DC Child Accident & Safety Blog

Mothers of young children concerned about wagging tongues impugning their parenting ability if they also hold jobs can stop worrying. A new study from the United Kingdom determined that "There was no evidence of detrimental effects of maternal employment in the early years on subsequent child socio-emotional behaviour."

The research, published in the Journal of Epidemiology & Community Health, compared parental employment with the social and emotional behavior of their children at three different ages up to 5. Researchers analyzed if the mothers' work status affected the childrens' risk for problems when they were older.

No surprise that the results indicated that the best situation for any child is one in which both mothers and fathers were present in the household and in paid work, regardless of the mother's educational level and the household income.

But, clearly, one formula that does not compute is Mom + Job=Trouble.

Many adolescents diagnosed with depression and attention deficity-hyperactivity disorder (ADHD) are prescribed both methylphenidate (Ritalin) and fluoxetine (Prozac). A study on rats given the two drugs might give humans pause.

As reported in the Los Angeles Times, the study showed that adult rats who got that drug combination as pups were more likely than those with no early exposure to psychotropic drugs to choose highly sugared water over plain water, and to linger in a compartment where they had gotten a dose of cocaine, which suggests they were hoping for more. Those are disturbing signs of developing addiction.

"Taking Ritalin and Prozac together during adolescence appears to set in motion subtle changes in brain function that, in adulthood, makes an individual more sensitive to reward as well as to stress, and more likely to exhibit the pessimism and hopelessness seen in depression," was how The Times summarized the study published in the Journal of Neuroscience.

The study's authors wrote, "combining methyphenidate and fluoxetine early in life may lead to lifelong behavioral and chemical abnormalities." They said the drugs--one a stimulant, one an anti-depressant--in combination appeared to act on the brain in much the same way as does cocaine.

Those drugs affect production of certain proteins in the brain's reward circuitry. If it's disrupted during adolescence, the adult later might struggle with the ability to regulate mood and to moderate reward-seeking behavior such as eating or sexual activity.

Baby rats who got only Prozac seemed more sensitive to rewards as adults, but were also more resilient to stress than those who didn't. The rats who got only Ritalin demonstrated less inclination toward sugar water, as well as a "significant aversion to cocaine" as adults--a sign that treating ADHD might thwart drug abuse later. But they also showed greater sensitivity to stress later on.

A rat is not a kid, and a trial subject rat is not depressed or afflicted with ADHD. So no straight line can be drawn between the study results and a child with these disorders who takes these drugs. If the study is notable, it is too preliminary for parents to withhold these drugs if they've been prescribed for their children with mood and behavioral problems. It's never too early, however, for a conversation with your doctor about the appropriate use of prescription drugs, and alternative treatments.

The parental instinct to protect one's child is evolutionary. If something isn't safe, the parent's instinct is to remove the child from the danger, or otherwise minimize the threat.

That's a noble instinct, But is it always the best instinct? A recent story in the New York Times suggests that too much protection can stunt growth and inhibit an otherwise healthy desire to try new things and expand horizons.

Parental concern, government regulation, product safety guidelines and the fear of lawsuits have all contributed to the makeover of playgrounds from tall, creaky equipment resting on hard surfaces to kinder, gentler forms of outdoor apparatus. Shorter equipment sited on enclosed platforms underlain with absorbment material unquestionably prevents some injuries. But experts wonder at what cost.

“There is no clear evidence that playground safety measures have lowered the average risk on playgrounds,” said David Ball, a professor of risk management at Middlesex University in London. He noted that the risk of some injuries such as arm fractures increased after the introduction of softer surfaces on playgrounds in Britain and Australia.

“This sounds counterintuitive, but it shouldn’t ...,” Ball told The Times. “If children and parents believe they are in an environment which is safer than it actually is, they will take more risks.”

Playground equipment should be age-appropriate, of course--lower monkey bars will help develop a toddler's physical abilities. But they might impede an older child's psychological development or, because they're insufficiently challenging, encourage her to engage in play somewhere else--goofing around a high bridge over a river--that's too risky.

A study published in Evolutionary Psychology describes the value of risky play in encouraging children to confront their fears in order to overcome them. "[W]e may observe an increased neuroticism or psychopathology in society," the authors suggest, "if children are hindered from partaking in age adequate risky play."

Some researchers aren't convinced that children do suffer fewer physical injuries when their recreational corners are padded, but if so, they contend that such playgrounds may stunt emotional development and leave children anxious and fearful. Isn't that worse than a broken ankle?

As Ellen Sandseter, co-author of the Evolutionary Psychology study, told the New York Times, “I think monkey bars and tall slides are great. As playgrounds become more and more boring, these are some of the few features that still can give children thrilling experiences with heights and high speed.”

Sandseter identified six categories of risky play: exploring heights, experiencing high speed, handling dangerous tools, being near dangerous elements (water, fire), rough-and-tumble play (wrestling) and wandering alone away from adult supervision. The most common is climbing heights.

Children progressively raise their adventure bar, Sandseter, said. And that's the way they learn to accept and master challenge. When they fail, they get hurt, physically or emotionally. But as The Times' story reports, if parents and psychologists worry that a kid who suffers a bad fall will develop a fear of heights, studies have shown the opposite: A child younger than 9 who gets hurt in a fall is less likely as a teenager to have a fear of heights.

The gradual exposure to increasing danger is known as habituation. It's the same technique therapists use to help people overcome phobias. And it's hard-wired into our primordial brains: As The Times summarizes, "While a youthful zest for exploring heights might not seem adaptive — why would natural selection favor children who risk death before they have a chance to reproduce? — the dangers seemed to be outweighed by the benefits of conquering fear and developing a sense of mastery."

“Paradoxically,” the authors write in Evolutionary Psychology, “we posit that our fear of children being harmed by mostly harmless injuries may result in more fearful children and increased levels of psychopathology.”

So, parents, here's your long-term homework assignment. Try to understand that your instinct to keep the kids safe is normal and laudable, but it can overrun your child's need to take risks. You can't soften every blow, and--here's the take-home--you shouldn't try.

On the other hand, efforts to remove safety hazards from playgrounds are still important. When the issue is not just bumps and bruises, but head injury and serious harm, parents have a right to insist that playgrounds conform to safety standards.

Because nicotine is possibly the most difficult addiction to kick, because inhaling smoke carries so much destructive potential, you can never try too hard or too often to quit. Now another study shows why smoking around children is a terrible idea.

“Not only are children who are surrounded by secondhand smoke at greater risk for asthma and other health problems,” says the Los Angeles Times, “but they may be more likely to have attention-deficit/hyperactivity disorder or learning disabilities too.”

Researchers at the Harvard School of Public Health found that children who lived with smokers were 50% more likely to suffer from a learning disability, a behavioral or conduct problem or attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD).

Although the study was less than scientifically ideal—it was a phone survey of parents—and some variables were not considered, such as whether the mothers smoked during pregnancy, this is not the first study to connect mental health problems and secondhand smoke.

Another study published in Archives of Otolaryngology–Head and Neck Surgery concludes that exposure to secondhand smoke is associated with increased risk of hearing loss among adolescents.

Fetuses and young children exposed to secondhand smoke are vulnerable to an array of possible problems, including low birth weight, respiratory and ear infections and behavioral problems. Now evidence suggests that adolescents are at risk of compromised hearing.

In the new study, adolescents who were exposed to secondhand smoke showed higher rates of hearing loss than teens who weren’t exposed.

If your teens have been exposed to secondhand smoke, the researchers suggest they be closely monitored for hearing loss, and informed that noise from recreational or occupational endeavors can further impair hearing, even if the kids aren’t aware of it.

The kid who started sneezing and itching and was diagnosed with an allergy when he was 3 might well have communicated sensitivity to the responsible allergens even before he could roll over.

A study in the American Journal of Respiratory and Critical Care Medicine indicates that an allergic future can signal itself within the first month of life, long before symptoms develop.

A certain protein expressed in infant urine predicted lung, nasal and skin irritation by the time children start school. The findings are useful, the researchers wrote, for prevention and to customize treatment when symptoms do manifest.

All of the infants in the study were symptom-free when they were tested at 1 month old. By the time they were a year old, 4% developed chronic respiratory problems (wheezing, coughing), and 27% developed eczema. By the time they were 6, 17% and 15% respectively developed those symptoms.

One health-care analyst takes issue with the groundswell of states considering a mandatory test for newborns that looks for signs of congenital heart disease. Writing on Medpagetoday, Gary Schwitzer says, "The tests aren't always accurate ... and some doctors say they will prompt follow-up tests that could prove expensive -- perhaps as much as $1,500."

He quotes physicians concerned not only about cost, but who question that the tests will even have a positive effect on outcomes. "Politicians love screening tests," Schwitzer writes, "[w]hether evidence supports the tests or not."

For example, he says that at least 28 states have enacted laws requiring insurers to include coverage for prostate-specific antigen (PSA) testing, never mind that the U.S. Preventive Services Task Force (USPSTF) disagrees. He also cites the new federal health-care reform legislation, which ignores the U.S. Preventive Services Task Force recommendations on mammography.

"In the apparent attempt to look like do-gooders, politicians may inadvertently cause harm by legislating screening mandates that don't reflect all of the available evidence."

The trouble with both prostate testing and mammograms is that they produce a lot of false alarms that lead to further testing and sometimes harmful treatment, with no eventual upside in lives saved or lives prolonged.

Of all neurodevelopmental disorders, autism has been deemed the one most likely to be inherited. But this study shows that genes exert only moderate susceptibility for autism, and that its environmental component is substantial.

Autism is a complex disorder whose signature is the disruption of the normal course of social, communicative and cognitive development. Diagnosis is made in early childhood, and symptoms manifest by the time a child is 3 years old. In the last generation, a substantial increase in the prevalence of autism has been reported, from 4 or 5 per 10,000 in the 1960s to around 40 per 10,000 children today. It's even more common to be somewhere on the "autism spectrum" -- as many as one in 100 children qualify. The increase in recent years often is ascribed to better recognition, not necessarily to a greater occurrence.

The study appears to be the largest "population-based twin study of autism that used contemporary standards for the diagnosis of autism," a standard necessary to examine genetic influences. As the authors report, "The results suggest that environmental factors common to twins explain about 55% of the liability to autism. Although genetic factors also play an important role, they are of substantially lower magnitude than estimates from prior twin studies of autism."

In another study related to autism published in in the Archives of General Psychiatry, prenatal exposure to the most widely prescribed kind of antidepressants--including Celexa, Lexapro, Prozac, Paxil and Zoloft— is associated with a modest increase in the risk of developing autism, especially during the first trimester.

"The potential risk associated with exposure," the authors wrote, "must be balanced with the risk to the mother or fetus of untreated mental health disorders. Further studies are needed to replicate and extend these findings."

Pop quiz: Which of the following promote tooth decay?

(A). sugar;
(B). genetics;
(C). low immunity;
(D). watching "American Idol."

The correct answer, of course, is "all of the above" ... with a qualifier for (D). (You have to be snacking on Raisinettes or another sticky fruit while watching the show.)

Although sugar remains the primary suspect in the creation of cavities, people can be genetically disposed toward tooth decay, and low immune function can contribute, as can dietary habits generally considered healthful--sticky fruits such as raisins, although preferable to sucking on a Popsicle, also leave teeth vulnerable to the ravages of sugar residue.

So what can a concerned parent do?

It's hard enough for parents to control so many factors conspiring to turn their kids' mouths into a gaping maw of dental disaster, but now there's something else to consider. According to the Los Angeles Times, several studies have shown that cavity-causing bacteria can be passed from primary caregivers to wee ones.

Children are most susceptible as infants and toddlers, when their immune systems are works-in-progress. But any age before children have the motor skills necessary to brush well by themselves requires parental invervention for maximum protection.

If you want to hold the line on sharing the bacterial love that can compromise your child's oral health not only as a youngster but after the arrival of permanent teeth and into adulthood, first take care of yourself. Expectant mothers should address any dental decay or gum problems before Junior arrives to reduce the likelihood of transmitting disease. And the use of an antibacterial mouthwash during the lower-immune period of infancy and toddlerdom might be wise.

In addition, the dentist should become a close, personal friend of your child probably earlier than you expect. Measures you should take include:

• schedule the first visit to a pediatric dentist at the time the first tooth appears or by the first birthday;


• limit the contents of bottles and sippy cups to water except at mealtime;


• limit snacking to a short interval--bacteria like any kind of sugar, whether from fruit, milk, honey or the refined white sugar in candy;


• assist your child with tooth-brushing until he or she is old enough to tie shoes or write cursive--generally 7 to 9 years old.