Twitter Facebook RSS Feed Print
Play
772 views in 1 month

Keeping Kids Heart Healthy

Daily Dose

Codeine & Children

1:30 to read

I order to keep us all safe, the FDA is constantly monitoring drugs and their side effects.  For many years codeine was prescribed for children for pain relief as well as to suppress coughs.  Over the last few years there has been more and more discussion about limiting the use of narcotics in children, but I continue to see some children who come from seeing other physicians and have received a prescription that contains codeine.

 

The FDA just issued new warnings against using prescription codeine in children and adolescents. The FDA reviewed adverse event reports from the past 50 years and found reports of severe breathing problems and 24 deaths linked to codeine in children and adolescents. Genetic variation in codeine metabolism may lead to excessive morphine levels in some children.

 

The FDA also performed a literature review which noted excessive sleepiness and breathing problems, including one death, in breast-fed infants whose mothers used codeine.

 

Due to these findings the FDA is now recommending that “codeine should not be used for pain or cough in children under 12 years of age”. They have also issued a warning that codeine should not be used in adolescents aged 12-18 “who are obese or have conditions associated with breathing problems, such as obstructive sleep apnea or severe lung disease”. In retrospect, codeine was prescribed to more than 800,000 children younger than11 years in 2011. Amazingly, codeine is currently available in over-the-counter cough medicines in 28 states.  

 

Lastly, the FDA “strengthened the warning” regarding codeine and breast feeding. They now recommend that breast- feeding women do not use codeine…which may change the post delivery pain protocol. Nonsteroidal anti-inflammatories (Ibuprofen) and acetaminophen (Tylenol) are preferred and are effective for mild to moderate postpartum pain. As a pediatrician it is important that I discuss this with new breast-feeding mothers as well. 

Your Teen

Fewer Teens Having Sex, More Using Contraception

2:00

With the abundance of sexualized media directed at teens today, you might get the impression that they are constantly on the prowl to “hook up.” That’s not the case according to a new government study.

"The myth is that every kid in high school is having sex, and it's not true," noted Dr. Cora Breuner, a professor of pediatrics at Seattle Children's Hospital, who reviewed the findings. "It's less than half, and it's been less than half for more than 10 years," she said.

Sexual intercourse among teens has declined again after rates stabilized between 2002-2010, according to the National Center for Health Statistics report on teen sexual activity and contraceptive use released recently by the Centers for Disease Control and Prevention (CDC).

While the numbers aren’t exactly low enough to ease many parents’ minds, they are better than in previous years.

The study found that 42 percent of girls and 44 percent of boys - aged 15 to 19 - reported having sex at least once. That’s a huge decline from the peak of 1988 when 57 percent of teens between the ages of 15 and 19 reported having had sex.

And Breuner said that finding is nothing new. Going back to 2002, fewer than half of older teens told researchers that they are sexually active, federal data show.

Researchers also found that a higher percentage of teens having sex are involved in a relationship that is ongoing.

Three out of four girls participating in the study, said they were "going steady" with their first sexual partner, and a little more than half of the boys said the same. By comparison, only 2 percent of girls and 7 percent of boys said they lost their virginity to someone they just met.

"There's this myth that kids hook up quite a bit and have sex with someone they literally just met," Breuner said. "This dispels that myth, that our teenagers are having sex with people they don't know."

The statistics come from in-person interviews conducted with more than 4,000 teenagers across the United States between 2011 and 2015. Participation was voluntary and required parental permission, but responses were anonymous.

Today’s teens are more aware of and better educated about the dangers of sexually transmitted diseases such HIV and AIDS. Back in 1988, 51 percent of girls and 60 percent of boys between 15 and 19 said they were sexually active, but those numbers dropped to today's levels after word spread of a sexually transmitted disease that could kill, Breuner said.

Teens are also more concerned about the long-term consequences of pregnancy. Nine out of ten participants in the study said they use some form of birth control. Contraception is widely available now; particularly condoms and teens have better access to all forms of birth control than in decades before.  

At the same time, parents have become more at ease with talking about sex and making sure their teens engage in smart sex, Breuner added.

"Parents honestly to their credit were much more willing to talk about this with their teenagers and were more proactive in making sure they had access to contraceptives," she said.

The study was published in the June edition of the CDC’s National Health Statistics Report.

Story sources: Dennis Thompson, http://www.upi.com/Health_News/2017/06/22/Study-Most-US-teenagers-arent-having-sex/4041498137424/

Shamard Charles, M.D., http://www.nbcnews.com/health/kids-health/waiting-right-one-teens-having-sex-later-cdc-finds-n775236

 

 

Daily Dose

Maternity Leave & Breastfeeding

1:15 to read

When Facebook’s Mark Zuckerberg and Priscilla, his pediatrician wife, had their baby last year he announced that he would be taking off 2 months to be at home with his wife and baby. For those fortunate enough to work for Facebook or Google or another company with a generous maternity/paternity leave policy they too may get anywhere from 2-6 months of paid leave after the birth of their baby. But for most workers, it is more the “norm” that a mother receives anywhere from 4-6 weeks of maternity leave, and in many cases it is not paid.   The first several months of being a new parent are often overwhelming, but knowing that you have 4-6 months of paid leave which allows you time to “become a family” certainly makes the adjustment to parent hood a bit easier.

Unfortunately, physicians (including pediatricians) are faced with returning to their practice often “as quickly as possible”.  I found that going back to work after 12 weeks (which I had to beg for) and trying to juggle a full load of patients, answering phone calls, taking night call and making hospital rounds really did impact my mood as well as my breastfeeding. Although I enjoyed breastfeeding,  I could not figure out how to find any time to pump between patients (talk about running late) to keep my milk supply up. So….I eventually made the decision that in order to keep working I would need to stop breast feeding, which was a bit traumatic for me…..in retrospect I was tougher on myself than I needed to be, but 30 years ago I didn’t realize the numerous other difficult parenting decisions that lay ahead.

Interestingly, a new study just published in Pediatrics is what made me ponder all of this.  Many studies have shown that mothers may have trouble continuing to breast feed after returning to work. This latest study from Australia actually found that the amount of time to return to employment was actually “far less significant than the number of hours a woman worked”.  The study found that working 19 hours or less per week was associated with a higher likelihood to continue breastfeeding.  Those women who returned to a work week of 19 hours or less “experienced no decline in the likelihood that they were breastfeeding regardless of when they returned to work and they were more likely to sustain breastfeeding as well”.  In other words longer breastfeeding, a win win for mother and child. 

As more and more women are employed during their child bearing years, the ongoing debate surrounding the appropriate length of time for maternity leave continues. While there have been many studies to show the importance of family leave after the birth of a baby ( better bonding, less post partum depression) this study is one of the first to show the benefit of a reduction of hours worked upon re-entry to the workplace.  It is my hope that this research may open the door for discussions examining the feasibility of reduced work hours for women who return to work after giving birth.  This new data may be pivotal in improving longer breastfeeding rates in the U.S.  

I am sure many women, although not included in the study,  who have juggled a career and breast feeding would agree.

Your Child

Safety Recalls: Finger Paints, Baby Bathtubs, Strollers and More

2:00

The American Academy of Pediatrics’ (AAP) online Gateway issue has listed several children’s products that have been recalled due to health and safety concerns.

The list includes

·      Sargent Art tempera finger paints, Lil’ Luxuries Whirlpool, Bubbling Spa & Shower

·      Peg Perego’s 850 Polaris Sportsman ATV-style ride on toy

·      Mamas & Papas’ Armadillo Flip and Armadillo Flip XT strollers

·      Fiddle Diddles LullaBelay adjustable car seat strap system

·      Chimparoo brand Trek baby carriers

Sargent Art tempera finger paints: About 2.8 million units of paint have been recalled. The paint can contain harmful bacteria, putting children with weak immune systems at risk of serious illness. Those with healthy immune systems may not be affected.

Recalled are 13 types of Sargent Art tempera and finger paints. All colors and sizes of the following types of paints are recalled: Art-Time brand of tempera paint, washable finger paint, washable fluorescent finger paint, washable fluorescent tempera paint, washable glitter finger paint, washable paint and fluorescent tempera paint.

Sold at: Hobby Lobby, Wal-Mart and other stores nationwide and online at Amazon.com and ShopSargentArt.com from May 2015 to June 2016 for $1 to $8.

Stop using the paints and contact the company for a refund at 800-827-8081 or visit www.sargentart.com.

Lil’ Luxuries Whirlpool, Bubbling Spa & Shower: About 86,000 units have been recalled. Fabric slings can come off the infant bathtubs, and infants can fall or drown.

Lil’ Luxuries Whirlpool, Bubbling Spa & Shower is a battery-operated whirlpool bath with motorized jets intended for use with children from birth to 2 years. The product has a fabric sling on a plastic frame onto which the infant is placed for bathing. The fabric sling on the tub does not have a white plastic clip to attach the headrest area of the fabric sling to the plastic frame. Recalled bathtubs have numbers 18840, 18850, 18863 or 18873 with date codes starting with 1210, 1211, 1212, 1301, 1302, 1303, 1304, 1305, 1306, 1307 or 1308, which stand for the two-digit year followed by the two-digit month, on the fabric sling.

The products were sold at Toys R Us/Babies R Us and other juvenile product specialty stores nationwide from October 2012 through October 2013 for about $60. The tubs also might have been sold secondhand.

Stop using the fabric sling in the tub, and contact the company for a replacement sling with a white plastic attachment clip. You can call 844-612-4254 or visit http://bit.ly/2f1wQNG.

Peg Perego’s 850 Polaris Sportsman ATV-style ride on toy, About 3,000 toys were recalled. A relay on the circuit board can fail causing the vehicle’s motor to overheat and catch fire.

Recalled are Peg Perego’s 850 Polaris Sportsman ride-on, 24-volt battery-operated toy vehicles for children ages 5 to 7 years. The ATV-style vehicles for two people are silver, red and black and have four wheels, a flip-up backrest for the back passenger and a front and rear luggage rack. Vehicles with date codes 651016, 651017, 651020, 651021, 651022, 651023, 651024, 651027, 651028, 651029, 651030, 660304, 660305, 661123, 661124, 661125 and 661130 are recalled. The date code is under the vehicle seat. Sportsman Twin and 850 EFI are printed on the side and Polaris is on the side of the seat.

Items were sold at online retailers including Amazon.com, Cabelas.com, Target.com, ToysRUs.com and Walmart.com from October 2014 through April 2016 for $500 to $600.

Remedy is to Contact Peg Perego for a replacement circuit board with instructions, including shipping. Call 877-737-3464, email 850recall@pegperego.com or visit https://us.pegperego.com/cs/recalls/.

Mamas & Papas’ Armadillo Flip and Armadillo Flip XT strollers: About 3,000 strollers have been recalled. A loose latch on the stroller can cause the infant in the seat to tip back unexpectedly and possibly fall out when facing the parent.

Recalled are Mamas & Papas’ Armadillo Flip and Armadillo Flip XT strollers. All models are folding strollers for one infant. They come in black, teal and navy and weigh about 22 pounds. Lot number ranges for recalled Armadillo Flip strollers are 00814 through 00416. Lot number ranges for the Flip XT are 01214 through 00416. The number is printed on the sewn-in label on the stroller.

Strollers were sold at Albee Baby, Babies ‘R’ Us, Buy Buy Baby and other stores nationwide and online at www.mamasandpapas.com and www.amazon.com from December 2014 through July 2016 for $500.

Stop using the strollers and contact the company for a repair at 800-309-6312 or visit www.mamasandpapas.com/us.

Fiddle Diddles LullaBelay adjustable car seat strap system: About 250 units have been recalled. The carabiners attached to the strap system have small parts inside that can come loose and be swallowed and choked on by young children.

The Fiddle Diddles LullaBelay adjustable car seat strap system with model number LB1001 includes two fabric straps, carabiner hardware, a mesh car seat cover and a tote bag. The carabiners are used to hang a car seat from a shopping cart. The model number is printed on the straps.

They were sold at Amazon.com from November 2015 through June 2016 and Fiddlediddles.com from May through June 2015 and at Zoolikins stores in Arizona from November 2015 through June 2016 for about $40.

You can contact the company for a repair kit with three new carabiners. Call 888-741-2957, email info@fiddlediddles.com or visit http://fiddlediddles.com/replacement-kit.html.

Chimparoo brand Trek baby carriers: About 130 units are being recalled. The carriers’ side strap can loosen unexpectedly from the buckle, and the child can fall out.

Recalled are Chimparoo brand Trek baby carriers that allow the user to carry a baby tummy to tummy, on the hip or on the back. The 100% twill fabric carriers were sold in 18 solid, striped and pattern color combinations. The carriers attach to the wearer’s body with adjustable straps made of polypropylene webbing and plastic buckles. “Chimparoo” is printed on the upper right hand corner of the carrier. “Trek” is embroidered on the belt.

The carriers were sold at Children’s boutique stores, such as Granola Babies, of Costa Mesa, Calif., Eat/Sleep/Play, of Summerville, S.C., and Top to Bottom, of Omaha, Neb., and online at www.Amazon.com and www.Chimaparoo.ca from May through July 2016 for about $170.

Contact the company for a replacement buckle for the baby carrier’s side-buckle. Call 855-289-5343, email safety@Chimparoo.com or visit www.Chimparoo.ca/en/recall.

Story source: Trisha Korioth, at http://www.aappublications.org/news/2016/11/17/HealthAlerts111716

Your Baby

Moms Getting Poor Advice on Baby’s Health Care

2:00

Moms are getting conflicting advice on infant and child care from family members, online searchers and even their family doctors a recent study found.

Oftentimes, that advice goes against the American Academy of Pediatrics (AAP) recommendations for topics such as breast-feeding, vaccines, pacifier use and infant-sleep, researchers say.

"In order for parents to make informed decisions about their baby's health and safety, it is important that they get information, and that the information is accurate," said the study's lead author, Dr. Staci Eisenberg, a pediatrician at Boston Medical Center.

"We know from prior studies that advice matters," Eisenberg said. Parents are more likely to follow the recommendations of medical professionals when they "receive appropriate advice from multiple sources, such as family and physicians," she added.

The researchers surveyed more than 1,000 U.S. mothers. Their children were between 2 months and 6 months old. Researchers asked the mothers what advice they had been given on a variety of topics, including vaccines, breastfeeding, pacifiers and infant sleep position and location.

Sources for information included medical professionals, family members, online searches and other media such as television shows. Mothers got the majority of their advice from doctors. However, some of that advice contradicted the recommendations from the AAP on these topics.

For example, as much as 15 percent of the advice mothers received from doctors on breast-feeding and on pacifiers didn't match recommendations. Similarly, 26 percent of advice about sleeping positions contradicted recommendations. And nearly 29 percent of mothers got misinformation on where babies should sleep, the study found.

"I don't think too many people will be shocked to learn that medical advice found online or on an episode of Dr. Oz might be very different from the recommendations of pediatric medical experts or even unsupported by legitimate evidence," said Dr. Clay Jones, a pediatrician specializing in newborn medicine at Newton-Wellesley Hospital in Massachusetts. He said inaccurate advice from some family members might not be surprising, too.

Mothers got advice from family members between 30 percent and 60 percent of the time, depending on the topic. More than 20 percent of the advice about breast-feeding from family members didn't match AAP recommendations.

Similarly, family advice related to pacifiers, where babies sleep and babies' sleep position went against the AAP recommendations two-thirds of the time, the study found.

"Families give inconsistent advice largely because they are not trained medical professionals and are basing their recommendations on personal anecdotal experience," Jones said.

Less than half of the mothers said they used media sources for advice except when it came to breastfeeding. Seventy percent reported their main source of advice on breastfeeding came from media sources; many of these sources were not consistent with AAP recommendations.

In addition, more than a quarter of the mothers who got advice about vaccines from the media received information that was not consistent with AAP recommendations.

"Mothers get inconsistent advice from the media, especially the Internet, because it is the Wild West with no regulation on content at all," Jones said.

The possible consequences of bad advice depend on the topic and the advice, Jones said.

"Not vaccinating your child against potentially life-threatening diseases like measles is an obvious example," he said. "Others may result in less risk of severe illness or injury but may still result in increased stress and anxiety, such as inappropriately demonizing the use of pacifiers while breast-feeding."

Mothers who look for information online should stick to sources such as the AAP, the American Academy of Family Physicians or the U.S. Centers for Disease Control and Prevention, Eisenberg suggested.

Even though some advice from doctors did not follow AAP recommendations entirely, Eisenberg and Jones agreed that doctors are the best source for mothers on the health and care of their children.

"While our findings suggest that there is room for improvement, we did find that health care providers were an important source of information, and the information was generally accurate," Eisenberg said. "But I would encourage parents to ask questions if they don't feel like their provider has been entirely clear, or if they have any questions about the recommendations."

The study was published in the July edition of the journal Pediatrics.

Source: Tara Haelle, http://www.webmd.com/parenting/baby/news/20150727/new-moms-often-get-poor-advice-on-baby-care-study

 

Daily Dose

New Dietary Guidelines

1:30 to read

The United States Department of Agriculture has just issued their new dietary guidelines for 2015-2020.  (Isn’t it 2016 already as well?). At any rate, this seemed like a good time to re-visit the topic of healthy eating habits for families…..always a topic of conversation with my patients.

While so many of us talk about healthy eating and reducing needless calories, the government is now also focusing on one of the main culprits, SUGAR.  The new guidelines recommend that we limit sugar intake to about 12 tsp of sugar a day which may sound like a lot until you realize that a can of Coke contains nearly 10 tsp of sugar.  Studies have shown that the “average” (not defined) American currently consumes 22 tsp of sugar /day.  It seems that nearly half of the sugars in our diets are from sweetened beverages and sports drinks. While I know that many the families in my practice have cut out soft drinks, their kids do drink a lot of sports drinks. If it’s a sticky drink it probably has sugar.

At the same time the FDA is also proposing that food labels be changed yet again, to list added sugars. While the current labelling lists “total sugar”, this is a combination of added and natural sugars.  There is a difference between natural sugars found in fruits such as apples and berries, than there is in the processed added sugar found in a chocolate chip cookie or granola bar.  Kids can attest to that all day long!  There are also added sugars in many of the pouches that are marketed for babies and young children…despite the fact that they may be “organic” some have a lot of sugar that also sticks to their teeth as they “suck” on the yogurt or applesauce rather than eat it from a spoon.

The new guidelines also state that teenage boys and men are eating too much protein. The guidelines now recommend, “men and boys reduce their overall intake of protein foods such as meat, poultry, and eggs”.  This group (and all of us I think) should add more vegetables to their diet.

The newest guidelines really seem to focus more on healthy eating habits, rather than on individual nutrients, which seems to have been the take home message. I think we all “know” that eating more fruits and vegetables is good for you, but many people need more guidance than that broad statement. Eating a diet that is colorful which means more fruits and veggies and less carbs and meat has been the goal for a long time.

These guidelines are especially important as they affect the foods that are chosen for our children’s school lunch programs which feed more than 30 million children each day.  The guidelines also contribute to how food assistance programs like WIC are determined.

But, back to basics….eating family meals at home is always important. Making even small changes towards a broader, colorful diet rich in lean meats, fruits, veggies and whole grains will be beneficial to everyone. Lastly, why not try a meat free night once a week as well…have you tried cauliflower steaks yet?

Daily Dose

Commencement Speech Advice

1.15 to read

It is commencement season and I have recently enjoyed attending a few college graduations with a few high profile speakers. I have been privileged to hear both Condoleezza Rice at SMU and Robert Gates at University of Texas in Austin, both of whom gave excellent speeches.  

I was listening to another interesting speech given by Eric Schmidt at Boston University’s commencement which really hit home with me. Schmidt is the chairman of Google, and while much of his address was directed at the graduates and the many advantages that they would have as  “the first fully connected generation” he also made the comment that “computers, while exceptionally complicated, just don’t have a heart”.   

While he spoke eloquently about technology and connectivity and his belief that “technology can and has changed the world to be a better place”, he also realizes that being connected on line is not the same social experience as face to face discussions and interactions. 

In the middle of his commencement address he charges the students to “take one hour a day and turn that thing off!  Take your eyes off that screen and have a conversation, a real conversation. Don’t push a button saying you “like” someone, actually tell them.”  (while he is delivering the speech they are showing graduates riveted to their phones and texting rather than listening..very funny). 

Eric Schmidt and I have one thing in common, we agree on the importance of human to human contact and interaction. Turning off our computers, phones and iPads and sitting down to read a child a story or have a discussion about the world economy during a family dinner is necessary and important to stay truly connected. (Pick any topic for dinner table discussion). 

Singing a song to a child as you take them on a walk (rather than talking on the phone and ignoring the child in the stroller). Play a board game (not on line) or play cards as a family. The list is endless!! 

I encourage you to watch his commencement address and make this a topic of conversation with your children. Only 1 hour a day, but what an important hour! 

Try it and let me know what you think!

Daily Dose

Tragic Accidents

1:30 to read

There have been several recent tragic accidents in the national news involving young children one of whom was injured while another died. Just the other day there was a death in our community of a young child who had been forgotten in the family car during the summer heat. I am heartsick for the families that have been involved in all of these situations.  But, I am even more sickened by the fact that there has been such a backlash against these parents and “shaming” rather than compassion.

I have practiced pediatrics long enough to have known several children who died in tragic accidents. Yes, accidents!   For my parenting “peer” group,  these accidents occurred long before social media, and the constant barrage of iPhone footage being shown on a news loop across the country 24 hours a day.  Fortunately, for my friends who lost a child, or for a child I cared for in my practice, the out pouring of sadness and compassion came from their family, friends and neighbors.  I cannot remember anyone “judging” these parents as we too all had small children and our whispered sentiments were often, “there but for the grace of God go I”.

If you are in the throes of raising your children, I would expect that you can remember and now   understand what your parents told you and mine told me, “accidents happen”. Fortunately for most of us these accidents involve bumps, bruises, stitches or even broken bones.  When that happens, I would heave a big sigh of relief that all of these “accidents” and injuries were “fixable”, even if they left a few scars.  (My boys were great at soothing my tears as they said, “scars are cool Mom”).

Fast forward to today and the sentiments seem to have changed.  Over the last weeks, I have watched TV and read different sites on the internet only to see and hear too many terribly mean and downright hurtful comments regarding the parents of the children involved in the accidents. Whether it was the child who fell into the gorilla enclosure who thankfully survived, or the toddler who was pulled into the lagoon by an alligator and drowned, or the child who died in a hot car….these are just unspeakable, tragic accidents. It doesn’t matter how many children you have, it is not possible to keep your child within arms reach, or to have constant eye contact with them from birth-21 years of age (and accidents happen after that as well). I just had an friend who lost her 29 year old son in a tragic accident on their ranch….I am heartsick for them. 

The definition of an accident is “an unfortunate incident that happens unexpectedly and unintentionally, that typically results in damage or injury”.  So, it is not a planned event, or even something that is preventable, despite all of the latest gizmos and safety features we wrap around our children. But when the tragic unforeseen accident occurs and a child is harmed, who are we to judge that parent or family. These were not cases of child abuse, or of a child being left unattended , or not riding in a car seat…these were all accidents that occurred within a few feet of the parents. Horrible, terrible, unfair and all accidental.

So, as both a parent and pediatrician I wonder what has happened to empathy in today’s society? Would it not be more appropriate for the parenting public to be saying ( or posting or texting or whatever)  “there but for the grace of God go I ”? These are the times you hug your child a bit tighter or call them to just check in and hope and pray that you never find yourself on the other side of an accident, because accidents can happen - even to great parents and happy children. 

Pages

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

When your child loses a tooth.

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.