January 30, 2015

Why Should Toys Be Safer than Guns?

Guns don’t kill people, the saying goes, people kill people. Some of those people killers and their victims are children. It’s astonishing that this country seems unwilling to protect our young from the dangers of firearms.

A recent column in the New York Times by Nicholas Kristof recited figures from the FBI and the Centers for Disease Control and Prevention (CDC) that more preschoolers are killed by guns every year (about 80) than are police officers, about 50 of whom are killed by guns. According to a study published in the journal Pediatrics, 20 children and teenagers are shot every day in the U.S.

Death by gunfire is a public health issue from which children are not exempt, and Kristof reminded readers of some of their recent, sad stories:

  • Last month, Veronica Rutledge was shot by her her 2-year-old in a Wal-Mart when the little guy reached into his mom’s purse, found handgun that she legally carried and pulled the trigger.

  • In November, a 3-year-old boy was shot in the face by a 4-year-old, and a 2-year-old shot and killed his 11-year-old sister.

Maryland passed a law in 2002 to require gun dealers to sell handguns manufactured from 2003 onwards, only if the handgun is equipped with an "integrated mechanical safety device" to prevent discharge unless the device is deactivated. Older handguns can be legally sold by dealers only if they are provided with an external lock of some kind (like a locked case). Unfortunately the law has plenty of loopholes and hasn't had much impact to make all guns truly child-proof.

In this country, it’s common practice to childproof your cabinets and electrical outlets. It’s common sense to protect young ones from dangerous toys. So why did a Florida court rule that doctors who ask their patients if they own firearms violate the patients' right to privacy?

It’s not a privacy issue, it’s a health issue. As a story in The Atlantic explained, the American Medical Association (AMA) considers gun violence an epidemic; in 2011, it advised doctors to counsel patients on gun safety.

The American Academy of Pediatrics, the magazine said, considers gun safety counseling a doctor’s job just like it is his or her job to counsel patients about the dangers of lead paint, and the risks of not using seat belts. “Pediatricians,” the policy statement reads, are “urged to counsel parents about the dangers of allowing children and adolescents to have access to guns inside and outside the home.”

The kid death toll, Kristof wrote, “is utterly unnecessary, for the technology to make childproof guns goes back more than a century. Beginning in the 1880s, Smith & Wesson … actually sold childproof handguns that required a lever to be depressed as the trigger was pulled.”

“Doesn’t it seem odd,” he continued, “that your cellphone can be set up to require a PIN or a fingerprint, but there’s no such option for a gun?”

The investigative news site FairWarning.org recently published a story about how different states are addressing (or not) the issue of gun control. One of its sources, Daniel Webster, director of the Center for Gun Policy and Research at Johns Hopkins University in Baltimore, commented on NRA-backed measures to allow guns where alcohol is sold and on college campuses, and noted that a Missouri provision lowers the minimum age for a concealed carry permit to 19.

“That age group gets into a lot of trouble,” he told FairWarning. “I just really question how prudent it is to allow 19-year-olds to carry concealed handguns around. We don’t even let 19-year-olds drink a beer legally.”

Maybe it takes a kid to protect a kid. Kristof introduced readers to Kai Kloepfer, a 17-year-old in Boulder, Colo., who was inspired to do something after the cinema shooting in a Denver suburb in 2012. Kloepfer made childproofing guns his science fair project.

Kloepfer’s “smart gun” can be fired only by an authorized user recognized by the fingerprint on the grip. More than 1,000 fingerprints can be authorized per gun; neither a child nor a thief nor anyone can shoot it if their prints haven’t been authorized.

Kloepfer won a grand prize in the Intel International Science and Engineering Fair for his design, as well as a $50,000 grant from the Smart Tech Challenges Foundation to refine it. By the time he enters college, he hopes the technology will be ready to license to a manufacturer.

Kristof enumerated other ways to make smarter, safer guns, including the Armatix iP1, which can be fired only if the shooter is wearing a companion wristwatch.

But of course the NRA rejects the idea of smart guns because it doesn’t think any safety measure should become mandatory. “One problem has been an unfortunate 2002 New Jersey law,” Kristof wrote, “stipulating that three years after smart guns are available anywhere in the United States, only smart guns can be sold in the state. The attorney general’s office there ruled recently that the Armatix smart gun would not trigger the law, but the provision has still led gun enthusiasts to bully dealers to keep smart guns off the market everywhere in the U.S.”

Kristof quoted Stephen Teret, a gun expert at the Johns Hopkins Bloomberg School of Public Health, who said “Smart guns are going to save lives. They’re not going to save all lives, but why wouldn’t we want to make guns as safe a consumer product as possible?”

Indeed, why should safety take a back seat to commerce? Why can’t commerce embrace safety, as a promotional tool?

That’s what David Hemenway, a public health expert at Harvard whom Kristof interviewed, believes. He told the reporter that police departments or the military should buy smart guns to create the market and prove that they work.

“Something is amiss,” Kristof concluded, “when we protect our children from toys that they might swallow, but not from firearms. So Veronica Rutledge is dead, and her son will grow up with the knowledge that he killed her — and we all bear some responsibility when we don’t even try to reduce the carnage.”

You can read a summary of federal and state laws on "smart guns" and related issues at the website of the http://smartgunlaws.org/gun-policy/">Law Center to Prevent Gun Violence.

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January 23, 2015

Do You Have One of These Dangerous Crib Mattresses?

Last week, the Consumer Product Safety Commission (CPSC) announced that the manufacturer of certain baby mattresses was recalling them because of the potential for injury.

Nearly 170,000 mattresses are being recalled by IKEA because they leave a gap between the mattress and crib that could entrap or suffocate babies. Only a couple of problems have been reported, and so far no injuries have been sustained, but the company deems these mattresses unsafe: VYSSA style mattresses sold under brand names VACKERT, VINKA, SPELEVINK, SLOA and SUMMER.

The recalled mattresses were manufactured before May 5, 2014 and can be identified by the label attached to the mattress cover where the manufacture date is displayed next to the VYSSA name. They were sold exclusively at IKEA stores nationwide and online at www.ikea-usa.com from August 2010 to May 2014 for about $100.

If you have or think you have one of these products, call IKEA toll-free at (888) 966-4532 or contact the company online at www.ikea-usa.com; click on the recall link.

The guideline for crib mattress safety is simple: If the space between the mattress and the crib is larger two fingers, the child who sleeps there is in danger of being trapped.

As reported by AboutLawsuits.com, the feds have stepped up regulation of cribs and mattresses since the Consumer Product Safety Improvement Act (CPSIA) was enacted in 2008. And in 2013, the CPSC, the International Sleep Production Association (ISPA) and the American Society for Testing Materials (ASTM) set size requirements for cribs and mattresses. Their standard requires that crib mattresses include consumer safety labels to ensure a proper mattress fit, and warnings to help prevent Sudden Infant Death Syndrome (SIDS).

For more information about SIDS, link to our blog here.

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January 16, 2015

Fetal Scans Are a Medical, Not Entertainment, Event

There’s an increasing awareness of the risks to patients of getting unnecessary imaging tests, but only recently have these concerns arisen about fetuses. Last month, the FDA issued a consumer warning that undergoing unnecessary fetal ultrasounds or fetal Doppler heart beat monitoring might endanger the tiny residents of a womb.

As explained on AboutLawsuits.com, Doppler heartbeat monitors and ultrasound scans are prescription devices to be used only by trained health-care professionals. But a lot of parents-to-be are paying for these images and videos of their fetuses as keepsakes, when there is no real medical need. Some, the story said, turn the prenatal photo sessions into entertainment; some parents stage “ultrasound parties,” and post the images and videos on the internet.

We won’t comment on the material someone chooses to make electronically viral. But a procedure once done only under doctor’s supervision has become a novelty event for many people, and we’re concerned about consequences they might not anticipate.

The FDA acknowledges that ultrasounds generally are considered safe, but they have potential biological effects. Ultrasound can heat body tissue slightly, which produces small bubbles, or pockets of gas, in body fluids or tissue, a condition called cavitation.

Long-term effects of ultrasound and the potential for cavitation to a fetus are unknown, so the feds encourage consumers not to use the machines as over-the-counter devices or for the mere purpose of capturing the image of a human developing in utero.

“In creating keepsake videos there is no control on how long a single imaging session will last, how many sessions will take place or whether the ultrasound systems will be operated properly,” according to the consumer update.

The health watchdogs understand the appeal of ultrasound imaging to parents, they understand that it can “promote bonding between parents and the unborn baby.” But parents can achieve the same result from the procedures given during regular prenatal care appointments.

Regarding the Doppler fetal ultrasound heartbeat monitors, often sold over-the-counter as Doptones, the FDA said casual use exposes the fetus to prolonged, unsafe energy levels. And the monitor might yield information parents interpret incorrectly. That can lead to unnecessary worry and expense for follow-up care.

Ultrasound imaging is the most widely used medical imaging method during pregnancy, AboutLawsuits noted. Doctors have used it for a generation to check on fetal health, including breathing, movements and size. It renders real-time images from high-frequency sound waves moving inside the uterus. Unlike X-rays, it doesn’t involve radiation. (See our blog, “Kids and CT Scans: Not So Fast, Parents.”)

But it might involve other complications as yet unknown that present with overuse, and inappropriate use. It’s normal to be curious about the life forming in your womb. But curiosity is best served by careful medical application.

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January 9, 2015

What to Do About Unvaccinated Kids in Day Care

A wave of disinformation in recent years has overwhelmed some otherwise thoughtful parents, prompting them to decline standard vaccinations for their children. But a recent study gives hope that wiser minds still prevail.

According to University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health, nearly 3 in 4 parents would remove their child from a day-care facility if other children there are unvaccinated. And more than 4 in 10 say kids who are “under-vaccinated” should be excluded from day care.

As explained in a news release from the university, all states require vaccines for children who attend day care, but the requirements might not include every recommended vaccine from birth to age 5. So some children still don’t receive all of those vaccines, which means day-care providers and parents must decide for themselves what to do about children in their child’s midst who aren’t up-to-date on all of their vaccines.

Some of the results from the national survey of parents with children as old as 5:

  • 74 percent agreed or strongly agreed that children’s immunization status should be reviewed every year to ensure they are up-to-date;

  • 74 percent would consider removing their child from a day-care facility where 1 in 4 kids weren’t up-to-date on vaccines;

  • percent that supported excluding children from a day-care facility who hadn’t gotten all vaccines: 41; percent that would allow a grace period for getting vaccinated: 28; percent that would insist on a doctor’s waiver for an unvaccinated child: 21; percent that would allow an unvaccinated child to attend a day-care facility: 10;

  • percent that say they should be informed of how many children at their day-care facility who aren’t up-to-date on vaccines: 66; percent who say the unvaccinated children should be named: 25.

Although the study “mirrors the national statistics that show approximately 25% of preschool children in the United States are not fully vaccinated,” according to Sarah J. Clark, associate director of the poll and a research scientist in the university’s department of pediatrics, the results “indicate that most parents want strong policies around making sure children in day care are up-to-date on vaccines. Checking vaccination records every year is beyond the scope of many state requirements, and may represent a significant change in practice at many day cares.”

Because the poll shows that parents want to know how many children lack vaccines, Clark believes that such information “might help parents understand the risk that their child could contract a vaccine-preventable disease — or transmit the disease to a vulnerable family member, such as a person with cancer.

“… Parents should feel empowered to ask about day-care vaccination policies, such as how the day-care handles the situation of children who are not up-to-date, and whether they check children’s vaccination status every year.”

To learn more about children’ vaccines, see our blogs here.

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January 2, 2015

Adolescents Abuse Fewer Substances … Except for E-Cigs

A national survey of U.S. middle- and high-school students painted a mostly positive portrait regarding substance abuse. But one area — smoking e-cigarettes — yielded troubling results.

The University of Michigan’s Monitoring the Future study showed that both alcohol and cigarette use in 2014 were at their lowest points since the study began in 1975. And use of several illicit drugs also notched declines.

But in 2014, more teens used electronic cigarettes (“e-cigs,” or “vaping,” so-called for the vapors that are emitted instead of smoke) than traditional tobacco cigarettes or any other tobacco product. It’s the first U.S. national study to show that teen use of e-cigs surpasses use of tobacco cigarettes.

The Monitoring the Future study tracks trends in substance use among students in 8th, 10th and 12th grades. It’s an annual survey now in its 40th year of 40,000 to 50,000 students in about 400 secondary schools throughout the U.S.

Here’s a breakdown of substances and survey results:

Alcohol use declined among all three grade levels. Students reporting any alcohol use in the 12 months before to the survey in the three grades combined dropped from 43 in 100 to 41 in 100, a statistically significant change. The peak year was 1997, when more than 6 in 10 respondents reported using alcohol.

And the proportion of teens who reported "binge drinking" — that is, consuming five or more drinks in a row at least once in the two weeks preceding the survey — fell significantly again this year to 12 in 100 for the three grades combined, down from a high point of 22 in 100 in 1997. But the researchers said that about 1 in 5 12th-graders still reported binge drinking at least once in the last two weeks, and some drink even more heavily.

Cigarette smoking reached historical lows among teens in 2014 for all three grades. In 1997, for the three grades combined, 28 in 100 reported smoking in the last month; in 2014, the rate was 8 in 100.

Synthetic marijuana ( also called K-2 or "Spice") is sold over the counter in many states, particularly in gas stations, convenience stores and head shops. Its synthetic chemical components of marijuana are sprayed onto shredded plant material that’s smoked. It’s an unregulated product and often is imported. It can be very potent and unpredictable in its side effects, which can be as severe as acute psychosis and heart attacks.

In 2011, 11 in 100 survey respondents reported using it, and in 2014 it was 6 in 100.

"Bath Salts," another class of synthetic drugs sold over the counter, also have declined in use, with fewer than 1 in 100 students in all three grades using them. It’s a dangerous synthetic stimulant, and apparently the substantial efforts to make them illegal are showing results.

Marijuana, after five years of increasing use among teens, declined slightly in 2014, down from 26 to 24 users per 100 teens for the three grades combined.

Daily or near-daily marijuana use also declined a bit, but it’s still high (no pun intended). About 1 in 17 high school seniors is a current daily or near-daily marijuana user, down from 6.5 in 100 in 2013.

Ecstasy (MDMA) use declined significantly in 2014. For the three grades combined use in the last 12 months dropped from 2.8 in 100 in 2013 to 2.2 in 100 in 2014. Used peaked in 2001, at 6 in 100.

Salvia, another drug used for its hallucinogenic properties, fell significantly, as it has in recent surveys. In 2009 nearly 6 in 100 12th-graders had used it in the last month; in 2014 it was fewer than 2 in 100.

Hallucinogens other than LSD, such as mushrooms (Psilocybin or "shrooms"), continues a long-term decline.

Prescription drug misuse (narcotics, sedatives, tranquilizers and/or amphetamines without medical supervision) is of considerable public health concern especially because its use increased substantially in the 1990s, then began to decline in the 2000s.

Only 12th-graders reported on their use of all of these drugs, and it declined between 2013 and 2014, from 16 in 100 to 14 in 100. In 2005, 17 in 100 indicated misuse of any of these drugs.

Narcotic drugs other than heroin, which are among the most dangerous of the prescription drugs, have been declining in use by 12th-graders since 2009, when 9 in 100 teens said they had used them in the last 12 months without medical supervision. In 2013, there were 7 in 100 users, and 6 in 100 in 2014.

Cough and cold medicines available over the counter usually contain the drug dextromethorphan. To get high, teens sometimes take it in large quantities, which is dangerous. But among all grades, its use declined significantly in 2014, to 3.2 in 100 kids.

Use of several other illicit drugs remained essentially unchanged between 2013 and 2014, including some particularly dangerous ones — heroin, crack, methamphetamine and crystal methamphetamine. Other drugs whose use remained unchanged in 2014 include Ritalin and Adderall, stimulants used to treat ADHD, as well as LSD, inhalants, powder cocaine, tranquilizers, sedative and anabolic steroids. But the use of most of these drugs is well below their peak levels.

E-Cigarettes are battery-powered devices with a heating element that produces an aerosol, or vapor, that users inhale. Usually the vapor contains nicotine, but specific contents are proprietary and not regulated. The liquid that is vaporized in e-cigarettes comes in a variety of flavors that appeal to youngsters.

In the last 30 days before the survey in 2014, the number of all-grade users of e-cigs who had never smoked tobacco ranged from 4 in 100 to 7 in 100.

“Whether youth who use e-cigarettes exclusively later go on to become tobacco cigarette smokers is yet to be determined by this study,” researchers reported, “and is of substantial concern to the public health community.”

For more information on drug, alcohol, tobacco and e-cigarette use by children, see our blogs here.

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December 26, 2014

Feds Cancel Long-Term Children’s Health Study

Last month, we wrote about the precarious position of the National Children’s Study (NCS), an initiative to track the health of children from birth to adulthood to identify the best ways to prevent childhood disorders.

Despite an investment of 10 years and $1.3 billion, it was canceled last week by the National Institutes of Health (NIH) because of mismanagement, cost and outdated research methods, as reported by KaiserHealthNews.org (KHN).

“Researchers and children's health advocates,” according to KHN, “now fear that while funding for smaller projects will continue in 2015 with an already appropriated $165 million, NIH may use that money for research not related to children's health.”

When Congress passed the Children’s Health Act in 2000, the ambitious study was commissioned to follow 100,000 newborns until they turned 21 to examine how environmental and biological influences affected their health. But as Dr. Francis Collins, the director of the NIH, announced with the study’s demise, “"Based on the working group's findings and internal deliberation, I am accepting ... findings that the NCS is not feasible. I am disappointed that this study failed to achieve its goals. Yet I am optimistic that other approaches will provide answers to these important research questions."

Several prestigious agencies, including the Institute of Medicine and the National Academy of Sciences, had weighed in over the last few months to a “working group” the NIH assembled to assess the program’s viability, and they hadn’t been optimistic.

An NIH official indicated that the agency will make lemonade out of the NCS lemon by refining best practices on data collection and study recruitment, and applying that knowledge to examine the links between environmental factors and child health and development in smaller studies starting next year.

But the study’s cancellation disappointed a lot of people, including Dean Baker, director of the Center for Occupational and Environmental Health at the University of California Irvine. He told KHN the NIH might just use the $165 million for other research and still claim it’s doing what is required by the Children's Health Act.

Nigel Paneth, a professor of epidemiology and pediatrics at the University of Michigan, helped design the study starting in 2000. He supports its cancellation, but told KHN that he disagrees with how the NIH dismantled the work at the original 40 pilot sites, and he says communications announcing the decision were bungled, noting that researchers put a large effort into engaging these communities.

"They [NIH] had no concept that they were real people out there," he told KHN. As the research was slowing down, researchers were expected to turn over individuals' information to other researchers without consulting the participants. "It was mismanaged, from the conceptual idea to actualization in the field."

How many times has that happened, when a public agency makes a rational decision, then forgets that there are consequences for the people who were invested in the process?

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December 19, 2014

Unnecessary Chest X-Rays for Kids

X-rays should never be given unless there’s a good reason, but researchers at the Mayo Clinic have found that too many children are being given chest X-rays when there’s no benefit to them.

In a news release issued by the Radiological Society of North America, Dr. Ann Packard said, "Chest X-rays can be a valuable exam when ordered for the correct indications. However, there are several indications where pediatric chest X-rays offer no benefit and likely should not be performed to decrease radiation dose and cost." Packard is a radiologist at the Mayo Clinic.

The dangers of radiation are cumulative. That is, exposure to radiation builds up in the body, and problems might not present for decades. So being exposed to the radiation in an X-ray should be carefully considered, especially in young people because the effects of the experience stay with them forever.

Packard and Dr. Kristen B. Thomas, co-author of the study and head of the pediatric division at the Mayo Clinic, reviewed 719 pediatric chest X-ray exams given over a six-year period in inpatient, outpatient and emergency room settings. The patients ranged in age from newborn to 17 years old.

Of the 719 X-rays:

  • 377 exams were ordered for chest pain

  • 98 for syncope (fainting) or presyncope

  • 21 for a general feeling of being unwell or under distress (spells)

  • 37 for postural orthostatic hypotension (POTS), a condition in which blood pressure drops suddenly when the individual stands up from sitting or lying down

  • 185 for dizziness

  • 1 for cyclical vomiting

Eighty-two of the 719 exams were excluded because of congenital or other known heart disease, and other causes.

A key finding was that in nearly 9 in 10 of the nonexcluded patients, the exam did not alter clinical treatment. None of the patients who underwent X-rays for syncope, spells, POTS, dizziness or cyclical vomiting had any finding that affected treatment.

Only about 12 in 100 of the chest X-rays for chest pain were positive, and included respiratory symptoms such as cough, fever or trauma.

Clearly, too many kids are getting too many chest X-rays. "I would like this research to help guide clinicians and deter them from ordering unnecessary exams which offer no clinical benefit to the patient," Packard said in the statement.

If your practitioner wants to give your child a chest X-ray, ask why he or she believes this is the best, or only approach, especially if the patient has no respiratory symptoms. Ask the doctor what he or she expects to learn from the test.

For more information, see our safety tips for radiation exposure, and read our patient safety blog on new guidelines for imaging tests.

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December 12, 2014

Don’t Rely on High-Tech Baby Monitors

Baby monitors are a wonderful parental aid … or are they?

Dr. David King, a pediatric researcher at the University of Sheffield in England, recently wrote about his baby monitor studies in BMJ (the British Medical Journal). They indicate that the information provided by newer, high-tech devices isn’t a reliable signal of danger, and that they don’t provide reliable information about your child.

"It's not a medical device; it's not registered as a medical device. It's just for fun, really," King said in an interview for NPR. "But if you look at the marketing so far, I don't think that's the message that comes across."

His point is that companies are very good at capitalizing on parents’ concern over their newborn’s health. High-tech monitors are developed less to impart useful medical information than to address parental anxiety by monitoring a baby's vital signs and sending them to a smartphone.

When King first heard a discussion about baby vital sign monitors on the radio, he told NPR, "I suspected there wasn't much evidence behind it, because I knew cardiovascular monitoring wasn't recommended in SIDS."

Sudden infant death syndrome (SIDS), also known as crib death, is the unexplained death, usually during sleep, of an otherwise healthy baby younger than 1 year.

Experiments in the 1980s and 1990s using monitors as an intervention for SIDS failed to reduce its incidence in healthy infants. They’re no longer recommended by the American Academy of Pediatrics and other medical groups. "Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS," the academy says, because "there is no evidence that use of such devices decreases the incidence of SIDS."

The newer monitors include the Mimo, which costs about $200. It monitors a baby's breathing, body position, sleep activity and skin temperature via a sensor attached to a special onesie. But if you read its website terms of service carefully, you find this disclaimer:

The Mimo baby monitor system is not a medical device, is neither regulated nor approved by the U.S. Food and Drug Administration, and is not designed to detect or prevent causes of sudden infant death syndrome (SIDS). The Mimo baby monitor system is intended to help you monitor your baby and is not to be used as a substitute for parenting or other adult supervision. Use of the services and any content is entirely at your own risk.

Promotional language for similar monitors suggests that tracking a healthy baby like Russia tracks spies is what all good parents do.

But some parents won’t know how to use data on an infant's heart rate and blood oxygen level as a way of ensuring a kid’s safety. What’s the point of information if you can’t apply it?

And, according to NPR, a big problem with SIDS monitors is false alarms, which serves only to panic parents.

As we’ve blogged, to reduce the risk of SIDS, put babies to sleep on their backs, keep soft bedding out of the crib and don’t let them sleep on couches.

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December 5, 2014

Misleading Claims of Protection Against Allergy and Eczema

If you think a label claiming that the product is hypoallergenic will protect your kids against allergic reactions, think again. Research published in the Journal of Allergy and Clinical Immunology showed that a lot of products marketed for kids with itchy skin often contain ingredients that cause the very problem they’re promoted to address.

As explained in a story by Reuters, labels with the word “hypoallergenic,” which means unlikely to cause or designed to reduce an allergic reaction, are not regulated by the FDA. That means there’s no oversight of the claim and nothing to enforce its veracity.

The study tested products that might be used by children with eczema, a red, itchy skin condition common among children, but which can strike anyone at any time. It’s chronic, and tends to flare up, then die down without any clear cause. There is no cure for the long-lasting condition, known formally as atopic dermatitis.

Eczema affects nearly 18 million people in the U.S.

“Kids who have eczema or atopic dermatitis use more lotions and creams and ointments, …,” Carsten Hamann told Reuters. He’s the medical student who was lead author of the study. “Ostensibly, their caregivers who purchase these products to use on the kids' skin, give preference to products using these meaningless marketing terms.”

His team tested 187 cosmetic products sold in six different stores in California. They looked for any of the 80 most common known allergens identified by the North American Contact Dermatitis Group.

All of the products tested were promoted as safe for use by children, and all were labeled as “hypoallergenic,” “dermatologist recommended/tested,” “fragrance-free” or “paraben free.”

  • Nearly 9 in 10 products contained at least one allergen.

  • More than 6 in 10 contained two or more, and more than 1 in 10 contained five or more.

  • The average number of allergens per product was 2.4.

  • Preservatives and fragrances accounted for nearly 6 in 10, and 3 in 10 allergens, respectively.

  • One in 10 products contained methylisothizolinone, a preservative the European Union plans to ban because it can cause severe skin irritation, according to the researchers.

Doctors usually advise eczema patients to use moisturizer on inflamed skin, but a lot of people with eczema also suffer from so-called “contact allergies.” That is, they might have allergic reactions to substances that touch their skin, including fragrances and preservatives.

“It would be very difficult for even the most caring, intelligent and well-read parent to know the names of 80-plus allergens and their synonyms,” Hamann told Reuters, “let alone compare that list of allergens to a 15-plus long ingredient list on the back of a pediatric product.”

The study wasn’t universally embraced. Dr. Donald Belsito, Professor of Dermatology at Columbia University Medical Center in New York, commented to Reuters Health that the study “misrepresents a lot of these chemicals because they’re listing the frequency with which they were found in a product, not the frequency at which they cause allergy. … Many of the chemicals on that list are very, very rare causes of allergy.”

Another skin disease specialist, Dr. Michael Ardern-Jones from the University of Southampton in the U.K., noted the difficulty of defining terms associated with allergies. “Almost any chemical compound could be implicated as an allergen, so it is almost impossible for a cream to be truly nonallergic,” he told Reuters. “… as there is no true ‘hypoallergenic’ cream, there is no agreed meaning of ‘hypoallergenic.’”

But the greater point is that consumers — parents — believe that something called “hypoallergenic” offers a degree of protection. And with or without this study, it doesn’t, because there is no regulatory standard or oversight for the claim.

Both experts recommend treating eczema with ointments rather than creams and lotions, which contain water and therefore also must contain preservatives. That makes them more likely to contain allergens.

Belsito recommends petroleum-based products such as Vasoline, and advises keeping skincare products simple. Ardern-Jones said that prescription moisturizers generally are reliable, and advises against using products that contain fragrance and color, and that lack a list of ingredients.

The National Eczema Association reviews products and, according to Reuters, “is a more reliable resource than the product labels.”

To learn more about an additional risk factor for children developing eczema, see our blog, “Early Use of Antibiotics May Lead to Eczema Later”

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November 28, 2014

Ground-Breaking Study of Kids' Health Could Be Grounded

Devised by Congress in 2000, the National Children’s Study (NCS) was designed to track the health of children from birth to adulthood in an effort to identify the best ways to prevent childhood disorders including asthma, autism and attention deficit disorder. But it’s in danger of being stopped before it even starts, thanks to cost, mismanagement and outdated research methods.

The study was supposed to begin this year, as explained by KaiserHealthNews.org (KHN), and was considered to be boldly ambitious. Advocates say it could influence a wide range of parental choices, from what to feed their kids to what household products to buy. They say its potential is endless for preventing illness that presents later in life, and probably will influence not only parents, but insurance coverage and public policy.

“We don’t have the evidence we need to truly improve children’s health in this country. We need this study. … The importance of the investment is clear,” Lisa Simpson told KHN. She’s president and CEO of AcademyHealth, a membership group of policy analysts and health services researchers.

The study is to follow 100,000 children for 21 years. But it’s expensive, and some people believe its scientific approach is antiquated. According to KHN, experts from the National Institutes of Health (NIH) are studying these concerns, and they’re due to make recommendations next month about the initiative’s future.

The impetus behind the study was a growing sense that children suffer disproportionately from the effects of social and environmental factors. In 2007, the Vanguard Study began a precursor to the NCS, sort of a smaller, beta version. It is underway in 40 sites testing how to recruit women who expect to be pregnant in the near future, and testing data systems.

But it’s been a rocky adventure, KHN reports, and in July, the Institute of Medicine, the nonprofit, independent organization that advises government and the public with unbiased and authoritative analysis, issued a report questioning whether the main study should proceed if it didn’t undergo major changes.

The Vanguard Study’s own researchers criticized its design and technological deficiencies.

Still, Jane Holl told KHN, “It could tell us so much about relationships — starting in the prenatal period through late childhood — and how those factors affect early adulthood.” Holl oversees 10 of the 40 pilot sites.

In 2013, federal funding for the research was put on hold for the main study after Congress appropriated $165 million per year for it — $30 million less than initially planned. It made that money contingent on the IOM evaluation, which focused the study’s advocates on the NIH recommendations, and how to make less money go farther.

It would be a shame if this truly novel idea disappeared into dust. Usually, research focuses on adult illnesses, so studying children until adulthood and figuring out how to prevent later problems would be a significant addition to the body of health science.

“If I’m a member of Congress,” James Perrin told KHN, “I’m more concerned about heart disease at 50 years old, and that’s where we’ve funded it more actively. We need to know what we can do in childhood,” said Perrin, who is president of the American Academy of Pediatrics.

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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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