Posted On: May 31, 2013

Feds Call for National Standards for Child Care Facilities

Earlier this month, the federal Department of Health and Human Services (HHS) announced stringent new health and safety standards for any child-care facility that receives government funding.

As reported in the Washington Post, reports of injuries and deaths in child-care facilities prompted the action. HHS officials said the new regulations also were developed because of emerging science on how critical the early years are for brain development and future success.

The regulations are meant to supersede individual state measures that critics claim are too lax and endanger children. As many as 1 in 5 children who receive the child-care subsidy, according to The Post, are in unlicensed and unregulated facilities that have no health and safety requirements.

The regulations will require workers in all subsidized child-care centers and homes to be trained in first-aid procedures, such as CPR, and safe sleeping practices. They demand quality-rating systems parents can access, and universal background and fingerprint checks of child-care workers. They also impose tough standards for monitoring and unannounced inspections to ensure compliance.

It has been 15 years since child-care rules were updated.

The regulations apply only to the 513,000 child-care centers and family homes that accept subsidies for the 1.6 million children who receive them through the federal Child Care and Development Fund, which expired in 2002. The HHS announcement, the paper said, was a surprise to Congressional representatives, including the bipartisan group of senators who have been negotiating a bill to reauthorize the child-care fund.

Nothing the feds do, it seems, can be devoid of politics. Sen. Barbara A. Mikulski (D-Md.) said that she appreciates the administration’s efforts, but that regulations are not enough. She wants Congress to reauthorize a child-care subsidy program “that not only addresses health and safety standards, but also improves the quality of our nation’s child-care programs.”

Rep. John Kline (R-Minn.) said, “The latest announcement by HHS is yet another effort to usurp Congress and move forward with the administration’s preferred policies.”

Many day-care centers in the U.S., The Post notes, are poorly run and often unsafe. And child care remains unaffordable for many people.

Current federal health and standards require only that:


  • subsidized providers prevent and control the spread of infectious diseases;

  • building and physical premises are safe;

  • providers have minimum health and safety training.


Beyond that, states pretty much impose whatever standards they wish. In South Dakota, for example, a family home child-care provider may care for as many as 12 children without a license or meeting any standards. In Virginia, that number is five. In Maryland and the District of Columbia, it’s one.

Many states, according to The Post, require only state, not federal, background checks of providers. That’s the standard in Virginia, where one infant died and only the commonwealth attorney’s investigation into the unlicensed family care provider’s home uncovered the fact that that the provider had several aliases and previous felony charges.

Some states exempt child-care centers run by religious organizations from meeting health and safety licensing standards. In Virginia, a 7-week-old boy was left for two hours in a small, overheated utility room with 14 other infants on a single foam pad while the caretaker ate lunch in another room. The baby died. Only one person at the facility, a janitor, had been trained to perform CPR.

Those child-care workers were charged with negligent homicide, but a judge dismissed the charges because of the center’s religious affiliation.

HHS officials said the proposed regulations couldn’t address all child-care ills; the $5 billion the government spends covers only about 18 in 100 low-income children who are eligible for the subsidy. But it’s a start.

If you want to know more about the sorry state of child care in America, link here to a recent investigative story in the New Republic. Some of its substantiated conclusions:

1. Most American day care centers are rated “fair” or “poor.”
2. Child-care workers are often poorly paid and minimally trained.
3. State regulators don’t have enough people to inspect facilities regularly — and often face pressure to keep appalling centers open anyway.
4. Child care remains extremely expensive for many families.
5. Governments in other countries spent a lot more on child care.

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Posted On: May 24, 2013

Danger Lurks on Innocent-Looking Mall Rides

Sometimes it’s a mechanical pony. Sometimes it’s a small-scale race car. It might be at the mall or outside the supermarket—any prime territory to amuse and divert little ones while mom or dad needs to get the errands done.

Usually, it’s mission accomplished, but sometimes someone gets hurt.

As reported by CBSnews.com, between 1990 and 2010 nearly 93,000 children were treated in U.S. emergency rooms because of ride-related injuries. More than 7 in 10 such injuries occurred from May through September; about 20 injuries occurred daily during the summer months.

The study, published in Clinical Pediatrics, analyzed child injuries on rides found in amusement parks, fairs, festivals, arcades, restaurants, stores and malls. More than 4,400 ride-related injuries send kids to the ER every year, many of which occurred outside of traditional amusement park settings.

Researchers found that kids who use "mall rides" might face a higher risk of head, neck or face injuries or concussions.

In a news release, study author Gary Smith, professor of pediatrics at The Ohio State University College of Medicine said, "Injuries from smaller amusement rides located in malls, stores, restaurants and arcades are typically given less attention by legal and public health professionals than injuries from larger amusement park rides, yet our study showed that in the U.S. a child is treated in an emergency department, on average, every day for an injury from an amusement ride located in a mall, store, restaurant or arcade. We need to raise awareness of this issue and determine the best way to prevent injuries from these types of rides."

Amusement parks feature "fixed-site rides"; fairs or festivals feature "mobile rides"; those at an arcade, strip mall or restaurant are "mall rides." They’re subject to different oversight.

The U.S. Consumer Product Safety Commission oversees mobile rides at fairs, but state or local governments regulate fixed-rides at amusement parks (see our blog about amusement park ride safety). The study found that 1 in 3 injuries occurred on a fixed-site ride; 29 in 100 on mobile rides and 12 in 100 on mall rides. Although they represent the smallest percentage of injuries, they are under the most direct control of parents, so probably are the easiest injuries to avoid.

Most injuries were caused by a fall—nearly 1 in 3 injuries reported over the 20-year span; 18 in 100 were caused by being hit by something while riding or by hitting a part of the body on the ride.

Head and neck injuries accounted for 28 in 100 injuries; nearly 1 in 4 injuries involved arms; the face was involved in18 in 100, and legs accounted for 17 in 100. Soft-tissue injuries, such as bruises, were common, as were sprains, cuts and broken bones.

Although injuries serious enough to require hospitalization were relatively rare, they are more common during the summer—one occurs about every three days.

Because nearly 3 in 4 mall ride injuries occur when a child falls, parents should ensure that these rides have restraints, especially if they are located on hard surfaces, which they invariably are. In addition:


  • Follow all posted height, age, weight and health restrictions.

  • Follow any special seating order and/or loading instructions.

  • Use safety equipment such as seat belts and safety bars.

  • Keep the hands and feet inside the ride at all times.

  • Know your child: If you don't think he or she will follow the rules, give that ride a pass.

  • Follow your instincts: If you don’t trust the ride, stay away.

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Posted On: May 17, 2013

Why the Pacifier Shouldn’t Be Too ‘Clean’

It’s a Pavlovian response—you lick your thumb to clean the pureed peas off your baby’s face. But licking her pacifier clean after she knocked it onto the floor? Ewwww.

Get over it. According to a new study in the journal Pediatrics, that’s exactly what you should do. Parents who perform this protective act might be reducing the kid’s risk of developing allergies.

As explained on MedPageToday.com, the study suggests that transferring the microbes in your mouth to your baby’s mouth could modify its population of bacteria and cultivate a broader immune response to future invaders.

The researchers looked at kids who were 18 months and 36 months. In the younger group, children born to parents who said they cleaned their child's pacifier with their mouths were less likely than those born to parents who cleaned it with water to have asthma and eczema. At 36 months, the association remained for eczema, but not for asthma.

The benefit of this “oral hygiene,” the researchers suggest, might extend to a kid’s nether regions—because the baby swallows the newly transferred parental bacteria, they could affect the microbiology in the intestines, which could improve general gut tolerance.

Infants with less diversity among their gut microbes, according to MedPage Today, are more likely to develop allergies. That suggests that exposing youngsters to a wider variety of microbes could promote immune system function.

As Dr. Amal Assa'ad of Cincinnati Children's Hospital Medical Center told MedPageToday, "[W]e have to let nature play out a little bit and not be too clean and not be forming artificial barriers in the connection between the mother and the infant and the parents and the infant."

"We have to at some point reach a balance where we're making sure we're not predisposing [infants] to infections at the same time [we're making] sure we're giving them what they were naturally expected to get from the parents ... so we end up with a balanced body that doesn't veer towards allergies and doesn't veer towards serious infections and harm."

It’s interesting that, according to the study, the method of birth (cesarean or vaginal) was related to the likelihood of a parent sucking on the pacifier. Vaginal delivery and parental pacifier sucking independently were associated with a reduced likelihood of developing eczema; babies delivered vaginally and whose parents licked their pacifiers had a lower incidence of eczema.

The theory is that vaginal delivery, which also transfers bacteria from mother to infant, has a beneficial effect on allergy resistance.

Regarding the “ick” factor, and the concern that transferring a pacifier from a parent's
mouth to a child's could spread respiratory infection, the study showed no difference in the rate of such infections based on pacifier cleaning practices.

Keep in mind that this study had a relatively small sample size (184 kids), and that it’s relatively difficult to diagnose asthma in early childhood. So a larger study also involving older children is necessary to replicate—and confirm—these results.

But, for now, if you think it’s better to wash your kid’s pacifier under the tap than in your saliva, it’s probably time to think again.

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Posted On: May 10, 2013

When to Call the Doctor

Claire McCarthy gets it. The primary care physician and medical director of Boston Children’s Hospital’s Martha Eliot Health Center knows that when your kid is sick, it can be difficult to know when you can treat him or her on your own, and when it’s time to call the doctor.

Writing on KevinMd.com, she confides, “Sometimes, when a parent tells me about something that happened with their child, I think (and say, as nicely as I can): Why didn’t they call right away?”

“And sometimes, when I’m talking to a parent or seeing their child in the office, I think (but don’t say): Why did they call about this?”

Sometimes you have no idea what’s ailing your child. You don’t know if the problem has peaked, or is getting worse. You don’t want to believe there’s something really wrong, you don’t want to miss something and you don’t want to worry the kid—or anyone—unnecessarily by being overprotective.

As the old TV ad used to say, “What’s a mother to do?”

According to McCarthy, call the doctor if:


  • The symptoms are bad. “Bad anything," says McCarthy. “Bad pain. Bad trouble breathing. Bad bleeding. Bad vomiting. I know, bad is subjective. But if in your head the word ‘bad’ seems to apply, better to get advice than wait and watch.”

  • The symptoms aren’t going away. Even if it’s a little thing … a slight limp, a nagging headache, a rash that the cream isn’t resolving, the diarrhea that’s mild but doesn’t end …

  • Your gut is telling you something is wrong. “I can’t tell you how much I’ve come to respect and rely on parental instinct,” McCarthy says. “The parents are nearly always right."

  • You can’t say: “I know what to do,” and really mean it. Be honest with yourself. Nobody knows what to do in every situation.


And, finally, says McCarthy, “[R]ead the list—but if what’s going on isn’t on the list and you’re worried, call.”

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Posted On: May 3, 2013

Cold Medicines Are Dangerous for Very Young Children

All parents of children old enough to spend time around other children know that their offspring are little cold factories. Data from the University of Michigan’s C.S. Mott Children’s Hospital indicate that kids get 5 to 10 colds a year.

To relieve their symptoms, their parents often give wee ones over-the-counter (OTC) cough and cold products. In many cases, that’s bad medicine.

According to a national poll on children’s health by the Mott Children’s Hospital, more than 4 in 10 parents give their children younger than 4 cough medicine or multi-symptom cough and cold medicine. One in 4 gives them decongestants.

In 2008, the FDA issued an advisory that these OTC meds should not be given to infants and children younger than 2. Not only are they not proved to be effective for young children, they can cause serious side effects that might include:


  • convulsions

  • allergic reactions

  • elevated or uneven heart rate

  • drowsiness or sleeplessness

  • slow and shallow breathing

  • confusion or hallucinations

  • nausea and constipation.


A couple of years ago, we wrote about the dangers of Tylenol and dosing information for children younger than 2.

After the FDA warning, manufacturers of OTC cough and cold products rewrote their labels to read that the medicines should not be given to children younger than 4.

Although parents might feel as though they should give their ailing children something, anything, these products “don’t reduce the time the infection will last and misuse could lead to serious harm,” said Dr. Matthew M. Davis, director of the poll, in a University of Michigan news release.

“What can be confusing,” Davis said, “is that often these products are labeled prominently as ‘children’s’ medications. The details are often on the back of the box, in small print. That’s where parents and caregivers can find instructions that they should not be used in children under 4 years old. … [W]hat’s good for adults is not always good for children.”

As with any medication, prescription or OTC, you should always read the labels and patient information that comes with it. Contact your doctor if you’re uncertain about how, or to whom, it should be given.

To learn more about the difficulty in adjusting adult medicine for pediatric use, see our blog, “Drug Labels Still Leave Pediatricians Playing a Guessing Game.”

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