November 21, 2014

Laundry Detergent Pods Remain Risky for Kids

More than two years ago we blogged about the toxic quality of laundry detergent packaged in colorful plastic pods that look like candy to some small children. Although the danger flag was raised then by poison control centers, and the Consumer Product Safety Commission issued a safety alert, these products are still harming wee ones.

A recent study published in the journal Pediatrics found that between 2012 and 2013, U.S. poison control centers fielded more than 17,000 reports of kids younger than 6 who swallowed, inhaled or were otherwise exposed to the chemicals in laundry detergent pods.

That’s about one kid an hour. About 770 children were hospitalized, an average of one a day, and one died.

The highest risk was for 1- and 2-year-olds, which won’t surprise parents who know that these small fry explore the world largely through putting stuff in their mouths. Nearly half of children vomited after being exposed to these products, and other problems were coughing, choking, eye pain or irritation, drowsiness, lethargy and “pink eye” ( conjunctivitis).

Some manufacturers are modifying pod packaging to be more kid-resistant, and some include warning labels to the containers. But a lot of detergent pods are available in see-through packages easily opened.

“It is not clear that any laundry detergent pods currently available are truly child resistant; a national safety standard is needed to make sure that all pod makers adopt safer packaging and labeling,” said Dr. Gary Smith in a news release. Smith is the study’s senior author and director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio.

Keep kids safe from laundry detergent products by:


  • using traditional laundry detergent, which is much less toxic than laundry detergent pods;

  • storing any detergent pods you might have high and out of sight; a locked cabinet is best;

  • closing the containers and storing them immediately after use.

If your child does ingest a laundry detergent pod or has a bad reaction after exposure, call the national Poison Help Line number at (800) 222-1222. Of course, if he or she is having trouble breathing or otherwise shows serious problems, head for the emergency room.

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November 14, 2014

Too Many Docs Don’t Follow Antipsychotic Prescribing Guidelines for Kids

Last month, a hearing in the Vermont Legislature yielded information about how that state’s doctors prescribe antipsychotic drugs to children. About half the time, it seems, they don’t follow the recommended guidelines for those powerful drugs.

Such drugs sometimes are prescribed for children with bipolar disorder and schizophrenia, as well as other problems.

The hearing, as reported by AboutLawsuits.com, included testimony that although rates of antipsychotic prescriptions to children in that state are declining, Vermont doctors followed prescribing guidelines by the American Academy of Child and Adolescent Psychiatry (AACAP) only about half the time.

And the decline in use isn’t as significant as it should be. Dr. David C. Rettew, director of the Pediatric Psychiatry Clinic at University of Vermont’s College of Medicine, referred to a recent survey showing that despite FDA recommendations to give antipsychotics to minors even less often, doctors chose the less-is-more approach only about 1 in 4 times. There’s no reason to believe there’s anything about Vermont that would make it unusual in this regard.

Rettew said the biggest problem wasn’t overprescribing, but failing to review laboratory practices. “The main reason best practice guidelines were not followed,” he testified, “was much more related to a lack of lab work monitoring rather than prescribing these medications for mild problems or before other pharmacological and nonpharmacological treatments had been tried first.”

As we’ve reported, side effects of antipsychotic drugs can include weight gain and a greater risk of developing diabetes (Abilify). Male breast growth also has been correlated with some of these drugs (Risperdal), as have urinary problems (clozapine). No one should take them without trying other treatments first.

Rettew said that only 15 in 100 children received psychotherapy before being prescribed antipsychotic drugs, and that in many cases the current prescribing doctor wasn’t the provider who originally prescribed the drug, so there was a disconnect between the current doctor’s treatment and a patient’s treatment history.

The news from Vermont, AboutLawsuits recalled, follows an investigation from last year by the Department of Health and Human Services’ Office of the Inspector General (DHHS-OIG) about the use of antipsychotic drugs by recipients of Medicaid younger than 18.

Scrutiny has sharpened not only on the use of these drugs for FDA-approved disorders, but for “off-label” uses; that is, for problems for which they have not been approved by the FDA as safe and effective. Many people are concerned that instead of focusing on the causes of a child’s behavioral problems, doctors — and parents — seek to treat the symptoms, often first with drugs.

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November 7, 2014

Don’t Let Babies Sleep on Couches

A recent study confirms that babies who sleep or nap on soft surfaces, like sofas, are at risk of dying.

According to the research published in Pediatrics, about 1 in 8 cases of so-called “crib death,” occurs among infants who have been placed on sofas. Crib death, also known as sudden infant death syndrome (SIDS), is the unexplained death, usually during sleep, of an otherwise healthy baby younger than 1 year.

Earlier research, according to the New York Times, showed that couches were hazardous for infants, and the new research set out to pin down all the factors contributing to these deaths.

Researchers analyzed data on 7,934 sudden infant deaths in 24 states. They compared those that occurred on sofas with those in cribs, bassinets or beds. Almost 3 in 4 deaths occurred among infants 3 months or younger.

Most parents in the study shared the sofa with the baby they placed there. But researchers said it was a mistake to believe that if you’re awake or watching the child, he or she is not at risk of SIDS.

Sleep-deprived parents, the thinking goes, are more likely to fall asleep on the couch next to their newborns. The design of the furniture can be a problem, too — some sofas slope toward the back cushions, and infants get wedged into a position where they can’t breathe.

Dr. Barbara Ostfeld, program director of the SIDS Center of New Jersey, told The Times, “Many parents think for safety, ‘I’ll put the baby between myself and the back of the sofa.'” But, “the unplanned and unexpected happens. The grief is beyond painful and endures for a lifetime.”

The lead researcher said that infants “need to sleep alone, on their backs and in a crib, and it doesn’t matter if it’s for a nap or overnight. And it doesn’t matter if the parent is awake or asleep.”

The New York Times has assembled a resource for SIDS information. See our blog about the Consumer Product Safety Commission and crib safety here.

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October 31, 2014

Improper Splinting of Kids' Fractures Is Common, and Can Cause Serious Complications

A lot of parents with active kids are familiar with the emergency department of their local hospitals, thanks to the common incidence of broken bones and sprained ligaments. According to a new study by researchers at the University of Maryland School of Medicine, mom and dad should pay careful attention to how their child’s injury is treated initially.

More than 9 in 10 potential pediatric fractures, the researchers found, are splinted improperly in ERs and urgent care centers. Such errors can cause swelling and skin injuries, and can lead to long-term structural and mobility problems.

These mistakes are significant, given the frequency of broken bones among children and adolescents — nearly half of all boys and one-quarter of all girls experience a fracture before they’re 16. The patients in the UM study had a range of fractures affecting all extremities, including fingers, arms, ankles and knees.

The results were drawn from reviewing 275 cases of children as old as 18 who were treated initially at community hospital emergency rooms and urgent care facilities in Maryland, and evaluated later by pediatric orthopedic specialists at UM.

A splint is created from at least one strip of rigid material placed against the injured extremity, which is then wrapped with padding and an elastic bandage to hold it in place and immobilize the joint. ERs and urgent care centers use splints as temporary stabilizers for possible fractures, and to reduce pain.

After being splinted, patients are referred to an orthopedic specialist, who removes the splint and evaluates the problem completely.

Dr. Joshua M. Abzug, an orthopedic specialist at the UM School of Medicine and the study’s lead author, said in a news release, “Unfortunately, many practitioners in emergency departments and urgent care settings incorrectly applied splints, potentially causing injury.”

The most common mistake in splinting kids, according to the study, was wrapping the elastic bandage directly onto the skin. That happened in more than 3 in 4 patients. In nearly 6 in 10, the joints were not immobilized correctly, and in more than half, the splint was not the proper length. Skin and soft-tissue complications were observed in 4 in 10 patients.

According to a report on NPR, the study showed that in some cases, the elastic bandage had been wound too tightly, which impedes blood circulation.

Sometimes, the bandage placement opened a wound. And one patient’s foot was immobilized at the wrong angle to her leg, which complicates her ability to walk she’s ready a few weeks later.

Abzug told NPR that broken bone treatment has changed in the last decade or two. Before, when parents and kids landed in the emergency room after an injury, the same person who diagnosed the break probably would fix it. But today, with increasing medical specialization and a proliferation of urgent care centers, it's more common for the emergency caretaker who splints the break to instruct the parent to follow up with an orthopedist for more treatment the next day.

"For whatever reason, many parents don't follow up right away," Abzug told NPR. "Sometimes it's a problem with health insurance, or they can't take time off work, or they just didn't understand the instructions."

But if the splinting wasn’t correct, waiting too long can cause devastating complications, including permanent loss of motion or a need for skin grafts. If the bandage was applied too tight, waiting even one night can produce lasting damage.

If your child’s injury has been splinted, observe the process to ensure only the rigid piece and the padding, not the bandage, make contact with the skin. Don’t ignore your child’s complaints about comfort or pain. Major swelling or discoloration in the area around the splint is sign that something’s wrong.

See an orthopedist as soon as possible if the treating emergency practitioner did not completely diagnose and treat the injury.

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October 24, 2014

The Best Birth Control for Adolescents

Many parents might not want to acknowledge it, but a lot of teenagers are having sex. A new study has identified the most effective contraception for adolescents who can't or won't delay sexual activity.

Long-acting reversible contraception (LARC), which includes progestin implants and intrauterine devices (IUDs), according to research in the journal Pediatrics, should be the first choice for teenage birth control.

The American Academy of Pediatrics (AAP) supported this conclusion. A technical report that accompanied the Pediatrics study depicted that LARCs were effective, safe and easy to use.

A story on MedPageToday.com, deemed the report an update of AAP guidelines from 2007, when the use of latex condoms was encouraged as the only specified form of birth control.

But the recommendations aren’t exactly new: In 2012, the American Congress of Obstetricians and Gynecologists (then called the American College of Obstetricians and Gynecologists), or ACOG, said that contraceptive implants and IUDs offered the best protection against unintended pregnancy in adolescents.

In 2009 only 4.5 in 100 sexually active, 15- to 19-year-olds used LARCs. The most popular contraception among teenagers was condoms — 95 in 100 sexually active kids used them, but 55 in 100 also had used oral contraceptives.

Of course, oral contraceptives aren’t effective if they’re not used exactly as intended, and if there’s any group of people who are likely to forget to take a daily pill, it’s adolescents.

An unsettling 57 in 100 female adolescents had used the withdrawal method for birth control, which, according to MedPage, has more than a 1 in 5 rate of failure rate among all users.

The Pediatrics researchers made clear that the easiest, most long-lasting form of contraception was best for adolescents. "The most effective methods rely the least on individual adherence," according to an AAP statement by the authors of the study. "For these methods, typical use effectiveness approaches perfect use effectiveness."

After one year of use, the number of unintended pregnancies among women who used progestin implants was less than 1 in 100, as it was among those use used a levonorgestrel or copper IUD.

Single-rod progestin implants are inserted into the inside of the upper arm, and are effective for three years. They contain a hormone that prevents ovulation and makes the uterine environment less hospitable to sperm and eggs.

IUD technology has a come a long way since the Dalkon Shield scare of several decades ago. That device promoted bacterial infections because of its porous design and string configuration, shortcomings that have been addressed.

IUDs, some of which remain effective for as long as 10 years, have a good safety profile, but they’re more likely to be expelled by adolescents than by older women. And many young women who have not borne children report moderate to severe pain when the IUDs are inserted.

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October 17, 2014

Marijuana: Sometimes It’s Legal, but Always Dangerous for Children

With the increasingly relaxed laws on the use of marijuana, more youngsters are sampling weed with the idea that it’s safe. It’s not.

Dr. Garry Sigman, director of the Adolescent Medicine division at Loyola University Health System and professor in the Department of Pediatrics at Loyola University Chicago, said marijuana is an addictive substance and, compared with adult users, adolescents are as many as four times more likely to become dependent on the drug within two years after first using it.

As more adults legally are allowed to smoke dope, and as more states refrain from imposing many of their marijuana laws, teenagers particularly perceive marijuana as a safe substance. But, as Sigman noted in a news release, “[I]ts effects on the adolescent brain can be dangerous, especially if there is heavy use. As the stigma of marijuana use decreases, the number of teens using the drug has increased. More U.S. high school students now smoke marijuana than they do cigarettes.”

Loyola Medicine referred to a recent study showing that more than 1 in 3 high school seniors and 7 in 100 eighth-graders reported using marijuana in the last month. A report in the October issue of the Journal of Leukocyte Biology indicates that using marijuana in adolescence might damage the immune system in the long term.

Some teens use marijuana only occasionally, mostly the result of peer pressure in a social setting, but others self-medicate to cope with stress and emotional issues.

“Marijuana is the most common substance addiction being treated in adolescents in rehabilitation centers across the country,” Sigman said. But because it’s perceived as a “softer” kind of drug, because it moderates anxiety and depression, many people don’t realize that its addictive quality can come with the cost of dependence, and the problems associated with withdrawal.

According to Loyola Medicine, heavy use of marijuana by adolescents can lead to:


  • impaired thinking;

  • poor educational outcomes and perhaps a lower IQ;

  • increased likelihood of dropping out of school;

  • symptoms of chronic bronchitis; and

  • increased risk of psychotic disorders for people who are predisposed.


Parents, Sigman advised, need to know that today’s “joint” is as many as four times as potent as the stuff they might have smoked in their youth. “Parents should inform themselves about the scientific facts relating to marijuana and the developing brain and be able to discuss the topic calmly and rationally,” Sigman advised. “Also, if the parents occasionally used marijuana during their lives, they should now know that there’s a risk if used before adulthood.”

To learn more about the addictive qualities of marijuana, how to recognize if your child is smoking it and what to do about it, consult the website of Choose Help, a resource for information about addiction and access to treatment.

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October 10, 2014

Breakfast: One Way to Reduce Kids' Risk of Developing Diabetes

Eating a healthful breakfast is good for you for many reasons, and a new study says that for kids, this regular practice can reduce the risk of developing diabetes.

Type 1 diabetes, once referred to as “juvenile” diabetes, develops early in life as a chronic condition. The pancreas is unable to produce the hormone insulin, or sufficient amounts of it, to maintain a proper level of glucose, or blood sugar. The more common type 2 diabetes develops later in life, often with a significant contribution by unhealthful behaviors that encourage the body to become resistant to insulin.

According to a recent study published in PLoS Medicine, getting into the habit early in life of eating a healthful breakfast might help kids lower their risk of developing type 2 diabetes. In the study, children who skipped breakfast most days had higher levels of known diabetes risk factors.

More than 4,000 children ages 9 and 10 were studied. More than 1 in 4 said they did not eat breakfast every day. Their resistance to insulin, a marker for diabetes, was higher than those who said they ate breakfast every day.

The kind of breakfast was important, too. Kids who ate a high fiber cereal, or one composed of complex carbohydrates, showed a lower insulin resistance than the ones who ate a meal higher in simple carbohydrates, such as biscuits.

There are two kinds of carbohydrates: complex and simple. Complex carbs are more healthful because they are less refined and the body takes longer to digest them. That helps moderate glucose levels. Simple, or refined, carbohydrates are digested more quickly and can cause blood sugar to spike.

Whole grains, or complex carbs, have more dietary fiber and are found, for example, in whole wheat and whole oats. Simple carbs have more sugar, and, in addition to refined grains, are found in milk products and fruit. They can be part of a healthful diet, but refined sugar products — foods rich in white flour and added sugar — are not. So it’s better to sweeten your whole wheat flake cereal with fruit than white sugar.

Of course, a good breakfast also has some protein (eggs, for example), but this study focused on carbohydrates. And because it showed only an association, further studies are required to adjust for factors such as a child’s socioeconomic status, degree of physical activity and body fat in order to draw concrete conclusions.

But there’s no question oatmeal is a better breakfast choice than toast made from white bread. Anything that might stave off diabetes and its chronic complications is a good thing. (See our blog, “Teens Who Develop Diabetes Have a Stark Future.”

To learn more about carbohydrates, visit the information page on the website of the Centers for Disease Control and Prevention.

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October 3, 2014

Poll Shows Gaps in Parents’ Knowledge About Concussions

Before their children are allowed to participate in sports, many parents must sign a document acknowledging that they understand concussions and their risks for brain injury. But a new poll on children’s health suggests that even if they know about the risk of concussion, they’re not necessarily capable of handling it properly.

According to the C.S. Mott Children’s Hospital National Poll on Children’s Health, about half of the 912 parents of middle- and high-school children surveyed said they had participated in some kind of concussion education.


  • Nearly 1 in 4 had read a brochure or online information.

  • Seventeen in 100 had watched a video or attended a presentation.

  • Eleven in 100 had signed a waiver form, but had no other educational information.

  • Nearly half had received no concussion education at all.


As you might expect, it was more common for parents of children who play sports to have gotten some kind of concussion education than for parents of nonsports kids (58% vs. 31%).

Some education is better than none, but, according to Sarah J. Clark, associate director of the Mott national poll, “The way the concussion information is delivered is linked to the parents' confidence about managing their child's injury." Clark is also a research scientist at the University of Michigan Department of Pediatrics/University of Michigan Medical School.

"Many schools mandate that a waiver form … be signed, but the danger is that parents will skip over information to get to that required signature line," she said in a news release.

More than 6 in 10 parents who watched a video or a presentation rated it as very useful. About 4 in 10 parents who read a brochure or online information rated that as very useful. Only 11 in 100 parents whose only concussion education was signing a waiver form reported that was very useful.

Parents lacking sufficient information about concussion, and its potential for brain injury, won’t know what to do if their child is injured.

According to the U.S. Centers for Disease Control and Prevention (CDC), nearly 175,000 children are treated every year in U.S. emergency rooms for concussions related to sports or recreational activities, including bicycling, football, playground activities, basketball and soccer.

Although it’s never a minor event, a concussion affects children differently from adults. The healing process is different, and getting more than one concussion in a short period is particularly dangerous for kids.

All parents, but especially those with sports-playing youngsters, should get become informed about what is concussion, how to monitor its symptoms and when to seek medical attention. Until symptoms have subsided, parents should limit the child’s physical activity, and maybe mental activity including homework, to allow the brain to heal. (See our blog, “Getting Back Into the Game After Suffering a Concussion.”) Watch the video from the C.S. Mott Children’s Hospital here.

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September 26, 2014

Scary Virus Is Spreading, but Isn’t Life-Threatening

An unusual respiratory infection that strikes primarily children is spreading across the country. The virus isn’t new, but its effect on children seems to be, according to a story on KevinMd.com.

There are many strains of enterovirus, but enterovirus D68 ( EV-D68) has hit the Midwest especially hard, and as of last week involved 13 states, the most recent being California. According to the Centers for Disease Control and Prevention (CDC), the symptoms can be severe, although no deaths have been reported.

As detailed by Dr. Wendy Sue Swanson, a pediatrician, the CDC’s data concern children from 6 weeks to 16 years old, with a median age of 4 years. Nearly 7 in 10 enterovirus patients had a history of asthma or wheezing.

“No question the illness has taken many by surprise,” Swanson wrote, “as it’s an unusual time of year to see huge numbers of children with cold symptoms with severe wheezing. In areas where the infections started to pop up, schools [have] been in session for a month or more so kids have been doing what they do best, playing in close contact and exchanging germs.”

Here’s what she says parents need to know:


  • Enteroviruses can cause a common upper respiratory infection often causing summertime “colds”; rarely do they cause serious infections.

  • Enteroviruses typically spread in fecal-oral fashion — that is, from not washing one’s hands after using the toilet, and spreading germs to the mouth. But EV-D68 also spreads from mucus and droplets in the air, from close contact.

  • Both children and adults can recover from enterovirus infections with rest.

  • Asthma is a risk factor for more severe symptoms associated with EV-D68. More than half of the children with lab-documented EV-D68 also had asthma.

  • There’s no vaccine to protect from this virus and no current medications to treat it; the body’s immune system needs time to eradicate it, and sometimes symptoms are so severe as to require hospitalization for respiratory support.

  • Prevention is the most important thing if the virus continues to spread throughout the U.S. Washing hands with soap and water for 20 seconds before eating and after coughing or sneezing or after changing diapers, is essential. Children and adults should stay home when they’re ill.


In addition, the American Academy of Pediatrics advises, “Children who have previously been diagnosed with asthma should follow their asthma action plans and communicate with their health care provider regarding yellow and red zone instructions.”

Remember that the symptoms of EV-D68 begin like a common cold, and you might not recognize its severity until your child is very ill. But most kids will recover on their own. If your child is unusually sick or is having breathing difficulty, call the doctor.

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September 19, 2014

CDC Says Kids Eat Too Much Salt

According to the U.S. Department of Agriculture’s dietary guidelines, children should consume no more than 2,300 mg of sodium every day. According to a new report by the CDC, they’re eating about 3,300 mg.

The risks of eating too much salt include high blood pressure, which can lead to stroke and heart disease later in life. And high-sodium foods often have a lot of calories, which undermines weight control.

American youngsters already show the effects of their salty diet. As federal officials said in a story on Reuters.com, 1 in 6 Americans 7 to 18 years old has elevated blood pressure, which is linked closely linked to a high sodium intake and obesity.

Most of the sodium kids eat comes from processed foods including pizza, sandwiches like cheeseburgers, cold cuts and cured meats, pasta with sauce, cheese, salty snacks like potato chips, chicken nuggets and patties, tacos and burritos, bread and soup.

"Most sodium is from processed and restaurant food, not the salt shaker," CDC Director Tom Frieden said in a statement. "Reducing sodium intake will help our children avoid tragic and expensive health problems."

According to the report, more than 9 in 10 U.S. kids between 6 and 18 years old eat too much sodium every day. Teenagers eat more salt than younger kids.

About 65% of their sodium consumption comes from foods purchased in stores; fast food restaurants account for about 13%. Meals provided at school represent 9% of total sodium consumption.

And if you think snacking, and food eaten outside of parental control, is the root of this evil, think again — dinner is the largest single source of sodium, accounting for nearly 40% of daily consumption.

The study involved the National Health and Nutrition Examination Survey in 2009 and 2010, and included interviews with more than 2,000 school-aged children.

Developing a taste for salty foods occurs early, so it’s important for parents to influence diet from a young age, and help their children develop a taste for less salty meals through what they buy, how they prepare it and by establishing healthful eating habits themselves.

As the researchers said, the need is to reduce sodium "across multiple foods, venues and eating occasions." In calling for processed foods with less sodium, they acknowledged that efforts in Britain to reduced total sodium consumption resulted in a 15% decline over seven years.

The CDC recommends that parents and caregivers:


  • Model healthful eating for their children by providing a diet rich in fruits and vegetables without added sodium.

  • Compare Nutrition Facts labels to choose the lowest sodium option before they buy.

  • Ask the grocery manager to provide more low sodium options for their family's favorite foods.

  • Request restaurant nutrition information to make lower sodium choices when dining out.

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September 12, 2014

Weight Gain Makes Kids More Vulnerable to Asthma

Asthma and obesity are common problems among U.S. children, and a new report in the Annals of Allergy, Asthma & Immunology ponders how obesity contributes to childhood asthma.

Nearly 7 million U.S. children have asthma, and more 12 million kids from 2 to 9 years old are obese. According to the American College of Allergy, Asthma and Immunology (ACAAI), obese children have an increased risk of developing asthma. An ACAAI news release accompanying the journal report acknowledges link between childhood obesity and asthma, but said research hadn’t determined which condition generally occurs first, or whether one causes the other.

This study suggests that being overweight comes first, although the connection is complex and many factors have yet to be examined.

The report showed that rapid growth in body mass index (BMI) during the first 2 years of life increased the risk of asthma until kids were 6 years old. Previous studies showed that the onset and duration of obesity and the ratio of lean tissue to excess fat can affect lung function. (See our blog, “Fast Food Diet Shows Link to Breathing Problems.”)

But practitioners often don’t know if the constricted airways characteristic of asthma makes kids unwilling to exercise, and therefore gain unhealthy amounts of weight, or if being overweight narrows airways, prompting the development of asthma.

“Most kids who suffer from asthma also have allergies,” Michael Foggs, MD, and president of ACAAI, said in the news release. “These allergic responses in the lung can lead to symptoms of allergy. Coughing, wheezing and shortness of breath are all symptoms that make exercise harder.”

The ACAAI says that children with asthma and other allergic diseases should be able to participate in any sport they want to as long as their condition is monitored and controlled. If they show symptoms of asthma during or immediately following exercise, it’s an indication that their condition is not being properly controlled.

In other words, asthma shouldn’t be so severe that it restricts a kid from being active; it’s a condition that can be managed and accommodated.

For advice from allergists about dealing with your child’s asthma, link here. To learn more generally about asthma and allergic conditions, and to locate an allergist in your area, link here. For information about hospital treatment of children with asthma, see our blog, “Assessing the Quality of Hospital Care for Children with Asthma.”

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September 5, 2014

Schools Start Early, but Teens Need to Sleep Later

Although plenty of studies show that the natural sleep cycle of teenagers skews late, school hours start early. In addition to health problems, sleep deprivation can cause lower academic performance and increased risk of accidents.

The American Academy of Pediatrics (AAP) recently issued a new policy statement supporting the idea of a later start time for middle and high school. The academy recommends starting no earlier than 8:30 a.m., it says, to “align school schedules to the biological sleep rhythms of adolescents, whose sleep-wake cycles begin to shift up to two hours later at the start of puberty.”

The September issue of the journal Pediatrics published the statement, “Insufficient Sleep in Adolescents and Young Adults: An Update on Causes and Consequences,” which referred to research showing that adolescents who get enough sleep enough lower their risk of being overweight, suffering depression and being in an automobile accidents. They also get better grades and report a better quality of life, according to Dr. Judith Owens, a pediatrician and lead author of the policy statement.

“Chronic sleep loss in children and adolescents is one of the most common – and easily fixable – public health issues in the U.S. today,” she said.

Mark Fischetti, a senior editor at Scientific American, voiced strong support for the movement toward later school hours.

“Ask any groggy teenager waiting for a bus or yawning in ‘home room,’” he wrote, “and he or she will tell you that it’s just too darn early in the morning to learn chemistry equations or analyze a narrative by some Russian novelist.

“Are they just lazy? No. Scientific studies of teen sleep patterns say they’re right. So do results from numerous schools across the country that have delayed start times: The later classes begin, the more academic performance improves. Bonus points: attendance goes up, teen depression goes down, and fewer student drivers get into car crashes.”

It’s all about circadian rhythms, the biological clock that makes you feel awful when you travel across several time zones (jet lag) and can disrupt workers whose shifts change from day to night to day.

Circadian rhythms, Fishchetti noted, shift during the teen years. Starting around age 13 or 14, the kids naturally stay up later and sleep later, a pattern that peaks between 17 and 19. Adolescents also need more sleep than an adult.

One study of 9,000 high school students in three states showed that grades in science, math, English and social studies rose when school began at 8:35 or later. Experiments at two North Carolina high schools and at the U.S. Air Force Academy also showed that academic performance improved when start times were later.

School districts might be reluctant to revise what they’ve always done, but Fischetti reported that their concerns about starting school later aren’t fulfilled — kids still can hold an after-school job, and participate in after-school programs.

“The issue is not the start time. It’s that the students are overly busy,” said Kyla Wahlstrom, one of Fischetti’s sources. “There is too much pressure to cram it all in just to have a good resume to get into college.”

Wahlstrom is director of the Center for Applied Research and Educational Improvement at the University of Minnesota. She said students, parents and school advisors should ratchet back the activities, and emphasize certain ones they enjoy or do well at, rather than participate in order to impress colleges. She said students should get eight, and preferably nine, hours of sleep every night.

Other countries seem to be learning this lesson. Studies in Brazil, Italy and Israel associate later start times with improved learning, and high-school level students in Europe seldom start before 9:00 a.m.

Even if it’s not about academics, it’s about safety. Fischetti referred to a high school in Wyoming that moved the start time from 7:35 a.m. to 8:55 a.m. and saw a 70% reduction in car crashes among drivers ages 16 to 18.

University of Kentucky researchers studied the issue and found that crash rates of teen drivers fell 16.5% in the two years after start times were delayed one hour, while the teen crash rate where they remained the same rose 7.8% in the same time period. The students in each of those groups, respectively, slept different amounts. In the reduced-crash group, those who got at least eight hours of sleep during weeknights rose from 36% to 50% percent, and those who got at least nine hours rose from 6% to 11%.

Your teen probably isn’t willing to go to bed earlier, and if he or she does, might not be able to fall asleep. But almost all of them would be willing to sleep later.

It’s time for school districts to wake up and smell the coffee.

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