Posted On: October 25, 2013

Too Many Car Seats Are Installed Improperly

With the exception of seatbelts, fewer products have done so much so fast as child car seats in the category of transportation safety. But as a recent story in the New York Times explains, improper installation of the tiny chairs is common, and seriously compromises the restraint’s ability to protect the child.

What should be a fairly simple operation can be devilishly complicated. One father in The Times story spent more than two hours trying to secure his kids’ car seats. He wasn’t sure he’d done it right, so he went to a local fire rescue unit that helps parents install seats and found out he’d done it wrong. And he’s a research scientist with a Ph.D.

Approximately 3 in 4 car seats are installed improperly, says the National Highway Traffic Safety Administration (NHTSA). And in communities without education programs or places to check installation, that ratio is higher.

Automobile crashes are a leading cause of death for children 13 and younger; many fatalities involve children in car seats.

Although deaths of children in car seats declined from 614 in 2002 to 397 in 2011, according to The Times, the numbers could be even lower if car seats were easier to install.

It’s not as if people haven’t tried to simply the process. In 2000, NHTSA implemented a latch system to enable car seats to be secured to anchors in a vehicle’s seats instead of looping a seat belt through the car seat. Automakers were required to design cars to facilitate easier kid-seat installation.

Still, many parents use only seat belts to secure the car seats, Times’ sources said.

One explained that, in a collision, a car seat can move much farther forward if it is installed using only a seat belt and the top of the seat is not secured. That presents a much higher likelihood of the child incurring head or spine injuries.

To address the car-seat information gap, the feds are developing a new program to encourage automakers to recommend the most appropriate child seats for use in each of their models. Regulators hope parents will choose the type of seat — rear-facing, forward-facing or booster — that works best for their children, based on age and size.

But car seat manufacturers don’t work closely with a lot with automakers, largely because the car people don’t like to divulge their future designs. The automakers say they offer as wide a range of child restraint systems as possible.

Safety advocates point to constant vehicle redesign as a primary challenge to routine, proper installation of car seats. They recommend parents seek help from local safety programs and car-seat specialists.

To find one in your area, link to Safe Kids Worldwide. To learn more about specific products, link to the Juvenile Products Manufacturers Association. For general car-seat safety and installation information, link to the Car Seat Lady, a group headed by a New York pediatrician.

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Posted On: October 25, 2013

When Kids Get Headaches

Almost everyone gets the occasional headache, even children. Almost always, they’re insignificant in the grand scheme of health.

As described on KevinMD.com by Dr. Roy Benaroch, a pediatrician and author of “A Guide to Getting the Best Health Care for Your Child,” so-called “primary” headaches are those without a specific cause or association to a specific medical condition.

Often, he writes, headaches in children are are caused by a minor infection, dehydration, hunger or stress. “If they’re recurrent,” Benaroch says, “they’re likely to be one of the common primary headaches, like tension headaches or migraine or chronic daily headache. Headaches that are progressive (worsening), or associated with other prominent or worsening symptoms, need an urgent medical evaluation, but those are fortunately rare. More typically, headaches just need to be treated like, well, headaches.”

And what does that mean? As is often the case, it’s simple: a kiss to make it better, rest, a cool compress, something to help the kid relax. “In the long run,” Benaroch says, “those are probably better headache remed[ies] for children than any medication.”

Benaroch’s primer on primary headaches:

Migraine. This might be the most common of the more severe headaches. In children it’s often bilateral (not limited to one side of the head, as is common with adult migraines), and fairly brief. Sometimes it’s accompanied by vomiting, and gets worse with light or sound. Often the best treatment is to go to sleep. Migraines often run in families.

Tension. This creates a constricted feeling in the head, and isn’t usually severe. Kids of all ages get tense.

Chronic daily headache. This often occurs in addition to occasional more severe headaches, like migraines.

To treat chronic daily headache:


  • Avoid daily Advil or Tylenol. Using them more than three days a week perpetuates the headaches.

  • Follow a healthful lifestyle—good, regular sleep, sound diet without a lot of preservatives and chemicals, regular exercise.

  • Try not to miss school; it makes headaches worse.

  • Consider massage/yoga/relaxation therapy.

  • Address any depression/anxiety/mood issues. They often have a psychological component, either contributing to the headaches, or being caused by the headaches and missing school and activities.

  • Consider a daily medicine to control the headaches. Not painkillers, but meds that prevent headaches, which require a physician’s guidance.

CT scans are almost never necessary for chronic, ongoing, stable headaches, which come and go in a stable pattern. Imaging is useful only for acute, worse-in-a-lifetime headaches, those associated with other symptoms, such as seizures, or progressively worse headaches. CTs (or MRIs) are completely unnecessary in the workup of most children with headaches, and will sometimes give misleading results that lead to overtesting and misery. (See our blog, “CT Scans for All Kids with Head Injuries?”)

Most people who believe they have sinus headaches don’t. Truly recurrent sinus headaches are uncommon. When they do occur, they’re associated with persistent nasal congestion and cough that precede the headache. Migraines, which are far more common than recurrent headaches from sinusitis, can cause nasal or sinus symptoms that begin about the same time as the headache.

Another uncommon association with recurrent headaches in kids is vision problems. Some nearsighted people squint, and by the end of the day might develop pain from contracting the muscles of their face and scalp, but that, too, is uncommon.

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Posted On: October 18, 2013

Doctors Are Prescribing Fewer Psychotropic Drugs

A few years ago, we blogged about the high, atypical use of antipsychotic medicine for children, and the disturbing questions such practices sparked about such widespread use of these powerful drugs. We also wrote about how the boom in diagnoses for attention deficit hyperactivity disorder (ADHD) can lead to overmedicating.

A recent study published the journal Pediatrics, however, shows that by the end of 2009, psychiatric medications were used less often for young children.

Psychotropic drugs, which affect one’s mental state and often his or her cognitive abilities, are powerful meds that can be life-saving for some people. But, like all drugs, they carry risks as well as benefits. Children, whose brains are still developing, could be particularly vulnerable to psychotropic side effects.

We’ve written, for example, about the risk of suicide for some drugs that treat attention deficit hyperactivity disorder (ADHD). And in 2004, the FDA issued a warning about the association between antidepressant use among children and suicide risk.

More recently, an association between diabetes and the use of antipsychotics by children has been shown.

So the fact that the percentage of children who are prescribed antipsychotics, stimulants and antidepressants during doctor visits is lower than it was in the mid-2000s is good news.

Dr. Tanya Froehlich, the study’s senior author, told Reuters.com, "I'm very excited that the use of these drugs in this age group seems to be stabilizing.

"It's good to get a gauge on what we're doing with psychotropic medications in this age group, because we really don't know what these medications do to the developing brain."

Earlier studies looked at the use of psychotropic drugs among preschoolers, but they usually focused on one class of medication or only one segment of the population. For this study, national data for about 43,500 doctors' visits from 1994 to 2009 was used, involving kids ages 2 to 5.

In that time span, Reuters explained, the proportion of psychotropic drug prescriptions varied between one prescription for every 217 doctors' visits in 1998 and one for every 54 visits in 2004.

Between 1994 and 1997, about 1% of preschoolers left the doctor’s office with a psychotropic prescription. Between 1998 and 2001, the percentage declined to about 0.8%. It rose to a high of about 1.5% between 2002 and 2005, and dropped to 1% between 2006 and 2009.

Although the latest figure wasn’t the lowest, it was still notable because the decrease and stabilization occurred while increasing numbers of children were diagnosed with behavioral disorders. More diagnoses, but less treatment with heavy drugs.

The study didn’t explain the lowest rate between 2006 and 2009, but the researchers suggested it might be because of a greater awareness of the meds’ possible side effects.

The drugs have been widely prescribed to address disruptive behavior by preschoolers, so perhaps other behavioral interventions are being tried first, and with at least some success.

"The thing pediatricians should be asking themselves is, ‘Are we really following the guidelines in treating these children?' which is trying behavioral therapy and then going to the medications," Froehlich told Reuters.

See our blog, “Does Your Kid Really Need a Psychotropic Drug,” if you think your doctor might prescribe one to address your child’s behavioral issue. Learn more about these medicines on the National Institutes of Health site, Mental Health Medications.

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Posted On: October 11, 2013

Not Every Child Who Stutters Needs Treatment

If your preschooler is a stutterer, there’s good news from a study recently published in the journal Pediatrics. Four-year-olds who stuttered were not found to be different from their peers when it comes to temperament or mental health. Also, their language skills, nonverbal cognition (the nonword ability to think and process information) and health-related quality of life was superior to that of children who didn't stutter.

As interpreted by MedPageToday.com, the study results support the idea that parents should watch and wait instead of trying to intervene as soon as their youngster begins to stutter.

Long-term stutterers often report a lower quality of life, and they may experience lower educational achievement and a higher incidence of psychological problems, such as social phobias. But the Pediatrics report refutes the idea that all stutterers have poorer health outcomes.

Most young children aren’t aware of stuttering, and generally they don’t react to stuttering behavior, especially when it first begins.

Among the study’s findings:


  • More than 8 in 100 children stuttered by the age of 3; more than 11 in 100 did so by age 4.

  • More than 6 in 100 children recovered within one year of the onset of stuttering, and four of them had professional help, typically from a speech pathologist.

  • This rate of stuttering was about twice that of previous reports.


Among factors that predicted the onset of stuttering onset were:

  • mothers with higher education;

  • male gender;

  • twins.


It’s interesting to note that family history of stuttering was not among predicting factors.

Most children, the study shows, resolve their stuttering disorder within about 4 years from its onset, but intervention can help those who don't. Current guidelines, according to MedPage Today, advise parents to wait one year to see if kids will recover on their own before launching into expensive, time-intensive treatment. The new study suggests suggest many could wait longer.

"What we used to think was a disorder that required earlier intervention is a disorder that we could do a more watch-and-see approach with," Irv Wollman, clinical director of speech-language pathology at Cincinnati Children’s Hospital Medical Center told MedPage Today. "Rushing into early intervention may not necessarily be the route to go."

There’s a difference, though, between stuttering and the more troubling symptoms of such distress at the disorder that kids avoid talking, or they talk only with increased physical effort. If that describes your child, it’s time to consult with a speech-language pathologist.

Otherwise, the researchers said the more conservative, wait-and-see approach would reserve scarce resources for the few children for whom stuttering doesn't resolve and who suffer adverse outcomes.

At least one powerful voice has been raised in opposition to that advice. As reported on MedPage Today, The Stuttering Foundation called the study conclusions a "blunder" that could mislead parents into believing that there's little cause for concern or no immediate need to seek help.

"The biggest problem with the data,” said Jane Fraser, president of the foundation, “is that it stops at age 4, just when one might expect to see some harmful effects from stuttering. It is far too early to interpret the findings because we do not know how many of these children continued to stutter and what effects it had on them and their lives."

For The Stuttering Foundation’s advice to parents, link here.

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Posted On: October 4, 2013

How Bullying Makes Kids Sick

According to a new study published in the journal Pediatrics, children who are bullied suffer more than just psychological and social problems; their risk of physical health problems might be about double that of kids who aren’t bullied.

The study findings, discussed on MedPageToday.com, weren’t surprising, as all the individual studies included in this meta-analysis (several separate studies examined in conjunction with each other) had shown higher rates of health complaints in bullied versus nonbullied children, and in nearly all of them, the differences were statistically significant.

The data pooled from six studies involved more than 3,900 children. They looked at complaints such as headache, disordered sleep and abdominal pain in kids who reported being bullied at school compared with those who didn’t report being bullied.

Another set of data derived from 24 different studies was similar; those studies involved more than 200,000 children.

The studies occurred throughout the world, in the U.S., China, India, Mexico, Turkey and many nations in Western Europe. The follow-up ranged from nine months to 11 years.

The researchers used studies that reported incidences of physical symptoms other than traumatic injuries in children who reported bullying or no bullying. The determination of whether or not one had been bullied was that of the interviewed children, or in reports by parents or teachers. Voluntary, self-reporting can skew study results because it’s subject to mistakes or misperceptions in recalling the events. But meta-analyses such as this one provide more persuasive results because of their size and scope.

The study’s authors recommended that pediatricians consider bullying as a cause when their patients present with headache, respiratory and eating problems and insomnia. "Any recurrent and unexplained somatic symptom can be a warning sign of bullying victimization," the researchers wrote.

They also said that physicians should review the potential symptoms of bullying with parents because children are often reluctant to talk openly about bullying episodes. If your child complains of something like a headache or stomach ache that has no apparent or logical explanation, consider the possibility that he or she is being bullied, and treat it as the health issue it is.

For more information about conditions that might invite bullying, see our blog “A Profile of Kids at Risk of Being Bullied.” Also, consult StopBullying.gov, an initiative of the U.S. Department of Health and Human Services.

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