Posted On: October 27, 2011

Stripping Down the Crib to Cut the Risk of Sudden Infant Death

When it comes to babies and sleep, the American Academy of Pediatrics (AAP) has made it official: Less is more.

Its new guidelines call for cribs empty of everything except the baby and the tightly sheeted mattress. No blankets. No bumpers, pillows or toys. They’re all hazardous for babies because they present a risk of suffocation, entrapment and asphyxia.

In a report for NPR, pediatrician Rachel Moon, chairwoman of the AAP Task Force on Sudden Infant Death Syndrome (SIDS), said, "Babies can roll into [anything] soft and suffocate against it, and babies can crawl under it and suffocate. Even the hard bumper pads are a problem because babies can scoot in and get their head wedged in between the mattress and the bumper pad and can't get out."

In the last two decades, the incidence of SIDS has fallen dramatically, thanks to the academy’s evolving understanding of the syndrome. All parents now are schooled in the "Back to Sleep" idea: Put your baby to sleep on her back, not her stomach; the admonition to keep cribs clear is another effort to address SIDS, which still causes about 2,300 babies to die every year in the U.S.

Some products claim they can help prevent SIDS, but that’s bogus. In fact, the FDA has issued a consumer alert about such claims.

The only proven methods to reduce the chances of SIDS are proper sleeping posture and clear cribs. In addition, the academy recommends that cribs be located in the parents’ room -- but babies should not sleep in the same bed – and that babies be breast fed and immunized to prevent infant death. The latter two help prevent infection, which often precedes an incident of SIDS.

Other habits pregnant women indulge that appear to increase the risks are smoking, drinking alcohol and taking illicit drugs.

Still, accidental suffocation may account for some SIDS casualties, and some babies are particularly vulnerable because their brains haven’t fully matured and they don't wake up easily when faced with an obstacle.

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Posted On: October 18, 2011

Youth and Tanning Beds: Do Not Mix

The groundswell against the use of tanning beds got an additional boost last week when California Gov. Jerry Brown signed legislation prohibiting children younger than 18 from using the body-bronzers as of January 2012. California is the first state to enact such a ban.

In March, the American Academy of Pediatricians called for a tanning-bed ban for minors, and last year an FDA advisory committed made similar recommendations.

An increasing body of evidence says that the risk of skin cancer from tanning beds might be much higher than previously expected. According to the Journal of Investigative Dermatology, the ultraviolet rays produced by most tanning beds penetrate deeply into the skin, causing significant damage.

According to AboutLawsuits.com, some studies have shown that use of tanning beds by young adults results in eight times the risk of developing melanoma, a deadly form of skin cancer. A study by the World Health Organization indicated that use of tanning beds before the age of 30 might increase the risk of skin cancer by 75%.

The American Cancer Society says that melanoma is diagnosed in about 69,000 Americans each year and causes about 8,650 deaths annually. Melanoma is highly curable while it's confined to the skin, but once it penetrates deeper, it can go to the brain and other vital organs.

A memorable client of Patrick Malone's died from medical malpractice in the failure to remove a mole from his lower back before it turned into a fatal melanoma. You can read about Richard Semsker in Malone's book, "The Life You Save," and on Patrick Malone's law firm website. Mr. Semsker's case had nothing to do with tanning beds, but shows how simple missteps in communications among his doctors could cause an unnecessary death.

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Posted On: October 9, 2011

MRIs and Children: What Is the Appropriate Use?

Medical ethicists have been grappling with the use of magnetic resonance imaging (MRI) for pediatric clinical trials. They have been trying to clarify how MRIs can meet the “minimal-risk standard” used by ethics committees to determine if a study is permitted to proceed.

The side effects of MRIs have been clear, but until the publication of a study in IRB: Ethics & Human Research, it wasn’t clear what factors contributed to the diagnostic tool’s problems overwhelming its utility.

The study concluded that the risks of physical and psychological harm to a child undergoing an MRI are no greater than the risks associated with a healthy child’s everyday activities. The problem comes in the form of the intravenous contrast dye or sedation sometimes used in conjunction with the MRI – they increase the odds of harm to an unacceptably high degree.

MRI is a popular diagnostic device because it affords exceptional views into the human body. The physical risks involve its strong magnetic force, and the psychological harm most often comes in the form of anxiety. The procedure can be claustrophic, noisy and time-consuming.

To parse the problems with MRIs, researchers examined the risks from MRI alone, and those attendant to using contrast-enhancing agents and sedation in conjunction with it. They found that:


  • The risk of physical injury from MRI was 17 in 100,000 examinations, and the risk of death was 4 in 100 million examinations.

  • The risk of injury in children younger than 16 was 4 in 100,000 hours of playing soccer, and 12,730 in 100,000 hours of playing ice hockey.

  • The risk of death from riding in a motor vehicle for children younger than 14 was 6 in 100 million car trips, and for teens from 15 to 19, 40 in 100 million.


Assuming that an MRI examination lasts an hour, the risk of injury associated with an MRI falls within the lower end of this range, the authors write.

Psychological harm in children between 10 and 18 included:


  • being disturbed by the confined space, about 1 in 10;

  • being bothered by the noise, about 15 in 100;

  • being unable to complete the MRI scan because of claustrophobia, 1 in 100.

The rates were lower on average than those of children who report fears associated with anxiety disorders; in one study of children between 8 and 13, nearly half reported fears associated with subclinical anxiety and 1 in 5 met the full criteria of an anxiety disorder.

When an MRI examination calls for the injection of a contrast dye, the risk is allergic reaction, such as fever, headache and anaphylaxis (airway constriction, heart abnormalities). The risk of minor reactions from MRI contrast dyes was about 5 in 100, which is comparable to the risk of minor reactions from routine vaccinations. The risk of anaphylaxis was 7.5 in 100,000 doses; that’s higher than the risk of anaphylaxis from vaccinations. “MRI with contrast enhancement therefore does not meet the minimal-risk standard,” concluded the researchers.

They also concluded that the risk from sedation in MRIs, which includes gastrointestinal complaints and motor imbalance, does not meet the minimal-risk standard, based on the risks posed by sedating medications such as over-the-counter cold medicines.

MRI is a valuable diagnostic tool. But in refining its application, we're starting to see, again, how a child is not an adult.

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Posted On: October 3, 2011

Choosing Safe Toys

Toys might be playthings, but protecting your kids from their dangerous effects is serious business. The 2-year-old Consumer Product Safety Improvement Act helped protect little ones from exposure to lead and phthalates in toys, but now there’s another concern: cadmium.

As described by WebMD, it’s also a toxic metal used by manufacturers instead of its predecessors. Regulators and health and safety advocates are lobbying to lop cadmium from the list of toy ingredients, but the question remains: What’s next?

It’s impossible to create a “clean room” for kids, nor would you want to raise a child so divorced from real life. But that doesn’t mean there aren’t ways to reduce exposure to substances that can impair health and to minimize the negative effects some toys have on the environment.

Healthy Stuff is a consumer guide/database that identifies safe toys. It also offers information about testing if any has been conducted. The Consumer Product Safety Commission posts recalls online, as does Recalls.gov. If a toy you own is recalled, follow the company’s instructions on how to get a safe replacement.

Otherwise, here are a few tips to promote fun and reduce the chances of a toy causing more trouble than it’s worth. For everybody.

  • Choose natural over synthetic. Opt for toys made of solid woods with no finish or a nontoxic finish, and organic cotton, wool, felt, and other textiles.
  • Recycle household items. Kids are happy when their imaginations are encouraged to run free. An empty box, a set of stainless steel bowls, empty rolls of paper towels can become a fort, an orchestra, an arsenal of gentle weapons.
  • Avoid cheap jewelry and kids’ cosmetics. These products generally carry a higher health risk. Kid jewelry often contains high lead or cadmium levels and kid cosmetics often are laden with questionable chemicals.
  • Purge plastics. It’s difficult – OK, impossible – but strive to buy less plastic. And when you do, look for those labeled Nos. 1, 2, 4, or 5 within the triangular, recycle arrow icon usually found on the bottom of the product. If there’s no label, call the manufacturer.
  • Buy less. Buy fewer toys. It’s better for the planet and saves you money.
  • Spend more for what you do buy. High-quality toys last much longer and can be enjoyed by successive users.
  • Read labels. What’s the toy made of? Where was it made? Google the manufacturer and/or the toy’s name to find out what other users say.
  • Buy local. The shorter the distance a toy travels from manufacturer to user, the less the greenhouse gas emissions. If you’re buying foreign products, remember that Europe, Canada and Japan have more stringent toy regulations.

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