A true story that happened in Britain recently suggests that the heart monitors shouldn’t replace a trip to the obstetrician if there is any concern for the baby’s health, writes Tara Parker-Pope of the New York Times.
According to a commentary published at BMJ.com by doctors of the Princess Royal Hospital in Britain, a woman who was nearly full-term at 38 weeks noticed one day that the baby wasn’t moving. Instead of seeking medical advice, she turned to a home fetal heart monitor and heard what she thought was the baby’s heartbeat. After three days when she finally went to a doctor, an ultrasound scan showed the baby had already died.
Although the doctors cannot know for sure in this case that the baby would have been saved had the mother sought medical advice earlier, they said the monitors should never be used for reassurance. Dr. Chakladar, one of the authors of the BMJ commentary, said that it takes experience to determine the baby’s health. Sometimes what sounds like a baby’s heartbeat may be the mother’s own heart. And even when parents can pick up the baby’s heartbeat, it is still difficult to determine if the baby is healthy or distressed. “If a mother is concerned and feels she needs reassurance, she should immediately consult her doctor,” writes Parker-Pope.
So what is the bottom line? Dr. Chakladar advised, “On their own, these monitors are harmless; it is their improper use by parents to reassure themselves which can be dangerous…they are dangerous if they are used by untrained people as an alternative to seeking medical advice.”
The JAMA study examined four top-selling atypical antipsychotics (powerful drugs prescribed to treat schizophrenia and bipolar disorder): Abilify, Risperdal, Seroquel and Zyprexa. Among them, Zyprexa was found to cause the most weight gain: 19 pounds in 11 weeks. It was also found to “significantly raise levels of blood sugar, cholesterol, insulin and triglycerides,” thereby increasing users’ risk of diabetes and heart problems. Patients taking other three medications had an average of 10 to 13 pounds of weight gain.
Dr. Correll, the lead author of the study, recommends using extra caution in prescribing these atypical antipsychotics to youths under the age of 18, and encourages psychiatrists to frequently monitor the weight and metabolic rate of those who are taking these drugs.
Sandra Boodman's article interviews Patricia Dawn about her 4-year-old daughter Brooke's illness, that was eventually discovered to be Kawasaki disease, an unusual heart condition. Brooke got the right treatment in time, but only because of her mother's persistence. Mrs. Dawn refused the recommendation of the emergency room doctors to take her daughter home at 2 a.m. when she wasn't feeling any better but they had run out of things to do. At her insistence, her daughter was hospitalized, and an infectious disease specialist eventually figured out that the red lips, red eyes, fever longer than five days, and swollen lymph node in the neck all were signs of Kawasaki, which affects about 2,000 American children a year.
It was also at the family's suggestion that the infectious disease doctor was brought in who made the correct diagnosis.
The story underlines the importance of having a good advocate present at all times with a patient in the hospital. Even a lay advocate can see when symptoms aren't improving and can insist on action.
I discuss this subject in depth in Chapter 12 of my book, "The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst."
]]>A medical adviser to Consumer Reports and also a board-certified neurologist, Dr. Orly Avitzur says that carrying a heavy backpack can cause low-back pain in children, and carrying the backpack on one shoulder instead of two exacerbates the problem.
Parents can consult some suggestions provided by the American Academy of Pediatrics about how to choose the best-fitting backpack and how to prevent injuries. Consumer Reports has also published its full report and buying guide.
Some of the American Academy of Pediatrics' guidelines include the following:
- Always use both shoulder straps. Slinging a backpack over one shoulder can strain muscles. Wearing a backpack on one shoulder may increase curvature of the spine.- Tighten the straps so that the pack is close to the body. The straps should hold the pack two inches above the waist.
- Pack light. The backpack should never weigh more than 10 to 20 percent of the student's total body weight.
- Organize the backpack to use all of its compartments. Pack heavier items closest to the center of the back.
- Stop often at school lockers, if possible. Do not carry all of the books needed for the day.
- Bend using both knees, when you bend down. Do not bend over at the waist when wearing or lifting a heavy backpack.
- Learn back-strengthening exercises to build up the muscles used to carry a backpack.
- Ask your pediatrician for advice.
But an article appearing in the latest Journal of American Medical Association has good news, as reported by Shirley Wang of The Wall Street Journal: a multicenter trial conducted in 4 U.S. cities found that a group prevention program effectively reduced the risk of subsequent depression for a target group of teenagers.
The study involved 316 “at-risk” teenagers (ages 13-17). All had a history of clinical depression and parents who had had depressive disorders. The youths were assigned to either a group cognitive behavioral prevention program or usual mental health care. After 9 months of treatment, of the teenagers who were assigned to the group CB prevention program and whose parents were not depressed at the time of the study, only 11.7% had a new depressive episode. In contrast, among teenagers in usual care whose parents were not depressed at the time, 40% experienced another episode of depression.
Although the prevention program only worked for teenagers whose parents were not currently depressed, the new finding is still encouraging, shedding light on future research directions and clinical recommendations.
Although scientists have not had a chance to develop conclusive findings on the health effects of texting because the phenomenon emerged so recently, they already see that the behavior causes “anxiety, distraction in school, falling grades, repetitive stress injury and sleep deprivation.”
Dr. Martin Joffe, a pediatrician in Greenbrae, California, surveyed two local high schools and found many of the students regularly send hundreds of texts every day. When a text message comes in or goes out every few minutes, it’s almost impossible for a student to stay focused on his or her work. That results in, among other things, poorer school performance and disrupted sleep at night.
Teenagers often rely on text messaging to get immediate updates on their buddies’ lives because they are genuinely interested in what’s going on with their friends. Many of them also are driven by a fear of being “out of the loop,” says Michael Hausauer, psychotherapist in Oakland, California. The nonstop line of communication created by so much texting can, Mr. Hausauer worries, make teenagers feel “frightened and overly exposed.”
The 80-text per day “thumb exercise” may also result in musculoskeletal diseases often found in computer users, said Peter W. Johnson, associate professor of environmental and occupational health sciences at the University of Washington. “Intensive repetitive use of the upper extremities,” be it on the computer keyboard or on a cell phone, can lead to temporary or permanent musculoskeletal disorders.
Teachers and parents are often unaware of the extent to which texting has affected the children’s physical and mental health. But once they learn of the problem and impose some restrictions – such as a no-texting window overnight or a limited number of texts allowed each month – they can see visible improvements in the students’ grades and probably energy level too, from regained quality sleep.
The FDA is advising consumers to stop using these face paints, which were manufactured by a Shanghai, China company. The agency has also published a complete list of face paint products in this recall.
On May 13, 2009, Chicago’s City Council joined a handful of other jurisdictions in a unanimous decision to ban the sale of baby bottles and sippy cups that are made with BPA and intended for children under the age of 3, reports Karen Ann Cullotta of the New York Times.
One of the reasons why not more jurisdictions are banning BPA use in plastic containers is the lack of direct evidence that human exposure to this chemical is harmful to our health. So far, all the evidence for the adverse effects of exposure to BPA comes from animal research studies. FDA said last year that BPA levels found in products appeared to be safe – a conclusion condemned by a panel of scientific advisers to the agency, saying the FDA “ignored crucial studies and used flawed methods.”
To protect their children from exposure to BPA and its potential dangers, parents can turn to the BPA-free products that are already available at retailers.
The Jardine cribs in the recalls, mostly sold at Toys R Us and Babies R Us, are responsible for more than 30 reports of broken slats, one of the deadliest hazards of baby cribs. When a slat breaks, babies’ bodies slip through the gaps but their heads get stuck, resulting in strangulation and even death.
Parents can access a full list of recalled models at www.cpsc.gov. For those who bought one of the recalled cribs, a credit is available toward the purchase of a replacement.
As a result of the Chicago Tribune’s investigations, the National Highway Traffic Safety Administration has ordered a thorough review of safety regulations for car seats and taken steps to make the safety test results more available to consumers. Before, parents could compare safety ratings for cars, but would have no way of comparing which car seats do better at protecting their babies. They would not have known that more expensive car seats are not necessarily safer, or that some smaller cars performed better than the larger ones in these collision tests.
Enrico Moretti, one of the study’s authors, indicated that the study does not explain why students closer to a fast food restaurant are more likely to become obese, but affirmed the “credible and unbiased” causal effect it establishes between obesity and fast food.
Providing one more piece of evidence that fast food contributes to child obesity, this study has implications for public policy, said Kelly Brownell, director of the Rudd Center for Food Policy and Obesity at Yale University. Neighborhoods and school district may choose to “zone out” fast food restaurants to protect their children’s health.
About 1 out of 20 teens suffer from depression, which has been linked to lower grades, more physical illness and drug use, as well as early pregnancy.
Questionnaires can accurately identify teens prone to depression, plus there's new evidence that therapy and/or some antidepressants can benefit them, according to a report from the U.S. Preventive Services Task Force, published in the April 2009 edition of the journal Pediatrics .
Accompanying the task force advisory in Pediatrics is a research review saying there have been few studies on the accuracy of depression screening tests, but the tests "have performed fairly well" among adolescents. Treatment can help with symptoms of depression, say the reviewers from Kaiser Permanente and the Oregon Evidence-Based Practice Center in Portland, Ore.
But careful monitoring is vital since there's "convincing evidence" that antidepressants can increase suicidal behavior in teens, according to the Preventive Services Task Force report.
The new recommendation reverses what the task force said in 2002, when it reported that there was not enough evidence to recommend for or against routine screening of adolescents for depression.
]]>In a report in the Washington Post by Shankar Vendatam, scientists involved in a large federal study of the drugs sharply disagreed with one another about what the public should be told about their study results. One psychologist in the group of researchers said that parents needed to know that careful comparisons of the children in the study showed definite advantages of the drug treatment only in the first twenty-four months of use, and that longer use resulted in stunted growth, with drug-treated children typically an inch shorter and six pounds lighter than non-drug treated peers after 36 months of treatment. Another psychiatrist who participated in the study said long-term benefits were real but hard to demonstrate statistically.
The study is called the Multimodal Treatment Study of Children With ADHD (MTA). When its initial results were first published in 1999, a clear advantage was seen for behavior improvement in children who had taken the ADHD drugs in the first fourteen months of the study, compared to children who received only talk therapy or no treatment at all, and those results ignited a huge wave of popularity for the ADHD drugs with pediatricians and parents. But as the researchers have continued to follow the same children over the years, the advantage of drug therapy, at least as measurable statistically, disappeared.
Statistics, of course, do not necessarily apply in any one individual case. The take-away for parents is to be careful about any long-term use of drugs in their children and to continue to ask questions of doctors, and reach your own informed decisions about what to do.
]]>These IVF-related risks may include increased risk of low birth weight and premature birth, as well as severe birth defects like “a hole between the two chambers of the heart, a cleft lip or palate, an improperly developed esophagus, and a malformed rectum.” Studies indicate that IVF possibly give rise to abnormal genetic expression patterns that are responsible for these genetic disorders.
In addition to the more common birth defects, children born by IVF are also suspected to be at greater risk for other genetic disorders that are much rarer: Beckwith-Wiedemann syndrome (children with this syndrome are much more predisposed to childhood cancers of kidney, liver or muscle) and Angelman syndrome (severe mental retardation, motor defects and inability to speak).
Although certain risks of in vitro fertilization are beginning to surface, no finding is conclusive yet – these are preliminary studies that show “comparative risks,” but no “absolute risks” are known yet. Researchers are still in the process of discovering exactly what the risks are and what can be done to minimize them. More research reports will be available as scientists track the development and growth of babies born by IVF, and couples interested in fertility treatment should educate themselves about the risks in order to make informed decisions.
The study, published last week in Environmental Science and Technology, contradicts the federal and DC health officials' repeated assurance that there was “no identifiable public health impact from elevated lead levels in drinking water.” The US Environmental Protection Agency and the DC Water and Sewer Authority cited a 2004 report issued by the Centers for Disease Control and Prevention, which found no increased blood lead level in households where high levels of lead were found in tap water.
The problem in the District of Columbia is that many homes still have lead pipes that run from the water main under the street to the home.
Lead-poisoned children are at risk of many permanent neurological damages, including irreversible IQ loss, developmental delays, aggression, and difficulty focusing in school. D.C. residents whose children were two-years-old or younger during the water crisis are encouraged to monitor their kids. To reduce the impact of lead poisoning, doctors recommend “healthful, calcium-rich diet and an enriching educational environment that includes reading to them regularly.”