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Fight the Flu

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Your Child

Should Facebook Delete Its Messenger Kids App?

2:00

A battle is brewing between groups of child advocates, medical experts and Facebook over their Messenger Kids app.

The 19 groups say in a open letter to Facebook’s chief executive, Mark Zuckerberg , that the app could pose health and developmental risks to children 13 and under. They want to see the app removed.

According to an article in the Washington Post, the groups assert that children are not prepared for online relationships and don't have an understanding of privacy and the appropriateness of sharing texts, pictures and videos

Facebook’s Messenger Kids app is designed for kids 13 and under. According to Facebook’s website, the app makes “it easier for kids to safely video chat and message with family and friends when they can’t be together in person.” Facebook says that parents have control over the app’s functions and contacts.

The letter, organized by the Campaign for a Commercial-Free Childhood, said research suggests a link between social media use and higher rates of depression among teens, and said it's irresponsible to expose preschool children to the Messenger Kids app.

Also included in the letter are concerns that increasing children's screen time could interfere with important development skills such as interacting with the physical world, delaying gratification and reading other people's emotions, the Post reported.

Josh Golin, executive director of the Campaign for a Commercial-Free Childhood, believes that children don’t need their own social media account.

"We are at a pivotal moment, and the tech companies need to decide if they are going to act in a way that is more ethical and more responsive to the needs of children and families, or are they gong to continue to pursue profits at the expense of children's well-being?"

Antigone Davis, Facebook's global head of safety, responded in a statement to the Post that, "We worked to create Messenger Kids with an advisory committee of parenting and developmental experts, as well as with families themselves and in partnership with National PTA. We continue to be focused on making Messenger Kids the best experience it can be for families."

Recent studies have suggested that social media outlets take kids away from activities that are more valuable to their mental and physical health such as sports, exercise and face-to-face interaction with family and friends.

This generation of children will never know a time when apps didn’t exist.  Many parents are concerned that their teens already spend too much time worrying about and interacting on social media and they’re not quite sure that they want their younger children starting down that road so early.

Story sources: https://www.webmd.com/parenting/news/20180130/groups-ask-facebook-to-scrap-messenger-kids-app

http://www.commercialfreechildhood.org/sites/default/files/devel-generat...

 

 

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Daily Dose

Ear Infections

1:30 to read

Musings from the very busy pediatric office:  with all of the advances in technology over the last 30 years why is it that examining a child’s ears and visualizing their eardrum continues to be challenging?  I started thinking about this while examining a very unhappy, strong and febrile toddler….probably the 20th patient of the day. 

 

During the “sick season” many of the patients who come to my office are young children whose parents are worried that they may have an ear infection.  This concern is one of the most frequent reasons for pediatric office visits. While I realize that many of my colleagues are in the operating room operating on brains or doing open heart surgery (truly saving lives) the one advantage that they have is that their patient is under anesthesia while they are doing complicated procedures. Which only means that they are not trying to wrestle, cajole, or coax a child into letting them look into their ear canal, and then only to find that you can’t see a thing as the canal is full of wax (cerumen).  

 

At times examining ears can be fairly simple and straight forward, but some days it seems that it may be easier to attempt to fly than to look at a 16 month old child’s ears. Today was one of those days. It seemed that every child I saw had a temperature over 102 degrees, and they all had “waxy” ears. While there are several ways to remove wax from the ear canal, none of them is easily done in a toddler, especially when the wax is hard and difficult to remove. Having 3 children myself and one who had recurrent ear infections and tympanostomy tubes, I know what it is like to have to hold your child on the pediatrician’s exam table while they irrigate or “dig” wax out of the ears.  Not fun….!!!  But, at the same time I realize that this is the only means to see if the ear is infected and if there is the need for an antibiotic. 

 

With the advent of the HIB and Pneumococcal vaccines the incidence of ear infections has dropped significantly, as these bacteria were common causes of otitis. But, ear infections are still the #1 reason that a child receives an antibiotic, especially in the first 2 years of life.  Therefore, a good ear exam is one of the most important things your pediatrician does, as I know you don’t want your child to receive an unnecessary antibiotic!

 

Please know that pediatricians do not enjoy making a child uncomfortable, but somehow that ear drum needs to be seen…especially in a sick child.   

 

So…why has some brilliant medical device inventor not found a way to wave a magic wand over a child’s ear to “tell me” if their ear is infected?  To date, I have not seen any “new” ways to accurately examine an ear other than with the otoscope…and a clean ear canal…which means unhappy children (and parents ) while I try to clean their ears.  

 

Remember, don’t use q-tips in your child’s ears and if your pediatrician has to struggle a bit to clean out  your child’s ears, it is only because they are doing a good job!!  I am waiting for the “easy” button.

   

Your Baby

Recall: Skip Hop Convertible High Chair

2:00

The U.S. Consumer Product Safety Commission (CPSC,) Health Canada and Skip Hop have recalled the Skip Hop Tuo Convertible High Chair after discovering that the front legs on the highchair can detach from the seat, posing a fall and injury hazard to kids.

The recalled item is the charcoal colored Tuo Convertible High Chair, which converts into a toddler chair.

Consumers with the chair should check for style numbers 304200 and 304200-CN with the date codes HH102016, HH11/2016, HH3/2017 and HH4/2017, which can be found on the back of the chair.

Skip Hop has received 13 reports of the legs of the high chairs detaching, resulting in two reports of bruises to children.  

The Skip Hop Convertible High Chair was sold at Babies ”R” Us, Buy Buy Baby, Target, Kohls, Dillards and other children specialty stores nationwide and online at Amazon.com and Skiphop.com from December 2016 through September 2017 for about $160.

Consumers should immediately stop using the recalled high chairs and contact Skip Hop for a free replacement. 

You can contact Skip Hop toll-free at 888-282-4674 from 9 a.m. to 5 p.m. ET Monday through Friday, or online at www.skiphop.com and click on “Recalls” for more information.

Story source: https://www.cpsc.gov/Recalls/2018/Skip-Hop-Recalls-Convertible-High-Chairs-Due-to-Fall-Hazard

Your Child

Measles Outbreaks Continue to Grow

2:00

The current outbreak of measles in Ellis County, Texas, is another example of why vaccinations are important in preventing infectious communicable diseases.

Ellis County health officials have confirmed that the people who had not been vaccinated contracted the 6 cases of measles.

Measles is a highly contagious respiratory infection caused by a virus. Ninety percent of people who haven’t been vaccinated will get it if they are near an infected person. The people at highest risk of getting measles during these outbreaks are infants (who aren't old enough to get the vaccine), pregnant women, and people with poor nutrition or weakened immune systems.

Some people have proposed that measles is not a serious disease and therefore children do not need to be vaccinated. It’s true that some children do not experience more than a rash and fever for a few days, but children younger than 5 years of age are more likely to suffer complications that can be quite serious. They also expose others to the virus.

Common complications can include ear infections that can cause hearing loss and diarrhea that can result in dehydration.

More serious complications include pneumonia and encephalitis (swelling of the brain) – both of which can require hospitalization and may result in death.

I think it’s safe to say that nearly all parents of young children today were not even born when a vaccine for measles became available in 1963. According to the U.S. Centers for Disease Control and Prevention (CDC,) in the decade before that, nearly all children got measles by the time they were 15 years of age. It is estimated 3 to 4 million people in the United States were infected each year. Also each year an estimated 400 to 500 people died, 48,000 were hospitalized, and 4,000 suffered encephalitis (swelling of the brain) from measles.

In 2000, measles was declared eliminated in the U.S. This was thanks to a highly effective vaccination program in the United States, as well as better measles control in the Americas region. 

Then came a fraudulent 1998 study published in The Lancet, that suggested the measles, mumps and rubella (MMR) vaccine could trigger autism.  Numerous investigations and follow-up studies determined that there is no link between the MMH vaccine and autism, but that hasn’t deterred some parents from making sure their child receives the vaccine. Therefore, putting their own child and other children at risk for infection.

Slowly but surely, reported measles cases have increased in the U.S. with a high reaching 667 in 2014. Last year’s count was 120 reported cases.

Measles is not a “safe” disease to experiment with and children’s health organizations worldwide agree that parents need to have their children immunized with the MMH vaccine.

Story source: https://www.cdc.gov/measles/cases-outbreaks.html

Jason Terk, MD, https://www.dallasnews.com/opinion/commentary/2018/01/24/ellis-county-measles-outbreak-shows-vaccination-crucial

Daily Dose

Constipation

1:30 to read

Constipation is a topic that every pediatrician discusses….at least weekly and sometimes daily. It is estimated that up to 3% of all visits to the pediatrician may be due to constipation. Constipation is most common in children between the ages of 2 and 6 years. I have been reading an article on updated recommendations for diagnosing and treating common constipation. The most important take home message is “ most children with constipation do not have an underlying organic disorder. Diagnosis should be based on a good history and physical exam for most cases of functional constipation”.

 

Like many things in medicine….the evaluation and treatment of constipation has also changed a bit since the last guidelines were published in 2006. It is now appropriate to define constipation with a shorter duration of symptoms (one month vs two) and some of the most common diagnostic criteria (Rome IV Diagnostic Criteria) include the child having less than 2 stools/week, painful or hard bowel movements, history of large diameter stools (parents will tell me their 3 year olds “poops” clog the toilet), and some may have a history of soiling their underpants. 

 

By taking a good history you can avoid unnecessary tests..including X-rays which are not routinely recommended when evaluating a child with possible constipation.  In most cases physical findings on the abdominal exam will confirm the diagnosis in combination with the history. I often can feel hard stool in a child’s left lower quadrant and when asked the last time they “pooped”, no one can really recall. 

 

The preferred treatment is now polyethylene glycol (PEG) therapy. PEG is now used to help “disimpact a child” as well as to maintenance therapy.  Where as enemas were often previously prescribed, PEG therapy has been shown to be equally effective in most cases, is given orally and is much less traumatic (for parent and child!). PEG works by drawing more water into the stool, causing more stool frequency. There are many brands of PEG including Miralax and GoLytely among others. Miralax works well for children as it is tasteless and odorless and can easily be mixed in many liquids without your child knowing it is there. 

 

The guidelines now state that for children with functional constipation maintenance therapy with PEG should continue for as least 2 months with a gradual tapering of treatment only after a full month after the constipation symptoms have been resolved. I usually tell parents that this is equivalent to about how long it takes for them to forget that they have been dealing with constipation….and then begin tapering.

 

Lastly, there is no evidence that adding additional fluid or fiber to a child’s diet is of benefit to alleviate constipation….although it may “just be good for them in general”.

 

 

Your Teen

Teens and Phone Use

2:00

The results of a new study on teens and their cell phone use will not surprise anyone that has been around an adolescent in the last ten years or so. Parents know all too well that the two are typically not far apart.

A 2015 study by the Pew Research Center found that 88 percent of teenagers, ages 13 to 17, have or have access to a cellphone, and 91 percent of teens go online from a mobile device at least occasionally.

"I have not worked with any parents who do not allow their teens to have access to a phone," said Denise Berotti Tuckruskye, a clinical psychologist at the Developmental Disabilities Institute in Ronkonkoma, N.Y. "It seems all parents appreciate that phones allow teens to contact them easily if there are any problems." 

Having the ability to contact their parents if something goes wrong is probably the top reason parents allow their child to have a cell phone in the first place. However, with that purchase you may also notice the loss of your child’s attention and desire to hang out with the family.

Kids aren’t usually using the phone to actually talk to each other; they are more likely to be texting, reading and posting on social media sites. That’s where phone use can get tricky and addictive. Texts and website posts can be positive or extremely negative – depending on someone’s mood or psychological makeup.

What can parents do if they are concerned about the amount of time their teen is spending on his or her phone? One thing is to not pretend that you don’t have a say in what your teen is allowed to post and the amount of information they can give out online as well as the amount of time they spend on the phone when they are home.

Experts suggest that parents stress the use of smartphones and social media in moderation. Beyond that, there are tactics parents can use to moderate their teens' phone use without cutting them off from the digital world entirely.

For instance, "some families I work with restrict phone use until their child's homework is done," Tuckruskye said.

Another option is so-called "interval training," suggested Sandra Bond Chapman, a cognitive neuroscientist who directs the Center for BrainHealth at the University of Texas in Dallas. 

For this, teens would spend 30 minutes doing homework without any disruption and then 30 minutes where they're allowed to check their phones.

This is not easy. Teens naturally go through a stage where independence and rules can quickly become a battleground.  It takes patience and the right approach (sometimes many different approaches) to help them understand why constant cell phone use can be a problem.

Cell phone and computer use before bed has been shown to cause sleep difficulties in children as well as adults. Left to their own devices, young adults are likely to use their phone in bed and keep it close to them while sleeping, according to analysis of a National Sleep Foundation survey, published in 2013 in the Journal of Clinical Sleep Medicine. Research has shown that this can lead to sleep complications.

A study published in JAMA Pediatrics in December 2016 found "strong and consistent evidence of an association between the access to or the use of devices and reduced sleep quality, as well as daytime sleepiness."

Jenna Glover, director of psychology training for Children's Hospital Colorado, suggests that parents limit their teen’s use of cell phones- especially before bedtime.

"Teens should have specific times a day where they have access to their social media accounts, but also tech-free time at home," Glover said.

Others, however, contend that how much time teens spend on their phones is less important than the effect phones are having on the youths.

A recent study from the University of Michigan found that the way children use their devices was a stronger predictor of emotional or social problems tied to screen addiction. 

"What matters most is whether screen use causes problems in other areas of life or has become an all-consuming activity," said lead author Sarah Domoff in a university news release. She is now an assistant professor of psychology at Central Michigan University.

For instance, does screen time interfere with daily activities? Does it cause family conflicts? Has it become the only activity the teen seems to enjoy?

Those are just a few of the ways unhealthy use of phones and similar devices can lead to problems with relationships or conduct and with other emotional symptoms, Domoff said. 

The combination of time teens spend on the phone and the content being seen and produced is where parents can have an impact. One conversation isn’t going to convince a child that there may need to be some changes made in their phone use. It’s an ongoing dialogue that needs to happen with families in a positive, educational and helpful way. In some situations, professional counseling may be needed.

The study was published online in November 2017, in the journal Psychology of Popular Media Culture

Story source: Briana Panetta, https://consumer.healthday.com/kids-health-information-23/adolescents-and-teen-health-news-719/teens-and-their-phones-what-you-should-know-728942.html

 

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