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Heart Healthy Kids

Heart Health

Your Child

Concussions May Have Long Term Impact on Kids’ Mental Health

1:45

There’s been a tremendous amount of information about concussions in the news lately. One question many parents want answered is, if my child suffers a concussion could it have an impact on his or her mental, physical or intellectual health for the rest of their lives?

The answer is yes according to a recent study, and for kids who have had more than one concussion; the risks are even higher that they will suffer repercussions into adulthood.

A report released by the health insurer, Blue Cross Blue Shield, said diagnosed concussions among people under the age of 20 climbed 71 percent between 2010 and 2015. Part of that increase may be attributed to an improved awareness of the dangers of concussions, prompting coaches and parents to seek medical attention for athletes and kids.  However, the high numbers also suggest that more children are experiencing head injuries than in the past.

The data also showed that twice as many boys were diagnosed with concussion than girls, although the rates for girls increased by 119 percent during the dates examined.

While more general information about concussion is becoming abundant, the effects on the health of children into adulthood have largely remained unknown.

For the new study looking into the long-term effects, multiple data sources were reviewed including a valuable collection of records from Sweden.

A plethora of linked registries in that nation contain information about people’s medical and hospital visits, socioeconomic status, education, physical disabilities and other aspects of their lives, says Dr. Seena Fazel, a professor of forensic psychiatry at Oxford and the new study’s senior author. The registries also allow researchers to compile information about family members.

In this case, the scientists concentrated on all Swedes born between 1973 and 1985 and looked for those who had experienced a head injury of some kind before the age of 25. More than 104,000 people qualified. Researched reviewed data about these people for 40 years.

Along with each patient, researchers also compiled similar medical records for a sibling who had not been diagnosed with a head injury and compared the results between family members and the total population of the country.

The results of the study were unsettling. They found that young people who had experienced a single diagnosed concussion were more likely to be receiving medical disability payments as adults, to have at some point sought mental health care, were less likely to have graduated from high school or attended college and were twice as prone to die prematurely than their uninjured sibling.

If the patient had experienced more than one concussion while young or if the brain injury was more severe than a concussion, the possibility of physical and psychological problems during adulthood increased.

While the results of the study were disconcerting, there was also good news in the report. Not everyone who had a concussion or brain injury as a child or teenager experienced mental or intellectual problems -related to the brain injury - as an adult.

“The majority of individuals who had diagnoses of brain injury in our study did not experience adverse outcomes,” Dr. Fazel says.

Unfortunately, it is impossible at the moment to identify which children or teenagers who experience head trauma may be most at risk of struggling in later life and which will instead recover without apparent complications, he says.

The overall message from this study is that all steps should be taken to prevent childhood head injuries.

If a young person does suffer head trauma, he continues, more and longer-lasting monitoring is also probably a good idea. Such monitoring may be especially important if the child shows any signs of “a decline in psychosocial performance,” Dr. Fazel says, such as a drop in grades or a change, even subtle, in personality. A neurologist can provide useful assessments, and regular follow-up neurological assessments may need to be continued, even into adulthood.

The study was published online in the journal PLOS Medicine.

 Story source: Gretchen Reynolds, http://www.nytimes.com/2016/10/05/well/move/a-single-concussion-may-have-lasting-impact.html?WT.mc_id=SmartBriefs-Newsletter&WT.mc_ev=click&ad-keywords=smartbriefsnl

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Your Child

Positioning an Unconscious Child

1:45

Children that have lost consciousness and are placed on their sides have lower odds of needing to stay in the hospital, according to a new European study.

"This is just a simple part of the first aid and resuscitation techniques that anyone can be taught," said Dr. Elizabeth Murray, who was not involved with the new study but is an expert in pediatric emergency medicine at the University of Rochester Medicine’s Golisano Children’s Hospital in New York.

The “recovery” position has the patient on their side, with the mouth facing downward to allow any fluid to drain. The researchers say this position should be used on unconscious children who are breathing normally with already cleared airways.

The researchers looked at data on 553 infants and children up to age 18 who were brought to 11 pediatric emergency rooms across Europe for loss of consciousness in 2014.

As reported in the Archives of Disease in Childhood, the average age was about three years. The average time spent unconscious was about two minutes, although about a third of the group had lost consciousness for more than 20 minutes.

About one in five patients had an existing condition like epilepsy. And about half of the patients had previously lost consciousness.

About 26 percent of parents had put their children into the recovery position, with about 70 percent of those parents reporting they'd learned that technique from doctors or first aid classes.

Those who were put into the recovery position were ultimately 72 percent less likely to be admitted to the hospital than those who weren't put in the position.

More than half of the parents had tried other potentially dangerous techniques to bring their child out of an unconscious state, such as shaking or slapping them.

Those parents said they had learned those techniques from other family members or from media outlets such as TV shows or the movies.

"You can understand why a family member would do anything to make it stop," said Murray. "Just like fever or other medical conditions, there are remedies or potentially folklore that can be passed down."

Kids whose parents used a potentially dangerous technique to try to restore consciousness had twice the odds of being admitted to the hospital, according to the researchers, who were led by Dr. Sebastien Julliand of Paris Diderot University in France.

Murray told Reuters Health that parents who don’t know what to do in this kind of situation, should call 911 and speak to an emergency operator. "It’s really important to remember that the majority of dispatchers in our 911 system can give advice over the phone," she said.

Source: Andrew M. Seaman, http://www.reuters.com/article/us-health-pediatrics-recovery-idUSKCN0V32SY

 

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

 

Daily Dose

MMR Vaccine Update

vaccine, virus, health, parenting

Although there is more and more data to confirm that childhood vaccines are safe, and DO NOT cause autism….there  continues to be some parental concern surrounding the timing of a child’s vaccines.  The majority (read as all of my patients) receive their vaccines according to the CDC guidelines…and for the most part my patients realize the importance of vaccines and how many lives have been saved as more vaccines are given to children today than 25 years ago.  

But, when it comes time for the MMR (measles, mumps, rubella) vaccine, there are still a few parents who express concerns and some who would “like” to defer the vaccine to a later date when their child is “older”….typically after their child reaches the age of 18-24 months. Concerns are not only about safety, but also about efficacy of the vaccine at a younger age.   There have been several recent studies that should help to allay fears and actually reassure parents that giving the vaccine at 12 months of age is preferable and may have even have fewer side effects, if any, than when given when the child is older.

A study from Finland (which uses the same MMR vaccine)  looked at whether the antibody response (protection) from the MMR vaccine was any different when given at 12 months vs 18 months of age.  This study showed that the antibody response and protection from the MMR vaccine was similar when given at 12 months vs 18 months. Good news for giving it younger and protecting the child earlier.

Another study looked at the risk of febrile seizures after the MMR vaccine. This study reported that the risk of a seizure was more than 6 times higher during the 7 - 10 day interval after the MMR vaccine among children who were 16-23 months, as compared to those who were 12 -15 months.  So..in fact, delaying the vaccine actually put a child at more risk for a seizure than if given earlier.

These studies point to the win-win in giving the MMR vaccine to children at their 1 year old well child visit.  Not only does it provide earlier protection against measles, mumps and rubella ( a new outbreak of measles in the Amish community in Ohio was just reported), the chance of your child having any adverse effects are actually even lower. 

But remember, while this study showed “twice the risk” for delaying the vaccine…it is still a VERY LOW number, out of 10,000 kids there may be 4 extra febrile seizures.  While that number may seem insignificant,  when your child is one of the 4 to have a seizure it is significant. This is coming from a mother whose child had a febrile seizure (unrelated to vaccines) and who is a pediatrician.  It was even frightening for me to watch my child have a febrile seizure and I knew what was happening. While most febrile seizures only last 1-2 minutes he of course decided to have a prolonged seizure, (always doctor's kids). I am happy to report that he is of course totally fine and never had another febrile seizure…as most children “outgrow” febrile seizures during the pre-school years. 

Bottom line,  with these studies in hand…you should feel reassured that immunizing at 12 months is  preferable, safe and prevents serious illnesses.  

Your Child

Make It a Safe Summer!

2:30

Summer is a time when lots of family create life-long memories. Vacations offer a chance for everyone to get away from the daily grind and explore someplace new. Some families choose to spend the summer closer to home with a “staycation.” You can still relax, have fun and spend time together without the added expense of travel.

One experience a family doesn’t want to have is when someone is injured or worse or falls ill during the summer break. To help make summer is a little safer remember these common sense safety tips.

Water Safety: Probably the number one danger to children in the summer is drowning.

·      Make sure your child learns how to swim.

·      Never leave your child unattended around water. We know it sounds strict, but there is no room for compromise on this one. Babies can drown in as little as one inch of water.

·      Drowning is silent. Always watch your child when they are in a pool, lake, ocean or pond.

·      Have a flotation device nearby to toss into the water for a child to grab if they are tired or in danger.

·      If you cannot swim, make sure that there is an adult who can swim with you when your children are in the water.

·      Put the cell phone away, forget about all the other things you have to do and give young children 100 percent of your attention when they are near or around water.

·      Keep pool areas fenced and locked when no one is in the pool.

·      Empty all tubs, buckets, containers and wading pools immediately after use. Store them upside down and out of children’s reach.

·      Keep toilet lids closed and use toilet seat locks to prevent drowning. It’s also a good idea to keep doors to bathrooms and laundry rooms closed. 

·      Parents have a million things to do, but learning CPR should be on the top of the list. It will give you tremendous peace of mind – and the more peace of mind you have as a parent, the better.

Hot Cars: Another danger for small children is hot cars. When a child dies or is injured in a hot car, it’s one of the most preventable tragedies. Parents and caregivers can forget they have a small child in the back seat of a car, or they can leave them in the car not realizing how fast the temperature will rise in a very short time. Occasionally, a child will enter a parked car and accidently lock themselves in. 

·      Always look before you lock your car.

•       Always check the back seats of your vehicle before your lock it and walk away.

•       Keep a stuffed animal or other memento in your child’s car seat when it’s empty, and move it to the front seat as a visual reminder when your child is in the back seat. Put something you’ll need in the back seat- like a briefcase or purse.

•       If someone else is driving your child, or your daily routine has been altered, always check to make sure your child has arrived safely.

•       Never leave a child unattended in a car. Opening windows will not prevent heatstroke. Heatstroke can happen on cloudy days and when the temperature outside is below 70 degrees.

•       If your traveling with several children, do a head count – see each child- before locking or leaving the car.

•       If your child is missing, check your car first thing.

If you see an unattended child alone in a car, take action!. Don’t wait more than a couple of minutes for the driver to return. If you see a child is unresponsive or in distress; call 911. Get the child out of the car then spray the him or her with cool water (not an ice bath). If the child is responsive, stay with them until help arrives. Send someone else to find the driver.

Food Safety: Who doesn’t love a good picnic or grilled meal? However, food borne illnesses are not something you’ll enjoy.

•       Keep cold foods cold.

•       Don’t keep any foods at room temperature longer than 2 hours -- or 1 hour if it’s warmer than 90 degrees.

•       Don’t reuse platters that have held raw meat until you wash them thoroughly.

•       Keep your grill away from buildings and branches.

•       Don’t let grease build up.

•       Never leave your grill unattended.

•       Keep kids and pets away.

•       Does yours use propane? Test for leaks before the season starts. If you ever smell gas while you’re cooking, get away from the grill and call the fire department.

Bug Bites: Summer brings bugs, ticks, bees, mosquitoes, fire ants, chiggers, spiders and other pests.

Mosquitoes are more than a bother. They can spread West Nile virus. Most people who get the virus have no symptoms at all. But very serious and sometimes fatal illness can happen in less than 1% of those infected.

The only way to avoid West Nile is to avoid mosquito bites. Wear mosquito repellent and, if weather permits, long pants and long sleeves outside from dusk to dawn.

At home, get rid of standing water in birdbaths, buckets, and tire swings. They’re breeding grounds for mosquitos.

A bite from a tick is not usually a big deal, but the wrong type of tick can cause real problems. Ticks can cause diseases such as Lyme disease and Rocky Mountain spotted fever, a bacterial infection that occurs mostly in the South Atlantic region in the U.S. If the family is trekking in wooded areas. Make sure that everyone is: 

•       Wearing light-colored long pants, so it’s easier to spot ticks.

•       Tucks their pants into socks or high-top boots or tape them to boots.

•       Wearing a hat and long-sleeved shirt, tucked in.

•       Sprays or rubs insect repellent on the tops of boots, exposed area of socks, and pants openings (inside cuffs, waistband, and fly).

•       Using insect repellant with DEET on your exposed skin.  For children, choose a repellent with no more than 10% to 30% concentration of DEET. If your pets go outside, check them regularly for ticks so they don't bring them in the house.

Fire ants have a painful bite and some children are allergic to them. Check your yard for fire ant mounds and if you find any, have them removed professionally.

If you’ve ever had chigger bites, you know how miserable they are. Keep your grass cut short and use bug repellent. Shoes and socks also offer some protection.

During bug season, a good repellent is going to be your best bet to protect your child and yourself from many of these pesky critters.

Shark Attacks: If you’re headed to the ocean, sunburn is more likely to be a problem for your child than a shark bite, however, this year is quickly on the way to setting a record for shark attacks. Here are some ways to lessen the risks.

•       Avoid being in the water at twilight, when sharks are most active.

•       Don’t go in the water if you’re bleeding.

•       Don’t wear shiny jewelry when you swim. It could look like fish scales to a shark.

•       Know that sharks are sometimes near the shore. Sandbars can trap them close to the beach at low tide.

•       Skip swimming after heavy rains, which may move some freshwater fish, including sharks, into areas they would not otherwise frequent.

Sunburn: Summertime can mean sunburn time as well. Not only are they painful; but sunburns can do more damage to the skin long after it has healed. Children are more prone to sunburn because of their delicate skin.

Try to keep your child out of the sun when the peak ultraviolet rays occur (between 10 A.M. and 4 P.M.).

In addition, follow these guidelines:

•       Always use a sunscreen to block the damaging ultraviolet rays. Choose a sunscreen made for children with a sun protection factor (SPF) of at least 15. (Check the label.) Apply the protection 15 to 30 minutes before going out. Keep in mind that no sunscreens are truly waterproof, and thus they need to be reapplied every one and a half to two hours, particularly if your child spends a lot of time in the water. Consult the instructions on the bottle. 

•       Dress your child in lightweight cotton clothing with long sleeves and long pants. 

•       Use a beach umbrella or similar object to keep her in the shade as much as possible. 

•       Have her wear a hat with a wide brim. 

•       Babies under six months of age should be kept out of direct sunlight. If adequate clothing and shade are not available, sunscreen may be used on small areas of the body, such as the face and the backs of the hands.

Heat Exhaustion: Too much heat can make you or your child very sick. Take special care with children and the elderly, because their bodies don’t cool as well. Kids are particularly at risk for heat cramps when they aren't drinking enough fluids.

Although painful, heat cramps on their own aren't serious. Cramps can be the first sign of more serious heat illness, so they should be treated right away to help avoid any problems.

Don’t let your child play outside during the hottest part of the day. Make sure they have plenty of fluids and a cool place to rest. If you suspect your child is suffering from heat exhaustion, call 911. Symptoms can include:

•       Increased thirst

•       Weakness

•       Fainting

•       Muscle cramps

•       Nausea and/or vomiting

•       Irritability

•       Headache

•       Increase sweating

•       Cool, clammy skin

•       Elevation of body temperature, but less than 104°F (40°C)

Protect Your Feet!

One minute you’re strolling barefoot. The next, you’re in pain. Puncture wounds happen more often in summer, when bare feet meet nails, glass, toothpicks, and seashells. 

The biggest problem is infection. Heat, swelling, and drainage are signs that need quick medical attention. You may also need to update your tetanus shot. 

These are just a few tips to help prevent some serious summertime injuries. Sometimes the problems are just an annoyance, other times they can be fatal. Summer is about fun and family time together. Just use common sense and follow these simple rules for a safer summer.

Sources: http://www.webmd.com/a-to-z-guides/ss/slideshow-summer-health-hazards?print=true

http://www.safekids.org/watersafety

http://www.safercar.gov/parents/InandAroundtheCar/heatstroke.htm

 

Daily Dose

Being a Dad

1:30 to read

Seeing that this is the week of Father’s Day (have you made your card or shopped yet?), I thought this was a good time to discuss some recent data that might be of interest to men….especially those who may be planning a family in the near future. 

For years research has shown that maternal age may contribute to birth defects and chromosomal abnormalities, including Down’s syndrome.. It has also been known that a pregnant woman’s health and habits may also affect their unborn baby’s health, therefore  woman are instructed to stop smoking and drinking alcohol while trying to get pregnant as well as throughout their pregnancy.

Dr. Joanna Kitlinska a researcher from Georgetown University has been studying how men’s age as well as their habits might also impact a child.  Her findings have shown a link between men who are over 40 years- “advanced paternal age”  and the incidence of autism as compared to fathers under 30 years of age.  Studies have also found that older fathers are more  likely to have children who develop schizophrenia.  Researchers wonder if this link may be due to changes in a father’s genes as they age….but to date this is unclear. “Biological clocks” and a woman’s decision to delay a pregnancy until their career is established (or for a myriad of reasons) may now be a decision that men will face as well.  Could both aging eggs and sperm play a role in genetic abnormalities? 

Smoking seems to be another habit that may somehow affect a man’s sperm and could potentially lead to genetic abnormalities in a child. 

While fetal alcohol spectrum disorders are known to be found in women who have consumed alcohol throughout their pregnancy,  researchers have also noted that 3 out of 4 children diagnosed with FAS also have alcoholic fathers.   Could their father’s excessive use of alcohol have also played a role in their developing brain?  This association has been found even if the mother did not drink alcohol during her pregnancy. Again, did the alcohol affect a father’s sperm and genes which was passed on to their child?

So…bottom line, it is important that “fathers to be” are equally invested in a healthy lifestyle when they are planning on having children.  It goes without saying that smoking, drinking, and even obesity and stress are not good choices for anyone …..but the fact that these choices may affect a future child are good reasons for both fathers, and mothers to be aware of this research when they are planning a family. 

 

Your Teen

Preventing ACL injuries in Young Athletes

2.00 to read

A new report states that young athletes are more susceptible to serious and potentially debilitating knee injuries. 

An increasing number of American children and teens are tearing up their knees, particularly kids who are involved in sports such as basketball, soccer, volleyball and gymnastics.  The most dangerous injury is a tear in the anterior cruciate ligament (ACL), which provides stability to the knee.

Specific types of training can reduce the risk of an ACL tear by as much as 72 percent, the report from the American Academy of Pediatrics (AAP) says.

"Neuromuscular training programs strengthen lower-extremity muscles, improve core stability and teach athletes how to avoid unsafe knee positions," lead author Dr. Cynthia LaBella, medical director and associate professor of pediatrics at Northwestern University Feinberg School of Medicine, and a member of the academy's council on sports medicine and fitness, said in an academy news release.

The AAP recommends that coaches who run these types of sports programs should learn more about the exercises that can help athletes strengthen their muscles and encourage their athletes to use them.

The risk of ACL injury among young athletes increases at age 12 for girls and age 14 for boys. The largest numbers of ACL injuries occur in female athletes ages 15 to 20. After an ACL tear, girls are much more likely to have surgery and less likely to return to sports than boys, experts said.

"After puberty, girls have a 'machine motor mismatch,'" report co-author Timothy Hewett, professor and director of research at Ohio State University's sports medicine department, said in the news release. "In contrast, boys get even more powerful relative to their body size after their growth spurt. The good news is that we've shown that with neuromuscular training, we can boost the power of girls' neuromuscular engine, and reduce their risk of ACL injuries."

Before some of the newer less-invasive surgical treatments were available, surgery was often delayed until the child’s skeletal structure was fully mature. Now though, improved treatment can avoid impact to the developing growth plates, which means that they can have surgery to stabilize the knee.

Overall, ACL surgery is about 90 percent successful in restoring knee stability, according to the report published online April 28 and in the May print issue of Pediatrics.

"In many cases, surgery plus rehabilitation can safely return the athlete back to sports in about nine months," report co-author Dr. William Hennrikus, professor of pediatric orthopedic surgery at Penn State Hershey Bone and Joint Institute, said in the news release. "Parents who are considering surgery for their child should seek out a pediatric orthopedic surgeon with sports medicine training."

ACL tears can have long-lasting effects. People who suffer an ACL tear are up to 10 times more likely to develop early-onset degenerative knee osteoarthritis, which can lead to chronic pain and disability, the report said. "This is important, because it means athletes who suffer an ACL tear at age 13 are likely to face chronic pain in their 20s and 30s," LaBella said.

If your child participates in any of these sports, check with your child’s coach to see if they are providing the appropriate amount of muscle strengthening exercises to fortify your child’s knee support system.

If you feel they are not getting any or enough of these needed exercises, consider enrolling your child in a muscle strengthening exercise program or begin doing them together at home.

Source: Robert Preidt, http://www.philly.com/philly/health/topics/HealthDay687065_20140428_Training_Programs_Protect_Young_Athletes_From_ACL_Tears__Report.html#cPXEpJy1wK9xQl6s.99

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