Child Safety Blog

Stroke, an injury to the brain usually caused by a clot of blood that blocks delivery of oxygen to a portion of the brain, is thought of as an adults-only disease. It does happen in children, though, and it's worthwhile for parents to know about it, because the symptoms are frequently misdiagnosed.

A father's account in the New York Times tells the story of his son Jared, who had a stroke at age seven. Now, two years later, his brain has mostly recovered, a testament to the remarkable power of children's brains to "rewire" themselves, especially when damage is limited to a discrete area.

The most common signs of stroke in children or teenagers include the sudden appearance of:

* Weakness of the face, arm or leg, usually on one side of the body
* Trouble walking due to weakness or trouble moving one side of the body
* Problems speaking or understanding language, including slurred speech, trouble trying to speak, inability to speak at all, or difficulty in understanding simple directions
* Severe headache, especially with vomiting, sleepiness, or double vision
* Trouble seeing clearly in one or both eyes
* Severe dizziness or unsteadiness that may lead to losing balance or falling
* New appearance of seizures, especially affecting one side of the body and followed by paralysis on the side of the seizure activity.

This list comes from Children's Hospital of Philadelphia (CHOP), which has the first pediatric stroke center in the country.

In babies and newborns, the signs of stroke can be more subtle, but include seizures and extreme sleepiness, or unusual favoring of one side of the body.

Parents who see sudden onset of these signs in their child should call 911 or get the child to an emergency room with expertise in stroke, and should consider a consult by telephone with the experts at CHOP.

The stroke experts say that recognition of stroke is often delayed or even missed in most children. Many kids with stroke syndromes are misdiagnosed with more common conditions that mimic stroke, such as migraines, epilepsy or viral illnesses.

But the key message is that early recognition and treatment during the first hours and days after a stroke is critical in optimizing long-term functional outcomes and minimizing the risk of a repeat stroke.

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Posted In: Cases , Medical Malpractice

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Testing of children's cheap jewelry trinkets has found toxic levels of heavy metals including cadmium and lead, according to an Associated Press report.

The Consumer Product Safety Commission recommends parents don't buy these bracelet charms and pendants, and throw away any that they already have. Don't try to sell them!

Some Chinese manufacturers have started using cadmium in these trinkets to replace lead, which they were required to remove by safety regulators. Cadmium is just as bad.

The health danger comes when children chew, suck on or even swallow these shiny metal trinkets.

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Posted In: Product Liability

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As deadly as some of the risky behaviors today’s adolescents engage in, like drunk driving and drug use, is the much lesser known “choking game” that some physicians have never heard of. Amina Khan writes in The Los Angeles Times that the choking game, also known as “space monkey,” “sleeper hold” and “funky chicken,” can be played two ways:

One can be a solo operation, using a necktie, belt or other type of binding to put pressure on the carotid artery in the neck. The other method involves a partner, who can apply pressure to the neck or chest until the subject passes out, cutting off blood flow to the brain.

The resulting rush of oxygen once pressure is released generates a pleasurable sensation, or "natural high."

Statistics on the exact number of deaths over the years can be difficult to ascertain because such deaths are often mistaken for suicide. But the Centers for Disease Control and Prevention estimated in February 2008, from surveying news stories, that the game probably resulted in 82 deaths from 1995 to 2007.

The relatively low incidence rate corresponds to fewer physicians being aware of the game than is ideal. In an Ohio survey, only 68% of responding physicians had heard of the game. However, there is plenty of reason for doctors to learn about and screen for the signs of patients playing this game: there have been at least 65 YouTube videos of the game, and according to surveys, many children do not realize the dangers associated with the game. An Injury prevention article reported that as many as 40% of students in a survey “said they perceived no risk from [the game].”

Doctors are encouraged to educate themselves and their patients about the game, and to look out for signs such as “unexplainable headaches, red marks dismissed as hickeys, bloodshot eyes, signs of depression,” says Khan in the Times story.

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The death toll from Simplicity cribs, which were recalled four years ago but are still in widespread use, has jumped from four to eleven, according to the Consumer Product Safety Commission.

The Associated Press reports:

The recall of Simplicity-manufactured cribs began in December 2005. More than 2 million Simplicity drop-side cribs have been recalled so far because of problems with their plastic hardware. Some of the recalled cribs have the Graco logo and Winnie the Pooh motif.

The crib's hardware can break or deform, causing the drop side to detach. This detachment creates a space between the drop side and crib mattress that babies can roll into and become entrapped, leading to suffocation risk.

The CPSC says caregivers should check their cribs to see whether they have a recalled Simplicity crib. If they do, consumers should stop using them immediately and should not attempt to fix the cribs.

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This week the Consumer Product Safety Commission announced a voluntary recall of 24,000 motion beds for babies, writes Jennifer Kerr of the Associated Press. Manufactured by Amby Baby of USA and sold online through its website since 2003, Amby Baby Motion Beds consist of a steel frame and a fabric hammock that has mesh sides and hangs from a spring. The bed gently swings as the baby moves, a feature designed to resemble babies’ motion in the maternal womb.

Although many babies have found comfort in these hammock beds, there is a hidden risk of suffocation: as the bed moves back and forth, babies could roll and become trapped or wedged against the fabric or the mattress pad. In fact, as Jennifer Kerr reports, two infant deaths in the United States have been associated with Amby Baby Motion Beds, which prompted the CPSC’s recall of the product.

In her story, Jennifer Kerr quotes Nancy Cowles, executive director of Kids In Danger, “There is currently no safety standards that would cover hammocks.” Kerr says that safety advocates maintain that it’s safest for babies to be “in cribs or bassinets with a firm bottom support and no soft bedding, gaps or other points where they could become trapped.”

The CPSC urges parents to immediately stop using the hammock beds for the safety of their babies.

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Posted In: Infant Mortality , Infants , Product Liability

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According to a Consumer Product Safety Commission (CPSC) report, in 2007, there were 22 toy-related deaths in the United States, and in 2008 there were 19. That translates to at least one death every month in from dangerous toys – toys that should provide enjoyment but instead have hidden death traps.

The causes of deaths include, among others, airway obstruction, strangulation, and blunt force. Dangerous toys also account for other serious injuries like laceration and burns, as well as more than 170,000 emergency room visits annually for injuries to children 15 years or younger, according to Don Keenan, Atlanta attorney and child advocate.

Don Keenan has put together a list of Top 10 Dangerous Toys for 2009, available on his website, Keenan’s Kids Foundation. He also has a link to CPSC’s list of recalled toys.

Notably, in Don Keenan’s introduction to the Top 10 Dangerous Toys list, he cautions consumers that many of these dangerous toys, although banned or recalled by the CPSC, still made their way onto the shelves in stores like Target or Walmart. The recalled toys are also easily available on the Internet at sites like eBay or in used toy stores. Other toys that were not recalled also may not be completely safe – in February 2009, the government enacted stringent standards, but Keenan’s Kids Foundation estimates that as many as 5% of toys currently on the market probably do not meet the new safety standards (such as requiring all children products to be tested by a third-party lab to ensure they meet safety standards, and banning the use of phthalates, a plastic softener, or products that contain trace amounts of lead).

Therefore, in this holiday gift-buying season, parents are urged to use extra caution in selecting safe toys, by carefully reading the safety warning label to see if the toy is age-appropriate for your children, and comparing against the CPSC’s recall list.

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

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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.”

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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.

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Posted In: Medication , Mental Health

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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."

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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.

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Posted In: Education , Product Liability , School Safety

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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.

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Posted In: Mental Health

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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.

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