Posted On: April 26, 2012

Good News for the No. 1 Killer of Children -- Accidental Deaths Are Way Down

The No. 1 killer of children is accidents. More than 9,000 children in the U.S. died in 2009 from what the Centers for Disease Control and Prevention (CDC) call “unintentional injury.”

As grim as is the reality of children who don’t live to see adulthood, the cold statistics are actually good news—death rates from unintentional injuries among people from birth to 19 declined almost 30 percent from 2000 to 2009, according to the CDC.

Despite the overall good news, a couple of causes of death did see an increase—suffocation rose 54 percent among babies younger than 1 year, and poisonings increased a whopping 91 percent among teenagers 15 to 19. The CDC attributes that stark reality to prescription drug overdoses.

The graphically colorful report in the CDC’s April issue of Vital Signs is the first such study to depict fatal unintentional injury trends by cause and by state for this age group.

The most common cause of accidental death is motor vehicle crashes. Other leading causes are:

  • suffocation;

  • drowning;

  • poisoning;

  • fires;

  • falls.

Thomas Frieden, director of the CDC, said, “Kids are safer from injuries today than ever before. In fact, the decrease in injury death rates in the past decade has resulted in more than 11,000 children’s lives being saved.”

Significantly, death rates from motor vehicle crashes declined 41 percent during the decade of study. The CDC attributes that improvement to improvements in the use of child-safety and booster seats, and the implementation of graduated licensing systems for teen drivers.

Differences in injury death rates varied enormously from state to state. Massachusetts notched fewer than five deaths per 100,000 children, versus New Jersey, South Dakota and Mississippi, which tallied 23 deaths per 100,000 kids.

Addressing the problem of infant suffocation the CDC says, requires widespread adherence to the American Academy of Pediatrics’ guidelines for safe sleeping environments. Those measures include infants sleeping alone, on their backs in cribs with no loose bedding or soft toys.

To reduce prescription drug poisoning, the agency says, providers must prescribe drugs appropriately, and parents must ensure their teens store and dispose of drugs properly, and they should monitor these practices. Also, teens must be discouraged from sharing medications. The CDC also recommends that states establish prescription drug monitoring programs. We recently wrote about prescription drug misadventures being responsible for a disproportionate number of childrens’ emergency room visits.

“Every four seconds,” said Linda C. Degutis, director of the CDC’s National Center for injury Prevention and Control, “a child is treated for an injury in the emergency department, and every hour, a child dies as a result of an injury. Child injury remains a serious problem in which everyone–including parents, state health officials, health care providers, government and community groups–has a critical role to play to protect and save the lives of our young people.”

For more information about preventing injuries to children and a copy of the CDC’s National Action Plan on Child Injury Prevention, compiled in conjunction with 60 partner organizations, link here.

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Posted On: April 19, 2012

Children Whose Hearts Stop

Happily for most parents, heart trouble is pretty well off their child-care radar. When a child succumbs to cardiac arrest, often it’s a shock and a surprise.

But by some estimates, according to a recent story on MedPage Today, there might be warning signs in as many as half of all cases of sudden cardiac arrest in children. Awareness by clinicians of these signs and a thorough understand of family history by both parents and pediatricians can prevent sudden cardiac arrest in youngsters, says the American Academy of Pediatrics in the journal Pediatrics.

A primary point in the academy’s statement was that some symptoms of cardiac problems in children commonly are associated with other, less dire disorders. Pediatricians must remain not only vigilant in observing them, but open-minded about their cause because pediatric sudden cardiac arrest can be lethal within minutes if it goes unrecognized and untreated.

Approximately 2,000 such deaths are estimated to occur annually in the United States.

Symptoms can include chest pain, dizziness, exercise-induced syncope (temporary loss of consciousness) and dyspnea (difficult or labored breathing). Any or several of these symptoms might have been disregarded by the patient and family, the article notes.

A detailed family history that yields knowledge of a sudden, unexplained death of a young relative also warrants scrutiny of any child exhibiting symptoms of what can easily be ascribed to getting tackled on a Pop Warner football game, or too many rides on the Tilt-a-Whirl.

The most common underlying causes of sudden cardiac arrest among children are:

  • structural or functional disorders such as hypertrophic cardiomyopathy, a heart defect in which the muscle wall is so strong that it can’t relax enough to allow sufficient blood flow;

  • coronary artery anomalies, or congenitally malformed heart vessels;

  • primary cardiac electrical disorders, when the heart’s electrical system malfunctions.

An afflicted child most frequently experiences ventricular tachyarrhythmia, which is an abnormal heart rhythm that is rapid and regular. It originates in the lower chamber, or ventricle, of the heart. Sometimes arrhythmias are of short duration, and resemble seizures.

If a doctor or parent believes a child is having a seizure, he or she probably will be referred to a neurologist. If the real problem, however, is heart-related, the delayed diagnosis can be disastrous.

Similarly, if a child experiences breathing trouble, someone might believe he or she has a respiratory problem, and send to a pulmonary specialist.

If your child has experienced any of the symptoms above, was diagnosed and treated for a problem other than a heart issue and has not responded, see a pediatric cardiologist immediately.

The academy advises use of these risk-assessment tools, which haven’t been validated or assessed for sensitivity or specificity; nevertheless, experts emphasize that if any of the following have occurred, the patient should get a cardiac assessment as soon as possible:

  • a history of fainting or having a seizure, especially during exercise;

  • past episodes of chest pain or shortness of breath with exercise; and/or

  • a family member with unexpected sudden death or a condition such as hypertrophic cardiomyopathy or Brugada syndrome (a certain kind of heart rhythm disorder heart rhythm disorder characterized by a specific abnormal heartbeat and detected by an electrocardiogram test).

Although heart screenings have long been overused, in the case of young athletes, the academy advised against following earlier American Heart Association guidelines that did not endorse widespread use of ECG tests. (The AHA rightfully cited the possibility of false-positive and false-negative results, additional cost and associated problems.) The academy advised screening young athletes before they participate in sports.

The academy also recommended that automated external defibrillators be widely available in schools, as well as cardiopulmonary resuscitation training of staff and others. Parents should determine if these tools are present in their child’s school, and lobby for them if they are not.

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Posted On: April 13, 2012

Autism Rates Rise

When awareness of a disease or disorder hits critical mass, often its rate of diagnosis increases. That provokes the chicken-and-egg question of which came first, the incidence of disorder or the awareness of it?

In recent years, many people have looked at autism, and the spectrum of autism disorders, through that lens. A recent study boosts the notion that the prevalence of autism in children is increasing. The U.S. Centers for Disease Control and Prevention concluded that 1 in 88 8-year-olds has some form of autism. The previous estimate was 1 in 110.

Based on 2008 data, the updated figure is sure to fuel debate, according to the Los Angeles Times, over whether a growing environmental threat could be responsible. “But autism researchers around the country said the CDC data—including striking geographic and racial variations in the rates and how they have changed—suggest that rising awareness of the disorder, better detection and improved access to services can explain much of the surge, and perhaps all of it.”

Some experts questioned the validity of relying on records to reach the new estimate.
David Mandell, an autism expert at the University of Pennsylvania, told The Times that the CDC's numbers primarily reflect the degree to which the diagnosis and services have become established in different places and among different groups.

"As the diagnosis is associated with more and more services, this becomes a less and less rigorous way to determine the prevalence of autism," he said, referring to the CDC's methods.

Among the CDC’s results:

  • Utah, which has widespread screening programs, had the highest rate—1 in 47 children.

  • New Jersey, which also boasts generous autism services, is next at 1 in 49.

  • Alabama, one of the poorest states in the country, ranked last. Its autism rate fell between 2006 and 2008 from 1 in 167 to 1 in 208.

The study did have limitations. Researchers looked at tens of thousands of health and special education records in 14 states, looking for an autism diagnosis or symptoms that might indicate one. In some areas, researchers had access only to health records, not school records, and prevalence estimates there generally were lower.

The researchers’ goal was to focus attention on the need for more vigorous screening early in life. Early intervention has been shown to confer the best long-term prospects for autistic children. More than 1 in 5 children deemed autistic by the CDC had no such diagnosis in their records.

A recent series of studies in the journal Nature indicated that the genetic origin of autism is complicated and involves multiple genes. The cause of autism is unknown. There is no blood test or other biological marker—it’s diagnosed by symptoms, which are social and communication difficulties starting in early childhood, and repetitive behaviors or abnormally intense interests. The severity of symptoms can vary widely. Boys are more likely to have the disorder, and whites somewhat more likely than minorities. Ultimately, a diagnosis involves clinical judgment.

Some people, including representatives of Autism Speaks, an advocacy group, believe that the disorder is becoming epidemic in the United States. Others say raised awareness of the disorder enables health-care providers and school authorities to deem a child autistic.

To learn the symptoms of autism, link here. Autism Speaks’ Autism Response Team (ART) members are trained to connect families with information, resources and opportunities. Contact them at 888-288-4762.

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Posted On: April 4, 2012

Common Products That Can Poison Children

According to the American Association of Poison Control Centers, approximately half of all poison exposures involve children younger than 6.

Most parents are pretty good at identifying and keeping their children safe from obvious toxins, from cleaning fluid to blood thinners. But many common household items, not to mention the contents of mom’s purse, are attractive and potentially lethal.

In his job as director of the Toxics Epidemiology Program for the Los Angeles County Department of Public Health, Dr. Cyrus Rangan tracks and responds to toxic exposures and consults with patients exposed to toxins. Following is his list of common products that pose a poison threat, and why.

  • Button batteries (for hearing aids, watches, etc.) can get lodged in the airway or the esophagus, causing third degree burns and bleeding. Note that these potentially lethal button batteries can even be found in toys.

  • Chewing gum is generally safe, but a young child can choke on pieces of gum. Nicotine gum is very poisonous to young children.

  • Cough drops taste sweet and might seem like candy to young children. But some contain medications like destromethorphan, which can cause gastrointestinal and vision problems, among others. Also, kids can choke on cough drops.

  • Sanitary gel can be 60 percent alcohol (120 proof). If ingested, a small bottle is like giving a kid a couple small shots of hard liquor.

  • Cigarettes carry a unique smell and taste that is attractive to some young children. Acute nicotine poisoning can result if they ingest a cigarette.

  • Nail polish remover can cause gastrointestinal distress, and can be even more harmful if vomited and inhaled into the airways. These products seldom come in child-resistant containers.

  • Pepper spray can be extremely irritating to the eyes, mouth, throat and lungs of anyone, but it’s worse for children, and such devices are easily deployed by accidental.

  • "Gummy" vitamins look and taste like candy. Although toxicity is likely to be low, there’s a larger issue here of referring to medicine as candy. Children should learn that medicine is medicine, candy is candy and confusing them is dangerous.
  • Over-the-counter medications, like cough drops and gummy vitamins, are often colorful, coated with sweetener and mistaken for candy. Some can be just as dangerous to a young child as prescription medications. We’ve tracked the checkered history of one such notable example, acetaminophen.

  • Prescription medications that aren’t stored safely away from youngsters are hazardous. We’ve addressed this hazard, and the fact that many can kill a 2-year-old in a single dose. Never store them in a container other than what they came in.

If your child has ingested a toxic product or substance, or has a reaction to something he or she has touched, contact the National Capital Poison Center at (800) 222-1222. If you think your child might have swallowed a button battery, go to the nearest emergency room.

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