Only four in ten of the preschoolers who receive prescriptions for these powerful drugs have been given a proper mental health assessment, according to the Columbia study. That worries some experts. As one told the New York Times:
“There are too many children getting on too many of these drugs too soon.”
This quote was from Dr. Mark Olfson, professor of clinical psychiatry at Columbia and lead researcher in the new study, which was financed by the government.
Olfson and other researchers worry that the drugs can interfere with physical and mental development in young children. What many kids need is talk therapy, but it's cheaper and more convenient to medicate them, they say.
Read more in the Times' article here.
]]>“In some cases, a child’s well-being may be seriously compromised if parents are given misinformation by a pediatrician based on these misconceptions and old wives’ tales,” said Andrew Adesman, M.D., lead investigator of the study and chief of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Children’s Medical Center of New York.
The study was based on a questionnaire sent to a national sample of board-certified primary-care pediatricians and included a mix of 34 myths and 14 true statements. Analysis of more than 1,000 responses indicated that the majority of pediatricians (76 percent) mistakenly endorsed one or more of the parenting myths as being true, and 13 percent got three or more wrong.
Although most of the myths are benign old wives’ tales, Adesman said, there were a “dangerous dozen” health beliefs that reflected outdated parenting beliefs that could pose a risk to a child’s safety or well-being. For example:
• 33 percent said a burn can be treated with an application of ice. Risk: Ice can also cause injury to the skin.• 33 percent said it is safe to put a baby to sleep on his or her side. Risk: Crib death -- also known as sudden infant death syndrome. (All babies need to sleep on their backs.)
• 5 percent said children can be given an ice bath to treat a fever. Risk: Hypothermia.
• 5 percent said children over age 6 can be given aspirin for a fever. Risk: Reye’s syndrome.
• 5 percent said it’s OK to place a soft object in a child’s mouth during a seizure. Risk: Dental injury to the child, hand injury to the adult.
• 3 percent said babies younger than six months can be given honey. Risk: Botulism poisoning.
Many pediatricians also endorsed less dangerous myths.. For example:
• 15 percent said children should not swim until 30 minutes after eating.• 17 percent said vitamin C helps ward off colds.
• 16 percent said eating carrots improves a child’s vision.
• 8 percent said eating chocolate causes acne.
• 11 percent said listening to Mozart makes a baby smarter.
• 7 percent said reading in the dark causes visual problems.
• 11 percent said sugar causes hyperactivity.
• 7 percent said sitting too close to the TV damages vision.
• 9 percent said sleeping with a nightlight causes nearsightedness.
Source: Los Altos Town Crier
You can view the complete study here.
The Canadian “Managing Obstetrical Risk Efficiently” (MOREOB) patient safety program has a measurable, positive impact on the health of mothers and babies, according to a study published in the Journal of Obstetrics and Gynaecology Canada.
According to the study, the program results in a significant reduction in severe morbidity for newborns, as measured by the rate of serious complications such as respiratory distress syndrome, sepsis and severe intraventricular hemorrhage. For mothers, there was a significant reduction in third- and fourth-degree vaginal tears and length of stay in hospital.
MOREOB is a comprehensive, three-year, patient safety, professional development and performance improvement program for caregivers and administrators in hospital obstetrics units. The program structure's first priority is safety, followed by effective communication, teamwork, decreased hierarchy in emergencies, practice for emergencies, and reflective learning. It integrates evidence-based professional practice standards and guidelines with current and evolving patient safety concepts, principles and tools.
By learning and working together in their own practice environment, health-care teams use the shared knowledge, skills, attitudes and behaviors that contribute to safe, effective, patient-centered care in an efficient, collaborative, healthy practice environment.
“MOREOB is an innovative program that seeks to ensure that every pregnant woman receives optimal care. With the results of this new study, it is hoped that many other North American hospitals will emulate Alberta, and make MOREOB a key component of their hospitals’ training, standards and approach to obstetrical patient care,’ said Dr. André Lalonde, Executive Vice-President of the Society of Obstetricians and Gynaecologists of Canada.
Source:
Society of Obstetricians and Gynaecologists of Canada
You can view SOGC's press release here.
But maybe the real issue is basic patient safety, and the failure of hospitals and doctors to have the right staffing necessary to make vaginal childbirth safe after a previous C-section.
If you listen to the euphemisms from the medical industry, "less than perfect outcome" sounds like parents suing over a small blemish or other trivial injury. What is really at stake, however, is permanent devastating brain injury caused by a hospital not having the resources to deliver a baby quickly enough when the vaginal birth attempt has gone south.
Three in ten American women now deliver their babies by Cesarean section, which seems like a lot. And many of those are repeat Cesareans which only happen because of the prior Cesarean, even if it might be safe to at least try normal labor and see if the baby can be delivered safely. Recent headlines suggested that hospitals were refusing to even let women try a course of normal labor after a prior Cesarean. They couldn't afford the lawsuits, it was suggested.
But here's the problem with VBAC -- vaginal birth after Cesarean. In one in 100 to one in 200 VBAC attempts, the uterus ruptures. This cuts off the baby's lifeline. The best studies show that brain damage begins in around 17 to 18 minutes, and worsens dramatically every minute after that the baby remains undelivered. After 30 minutes, most babies in ruptured uteruses are dead if not delivered.
New guidelines from the American College of Obstetricians and Gynecologists (ACOG) for VBAC have stuck to the group's 1999 recommendation that a surgical team has to be "immediately available" to deliver the baby by C-section in the event of a rupture. Immediate means right there in the hospital, ready to operate.
Hospitals don't like the "immediately available" standard, and prefer the old, looser guideline of "readily available," whatever that means. After the 1999 guidance of "immediately available" was issued, a number of hospitals, rather than having the right staffing level to ensure baby safety, simply banned VBAC procedures and said any pregnant woman with a prior C-section had to have another C-section in their hospital. This conjures up an image of tying women to hospital beds and hovering over them with scalpels, so that doesn't sound right either.
In March 2010, the National Institutes of Health convened a panel of experts who took a step backward by asking the obstetricians to consider softening the guidance back to the old "readily available" or some other mushy language.
Thankfully, ACOG didn't do that. But -- and this is a big but -- the obstetricians are now talking about pushing the risk of brain damage back onto the parents -- without giving them the full picture to make an intelligent decision.
As quoted in the New York Times, the new ACOG guideline adds the recommendation that if an immediate Caesarean is not available, it should be explained to the patient, and she should be "allowed to accept increased levels of risk." And Dr. Richard Waldman, president of the obstetricians' group, said: "What I'm hoping is that everybody will get together and do the right thing. That includes patients. If they take the risk, they have a certain responsibility not to sue the physician if there's a bad outcome, knowing that they took the risk."
You can search ACOG's statement about its new guidelines high and low, and you will never find the key facts spelled out about what this risk really means -- a child who can never walk, talk or have normal development.
ACOG and the hospitals seem more focused on the risk of lawsuits than the risk of catastrophically injured babies. It would be like talking about the danger of oil spills from deepwater drilling based on how many lawsuits would happen, not on how much damage to the environment would result.
Let's make sure our communications are very clear. We're talking about delivering babies safely. The lawsuit buzz is just a convenient whipping boy for those who want to avoid tough questions about why they're not investing in safe childbirth facilities for mothers and families.
As of this summer, manufacturers of children's products have to comply with new safety requirements per the “Danny Keysar Child Product Safety Notification Act,” named after a child who was strangled to death in a defective crib. The act requires manufacturers of children products to “establish and maintain a registration card program,” reports Lisa Parker of NBC Chicago. The registration cards will be included with the product and the program will keep records for at least 6 years of consumers who do register. This will facilitate notification of any recalls or safety concerns regarding the product.
The act, which took effect on June 28, 2010, affects the following product categories, according to Parker: Full-size and other cribs, Toddler beds, High chairs, Booster chairs, Hook-on chairs, Bath seats, Gates, Play yards, Stationary activity centers, Infant carriers, Strollers, Walkers, Swings, Bassinets, Cradles, Children’s folding chairs, Changing tables, Infant bouncers, Infant bathtubs, Portable toddler bed rails, and Infant slings.
An announcement of the act going into effect can be found on the Kids In Danger website.
In a study published in British Medical Journal’s July 2010 issue, researchers from University of Cambridge and University of Glasgow report a slightly higher mortality rate of babies born outside of normal working hours, according to NHS News of the U.K.
The study analyzes Scotland’s records of more than one million full-term, single baby births from 1985 to 2004. After adjusting several factors (e.g. socioeconomic and maternal age, among others), the researchers find that babies born over weekends or overnight during weekdays are three times more likely to die of lack of oxygen than those born during normal working hours. However, the mortality rates in both groups are still very low: the mortality rate of those born during normal working hours is 4.2 out of 10,000 births; and that of babies born outside of the “safer” hours is 5.6 out of 10,000.
Authors of the study did not explore causes of the higher mortality rate for births outside of normal working hours, but cited fatigue and shortage of hospital staff as some of the possibilities. The BMJ article can be found here.
Vitamin D supplements are recommended for some children to promote growth of healthy and strong bones. However, if fed with excessive amount of vitamin D, infants experience a myriad of symptoms ranging from nausea to muscle weakness, and sometimes even kidney damage.
Here are the FDA’s recommendations for parents whose children receive vitamin D supplements:
* Ensure that your infant does not receive more than 400 international units (IUs) of vitamin D a day, which is the daily dose of vitamin D supplement that the American Academy of Pediatrics recommends for breast-fed and partially breast-fed infants.]]>
* Keep the vitamin D supplement product with its original package so that you and other caregivers can follow the instructions. Follow these instructions carefully so that you use the dropper correctly and give the right dose.
* Use only the dropper that comes with the product; it is manufactured specifically for that product. Do not use a dropper from another product.
* Ensure the dropper is marked so that the units of measure are clear and easy to understand. Also make sure that the units of measure correspond to those mentioned in the instructions.
* If you cannot clearly determine the dose of vitamin D delivered by the dropper, talk to a health care professional before giving the supplement to the infant.
* If your infant is being fully or partially fed with infant formula, check with your pediatrician or other health care professional before giving the child vitamin D supplements.
Infantile spasm (IS) presents itself in the form of muscle contractions. Different from other conditions, IS occurs in clusters: “Babies can have clusters of 100 spasms or more at a time, dozens of times a day,” according to Jeanne Milsap in her article for Sun-Times Media. Milsap describes the spasms as “a sudden bending forward of the body with stiffening of the arms and legs. Some babies arch their backs. Most typical are little flexion jerks similar to the startle reflex.”
IS can be diagnosed simply with an EEG that would show chaotic brain waves. It is treated with anti-convulsants, hormonal injections, diet change, or surgery in more serious cases.
The batteries, which are found in remote controls, watches, and other home electronics and toys, cause a chemical reaction when swallowed that can burn through the delicate tissues in the neck. Kids sometimes swallow them when they take apart a toy, find the battery, and think it's candy.
While rare, a death was reported in one child where the battery burned through the esophagus and attacked the aorta. Another child was left with a lifelong whisper from vocal cord damage. Another had to have feeding tubes and multiple surgeries for the damage to the gastric tract.
The journal Pediatrics reports the dangers of ingestion of lithium batteries by infants, which can and has caused deaths, writes Tara Parker-Pope of the New York Times.
The lead author of the medical journal article on this subject, Dr. Litovitz, says there is a “tight timeline” in which to rescue children from the injuries caused by lithium ingestion: while the batteries start causing severe damages as quickly as within 2 hours of ingestion, the problem is difficult to be diagnosed because small children cannot verbally communicate, and their symptoms (which can be loss of appetite, vomiting, coughing up blood) are nonspecific.
Pediatricians and parents are working to raise awareness of the dangers of small lithium batteries and to urge manufacturers of electronics to secure the battery in all electronic devices, not just toys. A woman whose 18-month-old daughter died after ingesting a lithium battery said that “there should be warnings on every item the batteries are in. They are in greeting cards and children’s books that talk. They’re everywhere.”
Although the 1978 law banned the use of lead paint, local laws and enforcement have yet to catch up with their own laws requiring inspections and cleanup of houses built before 1978. Dr. Mary Jean Brown, chief of the lead poisoning prevention branch at the CDC, said that there are still jurisdictions that do not have laws requiring landlords to check for lead-based paint. Even in places that do have such laws, landlords are not always compliant – in a survey done from 2007 to 2009 in Brooklyn, New York, “59 percent of tenants reported that their landlords had not followed any of the law’s provisions,” Navarro reported in the NY Times article.
In addition to experts’ recommendation of strengthening local laws and enforcement, the EPA implemented a regulation in April, 2010, that “requires renovation and remodeling contractors to be certified in techniques for containing lead dust stirred up during work” in buildings constructed before 1978.
Elevated lead levels in young children, especially those under 6, can “cause irreversible impairment intelligence quotient, motor skills and behavior,” says Dr. John Rosen, who founded a lead prevention program at Montefiore Medical Center in the Bronx.
In Washington, D.C., lead safety laws impose strict liability on landlords who know they are renting to families with children under eight years old. However, many landlords still are lax about cleaning up apartments unless families complain loud and often. In our law firm's work in representing such families, we find that landlords don't take their obligations seriously until they are taken to court.
]]>According to Wilson, in a study published in the April issue of the Pediatrics journal, researchers say that Camel Orbs and other dissolvable tobacco products are “packed with nicotine and can poison children and lure young people to start using tobacco.” These smokeless products are appealing to teenagers because of their “candy-like appearance, added flavors, and easily concealable size,” says Dr. Laurence Deyton of the FDA in a commentary in the same issue of the Journal. In fact, a group of teenagers were seen sharing Camel Orbs.
Not only do these pellets increase the likelihood of more teenagers becoming addicted to tobacco, their dissolvability and high level of absorbable nicotine also pose health hazards to younger children: children who ingest tobacco products suffer nausea and vomiting.
To combat the emergence of these new products, Congress passed legislation last year to require Reynolds to produce research results and other materials about the dissolvable tobacco products. The FDA is also required under the legislation to study the products within two years; and “depending on the outcome of that review, the agency could ban them or require product changes,” writes Duff Wilson.
Rabin cites a study appearing in the December 2009 issue of the Journal of the American Association for Pediatric Ophthalmology that describes two eye injury cases linked to the patients’ use of swings. In both cases, young autistic children presented to the hospital multiple times with small foreign objects in the eye that were found to be metallic fragments. Noticing that the multiple occurrences pointed to a common cause, the paper’s author, Dr. Dean Bonsall of the University of Cincinnati, took extensive history of the boys’ daily activities and discovered their frequent use of a swing.
Dr. Bonsall hypothesized that wear and tear of the swings caused small metal fragments to become dislodged and fall into children’s eyes. He recommended protective eyewear for one of the patients, which prevented further recurrence of the injury.
The study explains that the metallic foreign bodies in the eyes “leave a white scar and may become secondarily infected and lead to vision loss,” therefore requiring timely medical attention. However, autistic children, especially those who are non-verbal, often have difficulty communicating discomfort of foreign objects in their eyes and therefore can fall victim to delayed diagnosis.
Dr. Bonsall encourages parents of autistic children who use swings to give them protective eyewear or wrap the swing mechanism in a cloth.
Used by about one in three 17-year-old girls in the country, these ultraviolet radiation-emitting beds actually pose grave dangers to human health, resulting in skin and eye cancer. According to Szabo, the tanning beds increase the risk of skin cancer by 75% for users under the age of 30.
In a USA Today article from July 2009, it was reported that “international cancer experts have moved tanning beds and other sources of ultraviolet radiation into the top cancer risk category, deeming them as deadly as arsenic and mustard gas.”
In addition to the new tax, the FDA is considering putting restrictions such as requiring teens to get parental consent before using the sunbeds. The FDA may eventually ban the use of tanning beds among teenagers.