Child Safety Blog

Home fetal heart monitors allow pregnant women to listen to their baby’s heart beat and have the assurance without a visit to the doctor’s office that the baby is healthy and well – but is this assurance always reliable?

A true story that happened in Britain recently suggests that the heart monitors shouldn’t replace a trip to the obstetrician if there is any concern for the baby’s health, writes Tara Parker-Pope of the New York Times.

According to a commentary published at BMJ.com by doctors of the Princess Royal Hospital in Britain, a woman who was nearly full-term at 38 weeks noticed one day that the baby wasn’t moving. Instead of seeking medical advice, she turned to a home fetal heart monitor and heard what she thought was the baby’s heartbeat. After three days when she finally went to a doctor, an ultrasound scan showed the baby had already died.

Although the doctors cannot know for sure in this case that the baby would have been saved had the mother sought medical advice earlier, they said the monitors should never be used for reassurance. Dr. Chakladar, one of the authors of the BMJ commentary, said that it takes experience to determine the baby’s health. Sometimes what sounds like a baby’s heartbeat may be the mother’s own heart. And even when parents can pick up the baby’s heartbeat, it is still difficult to determine if the baby is healthy or distressed. “If a mother is concerned and feels she needs reassurance, she should immediately consult her doctor,” writes Parker-Pope.

So what is the bottom line? Dr. Chakladar advised, “On their own, these monitors are harmless; it is their improper use by parents to reassure themselves which can be dangerous…they are dangerous if they are used by untrained people as an alternative to seeking medical advice.”

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Infants

Bookmark:

An article recently published in the Journal of American Medical Association documents findings that associate atypical antipsychotics to weight gain in children who are first-time users of the drugs. The study, headed by Dr. Christoph Correll in New York, includes 272 youths age 4 to 19 and is “the largest and most definitive to date to establish a link between the drugs and weight gain,” writes Jonathan Rockoff of the Wall Street Journal.

The JAMA study examined four top-selling atypical antipsychotics (powerful drugs prescribed to treat schizophrenia and bipolar disorder): Abilify, Risperdal, Seroquel and Zyprexa. Among them, Zyprexa was found to cause the most weight gain: 19 pounds in 11 weeks. It was also found to “significantly raise levels of blood sugar, cholesterol, insulin and triglycerides,” thereby increasing users’ risk of diabetes and heart problems. Patients taking other three medications had an average of 10 to 13 pounds of weight gain.

Dr. Correll, the lead author of the study, recommends using extra caution in prescribing these atypical antipsychotics to youths under the age of 18, and encourages psychiatrists to frequently monitor the weight and metabolic rate of those who are taking these drugs.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Medication , Mental Health

Bookmark:

A riveting story in the Washington Post tells how a Washington area woman's advocacy in the emergency room likely saved her sick daughter from harm.

Sandra Boodman's article interviews Patricia Dawn about her 4-year-old daughter Brooke's illness, that was eventually discovered to be Kawasaki disease, an unusual heart condition. Brooke got the right treatment in time, but only because of her mother's persistence. Mrs. Dawn refused the recommendation of the emergency room doctors to take her daughter home at 2 a.m. when she wasn't feeling any better but they had run out of things to do. At her insistence, her daughter was hospitalized, and an infectious disease specialist eventually figured out that the red lips, red eyes, fever longer than five days, and swollen lymph node in the neck all were signs of Kawasaki, which affects about 2,000 American children a year.

It was also at the family's suggestion that the infectious disease doctor was brought in who made the correct diagnosis.

The story underlines the importance of having a good advocate present at all times with a patient in the hospital. Even a lay advocate can see when symptoms aren't improving and can insist on action.

I discuss this subject in depth in Chapter 12 of my book, "The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst."

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Medical Malpractice

Bookmark:

Consumer Reports recently conducted a survey in rating the most durable backpacks, and found in the survey that an average 6th grader carries a backpack weighing 18.4 pounds, but some are as heavy as 30 pounds, according to Tara Parker-Pope of the New York Times.

A medical adviser to Consumer Reports and also a board-certified neurologist, Dr. Orly Avitzur says that carrying a heavy backpack can cause low-back pain in children, and carrying the backpack on one shoulder instead of two exacerbates the problem.

Parents can consult some suggestions provided by the American Academy of Pediatrics about how to choose the best-fitting backpack and how to prevent injuries. Consumer Reports has also published its full report and buying guide.

Some of the American Academy of Pediatrics' guidelines include the following:

- Always use both shoulder straps. Slinging a backpack over one shoulder can strain muscles. Wearing a backpack on one shoulder may increase curvature of the spine.

- Tighten the straps so that the pack is close to the body. The straps should hold the pack two inches above the waist.

- Pack light. The backpack should never weigh more than 10 to 20 percent of the student's total body weight.

- Organize the backpack to use all of its compartments. Pack heavier items closest to the center of the back.

- Stop often at school lockers, if possible. Do not carry all of the books needed for the day.

- Bend using both knees, when you bend down. Do not bend over at the waist when wearing or lifting a heavy backpack.

- Learn back-strengthening exercises to build up the muscles used to carry a backpack.

- Ask your pediatrician for advice.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Education , Product Liability , School Safety

Bookmark:

One in five American teenagers have an episode of depression before they turn 18. If untreated, adolescent-onset depression often returns during adulthood and becomes a chronic and persistent condition that is crippling and even life-threatening. One of the risk factors is having a depressed parent: that increases the odds of becoming depressed in one's teen years by two- to three-fold.

But an article appearing in the latest Journal of American Medical Association has good news, as reported by Shirley Wang of The Wall Street Journal: a multicenter trial conducted in 4 U.S. cities found that a group prevention program effectively reduced the risk of subsequent depression for a target group of teenagers.

The study involved 316 “at-risk” teenagers (ages 13-17). All had a history of clinical depression and parents who had had depressive disorders. The youths were assigned to either a group cognitive behavioral prevention program or usual mental health care. After 9 months of treatment, of the teenagers who were assigned to the group CB prevention program and whose parents were not depressed at the time of the study, only 11.7% had a new depressive episode. In contrast, among teenagers in usual care whose parents were not depressed at the time, 40% experienced another episode of depression.

Although the prevention program only worked for teenagers whose parents were not currently depressed, the new finding is still encouraging, shedding light on future research directions and clinical recommendations.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Mental Health

Bookmark:

With unlimited text messaging cell phone plans comes a surge in the number of texts sent from teenagers’ cells. Every day, an American teenager sends and receives, on average, almost 80 text messages. That’s 2,272 messages a month, sent from behind the wheel, in classrooms, or while crossing busy streets. This texting behavior worries doctors and psychologists for a host of reasons: Texting is blamed for increased risks of car accidents when teens keep their thumbs on the phones while driving, and now texting is believed responsible for direct issues with physical and mental health, reports Katie Hafner of the New York Times.

Although scientists have not had a chance to develop conclusive findings on the health effects of texting because the phenomenon emerged so recently, they already see that the behavior causes “anxiety, distraction in school, falling grades, repetitive stress injury and sleep deprivation.”

Dr. Martin Joffe, a pediatrician in Greenbrae, California, surveyed two local high schools and found many of the students regularly send hundreds of texts every day. When a text message comes in or goes out every few minutes, it’s almost impossible for a student to stay focused on his or her work. That results in, among other things, poorer school performance and disrupted sleep at night.

Teenagers often rely on text messaging to get immediate updates on their buddies’ lives because they are genuinely interested in what’s going on with their friends. Many of them also are driven by a fear of being “out of the loop,” says Michael Hausauer, psychotherapist in Oakland, California. The nonstop line of communication created by so much texting can, Mr. Hausauer worries, make teenagers feel “frightened and overly exposed.”

The 80-text per day “thumb exercise” may also result in musculoskeletal diseases often found in computer users, said Peter W. Johnson, associate professor of environmental and occupational health sciences at the University of Washington. “Intensive repetitive use of the upper extremities,” be it on the computer keyboard or on a cell phone, can lead to temporary or permanent musculoskeletal disorders.

Teachers and parents are often unaware of the extent to which texting has affected the children’s physical and mental health. But once they learn of the problem and impose some restrictions – such as a no-texting window overnight or a limited number of texts allowed each month – they can see visible improvements in the students’ grades and probably energy level too, from regained quality sleep.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In:

Bookmark:

The FDA announced a voluntary recall of face paints by the distributor of the products, Oriental Trading Co., Omaha, Nebraska, reports Miranda Hitti of WebMD Health News. The recall decision was made after reports of adverse skin reactions from exposures that all occurred on the same day at an organized event. Children exposed to various colors of the face paints experienced adverse skin reactions, including rashes, itchiness, burning sensation and swelling on the area where the product was applied. Results of tests by an FDA laboratory indicated significant microbial contamination in most of the face paints.

The FDA is advising consumers to stop using these face paints, which were manufactured by a Shanghai, China company. The agency has also published a complete list of face paint products in this recall.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Product Liability , Toys

Bookmark:

Bisphenol-A, a chemical used to harden plastics, is found in many plastic containers even though it’s known to be linked to diseases. Bisphenol-A, or BPA, have been found in animal studies to accelerate puberty and increases risks of cancer. Babies can be exposed to traces of the chemical when it gradually leaks into the fluids from the plastic containers. BPA exposure can also result in health problems in adults, such as elevated risk of heart diseases and diabetes.

On May 13, 2009, Chicago’s City Council joined a handful of other jurisdictions in a unanimous decision to ban the sale of baby bottles and sippy cups that are made with BPA and intended for children under the age of 3, reports Karen Ann Cullotta of the New York Times.

One of the reasons why not more jurisdictions are banning BPA use in plastic containers is the lack of direct evidence that human exposure to this chemical is harmful to our health. So far, all the evidence for the adverse effects of exposure to BPA comes from animal research studies. FDA said last year that BPA levels found in products appeared to be safe – a conclusion condemned by a panel of scientific advisers to the agency, saying the FDA “ignored crucial studies and used flawed methods.”

To protect their children from exposure to BPA and its potential dangers, parents can turn to the BPA-free products that are already available at retailers.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Infants , Product Liability

Bookmark:

On May 1, 2009, the U.S. Consumer Product Safety Commission announced another recall of cribs made by Jardine Enterprises, the third safety recall since June 2008, reports Patricia Callahan of the Chicago Tribune. All three recalls involved cribs made in China and Vietnam.

The Jardine cribs in the recalls, mostly sold at Toys R Us and Babies R Us, are responsible for more than 30 reports of broken slats, one of the deadliest hazards of baby cribs. When a slat breaks, babies’ bodies slip through the gaps but their heads get stuck, resulting in strangulation and even death.

Parents can access a full list of recalled models at www.cpsc.gov. For those who bought one of the recalled cribs, a credit is available toward the purchase of a replacement.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Infant Mortality , Infants , Product Liability

Bookmark:

The Chicago Tribune uncovered federal safety test results of infant car seats that were never publicized or even made known to some of the infant-seat manufacturers, reported Chicago Tribune’s Patricia Callahan. In the frontal crash tests, a video showed the car seats flying off their bases, throwing baby dummies face-first into the back of the driver’s seat. The test reports also documented that almost half of the 66 seats that were tested in front crashes “either separated from their bases or exceeded injury limits.”

As a result of the Chicago Tribune’s investigations, the National Highway Traffic Safety Administration has ordered a thorough review of safety regulations for car seats and taken steps to make the safety test results more available to consumers. Before, parents could compare safety ratings for cars, but would have no way of comparing which car seats do better at protecting their babies. They would not have known that more expensive car seats are not necessarily safer, or that some smaller cars performed better than the larger ones in these collision tests.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Cars , Infant Mortality , Infants , Product Liability

Bookmark:

A study that tracked millions of schoolchildren shows that children are more likely to be obese when their schools are close to a fast food joint, reports Roni Rabin of New York Times. The study is headed by economists at the University of California and Columbia University, and spanned almost a decade.

Enrico Moretti, one of the study’s authors, indicated that the study does not explain why students closer to a fast food restaurant are more likely to become obese, but affirmed the “credible and unbiased” causal effect it establishes between obesity and fast food.

Providing one more piece of evidence that fast food contributes to child obesity, this study has implications for public policy, said Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University. Neighborhoods and school district may choose to “zone out” fast food restaurants to protect their children’s health.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Childhood Nutrition

Bookmark:

Nearly two million American teenagers are afflicted with depression, and major medical groups are now recommending that pediatricians give a simple but detailed questionnaire to all their teenage patients to try to detect this condition so that treatment can be offered.

About 1 out of 20 teens suffer from depression, which has been linked to lower grades, more physical illness and drug use, as well as early pregnancy.

Questionnaires can accurately identify teens prone to depression, plus there's new evidence that therapy and/or some antidepressants can benefit them, according to a report from the U.S. Preventive Services Task Force, published in the April 2009 edition of the journal Pediatrics .

Accompanying the task force advisory in Pediatrics is a research review saying there have been few studies on the accuracy of depression screening tests, but the tests "have performed fairly well" among adolescents. Treatment can help with symptoms of depression, say the reviewers from Kaiser Permanente and the Oregon Evidence-Based Practice Center in Portland, Ore.

But careful monitoring is vital since there's "convincing evidence" that antidepressants can increase suicidal behavior in teens, according to the Preventive Services Task Force report.

The new recommendation reverses what the task force said in 2002, when it reported that there was not enough evidence to recommend for or against routine screening of adolescents for depression.

Posted by Patrick A. Malone | Permalink | Email This Post

Posted In: Mental Health

Bookmark: