March 6, 2015

Autism Organization Supports Immunizations

The Centers for Disease Control and Prevention reported last week that nearly 120 people have contracted measles as a result of the outbreak that started a couple of months ago in Disneyland. According to a CNN poll, nearly 8 in 10 Americans believe parents should be required to vaccinate their healthy children against such preventable diseases.

But some people won’t vaccinate their kids because they still believe the falsehood that it raises the risk of autism. In the face of the measles outbreak, Autism Speaks, a leading autism advocacy organization, urges parents to vaccinate their children.

As reported by the Washington Post, Rob Ring, the chief science officer for Autism Speaks, issued a statement that vaccinations cannot cause the disorder — and telling parents to vaccinate their children.

“Over the last two decades, extensive research has asked whether there is any link between childhood vaccinations and autism,” it said. “The results of this research are clear: Vaccines do not cause autism. We urge that all children be fully vaccinated.”

Could anything be clearer for the people who have shown a disturbing inability to accept hard science? Yes, fear is a powerful motivator, but when it has been proved to be unfounded, when a reputable nonprofit organization that promotes autism awareness and sponsors research in the field is on the record as supporting immunization, fear should fall victim to fact.

The bogus study that started the whole fiction claimed that there was a link between the measles, mumps and rubella (MMR) vaccine and autism. But it was discredited, the journal that published the study retracted it and the British doctor who conducted it lost his medical license.

Last year, The Post reported, Ring also definitively supported vaccinating children. “Autism Speaks’ own policy on vaccines echoes those of other credible health-care organizations like the American Academy of Pediatrics and the World Health Organization,” he said. “We strongly encourage parents to work with their physician to ensure their children receive the full benefits immunization offers in protecting their loved ones against a variety of preventable childhood diseases.”

All states grant parents the right not to vaccinate children for legitimate medical reasons, such as certain medical conditions or for religious reasons. But nonmedical exemptions are increasingly suspect, and since the recent outbreak, more medical professionals have weighed in publicly about the anti-vaccine movement. Some refuse to treat patients who refuse their immunizations.

Said one, as quoted by the Associated Press, “Parents who choose not to give measles shots, they’re not just putting their kids at risk, but they’re also putting other kids at risk — especially kids in my waiting room.”

The risk is especially unfair for people who can’t be vaccinated because they have a medical condition or because they are too young (less than a year old). One doctor interviewed by WWBT-TV in Richmond, Va., said, “I’ve seen the horror stories of what happens from these diseases and now this generation of doctors have never seen them because of immunization practices. One out of a thousand people infected with measles dies. And just because we haven’t seen it doesn’t mean it’s not coming.”

For more information, read the policy statement of Autism Speaks and see our blogs about childhood vaccinations.

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February 27, 2015

Uncertified Play Yards Present Risk of Suffocation

Product safety advocates have long warned parents about the suffocation dangers of padding and bedding in a child’s crib. Earlier this month, a related warning was given about padding in a play yard.

The issue was raised by The Safety Institute, a nonprofit organization that promotes injury prevention and advocates for product safety. It noted that The Juvenile Products Manufacturers Association (JPMA) advises consumers never to add a mattress, pillow, comforter or padding to a play yard.

These products are equipped by their manufacturers with a mattress properly sized for maximum safety, and designed to meet a standard established by ASTM International, a global outfit that establishes standards companies voluntarily accept.

But some companies, according to the JPMA, sell mattresses as “replacement” or “supplemental mattresses,” and the buyer must beware: An “add-on” or replacement mattress or bedding is not safe.

Potential danger lies in the gaps between a mattress that is too small or too thick, or with bedding a child can get wrapped up in — they present an immediate risk of suffocation.

A JPMA certification guarantees that products with its seal meet ASTM International safety standards. So if you’re shopping for a play yard, make sure you see that seal, which shows that it meets the voluntary standard.

Many of the supplemental, risky replacement parts are sold over the Internet, but bricks-and-mortar retailers offer them as well. Per the institute’s alert, “When industry suddenly creates a supplementary product which conflicts with the warning labels on the primary product it can be confusing and potentially dangerous. Products such as play yards are tested for foreseeable risks, and to the extent feasible, controllable risks are engineered out of the product.”

But consumers as well are responsible for ensuring the safety of these products. Don’t put anything on top of the existing mattress. If you need to replace it, call the company from which you bought the play yard. As the ASTM explains, each manufacturer tests its play yard with the mattress it supplies, so if you’re buying a replacement mattress from some other company, it hasn’t been tested for use with the play yard you have, and might not be safe.

Although the dangers are similar, play yards are a bit tougher to ensure for safety because their sizes and shapes vary more than cribs. Review the ASTM specifications here, and those for cribs here.

For play yards, the standard for total thickness of the mattress, including all fabric or vinyl layers, filling and material any structural components such as wood or hardboard, should not exceed 1.5 inches. Supplemental play yard mattresses and second-party replacement mattresses are available in different thicknesses, and some could raise the floor high enough so that a kid could get out of the enclosure.

The Consumer Product Safety Commission (CSPC), a federal agency, is in sync with the JPMA and Safety Institute concerning these products. It endorses the Keeping Babies Safe initiative; Chairman Elliot Kaye has said, “CPSC staff will continue to support these efforts as we all try to address this hazard and protect babies while they sleep.”

For crib and play yard safety tips, see JPMA videos here. Find out more about injuries to babies and children here.

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February 20, 2015

Delay in Newborn Testing Can Be Life-Threatening

For a couple of generations, the U.S. routinely has screened the blood of newborns to identify rare genetic conditions. But a recent editorial in USA Today reminded readers that too many delays at too many hospitals and labs are undermining the system’s ability to protect babies.

Noah Wilkerson was one newborn harmed by a health-care facility that took too long. He seemed to be healthy when he was born in 2009 at a hospital in Colorado Springs, Colo. His blood was drawn the next morning, but it took two weeks later before his sample was sent to the state lab, which didn’t process samples on weekends.

A day before the results came back, Noah died of a genetic disorder called MCAD deficiency. It’s a condition in which the body can’t convert some fats to energy. As explained in the original story about Noah in the Milwaukee Journal, a newborn with MCAD deficiency can appear perfectly healthy, but fatty acids are building up in the body, and soon there’s a metabolic crisis.

If the baby goes too long without eating, he or she can die suddenly or end up brain damaged.

But the real tragedy is that if the disorder is detected early, parents can treat it by feeding the child every two hours. “That's often all it takes for a baby with the condition to grow up and lead a normal, healthy life,” the Milwaukee Journal said.

“In an era when overnight delivery is routine,” the USA Today proclaimed, “it is inexcusable that many hospitals fail to get life-saving samples to labs within the three days recommended by the American College of Medical Genetics and Genomics. And inexcusable that state public health officials let them get away with it.”

That pretty much says it all.

About half of all state-run labs are closed on weekends and holidays, according to USA Today. So if your baby has the bad luck to be born late in the week, he or she is even more likely not to get test results in timely fashion.

Many hospitals simply ignore state requirements that samples be sent to labs with dispatch. Some hospitals wait to send samples until they can do so in bulk, and instead of using overnight delivery, as they might be required to do, they use the U.S. mail. States with the worst records, the newspaper said, are Arizona, Mississippi, South Carolina and Texas, where at least 15 in 100 hospitals take five or more days to get samples to labs.

But it’s not easy to find out who’s prompt and who’s dangerously tardy. Public officials in more than 20 states refused to release information to USA Today about hospital timeliness. “Secrecy denies expectant parents the ability to choose hospitals that are speedy and eliminates public pressure to force improvement,” the paper pointed out.

This is inexcusable. Although genetic disorders requiring immediate attention are rare, affecting about 1 in 4,000 newborns a year, if that baby is yours would you want to wait? There’s a reason babies are tested routinely, and the system should address the most vulnerable patients.

In 2012, the paper reported, only two states, Delaware and Iowa, met the speed standard — 99 in 100 of their hospitals delivered samples to labs within three days. Five years after Noah Wilkerson died, Colorado still doesn't process samples on weekends.

Long before you arrive at the hospital to deliver your baby, make sure you know what its newborn testing timeline is, and make sure the staff knows you’re keeping track. After you deliver, ask when the baby will be tested, and when the sample will be sent. Follow up and get confirmation that the promises have been kept.

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February 13, 2015

Feds Warn Against Bone Graft Implants in Kids

Bone graft surgery often involves bone morphogenic protein (BMP), an implanted material that encourages bone growth and fuses the gaps between spinal vertebrae. Instead of using natural bone, many people have been implanted with these substitute products, and too many have experienced horrible outcomes.

Now, the FDA officially is warning against their use for children.

Last month, the feds issued a safety communication to doctors advising against routine use of bone graft substitutes that contain certain proteins, like those in Medtronic Infuse, because they might cause bone growth problems for children. This product, as explained on, is widely used even though the FDA has approved it only for limited spinal procedures in adults. Its “off-label” use, however includes other types of spine fusion surgery that are associated with an increased risk of severe and painful complications caused by excessive bone growth, fluid accumulation, retarded healing and swelling.

“While these types of events are similar to those seen in patients over age 18,” the warning reads, “they are of more concern in patients under 18 because of their overall smaller size and because their bones are still growing.”

Three years ago, an article published in the Journal of the American Medical Association (JAMA), expressed concern about bone graft substitutes in children, indicating that nearly 1 in 10 spinal fusion surgeries relied on them despite long-term risks.

What’s possibly bad for adults, the FDA is saying, looks even worse for kids. “In a body that is still growing, vital organs and tissues are closer together than in a body that is done growing. This could potentially allow small changes from one organ/tissue to have serious effects on another,” the alert read. “For example, there is less space between the spinal cord and the bones surrounding it. If one of these products is used in the spine of a patient under age 18, who then experiences the same amount of excess bone growth or fluid accumulation as a patient over age 18, it may more easily lead to spinal nerve injury, pan, or weakness.”

If your doctor advises treating your child’s bone defect or bone disorder with a bone graft substitute, especially Medtronic Infuse, discuss your concerns and ask about other options, AboutLawsuits suggested, such as autograft bone. That involves taking bone from another part of the child’s body instead of using a substitute product. Another option to ask about is allograft bone, which is material transplanted from another person.

The FDA also recommended that doctors consider bone graft substitutes that do not contain recombinant proteins or synthetic peptides.

As we blogged regarding Medtronic Infuse, the company has vigorously promoted it since its introduction in 2002. But in 2008, the FDA warned about its risks for off-label uses after receiving many reports about serious complications and deaths.

And the company has been accused of promoting off-label use of Infuse, which is illegal. Although practitioners may use a drug or device off-label, manufacturers are not allowed to promote it for any use other than what the FDA approves. Medtronic has agreed to pay about $22 million to settle nearly 1,000 lawsuits associated with bone graft problems.

This is a dangerous device for anybody, and now, it seems, especially for kids.

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February 6, 2015

Exposure to Certain Chemicals During Pregnancy Might Affect Fetus

Researchers have found a link between a fetus’ exposure to two common household chemicals and a lower IQ among the children several years later.

The scientists from Columbia University’s Mailman School of Public Health published their research in the journal PLoS ONE last month. In a news release, they described how children exposed during pregnancy to elevated levels of di-n-butyl phthalate (DnBP) and di-isobutyl phthalate (DiBP) had an average IQ score more than six points lower than children exposed to those chemicals at lower levels.

DnBP and DiBP are found widely in consumer products ranging from dryer sheets to vinyl fabrics to lipstick, hairspray, nail polish and even some kinds of soap. In the U.S., according to the Consumer Product Safety Commission, six kinds of phthalates are banned from toys and other child-care products. But no measures have been taken to protect a developing fetus, such as alerts to pregnant women about potential exposure. In fact, according to the Columbia release, in the U.S., phthalates seldom are listed in a product’s ingredients.

For the study, researchers followed 328 women and their children. They assessed the mothers' exposure to four phthalates — DnBP, DiBP, di-2-ethylhexyl phthalate and diethyl phthalate — during their third trimester of pregnancy by measuring levels of the chemicals' metabolites (signals of how a body processes a substance) in urine. When they were 7, the children were given IQ tests.

Children of mothers exposed during pregnancy to the highest 25% of concentrations of DnBP and DiBP had IQs 6.6 and 7.6 points lower, respectively, than children of mothers exposed to the lowest 25% of concentrations.

The pattern held when specific aspects of IQ were tested, including perceptual reasoning, working memory and processing speed.

The researchers found no associations between the other two phthalates and child IQ.

It’s especially worrisome that, as the study’s lead author said in the news release, "Pregnant women across the United States are exposed to phthalates almost daily, many at levels similar to those that we found were associated with substantial reductions in the IQ of children."

Another scientist involved with the research said, “A six- or seven-point decline in IQ may have substantial consequences for academic achievement and occupational potential.”

It’s impossible to avoid all phthalates in the U.S., but the researchers recommend that pregnant women try to limit their exposure by:

  • not using plastic when they microwave food;

  • avoiding scented products such air fresheners and dryer sheets; and

  • not using recyclable plastics labeled as 3, 6, or 7.

The Columbia results advance earlier research showing an association between prenatal exposure to DnBP and DiBP and children's cognitive and motor development, and behavior when they are 3. And a couple of months ago, Columbia researchers reported a link between prenatal exposure to phthalates and risk for childhood asthma

Although it's not clear how phthalates affect child health, numerous studies show that they disrupt the actions of hormones, including testosterone and thyroid hormone. So it’s best to avoid them if you can.

To see the degree to which pregnant women are exposed to all kinds of chemicals, see our blog of a few years ago, “Dangerous Products Found in Virtually All Pregnant Women.”

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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 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">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 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; 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, 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, 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 (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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