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 (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, 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, 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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