DC Child Accident & Safety Blog

Parents who turn to their child’s pediatrician for health and safety advice may end up hearing recycled parenting myths, a new study reports.

“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of the myths are benign old wives’ tales, Adesman said, there were a “dangerous dozen” health beliefs that reflected outdated parenting beliefs that could pose a risk to a child’s safety or well-being.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.

Who's at fault for the high rate of Cesarean sections in the United States? If you listen to the obstetricians, it's all about lawsuits -- they are at risk of being sued for "anything short of a perfect outcome," as two doctors wrote last week in a letter to the editor in the New York Times.

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.

The rate of C-section births in the United States has been increasing every year since 1996 for women of all ages and racial and ethnic groups, and now the procedure is the most common operation in the country. In 2007 alone, 1.4 million Caesareans were performed, representing 32 percent of all births. However, although C-sections can be life-saving in some instances, experts are concerned with the ever-increasing number of the procedures, reports Denise Grady of the New York Times.

Joining other critics, Dr. George Macones, spokesman for the American College of Obstetricians and Gynecologists, is worried that the rise in number of C-sections “is not going to be good for anybody.” The procedure, a costly major surgery, poses health risks to the mother as well as the baby:

Risks to the mother increase with each subsequent Caesarean, because the surgery raises the odds that the uterus will rupture in the next pregnancy, an event that can be life-threatening for both the mother and the baby. Caesareans also increase the risk of dangerous abnormalities in the placenta during later pregnancies, which can cause hemorrhaging and lead to a hysterectomy. Repeated Caesareans can make it risky or even impossible to have a large family.

The new report notes that Caesareans also pose a risk of surgical complications and are more likely than normal births to cause problems that put the mother back in the hospital and the infant in an intensive-care unit.

According to Grady, the reason for the rising popularity of the procedure is manifold: doctors fearful of malpractice liability should babies be born injured with vaginal delivery; women requesting the procedure even when it’s not medically warranted, not understanding its risks; increased tendency to induce labor for reasons of convenience. Also, many hospitals have banned vaginal births for women who have had Caesareans, adhering to the obstetricians’ college’s guidelines.

In light of the many risks of Caesareans, expecting mothers should educate themselves about their delivery options and consult their doctors to decide whether the procedure is medically necessary.

The bottom line is to find the best way to ensure the baby's health. Sometimes that is with vaginal delivery, but sometimes not. In our law firm's practice, for example, we have represented several families whose children suffered terrible injuries because the mother's uterus ruptured during a VBAC delivery (Vaginal Birth After Caesarean), and all of those mothers would have skipped the effort at vaginal birth if they had known the risk of catastrophe. Our firm's website has extensive information about birth injuries here and here.

Stroke, an injury to the brain usually caused by a clot of blood that blocks delivery of oxygen to a portion of the brain, is thought of as an adults-only disease. It does happen in children, though, and it's worthwhile for parents to know about it, because the symptoms are frequently misdiagnosed. A father's account in the New York Times tells the story of his son Jared, who had a stroke at age seven. Now, two years later, his brain has mostly recovered, a testament to the remarkable power of children's brains to "rewire" themselves, especially when damage is limited to a discrete area. The most common signs of stroke in children or teenagers include the sudden appearance of:

• Weakness of the face, arm or leg, usually on one side of the body
• Trouble walking due to weakness or trouble moving one side of the body
• Problems speaking or understanding language, including slurred speech, trouble trying to speak, inability to speak at all, or difficulty in understanding simple directions
• Severe headache, especially with vomiting, sleepiness, or double vision
• Trouble seeing clearly in one or both eyes
• Severe dizziness or unsteadiness that may lead to losing balance or falling
• New appearance of seizures, especially affecting one side of the body and followed by paralysis on the side of the seizure activity.

This list comes from Children's Hospital of Philadelphia (CHOP), which has the first pediatric stroke center in the country. In babies and newborns, the signs of stroke can be more subtle, but include seizures and extreme sleepiness, or unusual favoring of one side of the body. Parents who see sudden onset of these signs in their child should call 911 or get the child to an emergency room with expertise in stroke, and should consider a consult by telephone with the experts at CHOP. The stroke experts say that recognition of stroke is often delayed or even missed in most children. Many kids with stroke syndromes are misdiagnosed with more common conditions that mimic stroke, such as migraines, epilepsy or viral illnesses. But the key message is that early recognition and treatment during the first hours and days after a stroke is critical in optimizing long-term functional outcomes and minimizing the risk of a repeat stroke.

A riveting story in the Washington Post tells how a Washington area woman's advocacy in the emergency room likely saved her sick daughter from harm.

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."

The Virginia State medical board has reprimanded two obstetricians for how they handled the births of infants that were severely and permanently injured during delivery.

The doctors in question are immune from lawsuit because of a 20-year-old no-fault Virginia program that provides medical care to injured children without requiring a trial while protecting obstetricians from legal action. A consequence of this program was that birth-injury cases would often go unscrutinized and negligent obstetricians could go unnoticed and without reprimand. That is why this an unusual event and the first of its kind in twenty years.

The reprimands do not impose monetary sanction on the doctors, nor do they limit the doctors' ability to practice.

Tripler Army Medical Center must, thanks to the order of U.S. District Judge David Ezra, pay $9 million to the family of Parker Kohl. Parker is a 3-year-old who suffered severe brain damage while being treated at Tipler; he now has an IQ of less than 30, must be fed through a tube, is blind and cannot walk. Judge Ezra found that the hospital was negligent in its treatment of Parker.

This resolution is the best news the family could have hoped for, as they now have the resources to care for Parker's needs.

What happened to injure this child so grievously? Parker was diagnosed with a heart defect shortly after he was born and later developed a respiratory infection that led to hospitalization--except that his condition worsened while he was in the hospital's care, leading to cardiorespiratory arrest and subsequent brain damage. According to Judge Ezra, the hospital staff's failure to monitor Parker and prevent this incident was negligent. This is an example of the importance of attentive hospital care and the disastrous consequences of a lack of such care. What can you do to prevent this kind of thing from happening to you or your child? Only one thing has a real chance of helping, and that is asking questions and speaking out if you notice anything in your care that looks improper or inadequate.