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Daily Dose

Radiation & X-rays

1:15 to read

Radiation exposure and the cumulative radiation a child receives continues to be a topic of research and study. The less radiation a child receives the better.  Ultrasounds are an imaging modality that does not expose a child to radiation. There are more and more instances where ultrasounds are being used rather than X-ray or CT scans. 

 

Pediatric ultrasounds are used to help diagnose appendicitis, pneumonia, congenital heart disease,  abdominal masses, kidney disease, thyroid masses, testicular abnormalities and a host of other issues during childhood. The fact that an ultrasound machine is easily transported to an infant or child’s bedside is another reason that ultrasounds are utilized whenever possible.

 

Interestingly, bedside ultrasounds performed in the ER by trained physicians are now being utilized to diagnose simple forearm fractures which are common during childhood.  The most  common being a “buckle fracture” (non-displaced fracture of the radius).

 

Ultrasound studies of the forearm in a child with a suspected fracture seemed to not only be accurate but were more timely and in studies were also associated with less patient pain. Win - Win - Win.

It may be awhile before this is the standard of care in every ER, but look for less X-rays and more ultrasounds over the next years. I wonder if one day there will be ultrasound machines in pediatric offices….who knows?!

Your Teen

Are Today’s Teens Avoiding Adulthood?

2:30

Are today’s teens riding a slow boat to maturity? Compared to teens in the 1980s and 90s, this generation of teenagers are not in any hurry to grow-up, according to a new study.

In some ways, that’s a good thing. High school kids today are less likely to drink alcohol or have sex, compared to their counterparts a couple of decades ago.

However, they are also less likely to go on dates, have a part-time job or learn to drive – all conventional steps to adulthood.

Are these changes in development good or bad?  Actually, they are both, researchers said.  It depends on how you look at it.

Jean Twenge, a professor of Psychology at San Diego State University, said there are “trade offs’ to each path.

"The upside of slower development is that teens aren't growing up before they are ready," she said. "But the downside is, they go to college and into the workplace without as much experience with independence."

Being unprepared for work or college is definitely a problem for many of today’s adolescents, according to one specialist in teen mental health.

"I think if you ask any college professor, they'll tell you students these days are woefully unprepared in basic life skills," said Yamalis Diaz.

Diaz, who was not involved in the study, is a clinical assistant professor of child and adolescent psychiatry at NYU Langone Medical Center, in New York City.

Today's students may be sharp academically, Diaz said -- but they often have trouble with basics like planning, time management and problem solving.

The findings, published online in the journal Child Development, are based on nationally representative surveys done between 1976 and 2016. Together, they involved over 8 million U.S. kids aged 13 to 19.

On the upside, many of today’s teens aren’t attracted to activities that can be destructive such as drinking alcohol, drug and tobacco use and having sex at an early age. Those are important changes that bode well for young adults and make parents happy.

So why the change in attitude and priorities? It’s complicated. Technology has altered how many people, particularly teens, communicate. Many are spending less time in face-to- face conversations, choosing to text or post on social media.

Parenting styles have also seen a transformation. The “helicopter” or “hovering” parental style has gained in popularity. Some parents are involved so heavily in their kids’ lives that they make all the decisions for them and try to keep their kids from experiencing any type of failure.

In recent years, Diaz said, parents have become much more "child-centric," compared with the days when parents would send their kids outside with instructions to be back by dinner.

And while that is well-intended, Diaz said, kids today may have few chances to deal with relationships, work through their own problems -- and otherwise "stand on their own two feet."

"On one hand," Diaz said, "today's parents should be commended for sending their kids the right messages about what's appropriate for their age."

But, she added, "sometimes parents want to keep doing everything for their kids."

Diaz suggests that parents give kids the space they need to develop necessary skills, like problem-solving, time management and the ability to hold down a part-time job. She also advised parents to create some "no phone" time every day at home -- and to encourage their kids to do the same when they're with their friends.

Story source: Amy Norton, https://consumer.healthday.com/kids-health-information-23/adolescents-and-teen-health-news-719/are-today-s-teens-putting-the-brakes-on-adulthood-726634.html

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”.

 

 

Daily Dose

Walking to School

1:30 to read

Now that school is back in session and the temperatures are cooling off, an easy way to get you and your child some extra exercise is to walk to school!!  I am thinking it should become a weekly event across the country - how about “walk to school Wednesdays”?

 

I realize that not everyone lives in an area where it is possible to walk to school. But, there are many children who do live close enough, but they are typically driven to school by parents or in a carpool.  I practice in an area where it would be easy for many children to walk to school, but when I ask them if they walk to school they typically give me a quizzical look and answer “no”.  

 

Many parents are concerned that their children don’t get enough exercise and this is a way to sneak in some daily exercise.  Walking together also gives parents a time to talk with their children. It is really a gift of time together. I remember that my children could walk to school for the several years when we lived nearby their elementary school. They are really some of my fondest memories, coffee cup in hand and the dog on a leash and walking the boys to school. It was a sad day when they said, “mom, we want to ride our bikes”.  They would meet some of their other friends (I was the helmet “cop”) and off they went.  No more talks with their mother or holding hands to cross the street…but growing up.

 

There are other perks of walking too!!!  Think about avoiding those long carpool lines. What about the gas that is saved and less pollution for the environment.  No one arguing about sitting next to the window or what radio station to listen too either. And for those children who tend to get car sick…this is a great solution!

Daily Dose

Hot Car Deaths

1:30 to read

Did you know that heat stroke is the second leading cause of non-traffic fatalities among children, with the first being backover deaths.  As the summer temperatures are rising these tragic accidents become all too frequent.  

My home state of Texas leads the country in child vehicular heat stroke deaths, followed by Florida and California.  But children who are trapped in vehicles have died in milder climates as well. The temperatures outside may be as low as 60 degrees, but the inside of a car heats up quickly, with 80% of the increase in temperature happening in the first 10 minutes. The reason for this is due to physics.....the sun’s short-wave radiation is absorbed by dark dashboards and seats...the heated objects including child seats then emit long wave radiation which heats a vehicle’s interior air.  All of this leads to tragedy.

A child’s thermoregulatory system is not the same as an adult’s, and their body temperatures will warm 3-5 times faster.  When a child’s body temperature rises to about 107 degrees or greater, their internal organs begin to shut down.This scenario can then lead to death. If you see a child who has been left in a hot car call 911...every minute matters.

The greatest percentage of these tragic deaths are totally unintentional.  These parents are not “bad parents” or “child abusers”, they are loving, good parents who simply forgot that their child was in the car. On average there have been around 37 deaths per year due to vehicular heat stroke and in most cases this is not due to reckless behavior but simply to forgetfulness.  Parents and caregivers both admit to “just forgetting” a child was in the car.  It truly can happen to anyone.

So, how can you remember that your precious, quiet, sleeping child is in back seat. Make it a routine to always look in the back seat before you lock and leave the car.  Try putting your purse, briefcase, or cell phone in the back seat as a reminder to look for your child.

Lastly, if your child is in childcare, have a plan that the childcare provider will call you if you have not notified them that your child will not be coming to school,  and they don’t show up.

Parenting

Parents, Encourage Your Child to Stand Up to Bullying!

2:00

We’ve all read the stories about how a crowd of bystanders have not intervened or called the police for help, as someone was being bullied, attacked or beaten. It’s a horrible thought that if you need assistance, no one will respond.

When children grow up in a home that encourages standing up to bullying, they are more likely to step up to the challenge than kids who’ve been taught to stay out of it, according to a recent U.S. study.

About one in 10 children are victims of bullying, and many anti-bullying programs are focused on getting bystanders to intervene, researchers note in the Journal of Clinical Child and Adolescent Psychology. While previous research has linked certain parenting practices to higher odds that kids will be victims or perpetrators of bullying, less is known about how parents impact what children do as bystanders.

Researchers surveyed more than 1,400 fourth and fifth graders about how their classmates responded in a bullying situation. On average, the kids participating in the study were 11 years old.

They also interviewed parents at home and gave them hypothetical bullying scenarios, asking them how they would advise their children to respond.

In school, kids whose classmates said they might intervene to stop bullies and to comfort victims were more likely to have parents at home who told them getting involved was the right thing to do, the study found. At the same time, kids whose parents told them to stay out of it were both less likely to help victims and more likely to become perpetrators. 

“We were surprised to find that when parents told children not to get involved, children were actually more likely to join in the bullying,” said lead study author Stevie Grassetti, a psychology researcher at the University of Delaware. 

Based on the study results, it makes sense for school anti-bullying efforts to involve parents and endeavor to give children consistent messages about prevention in both settings, the authors conclude.

One limitation of the study is that during school visits; researchers didn’t define what constitutes bullying the authors noted. With home visits, researchers assumed parents gave kids the same advice about the hypothetical incidents that they would offer in real life, which might not always be the case, the researchers also point out.

Parents are role models for how children learn to respond to life’s unpredictable situations. They see and absorb everything their parents say and do. To teach your child compassion and courage, start by being a good example of both and letting them know that standing by and doing nothing to remedy the situation is not an option.

Story source: Lisa Rapaport, http://www.reuters.com/article/us-health-children-bullying-parents-idUSK...

Your Baby

Gerber Recalls Two Batches of Organic Baby Foods

1:30

Gerber Products Company is voluntarily recalling specific Organic pouch products after identifying a packaging defect that may result in product spoilage during transport and handling.

The two kinds of Gerber Organic 2nd Foods Pouches being recalled are: Pears, Carrots and Peas and the other is Carrots, Apples and Mangoes, the company said.

“Consumers may notice that, in some cases, the pouches are bloated and product inside may have an off taste or odor. There have been three consumer reports of temporary gastrointestinal symptoms, however, we have been unable to confirm that these are related to the product. Consumers should not use the product, since it does not meet our high quality standards,” the company said in a statement.

The products were distributed at U.S. retailers nationwide and through on-line stores. Consumers who purchased pouches with UPCs, batch codes and expiration dates listed below, are encouraged to contact the Gerber Parents Resource Center at 1-800-706-0556 anytime day or night for a replacement coupon.

Replacement coupons are being offered for the following products:

GERBER® Organic 2ND FOODS® Pouches –Pears, Carrots & Peas, 3.5 ounce pouch UPC 15000074319

Best By dates/batch codes

•       12JUL2016 51945335XX

•       13JUL 2016 51955335XX

GERBER® Organic 2ND FOODS® Pouches- Carrots, Apples and Mangoes, 3.5 ounce pouch UPC 15000074395

Best By dates/batch codes

•       13JUL2016 51955335XX

•       14JUL2016 51965335XX

Consumers can also find more information on the Gerber Products Company website at https://www.gerber.com/recall-march-2016

Story source: http://www.fda.gov/safety/recalls/ucm492260.htm#recall-photos

Your Baby

Ditch the Smartphone Apps to Monitor Baby’s Health

1:45

If you use a smartphone app to monitor your baby’s vital signs, a new research paper suggests that you may want to send those apps to trash.

The apps are linked to sensors in a baby’s clothing and are marketed as a way to help parents be aware of things like breathing, pulse rate and oxygen levels in the blood and sound alarms when infants are in distress. But they aren't tested or approved for U.S. sale like medical devices and there's little evidence to suggest these monitors are safe or effective, said Dr. Christopher Bonafide, lead author of the opinion piece in JAMA; an international peer-reviewed medical journal.

"I’ve been there myself, peeking in the door of my son’s room late at night, making sure I could hear him breathing," Bonafide, a pediatrics researcher at the University of Pennsylvania and Children's Hospital of Philadelphia, said by email to Reuters.

Marketing ads of the monitors stop short of saying they can diagnose, treat or prevent illnesses, however, they do promise parents peace of mind that comes from an early warning system when something is wrong with babies' health, the study authors write.

Promotions for some apps also play into parents’ fear of SIDS (sudden infant death syndrome), suggesting that parents can have peace of mind that their baby is just sleeping,

The AAP advises parents not to use monitors like the ones paired with smartphone apps for home use because there's no evidence this reduces the risk of SIDS.

Instead, parents should rely on prevention efforts proven to work, like breastfeeding and sleeping in the same room with their babies, the AAP recommends.

"Perhaps in the future there may be a technology that is in development to lower the risk of SIDS," said Dr. Lori Feldman-Winter, a co-author of the AAP guidelines and pediatrics researcher at Cooper Medical School of Rowan University in Camden, New Jersey.

"However, we are not there yet," Feldman-Winter - who wasn't involved in the paper, - added in an email to Reuters.

Sometimes, we as consumers, assume that if something is for sale- particularly a health related item- that it has been approved or tested by a U.S. governmental agency. That’s not always the case. Smartphone applications can be created and sold relatively easily these days without any assurance the app actually performs as promoted. Parents of newborns are a good market for anything that promises to keep their baby safe.

New smartphone-integrated monitors currently available in the U.S. or expected to debut soon include Baby Vida, MonBaby, Owlet, Snuza Pico and Sproutling.

Some pediatric health experts express concern that using apps to monitor a baby’s health actually reduces the parent’s ability to know their own baby’s unique habits, body and cues that he or she may be in distress.

"We have lost sight of what babies need in order to keep them safe, and many parents and grandparents today do not realize that it is the presence of a responsive and vigilant caregiver that keeps a baby safe, but believe the job can be outsourced to a smartphone/video-monitor/technomattress etc," said Helen Ball, director of the Parent-Infant Sleep Lab at Durham University in the UK, in an email. Ball was not involved in the paper.

Ball believes that the best way to keep our babies’ safe is to use our eyes, ears and touch to respond to and monitor for any health concerns.

Story source: Lisa Rapaport, http://www.reuters.com/article/us-health-safety-baby-monitors-idUSKBN1582RA

http://jamanetwork.com/journals/jama/article-abstract/2598780

Parenting

When is Your Child Ready for a Cell Phone?

3:00

Did you know that ninety-five percent of Americans own a cell phone of some kind? The percentage of cell phone ownership among 18-29 year –olds is even higher at 100%, according to the Pew Research Center on Internet and Technology.

It’s no surprise that more and more young kids are asking their parents to get them one.

So, what is the appropriate age to give your child a phone? The answer depends on several factors.

There’s no doubt about the convenience of having a cell phone handy when you need to communicate with someone. If your child has a cell phone, you can call or text him to find out where he is and what he's doing and inform him of your own plans. It can make you feel safer just knowing where your kids are. And in an emergency, a cell phone can be crucial if your child needs to reach you -- or vice versa.

While there are many good reasons to have a cell phone on hand, there are some down sides too.

One thing to consider is that they can become addictive. Sending and receiving texts, playing video games, watching movies as well as checking in on social media sites can impact your child’s sleep patterns and psychological wellbeing. Do you think your child is able to handle that kind of extra stress? Are you willing to put in the time, or have the time yourself, to monitor your child’s phone use and lay down the rules about how often they can use their phone?

There are also other health considerations; cell phones use radio waves. That's radiation (though it's not like what you'd get from an X-ray). Can cell phone radiation affect your child’s health, especially if children start using phones at a very young age when their brains are still developing?

In 2011, an international study showed no link between cell phone use and brain tumors in adolescents and teens. The researchers pointed out, though, that the people in that study didn't use their phones as much as people do today. Many health experts believe more current studies need to be done over a longer period of time. It may be take several decades to find the answer.

Social interaction and cell phone use go hand in hand. It can often be positive thing. It's one way kids can learn to relate to other kids. But there is also the potential for "cyber bullying” which is social harassment via text, instant messaging, or other social media. Many smartphones have a "location sharing" feature, which could raise concerns about people stalking kids as they go from place to place.

There isn't a lot of research yet on how cell phones affect mental and emotional health. But early studies show that frequent texting and emailing can disrupt kids' concentration. It can also become compulsive if kids start being "on call" 24/7 to keep up with their friends. That’s one of the addictive challenges – even for adults.

A child’s age shouldn’t be the only determining factor before deciding on when children are ready for their own cell phone.

Caroline Knorr, parenting editor with the nonprofit group Common Sense Media, says, "Maturity and the ability to be responsible are more important than a child's numerical age.

She says, "We want our kids to be independent, to be able to walk home from school and play at the playground without us. We want them to have that old-fashioned, fun experience of being on their own, and cell phones can help with that. But parents have to do their research and talk to their children and make sure they're using the phones safely themselves, too."

As your child becomes more independent (think middle school or high school), they're closer to needing a phone than younger children whom you still take everywhere.

"Look for the developmental signs," Evans says. "Does your child lose his belongings? Is he generally a responsible kid? Can you trust him? Will he understand how to use the phone safely? The rate at which kids mature varies -- it will even be different among siblings."

And think long and hard about whether your child actually needs rather than just wants that phone. "Children really only need phones if they're traveling alone from place to place," Evans says. "Kids in carpools may not need phones, but kids traveling on a subway, bus or walking to school may. It's about who they are as individuals, what's going on in their lives, and how much they can handle, not a certain age or grade."

If you’ve made the decision that your little one can have a cell phone, here are some ideas to make it work for you and your child.

Should you check who your child is calling and what she's tweeting?

Absolutely, Knorr says. "I know that kids consider mobile devices to be personal property," she says. "And they don't want their parents snooping around. But I think parents are justified in saying, 'I understand this can be used for good but it also can be misused. So every now and then I'm going to check to make sure you're using it responsibly and respectfully.' Then make it an ongoing dialogue: 'Have you gotten weird texts?' 'Any calls that made you uncomfortable?' 'Who are you texting?'"

But you might want to skip the GPS locator services. Neither Knorr nor Evans recommends them unless your child is showing a pattern of getting into trouble.

"Most kids don't need GPS trackers on them," Evans says. "That's really feeding on our anxiety as parents more than meeting a true safety need."

"The issue is really about educating children how to use cell phones in appropriate ways," Evans says. "Cell phones can definitely be beneficial, as long as you know your individual child."

Start with a basic phone for a young child. There are still phones that do not include a camera, Internet access, games or texting.  You’ll most likely get some push back from your child on this, so be prepared to tell him or her why your starting with this type of phone. “ Remind her (or him) that phones are tools, not toys. "It's about safety, not social status or games," Knorr says.

If your child’s phone has texting or Internet abilities, set limits. Most cell phone companies allow you to cap the number of texts a user can send or receive as well as the number of minutes the cell phone can be used. You also can block Internet access and calls from unapproved numbers on most phones.

Designate times when the phone needs to be turned off such as meal times, study time, out walking and at least an hour before bedtime.

Provide your child with and teach them how to use earphones. Until more is known about the impact of cell phone radiation, it’s better to be safe than sorry.  However, also teach them the appropriate places to wear earphones. It can be dangerous for children (and adults) to wear them when walking or bicycling – they may not be able to hear oncoming traffic. It also can take their focus off of what is going on around them.

Teach your child good cell phone etiquette. Children aren't born knowing the rules about how to use cell phones respectfully, including not using them to spread rumors, not taking (or sending) photos without people's permission, not sending inappropriate photos or texts, not having personal conversations in public places – and, of course, never communicating with strangers, no matter how they present themselves. It's up to you to teach them. And by all means, make sure you obey the same rules. Children learn more by watching how their parents handle things than by simply being told what to do.

There’s also a clever contract you can sign with your child when you give them the cell phone. It sets certain rules that they agree to follow and is a good resource that can be reviewed time and time again. CTIA has it listed and printable at this link.

It’s a different world than when we were kids. For most parents, cell phones either didn’t exist or were not as complex and portable as they are now. So, when do you give your child his or her own cell phone? Only after careful consideration to how it will impact their life. Once he or she owns one, it will be an extreme challenge to take it back.

Story source:  Susan Davis, http://www.webmd.com/parenting/features/children-and-cell-phones#1

http://files.ctia.org/pdf/bsw/example_of_family_rules.pdf

 

 

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