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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

Your Baby Will Always Be Your Baby

1.15 to read

I feel like a new parent who is sleep deprived, but in actuality I am a sleep deprived parent of a 21 year old who had surgery this week. The interesting thing is that the feeling of utter exhaustion, coupled with parental love, really does not change from the time your baby is born; it just matures.  The parents of the four week old baby I saw this morning were also tired and wondered when their baby would sleep 4 -6 hours at a stretch. I just couldn’t bear to tell them; it really never ends.

I am happy to report that “baby” son is just fine after his surgery and is now home recovering while I am playing mommy/nurse (no doctor here).  That feeling when they wheel your child into the OR is the same whether your child is one year or 21 years.

This is not the first time that one of my children has had to have surgery, but each time I “know” that this feeling in the pit of my stomach will come as they wheel him through those double doors to the OR. The feeling only goes away once I know that the surgery is finished (thank God for good surgeons) and my child is safely in the recovery room.

Once in the recovery room, your child appears helpless and miserable but I have to remind myself that this too shall pass. This is when they need you the most, as they wake up dazed and confused.  Even a 21 year old is happy to have his mother there.

Thank goodness for medicine to help the pain and wonderful nurses who know just the right way to judge when and how to give medications.  I am amazed that my 6’3” son who is in pain and has IV narcotics going can still answer any questions and make sense! In fact, he is really so lucid that when I ask if he wants anything else for Christmas he manages to tell me the name of a video game and provides me instructions on how to order it right from the recovery room!  Technology progress on all fronts as Wi-Fi is available even at his bedside and the Amazon delivery will arrive about the time we get home from the hospital. That is also amazing!

He is now home recovering and after two sleepless nights I think that the worst is over and hopefully we will all get a bit more sleep. Why is it that sleep also seems to be the greatest healer?  He is hopeful to get a full night’s sleep and needs sleep to get well. We all need sleep to be able to take care of him so we can continue our “other” jobs.

The circle of parenting is really never ending, the difference is that the child is a bit taller and can talk.

Here’s to more sleep for all parents, especially for those with babies of all ages.  

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Daily Dose

Pregnancy & Sleep

1:15 to read

Why is it that as you get further into your pregnancy you sleep less?  I am sure that it is just a factor of being “bigger” and as one mother said to me, “having another human inhabit your body”. It is often hard to find a comfortable position to sleep in, and even if you do, the baby may not want to stop moving when it is your bedtime.

But, I also really think this is all in God’s plan to get a mother (and father who often says his wife keeps him up) ready to be new parents. It is just foreshadowing of the weeks to come when you bring that newborn home from the hospital.  You have already learned to “survive” with less sleep.

The first few weeks at home with that most precious baby is really just about survival. I don’t care what you read or how many classes you take...there really are no “rules” or “tricks” to get thru the first 6-8 weeks of being a new (or seasoned) parent.  

I tell my parents the only “rule” is that the baby MUST sleep on their BACK..other than that try to do the feed, play, sleep routine that you think will just happen, but know at times your baby just does not want to go to sleep when you want them to!! They are not abnormal and you are not a “bad” parent.....they are just newborns with developing brains and sleep cycles. I promise, this too shall pass and longer sleep cycles will come.

So, if you are awake one night toward the end of your pregnancy and reading this, look at the bright side.  Your body is just getting you even more prepared to be a “great” parent....you already know how to survive with interrupted and less sleep.      

Daily Dose

Waiting for the Doctor

1:30 to read

I just read a really good article from The Huffington Post that was written by a young woman from the UK.  She was discussing the issue of waiting for a doctor. She herself had been waiting for her doctor when she noticed another patient who was being very loud and quite verbal about waiting. He engaged her in conversation and said, “I bet that doctor is back there having a cup of tea”. He must have been stunned when she replied, “well, I certainly hope so”.  She knew that the doctors had recently seen her as an emergency when she began bleeding during her pregnancy. She knew that they had dropped everything to attend to her and her unborn baby and for that she was eternally grateful.  

I also “hate to wait” when I am seeing my own doctor, but I do know that he or she is not “back there eating bon-bons".  I also know that many patients have waited for me, sometimes for up to an hour.  I promise you that I know that I am running late and it makes me very anxious. But at the same time, I am doing the best that I can to treat each and every patient as if they were my own child or family member.  Sometimes a patient comes in with a more complicated or urgent problem and the time taken with that patient is much longer than was expected. Or, a child arrives wheezing and in respiratory distress without even having an appointment….they to will be “worked on” in front of everyone else…as they need a doctor immediately. 

The article continued to re-count how many times during her pregnancy that she had needed to be seen as she continued to have issues with bleeding, and each and every time, the doctors were there, no wait and no questions….they just did their job.

It is difficult to explain why doctors run late and I understand how patients are frustrated when they wait. But at the same time, how do you schedule the appropriate amount of time for a patient who calls for an appointment because their child is sick with a fever and a sore throat. But, while you are seeing their child they break down in your exam room and tell you that they have found out that their husband is “cheating on them” and that “he wants a divorce”.  As their pediatrician, do you tell them that you don’t “have the time” to listen to their problems. Do you just deal with their child’s sore throat and ignore the mother’s anguish. In my case, I choose to spend time with the mother, to empathize with her, and hope to help her.  I know that this reaction will make me late….but it is what I need and want to do for my patients and families.

Whenever I am talking to prospective patients I am perfectly honest when they ask me, “will I ever have to wait?”.  My response has changed over the years as I have come to realize that there will be times when they do wait….but it is not because I ever want to “run late” or make my patients wait. It is because, I have decided that my practice has just as many flaws as my parenting, not perfect. But similar to my children, at times one will need me more than another, and when they do I will spend more time with the one that needs me the most.  It may not seem “fair”, but how do you make it always be “fair”?  I hope that at the end of the 23-25 years I spend with these families they come to realize…it all evens out in the end…there are times that I spent too much time with them and then there are times that they waited.  But, just like parenting, you do the best that you can.  I will continue to practice that way as well. I promise, if you are waiting I am not having tea and bon-bons!!!   

Daily Dose

Timeout!

1.30 to read

When I am seeing toddlers for their check ups, the topic of behavior is usually at the top of both the parent’s and my list for discussion.  Once a child is walking and beginning to talk, all sorts of new behaviors seem to occur! 

Parents ask, “how do I stop my child from hitting or biting?”  “What about misbehaving and not listening?”  The toddler years are challenging for behavior as a child is gaining independence, and testing as well.  Toddler and teens have some of the same attributes and it is important to begin behavior modification during the toddler years. 

Time out is the most commonly used behavior modification and not only will parents use this method at home, but preschool and day care teachers begin using this technique as well. This is the age that children begin to understand rules and consequences. 

So how do you “do” time out and when?  I usually start using time out when a child is between 15 -18 months of age. While I try to ignore and distract tantrums, I use time out for biting, hitting and those age appropriate yet inappropriate behaviors. 

I pick a chair in the house (we had a small set of table and chairs which seemed perfect) and every parent needs a kitchen timer to use for time out.   It is important to get at your child’s level when disciplining them as well. Tell them why they are going to time out and then have them sit in the chair for 1 minute per year of age.  (Trust me a minute sometimes feels like forever!)  

Here is the trick, if your child will not just sit in the chair (and many won’t), go behind them and hold them in the chair as if you were a human rope.  In most cases the child will be crying and trying to get up out of the chair, but you calmly hold them in the chair from behind. No eye contact!  Once the timer goes off, you let go of them, go back around so that you make eye contact again, get down to their level, and explain once again that they had to sit in the chair because they (fill in the blank).  

Time out takes time and patience.  If you are consistent about using time out for misbehaving, your child will learn to sit in the chair.  For some it may only take 1 time and others are more head-strong and it may take months of “human rope” before they decide to sit alone. 

Don’t give up!!!  This is a very important lesson for children to learn and you will use time out many times, not only in that little chair, but in other venues as your child gets older.    

Your Child

Pre-teen Football Linked to Brain Changes in NFL Players

2:00

The start of a new school year also brings after-school sports programs. Late summer and fall is prime football season for many middle and high schools. In some states, it’s a hallowed tradition that boys and girls look forward to participating in whether it’s running down the field or cheering on the team.

While school football doesn’t typically offer the same ferocious body beating and brain –rattling that are seen in the National Football League (NFL), a new study shows that brain development can still be affected by playing football at a young age.

The study looked at the possible connection between a greater risk of altered brain development in NFL players who started playing football before the age of twelve as opposed to those players who began playing later in life.  The study is the first to show a link between early repetitive head trauma and future structural brain variations.

The study was small but interesting. It included a review of 40 former NFL players between the ages of 40 and 65 who played over 12 years of structured football with a minimum of 2 years at the NFL level.

One half of the players took up football prior to the age of 12 and half started at age 12 or later. The number of concussions suffered was very similar between the two groups. All of these players had a minimum of six months of memory and cognitive issues.

"To examine brain development in these players, we used an advanced technique called diffusor tensor imaging (DTI), a type of magnetic resonance imaging that specifically looks at the movement of water molecules along white matter tracts, which are the super-highways within the brain for relaying commands and information," study author Dr. Inga Koerte, professor of neurobiological research at the University of Munich and visiting professor at Harvard University, said in a press release.

The researches believe their findings add to the growing amount of scientific evidence that shows the brain may be especially vulnerable to injury between the ages of 10 and 12.

"Therefore, this development process may be disrupted by repeated head impacts in childhood possibly leading to lasting changes in brain structure," said study author Julie Stamm, currently a post-doctoral fellow at the University of Wisconsin School of Medicine and Public Health.

Despite finding a link to the brain development window where kids are more likely to suffer brain injury by repeated head impacts, the small size of the study means the results may not necessarily apply to non-professionals.

"The results of this study do not confirm a cause and effect relationship, only that there is an association between younger age of first exposure to tackle football and abnormal brain imaging patterns later in life," said study author Martha Shenton, a professor of psychiatry at Harvard Medical School.

Because of the intense publicity about and the findings of many studies on the short and long-term dangers of concussions, many school sports programs are looking at changing how they allow students to play in games associated with head injuries.  Where it was once common for coaches to let players continue playing after a particularly rough tackle or head butting, they are more likely now to insist that a field medical professional examine the child. Some schools are also implementing no tackle policies to protect very young players.

While traditional football isn’t likely to become extinct, parents and coaches can educate themselves about brain injuries and learn how to best protect young players from the chances of long and short-term disabilities.

Source: Brett Smith,  http://www.redorbit.com/news/health/1113407634/pre-teen-football-linked-to-more-severe-brain-changes-in-nfl-players-081115/

 

 

Daily Dose

PU: Body Odor

1.00 to read

I received an email from a mother who asked if her 5 year old son, an avid athlete, could wear deodorant?  It seems that his arm pits “smell like a grown man”.  I have actually been asked this on occasion in my office and I have even noticed body odor (BO) during exams on some 5-8 year olds.   

Most children start to “stink” as they begin to enter puberty, but there are occasional children that for unknown reasons, develop BO without any signs of puberty. If it seems that your child is entering puberty at an early age, you do need to talk to your doctor.  If your child happens to be one of those kids who are just odiferous, there are several things that you can do.

Number one, make sure that your child is bathing/showering everyday, and that they wash their armpits well. Some little boys (and I bet a few girls) just pop in and out of the shower without touching soap on most of their bodies.  (I used to smell my boys hair when they came out of the shower, sometimes still smelled sweaty, no soap!).

If daily bathing does not do the trick, it may be time to use a deodorant, which just masks the smell. This often works for younger kids who are really stinky rather than sweaty.  An anti-perspirant actually stops and dries up perspiration and may not be needed until an older age.

There are numerous deodorant products available, some of which are natural as well. Head to the store and read labels to decide which one you prefer.

Daily Dose

Best Toys for Kids: No Batteries!

1.30 to read

I have been talking with my patients about gift ideas for the holidays and I had an epiphany!!  I think this season we should all try to buy children’s toys with the slogan “no batteries required”.  This is a great idea for children of all ages, even for my “almost adult” children.  By going back to basics and skipping the electronics I am certain that there will be more family time, maybe face to face, rather than having your child’s face staring at yet another screen.

So with that in mind I have polled patients/parents on toy ideas that will fit the “no batteries required”. Top of the list would be blocks for toddlers through pre-schoolers.  A good set of blocks will last a lifetime and you can add on to the set each year.  Blocks also work well for both boys and girls and siblings can play together and use their imagination to build towers, forts and cities. Children can easily spend hours with a set of different shaped and sized blocks.

Along the same line as blocks, but for older children are the classic Lego sets. I still have tubs of Lego’s in our house that I hope will one day be used by grand children. What a great way to learn to basic engineering as well as fine motor skills while putting a Lego set together. From beginner to adult, there are sets for all ages.  One of my pediatric partners still loves to build and has the Empire State building and Eifel Tower on display in his office.

Games are always a great gift. The classics like Candyland, Chutes and Ladders, Clue and Monopoly. What about checkers, chess and our family favorite (at least mine) Rummikub.  I still love to have “family game night” and the boys will humor me and play a few games before slowly begging off.

What about card games as well, from Go Fish for the preschool child to bridge for the teen (I am still taking lessons!)? The kids all still love to play Spades and Hearts and we also play a lot of Onze during the holidays. Cards work for all generations too and are a great way to keep everyone engaged.

Lastly, what about some crafts. Crayons and markers and coloring books can be just as much fun as fancy Apps for coloring on the I-pad. Learning to color between the lines and hold the crayon are great exercises in fine motor skills as well. Not sure you get the same benefit on the screen version? Teaching a child how to weave, or use scissors to cut strips of paper to make chains to decorate the house for the holidays. There are also some fun sewing crafts too. Good way to teach your child how to hem and sew on a button as well, which are definitely life skills!

So this year, think about trying the “no batteries required” idea. I am sure you too have your old favorites. But, you may have to exchange a few gifts before Christmas???

That’s your daily dose for today. We’ll chat again tomorrow.

 

 

Daily Dose

Power of Medical Attorney While Away

When you're out of town, make sure you prepare a medical power of attorney for your child's caregiver in case of an emergency.It is the time of year for family vacations and I have noticed many parents are also opting for a little vacation time for themselves too! (I tell my patients it’s important).  I have recently seen a number of grandparents and family babysitters bringing their “charges” into the office for a visit while mom and dad are out of town.

Have you prepared a temporary power of attorney so that in case of am emergency your child can receive medical care when you leave town? In reality, you should always leave a notarized letter that states who legally has the right to seek medical care for your children. Why does it seem like a 2 year old always gets a fever within 2 days of their parent’s departure?  While your long standing pediatrician may not require this document to see your child for an office visit while they are under the care of grandparents, there are times when it might really be needed. If your child needed surgery, stitches or even a trip to the ER to rule out a broken arm, the emergency room will require the letter that states that the caregiver in question has the authority to seek medical care for the under age child. In most cases a parent could be reached by cell phone, even in very remote areas of the world, but on the occasion that the parents cannot be reached this document will be needed. So, why not be prepared? We used to leave the letter on the front of the refrigerator with the names of everyone that might have the need to take our child to the hospital or doctor. The same letter was there for years, and included not only the grandparent’s names, but also friends and neighbors who would be available if necessary.  We had it notarized and updated as necessary, and thankfully I don’t think it was ever used. (My children always seemed to get hurt with me around!) Before leaving for an adult trip, you should leave the numbers of the pediatrician, the dentist, and any other doctors that your child routinely sees. It is also helpful to leave a copy of the medical insurance card! Seems you can’t do anything without it! Lastly, include the phone number for your pharmacy. For the very organized, you might also leave directions on how to get to the doctor, pharmacy or hospital etc. I have drawn many a rudimentary map for a lost grandparent who is now going to have to head from my office to the pharmacy to get the pink medicine filled. In most cases, the child is already well before the parents even return! That's your daily dose for today.  We'll chat again tomorrow.

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