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Your Teen

FDA to Regulate E-cigarettes, Raise Age for Purchasing

2:00

Cigarette smoking among teens and young adults has been on a slight decline in the past few years, but e-cigarette use has been rapidly increasing.

Because there are no regulations and scant information on the products used to fuel e-cigarettes, many leading health organizations, including the American Academy of Pediatrics have been urging the Federal Drug Administration (FDA) to bring e-cigarettes and liquid nicotine under its authority.

The U.S. government has responded and taken action. The FDA issued a tough set of rules for the e-cigarette industry that included banning sales to anyone under 18, requiring package warning labels, and making all products—even those currently on the market—subject to government approval.

For many teen and health organizations, the ruling has been long overdue.

Though the product-approval process will be phased in during three years, that will be little solace to the fledgling but fast-growing $3.5 billion industry that has, until Aug. 8 when the rules take effect, largely been unregulated and dominated by small manufacturers and vape shops.

Many of the vape shops, device manufacturers and liquid nicotine producers are not happy with the change.

“This is going to be a grim day in the history of tobacco-harm reduction,” said Greg Conley, president of the American Vaping Association, an industry-funded advocacy group. “It will be a day where thousands of small businesses will be contemplating whether they will continue to stay in business and employ people.”

In June, the FDA proposed requiring warning labels and childproof packaging because of an increase in nicotine exposure and poisoning incidents. The agency could move to regulate advertising or flavors such as cotton candy and watermelon that also might appeal to youth.

“We’re looking at the flavor issue with e-cigarettes,” said FDA Tobacco Center Director Mitch Zeller during a news conference. Later, he said, that while the agency was aware of “anecdotal reports” that e-cigarettes have helped smokers kick their habit; those benefits were outweighed by concerns about youth using the devices.

E-cigarettes are not the only tobacco related products that will come under the control of the FDA. Unregulated tobacco items, including pipe tobacco and water-pipe tobacco, will also fall under the supervision of the FDA.

The FDA has been regulating cigarettes since Congress granted it oversight of traditional smokes with the 2009 Family Smoking Prevention and Tobacco Control Act.

“Today’s announcement is an important step in the fight for a tobacco-free generation—it will help us catch up with changes in the marketplace, put into place rules that protect our kids and give adults information they need to make informed decisions,” Department of Health and Human Services Secretary Sylvia Mathews Burwell said in a statement.

Most researchers agree e-cigarettes are less harmful than cigarettes because, unlike cigarettes, they don’t combust. Studies have shown that when traditional cigarettes combust they release more than 60 carcinogens. But the long-term effects of using the electronic devices remain largely unknown, and many anti-tobacco groups and public health officials are concerned they could become a gateway to traditional smoking.

Anti-tobacco groups have been frustrated with FDA, saying the agency has taken far too long to finalize its rules.

Concerns escalated when a study published in August by the Journal of the American Medical Association found ninth-graders who used e-cigarettes were 2½ times as likely as peers to have smoked traditional cigarettes a year later.

The Centers for Disease Control and Prevention reported in April that e-cigarette use tripled among U.S. teenagers in 2014.

The AAP issued its recommendations on tobacco and e-cigarettes in late 2015.

In a press release, the organization said it strongly recommends the minimum age to purchase tobacco products, including e-cigarettes, should be increased to age 21 nationwide.

"Tobacco use continues to be a major health threat to children, adolescents and adults," said Karen M. Wilson, MD, MPH, FAAP, chair of the AAP Section on Tobacco Control and section head of Pediatric Hospital Medicine at Children's Hospital Colorado. "The developing brains of children and teens are particularly vulnerable to nicotine, which is why the growing popularity of e-cigarettes among adolescents is so alarming and dangerous to their long-term health."

Under the new rules, e-cigarette manufacturers would have up to two years to continue to sell their products while they submit an application to the FDA.

Story sources: Tripp Mickle, Tom Burton, http://www.wsj.com/articles/fda-to-regulate-e-cigarettes-ban-sales-to-minors-1462455060

https://www.aap.org

 

Daily Dose

Medicine Dosing Errors

1:30 to read

How do you give your baby/toddler/child their medications? In a recent article in Pediatrics it was found that up to 80 percent of parents have made a dosing error when administering liquid medicine to their children.  The study looked at children eight years old or younger. 

 

In the study both English and Spanish speaking parents were asked to measure different amounts of liquid medicines using different “tools”, including a dosing cup, and different sized syringes. They also were given different instructions with either text only or text with pictures. The different dosing tools were labeled with either milliliters/teaspoon or milliliters only.  Lots of variables! 

 

Not surprising to me, the parents who used the texts/picture combination instructions and who also used the milliliter only labeled dosing tools had the lowest incidence of dosing errors.  When parents had to use any math skills to calculate the correct dosage there were more dosing errors.  Most dosing errors were also overdosing rather than under-dosing the liquid medications.

 

This was an important article not only for parents to realize that it is not uncommon to make an error when giving their child medication, but also for doctors who write the prescriptions.  Before electronic medical records and “e-prescribing” I would typically write medication instructions in milliliters and teaspoons…in other words “take 5ml/1 tsp by mouth once daily”.  With electronic record you can only make one dosing choice which I now do in milliliters. But, with that being said, I still get phone calls from parents asking “how many teaspoons is 7.5 ml?”.

 

Previous studies have also shown numerous dosing errors when parents use kitchen teaspoons and tablespoons to try and measure their child’s medication. 

 

Some over the counter drug makers have tried to cut down on dosing errors with their liquid medications by making all of their products, whether for infants or children, the same strength. The only difference is the dosing tool that accompanies the medicine (syringe vs cup).  Interestingly, these medications may have a price difference when they are actually the same thing.  

 

This study may help to find strategies for comprehensive labeling/dosing for pediatric liquid medications, which will ultimately reduce errors.  Stay tuned for more!

 

 

 

 

 

Your Baby

Teething May Make Your Baby Fussy, But Not Sick

2:00

Parents sometimes have trouble distinguishing between whether their cranky baby is actually ill or is just getting his or her first teeth. Because a baby’s gums may be tender and swollen as their teeth come in, a slight rise in temperature can occur.  Other changes may happen as well such as fussiness and increased drooling. All- in –all, babies can be pretty miserable till those first teeth break through.

That said, teething does not cause a full-fledged fever above 100.4 degrees Fahrenheit or any other signs of illness according to a new review led by Dr. Michele Bolan, of the Federal University of Santa Catarina, Brazil.

Certain symptoms can be confusing for parents says Dr. Minu George, interim chief of general pediatrics at Cohen Children's Medical Center, in New Hyde Park, N.Y.

"I get questions about this on a daily basis," said George, who was not involved in the study.

When a baby’s temperature reaches 100.4 degrees F or higher, it becomes an actual fever, not just a slight increase in temperature.

"Fevers are not a bad thing," she pointed out. "They're part of the body's response to infection." But, George added, parents should be aware that a fever is likely related to an illness.

Of course, new parents are going to be somewhat edgy when it comes to caring for their infant. It’s a new world of responsibility that can seem overwhelming at times. 

Pediatricians and family doctors regularly answer questions about this topic with an explanation of how a typical teething experience presents.

Over the ages, other symptoms have been linked to teething that should never apply. They include sores or blisters around the mouth, appetite loss and diarrhea that does not go away quickly. Any of these symptoms warrant a call to your pediatrician.

Babies differ in age as to when their teeth begin to come in.  Typically, the fist tooth begins to erupt around 6 months of age. It can also be as early as 3 months and as late as 1 year of age. There really isn’t a set age for teething to begin, just an average.

Baby’s teeth usually erupt through the gums in a certain order:

·      The two bottom front teeth (central incisors)

·      The four upper front teeth (central and lateral incisors)

·      The two lower lateral incisors

·      The first molars

·      The four canines (located on either side next to the upper and lower lateral incisors)

·      The remaining molars on either side of the existing line of teeth

By age 3, most children have all 20 of their primary teeth.

As for helping babies get through the misery of teething, George advised against medication, including topical gels and products that are labeled "natural" or "homeopathic."

Instead, she said, babies can find relief by chewing on a cooled teething ring or wet washcloth, or eating cool foods.

The analysis was published in the February online edition of the journal Pediatrics.

Sources: Amy Norton, http://www.webmd.com/parenting/baby/news/20160218/teething-makes-babies-cranky-but-not-sick-review

http://www.webmd.com/parenting/baby/tc/teething-topic-overview

Daily Dose

Everything in Moderation

1:30 to read

How often have you heard the words, “everything in moderation”?  That was an expression that my parents taught me years ago, and I am sure that their parents used those same words.  It seems that those words hold true today as well, but unfortunately moderation seems to be “out of style” and excessive is a word that comes to my mind more and more often.

I see this so often in my own practice….beginning as soon as a new baby is brought into the world.  There are so many gadgets and gizmos available to new parents, and they are inundated with so many choices.   Hundreds of bottles, pacifiers, sleep sacks, diaper wipe warmers, not to mention state of the art video monitors to watch your child when sleeping or awake just to “ensure they are breathing”.  When you walk into a baby store there is NO moderation, and even I am confused and overwhelmed with all of the “stuff”. I honestly think this only serves to make parents more anxious….even before the baby arrives.

What about moderation and electronics?  It is very hard to keep electronics away from babies and toddlers as they begin seeing an iPhone or iPad from birth, if only for taking pictures. It isn’t too long before a baby can recognize themselves on the screen and want to look at their picture and by the time some children are 18 months - 2 years they know how to open and icon to see their family pictures.  I am not really too concerned about their use of electronics for looking at their own pictures. With that being said, sitting your baby or toddler in front of a screen for hours everyday to watch videos rather than reading them books is excessive and inappropriate. Letting your child watch 30 minutes of Sesame Street or Daniel Tiger while you get dressed for work or make dinner sounds like “life”.  I feel badly when a young mother calls me and says, “I feel so guilty I let my 2 year old watch a video today and I know I should not allow that but I am 36 weeks pregnant with twins and it is 98 degrees outside!”. What, that sounds perfectly reasonable to me….everything in moderation.  

What about eating and food choices?  I have so many parents who worry if their child “won’t eat” so they will let them dictate what they will eat.  The kids then often end up eating “only” chicken tenders, macaroni and cheese, spaghetti and pizza….but won’t try new foods or drink milk. While I like all of those “kid favorite foods” as well, only in moderation. Catering to a child’s food choices all of the time is not healthy and also does not teach your children to eat a wide variety of foods.  Excessive focus on food and worrying if your child skips a meal only makes mealtime stressful and often leads to unhealthy food choices for a long time. Moderation…one night chicken tenders and mac and cheese, another salmon and green beans. Don’t worry they won’t starve!

So…with all of this being said, you can see what I am talking about with my own patients and their families….old school, but it seems to make sense and may make a family’s life a bit less complicated.

Your Child

Helping Children Cope With Frightening News Events

2:30

Gone are the days when most Americans got their news from 3 or 4 sources around the evening dinner hour. Today, thousands of news reports (some real, some fake) instantly flood our phones, computers, TVs and radios, sometimes with real time graphic images.

While some news events may be difficult for even adults to comprehend (with all our life experience and knowledge about current affairs), children don’t have that advantage when they hear and see things that feel threatening to their safety and family stability.

The Journal of American Medical Association, (JAMA) Pediatrics, has published a free online patient’s page dedicated to How to Talk to Your Children About Tragedies in the News.

The amount of information available on current events is almost instant. Sometimes parents don’t have a chance to screen what their children see and hear, so it’s important to know how to talk with your children about what they are experiencing.

The JAMA article is broken down into different age groups. Your approach should differ depending on your child’s age and ability to understand complicated situations.

A good place to start in discussing a tragic event is by asking what your child has already heard. After you listen carefully, you can ask what questions they have. It is important to be honest about what happened and to focus on the basics. It is not necessary to share every detail, and it is important to avoid speculating about what might happen next. Listen closely to your child for misinformation or underlying fears. Remind your child that you are there for him or her and will keep them safe. A key underlying message for parents to convey is, “It is ok if this bothers you; we are here to support each other.”

For very young children, news events can be frightening because they don’t understand context. Children may wonder; is this going to happen to us? Is this happening in our neighborhood? Are my friends ok? Are we next? News media coverage can include graphic images and sounds. It is best to share information with children by discussing it rather than showing the media coverage. Young children may have more questions about whether they are truly safe and may need help separating fantasy from reality. Some children may become clingy or regress in behavior such as wetting the bed or sucking their thumbs. It is important to be patient and to support your child if he or she reacts in this way. Do not ignore your child’s fears or brush them off. Realize that children see the world from a different perspective.

For older children and teenagers, it may be more difficult to avoid exposure to these events in the news. Kids on social media outlets often see stories and videos on their phones while at school or out with friends.- before you have a chance to preview the news. When there is a concerning news event and you have the opportunity, try to preview it before showing it to them so that you know what to expect and what key points to discuss. Then watch it together. Older children and teenagers may want more information about the tragedy and the recovery efforts. They may have opinions about the causes as well as suggestions to prevent future tragedies or a desire to help those in need. Listen to what they say and validate their concerns. If they’ve already seen something tragic, again, ask them what they think about it and talk about their concerns and what they see as a next step in coping.

Other ways you can help your child manage unsettling news are:

  • Be a calm presence. It is okay for children to see adults be sad or cry, but consider excusing yourself if you experience intense emotions.
  • Reassure your child of his or her safety. Consider reviewing your family’s plans for responding to an emergency.
  • Maintain the routine. To give your child a sense of normalcy, keep up your family’s usual dinner, homework, and bedtime routine.
  • Spend extra time together. This can foster your child’s sense of security. Encourage your child to express his or her feelings.
  • When possible, do something to help. Consider ways that you and your family can help survivors and their families.

Like adults, some children may have difficulty with events for a variety of unexpected reasons. Think back to 9-11. How many of us were prepared to watch the towers collapse and the horror and anguish of the families that were missing relatives and friends in the buildings? How we feared that there was a possibility that our country was under attack. It was one of the most devastating events our country has ever experienced in the modern age of instant media information.

Time has helped us put that day in perspective, but the repeated showing of the planes flying into the towers gave many Americans PSTD symptoms. It was almost too much to comprehend. Remember that when your child is scared or anxious about a current event. Help them realize that tragedies do happen, but we can and most often, do survive.

Some signs that a child is not coping well include sleep problems, physical complaints such as feeling tired, having a headache or stomachache, or just feeling unwell. Changes in behavior may include regressive behavior such as acting more immature or being less patient, and mental health concerns like sadness or heightened depression or anxiety. Sometimes it can be hard to tell if a child is reacting in a typical way to a tragic event or if there is something else going on.

Talk with your child’s pediatrician if you are concerned about your child’s reaction.

These are uncertain times. Everyone seems to be a bit on edge, wondering when the next shoe will drop. Have a plan on how to talk to your youngster about current events. Most of all have patience and be a good example of calmness and reassurance; that no matter what happens, you have their best interests at heart.

Story source: http://jamanetwork.com/journals/jamapediatrics/fullarticle/2646851

 

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Your Teen

“See it before you sign it”. Fire Safety for Off College Campus Living

1:45

Whether it’s in the spring, fall, winter or summer, many college kids will eventually move to off campus living quarters. Parents and students typically have time to do research on the areas around campus that are for rent. However, there are some fire prevention safety tips that you might not have thought about.

The best advice to help keep your college student safe is… don’t sign on the dotted line until you’ve actually seen the apartment or house.

Why? Because about seven people every year, die in fires in dorms, fraternities, sororities and off-campus housing.

Since 2000, nearly 120 people have died in campus fires, according to a U.S. Fire Administration (USFA).

Off-campus housing tops the list for fires.

Most (94 percent) fatal campus fires took place in off-campus housing, according to incidents examined by USFA between 2000 and 2015.

The U.S. Consumer Product Safety Commission (CPSC) has teamed up with USFA, the National Fire Protection Association (NFPA) and Campus Firewatch to help get this warning out. Don’t sign a contract for housing until you see it yourself. That goes for Mom and Dad too. See it, take a housing tour and make sure you look for:

#1 Working smoke alarms

Make sure there are working smoke alarms on every level and inside each bedroom. Smoke alarms save lives. Fire sprinklers add lifesaving protection too.

USFA found that smoke alarms were missing or did not have batteries in 58 percent of fatal campus fires. None of the fatal fire locations had fire sprinklers.

#2 Two ways out of each room for a safe escape. Make sure all windows and doors open easily. You need to be able to get out if there is a fire. Two ways out are best.

#3 Campus or off-campus housing that can handle today’s electric power needs.

Laptop computers, phones, televisions and coffee makers take a lot of power. Some older homes may not be able to handle all the electrical demand by today’s students. USFA found that electrical issues caused 11 percent of the fires.

#4 Be in the know.

Make sure that your college student knows how to be responsible around alcohol and smoking. The USFA study found these two things involved in the majority of the fires.

Also, if your child is going to be cooking his or her own meals, a discussion about keeping an eye on the food when it is cooking and avoiding distractions is a necessity.

College is a time of new and exciting beginnings. Be sure to “See it before you sign it” for off-campus housing so that an overlooked danger doesn’t have a chance to bring precious college years to an abrupt and devastating end.

Story source: http://onsafety.cpsc.gov/blog/2016/04/04/see-it-before-you-sign-it/

Daily Dose

RSV is Here

1:15 to read

RSV (respiratory syncytial virus) is here and seems to be hitting hard this year. RSV causes 64 million upper respiratory infections worldwide each year and some days it seems that every child in Dallas/Ft. Worth under the age of 2 has RSV. While there is has not been a lot of flu reported to date, RSV is being widely reported across the U.S. so I am sure your pediatrician’s office is busy as well. RSV season usually lasts until spring, so there are more weeks ahead.

RSV is a pesky virus and for most people causes symptoms of a “common cold”. Lots of congestion, runny nose, fever and a cough.  Bothersome, but not life threatening. But for some, especially those under 2 years of age, and for children with underlying medical conditions such as prematurity, heart disease, lung problems and other chronic medical issues, RSV may be more severe. While almost everyone under the age of 2 acquires RSV, 25-40 % may go on to develop wheezing and an illness known as bronchiolitis. In some cases RSV causes respiratory distress and a baby/child may need to be hospitalized for supportive care including oxygen…and in really severe cases an occasional child may require ventilatory support in the intensive care unit.

The local news in our area has been reporting that the ERs and hospitals are overwhelmed.  So what do you need to know about the course of RSV and when do you need to go to the doctor or ER? In a young child the illness starts off with a runny nose and congestion, but may progress to a frequent cough and wheezing.  While most children are uncomfortable and cranky, they handle the virus without any noticeable difficulty with their breathing. But, some children will develop signs of respiratory distress where their breathing is rapid, short and their chest wall pulls in and out (retractions) and their tummies move up and down with each breath. This is called “working to breath” and are signs of respiratory distress….which requires immediate medical care.

You also need to watch your child’s color…as some babies and children may turn dusky blue when coughing.  Most parents complain that their child turns bright red when they cough, but while some babies may only have a bit of a cough they may turn blue when they cough or even seem to gasp. Red is good, your child is oxygenating, but blue is bad! This is another reason to seek immediate care.

Lastly, make sure that your child stays hydrated….so if they have a good moist mouth, drool, tears and wet diapers (may not be soaking) you are keeping up with their fluid needs.  This is important as your baby/child will probably not nurse or take a bottle or fluids as well when they are sick .

Because RSV is a virus it is NOT treated with antibiotics. While there is a test to identify RSV it is not routinely recommended, as the treatment is symptomatic. The test may be run in certain situations when a child is hospitalized. Simple treatments such as suctioning your child’s nose, using a cool mist humidifier and treating fever with acetaminophen or ibuprofen (depending on their age) are all helpful As always, call your doctor if you have questions or concerns. 

What’s on the horizon…hopefully a vaccine one day!

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