pediatrics

RECENT POSTS

10 Ways The Birds And The Bees Have Changed

(Courtesy Candlewick Press)

(Courtesy Candlewick Press)

Way back in 1988, children’s book author Robie H. Harris was sitting in a New York editor’s office batting around ideas for possible books. The editor proposed that she write a book about AIDS for elementary school children; she counter-proposed an all-encompassing look at “almost every single question that kids might have” about anything related to sex.

She rattled off a list of topics, and the rest is history: “It’s Perfectly Normal” is just out in its 20th-anniversary edition, with more than a million copies already in print. The mix of text by Harris and illustrations by Michael Emberley do indeed seem to cover all the sexual topics pubescent kids wonder about, from masturbation to menstruation to orientation to contraception.

“Of course,” Harris says, “over the years, I’ve added more topics as the times have changed, as information has changed, and as kids coming into puberty and adolescence have changed in some ways.”

What might those topics be? And what do they say about how kids’ worlds have changed over the last 20 years? Herewith, 10 significant changes in the book and what Harris says about them:

1. The Infosphere:
“There can be a lot of inappropriate, weird, confusing, uncomfortable, creepy, scary or even dangerous websites that you can end up on when looking for information.”

The biggest change in kids’ lives over the last 20 years, Harris says, is how they get their information. “With the explosion of information happening everywhere, kids are bombarded by sexual images, sexual words, words in songs. And then there’s the Internet: Kids can go on the Internet and find responsible information, and they can also go on the Internet and find information that is not accurate and sometimes absolutely dishonest.“

“And so the biggest change is the need to help kids know how to understand the information you get, and how do you get help with it? That’s when you go to a trusted adult. There’s just much more information to sort through for kids, and that’s why the biggest expansion in the book is the Internet chapter.”

And just a note on porn: Harris says every mental health expert she consulted says youngsters should stay away from it. (The book is for age 10 and up.) So “It’s one of the few judgments I put into the book, because I think it has to do with the health and wellbeing of our kids.”

2. Gender
“Gender is another word for whether a person is male or female. Gender is also about the thoughts and feelings a person has about being a female or being a male.”

Author Robie H. Harris (Courtesy Candlewick Press)

Author Robie H. Harris (Courtesy Candlewick Press)

That’s the broader definition of gender in the opening chapter, and the new edition also includes an explanation of “transgender” and “LGBT.” Harris acknowledges that the section on transgender youth “should have been in the book earlier, but it’s in there now.”

The section also includes a discussion of some people’s disrespect for gay and transgender people, and says it generally stems from ignorance. “I can’t write without a point of view,” Harris says. And her litmus tests has always been, “Is this what I would say to my own children?”

3. Long-acting birth control
The IUD, the implant and Depo-Provera are the most effective kinds of birth control.

The ranking of the most effective birth control methods is new, Harris says. It reflects a strong consensus among medical authorities that those long-acting methods are appropriate for teens who become sexually active — and desirable because they’re by far the most effective: they require no further action by the user — no daily pill, no pause for diaphragm insertion. Continue reading

Curb Your Hysteria: Talking Rationally To Kids About Ebola Risk

A man diagnosed with Ebola this week is being treated at Texas Health Presbyterian Hospital in Dallas. (AP)

A man diagnosed with Ebola this week is being treated at Texas Health Presbyterian Hospital in Dallas. (AP)

By Gene Beresin, MD and Steve Schlozman, MD

On Sept. 30 the first case of Ebola was diagnosed in the United States. The patient, who is currently being treated in Dallas, had recently traveled to Liberia, and was back in this country for a few days before symptoms began.

Understandably, the coverage of this news is pervasive. Although it seemed inevitable that a case in the U.S. would eventually emerge, the story still ignites a fair bit of hand-wringing among just about everyone who has learned of it.

Additionally, our country has experienced some novel infections that have ignited increased concerns in recent weeks. Enterovirus D-68 has made its way across the nation, causing severe cold-like symptoms, and, in some children with conditions such as asthma, the need for hospitalization. There’s also a potentially new contagion on the horizon that appears to cause varying degrees of muscular paralysis, and may or may not be related to Enterovirus D-68.

But, as public health officials are eager to stress, a nuanced and thoughtful approach to these issues has been as necessary as it has been fleeting. Experts agree that our medical infrastructure is well-equipped to handle even a virus as scary as Ebola, and some doctors are quick to point out that viruses like respiratory syncytial virus (RSV) and influenza are much more likely to cause harm than these new ones.

This raises a critical point:

Ebola, as scary as it is, poses a relatively minor threat to the United States; and the current cases of Enterovirus D-68 are far out-numbered by the RSV and influenza cases we experience on a yearly basis. And the currently unknown contagion that appears to cause paralysis has only happened in a very small population of kids.

So why the massive reaction in the media and among worried parents? Intellectually, at least at this point, all indications point to little danger for our children and ourselves. Why, then, do we get so frightened?

Well, let’s start with this confession: We’re frightened.

Sort of.

We know, intellectually, that the threat is minor. But, when has intellect played a leading role in the emotionally driven process of threat assessment? And, especially with regard to infectious disease, when has anyone other than the most statistically driven scientists been able to preserve perspective? We’re not saying that we should massively worry, or even that we’ll be changing our instructions to our kids or our patients on how to behave with these new bugs dancing around.

What we’re saying is that germs, especially new germs, are scary. We have a long and probably evolutionarily derived tendency to fear disease, and when new ones rear their heads, we get alarmed.

Germs In Hollywood

As a society, we think about germs a lot — and nowhere, perhaps, does that play out more than in Hollywood. The 1954 novella “I am Legend” has been made into no less than three movies (“The Last Man on Earth,” “The Omega Man” and the more recent movie of the same title as the written work). You can rattle off other movies as well — there’s “Dawn of the Dead” (in 1978 and again in 2004), “Outbreak,” “Carriers,” “Contagion,” “The Crazies” (in 1973 and again in 2010),

“Quarantine” (and “Quarantine 2″) and most recently “World War Z.” You get the picture. Continue reading

Word To Pediatricians: IUDs And Implants Top Choices For Teen Birth Control

From a Planned Parenthood video on the IUD (YouTube)

From a Planned Parenthood video on the IUD (YouTube)

By Veronica Thomas
Guest contributor

When a teen girl tells her pediatrician she’s thinking about having sex, the response is often a brief talk about abstinence, a handful of condoms, and a referral to the family planning clinic across town.

But a new recommendation makes pediatricians likelier to discuss the whole gamut of birth control methods—with IUDs and hormonal implants topping the list.

Released today by the American Academy of Pediatrics, the recommendation says doctors should discuss a broad range of birth control options with sexually active teens, but should start with the methods that protect against pregnancy best: long-acting reversible contraceptives, which include the hormonal implant, copper IUD and two hormonal IUDs.

Teen pregnancy rates have dropped dramatically over the past two decades to a record low, but the U.S. still has one of the highest rates among developed countries: more than 750,000 pregnancies each year. Though most sexually active teens use some form of birth control, they rarely pick the most effective methods and often use them incorrectly—whether it’s missing a few doses of the pill or accidentally tearing a condom.

“It’s sort of a set-and-forget method.”
– Heather Boonstra, Guttmacher Institute

Because IUDs and implants don’t rely on any action from the user, they’re a particularly good fit for teens, says Heather Boonstra, Director of Public Policy at the Guttmacher Institute.

“It’s sort of a set-and-forget method,” she says. Once inserted by a trained professional, an implant or IUD can last from three to ten years, and will be over 99 percent effective. The implant is a matchstick-sized rod inserted in the upper arm; the IUD is a small, T-shaped device placed into the uterus.

Their use has been rising for years in the general population. From 2002 to 2009, implant and IUD use nearly doubled among women overall. But while use of these long-acting methods has also been increasing among teens, less than five percent of all teen contraceptive users currently choose them.

That’s because most teens have never even heard of the implant or IUD, says Boonstra. Continue reading

Study: Aerobics Plus Resistance Training May Be Best Against Teen Obesity

obese kid

A new study published online in JAMA Pediatrics finds that a combination of aerobic workouts plus resistance training offers the best hope for teenagers battling obesity.

From the abstract:

Aerobic, resistance, and combined training reduced total body fat and waist circumference in obese adolescents. In more adherent participants, combined training may cause greater decreases than aerobic or resistance training alone.

Here’s more from The New York Times coverage of the study, which found that “diet without exercise accomplishes little:”

Canadian researchers put 304 obese teenagers on a diet with a daily energy deficit of 250 calories (measured from their resting energy expenditure). Then they assigned them randomly to one of four groups for 22 weeks: aerobic training on exercise machines like treadmills, resistance exercise using weight machines and free weights, combined aerobic and resistance training, and a diet-only group with no exercise… Continue reading

Mass. Reports First Case Of Cold Virus, E68

Massachusetts has its first confirmed case of a cold virus that has sent hundreds of children to hospitals across the the country.

The case of an 8-year-old girl who was treated at Boston Children’s Hospital and released means Enterovirus 68 is here and spreading, says state epidemiologist Al DeMaria. It is not typically as dangerous as the flu, he says, except in children with asthma.

“Compared to influenza virus, this virus does not cause a lot of serious complications,” DeMaria said. “In fact, the vast majority of children who have asthma attacks get better.”

DeMaria urges children with asthma to take their management medications. He asks everyone to wash their hands often.

– Here’s the full press release from the state Health Department:

The Massachusetts Department of Public Health (DPH) today announced a confirmed case of Enterovirus D68. The patient is a school aged child with a history of asthma who became ill in early September and has since been treated and released from an area hospital. Due to privacy considerations, DPH will not be releasing additional patient information.

“With enterovirus D68 now widespread across the country, this news comes as no surprise,” said DPH Commissioner Cheryl Bartlett, RN. “We have been working closely with pediatric providers and area hospitals to ensure the proper testing was done to identify the virus. For most children, this virus is relatively mild – but for children with asthma or other respiratory illnesses, it can be serious. Parents should contact their pediatrician if their child is experiencing respiratory issues.”DPH State Epidemiologist Dr. Alfred DeMaria underscored the importance of simple, common-sense steps such as hand-washing to reduce the spread of illness. “As with any other respiratory virus, hand washing is the key to reduce spread, use soap and warm water for 20 seconds” said Dr. DeMaria.

Other tips for parents and patients include:
Avoid touching eyes, nose and mouth with unwashed hands
Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick
Clean and disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone in the home is sick

Continue reading

Winning Ideas In Contest On ‘How To Make The Breast Pump Not Suck’

A team at the MIT Media Lab's "hackathon" on "How To Make The Breast Pump Not Suck" presents its ideas. (Carey Goldberg/WBUR)

A team at the MIT “hackathon” on “How To Make The Breast Pump Not Suck” presents its ideas. (Carey Goldberg/WBUR)

Anyone who’s ever had a close encounter with a breast pump knows that it sucks in multiple ways: It sucks out breast milk, and it sucks because it makes mothers feel like milk cows at the mercy of a loud, dumb, unwieldy, uncomfortable machine.

“Pumping is the worst, it really is,” said Erin Freeburger, a mother and a user-experience designer who was attending her first-ever “hackathon” this weekend: the MIT Media Lab’s “Make The Breast Pump Not Suck!” contest. “That’s why we’re all here. No one here is like, ‘What? It’s fine, how it is!’ It’s awful. But we love our babies more than we hate our pumps, so that’s why we’re motivated to be here today.”

We love our babies more than we hate our pumps.
– Erin Freeburger

Freeburger’s team was among ten squads of brainstormers who took on the intense weekend challenge of improving upon current breast pump designs — and her team won the first prize of $3,000 and a trip to Silicon Valley to court investors. Their concept: The “Mighty Mom” utility belt, is “a fashionable, discreet, hands-free wearable pump that automatically logs and analyzes your personal data.” Milk data, that is.

The concept, she explained, involves both hardware — the utility belt to hold pumping parts needed on the go — and software: It imagines a “smart” breast pump that would collect and track data and upload it to the cloud: milk volume, even fat and protein content as analyzed by infrared sensors. (My reaction: So it’s, like, the iPump?)

The team that would ultimately win the "Make the Breast Pump Not Suck"  hackathon with its "Mighty Mom" utility belt. (Photo: Mason Marino)

The team that would ultimately win the “Make the Breast Pump Not Suck” hackathon with its “Mighty Mom” utility belt. (Photo: Mason Marino)

Other winners, according to the contest site: Second prize of $2,000 to “a sturdy, easy-to-clean, minimal-parts, hands-free compression bra designed by nursing moms. The bra helps women manually express breastmilk (a technique proven to be as effective as electric pumps) without their hands.”

It’s not an iPhone, it’s a mortar and pestle.
– Victoria Solan

And third prize of $1,000 to “an open software and hardware platform to make the breast pumping experience smarter, more data-rich and less isolating. PumpIO puts pumping women in touch with lactation consultants and communities as they are pumping, when they have questions and to help reinforce their commitment to their baby.”

And special recognition goes to “a breast pump that mimics the way that a baby suckles with massage and compression. This team also designed soft, low-profile flanges to be worn discreetly.” And more special recognition to this winner of the popular vote:

Compress Express: A breast pump that mimics the natural and age-old art of hand expression, instead of archaic vacuum technology that dominates the market. Inspired by the simplicity of blood pressure cuffs, this project’s gentle compression technology enables efficient milk expression and creates a discreetly wearable, virtually silent and hands-free breast pumping experience.

Debra Abbaszadeh, a founder of Simple Wishes, a hands-free bra company based in San Francisco, said she thought “the whole idea of compression versus expression was really interesting. I think it requires a lot of work. I think the concepts, exactly as they are, are not quite there, but it’s a very interesting idea.”

You might think, given the huge market for breast pumps in a country where most women work and most mothers breastfeed, that pump makers would already have been racing to improve on designs.

So why should a hackathon — an intense team brainstorming session that originated in computer engineering — even be needed?

Despite the commercial efforts, clearly, “Most women are still dissatisfied,” said Victoria Solan, a historian of architecture and design who attended the hackathon. “There’s a lot of talk about how they’re painful, they’re uncomfortable, they don’t work well. So I think the organizers’ original claim — that there’s no reason that the breast pump shouldn’t be as well designed as the iPhone — is true. It’s not. It’s not an iPhone, it’s a mortar and pestle.”

But as some hackathon participants discovered, improving upon it is not necessarily easy. Continue reading

If You Build A Crew Program For Overweight Kids, They Will Row — And Get Fitter

There was no comfortable place for 17-year-old Alexus Burkett in her school’s typical sports program of soccer and lacrosse and basketball.

“They don’t let heavyset girls in,” she says.

Alexus was “bullied so bad about her weight,” says her mother, Angelica Dyer, “and there was no gym that would take her when she was 14, 15 years old. There was no outlet.”

But Alexus has found a sports home that is helping her bloom as an athlete: an innovative program called “OWL On The Water” that offers rowing on the Charles River specifically for kids with weight issues.

She has lost more than 50 pounds over half a year, but more importantly, says her mother, “They’ve given me my daughter’s smile back.”

Alexus Dwyer during warm-ups before instruction time. (Jesse Costa/WBUR)

Alexus Burkett stretches during warm-ups before “OWL On The Water” instruction time. (Jesse Costa/WBUR)

“It’s given me a lot of good strength and it’s making me more outgoing,” Alexus says. “We’re all best friends and we’re all suffering with the same problem — weight loss — so we’re more inspiring each other than we are competing against each other.”

OWL On The Water offers a small solution to a major national problem: According to the latest numbers, 23 million American kids are overweight or obese, and only about one quarter of 12-to-15-year-olds get the recommended one hour a day of moderate to vigorous physical activity. Heavier kids are even less likely to be active, and only about one-fifth of obese teens get the exercise they need, the CDC finds.

“I know I need to be active, but please don’t make me play school sports!” That’s what exercise physiologist Sarah Picard often hears from her young clients at the OWL — Optimal Weight for Life — program at Boston Children’s Hospital that sponsors OWL On The Water.

Many gym classes still involve picking teams, “and my patients are the ones that are always picked last,” she says. “You’re the biggest one, you’re the last one, you’re picked last, and you’re uncomfortable.”

They are strong, powerful people.
– Sarah Picard

School fitness testing is important, Picard says, but it, too, can be an ordeal: “I have kids who sit in my office and tell me that they didn’t go to school for a week because they wanted to miss the fitness testing,” she says.

While many a coach might see bigger bodies as poorly suited to typical team sports, Picard sees them as having different strengths. Particularly muscular strength.

“What I’ve observed is that these kids are much better at strength and power-based activities,” she says. And rowing is particularly good for them, she says, because though it is strenuous, it is not weight-bearing, and thus more comfortable for heavier bodies — yet a heavier, strong body can pull an oar much harder than a smaller person’s body. The program begins by building on that muscular strength, she says, and then works on aerobic fitness. Continue reading

Tackling Autism In Babies? Small Study An ‘Absolute Miracle,’ Says Mom

Megan says the experimental trial she participated in with her daughter Isabel was "an absolute miracle," transforming the child from a troubled baby who looked headed for autism to a typical, happy preschooler.

Megan says the experimental trial she participated in with her daughter Isabel was “an absolute miracle,” transforming the child from a troubled baby who looked headed for autism to a typical, happy preschooler.

Research out this week suggests that it’s never too early to begin therapy to treat some of the defining symptoms of autism. Karen Weintraub reports on the promising new findings in USA Today under the headline, “Study: Autism Signs In Babies Can Be Erased.”

Karen expands on her report here:

In a small pilot study — the first to look at starting therapy in babies this young — researchers at the University of California Davis’ MIND Institute, began treating 7 babies who showed symptoms likely to turn into autism later. By their third birthdays, five of the children no longer exhibited any symptoms of autism, and a sixth was diagnosed with mild autism.

Because the study was so small, and autism cannot reliably be diagnosed in infancy, the researchers stopped short of calling the treatment a breakthrough. But they said they will be following up with a larger study, which they hoped would confirm the results.

One mother involved in the trial described the treatment as “an absolute miracle” for her daughter, Isabel. The mother, Megan, asked not to be fully identified, but talked openly about the trial and its benefits for her family.

At nine months old, Isabel wouldn’t turn her head when someone walked into a room calling her name. She never babbled, Megan said. She was physically delayed in fine and gross motor skills, and didn’t seem to know how to play with toys. All those are signs commonly seen in children who go on to be diagnosed with autism.

Megan heard about the trial through her pediatrician and the family – including Isabel’s dad and her older brother – moved from the Seattle area to Sacramento, so they could participate in the study.

In 12 weekly sessions, lead researcher Sally Rogers coached Megan and her husband John as they played with baby Isabel. Where most children will smile or giggle when happy, Isabel’s facial expressions didn’t change much; where others might cry if scared by a loud sound, Isabel rarely reacted to anything in her environment. But Rogers showed them that Isabel might glance over quickly when she was interested or look at her hands when something was too loud or overwhelming – cues that Megan and John could take to do more or less of whatever they were doing.

Once they learned to “speak” Isabel’s language, Megan said she and John were able to react to her and engage with their baby for the first time. Eventually, through this interaction, Isabel learned that she could communicate – and have fun doing it. That primed her to learn even more, Megan said.

Megan said she and her husband would never have figured out what to do without the coaching. Continue reading

When One Twin Baby Lives But The Other Dies

(stitches1975 via compfight)

(stitches1975 via compfight)

By Dr. Karen O’Brien
Guest contributor

Never before in my obstetric practice have I taken care of so many twin pregnancies. What I witness in my own office is part of a nationwide trend: Over the last two decades, the twin birth rate in the United States rose 76 percent, from 19 to 33 per 1,000 births.

And never before have I taken care of so many twin pregnancies with complications.

The specific complication that has given me pause in the last year or two is the loss of one twin, either during or after pregnancy.

This doesn’t happen often, but I have taken care of a number of patients recently who have lost a twin during or shortly after pregnancy. And I’ve learned that though outsiders might see a glass half full, this experience is uniquely devastating, both emotionally and medically.

We must all understand that the life of one twin does not eradicate grief for the sibling who died.

The hope and anticipation of bringing home two healthy babies comes grinding to a halt. The joy of delivery is clouded by sibling loss.

As early as 18 weeks, Melissa’s identical twins showed signs of a complication called twin-to-twin transfusion syndrome, which occurs when one of the twins essentially donates blood to the other.

At 19 weeks, Melissa underwent surgery to try to correct the problem. Unfortunately, two days after the surgery, one of the twins passed away. Melissa remained pregnant for 13 more weeks and ultimately underwent cesarean section at 32 weeks.

She and her husband were able to hold the deceased twin for several hours after delivery. Her live twin did well; she spent a few weeks in the neonatal intensive care unit (NICU) and is now home and thriving.

Samantha’s twins were not identical, and were conceived through in vitro fertilization. At 14 weeks, we found that one of the twins, a boy, had several serious abnormalities. Even at that early gestational age, we knew that he would not live for long after birth, and might pass away during the pregnancy. The other twin, a girl, appeared normal throughout the pregnancy. Continue reading

Pediatricians: Middle And High School Should Start No Earlier Than 8:30 AM

(eltpics/Flickr via Compfight)

(eltpics/Flickr via Compfight)

It’s one of the great joys of early parenthood: Finally being able to sleep until a reasonable hour — say, 6 a.m. Then, before you know it, you’re facing the opposite problem: Homeroom is just half an hour away, and your tween or teen remains an immovable lump beneath the covers.

As any parent who’s observed it would suspect, this is deep biology at work. Today, the American Academy of Pediatrics issues both an up-to-date explanation of research on adolescent sleep and a ringing call to the country’s schools to heed it and begin school later for “pathologically sleepy” older students. Sleep deprivation in youth is a common — “and easily fixable” — public health issue, the academy says in a policy statement.

From the press release, whose headline begins “Let Them Sleep:”

“The research is clear that adolescents who get enough sleep have a reduced risk of being overweight or suffering depression, are less likely to be involved in automobile accidents, and have better grades, higher standardized test scores and an overall better quality of life,” [statement lead author Dr. Judith] Owens said. “Studies have shown that delaying early school start times is one key factor that can help adolescents get the sleep they need to grow and learn.”

Many studies have documented that the average adolescent in the U.S. is chronically sleep-deprived and pathologically sleepy. A National Sleep Foundation poll found 59 percent of 6th through 8th graders and 87 percent of high school students in the U.S. were getting less than the recommended 8.5 to 9.5 hours of sleep on school nights.

This medical stance on sleep deprivation is not new; the research has been accumulating for many years. But the academy reports that about 40 percent of American high schools still start before 8 a.m., and only 15 percent launch the school-day at or after 8:30. Among middle schools, it says, more than one-fifth begin at 7:45 or earlier.

If schools are not shifting later as fast as pediatricians might like, that could be because, like virtually everything in education, it’s not as simple as it might seem.

‘Life is going on right now in hyperspeed for most of our young people.’

“Once you go deeper into the lives of kids today, things become more complex,” says Dr. Bob Weintraub, who was the headmaster of Brookline High School from 1992 to 2011 and is now a professor of educational leadership at Boston University. Based on the research, Brookline High shifted start times for most students to 8:30 during his tenure, he said, but such shifts do raise issues.

“One of the practical problems has always been for high school athletics and school activities,” he said; if school ends later, sports and other activities must start later, and outdoor sports are hindered when darkness descends. Continue reading