, riders have a harder time separating from the vehicle in a crash," said Gerene Denning. She's director of emergency medicine research at the University of Iowa Carver College of Medicine.

"The increasing size and weight of ATVs leads to more cases of the vehicle striking the rider. There is also a growing trend of riders being pinned by the vehicle, which can lead to compression asphyxia [a condition where the body doesn't get enough oxygen]," said Denning, who wasn't involved in this study.

The new study included records from 455 patients, 18 years old and younger. All had chest imaging at a trauma center in Houston after ATV-related incidents. The accidents occurred between 1992 and 2013. Of those admitted, 102 (22%) suffered a chest injury.

The researchers said that 40% of patients with chest injuries were treated in an intensive care unit (ICU), compared to 22% of patients without chest injuries. On average, patients with chest injuries were 13 years old.

The most common chest injury (61%) was pulmonary contusion, or bruising of the lung. About 45% of patients had a collapsed lung and 34% had rib fractures. Eight deaths occurred among the 102 patients who had chest trauma, the study found.

The study authors found that the biggest cause of chest injury was rollover (43%), followed by collision with landscape (2 %) and falls (16%).

In 41 cases, the injured child had been driving the ATV. In 33 cases, he or she had been riding along as a passenger. In the remaining 28 cases, it wasn't known whether the injured child was the driver or passenger.

While many parents are being more vigilant about ATV safety, some still believe bigger is better and are still allowing their children to operate adult-size vehicles.

"This increases both the risk of crashing and the severity of vehicle-related trauma," Denning said. "A group called Concerned Families for ATV Safety have story after story of children killed in ATV crashes. A common thread through those stories is a parent saying they didn't know how dangerous these vehicles were for their children."

ATV laws are not consistent nationwide. In many states, children younger than 16 can drive ATVs designed for adults, according to the CPSC. The American Academy of Pediatrics (AAP) recommends that children under that age be prohibited from riding ATVs.

Hagedorn is scheduled to present the study results at the annual meeting of the Radiological Society of North America, in Chicago. Findings presented at meetings are generally viewed as preliminary until they've been published in a peer-reviewed journal.

Concerned Families for ATV Safety, mentioned above, offers educational resources, news and ATV safety tips for parents. It also shares family stories of children injured or killed in an ATV accident. Their website is: http://www.cfatvsafety.org

Story source: Don Rauf, https://consumer.healthday.com/kids-health-information-23/child-safety-news-587/atv-accidents-can-cause-serious-chest-injuries-in-children-717207.html

Your Baby

Online Breast Milk May Be Cow’s Milk Instead

1:30

There are many reasons that someone may want to purchase breast milk online; but typically it’s because mothers cannot produce enough or any breast milk themselves.

A new study published in Pediatrics, found that more than 10 percent of samples of breast milk bought online contained cow’s milk in significant quantities.

That can be a real problem for infants that cannot tolerate cow’s milk.

Researchers anonymously bought 102 samples from sites that use classified advertising to connect milk buyers with sellers. The sites are generally not involved in the transactions beyond helping make the initial connection.

They isolated mitochondrial DNA from the samples by polymerase chain reaction, the same technique used for forensic and medical purposes. Every sample contained human DNA, but 11 of them contained cow’s milk, 10 of them at levels higher than 10 percent.

“This was high enough to rule out minor or accidental contamination,” said the lead author, Sarah A. Keim, a principal investigator at Nationwide Children’s Hospital in Columbus, Ohio. “This is deliberate adulteration no matter how you look at it.”

Children under one-year-old should not be fed cow’s milk according to the American Academy of Pediatrics (AAP.) Cow’s milk contains nutrients that are too high for a baby’s system such as protein, sodium and potassium. If breast milk is not available, infant formulas are a good substitute.

“In a previous study, we found that a fifth of these people were online because their infants were having trouble tolerating cow’s milk. Additionally, it is clearly not recommended for infants under 12 months to be on cow’s milk.” said Keim.

Much of online breast milk is unregulated and may contain bacteria, but there are certified milk-banks that are regulated and safe.

Source: Nicholas Bakalar, http://well.blogs.nytimes.com/2015/04/06/online-breast-milk-may-contain-cows-milk/?_r=0

 

 

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