DC Child Accident & Safety Blog

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

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

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

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

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

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

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

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

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

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

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

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

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

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.”

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.

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.

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.

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.