pediatrics

RECENT POSTS

Study: In ‘Healthy’ Fast Food Ads, Kids Mostly Just See French Fries

Just watch the video here and you’ll immediately get the gist of this study. To sum up: when fast food companies try to advertise to children their “healthier” dining options, (like apple slices) the kids, for the most part, don’t see beyond the fries.

The takeaway, according to researchers at Dartmouth, is that these ads from fast food giants like McDonald’s and Burger King “don’t send the right message.”

Here’s more from the Dartmouth news release:

In research published March 31, 2014 in JAMA Pediatrics, Dartmouth researchers found that one-half to one-third of children did not identify milk when shown McDonald’s and Burger King children’s advertising images depicting that product. Sliced apples in Burger King’s ads were identified as apples by only 10 percent of young viewers; instead most reported they were french fries.

Other children admitted being confused by the depiction, as with one child who pointed to the product and said, “And I see some…are those apples slices?”

The researcher replied, “I can’t tell you…you just have to say what you think they are.”

“I think they’re french fries,” the child responded. Continue reading

CDC: Autism Rate Up To 1 in 68 Kids, But Still No Why

A new CDC analysis of autism prevalence shows a nearly 30 percent jump in cases between 2008 and 2010: that means 1 out of every 68 eight-year-olds in the U.S. is diagnosed with the disorder.

But health officials still don’t agree on what’s driving the increase. Debate continues to rage over whether the increase in cases is due to changing definitions and greater awareness of autism spectrum disorders, or if it’s due to some environmental or other factor.

Karen Weintraub reports for USA Today:

…virtually every grade in every elementary school has at least one child with autism – a seemingly astonishing rise for a condition that was nearly unheard of a generation ago.

What’s still unknown is the driver of that increase. Many experts believe the rise is largely due to better awareness and diagnosis rather than a true increase in the number of children with the condition.

(Jesse Costa/WBUR)

(Jesse Costa/WBUR)

“We don’t know the extent those factors explain in terms of the increase, but we clearly know they do play a role,” said Coleen Boyle, director of the National Center on Birth Defects and Developmental Disabilities at the CDC. “Our system tells us what’s going on. It (only) gives us clues as to the why.”

The aging of parents is also known to be a factor; the chances of autism increase with the age of parents at conception.

“But that’s not the whole story is it?” said Robert Ring, chief science officer for Autism Speaks, a research and advocacy group. Whether something in the environment could be causing the uptick remains “the million-dollar question,” Ring said.

Despite their concern, experts said they were not surprised by the increase, because other data had suggested the numbers would continue to climb. In New Jersey, for instance, autism rates were 50% higher than in the rest of the nation in 2000, and they remained that much higher in 2010 – suggesting the national rates will continue to rise to catch up, said Walter Zahorodny, a psychologist who directs the New Jersey Autism Study. “To me it seems like autism prevalence can only get higher,” Continue reading

Care Parents Should Question: Medicating ‘The Happy Spitter’ And More

(Wikimedia Commons)

(Wikimedia Commons)

News bulletin: The American Academy of Pediatrics is encouraging parents to question their children’s medical care.

Well, at least on certain very specific procedures that the academy says are not “wise choices.”

“Choosing Wisely” is a new campaign stretching across many medical specialties, aimed at getting doctors and patients alike to “think and talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm.” (I’d add, and in virtually all cases cost lots of money.)

The Academy of Pediatrics had already put out five “things physicians and patients should question,” including the use of antibiotics for viral infections and the use of cold medicines for children under 4, and today they add five more. I’d like to think most doctors wouldn’t do these things anyway, but am also thinking maybe the full list should be handed out to new parents before they leave hospitals. The list is here, and the latest five include:

Don’t perform screening panels for food allergies without previous consideration of medical history.
Ordering screening panels (IgE tests) that test for a variety of food allergens without previous consideration of the medical history is not recommended. Sensitization (a positive test) without clinical allergy is common. For example, about 8% of the population tests positive to peanuts but only approximately 1% are truly allergic and exhibit symptoms upon ingestion. When symptoms suggest a food allergy, tests should be selected based upon a careful medical history. Continue reading

New Reason To Ban TV In Kid’s Bedroom: An Extra Pound A Year

(Aaron Escobar/Wikimedia Commons)

(Aaron Escobar/Wikimedia Commons)


By Jamie Bologna
Guest contributor

We’ve known for a long time that obesity is among the greatest health risks confronting Americans.

We also know that the challenge for many people starts early. In fact, children who are overweight or obese between the ages of three and five are five times more likely to be overweight or obese as adults.

Now, there’s new research out today that adds to our understanding about one risk factor for childhood obesity: televisions in kids’ bedrooms.

Radio Boston’s Anthony Brooks spoke with Diane Gilbert-Diamond, an assistant professor of Community and Family Medicine at Dartmouth and the lead author of a new study on childhood obesity and television. The conversation, edited:

AB: Professor Gilbert-Diamond, we’ve known for some time that TV viewing is an established risk factor for childhood obesity—what further information did you uncover in this study?

We found that even after accounting for TV viewing, having a TV in the bedroom is associated with about one extra pound of weight gain a year.

About 60 percent of adolescents have TVs in their bedroom. Forty percent of kids have TVs by the age of six.

Just having the TV there, not even necessarily turning it on, just having it there?

We presume that kids with a TV in their bedrooms are watching them. But having the TV in the bedroom, no matter how much TV they’re watching, is associated with more weight gain.

Any idea about what’s behind this connection between weight gain and having a TV in the bedroom?

Our study couldn’t look at the mechanism directly, but we think that what’s going is that kids with a TV in their bedroom have more disrupted sleep. So, for instance, they may stay up later watching TV or may have poorer quality sleep after seeing the bright screen or watching exciting TV shows late at night.

Every phone, every laptop, every tablet can now be used as a TV. Is the lesson here that parents should really lay down much stricter rules about screen time in their bedrooms? Continue reading

As Kids Grow, Oh, The Pills You’ll Take — And What They Cost

(Source: Health Care Cost Institute, Children's Health Spending Report, 2009-2012)

(Source: Health Care Cost Institute, Children’s Health Spending Report, 2009-2012)

When you become a parent, the word “development” stops referring to real estate and starts referring to the expectable changes that come as children grow. It’s “developmentally” typical for a child to walk at around 1, be talking some by 2 and be increasingly independent in the teen years.

Now, an informative new report just out from the independent Health Care Cost Institute, which mines millions of health insurance records, offers telling new data on what I would dub “pharamcodevelopment.” That is, as American children grow, what medications do they typically take, and at what cost?

One striking trend: Until teen girls start taking birth control pills, boys are significantly likelier to be prescribed drugs. (Yes, a lot of Attention Deficit Disorder meds, but not only.) Then, in the teen years, the genders tend to even out. The average total annual cost of children’s prescriptions ranges from about $169 per baby to about $500 per teen. I spoke with Carolina Herrera, director of research at the Health Care Cost Institute, for more insight. Our conversation, edited:

Is this report a “first” in any way?

These are the first numbers on children’s health care expenditures and utilization, and prices that were paid for their services, for 2012. The numbers are on 10.5 million children covered by employer-sponsored health insurance, weighted up to national averages covering every state in the union. So we have the first 2012 numbers on kids.

Between 2009 and 2012, what’s the most dramatic change or trend?

The most dramatic trend is probably that children’s health care spending grew at about 5.5 percent per year, and through the whole period, it grew faster than expenditures for most adult populations. Children’s health care spending per capita is a lower number than adults’, but we saw growth in quite a few areas. Prescription spending is definitely one of them. Spending on infants and teens is another. Both those groups had different motivating factors: For infants it was definitely hospital days; for teens, they continued using all the services they had used before and added more. In particular, we saw the prescription expenditures go up, and we saw the inpatient use for teenaged girls go up.

Inpatient mental health care for both teenaged boys and girls is definitely up. How much of that is coming from kids getting the care they need or families becoming more aware of possibilities of getting mental health care through the inpatient system? How much of that is occurring because maybe outpatient options weren’t available or appropriate? It’s really hard to tell at this macro level. That’s one of the areas we’ll be encouraging other researchers to look into more, and probably looking into more ourselves in our next big report.

Say you’ve just had a child. What does the data suggest you can expect for that child in terms of prescriptions over the next 18 years?

What’s interesting is what happens as the child ages. We start out life using gastrointestinal drugs and anti-infective drugs; those are the two most common drug classes we’re using. As the child gets a little older, to ages 4-8, there’s a shift. We see gastrointestinal drugs are no longer one of the top categories. We have anti-infective agents, though a smaller amount per child, and we see for the first time that the second-highest category of drug class use is Central Nervous System agents. CNS agents are typically associated with mental health care.

So that’s mainly ADD, Attention Deficit Disorder drugs? Continue reading

As Newton Grapples With Teen Suicides, A Quick Primer On Resilience

As Newton grapples with its third suicide by a teenager this school year, some of the discussion revolves around resilience. WBUR’s Martha Bebinger this week quoted Dr. Susan Swick, chief of child psychiatry at Newton Wellesley Hospital. She has been advising Newton schools and spoke to parents about how to build up their children’s resilience:

Nearly 400 parents attended Tuesday night's community forum on teen suicide at Newton South High School. (Martha Bebinger/WBUR)

Nearly 400 parents attended Tuesday night’s community forum on teen suicide at Newton South High School. (Martha Bebinger/WBUR)

“This involves maintaining good social connections,” Swick said. “It’s about coping skills, it’s about self-care, it about getting good sleep, adequate exercise and nutrition. It’s about cultivating an ability to be flexible, to use humor, some creativity. There’s no one recipe for the things that you do, but it’s cultivating good behaviors that build resilience.”

And make sure, Swick added, that children have a network of adults who know them, talk to them and keep an eye on them.

For more on resilience and how to cultivate it, we turned to Drs. Gene Beresin and Steve Schlozman, child psychiatrists at Massachusetts General Hospital and its Clay Center for Young Healthy Minds.

By Dr. Gene Beresin and Dr. Steve Schlozman
Guest contributors

A 10 year-old deeply invested in hockey develops juvenile diabetes.

Three kids, 4, 7 and 15, are told by their parents that they are getting a divorce.

The parents of a 16-year-old find to their horror that their son has taken a fatal overdose.

An 85-year-old woman who is a survivor of Auschwitz finds that her grandson is being deployed to Afghanistan.

A 35 year-old single mom who left an abusive relationship with her husband finds out that her 15-year-old has been sexually assaulted at school.

A 16-year-old boy is suddenly dumped by his girlfriend of two years.

Sometimes life deals a bad hand. While some might object to the relative merits of these particular vignettes as lacking equally weighted misfortunes, our goal here is not to rank the relative intensity of lousy events. Our goal, instead, is to accentuate that life itself is fickle, that life ebbs and flows, and that the fortunes and misfortunes that come with being human are in fact part of the human condition.

They key question is not “why” this stuff happens, but how in the world do we manage ourselves when these things occur?

That’s why we have pop music as well as Dostoyevsky.

The fact is that we all have horrible things happen to us. Understandably, these horrible things can potentially overshadow the good. It’s not like the vignettes above are uncommon. They are also, maddeningly, mostly not anyone’s fault.

They just happen.

They key question, then, is not why this stuff happens, but how in the world do we manage ourselves when these things occur?

Do we crumble? Do we become depressed or hopeless? Or do we rally?

Perhaps most important – how do we rally?

These questions of course make us once again visit the concept of resilience. How do we understand this? Are we born resilient, or do we build our resilience as we might train for a marathon?

Although we have some answers to these questions, the jury is still out. We’ve only recently as a culture become nationally invested in understanding the phenomena of resilience. Continue reading

New Podcast: Kids, Contact Sports And ‘Getting Your Bell Rung’

(Clappstar/Flickr Creactive Commons)

(Clappstar/Flickr Creative Commons)

If my son ever wants to play tackle football, my response will consist of four simple words: “Over my dead body.” (With perhaps the addendum: “Your brain is too precious to turn it into swiss cheese.”)

Thankfully, he has expressed no interest. But what if he did? And what about the concussion risks of other sports?

Happily, our regular CommonHealth contributors, Drs. Gene Beresin and Steven Schlozman, Massachusetts General Hospital child psychiatrists and excellent mental health communicators, have just created their first “What’s On Your Mind?” podcast. And their five-minute conversation addresses this very topic: Should my kid play contact sports? The podcast series is part of their public outreach mission at the new Clay Center for Young Healthy Minds.

Listen to the full podcast here. How often do you get to hear one psychiatrist call another “a shrimp”? But mainly, the information comes from solid sources — the CDC, concussion experts — and the upshot is clear: Kids shouldn’t start contact sports until age 14, according to the latest recommendations, because neck muscles get much stronger in adolescence and that helps protect the brain from impact. And the biggest takeaway: If a child take a significant head hit — if he “gets his bell rung,” as Dr. Schlozman’s football coach used to put it — he should be sure to sit out at least the rest of the game. Every concussion raises the risk for another concussion. When can he get back in? “Leave it up to their physician,” Dr. Schlozman says.

But all these new findings and warnings about concussions do not mean kids should avoid sports altogether. “They’re a huge part of growing up,” says Dr. Schlozman, who, at age 12, wandered over and sat on the opposing team’s bench after his own bell had been rung. “And as long as we’re careful, there’s no reason not to have fun.”

From the blog post that accompanies the podcast: Continue reading

Co-Sleeping Controversy, And Tips For Making Bedsharing Safer

bedshareBy Sarah Kerrigan
Guest Contributor

Over the last week, my post on co-sleeping and public policy has generated a huge, passionate response.

Comments ranged from heartfelt, personal stories of family bedsharing to adamant opposition to the practice, from questions about terminology to pleas for more information about safe bedsharing.

Riobound wrote: “I like the idea of ‘educate’ but don’t ‘dictate.’ The State should inform not impose.”

And PilgrimOnTheJames posted that “we shared our bed with each of our seven babies…for the first several months of their post-partum lives…because it allowed my wife to breast-feed them without her having to greatly disturb her much needed rest, and also, because the little tikes smelled so good and were so cute to watch sleeping. We moved them into a separate bed in our room once they were able to consistently sleep through the night. The bonds that were begun then have only grown and strengthened over the past 30+ years of family life. I thank God that we ignored the advice of many well-meaning, but totally scandalized family members and friends.”

Amelia Oliver commented, “Thank goodness the scientific community is finally considering moving away from trying to scare people out of bed-sharing and co-sleeping. The comparison with the policy of advocating abstinence instead of sex-ed is strikingly appropriate since almost everyone does it but we are all afraid to talk about it, let’s start teaching the safe way to do it.”

Molly pointed out “This article…conflates the issues of cosleeping in bed sharing, which are not the same thing. Cosleeping is risk free, end of story. Bed sharing does have risks if not done carefully and correctly.”

So in an effort to shed more light on the topic, I’ll try here to clarify the terms, explain why the research linking SIDS to bedsharing is inherently flawed, and provide some tips to make sleep as safe as possible for all babies.

1. Terminology

In the scientific community, “co-sleeping” is a general term for a child sleeping in close proximity to a caregiver, within sensory range.  “Room-sharing” is when a child sleeps in the same room as her caregiver.  Under this definition are two sub-categories: “separate-surface cosleeping,” in which the child has his own bed, and “same-surface cosleeping,” also known as bedsharing.   “Bedsharing” is the term that describes what most Americans think of when they hear “co-sleeping:” a child sleeping in an adult bed with his caregivers.  This sort of close proximity is natural to the human species.

2.  ‘Shaky Evidence’ And A Shift In Thinking

The AAP, a highly influential professional group of pediatricians, opposes bedsharing and has led the charge to promote the idea that sleeping in the same bed as your infant is dangerous. “The American Academy of Pediatrics (AAP) does not recommend any specific bed-sharing situations as safe,” the organization says in its latest statement on the matter, which then goes on to list what it characterizes as particularly unsafe bed sharing practices to be avoided “at all times,” including, “when the infant is younger than 3 months,” or with a smoker. The AAP also says bed sharing should be avoided “with someone who is excessively tired,” which makes us wonder if any of them have ever actually been parents.

But many researchers, medical professionals and worldwide organizations question the AAP’s position on bedsharing, in large part due to ‘shaky evidence’ as the basis of the academy’s position, and also given the benefits of the practice. Dr. Abraham Bergman, a prominent SIDS researcher and pediatrician said in an email that “the evidence linking bed sharing per se to the increased risk for infant death is shaky, and certainly insufficient to condemn a widespread cultural practice that has its own benefits.”  The WHO, UNICEF, La Leche League International, the Breast Feeding section of the AAP, and Academy of Breast Feeding Medicine all disagree with a sweeping recommendation to avoid bedsharing.

In an editorial published earlier this month in JAMA Pediatrics called “Bedsharing per se Is Not Dangerous” Bergman wrote: Continue reading

Is It Time To Rethink Co-Sleeping?

sundaykofax/flickr

sundaykofax/flickr

By Sarah Kerrigan
Guest Contributor

Pediatricians and public health officials have long warned that “co-sleeping,” or sharing a bed with an infant, is unsafe.

But let’s face it: almost everybody does it. So perhaps the time has come for the public health message to focus less on advising against it and more on advising how to do it more safely.

Because despite all the finger-waggling, co-sleeping is, and will continue to be, extremely common.

For instance, a recent survey, “Listening to Mothers III,” found that about 41 percent of new mothers report that they always or often share a bed with their babies in order to be closer. A 2007 study in Los Angeles County found bed-sharing rates in the range of 70-80 percent across races. And it’s likely that bed-sharing rates are grossly underestimated.

In so many ways, sharing a bed with your infant makes sense. “There is no way I would have had the energy to get out of bed 3-5 times per night to go feed [my baby] in another room,” says Lee, a Boston mother who asked that her last name not be used due to what she says is bias against bed-sharers.

There’s no denying that there can be risks involved in sleeping in the same bed as your infant.

In the United States in 2010, 15 percent of all infant deaths were designated as Sudden Unexplained Infant Death, which includes SIDS, and some of these babies were likely in unsafe bed-sharing situations. “We feel a certain responsibility to work to prevent these deaths,” said Carlene Pavlos of the Massachusetts Department of Public Health.

But just as using a message of abstinence in place of sex education has been shown to be ineffective, so too might a one-sided message that only tells parents, “Don’t share a bed with your baby.” Without offering a positive message of how to make bed-sharing safer, and even its potential benefits, public health organizations may be neglecting a key element to saving babies’ lives. Another Boston-area co-sleeping mother, Lindsey, said: “The fear around (co-sleeping) prevents people from talking about it. I know in my case, I was doing it in an unsafe way for a while because I was afraid to ask for advice.”
Continue reading

Extreme Mothering: When A Child Has A Relentless Disease

Kate and her children Jake and Brook, who has the fatal genetic disorder Tay-Sachs disease. (Mary White Photography)

Kate and her children Jake and Brook, who has the fatal genetic disorder Tay-Sachs disease. (Mary White Photography)

By Dr. Annie Brewster
Guest Contributor

In 2010, Kate, a single mom from Derry, New Hampshire, gave birth to Brook, a healthy baby girl.

Brook seemed to be developing normally and reaching all of her milestones — learning how to sit up and roll over, grasping at toys — until she was 6 months of age, at which point she started to regress. She lost skills she had already learned, and gradually Kate noticed other things. Brook didn’t respond to her name, she would fixate on her hands and just stare and stare; she started dropping toys, unable to hold onto one in each hand at the same time. Eventually, after a long medical work up, Brook was diagnosed with Tay-Sachs disease in 2012, and Kate was told that her daughter would most likely not live past her third birthday.

Today, Brook, is two-and-a-half years old and requires constant care. She is blind. She cannot swallow and is fed through a feeding tube. She is having constant seizures. And she continues to deteriorate. Brook’s older brother Jake, born to a different father and now 9 years old does not suffer from the disorder, but may be a carrier. This will remain unknown until genetic testing is done when he is a little older.

(Listen to the audio on the right to hear Kate’s story of living with and caring for her terminally ill daughter.)

Tay-Sachs is a fatal genetic disorder. A child is born with Tay-Sachs when he or she inherits two damaged copies of the HEXA gene on chromosome 15 (one from each parent), which results in a deficiency of the Hexosaminidase A enzyme and the subsequent build up of a damaging fatty substance in brain cells. The result is a relentless, progressive loss of physical and mental functioning and eventually, death. A person with one damaged gene and one normal gene will become a carrier with no clinical symptoms of the disease. If two carriers have children together, there is a 25% chance of giving birth to an affected child with each pregnancy.

Tay-Sachs, a rare disease with an incidence of approximately 1 in 320,000 in the general population, occurs with increased frequency in certain populations, including Ashkenazi Jews, French Canadians, and Cajuns (from Louisiana). In these groups, approximately 1 in 30 individuals is a carrier, and 1 in 3,500 children will be born with the disease.

Kate, who is of French Canadian descent, underwent no genetic testing and had no idea she was a carrier before Brook’s diagnosis. She knew nothing about Tay Sachs, and was unaware that French Canadians are at increased risk.

How does a mother manage life when her child is dying? She mothers. Kate spends most of every day in her living room with Brook, an oxygen machine hissing in the background, surrounded by pill bottles, suctioning her daughter’s secretions, moistening her lips, and giving her medication to temper her seizures. Kate’s primary goal is to keep Brook as comfortable as possible in her last days, and she works very hard to achieve this. “So many people for so long would say, ‘You’re so amazing, I don’t know how you do this; This is incredible, how do you manage this,’” Kate says. “I would look at them and think, ‘This is my daughter, how can I not do this?’” And every day she tries to spend as much time as possible with her older son, Jake, and to support him through the impending loss of his sister the best she can.

This project was completed in collaboration with Blyth Lord, founder of the Courageous Parents Network, a non-profit whose mission it is to empower parents caring for children with life-limiting illness, and Bill Parker, founder of Hindsight Media.

Dr. Annie Brewster, author and audio producer, is a Boston internist and founder of Health Story Collaborative, a non-profit organization dedicated to harnessing the healing power of stories. You can hear and read more of her stories here, here and here, as part of our Listening To Patients series.