July 25, 2014

Spray-On Sunscreen Is Not for Small Fry

Except for the youngest infants, using sunscreen is a good idea for anyone hoping to avoid the cancer and cosmetic risks of too much sun exposure. But one form of protection is not recommended for children: spray-on sunscreen.

Infants younger than 6 months should not use sunscreen; the best protection for them is to keep them out of the sun. That’s because their skin is immature and they have a higher surface-area-to-body-weight ratio compared with older children and adults. Those two characteristics make an infant’s exposure to the chemicals in sunscreens much greater, increasing their risk of side effects.

As explained by Consumer Reports, aerosol applications of sunscreen present the risk of inhaling ingredients that irritate the lungs. Earlier this summer, according to the magazine, the FDA said it was investigating these potential risks. Also, spray products are flammable, so don’t use them near a grill or fire, and don’t let even older kids fool around with them near an open flame.

No one of any age should inhale this stuff, but children are at greater risk because they’re more likely to move around while they’re being sprayed and accidentally get a dose where it doesn’t belong.

The safe use of sunscreen, says Consumer Reports, includes these practices:

  • Don’t use sprays on children, unless you have no other product available. In that case, spray the sunscreen onto your hands and rub it on. As with all sunscreens, be especially careful on the face, taking care to avoid the eyes and mouth.

  • Adults can use sprays, but don’t spray your face. Spray your hands and rub it on your face, making sure to avoid your eyes and mouth. Avoid inhaling it.

  • Make sure you apply enough. The magazine’s tests have found that sprays can work well when used properly, but it’s more difficult to gauge if you apply enough, especially when it’s windy. Spray as much as can be evenly applied, and then repeat the application, just to be safe. On windy days, spray the sunscreen on your hands and rub it on, or go with a lotion instead.

To see the FDA’s sunscreen recommendations, link here. For the agency’s sun safety tips for infants, link here. For Consumer Report’s recommendations for sunscreens for kids and babies, link here. To see what Consumer Reports has to say about sunscreens generally, and to review its list of recommended products, link here (some pages are subscription only).

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July 18, 2014

Kids and CT Scans: Not So Fast, Parents

Responsible doctors are worried that children can get way too much radiation exposure when they are tested for common problems in the emergency room. X-rays can have great benefit in diagnosing what's wrong, but they can also pose serious long-term risks of cancer from accumulated unnecessary testing.

The main culprit is the CT scanner. Parents need to know that CT scans send out X-ray beams. The typical CT study doses a patient with the equivalent of many dozen chest X-rays.

Ultrasound, by contrast, uses sound waves, so there's no exposure to potentially harmful radiation.

Smart parents sometimes mistakenly push for a CT scan because it's the fanciest and therefore "best" technology. But that's not always true. Ultrasound has now replaced CT as the first-line choice for imaging the abdomen to see if a kid with severe pain might have an inflamed appendix.

A group of doctors just published an article they titled An Appeal for Safe and Appropriate Imaging of Children, in the Journal of Patient Safety. They used as a case study a true story of an 11-year-old girl with abdominal pain who wound up getting two CT scans and scaring her parents to death, all because of a benign nodule found as an "incidental finding" in the lung. She should have received an ultrasound and no CT.

They wrote:

This child has already received an estimated ~20 mSv, which carries with it an increased cancer risk of approximately 1 in 500. Stories like this likely occur every day in the United States.

This unfortunate sequence of patient harm, waste, and needless anxiety could have been completely avoided with the Ultrasound First policy being used at many centers.

We've written before about how doctors are worried about overuse and misuse of radiation imaging. Parents need to know about the issue and work with medical professionals to get their sick and injured children the right imaging test and not necessarily the most high-tech one.

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July 11, 2014

24-Hour Pharmacists Make for a Safer ER for Kids

Medication errors are far too common among hospital patients, but one pediatric hospital is taking measures to reduce them and the sometimes life-threatening harm they can cause.

Making fewer medication mistakes, which, according to a story on NPR.org, contribute to more than 7,000 U.S. deaths every year, is a matter of more professionals remaining on the job for a longer period of time — specifically, hospital pharmacists. In the emergency department at Children's Medical Center in Dallas, pharmacists who specialize in emergency medicine review each prescription to ensure it's the correct one in the correct dose.

Children’s has 10 full-time emergency pharmacists, more than anywhere else in the country, and they’re on call 24 hours a day.

"Every single order I put in," Dr. Rustin Morse told NPR, "is reviewed in real time by a pharmacist in the emergency department prior to dispensing and administering the medication." Rustin is chief quality office and a pediatric ER doc.

That quality-control seems like a no-brainer, but especially in a busy ER, doctors treat fast and move on to the next patient. Writing down the name and quantity of a drug quickly invites mistakes. But in this ER, if that happens, it’s more likely a pharmacist will catch it.

Medication errors, as NPR notes, can be the result of poor handwriting, confusion between drugs with similar names, poor packaging design or confusion between metric or other dosing units. Often, more than one factor is involved.

That’s particularly dangerous for children because medication errors are three times more likely to occur with youngsters than adults. They absorb drugs at a different rate from adults.

So, for the nearly 20,000 drug orders processed at Children’s in a given week, pharmacists review all pertinent information — the child's weight, allergies, medications and health insurance coverage.

The electronic medical record system also automatically checks orders to prevent errors. You need both reviews, because neither human nor machine is infallible.

Dr. James Svenson, associate professor of emergency medicine at the University of Wisconsin, co-authored a study in the Annals of Emergency Medicine that found that even with an electronic medical record, 1 in 4 children's prescriptions had errors; 1 in 10 adult prescriptions also was wrong. So now, there’s a 24-hour ER pharmacist at Svenson’s hospital.

The reason most hospitals don’t embrace this practice is the usual one: money. "If you're in a small ER, it's hard enough just to have adequate staffing for your patients in terms of nursing and techs,” Svenson said, “let alone to have a pharmacist sitting down. If the volume isn't there, it's hard to justify."

But the investment has been proved to work. Researchers for the Journal of Pediatric Pharmacology and Therapeutics showed that prescription review can reduce the number of hospital readmissions. That not only saves money, but also lives.

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July 4, 2014

Warning of Suicide Risk with Antidepressants Had Unintended Consequences

Remember several years ago, when the FDA issued warnings about the risk of suicide for children and adolescents who were taking antidepressants? Well, stand by for an attitude adjustment. A study published last month in BMJ showed that the effort to save children probably harmed them instead.

The researchers tracked an increase in suicide attempts that seem to have been the result of depressed youngsters failing to seek treatment at all. They said the study shows how public health warnings that were intended to do good sometimes can backfire, especially if the subject is sensitive and gets a lot of media attention.

As the Washington Post recalled, the FDA issued warnings in 2003 and 2004 of an increase in suicidal thoughts among some children and adolescents who were taking a certain class of antidepressants (selective serotonin reuptake inhibitors, or SSRIs); you might recognize some of their brand names — Paxil and Zoloft.

So dire was the potential for harm that the FDA required manufacturers of the drugs to include a “black box” warning on the label. Such warnings denote the highest level of concern about side effects, including death. The warnings specified that the drugs presented an increased risk of suicidal thoughts and behaviors in youths who take them.

The media were all over this story, and the study’s researchers said the coverage focused more on the tiny percentage of patients with those thoughts than on the vastly larger number of youths who benefited from antidepressants.

After the warning, antidepressant prescriptions declined sharply among kids 10 to 17 years old, and among young adults from 18 to 29. Coincidentally, the researchers found, the number of suicide attempts rose by more than 1 in 5 among the younger group, and by more than 1 in 3 among the older group.

Of course the media’s lapel-grabbing headlines — “FDA links drugs to being suicidal” (New York Times), and “FDA confirms antidepressants raise children’s suicide risk” (The Washington Post) — “became frightening alarms to clinicians, parents and young people,” the researchers wrote. But consumers bore some responsibility as well.

“There was a sort of overreaction by the media, but also an excessive caution on the part of patients,” Christine Lu, a Harvard Medical School researcher and co-author of the BMJ study, told The Post. “Lots of people who needed treatment steered clear because of the fear factor. … For any drug, there are risks, for sure. But there’s also the risk of leaving the underlying condition untreated.”

Her team plotted the rise in suicide attempts by studying reports of nonfatal poisonings involving psychiatric medicines, which is a common indicator of attempted suicides. They thought the likely number of suicide attempts probably was much higher, because they didn’t track other suicide methods and poisonings that went unreported.

As The Post noted, the BMJ findings dovetail with a 2007 study in the American Journal of Psychiatry that showed a steep decline in antidepressant prescriptions after the feds issued the warnings.

That study didn’t prove that suicides rose as a direct result of fewer such prescriptions, but experts said there weren’t a lot of other explanations.

Despite their conclusion, the BMJ researchers don’t believe that the FDA was wrong in issuing the warning 10 years ago. But “FDA advisories and boxed warnings can be crude and inadequate ways to communicate new and sometimes frightening scientific information to the public,” they wrote.

And the researchers point out that media attention can raise awareness of medical situations people should know about, like the risk of Reye’s syndrome in children who are given aspirin. But, they said, sometimes “the information may be oversimplified and distorted when communicated in the media.”

Not every scientific mind agreed that advisories were too bold. In Discover magazine, an article by The Neuroskeptic titled “The FDA’s Antidepressant Warning Didn’t Really ‘Backfire,” took issue with the study’s conclusions:

“And while the authors never outright state that the FDA’s warning caused the extra suicide attempts,” it said, “they strongly imply that, using phrases such as ‘It is disturbing that after the health advisories, warnings, and media reports [...] we found substantial reductions in antidepressant treatment and simultaneous, small but meaningful increases in suicide attempts.’ “Are they right to be disturbed? By my reading – no. Their data just don’t support a causal effect.”
Neuroskeptic’s argument is interesting and rather geeky, and deserves consideration. The lesson here is that both regulators and the people who watch them must not be alarmists when communicating drug risks. And the lesson for parents with children who are depressed is to discuss frankly and fully the risks and benefits of all treatments. Like all drugs, antidepressants might be exactly what some people need, and not the best option for others.

It’s a matter of the degree of illness and managing its risk.

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June 27, 2014

New Rules Should Protect Quality of Baby Formula

Earlier this month, the FDA finalized new guidelines for manufacturers of infant formula in order to better protect babies from contaminated products. The move is a response to several prominent nationwide recalls of different formula products in the last several years.

As reported by MSN.com, in 2010, 5 million containers of Similac were recalled by Abbott Laboratories because they might have been contaminated by insect parts. In 2011, powdered versions of Enfamil, made by Mead Johnson Nutrition, were yanked from store shelves over concerns of contamination, which later proved unfounded.

Still, the red flag was raised, and now companies that make baby formula will be required to test for the presence of two kinds of bacteria, salmonella and cronobacter, that pose serious health risks to wee ones. They’ll also have to monitor their products for a longer period.

Salmonella can cause diarrhea and fever, sometimes to a life-threatening degree; cronobacter, which prefers dry environments such as powdered formula, can cause swelling of the brain — meningitis — in infants.

Most public health officials and medical professionals say breast milk is best for babies, but for various reasons of both necessity and convenience, many mothers don’t breast feed. So, many infants get all or part of their nutrition from formula.

Baby formula is not subject to FDA approval prior to sale. But all formula sold in the U.S. must meet federal nutrient requirements, and they do not change with the new regs. Infant formula manufacturers are required to register with FDA, and notify the agency before they market a new formula.

The FDA conducts yearly inspections of all facilities that manufacture infant formula. It collects and analyzes product samples, and inspects new facilities. If the feds determine that a formula presents a risk to human health, its manufacturer must conduct a recall.

The new requirements, according to the FDA, are meant to establish the "good manufacturing practices" that many companies voluntarily follow. These regulations establish federally enforceable standards for safety and quality.

They apply to formula sold "for use by healthy infants without unusual medical or dietary problems," said the FDA.

Under the new rules, companies must test their products' nutrient content and prove that the formulas can "support normal physical growth," the agency said. They must test the nutrient content in the final product stage, before entering the market and at the end of the products’ shelf life.

According to FDA, about 1 million U.S. infants are fed formula from birth; by the time they are three months old, about 2.7 million rely on formula for at least part of their nutrition.

Infant formula comes in three forms:

  • powder — the least expensive of the infant formulas, it must be mixed with water before feeding;

  • liquid concentrate — must be mixed with an equal amount of water;

  • ready-to-feed — the most expensive form of formula that requires no mixing.

The protein source varies among the different types of formula. The FDA’s nutrient specifications are set to meet the nutritional needs of average, healthy infants. Manufacturers use nutrient levels that usually exceed the FDA minimum. So babies fed infant formulas don’t need added nutrients unless they are fed a low-iron formula.

The formulas currently available in the U.S are either “iron-fortified” — with about 12 milligrams of iron per liter — or “low iron” — with about 2 milligrams of iron per liter. The American Academy of Pediatrics (AAP) recommends that formula-fed infants be fed iron-fortified formula to help reduce the prevalence of iron-deficiency anemia.

To learn more about safety and infant formula, such as proper storage, visit the FDA website. To learn more about childhood nutrition, see our blogs on the topic.

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June 20, 2014

CDC Says Parents Who Opt Out of Vaccinations Are Spreading Measles

A disturbing number of parents refuse vaccinations for their children because they believe immunization poses a risk of autism. They don’t believe the science proving not only the wisdom of being immunized, but the folly of the autism claim. And the consequences of their actions are beginning to emerge. In the first five months of this year, 288 cases of measles were reported to the Centers for Disease Control and Prevention (CDC).

That’s the highest year-to-date total in 20 years.

The CDC report was clear that the reason for measles’ renewed vigor in the U.S. was because more people are rejecting vaccination — 200 of the 288 cases occurred in unvaccinated people. And in 1 of 5 of the rest, vaccination status couldn’t be determined, so the 200 figure could well be low.

Measles is not just an inconvenient episode of itchy, red skin bumps. It can lead to pneumonia, encephalitis and even death, especially for children and infants.

Loyola University Health System in Chicago is renowned for its work in infection control and prevention. In a statement last month, Dr. Jorge Parada, its medical director for infectious disease, said, “People who consciously opt out of vaccines are depending on herd immunity — that enough other people will get vaccinated so as to prevent infection — which seriously undermines the herd immunity they depend on for safety. It's a numbers game, and America is losing ground in the fight against preventable disease.”

People in the anti-vaccination movement generally are affluent, educated and privileged. They have no excuse for choosing to be ignorant. They are vocal, but why anyone grants them a bully pulpit is mystifying. That question was plumbed by a recent episode on TV’s satiric “Daily Show," which was at once hilarious and painful.

We’ve regularly expressed our astonishment that people are so eager to accept bunk; that they are not, in fact, protecting their children from autism by withholding vaccinations, but instead are increasing their risk — and that of other people — of measles, polio and whooping cough. (See our blogs, “Feds Say Childhood Vaccine Schedule Is Safe and Effective” and “More Proof That Vaccines Have Nothing to Do With Autism.”)

The CDC noted that the three largest outbreaks of measles so far this year “occurred after introduction of measles into communities with pockets of persons who were unvaccinated because of philosophical or religious beliefs.”

“Religious, philosophical or personal reasons are not medical reasons for not getting vaccinated,” Parada said. And although that’s a harsh judgment, it’s based on concern for society at large.

Sometimes, the individual must sacrifice for the greater good, but in this case, it’s not even about sacrifice — when the reasons behind the anti-vaccination movement have been proved to be bogus, the only thing you’re sacrificing by doing the responsible thing is willful ignorance.

Some people have legitimate medical reasons for not being immunized — they might be allergic, or pregnant, for example. (See the CDC’s guide to who should not get vaccinated here.) These are the people most vulnerable to contracting disease when others opt not to protect themselves.

People who shun vaccination play the odds that they won’t get sick, but do they have the right to play with other peoples’ odds?

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June 13, 2014

Turning Normal "Spitting Up" Into a Disease

When does typical baby behavior become medically treatable baby behavior? When misguided doctors and scared parents promote it from what is normal to something that sounds ominous and urgent.

An essay published in the New York Times by Dr. Aaron E. Carroll says that calling an ordinary health problem a disease leads to bigger problems, and a primary example of it is brought to you by way too many people who care for babies.

Babies spit up. A lot. About half of all healthy infants, Carroll says, spit up more than twice a day. More than 9 in 10 completely stop this behavior without treatment. “When a majority of infants have (and have always had) a set of symptoms that go away on their own, it isn’t a disease — it’s a variation of normal,” Carroll writes.

Infants vomit more often than older people because their diet is all liquid, because they eat frequently and because their developing esophagus isn’t quite closed off from their small stomachs. Milk leaks back into the esophagus, producing symptoms of gastroesophageal reflux, one of which is regurgitation.

Gastroesophageal reflux disease (GERD) is different from this common baby behavior. Children with GERD are truly ill, but they are rare. “But over time,” Carroll says, “more and more babies with reflux were labeled as having a ‘disease.’ The incidence of a diagnosis of GERD in infants tripled from 2000 to 2005.”

We have a term for that, and readers of our patient safety blog will recognize it: disease-mongering. As defined by the journal PLoS Medicine it’s “the selling of sickness that widens the boundaries of illness and grows the markets for those who sell and deliver treatments.”

Carroll is familiar with the phenomenon. “When I was a pediatrics resident,” he writes, “my hospital constructed foam wedges for infants to sleep on. The thinking was that infants who were sleeping at an angle would be less likely to have milk come back up.

“The wedges cost about $150. They didn’t work.”

Carroll’s pediatric colleagues have tried other ways to control infant regurgitation — special infant seats; thickened food; special formulas. “None of these things really work,” he concludes. “An incredible amount of time and money has been wasted.

“The bigger problem, though, is that the vast majority of these infants weren’t ‘sick.’ We just gave them an official diagnosis. This labeling of patients with a ‘disease’ can have significant consequences, for both people’s health and the nation’s health-care budget.”

Drugs, of course, play a large role in disease-mongering. Infants may be treated with a group of drugs called proton pump inhibitors (PPIs). You might recognize some of their brand names — Nexium, Prilosec, Prevacid and Protonix. Between 1999 and 2004, the use of one liquid PPI increased more than 16-fold, Carroll reports, never mind that PPIs have not been approved by the FDA for the treatment of GERD in infants.

In 2009, a randomized, controlled trial whose results were published in The Journal of Pediatrics examined how well a PPI worked for infants with symptoms of GERD. It found that the drug had no more of an effect than a placebo, or fake, inert pill. But — and here’s the harm of disease-mongering — the children who took the PPI had significantly more serious adverse events, including respiratory tract infections.

Another study Carroll recalls was published last year in the journal Pediatrics. The researchers randomly chose parents who were told either that their baby’s reflux was GERD or was, instead, “a problem.” Half of each of group also was told that medications were ineffective.

Parents who were told that their kid had GERD were far more interested in having their child take medication, even when they were told that it was ineffective. Parents of babies who were not labeled with GERD weren’t interested in medication when they were told it didn’t work.

“Words matter,” Carroll says. “Studies have shown that once people with high blood pressure are labeled ‘hypertensive,’ they are significantly more likely to be absent from work, regardless of whether treatment was begun. Many diseases have become so much broader in definition that they now encompass huge swaths of the public.”

But medicalizing normal variations in physiology so that they become “treatable conditions” leads to unintended — and unwelcome — consequences. Needless worry. Treatments with unpleasant and possibly dangerous side effects. Unnecessary costs.

As one of Carroll’s colleagues puts it, “Our job as doctors is to make sick patients healthy, not to make healthy patients sick.”

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June 6, 2014

Dangerous Flame Retardant Chemicals Are Everywhere

Parents of small children know that day care centers and preschools are notorious providers of germs the whole family can share, but what they might not be aware of is that they also pose a danger because their furnishings often are treated with flame retardants.

The chemicals in flame retardants, polybrominated diphenyl ethers (PBDEs) and tris phosphate compounds, have been linked to hormone disruption and lower IQs in children. According to a study published in the journal Chemosphere, they were found in 100% of the dust samples collected from 40 child care centers serving more than 1,760 children in Northern California.

As reported by the San Francisco Chronicle, the study was conducted by researchers from the University of California, Berkeley’s Center for Environmental Research and Children’s Health. They said that the results were representative of what's found in many homes and other environments because the chemicals have been widely used for decades in the polyurethane foam inside upholstered furniture.

In the early 1970s, California imposed requirements that upholstered furniture be manufactured with flame retardant chemicals. Those measures became standard elsewhere as well. But they were changed to enable flammability standards to be met without the use of the chemicals. As we noted earlier this week in our Patient Safety blog, “Burn Surgeon’s Testimony Tainted by Conflict of Interest,” chemical industry interests have tried to promote these dangerous substances using unsavory and misleading means.

Although PBDEs have been banned in California for almost a decade, they’re still found in older furniture and other products. And in many cases, their replacement was chlorinated tris, never mind that it had been removed from children's pajamas in 1977, according to The Chronicle, after it was found to mutate the DNA of people exposed to it. In California, it’s considered a carcinogen, or cancer-causing substance.

The Chemosphere study found levels of PBDEs in the child-care facilities to be somewhat lower than what previous studies found in residences. But the amounts of chlorinated tris were similar or higher than household levels found in other reports.

The authors said that the higher tris levels probably were found in the mats children use for napping, as well as in furniture. Of the facilities studied, 29 had upholstered furniture and 17 had napping mats made of foam.

To minimize your child’s exposure to these chemicals:

  • Choose natural fiber wall coverings instead of paint.

  • Use cleaning supplies without harsh chemicals.

  • Maintain a low level of dust.

  • Cover childrens' mats with cotton sheets.

And don’t despair: Despite the study's results, Asa Bradman, its lead author and an environmental health scientist, told The Chronicle, "People shouldn't panic and feel like child care is toxic for children."

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May 30, 2014

Preventable Injuries Bring Many Children to ERs

A recent report by the National Center for Health Statistics (NCHS) paints a clear portrait of what most often brings kids into the emergency department.

As you might expect, injury is the leading cause of death and also a major source of morbidity (the relative incidence of a disease within a population) among children and adolescents, and the emergency room is where a lot of these victims land first. The report looked at ER visits throughout the nation by children and adolescents 18 years and younger from 2009 to 2010. Different age groups for injury-related visit rates were: as old as 4; 5 to 12; and 13 to 18 (that is, preschool, school-age and teenagers).

The key findings?

  • The annual average of injury-related emergency department (ED) visits made by children and adolescents 18 years and younger was 11.9 million. (Total visits were about 33.7 million.)

  • The injury-related ED visit rate was 151 per 1,000 patients 18 years and younger. Rates were higher for males than for females for all age groups.

  • Injury-related ED visit rates among patients 5 to 12 and 13 to 18 were higher for non-Hispanic blacks than for other race and ethnic groups.

  • Leading causes of injury-related ED visits among both males and females included falls and striking against or being struck unintentionally by objects or people. Visit rates were higher for males than for females for both causes.

As far as cost was concerned, public funds (Medicaid or Children's Health Insurance Program) covered 41.7% of injury-related visits, and private insurance covered. 40.7%. Youngsters with no insurance represented 8.6% of visits.

“Child and adolescent injuries represent a serious public health problem in the United States,” the report concluded, and more than one-third were the result of injuries.

It’s not always, or usually, possible to foresee and forestall your child’s illness, but injuries are often the result of inattention or lack of preparation (see our recent blog, “Ensuring the Safety of Baby Gates.”) Preventing injuries requires covering a lot of bases that can seem overwhelming to parents.

Proven strategies include researching the safety and recall information for childrens’ products on sites including the Consumer Products Safety Commission, sponsored by the federal government. Visit the Safety Research & Strategies Inc. website, which investigates, analyzes and advocates about safety issues.

Other guidelines are provided by Healthy People 2020, a federal government initiative to improve the health of all Americans that includes preventing injury and violence and reducing their consequences.

And review our blogs about a wide range of products including car seats, sleep machines, recreational equipment and rides, medicines and more.

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May 23, 2014

Ensuring the Safety of Baby Gates

Part of making your home safer for young children often includes installing a baby gate. But the risk of injury is high if it’s not set up right and used properly.

The Center for Injury Research and Policy at Nationwide Children’s Hospital conducted a study from 1990 through 2010 that was the first one of national scope to analyze injuries associated with the gates parents often install to keep the wee ones from tumbling down the stairs or entering a room where other harmful things pose a risk.

The rate of baby gate injuries more than tripled during the two decades of study, from nearly 4 in 100,000 children in 1990 to 12.5 in 100,000 in 2010. The researchers used data from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission, and provides information on consumer product-related and sports- and recreation-related injuries treated in hospital emergency departments.

The study, published in Academic Pediatrics, showed that U.S. emergency departments treated about 37,675 kids younger than 7 for injuries related to baby gates. As explained on ScienceDaily.com, that averages out to about five injured children a day.

More than 6 in 10 of the injured children were younger than 2. The most common circumstance for injury was falling down the stairs after a gate collapsed or wasn’t closed. The problems range from soft-tissue sprains to traumatic brain injuries. Children between 2 and 6 were injured frequently because they were climbing on the gate and got cut on its edges.

To reduce the chances of your kid having an unpleasant encounter with the thing that’s supposed to protect her, make sure it’s the correct type of gate for the location where you want to install it. And check to see if it meets the industry’s voluntary safety standards.

Pressure-mounted gates should be used only to divide rooms or at the bottom of stairs, not to prevent falls; they’re not designed to withstand much force. If you want to bar access at the top of a staircase, use only gates with hardware that requires screwing into the wall or railing.

Although the voluntary standards set by the American Society for Testing and Materials have helped make baby gates less hazardous, as the researchers noted, there is no substitute for mandatory standards for demonstrating a true commitment to safety.

In addition to the tips noted above, follow these to minimize the chances of injury:

  • Install gates in homes with children between 6 months and 2 years old.
  • Remove the gate when the child turns 2, or when he or she has learned to open it or climb over it. If you still need the gate because there are other little ones in the home, use a model without notches or gaps that could be used for climbing.

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May 16, 2014

Turning Childhood Into Illness

Hearing about the booming numbers of kids diagnosed with worrisome conditions like attention deficit hyperactivity disorder and bipolar disorder can make parenthood seem like punishment. But according to one reasoned mind, kids are no sicker now than they used to be, it’s just that we’re turning childhood into an illness.

Writing on KevinMD.com, Dr. Allen Frances, a psychiatrist and professor emeritus at Duke University, wants people to reject commonly heard “statistics” such as:

  • ADHD has more than tripled in 20 years, and is diagnosed in 1 in 5 teenage boys.

  • Autism occurs in 1 in 68 children and that 20 years ago, it was 1 in 500.

  • Bipolar disorder increased recently by 40-fold.

Too often, said Frances, children are “mislabeled for behaviors that used to be considered part of normal variation.”

What he calls “misplaced diagnostic exuberance” is a product of classroom research that showed that the youngest kids in class are much more likely than the oldest to be diagnosed as having ADHD, and to receive stimulant treatment. (See our blog, “Should Age Determine When Kids Start School?”)

“It is shameful,” writes Frances, “that simple immaturity due to being younger is now mislabeled as mental illness and mistreated with a pill.”

He says diagnosing ADHD should be reserved for kids who have “an early onset of very severe and persistent symptoms displayed in a wide variety of family, school, and social contexts.” That requires not only thorough evaluation, but a period of watchful waiting. That’s more frustrating for many parents and caregivers than rushing to diagnostic judgment and treatment. Make that overtreatment.

Among the harms of such overtreatment for the 2 in 3 active kids who have been misdiagnosed with ADHD is suffering from unnecessary stigma, reduced expectations and drug side effects.

“We need to do a better job of protecting our children from such widespread careless diagnosis and reckless treatment,” he says.”

He blames marketing and greed by pharmaceutical companies for fueling this diagnostic fire. “Massive and cleverly misleading marketing has transformed the stimulant drug market from a minor player to a $10-billion-a-year cash cow,” he notes. “This is great for executives and shareholders but bad for the kids who are mislabeled and mistreated.”

He, like other doctors we’ve written about, wants to reduce the “formidable lobbying” of the pharmaceutical industry, and stop it from advertising directly to consumers.

He wants resources spent on schools, educational tools, not on hawking drugs. “What makes more sense,” he asks, “promiscuous use of pills or smaller class sizes and more facilities for physical activity that allow kids to blow off steam?”

“It is completely irrational to shortchange our schools and then spend a bundle on misguided medical treatment for normally active kids who don’t do well in a stressed school environment.”

“[L]et’s diagnosis and treat our classrooms and playgrounds,” Frances concludes, “not overdiagnose and overtreat our children.”

In other words, let a kid be a kid.

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May 9, 2014

Texting or Parenting: What’s Your Priority?

You love your smartphone, but your kids might not.

An observational study by pediatrician Jenny Radesky indicates that many parents are depriving their children in favor of their phones, and that such techno-addiction can harm the kids.

When Radesky worked at a clinic in a high-tech savvy neighborhood, NPR reported, she realized how often parents ignored their kids while engaged with their mobile device. One mother kept her phone in the stroller between herself and the baby. "The baby was making faces and smiling at the mom," Radesky told NPR, "and the mom wasn't picking up any of it; she was just watching a YouTube video."

That gave Radesky the idea to study 55 different groups of parents and young children eating at fast food restaurants. Forty of the adults pulled out a mobile device immediately, and used it during most of the meal.

That’s bad for kids, Radesky said, because face-to-face interaction is how children learn language, emotional responses and how to regulate them. "They learn by watching us how to have a conversation, how to read other people's facial expressions,” she told NPR. “And if that's not happening, children are missing out on important development milestones."

Is anyone surprised that Radesky and the other researchers observed that kids whose parents were most absorbed in their devices were more likely to act out, trying to get their parents' attention?

Although her research was more of an anthropological observation than solid science, it was published in the journal Pediatrics.

According to Catherine Steiner-Adair, author of “The Big Disconnect: Protecting Childhood and Family Relationships the Digital Age,” when a parent’s priority is a digital device, there can be significant emotional consequences for the child. "We are behaving in ways that certainly tell children they don't matter, they're not interesting to us, they're not as compelling as anybody, anything, that may interrupt our time with them," she told NPR.

In her research, Steiner-Adair interviewed 1,000 children between 4 and 18 about their parents' use of mobile devices. Several reactions were common: "sad, mad, angry and lonely." Some kids told how they threw their parent's phone into the toilet, put it in the oven or otherwise hid it. One girl said, "I feel like I'm just boring. I'm boring my dad because he will take any text, any call, any time — even on the ski lift!"

Steiner-Adair said it’s not known when the cumulative moments of disconnect between a parent and a child begin to affect the youngster in the long term. So she hopes, before reflexively answering the phone, sending a text or reading email, that parents would make a thoughtful choice between paying attention a mobile device or to their children. If your default is to choose technology over children, you need to rethink your priorities.

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