September 26, 2014

Scary Virus Is Spreading, but Isn’t Life-Threatening

An unusual respiratory infection that strikes primarily children is spreading across the country. The virus isn’t new, but its effect on children seems to be, according to a story on

There are many strains of enterovirus, but enterovirus D68 ( EV-D68) has hit the Midwest especially hard, and as of last week involved 13 states, the most recent being California. According to the Centers for Disease Control and Prevention (CDC), the symptoms can be severe, although no deaths have been reported.

As detailed by Dr. Wendy Sue Swanson, a pediatrician, the CDC’s data concern children from 6 weeks to 16 years old, with a median age of 4 years. Nearly 7 in 10 enterovirus patients had a history of asthma or wheezing.

“No question the illness has taken many by surprise,” Swanson wrote, “as it’s an unusual time of year to see huge numbers of children with cold symptoms with severe wheezing. In areas where the infections started to pop up, schools [have] been in session for a month or more so kids have been doing what they do best, playing in close contact and exchanging germs.”

Here’s what she says parents need to know:

  • Enteroviruses can cause a common upper respiratory infection often causing summertime “colds”; rarely do they cause serious infections.

  • Enteroviruses typically spread in fecal-oral fashion — that is, from not washing one’s hands after using the toilet, and spreading germs to the mouth. But EV-D68 also spreads from mucus and droplets in the air, from close contact.

  • Both children and adults can recover from enterovirus infections with rest.

  • Asthma is a risk factor for more severe symptoms associated with EV-D68. More than half of the children with lab-documented EV-D68 also had asthma.

  • There’s no vaccine to protect from this virus and no current medications to treat it; the body’s immune system needs time to eradicate it, and sometimes symptoms are so severe as to require hospitalization for respiratory support.

  • Prevention is the most important thing if the virus continues to spread throughout the U.S. Washing hands with soap and water for 20 seconds before eating and after coughing or sneezing or after changing diapers, is essential. Children and adults should stay home when they’re ill.

In addition, the American Academy of Pediatrics advises, “Children who have previously been diagnosed with asthma should follow their asthma action plans and communicate with their health care provider regarding yellow and red zone instructions.”

Remember that the symptoms of EV-D68 begin like a common cold, and you might not recognize its severity until your child is very ill. But most kids will recover on their own. If your child is unusually sick or is having breathing difficulty, call the doctor.

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June 20, 2014

CDC Says Parents Who Opt Out of Vaccinations Are Spreading Measles

A disturbing number of parents refuse vaccinations for their children because they believe immunization poses a risk of autism. They don’t believe the science proving not only the wisdom of being immunized, but the folly of the autism claim. And the consequences of their actions are beginning to emerge. In the first five months of this year, 288 cases of measles were reported to the Centers for Disease Control and Prevention (CDC).

That’s the highest year-to-date total in 20 years.

The CDC report was clear that the reason for measles’ renewed vigor in the U.S. was because more people are rejecting vaccination — 200 of the 288 cases occurred in unvaccinated people. And in 1 of 5 of the rest, vaccination status couldn’t be determined, so the 200 figure could well be low.

Measles is not just an inconvenient episode of itchy, red skin bumps. It can lead to pneumonia, encephalitis and even death, especially for children and infants.

Loyola University Health System in Chicago is renowned for its work in infection control and prevention. In a statement last month, Dr. Jorge Parada, its medical director for infectious disease, said, “People who consciously opt out of vaccines are depending on herd immunity — that enough other people will get vaccinated so as to prevent infection — which seriously undermines the herd immunity they depend on for safety. It's a numbers game, and America is losing ground in the fight against preventable disease.”

People in the anti-vaccination movement generally are affluent, educated and privileged. They have no excuse for choosing to be ignorant. They are vocal, but why anyone grants them a bully pulpit is mystifying. That question was plumbed by a recent episode on TV’s satiric “Daily Show," which was at once hilarious and painful.

We’ve regularly expressed our astonishment that people are so eager to accept bunk; that they are not, in fact, protecting their children from autism by withholding vaccinations, but instead are increasing their risk — and that of other people — of measles, polio and whooping cough. (See our blogs, “Feds Say Childhood Vaccine Schedule Is Safe and Effective” and “More Proof That Vaccines Have Nothing to Do With Autism.”)

The CDC noted that the three largest outbreaks of measles so far this year “occurred after introduction of measles into communities with pockets of persons who were unvaccinated because of philosophical or religious beliefs.”

“Religious, philosophical or personal reasons are not medical reasons for not getting vaccinated,” Parada said. And although that’s a harsh judgment, it’s based on concern for society at large.

Sometimes, the individual must sacrifice for the greater good, but in this case, it’s not even about sacrifice — when the reasons behind the anti-vaccination movement have been proved to be bogus, the only thing you’re sacrificing by doing the responsible thing is willful ignorance.

Some people have legitimate medical reasons for not being immunized — they might be allergic, or pregnant, for example. (See the CDC’s guide to who should not get vaccinated here.) These are the people most vulnerable to contracting disease when others opt not to protect themselves.

People who shun vaccination play the odds that they won’t get sick, but do they have the right to play with other peoples’ odds?

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April 4, 2014

C. Diff Infections in Kids Linked to Overuse of Antibiotics

Antibiotics can be lifesavers. And they can be life-threatening.

The dangers of overprescribing and overusing antibiotics are well known (see our blog, “CDC Report on Antibiotic Resistance Sounds Ominous Note.”), and now there are disturbing new signals that they can pose a dire threat to children.

According to a report in Pediatrics, most Clostridium difficile (C. diff) infections in children might be linked to antibiotics prescribed by doctors.

Considered a “super bug” — that is, an unusually strong and difficult to eradicate microbe — C. diff is a bacteria that causes intestinal infections and severe diarrhea. It’s painful and can be deadly. More than 17,000 children in the U.S. contract C. diff infections each year.

The Pediatrics study showed that antibiotic use was associated with nearly 3 in 4 C. diff infections, even though the drugs weren't taken because of C. diff.

As summarized on, researchers analyzed data from C. diff cases of nearly 1,000 children between 1 and 17 years old. They were from 10 different U.S. regions.

More than 7 in 10 cases involved bouts of diarrhea. In more than 7 in 10 of those cases, doctors had prescribed antibiotics to treat other conditions within the previous 12 weeks. The subjects had not tested positive for C. diff within the previous eight weeks. No deaths were linked to the C. diff cases.

The highest incidence of infection was found among white children between 1 and 2 years old.

The study was not conclusive about the cause of the infections, but it did demonstrate a strong association between the C. diff and antibiotic use.

Most of the children in this study had taken antibiotics for ear, sinus or upper respiratory infections. Half of all antibiotics prescribed to children for respiratory infections are not required, noted Because antibiotics also destroy beneficial bacterial that can protect against infections, taking them unadvisedly — for a viral infection (the drugs address only bacteria, not viruses) or for a problem that, given time, rest and other less aggressive measures, will resolve on its own — invites a larger threat.

The story refers to a study last year that found that doctors prescribed antibiotics in 6 of 10 cases of sore throat; only 1 in 10 cases can be treated effectively with them.

So although parents are desperate to address their child’s pain, discomfort and fever, they shouldn’t routinely ask for an antibiotic prescription for most common childhood infections. And the new study shows that the danger might be even worse than we thought.

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March 21, 2014

Well Child Appointments Can Pose Illness Risks

Generally, you bring your child to the doctor to help him or her feel better, not worse. But a recent study published in the journal Infection Control and Hospital Epidemiology shows an increased risk of flu-like illnesses for the kid and the family after a doctor’s appointment for an annual exam or vaccination.

The risk, the study suggests, translates to more than 700,000 potentially avoidable illnesses every year.

As explained on, the researchers used 12 years’ of data from the Agency for Healthcare Research and Quality's (AHRQ) Medical Expenditure Panel Survey to analyze trends of 84,595 families. The analysis included demographic, office-based, emergency room and outpatient records. They found that well-child visits for children younger than 6 increased the probability of a flu-like illness within two weeks for the youngsters or their families. The increase was fairly minor — just more than 3 in 100 — but still notable.

In a commentary accompanying the report, Dr. Lisa Saiman, a pediatrician and public health practitioner, offered some context: “The true costs of ILI [influenza-like illness] are much higher, as many more cases are likely to result in missed workdays or school days. Furthermore, ILI visits are associated with inappropriate antimicrobial use.”

Most people are aware of the large number of prescriptions for antibiotics that are ill-advised, and that their overuse leads to stronger microbes that are better able to resist them. (See our blog, “CDC Report on Antibiotic Resistance Sounds Ominous Note.”)

The possibility of exposing your family to illness doesn’t mean you shouldn’t take your kids to their well-child appointments; it means you should be aware of the risks, and ask your doctor and office staff what measures have been taken to minimize them.

"Well child visits are critically important,” said the study’s lead author. “However, our results demonstrate that health-care professionals should devote more attention to reducing the risk of spreading infections in waiting rooms and clinics. Infection control guidelines currently exist. To increase patient safety in outpatient settings, more attention should be paid to these guidelines by health-care professionals, patients, and their families."

The authors are talking about measures such as sufficient office cleaning, cough etiquette and hand hygiene compliance.

"Even with interventions, such as the restricted use of communal toys or separate sick and well-child waiting areas,” they said, “if hand-hygiene compliance is poor, and potentially infectious patients are not wearing masks, preventable infections will continue to occur.”

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February 28, 2014

The Facts About Fever

Parents are wired to beware of fever in their children. But their fear often is misplaced.

According to Melissa Arca, a pediatrician writing on, a moderately elevated temperature is not necessarily a bad thing; in fact, it can be beneficial. Lots of kid problems cause fever — the flu, colds, croup, ear infections…. The better you understand the reasons a child is feverish, and the purpose fever serves, the better you will be able to determine a minor problem from one that your doctor should address.

Arca offers four fever facts that should help you tell the difference between one that needs hot soup, and one that needs a doctor’s care.

1. Fever is a symptom, not a disease.

Fever is a reaction to illness. It’s a warning to rest and drink fluids. Treating your child’s fever won’t “cure” whatever infection he or she is fighting. “Think of it like disabling your car’s ‘oil change needed’ light,” Arca suggests. “Sure, you can turn off that light but it doesn’t negate the fact that your car’s oil still needs changing.”

Even if you suppress the fever — for example, with ibuprofen — the child still needs time to rest and recover from the infection.

2. Fever can wax and wane for three or four days.

Most fevers persist for a few days before they completely depart. So even if you treat it with acetaminophen or ibuprofen, expect it to recur after a few hours. That’s normal.

3. The number on the thermometer is not as important as how your child looks and feels.

Arca knows that most parents get a little panicked when their child’s temperature reaches 103 or 104. But that number does not communicate the seriousness of the illness. So resist the panic. Give the child a fever reducer for comfort and keep him or her well-hydrated. Fever makes the heart beat faster and increases the child’s insensible water loss (fluids lost through the skin and respiratory tract). Keep a bottle of water by the bed, and anywhere else your child is resting.

Remember, the goal is to help the child feel better, not to get rid of the fever.

4. A true fever is a temperature of 100.4°F (38°C) or higher.

Children’s temperatures naturally fluctuate throughout the day. So knowing what is a true fever is important.

In summary, resist the urge to treat a slight temperature elevation. Remember, says the National Institutes of Health, fever is an important part of the body's defense against infection because most bacteria and viruses that cause infections in people thrive at 98.6 °F. Many infants and children develop high fevers with minor viral illnesses, and although that’s a signal of the body waging battle, the fever is a weapon favoring the child. So unless you’re dealing with a temperature of 102°F or higher fever, let the fever run its course and provide comfort through fluids.

Brain damage from a fever generally doesn’t occur with fever less than 107.6 °F (42 °C). Untreated fevers caused by infection seldom exceed 105 °F unless the child is overdressed or trapped in a hot place.

Arca says these red flags demand a pediatrician’s intervention:

  • infants younger than 3 months with rectal temperatures of 100.4°F or higher;

  • fever that persists more than five days;

  • your child just doesn’t look well, is having difficulty breathing or has had a febrile seizure (one caused by fever);

  • your child’s fever is 105°F or higher. Although such a high temperature usually isn’t harmful, it merits a call to the pediatrician and the right dose of acetaminophen or ibuprofen.

Because acetaminophen, especially, can be harmful to youngsters, see our blog about proper dosages here.

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January 24, 2014

Sharing Is Good, Except for Germs

If there’s an echoing theme among parents with small children, it might be “Don’t put that in your mouth, you never know where it’s been.” As it turns out, according to a new study, bacteria are in a lot of places you don’t expect them to be, despite your best efforts.

As published in the journal Infection and Immunity and interpreted on, the study by researchers from the University of Buffalo suggests that cultures of certain bacteria can linger on cribs, toys, books and other children’s items long after scientists originally thought was possible, posing a potential risk of spreading common infections.

Researchers analyzed cultures, or biofilms, of Streptococcus pneumoniae and Streptococcus Pyogenes, and found that bacteria survived outside of the human body, the typical host necessary for growth, and they lasted for months as viable forms of infection.

S. Pyogenes is the culprit behind strep throat and skin infections. S. Pneumoniae attacks the respiratory tract, ears and other sites common among children and elderly people, and can cause death.

The researchers tested surfaces and items kids touch every day. There were high levels of both types of bacteria many hours after the surfaces had been cleaned; 4 in 5 stuffed toys tested positive for S. Pneumoniae and other surfaces yielded colonies of S. Pyogenes.

Because bacteria might survive in environments other than the human body, they have the potential to be continually infectious. The thinking used to be that their transmission required humans to breathe in infected bodily excretions from sneezing or blood exposure.

Rethinking cleaning procedures seems to be in order for day care facilities, schools, home nurseries and hospitals.

The best defense against this kind of bacterial exposure is what experts have preached forever: Wash hands often — yours and your kids — and use warm water and soap. Lather for at least 20 seconds.

Wash hands especially after touching particularly germy surfaces, such as toys, door handles, faucets, computer keyboards, touch screens and remote controls. Try not to touch your face after touching these surfaces.

Ask the people who look after your children — day care providers, baby sitters, teachers — what they do to prevent little ones from sharing the things they shouldn’t. Simply letting these folks know that you’re interested in hygiene can help them adhere to a healthful regimen.

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August 5, 2013

Early Use of Antibiotics May Lead to Eczema Later

Antibiotics are often necessary to treat an infection, but kids who take them before they’re a year old appear to be more likely to develop eczema.

A report published in the British Journal of Dermatology resulted from a review of earlier research. It concluded that children who took antibiotics in their first year were about 40% more likely to develop the itchy skin disorder. As interpreted in a story by Reuters, the study supports the idea that antibiotics destroy intestinal microbes that contribute to the development of the immune system after birth.

Fetuses exposed to antibiotics taken by their pregnant mothers, however, were not at higher risk of getting eczema after birth.

The Dermatology report, the first to consolidate available results from several studies indicating that early-life exposure to antibiotics increases the risk of eczema, reinforces what’s known as the “hygiene hypothesis”—that babies and youngsters who are not exposed to a wide variety of microbes don’t develop immune systems as robust as those who are. The theory has been applied to immune overreactions such as allergies and asthma.

As we wrote a few months ago, the American Academy of Pediatrics issued new guidelines for diagnosing and treating children’s ear infections in an effort to reduce the unnecessary use of antibiotics because, in addition to helping bacteria develop resistance to the drugs, using antibiotics when they’re not necessary can cause stomach problems and allergic reactions.

For some infections, most kids improve within a couple of days without drug intervention.

As many as 2 in 10 kids will have symptoms of eczema; more than half of them continue to have symptoms into adulthood.

The new report analyzed results of 20 studies of antibiotic use, either prenatally or in the first year of life, and their association with later skin problems. The more antibiotics a baby took, the higher the risk. Each round of antibiotics bumped up the risk of eczema by 7%. Broad-spectrum antibiotics, or those that treat a wide variety of infections, like amoxicillin, seemed to have the strongest effect.

Some experts noted the possibility of "reverse causation”—that’s when a baby with eczema has more skin infections that might require antibiotics and confound the results of the studies. But the authors of the new review acknowledged that limitation and said the findings are still valid.

Another possible flaw in the review concerns when eczema symptoms began and when antibiotics were first administered. The onset of eczema often occurs before a baby is a year old, so if symptoms began before antibiotics were given, those children should have been excluded from the studies.

But even outside experts who pointed out that flaw agreed: Antibiotics should be given to anybody only when it’s necessary, and especially for wee ones whose immune systems are developing.

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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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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, 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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April 26, 2013

Nursing Shortages in NICUs Promote Infection in Babies

Any parent whose newborn has spent time in the neonatal intensive care unit (NICU) has felt helpless and frightened seeing their tiny baby swathed in more medical paraphernalia than you’d think he or she could withstand. They’ve probably also felt grateful and in awe of the medical army charged with nurturing delicate new life into viability.

Neonatal nurses are truly on the front lines of their babies’ survival. And a recent study published in JAMA Pediatrics concludes that the warriors fighting for your kid are under serious attack from a lack of numbers. Depleted staffs raise the risk of infection in critically ill babies.

The study, as interpreted on MedPageToday, shows that infection rates for very low birth weight infants were 40% higher in NICUs that were understaffed with nurses.

The problem seems to be widespread: The researchers found that hospitals understaffed nearly 1 in 3 of their NICU infants and more than 9 in 10 of their high-acuity NICU infants, relative to staffing guidelines. (“High-acuity” patients are seriously ill and require medical interventions of an emergency and/or specialized or complex nature.)

National guidelines spell out optimal nurse-to-patient ratios. They’re based on acuity. Staffing for low-acuity infants is supposed to be one nurse per three or four babies; levels for the highest-acuity patients are at least 1 to 1.

When these levels aren’t maintained, studies show, the patients have a higher rate of nosocomial infections, especially infants with very low birth weights. “Nosocomial” means the infection was contracted as a result of the hospital setting—from a treatment or other exposure.

The study examined data from 67 NICUs from the Vermont Oxford Network, a nonprofit collaboration of health-care professionals working in more than 900 NICUs around the world. Measured by the national guidelines, hospitals understaffed nearly 1 in 3 NICUs infants in 2009 and nearly 5 in 10 in 2008, but the levels varied by acuity. Hospitals understaffed more than 8 in 10 high-acuity infants in 2008 and more than 9 in 10 in 2009.

The study did have limitations—it might not represent all hospitals with a NICU or consider other factors that might be important in NICU staffing decisions, including non-nursing personnel.

But the researchers’ conclusion was unequivocal: The "most vulnerable hospitalized patients, unstable newborns requiring complex critical care, do not receive recommended levels of nursing care."

Usually, parents don’t choose the NICU in which their ailing babies are assigned. So if yours is a NICU patient, find out if your child is considered a low- or high-acuity patient, and let the staff know you’re aware of the staffing recommendation for each. If the facility is understaffed, be extra vigilant about monitoring its infection-control measures. Find out more on our blog, “Controlling Infections in Pediatric ICUs.”

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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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January 30, 2012

Controlling Infections in Pediatric ICUs

Hospital infections have been a hot topic for a few years now, and most hospitals have made strides toward cleaning up their microbial act. A recent story in Consumer Reports, however, presents a bad news-goods news scenario about hospital-acquired infections in pediatric intensive care units.

Pediatric ICUs, the consumer group found, often have higher infection rates than ICUs for adults. The most threatening infections are delivered by catheters, tubes that provide nutrition, fluids and medication. If not inserted and managed under completely sterile conditions, they can spread infection throughout the body. In 2009, 1 in 4 of such infections were fatal.

Children are more susceptible to infection because their immune systems are less developed. And the very ill kids in ICUs are particularly vulnerable.

Part of the difficult of infection control, Consumer Reports said, concerns lack of information: “Of the 423 pediatric intensive-care units in the U.S., information on bloodstream infection rates is publicly available for less than half.” You cannot solve a problem of which you’re unaware.

By analyzing information from 92 pediatric ICUs in 31 states and Washington, D.C., Consumer Reports concluded that they carried an infection rate 20 percent higher than national rates for adult ICUs.

That’s the bad news. The good news is that parents can do something to minimize the chances of their child contracting an infection courtesy of the ICU.

If your child requires ICU care, and if your proximity, doctor’s admitting privileges and insurance coverage permit you to choose among hospitals, examine their respective infection rates as charted on the Consumer Reports website.

In choosing a pediatrician, find out where he or she has admitting privileges, and how those hospitals have performed.

If you don’t have the luxury of choice—and even if you do—here’s the Consumer Reports prescription for keeping infections at bay.

Ask the staff how you can help. A nurse has several patients to care for; parents have one. Watch that the central line stays clean, and that everyone in contact with it scrubs it clean and uses sterile equipment to access it.

Make sure the hospital follows best practices for inserting and maintaining central lines. This means disinfecting the site and changing the dressings regularly and standardizing procedures for changing the catheter caps and tubes. Following a regular routine with the proper tools is more protective than re-inventing the wheel each time. It’s not your job to know each of the steps; simply asking about them can remind staff to be extra vigilant about adhering to the safety measures.

Ask if the central line is still needed. Smaller veins can make it more difficult to insert catheters into a child, so sometimes doctors prefer to leave it in until they’re sure it’s no longer necessary. And once a child has a central line, often it’s used for blood samples, reducing a child’s exposure to traumatic needle sticks. Those practices can be good medicine, but they’re not without risk.

Keep hands clean. Make sure you, visitors and the hospital staff wash their hands with soap or an alcohol-based solution before touching your child or the catheter.

Watch the catheter. The line can come into contact with a diaper; a fidgeting child might put the lines in his or her mouth.

Take notes. Keep track of how often hospital staff change the catheter or dressing and how long the catheter has been in.

Raise an alarm. If something seems amiss, trust your instincts. Voice them and make sure someone responds.

Share your story. If you or someone you care for has been harmed by a hospital-acquired infection, contact Consumer Union’s Safe Patient Project, which raises awareness about hospital safety. That site offers a wealth of information about how patients can influence their care and that of their loved ones in positive ways.

Another resource for hospital patients, and potential patients, is Consumer Reports hospital survival guide.

Also, see our Web page on hospital monitoring.

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April 22, 2010

Parents of Autistic Kids Need to Check Swingsets Carefully

For many children with autistic spectrum disorders who are learning to deal with autistic mannerisms, riding on a swing is a daily therapeutic activity whose effectiveness in improving sensory integration has been documented in scientific studies (see a ScienceDaily story published in April, 2008). However, a recent paper reports a potential hazard in these therapeutic swings that may cause eye injuries, according to the New York Times’ Roni Rabin.

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.

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February 11, 2010

A Checklist of Infection Symptoms for When to Take Your Child to the ER

Small children frequently get fevers and infections, and survive them just fine. But occasionally something more dangerous comes along. Here is a checklist of warning signs, put together by Consumers Report and the British Medical Journal. Go to the emergency room if your child has any of these:

  • A blue or purplish tinge to the child’s skin, often around the fingernails or the mouth
  • Rapid breathing
  • Poor blood flow to the hands and feet. Your child’s hands or feet might feel much colder than usual, or their fingernails might take longer than a couple of seconds to turn pink again after being squeezed
  • A rash caused by broken blood vessels under the skin. This kind of rash can be a symptom of meningitis. Some rashes will go away if you press them, but this kind won't.
  • You can check by rolling a glass over the rash
  • Drowsiness or loss of consciousness
  • A seizure
  • A fever measuring over 104 degrees Fahrenheit.

Also, trust your instincts. If you have a bad feeling that something might be seriously wrong, go ahead and take your child to the hospital. Those instincts are often correct, and if they're wrong, no harm is done by being cautious.

Here is the full report from Consumer Reports.

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