Posted On: October 26, 2012

How to Keep Your Kid Safe and Out of the ER on Halloween

If you can’t stand the idea of your children eating all that candy they collected on Halloween, maybe you can find consolation that at least they had to take a walk to get it.

OK, maybe not. But too much sugar might not be your biggest concern on this popular kid holiday.

"Nothing is scarier than a trip to the emergency room," Dr. Mark Cichon, chairman of Department of Emergency Medicine at Chicago’s Loyola University Health System, told "In a season devoted to frights, it is our goal to keep everyone safe."

Here, as published on ScienceDaily, are Cichon's tips to help keep your child from becoming one of the 9.2 million U.S. youngsters injured seriously enough every year to require ER treatment.

  • Don’t use common kitchen knives to carve a pumpkin—they’re difficult for an adult, much less a child, to manipulate on a hard rind. Invest in a pumpkin-carving kit.
  • Supervise anything that is burning, from candles to carved pumpkins to firepits. Fires ignite quickly and behave erratically.
  • Make sure costumes offer visibility and ease of movement. Masks, hats, wigs, glasses and hoods can obstruct vision, and restricting the legs and feet can cause trips and falls.
  • Dress for the weather. Make sure footgear is waterproof and has treads if it’s wet during the trick-or-treating adventure.
  • Make sure one adult in the trick-or-treating group wears a reflective safety vest. Make sure each child has a glow stick or flashlight. In other words, see and be seen. If you’re traveling with a group, stay together and put kids on the buddy system.
  • Drive slowly and cautiously on Halloween, especially on side streets.
  • Inspect the treats when you get home. Make sure the haul is age-appropriate—tiny pieces of candy are choking hazards for younger children. Reject anything unwrapped or, sadly, homemade, unless you know the chef.

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Posted On: October 19, 2012

Is It Safe for Pregnant Women to Eat Fish?

Americans are conflicted about fish. Some of us like to catch them, some of us like to release them and many of us eat them. Health professionals say that fish is good for us (it’s high in protein, most varieties are low in fat and many have heart-healthy properties), that we should eat more. Others take care to note that some varieties of fish are particularly prone to toxic exposure to mercury.

So what’s a pregnant woman to do, especially in light of a new study that shows that a prospective mom’s fish-rich diet can offer protection against the child later developing behaviors associated with attention-deficit/hyperactivity disorder (ADHD)? Especially in light of the Journal of the American Medical Association’s advice (JAMA) that for pregnant women, mothers who are breastfeeding and women of childbearing age, fish consumption is important for its DHA, an omega-3 fatty acid that aids infant brain development?

The new study, published in the Archives of Pediatric and Adolescent Medicine, involved children born during the 1990s in Massachusetts; 515 women who had just given birth completed a dietary survey and about 420 provided samples of their hair for mercury testing. About eight years later, researchers tested the kids to assess behaviors associated with ADHD.

The results, as reported on, ranged from children with almost no ADHD-related behaviors to some with clear clinical disease. The mother’s hair-mercury level related to where her child fell along the spectrum.

The data, the researchers said, demonstrate that a woman can eat fish regularly, but also maintain a low-mercury diet. “It really depends on the type of fish that you’re eating,” one of the authors told ScienceNews. Some study participants had been eating more than two servings of fish weekly but tested for relatively little mercury.

Like lead, mercury is a potent neurotoxin that has been linked to many health problems, including delays in neural development. To see our post about the toxic nature of lead, click here.

In the study, children of women with hair mercury levels in the top 20 percent of those tested showed a 50 to 60 percent increased risk of ADHD-related behaviors. But the kids with ADHD-related traits “were still considered to be within the normal range,” the researcher said, “and not maladaptive.” (On some components of the childrens’ assessment for attention, boys showed a greater sensitivity to mercury than girls.)

Other studies have reached similar results. One based in Canada, according to ScienceNews, found an association between elevated mercury concentrations in children at birth and at school age, and an increased risk of ADHD by about age 11. That study also confirmed earlier evidence suggesting a link between lead and ADHD.

Some studies, however, indicate a genetic susceptibility to ADHD in some people. Environmental pollutants, too, are considered by some people to be risk factors. They include tobacco smoke and possibly polychlorinated biphenyls (PCBs), certain pesticides and bisphenol A (BPA).

The new study didn’t collect data on the species of fish the mothers ate. But its researchers said that previous studies have shown that tuna, swordfish and shark can be particularly high in mercury; salmon and cod tend to be relatively low in the toxic metal.

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Posted On: October 12, 2012

Chronic Conditions in Kids Raise the Risk of Hospital Medical Error

About 44 in 100 pediatric inpatients suffer from chronic illnesses such as asthma, diabetes, epilepsy and cancer, according to the journal Pediatrics. And these sick kids are more likely to experience a medical error during the course of their treatment than patients who are seen for acute conditions.

In the study, medical errors were defined as abnormal complications to a specific medical procedure, adverse reactions to medications, infections and bedsores. But it is unclear how severe the medical mistakes were or if they caused significant or long-term harm.

Logic tells you that the increase in probability of a medical error is higher in someone who’s chronically ill—after all, the longer someone’s hospitalized and the worse his or her condition is, the higher the chances of complications from it. Duration and difficulty make treatment more challenging and exposure to infectious agents more likely.

The study involved 38 states in the 2006 Kids’ Inpatient Database (KID) to determine medical error rates. As reported on, not only was the medical error rate higher per 100 hospital discharges in children with chronic illnesses, but it was also higher per 1,000 inpatient days in children with chronic conditions.

In the 2006 KID:

  • more than 22 in 100 pediatric inpatients had one chronic condition;

  • nearly 10 in 100 had two chronic conditions;

  • 12 in 100 had more than three chronic conditions.

The researchers said that as many as 43 in 100 U.S. children have at least one chronic health condition, and almost 20 in 100 have two. These patients represent an increasing proportion of pediatric hospitalization, and account for the majority of noninjury hospital admissions. Children with special medical needs also are more susceptible to errors in emergency situations.

A report by the Institute of Medicine (IOM) found that nearly 98,000 people die in hospitals each year from a medical error that could have been prevented.

The message of the Pediatrics study was simple: The more chronic conditions a child suffers, the greater the likelihood that an error will occur when they are in the hospital. And the greater the need for parents to be strong patient advocates. To learn how, see our newsletter, “Protecting a Loved One in the Hospital.”

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Posted On: October 5, 2012

How to Treat Anaphylaxis When Kids Are at School

It might be the result of a bee sting or the ingestion of a peanut, but whatever the cause, when anaphylaxis occurs it can be life-threatening.

Anaphylaxis is an acute allergic reaction to a specific antigen (food, pollen, drugs, etc.); it’s the immune system’s whole-body response to the presence of an allergen it perceives as a threat. Symptoms generally occur immediately after exposure and might include respiratory distress, swelling of the lips, eyes and throat, rash, low blood pressure, bleeding and/or vomiting. It can result in cardiac arrest.

Parents of children with known allergies should ensure that their child’s school authorities are aware of the allergy and have a prescription on file for epinephrine in case of emergency. (Epinephrine is the hormone adrenaline and is the primary treatment for anaphylaxis.)

Epinephrine is generally safe, with few adverse effects, if given even when it is not needed.

But according to a recent story in the New York Times, school nurses can find themselves in a horrifying position if a child without such a prescription develops a sudden reaction to an undiagnosed allergy. If they inject epinephrine, they risk losing their nursing license for dispensing it without a prescription. Their only other option is to call 911 and hope the paramedics arrive in time.

Some states have passed laws to enable school caregivers to have epinephrine injectors on hand and to give a shot to any child with an emergency. Mylan, which markets Pfizer’s EpiPen, the most commonly used injector, is lobbying for such federal legislation. The company has lobbied individual state legislatures and has distributed free EpiPens this year to schools.

Sure, it’s a naked grab for market share, but it also makes medical sense.

As The Times reports, Mylan has spent millions on consumer advertising and has hired scores of sales representatives to help promote the product. It’s estimated that EpiPen sales will total $640 million this year, a 76 percent increase over last year, according to one analyst.

A study last year in the journal Pediatrics found that about 1 in 13 children had a food allergy, and nearly 40 percent of those with allergies had severe reactions.

Efforts to make epinephrine more widely available, The Times says, are an acknowledgment of the rising rates of food allergies among children and the handful of deaths from allergies across the country. Some children with known allergies carry their own epinephrine injectors to use themselves, if they’re old enough, or the devices are kept in their school nurse’s office.

It’s unclear why the rate of food allergies among children appears to be increasing. “I don’t think it’s overdiagnosis,” Dr. Scott H. Sicherer, a researcher at the Jaffe Food Allergy Institute at Mount Sinai Medical Center in Manhattan, told The Times.

A Mylan executive said schools were just the first place to make emergency epinephrine injectors more widely available. The company would like to see them as available as defibrillators—in restaurants, airplanes and other public places.

The Food Allergy and Anaphylaxis Network (FAAN) has not taken a position on placing injectors in public places other than schools, and Sicherer wondered about their suitability in settings such as restaurants, where staff might not be able to tell the difference among choking, a heart attack or anaphylaxis.

Next month, Sanofi plans to introduce a rival epinephrine delivery device, and in 2015, Teva may win approval of a less expensive generic version of the EpiPen, according to The Times. Sanofi’s Auvi-Q features voice instructions and Teva’s product, if approved by the FDA would closely mimic the EpiPen design and, like a generic drug, could be substituted by pharmacists even if doctors prescribed the EpiPen.

To learn about the latest developments in food allergies, visit the NAAN site. To learn about the widespread practice of bogus testing, see our blog about free allergy tests. To learn about the early signs of allergy, see our blog here.

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