Almost one in four American children are living in poverty, according to a new report by the Annie E. Casey Foundation. The long-term consequences of childhood poverty are bleak to say the least, but the report has a clear-cut policy recommendation to address this issue: invest in interventions that focus on early childhood development.
This policy direction strikes a chord with President Obama, whose most recent State of the Union address focused in part on early childhood education and its importance in setting the stage for a successful adult life.
And it fits perfectly with the spiffy new five-minute video above, narrated by Dr. Jack P. Shonkoff, director of the Harvard Center on the Developing Child.
From molecular biology to behavioral science, Dr. Shonkoff and teams of researchers have drawn from numerous scientific studies as they probed the issue of how a child’s early experiences are predictors of later life realities.
Their findings have led to a hypothesis that’s pointing a way forward in early childhood development research and policy directions. The hypothesis – or what Dr. Shonkoff calls a “theory of change” – is that to help a child’s life turn out better, considerable focus must be placed on building the capacities of the adults that are responsible for shaping children’s home environments and communities.
The theory is based on well-documented brain science indicating that neural circuitry begins developing from day one of a child’s life and the external conditions a child confronts have a profound impact on this process. Continue reading →
The CDC has just released a report on the prevalence of mental illness among American children. It notes: “A total of 13%–20% of children living in the United States experience a mental disorder in a given year, and surveillance during 1994–2011 has shown the prevalence of these conditions to be increasing.”
Yet as that prevalence increases, treatment options are decreasing, writes Lisa Lambert, executive director of the Parent/Professional Advocacy League, which advocates for Massachusetts families with mentally ill children. Below, she discusses one particular pending loss, of Cambridge Hospital children’s psychiatric beds long especially valued by families. The hospital announced last month that it would consolidate two units with 27 beds into just one with 16 beds. It cited tight budgets, declining utilization and cyclical demand. The details are still in play.
By Lisa Lambert
When Aiden was seven, it seemed like he would never be safe.
At home and in his second-grade classroom, he repeatedly talked about killing himself. He barely slept, raced from one spot to another and threatened to harm his younger sister. His parents stayed glued to his side, barely taking time to eat, shower or sleep.
One day, his mother caught him lighting a fire in his bedroom. Aiden ended up in the emergency room, and later in a bed in Cambridge Hospital. The staff had seen young patients like him before and they knew what treatment would work and what kind of follow-up care a seven-year-old needs. Without that hospital stay, his mother says, ”We don’t know where our family would be.”
Lisa Lambert of PPAL (Courtesy)
No one likes the idea of admitting a young child to an inpatient psychiatric program. It is a last resort, something to be avoided at all costs. Parents will tell you, however, that when they’ve exhausted all the options, Cambridge Hospital has provided the best possible care. Now, it seems that a major piece of that care is coming to a close, unless a miracle happens.
Last week, the Department of Public Health held a hearing to receive comments about closing the Cambridge Hospital child psychiatric unit and eliminating beds. Nurses stood shoulder to shoulder to tell stories of families they’ve helped and of their pride in the wonderful care they’ve given. Parents came to say that this place was a lifesaver and without it, their children would never have improved.
The Child Assessment Unit is one of a kind, they all said, where parents can visit anytime and even stay overnight. Since PPAL is a grassroots organization, we surveyed families about this and want their voices to be part of the public conversation. Continue reading →
Questions that may seem odd—even offensive — to some new mothers. Unless you are the mother of twins. Then you’re used to them.
The “babyrazzi” can be relentless, and the appearance of multiples in public can create an instantaneous barrage of questions. Earlier this year, I was in line at the Mothers of Twins sale (a huge biannual event in Winchester that is akin to the running of the bulls) comparing notes with other moms. Some of the more seasoned moms were used to the forward questioning, while the rest of us were still adjusting to the public’s keen interest in our multiples and our pregnancies.
Here’s my favorite. Upon seeing my boy and girl twins, “Are they identical?”
So when the hilarious cartoon above appeared in my Facebook feed on Mother’s Day, I didn’t mind the peering grandmothers at Costco later that afternoon. It captures just about every inquiry I’ve ever received and somehow it was validating to know that I’m not alone. I must say, all in all it’s a pretty special club.
Readers, any other cringe-worthy twin questions or comments you’d like to share?
Admit it, you’ve done this: your kid drops her pacifier on the floor and, too exhausted to schlep to the kitchen sink to rinse it, you just give it a good lick and hand the binky back.
Well, it turns out this not-so-pretty cleaning method you turn to when no one else is looking may, in fact, be one helluva gift for your child’s immune system.
Researchers in Sweden report that “children whose parents sucked on their pacifiers to clean them had one-third the risk of developing eczema (the most common early manifestation of allergy), at 18 months of age, compared to children whose parents did not use this cleaning practice.”
It gets better. Infants who were born vaginally and were lucky enough to have a parent suck clean his or her pacifier got an added boost, the study found: “The prevalence of eczema was approximately 2.5 times lower at 18 months of age in vaginally delivered children whose parents sucked their pacifiers than in caesarean section-delivered children whose parents did not have this habit (20% vs. 54%),” the study says.
The takeaway from the study, published online today in the journal Pediatrics, is this: It looks like early exposure to parents’ saliva may help stimulate a baby’s immune system, Continue reading →
Yesterday, the influential American Academy of Pediatrics issued, for the first time, a set of guidelines related to planned home births, a hotly debated practice (though not so much among women who do it) that has increased slightly in the past few years, mainly among highly educated white women.
Specifically, the guidelines are on caring for infants born via planned delivery at home. The first line of the guidelines underscores the fact that the new statement is hardly radical:
The American Academy of Pediatrics concurs with the recent statement of the American College of Obstetricians and Gynecologists affirming that hospitals and birthing centers are the safest settings for birth in the United States while respecting the right of women to make a medically informed decision about delivery.
Time Healthland reiterates that the guidelines, published in the journal Pediatrics yesterday, are pretty straightforward, including these recommendations:
“…at least one person at the birth should be responsible for tending to the newborn infant; that person should also be trained in infant CPR. Medical equipment should be tested before the delivery. A phone line should be available; while you’re at it, check the weather forecast too, in case complications arise and a trip to the hospital is necessary. In case of emergency, have a plan to transfer the laboring mom to a hospital. And do all the stuff that nurses do in the hospital to brand-new babies: monitor their temperature and heart rates, keep them warm and cozy, administer vitamin K and heel-prick newborn screening tests that are sent to outside labs for processing, among other things.
Still, Time says:
More controversial is the academy’s advice that pediatricians endorse only midwives who are trained and cleared by the American Midwifery Certification Board. Midwives accredited by this board typically attend deliveries at hospitals and birthing centers. That position has upset certified professional midwives, who deliver the majority of babies born at home in this country but are accredited by a different body — the North American Registry of Midwives (NARM).
Robin Hutson, executive director of the nonprofit Foundation for the Advancement of Midwifery, based in Boston, says these guidelines are only useful if consumers also have access to data on the risks of giving birth in other settings. In a hospital, for instance, Hutson notes there’s a higher likelihood of infections, unnecessary use of medical interventions and prolonged separation of mother and baby which can deter breast-feeding. “No method of birth is risk free,” Hutson says.
One local doula told me that even though the statement is certainly not a full-blown endorsement of home birth, just the fact that the AAP put it out somehow offers the practice added legitimacy in mainstream circles.
Of course it’s also pragmatic for the AAP to acknowledge that all babies, regardless of where they’re born, deserve the same level of care, particularly since home birth has been undergoing a mini-resurgence. (It ticked up a bit after actress and home-birth advocate Ricki Lake gave birth in a bathtub and then produced the film, The Business of Being Born.)
As we reported in 2011:
After a 15-year decline, home births in the U.S. rose 20 percent between 2004-2008. Though the actual numbers remain tiny — out of about 4 million births, 28,357 happened at home in 2008 — the reversal of the long downward trend is notable. So are the demographics: much of the increase was driven by highly educated white women.
This is a serious medical issue. But I must admit, the video above, demonstrating the issue at hand, provides some wonderful comic catharsis to aid with post-Boston-bombing recovery. So please take a minute to watch it if you could use a helpless laugh — nearly 30 million others have, among the tens of thousands of cinnamon videos on YouTube.
Here’s the medical issue in brief: If you’re foolish enough to take a dare and inhale a spoonful of cinnamon (or a ladle-ful as in the video above) you could end up with damaged, collapsed or scarred lungs. Here’s a press release on the paper just out in the journal Pediatrics:
THE ‘CINNAMON CHALLENGE’: A POPULAR DARE THAT JUST ISN’T WORTH TAKING
Young people often challenge each other to try various stunts that may not be safe, but one bad idea is getting the attention of millions of teens and young adults thanks to the Internet, and some of them are being injured.
An article in the May 2013 Pediatrics (published online April 22), “Ingesting and Aspirating Dry Cinnamon by Children and Adolescents: The ‘Cinnamon Challenge’,” looks at cases of children and teens who have accepted the dare to swallow a spoonful of cinnamon. There were more than 50,000 YouTube videos depicting youth attempting this activity as of August 2012, and they show the subjects coughing and choking as the spice triggers a severe gag reflex in response to a caustic sensation in the mouth and throat.
Eating cinnamon in small amounts, mixed with other foods, does not cause these problems for most people, but larger amounts can be harmful because of the fibers and other components of the spice. Continue reading →
Leading causes of death in children under 5 could be eliminated in 20 years
Diarrhea and pneumonia – regarded as relatively minor illnesses for most people living in high-income countries – are together the leading causes of death for children worldwide. In 2011, they were responsible for two million deaths of children under five, despite the fact that they can be treated and prevented at relatively low cost.
A new Lancet Series on childhood diarrhoea and pneumonia, from a consortium of academics and public health professionals led by Professor Zulfiqar Bhutta of Aga Khan University in Pakistan, provides the evidence for integrated global action on childhood diarrhoea and pneumonia, including which interventions can effectively treat and prevent them, and the financial cost of ending preventable deaths from childhood diarrhoea and pneumonia by 2025.
Dr. Christopher Gill of Boston University’s Center for Global Health & Development, who co-authored one of the Lancet papers, offers this (lightly edited) context for the series:
Roll back ten years. Around 2000, there was a big, passionate debate about what we should do about AIDS in Africa. The activists were saying, ‘This is a public health emergency, we’ve got to move. We can do this.’ And the skeptics and pessimists were saying, ‘This is too complicated and expensive.’ The activists won this debate, and today we can look back and say that we have made unprecedented progress on AIDS in Africa. Millions of people are in treatment, there are new drug supply chains and clinics, and the infrastructure is all built de novo. It’s spectacular.
So I look at that and say, ‘Okay, pediatric diarrhea and pneumonia kills 2 million kids a year, way more than HIV/AIDS does by many fold. The cure for pneumonia, amoxycillin, is widely available and costs nearly nothing to manufacture. For diarrhea, you need oral rehydration salts, sugar and water and zinc. Again, costs almost nothing and is wildly effective. We could cut mortality in half with interventions we’ve had available for literally decades, and we don’t do it. Why? It’s not too complicated. We’ve shown with HIV/AIDS you can take a problem that’s highly complicated and solve it in the most difficult situations possible. We have no plausible excuses why we don’t do this with diarrhea and pneumonia. We don’t need new technologies or vaccines or antibiotics to solve this. We can do it with what we have. If we’re not doing it, it’s simply because we’ve made a political decision not to, and I think that’s tragic.
In 10 years of taking my kids to the pediatrician, I’ve never been asked if I have a gun in the house.
Maybe it’s because I live in Cambridge, where I’m pegged as a left-leaning, kale-consuming, hybrid-driving, yoga junkie (guilty!) whose world view does not include gun ownership. Still, as part of routine children and family health, I like the idea of pediatricians getting more involved in the debate about gun violence since they may be positioned to intervene before disaster strikes.
In a thoughtful piece in The New England Journal of Medicine, two local pediatricians, Judith Palfrey (Children’s Hospital Boston, Harvard Medical School) and Sean Palfrey (Boston Medical Center, Boston University School of Medicine) make an excellent case for why more doctors should actively consider the prevention of gun deaths in children. In their piece, they cite this 2012 American Academy of Pediatrics statement:
The American Academy of Pediatrics (AAP), recognizing all these vulnerabilities, declared in a policy statement on firearms in October 2012 that “the absence of guns from homes and communities is the most effective measure to prevent suicide, homicide, and unintentional injuries to children and adolescents.”
Causes of Death among Persons 1 to 24 years of age in the United States, 2010. Data are from the Centers for Disease Control and Prevention. (New England Journal of Medicine)
The Palfrey’s write:
In the early 1990s, there was a surge of violence and firearm-related deaths. The death rate was so high (nearly 28 of every 100,000 people 15 to 19 years of age)2 that pediatricians joined with other professionals (police officers, clergy, and educators) to find ways to combat the epidemic. Pediatricians began to address the protection of children from gun-related causes alongside the prevention of other types of injuries, poisonings, child abuse, lead toxicity, and infectious diseases.
Screening tools and basic interventions became routine practice through nationally accepted programs such as Connected Kids and Bright Futures. AAP guidelines recommend that when families report the presence of firearms in the house, pediatricians should counsel about gun removal and safety measures (gun locks and safe storage). One mother responded to routine screening questions asked by one of our colleagues, “Why, yes, I have a loaded gun in the drawer of my bedside table.” Until that moment, she had apparently never considered the risk to her child. Continue reading →
On a perfect, sunny winter day, I watched helplessly as my son was slammed to the ground by a girl hurtling down our local sledding hill on a giant inner tube. She was moving at such velocity that she barely slowed even after knocking him down. Remarkably, other than a bruised ankle and a bruised ego, my son was fine.
But the girl, splayed on her back and unable to steer, was spun around by the collision. The impact sent her spinning and bouncing crazily, and then she flew off the tube like a rag doll. She barely missed a tree and landed with an ugly thud, slamming her head on the icy snow. I was the first to reach her and she was initially unresponsive, awake but staring blankly at the sky. Eventually her parents ran over and she stumbled to her feet. Then she began crying hysterically.
If her parents took her for a hospital evaluation (and I hope they did), they’d have found that her collision wasn’t a rare occurrence. There are a limited number of sledding days even in frosty winters like this one, yet an estimated 23,000 people are treated annually in the United States for sledding injuries, with the highest percentage being children between ages 10-14.
‘You literally have no control.’
–Dr. David Mooney
“Sledding injuries are common,” acknowledges Dr. Eric Glissmeyer, a fellow in Pediatric Emergency Medicine at the University of Utah. “They range from inconvenient and painful, like broken arms or collar-bones, to serious and life-threatening, such as skull fractures, and neck and brain injuries. As one would expect, the steeper the hill and the faster the speed and the more crowded the sledding day, the more likely injuries are to occur.”
And those dastardly, unsteerable, oversized inner tubes rank at the top of the sledding danger list. A study in the journal Pediatrics evaluated sledding injuries from 1997-2007, and found: “Traumatic brain injuries were more likely to occur with snow tubes than with other sled types.”
“The inner tubes are bouncy and you literally have no control,” explains Dr. David Mooney, director of the Trauma Program and an assistant professor of surgery at Boston Children’s Hospital. “Most of the real injuries we see are when people hit something. We’ve had horrible head injuries with kids hitting trees. With tubes they spin around and even if a kid is trying to be a good citizen (and travel feet first) it could spin when they’re halfway down the hill.” Continue reading →
This is the final installment in a special CommonHealth/WBUR series, The Life of Riley: A Rare Girl, A Rare Disease. It’s the story of Riley Cerabona, a remarkable ten-year-old girl born with an incurable, one-in-a-million disease that creates increasingly aggressive “lumps and bumps” on and in her body. So far, the only treatment for her disease, CLOVES syndrome, has been surgery. But this year, at Boston Children’s Hospital, Riley began taking an experimental drug in hopes that it would help her. See the full serieshere, and the introduction here.
Something was wrong. Riley was limping and her legs felt oddly tired, weakening; they tended to buckle when she took a step.
Could it be the sirolimus, the experimental drug she was taking? Would she have to drop it? Or was it yet another dangerous growth in her spine, caused by her exceedingly rare disease? Would she need one more risky operation?
Late summer was a time of dread for the Cerabona family. But MRIs of Riley’s brain and spine showed no new growths, and blood work suggested that the leg weakness was likely caused by an elevated muscle enzyme. The weakness passed, yet another threat averted — yet another dip and swoop in a roller-coaster year that has, overall, been an unusually fine one.
Riley sums up: “”It was a good year. This year I had fun, did stuff like surfing, drama called River Glee and boogie boarded and skiied, hung out with friends and didn’t have any surgeries. Life to me is like a brownie. Because you eat it slowly and you savor it. And if you savor it there will always be a bite left. (Plus a brownie is one of my favorite foods).”
Indeed, unlike so many past years, Riley underwent no major surgery and needed no extensive rehabilitation. No twisted nest of malformed blood vessels infested her spine and threatened her life; no huge pouch of lymphatic fluid swelled on her torso. And earlier this month, in a small exam room at Boston Children’s Hospital, she happily downed her last dose of the viscous sirolumus (si-ro-LI-mus) that has marred mealtimes for almost a year, and stuck out her tongue one last time at the nastiness.
Riley Cerabona celebrates her last dose of nasty-tasting medicine. Behind her: Dr. Cameron Trenor. (Photo: Kristen Davis)
After 48 weeks, her time on the sirolimus trial was over, and that juncture required a decision: Would she remain on the drug, apart from the study?
It might seem like a no-brainer: She had a good year on the drug; stay on it. But it is not so simple.
“The hard thing about this is that you don’t really know,” Marc Cerabona, Riley’s father, said. “And we knew this at the beginning, going into it. We don’t know if she had a good year because of the sirolimus or if she was just going to have a good year this year anyway. But the bottom line for us is, she had a good year and there were no significant side effects. So if there’s a chance that was related to the sirolimus, then why not stay on it? The doctors want to hear a compelling reason to stay on it; we almost want to hear a compelling reason not to be on it.”
Dr. Cameron Trenor, the Children’s specialist overseeing Riley’s trial here: “This is the problem in rare diseases — that everything is an unknown. That’s not talked about a lot. Families live with it every day, so they know it very well, and in pediatrics dealing with rare diseases, I guess we get a little used to it, but everything is new. And the tendency, which is just human nature, is to expect whatever happened to your last patient to represent the whole story, but I can tell you lots of cases where that’s not true. And it’s a real challenge in rare diseases, living day in and day out with the unknown.”