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Your Child

Lung Ultrasounds as Effective as Chest X-Rays for Detecting Pneumonia


Traditionally, when a child shows up at the ER or physician’s office with suspected pneumonia, a chest x-ray is ordered to verify a diagnosis.

A new report says that lung ultrasounds may offer a safer and equally effective alternative for diagnosing pneumonia in children.

"Ultrasound is portable, cost-saving and safer for children than an X-ray because it does not expose them to radiation," explained study leader Dr. James Tsung. He is an associate professor in the departments of emergency medicine and pediatrics at the Icahn School of Medicine at Mount Sinai, in New York City.

Ultrasound, also called sonography, is an imaging method that uses high-frequency sound waves to produce images that lead to diagnosis and treatment of many diseases and medical conditions. Radiation is not used in ultrasound testing, but is used in x-rays and CT scans.

The study looked at 191 emergency department patients, aged 21 and younger, who were randomly assigned to either an investigational group or a control group.

Patients in the investigational group had lung ultrasound and, if additional verification was needed, a follow-up chest X-ray. Those in the control group had a chest X-ray followed by lung ultrasound.

The patients in the investigational group had nearly 39 percent fewer chest X-rays, with no missed cases of pneumonia and no increase in complications. The reduction in chest X-rays led to overall cost savings of $9,200 and an average decrease in time spent in the emergency department of 26 minutes, according to the study published April 12 in the journal Chest.

"Our study could have a profound impact in the developing world where access to radiography is limited," Tsung said in an Icahn news release.

Pneumonia is a leading cause of death among children worldwide. Chest X-ray is considered the best way to diagnose pneumonia in children, but about three-quarters of the world's population does not have access to X-rays, according to the World Health Organization.

Parents in the U.S. may want to request a lung ultrasound instead of a chest x-ray when that option is available, to avoid their child’s exposure to radiation.

Story source: Robert Preidt,

Your Teen

Headlines: Another Teen Suicide

On September 6, 2007, the Centers for Disease and Prevention reported suicide rates in American adolescents (especially girls, 10 to 24 years old) increased 8%, the largest increase in 15 years.The sad and desperate story of a college student who killed himself after a roommate secretly videotaped him having sex, and streamed it live on the web has made headlines across the world.

18 year old, Tyler Clementi, was embarrassed and humiliated by the invasion of his privacy. He jumped to his death from the George Washington Bridge. Unfortunately, Tyler is not the only teen who thinks suicide is the only way to end his suffering. On September 6, 2007, the Centers for Disease and Prevention reported suicide rates in American adolescents (especially girls, 10 to 24 years old) increased 8%, the largest increase in 15 years. Amazingly, suicide is the third leading cause of death for 15-to-24-year-olds, and the sixth leading cause of death for 5-to-14-year-olds. The current headlines demonstrate that it is more important than ever that parents are aware of the symptoms of depression and substance abuse.  Suicides increase substantially when the two are combined. What symptoms should I look for? - Change in eating and sleeping habits - Withdrawal from friends, family, and regular activities. - Violent, rebellious behavior, or running away - Drug and alcohol use. - Unusual neglect of personal appearance - Marked personality change - Persistent boredom, difficulty concentrating, or a decline in the quality of     schoolwork - Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc. - Loss of interest in pleasurable activities. - Not tolerating praise or rewards. A teenager who is planning to commit suicide may also: - Complain of being a bad person or feeling rotten inside. - Give verbal hints with statements such as: “I won't be a problem for you much longer,”    “ Nothing matters,” “It's no use, and I won't see you again.” - Put his or her affairs in order, for example, give away favorite possessions, clean his or her room, throw away important belongings, etc. - Become suddenly cheerful after a period of depression - Have signs of psychosis (hallucinations or bizarre thoughts.) What should you do if you notice these symptoms in your child? If a child or adolescent says, "I want to kill myself," or "I'm going to commit suicide,"  always take the statement seriously and immediately seek assistance from a qualified mental health professional. People often feel uncomfortable talking about death. However, asking the child or adolescent whether he or she is depressed or thinking about suicide can be helpful. Rather than putting thoughts in the child's head, such a question will provide assurance that somebody cares and will give the young person the chance to talk about problems. If one or more of these signs occurs, parents need to talk to their child about their concerns and seek professional help from a physician or a qualified mental health professional. With support from family and appropriate treatment, children and teenagers who are suicidal can heal and return to a healthier mental outlook.

Daily Dose

Too Much Tanning

1.00 to read

With my previous posts on sun safety, I thought that it was a good time to discuss those who don’t heed the warnings about the risks of overexposure to ultraviolet radiation and are addicted to tanning. 

We all saw the pictures of the New Jersey mom who seemed to live in a tanning bed, and the media termed her “tanorexic”. I also take care of plenty of teens who seem to fall into this category as well. They are easy to spot as they are tan throughout the year, even on areas they “shouldn’t be”. 

There is actually data to show that tanning changes brain activity.  Researchers at University of Texas Southwestern Medical Center did a study with participants who used tanning beds.  They found that brain activity and blood flow in tanners is similar to that seen in people addicted to drugs and alcohol.  The rewarding effects in the brain may be due to an opiod release that occurs during tanning.  If frequent tanners missed tanning sessions they experienced withdrawal like symptoms and related that they were compelled to continue the tanning behavior. 

While UVA and UVB radiation both play a role in the development of skin cancer, artificial ultraviolet radiation (UVR) is used most commonly in tanning beds and sun lamps. Compared with solar radiation, artificial UVR contains 10 to 15 times the amount of radiation.  This is concerning as there are more than 1 million Americans (many of whom are teens) who use artificial tanning methods each day, putting them at even more risk for the development of skin cancer. 

If estimates are correct and more than 25% of lifetime sun exposure occurs within the first 18 years of life, avoiding artificial tanning would seem to be prudent. There are melanoma studies showing that artificial UV light exposure increases the risk of developing melanoma by 74% so why would you allow your teen to tan?  In many states bills have been passed to regulate  tanning access to minors.  But even with these laws in effect, some parents continue to “sign” to allow their children to tan, I know this from my own patients.  

So, while tanning may make you feel “good” for the short term, like many other things in life it is not good for the long term. Just another topic for discussion with your teen. 

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

Daily Dose

Why Kids Should Wear a Helmet

1:30 to read

Accidents in children are always an ever present problem. From scraped knees, to bumped heads, broken arms and stitches there are always injuries in our children. Accidents in children are always an ever present problem. From scraped knees, to bumped heads, broken arms and stitches there are always injuries in our children. Thank goodness most of them are traumatic at the moment, usually more to the parent than the child, and the child quickly recovers and is on to the next thing.

One way to help protect our children is by using protective "gear" when appropriate. We are really good about using car seats, child proofing houses and pools for the toddler set, but as the children get older there are other dangers lurking around with the bicycles, scooters, skateboards and the newest rip stick. All of these "wheeled" devices pose dangers for falls and "wipe outs" that may lead to things as mild as cuts and scrapes or as serious as a head injury. The hardest thing to get a school age child to understand is the meaning of the word ACCIDENT.

They do not understand that even if they think they have mastered the bike or rip stick, an accident can happen at any time. When I am talking to the elementary school set and ask them about mastering a bicycle on two wheels they are so proud to tell me of their accomplishments. But when I ask them what they are wearing on their head while riding, I don't always hear "a helmet". Children and adults on bicycles need to wear helmets at all times. I see kids riding their bikes to school (great exercise), but not a helmet in sight on their head. Don't let your child on their bicycles without a helmet, insist on a helmet just like a seat belt. If they become accustomed to always putting on a helmet before hopping on that bike or skateboard it will just become second nature. If they choose not to wear their helmet, then put the bike in "time out" for awhile to let them know that you are not going to allow them to ride without protection. Knee pads and wrist guards are great, but we can usually set a wrist fracture, or stitch up a knee. A head injury is another story!

That's your daily dose, we'll chat tomorrow.

Daily Dose

Teen Drivers

1:30 to read

As you know, when teens start to drive, I am a huge advocate for parent - teen driving contracts. I wrote my own contracts for my boys but I recently found a website that all parents who are getting ready to have teen drivers need to be aware of.

Injuries from motor vehicle crashes are the #1 cause of death for teens in the United States.  Studies have shown that having limits and boundaries in place for new drivers reduces the number of motor vehicle accidents that new drivers experience. Although not all states have “graduated driver’s licenses”, all parents can have discussions about the privilege and responsibility of driving and set their own guidelines for their new teen driver.

The website was developed by the National Institute of Child Health and Human Development and is an interactive site for both parent and teen.  The program is entitled “Checkpoints”.  The website includes teen driving statistics to help parents keep their teen drivers safe as well as giving information about state-specific teen driving laws.

The site has a great interactive component to help parents create their own parent-teen driving “contract” that addresses such things as teen driving hours, number of passengers allowed, and boundaries for driving. These parameters can be modified as the teen becomes more experienced and meets the “checkpoints” that were agreed to.  It is a great site as it not only gives you a template for the agreement, but sends emails as the allotted amount of time has passed for each step of the contract.  You don’t have to remember what you and your teen agreed to, they email you and then you and your child can revisit the agreement and expand it over time as your driver becomes more experienced.

Instead of handing out my “dog eared” old driving contracts that I wrote for my boys, I am now going to send my patients to this site (which is also being sustained by the American Academy of Pediatrics).  

Teen drivers whose parents are actively involved in monitoring their driving are not only less risky drivers but know ahead of time what their parent’s expectations are. Having a teen involved proactively with driving rules is far preferable to regretting that limits, boundaries and parental rules were not discussed prior to allowing your new driver on the road.

The website is not only free it is also evidence based, and within 5 - 10 minutes of reviewing the site a family is set to go with their own checkpoint agreement.  Here’s to teen driver safety!

Daily Dose

Thimerosal In Flu Vaccines

Confusion about thimerosal in flu vaccinesI received an email from a reader who “had a problem with my statement about vaccines being thimerosal free”.  Since 2001 all vaccines given to children under the age of 6 are thimerosal free, with the exception of the influenza vaccine.

She is correct in pointing out that influenza vaccines may contain a minimal amount of thimerosal (a mercury based preservative), but influenza vaccines are also available thimerasol free.  The LAIV (live nasal vaccine/flumist), is also thimerasol free and is available for use in children 2 and older.

Although injectable influenza vaccines may contain a minimal amount of thimerosal, the amount is negligible and is deemed safe by both the FDA and the CDC. Infants are not receiving a series of vaccines containing thimerasol, and at most would receive 2 influenza vaccines after they are 6 months of age during the first season that they are vaccinated, and subsequently would receive one dose per year thereafter.  There are also thimerasol free influenza vaccines available (this year both seasonal and “swine flu” vaccines) for use. By the time a child is 2 years of age, they would at most have received 3 doses of an influenza vaccine that had  0.01% thimerasol or less which would be between <1 mcg – 25 mcg/0.5ml vaccine dose. (Do you know how much mercury is in the fish you eat or other products you consume daily?)  After the age of 2 parents may choose to have their child immunized for influenza with the LAIV nasal vaccine that is also thimerasol free. As with many things in life one must weigh the risk benefit ratio, in this case of giving a vaccine that contains minimal thimerasol. In my opinion the science has quite eloquently proven that there is not a link between the preservative thimerasol and autism. With that being said,  I also believe that the risk of an infant developing flu and having complications from their infection, far outweighs any hypothetical or anecdotal concern about thimerasol. As I have said before, we know what does not cause autism and it was not thimerasol in vaccines. In fact the rate of diagnosis of autism has gone up, rather than down, since thimerasol was removed from vaccines. We need to continue to devote research dollars to finding the cause of autism. In the meantime, I stand corrected and wanted to give all of you more detailed information about thimerasol and influenza vaccines. That's your daily dose.  We'll chat again tomorrow! Send your question to Dr. Sue! (click here)

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Your Teen

FDA to Regulate E-cigarettes, Raise Age for Purchasing


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,


Your Teen

Newer Cars Safer for Teen Drivers


One of the most exciting days in a teen’s life is when he or she gets their driver’s license. It’s also one of the scariest for parents. Parents know that it takes time and experience to become a competent driver. Teens often believe that because they can stop at stop signs, put on their seat belt, Parallel Park and stay in a well-defined lane, they are competent enough.

Unfortunately, that’s not the case.  The Centers for Disease Control and Prevention (CDC), list motor vehicle crashes as the leading cause of death for U.S. teens.  Seven teens –ages 16 to 19- die every day from motor vehicle injuries.  According to a new study, more teens could survive serious auto accidents if they are driving newer cars.

While older cars may be less expensive, newer models are more likely to come with better standard safety features. Larger and heavier cars may also offer more protection.

"We know that many parents cannot afford a new vehicle," said the study's lead author, Anne McCartt, senior vice president for research at the Insurance Institute for Highway Safety. "Our message to parents is to get the most safety they can afford."

Researchers analyzed data from 2008 to 2012 from the U.S. Fatality Analysis Reporting System, which included information on 2,420 drivers ages 15 to 17 and 18,975 drivers ages 35 to 50.

The majority of teens that died (82%) were in cars that were at least 6 years old. A smaller, but significant proportion of teens (31%) were in cars 11 to 15 years old. For comparison, fatally injured teens were almost twice as likely as their middle-aged counterparts to be driving a car that was 11 to 15 years old.

Researchers say that they can’t prove that older cars driven by teens actually increase the risk of death if they are in a motor vehicle accident. However, there is good reason to think that teens would be safer in newer cars.

Older cars have older seatbelts that can wear and tear with age. Airbags were not required in cars till 1997 and 1998 for trucks. Today, they are standard equipment. The biggest safety upgrade though, has been the addition of electronic stability control.

Ultimately, McCartt said, though newer model cars tend to have more safety features, protecting your teens is not as straight forward as just steering clear of older vehicles. "We did find older vehicles that met our safety criteria," she said.

Still, it's a rare older vehicle that has electronic stability control — an important safety feature that helps drivers keep control in extreme maneuvers, McCartt said. "That's something that is standard on new cars since it was a requirement starting in 2012," she added.

Extreme maneuvers can quickly happen when something unexpected happens while driving. There are also plenty of distractions that can take your eyes off the road such as reading or replying to a text, eating or drinking while driving, cell phone calls, Changing CDs or radio stations, video watching, looking at or entering data for a GPS, talking to passengers. The list goes on. These distractions are certainly not limited to teens, but they have the least experience behind the wheel.

The Insurance Institute for Highway Safety (IIHS) has compiled a list of affordable used vehicles that meet important safety criteria for teen drivers that can be found at

They also have a list of recommendations to consider when purchasing a car for a teenager. They are:

•       Young drivers should stay away from high horsepower. More powerful engines can tempt them to test the limits.

•       Bigger, heavier vehicles are safer. They protect better in a crash, and HLDI analyses of insurance data show that teen drivers are less likely to crash them in the first place. There are no mini-cars or small cars on the recommended list. Small SUVs are included because their weight is similar to that of a midsize car.

•       Electronic stability control (ESC) is a must. This feature, which helps a driver maintain control of the vehicle on curves and slippery roads, reduces risk on a level comparable to safety belts.

•       Vehicles should have the best safety ratings possible. At a minimum, that means good ratings in the IIHS moderate overlap front test, acceptable ratings in the IIHS side crash test and four or five stars from the National Highway Traffic Safety Administration (NHTSA).

Most teens will eventually get their driver’s license – that’s a given.  If a teen is still a minor, it’s up to the parents or responsible guardians to help choose a car that will give them the best chance of survival if an accident should happen. That choice may include a newer model.

The study was published online in the journal, Injury Prevention.

Source: Linda Carroll,


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Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!


Struggling with feeding your kids healthy (er) meals. Rule of thumb: don't stress over it!

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