Posted On: March 29, 2013

Getting Back Into the Game After Suffering a Concussion

When we wrote about kids and concussions a while ago, the discussion concerned the rising awareness of how getting your head banged during an athletic competition can lead to traumatic brain injury, and that sports equipment manufacturers were responding by designing more protective gear.

How quaint. As of last week, the guidelines for treating kids who suffer a head injury on the field of play have become more stringent. At least that’s what the American Academy of Neurology advises.

As reported by the Associated Press, when athletes are suspected of having a concussion, they should be taken out of action immediately and shouldn't resume playing until they've been fully evaluated and cleared by a doctor or other professional with concussion expertise.

The academy’s recommendations support a position paper it issued in 2010, but the new guidelines are a more complete document for evaluating and managing a head injury based on a comprehensive review of scientific research.

The guidelines replace those published 15 years ago that advised grading the severity of a concussion at the time of injury as a way to measure when the player could return to the game. The new recommendations emphasize individual player assessment and management of the injury when it occurs, and are not flexible about returning to play: Don’t do it.

Athletes should not be allowed back into the game if they show any symptoms, such as dizziness, muddled thinking, blurry vision, headaches or nausea. The guidelines also say players of high school age or younger with a diagnosed concussion should wait much longer to return to action than older athletes.

AP pointed out that the research showed that the grading system didn't provide useful information about outcomes, and that recovery from concussion is not predictable—some people recover faster than others. But the first 10 days after a concussion, according to the guidelines, are when a player is at the highest risk of getting a second concussion

And getting that concussion before the first one is healed can lead to longer periods of disabling symptoms. Sometimes the damage, including mental impairment, memory loss, headaches and mood disorders, can be permanent.

So, parents, coaches and trainers, if a child of yours bangs his or her head in the course of the game and is seeing stars, having trouble with balance, unable to focus or complaining of headache, that child does not belong in the contest that day and for days to come. At least.

If your child’s coach (or any other authority) encourages him or her to just shake it off and get back into the game, it’s time to find another place to play.

To learn more about concussions, link here on website of the American Academy of Neurology.

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Posted On: March 22, 2013

EPA Continues to Ignore the Dangers of Lead for Children

In 2001, the Environmental Protection Agency (EPA) set hazard standards for levels of lead, the measure of which is critical to children’s health. Despite calls from the agency’s science advisors, says USA Today, the federal body has no plans to revise those outdated standards.

As we have written, the Advisory Committee on Childhood Lead Poisoning Prevention says no amount of lead in a child’s body is safe. Children’s developing organs are especially vulnerable to lead; it can compromise intelligence, and cause behavioral problems, impaired hearing, coma, convulsions and death.

Older and/or deteriorating houses pose a heightened exposure risk, as do homes undergoing renovation, thanks to the lead content of paint chips, dust and soil contaminated by leaded gasoline.

In response to the EPA’s sloth, Howard Mielke, a soil contamination expert at Tulane University’s medical school told USA Today, “It's outrageous we aren't acting on what we know.”

A year ago, the EPA's Children's Health Protection Advisory Committee asked then-administrator Lisa Jackson for “immediate and urgent attention” to several recommendations about lead poisoning, including revising the lead dust standards.

Yet its lead standard for house dust remains under review, and, says USA Today, seems to be years away. The agency told the paper earlier this month that no action is being taken to revise hazard standards for soil either. Compare with a California health model, the federal standard allows five times more lead in play areas than what’s required to protect children from losing one IQ point.

The standards are applied in home inspections for lead paint residues and when yard and playground soil is tested for contamination from paint, industrial sources or particles from when vehicles burned leaded gasoline.

“We have thousands of risk assessors around the country determining whether you have risks and using clearance standards that are outdated," Rebecca Morley, executive director of the National Center for Healthy Housing, told USA Today. “They matter to consumers as a right-to-know issue: If you're told your home is safe and in fact it's not.”

Last year, the Centers for Disease Control and Prevention revised its standard for children’s lead blood levels. It cut by half the amount that should trigger public health actions.

According to USA Today, some 500,000 U.S. children have a blood-lead level of at least 5, the CDC's new standard, although the agency and its scientific advisers emphasized that there is no safe level.

In 2009, the EPA received a petition from several consumer and children’s health organizations to lower the lead standards. The agency doesn't expect to change anything until September 2014.

And nothing’s happening in terms of soil contamination. The EPA's hazard standard for bare soil where children play, says USA Today, is 400 parts per million (ppm) of lead. The California model’s standard is 80 ppm.

Only a tiny amount of ingested lead dust can poison a child. A packet of artificial sweetener contains 1 gram of powder. A microgram is one-millionth of that amount, and swallowing just 6 micrograms of lead particles a day over about three months can raise a child's blood-lead level by up to 1 point and affect cognitive function.

Bruce Lanphear, a medical researcher who studies sources of lead in children's bodies and has served on EPA advisory panels told USA Today, "In every instance, the [EPA] standards are based less on science and more on what the feds though was feasible."

If you want to pressure the EPA to accept the science, tighten the standards and protect children from the insidious effects of lead poisoning, contact your congressional representatives. Find there here.

Read more about protecting children from lead paint poisoning, and watch a video, on the Patrick Malone law firm website.

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Posted On: March 20, 2013

Monster Beverage Gets Monstrous with a Nutritionist

Monster Beverage wants a pediatric nutritionist to back off her warnings about the dangers to children of consuming high-caffeine "energy" drinks, or else.

Monster threatened a defamation lawsuit against Connecticut nutritionist Deborah Kennedy. She responded by contacting her U.S. Senator, Richard Blumenthal, who got Monster to back down, a teeny bit. Imminent litigation is no longer threatened, but Monster issued a statement saying Ms. Kennedy's comments about its products are still defamatory.

Which caused her mind to reel, inasmuch as the newsletter she sent to schools who are her clients hadn't even mentioned Monster by name. Plus, her warnings about the dangers of these beverages are backed up by the American Academy of Pediatrics, which issued its own warnings about energy drinks and sports drinks two years ago.

The saber-rattling by Monster was reported by the New York Times' Barry Meier, who describes Monster's new strategy to insinuate its products into kids' lives, by rebranding them into "beverages," instead of "nutritional supplements" as they had been for years.

Not coincidentally, the beverage label gets the manufacturer off the legal hook of having to report to the Food and Drug Administration when consumers experience adverse reactions.

Bottom line is that high-caffeine energy drinks should not be consumed by children.

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Posted On: March 15, 2013

Rethinking the Use of Antibiotics for Ear Infections

It’s a simple equation: child + ear infection = antibiotic treatment. Except that the formula is being reworked.

In an effort to limit the unnecessary use of antibiotics, the American Academy of Pediatrics has issued new guidelines for diagnosing and treating children’s ear infections.

As reported by NPR, ear infections are among the most commons reasons parents bring their children to the pediatrician, and the primary reason kids get antibiotics. When your kid is screaming all night, and tugging at his ear, you will do anything to make the hurt go away.

But about 7 in 10 kids will improve within a couple of days without drug intervention; about 8 in 10 get better within a week to 10 days, said one of the doctors involved in writing the new guidelines.

In addition to helping bacteria develop resistance to drugs, taking antibiotics when they’re not necessary can cause stomach problems and allergic reactions.

According to the new guidelines, the first thing parents should do if their child is having ear discomfort is to ensure it’s really an infection instead of another problem that also causes pain. Infections can be diagnosed only by having a doctor view the eardrum to see if it’s bulging. Infection causes that structure to push outward, as if it wants to pop.

Even then, however, that doesn’t mean an antibiotic is in order. If the immediate need is to relieve pain, other drugs can do that without the side effects or bacteria-boosting consequences.

If a child clearly has a severe infection—intense pain, high fever, bulging eardrum—antibiotics are indicated. Also, any child 6 months to 2 years old who has infection in both ears should take antibiotics, as should a kid whose eardrum has ruptured.

Doctors have options they didn’t used to have, and they should consider whether it’s best to offer parents the safety net of antibiotics, or to adopt a wait-and-see approach, and treat only the pain for a day or two. If they opt for “watchful waiting,” a prescription for antibiotics can still be given, and filled only if the child isn’t better in a couple of days.

Breast-feeding seems to help a child resist ear infections in the first place, as does keeping the kids away from cigarette smoke.

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Posted On: March 8, 2013

The Perils of Underage Use of Social Media

It’s a techno world, we just live in it. As much as parents want to give their children everything they need for learning and having fun, the adoration many kids have for social media poses important boundary issues.

Writing on KevinMd.com, pediatrician Natasha Burgert recalls a visit from a 10-year-old patient who had a completely age-appropriate love for dancing, gymnastics and horseback riding, and, as Burgert saw it, a wholly unacceptable involvement in Pinterest, a photo-sharing website where users create and manage thematic posts based on their interests and events.

Burgert was discomfitted to learn that not only was the child active on Pinterest, but that her mother had helped her set up the account. Said mom: “[T]he stuff she looks at is OK. She likes arts and crafts, and looking at hairstyles. Sometimes she shares ideas with me.”

Burgert clearly believes it is not OK for a 10-year-old to be surfing the web alone. She said there’s a common misconception by parents that social media sites are suggested for children older than 13, based on the network’s content, like a PG-13 movie.

By federal law, users of social media sites must be at least 13 years old.

The long-term consequences of a 10-year-old’s online activity are unknown. Do you really want to risk your child’s future?

Here are Burgert’s reasons for encouraging parents to enforce the age limit on social media:

1. A child younger than 13 (U13) is protected by the Children’s Online Privacy Protect Act (COPPA). Essentially, COPPA protects a child’s personal information from being collected and shared. Such protection is being updated to include online data tracking, location, photos, videos, and information available to third-party advertising networks.

Creating an account for a child U13 using a false date of birth circumvents the federal law. That means the social networks, and all the information your child shares, are completely out of your control.

(Some people believe that COPPA laws decrease a child’s protection online, arguing that without COPPA, fewer children would lie about their age, which would enable better online protection based on their true age. But it’s still the law.)

2. Kids know the U13 rule. If you, as a parent, falsify your child’s age to create an account, you are saying that it’s OK to lie on the Internet. You are saying that the rules don’t apply to your kid. Is that really what you want to do?

“Teaching appropriate boundaries and limitations on the Internet are of paramount importance,” Burgert writes. “Parents should be providing an example of ethical and responsible internet citizenship. This means enforcing the rules.”

3. Children U13 do not have the intellectual or emotional maturity to handle many social media themes. Pre-teens have enough trouble with real-life social interaction. Their reasoning skills are developing, and they’re vulnerable to online harassment, solicitation and cyber-bullying. “Allowing a child U13 on a major social site,” says Burgert, “is only prematurely increasing this risk.”

4. There are safer alternatives for children U13. Learning how to navigate and interact on social media sites is an important skill, and kids need to learn responsible Internet behavior. But some pre-teen social networks enable this education, they’re fun and they provide legal protection. For guidance in this realm, and a list of such sites, link to Common Sense Media.

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