DC Child Accident & Safety Blog

One in 100 newborns has a malformed heart. It's the most common birth defect. Now, a federal advisory panel recommends a simple and painless test for all newborns to detect such defects before the babies are released from the hospital.

Pulse oximetry measures the amount of oxygen in the blood via a small light sensor taped to a baby's wrist, hand or foot. It's inexpensive ($5-$10), fast (five minutes) and can detect a life-threatening condition otherwise difficult to find in a physical exam. An infant's cardiovascular system might appear normal in the first few days after birth, even though it continues to mature.

According to WebMD, only two states -- Maryland and New Jersey -- legally mandate the test. Some hospitals elsewhere do it voluntarily, but it's not in widespread use.

The federal panel's advice has been endorsed by the American College of Cardiology, the American Heart Association and the American Academy of Pediatrics.

If you're expecting, and you don't live in Maryland or New Jersey, make sure your hospital knows you want the test to be performed before your bring junior home. The chances of heart problems are low, but it's better know if there is one -- and to address it -- before it presents far from where it can be treated.

Time was, if you “got your bell rung” on the field of athletic play, it was a badge of honor. And if you could “shake it off” and get back into the game, you were a stud, and a role model for the rest of your teammates and spectators.

How quaint. In recent years, studies have proved that a concussion — having your “bell rung” — is not something to banner on your jock resume, but a signal to slow down, recuperate and accept that concussions can be precursors to brain damage.

It is critical, especially, that parents receive and understand this message. Although equipment manufacturers, trainers, doctors and coaches are beginning to embrace the need to protect against concussion, there’s still a macho element of sports competition that believes you’re supposed to play through pain.

A story about wiser heads prevailing appeared recently in the New York Times, which profiled a new initiative by a sporting goods chain to prevent and treat concussions in student athletes. Dick’s Sporting Goods is sponsoring neurocognitive testing of more than 1 million athletes to establish a baseline of healthy brain activity.

Referred to as ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), the tests profile each student’s baseline of brains functions such as verbal and visual memory and reaction time. The results are compared with the results of the same tests given in the event of a suspected concussion. If the comparison signifies deterioration, the player is benched until deemed healthy enough to resume play.

Called Protecting Athletes through Concussion Education (PACE), the program employs a diagnostic procedure also used by professional sports associations including the National Football League, Major League Baseball and the National Hockey League.

As The Times’ story notes, approximately 300,000 sports- or recreation-related concussions are diagnosed nationwide yearly, but, according to the American College of Sports Medicine, approximately 8 in 10 concussions go undiagnosed.

There’s information, and there’s the useful application of information. To boost the chances of concussion-awareness getting through to student jocks and their parents, Dick’s has employed the services of former Pittsburgh Steelers’ running back Jerome Bettis in a commercial to convey the importance of baseline testing.

Known during his career as “The Bus” for dragging defenders down the field, he’s featured with a football helmet and saying, “You wouldn’t get on the field without this — and you shouldn’t get on the field without a baseline concussion test either.”

As reported by The Times, Bettis had several concussions, and said that he wished he had known more about the symptoms and the potential long-term impairment. “[H]ad I known then what I know now,” Bettis said, “I would have handled it differently and I would have told the trainers, because the last thing I want is 20 years down the road to not have my brain function correctly.”

If your children participate in sports or a recreational activity with even the slightest potential for head injury, ask the school, athletic association or your physician how to get a baseline concussion test. And stay involved during the season — ensure that equipment is adequate, and that the coaches, trainers and other adult supervisors are as concerned about head injury as you are.

The Empowered Patient Coalition has put together a moving short video of some of the many children killed from malpractice and other medical errors. Watch it here.

Then check out the Coalition's website for tools on how you can be a safer, smarter patient for yourself and your loved ones.

Helen Haskell and Dr. Julia Hallisy are mothers of children harmed by medical error who founded the Empowered Patient Coalition to try to make the medical system better and safer for future patients.

Another touching video on turning medical tragedy into something positive was put together recently by Mary Ellen Mannix, a mom who lost a baby to medical mistakes in 2001. She went on to start James's Project, which focuses on patient safety to improve infant mortality and maternal health. Watch the video here.

It’s parental instinct to want to make a child’s world as safe and normal as possible. And when that world is different from the one most other children live in, parents want to know why.

When a pediatrician’s patient lives in the world of autism, explaining the whys and whats to the parents is particularly daunting. Writing in the New York Times recently, Dr. Perri Klass addressed how she relates to parents of autistic children who want to know the cause and, for prospective parents, how they can reduce the risk for children they’re planning to have.

“[A]lthough there is more research in this area than ever before,” she writes, “it sometimes feels as if it’s getting harder, not easier, to provide answers that do justice to the evidence and also offer practical guidance.”

Autism is a complex disorder that research has shown is driven by both genetic and environmental factors. As Klass describes, “Genes matter, but we usually can’t tell how. Environmental exposures matter, but we usually don’t know which.”

Not much there for parents to work with.

A study of autism in twins showed that fraternal twins were both likely to have the disorder, which seems to compromise the strength of the genetic component (since fraternal twins share fewer genes than identical twins).

A couple of generations ago, when ignorance about all mental disorders was evident far more than common sense, autism was blamed on remote parenting. More recently, a noisy campaign was based on fake science supposedly indicating an association between childhood vaccinations and autism, a theory that has been wholly discredited.

But the genetic influences have been proved scientifically sound, and autism spectrum disorder has been described by the American Psychiatric Association as “among the most heritable of psychiatric disorders.”

This evolution of understanding has led scientists to accept that autism results both from genetic predisposition and from environmental influence. But “environment” is a fluid concept.

As one researcher quoted by Klass put it, it’s “everything that’s not the inherited DNA.” Parents might wonder about the chemical ingredients of the placenta’s soup, about the mother’s nutritional profile, her stress level, about the caustic cleaning products under the sink … They’re all part of a developing fetus’s environment.

According to Klass, “The causal links most strongly supported by research include rubella (measles) infection during pregnancy and prenatal exposure to medications like thalidomide and valproic acid, an anti-seizure drug.” Air pollution and exposure to pesticides have an association with autism, but there’s no evidence of causality.

Phthalates, which are chemicals found in flexible plastic products such as shower curtains and other household furnishings such as carpet and shampoo, can leach out in microscopic amounts and disrupt a variety of developmental processes, including brain development. But, again, they haven’t been shown to be a cause of autism, only as an association with its symptoms.

Bottom line: Autism is a custom-made disorder, and probably the result of several factors.
“So it’s hard — and frustrating — to offer prospective parents advice about avoiding risks we still can’t clearly identify,” Klass observes, “and factors that may differ from family to family.”

You can’t completely sanitize your environment, you can’t turn your uterus into a scientific “clean” room — potential toxins are simply a part life. But Klass does offer prospective parents concerned about autism some advice that’s more a prescription of common sense than a prophylactic:

• Take prenatal vitamins before trying to conceive.


• Ensure your immunizations are up to date.


• Get good prenatal care.


• Discuss the risks and benefits of any medications you take with your doctor.


• Avoid pesticides.


• Don’t microwave food plastic containers.


• Use fragrance-free personal products.

“Still, Klass concludes, “it’s hard to talk about this without terrifying parents. And I wonder if in giving advice about prevention, we risk repeating the errors of the past, making parents feel they’re to blame for a child’s autism because they failed to micromanage an environment full of complex agents with potential to interact with fetal genes in a range of damaging but poorly understood disruptions.”

A better, earlier way to diagnose amblyopia — commonly called “lazy eye” — has been reported by ophthalmologists at Children's Hospital Boston. A screening procedure that takes only seconds with a handheld scanning device may enable pediatricians to identify the disorder that causes a loss of vision in a structurally normal eye. The ophthalmologists tested 202 children with the Pediatric Vision Scanner, some as young as 2.

Lazy eye usually results from a misalignment of the eyes or from one eye having a weaker focusing power. In either case, one eye is underused, and vision deteriorates as the brain loses its ability to interpret visual information from that eye. Lazy eye affects 3% to 5% of children and is the leading cause of vision loss in childhood.

The younger the patient, the more responsive to treatment. But the disorder is difficult to detect in young children because they cannot reliably communicate what they’re seeing, and they can’t read eye charts.

"The eyes of a child with amblyopia can look perfectly fine, even while one eye is slowly losing vision," said David Hunter, chief of ophthalmology at Children's Hospital Boston and an author of the study published in the journal Investigative Ophthalmology and Visual Science. "Once a child reaches school age, treatment is less likely to restore useful vision.”

Doctors can reverse lazy eye by patching the stronger eye or blurring it with eye drops, forcing the child to use the weaker eye. Hunter hopes pediatricians will use the scanner to screen toddlers and preschoolers for amblyopia during annual well-child visits, and that health insurers will cover the cost. Some states mandate eye exams just before kids begin school, but that’s too late to treat amblyopia most effectively, according to Hunter.

Do you text while driving? Have a swimming pool at home without a cover? Have a gun in your house?

All sensible questions for pediatricians to ask parents and adolescent patients, looking for ways they can help improve home safety. But the last question, about guns, is now officially off limits for any Florida doctors to ask, thanks to a National Rifle Association campaign that succeeded in persuading the Florida Legislature that the question was too intrusive of privacy.

Having represented grieving parents whose child was killed by an accidental gun discharge at a neighbor's home whom they didn't know had a gun inside, I can relate to the desire of pediatricians to cut the toll of tragic gun deaths by asking parents this simple question. The question is intended to trigger a safety talk about the importance of keeping the gun unloaded and ammunition locked up where kids cannot get to it.

Because when kids are fooling around with a loaded weapon and it goes off, no one can put the bullet back in the gun.

Read more on the gun question from a pediatrician's perspective in a recent New York Times essay.

The information and advocacy outfit KidsHealth has issued a list of the top five illnesses parents should look out for during the school year, and how to address them. They are:

• 1. Pinkeye: Also known as conjunctivitis, pinkeye is very contagious when caused by viruses or bacteria. To prevent spreading it, kids should wash their hands often with warm water and soap; not touch their eyes; and avoid sharing eye drops, makeup, pillowcases, washcloths, and towels.


• 2. Strep Throat: It spreads through close contact, unwashed hands and airborne droplets from sneezing or coughing. Anyone can get strep throat, but it’s most common in school-age kids and teens. To prevent the spread of it: keep a sick child’s eating utensils separate and wash them in hot, soapy water or a dishwasher; the child shouldn’t share food, drinks, napkins or towels; teach kids to sneeze or cough into a shirtsleeve, not their hands.


• 3. Head Lice: The critters are common among kids 3-12 (affecting girls more often than boys), but anyone can get this infection. It’s not a sign of poor hygiene and lice do not spread disease. To prevent the spread of lice, discourage sharing combs, brushes, hats and helmets.


• 4. Molluscum Contagiosum: This skin rash is common among kids 1-12, yet many parents are not familiar with molluscum contagiosum. It spreads easily, most commonly through skin-to-skin contact, but kids can get it by touching objects bearing the virus such as toys, clothing, towels and bedding. To prevents the spread of the virus, wash hands frequently with soap and warm water and avoid sharing towels, clothing or other personal items.


• 5. Walking Pneumonia: The leading type of pneumonia in school-age kids and young adults spreads through person-to-person contact or breathing in airborne particles from sneezing or coughing. Walking pneumonia usually develops gradually and can be successfully treated with antibiotics. To prevent the spread, encourage kids to wash their hands thoroughly and frequently.





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

Posted In: School Safety

Few things are as satisfying in the parent-child relationship as affectionate physical contact. But some psychologists have drawn the line at parents sharing their bed with their children. As noted in a story on WebMD, the American Academy of Pediatrics advises parents not to sleep with their infants because of an increased risk of sudden infant death syndrome, but what about toddlers, who often are the ones seeking the comfort of the parental bed?

Not to worry. New research published in the journal Pediatrics says that toddlers who share a bed with their parents do not face increased risks for behavioral or learning problems at age 5.

"The idea that bed sharing may be bad for toddlers is mostly based on folklore," researcher R. Gabriela Barajas of Teachers College of Columbia University told WebMD. "From what we see, there is no additional risk of behavioral and cognitive problems among toddlers who share a bed with their parents."

The study involved children from 944 low-income families who were assessed at ages 1, 2, 3, 4 and 5. Nearly 50% of families said they had shared a bed at least once; 73% of the families in the study were living below the poverty line. The study did not look at why the children were sleeping in their parents' beds, information that could be critical.

"In some higher socioeconomic groups, co-bedding can be a parenting-style issue and in others, it may be trouble-shooting a sleep problem," said Nanci Yuan, M.D., of the Pediatric Sleep Center at Lucile Packard Children's Hospital at Stanford University.

"If it is because you feel like it is bonding and your child is otherwise healthy, growing, and thriving, then bed sharing is not associated with cognitive and behavioral problems," she said.

A new study published in the journal Pediatrics offers insight into why children with attention-deficit/hyperactivity disorder (ADHD) are able to observe safety measures when crossing the street, but often fail to do so.

Seventy-eight children from 7 to 10 years years old were involved in the study. Thirty-nine were diagnosed with ADHD and 39 were typically developing children. Researchers looked at three things: (1) how they evaluated their environment before crossing the street; (2) how they decided to begin crossing; and (3) how safe was the environment after the decision to cross was made.

No significant differences emerged in the latter two factors, but the children with ADHD chose riskier pedestrian environments in which to cross. Researchers concluded that this reflected trouble within the brain's "executive function" -- that is, the kids with ADHD were less able to process perceived information necessary to permit a safe cross.