Pediatrics

It makes a great story - or at least a great headline:

• Food Inspector Confiscates Kid's Homemade Lunch
• Preschooler's lunch rejected by official
• Food police reject preschooler's homemade lunch... in favour of chicken nuggets
• Food police confiscate 4-year old's lunch, bill parents
• Preschooler's Homemade Lunch Confiscated by Food Police
• Nanny state report: NC school officials confiscate preschooler's homemade lunch
• Flunking lunch in preschool
• State Agent Tells Preschooler She Can't Eat Home-packed Lunch
• My Kid's Lunch Is None of the Government's Business
• The Lunch Nazis Are Coming! No, They're Here.

So what happened? A preschooler at West Hoke Elementary School in Raeford, North Carolina was told that her home-packed lunch with a turkey and cheese sandwich, banana, potato chips, and apple juice was not a healthy lunch. She was given a tray lunch from the cafeteria instead, but just eat three chicken nuggets.

This all occurred because of a rule in North Carolina to help children in child care meet "minimum nutritional requirements" and comply with Meal Patterns for Children in Child Care standards.

These minimum nutritional requirements state that lunch should consist of at least four components (out of these five choices):

• milk
• 2 or more fruits or vegetables, which can include a serving of 100% fruit juice
• a meat or meat alternative, including alternate protein products (cheese, eggs, beans, peanut butter, nuts, seeds, yogurt, etc.)
• a bread or bread alternative, including muffins, cereal, pasta, etc.

Now since the preschooler in the article had a serving of meat (turkey), bread, and two servings of fruit (the banana and the apple juice), then she met the minimum nutritional requirements and should not have been given a tray lunch. And even if she had been missing something, the Food From Home rule is not that you replace the whole lunch, but rather that they "must provide additional food necessary to meet those requirements."

So the whole story is based on a mistake that was made by the school or state employee and not because of how the program is supposed to work. The "food police" aren't inspecting school lunches to create a nanny state. They are trying to help make sure preschoolers get a minimum level of nutrition.

North Carolina has some of the highest obesity rates in the country. Whether it is to make sure preschoolers learn to eat healthier or just meet minimum nutritional requirements, should we really target a program that might help them grow and avoid becoming overweight?

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The measles outbreak in Indiana is quickly expanding to include more people.

From the initial 4 cases last week to 10 cases yesterday, the Indiana State Department of Health now reports that at least 13 people have measles in Central Indiana. In addition to one of the initial cases that exposed up to 200,000 at last weekend's Super Bowl Village, there is now a case in at least one local school, the Noblesville Intermediate School, and exposures at other schools, health clinics, and churches, including:

• Delphi Electronics & Safety, Kokomo -- Feb. 1-Feb. 9
• Hartley Funeral Home, Cicero -- Jan. 25 and Jan. 26
• Kroger on West Logan Street, Noblesville -- Feb. 10
• Walmart on Clover Road, Noblesville -- Feb. 10
• College Park Church, Indianapolis -- Jan. 1, Jan. 15 and ongoing
• Indianapolis Grace Ethiopian Church/Westlake Community Church, Indianapolis -- Jan. 8
• Noblesville Intermediate School -- Feb. 9
• White River Elementary School -- Feb. 13
• Ivy Tech Community College, Anderson Campus -- Jan. 26, Jan. 31 and Feb. 2
• Delphi Electronics & Safety, Kokomo -- Feb. 1-Feb. 9
• Hartley Funeral Home, Cicero -- Jan. 25 and Jan. 26
• Kroger on West Logan Street, Noblesville -- Feb. 10
• Walmart on Clover Road, Noblesville -- Feb. 10
• College Park Church, Indianapolis -- Jan. 1, Jan. 15 and ongoing
• Indianapolis Grace Ethiopian Church/Westlake Community Church, Indianapolis -- Jan. 8
• Noblesville Intermediate School -- Feb. 9
• White River Elementary School -- Feb. 13
• Ivy Tech Community College, Anderson Campus -- Jan. 26, Jan. 31 and Feb. 2

If you live in the area and may have been exposed, be on the watch for measles symptoms. Remember to call before going to the doctor or to the hospital or a clinic if you think that you or your child has measles so that they can take appropriate isolation precautions.

And get vaccinated. The Indiana Super Bowl Village outbreak is shaping up to be one of the largest measles outbreaks of the last few years.

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Is your teenager ready to start driving yet?

Having a teen driver in the house is often a cause of extra anxiety for many parents. Sure, there is worry about the extra cost for a car and insurance and what your teen is going to do with the extra independence that the mobility of driving provides.

But even more concerning for most parents is the realization that car accidents are the leading cause of death for older teens and young adults.

Will taking a driver education class make your teen a safer driver and prepare them for the road?

Maybe, but a new study that will appear in the March issue of Pediatrics, "Variation in Teen Driver Education by State Requirements and Sociodemographics," found that only 78% of teens took a formal driver ed (DE) program. The rates were even worse in states that did not have a formal driver education requirement, especially among hispanics, blacks, males and students with lower academic achievement levels.

And even of the states that require driver ed, few require the latest curriculum, which was updated in 2002 and now includes 45 hours of classroom time and 8 hours behind the wheel.

The authors of the study conclude that "State DE requirements may be an effective strategy to reduce disparities in these groups."

That may be, but you have to wonder if it might be an even better idea to just continue to work at strengthening state Graduated Driver Licensing (GDL) Laws, which:

• encourage supervised practice driving in low-risk situations
• keep beginner drivers out of high-risk driving situations
• ban texting and the use of cell phones by beginner drivers
• limit when teens can drive (nighttime driving) and how many passengers they can have
• requiring beginner drivers to keep a clean driving record
• delay giving teen full driving privileges until they are more mature and experienced drivers

Three-stage Graduated Driver Licenses have been shown to decrease a teens risk of crashing by 20 to 50%. On the other hand, driver's ed classes have shown mixed results for effectiveness.

What will your teen have to do to get a license?

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Parents often have a lot of different roles on Valentine's Day.

They may have to help their younger kids buy or make Valentine's Day cards to take to school, console an older child who didn't get a Valentine from the right person, and hopefully have some Valentine's Day fun of their own.

But in all of the bustle of Valentine's Day, don't forget to show that you love your kids today.

To help, the American Academy of Pediatrics offers parents these Valentine's Day tips:

• Use plenty of positive words with your child. Try to avoid using sarcasm. Children often don't understand it, and if they do, it creates a negative interaction.
• Respond promptly and lovingly to your child's physical and emotional needs and banish put-downs from your parenting vocabulary. Be available to listen to your child when he/she want to talk with you even if it's an inconvenient time.
• Make an extra effort to set a good example at home and in public. Use words like "I'm sorry," "please," and "thank you."
• When your child is angry, argumentative or in a bad mood, give him a hug, cuddle, pat, secret sign or other gesture of affection he favors and then talk with him about it when he's feeling better.
• Use non-violent forms of discipline. Parents should institute both rewards and restrictions many years before adolescence to help prevent trouble during the teenage years. Allowing children of any age to constantly break important rules without being disciplined only encourages more rule violations.
• Make plans to spend time alone with your young child or teen doing something she enjoys. Send a Valentine's Day card to your older child or teen. Make Valentine's Day cards together with your preschool or younger school age child.
• Mark family game nights on your calendar so the entire family can be together. Put a different family member's name under each date, and have that person choose which game will be played that evening.
• Owning a pet can make children, especially those with chronic illnesses and disabilities, feel better by stimulating physical activity, enhancing their overall attitude, and offering constant companionship.
• One of the best ways to familiarize your child with good food choices is to encourage him to cook with you. Let him get involved in the entire process, from planning the menus to shopping for ingredients to the actual food preparation and its serving. It is wonderful when families eat together as much as possible. Good food, good conversations.
• As your child grows up, she'll spend most of her time developing and refining a variety of skills and abilities in all areas of her life. You should help her as much as possible by encouraging her and providing the equipment and instruction she needs. Start reading to your child beginning at six months. Avoid TV in the first two years, monitor and watch TV with your older children and use TV time as conversation time with your children. Limit computer and video games.
• Your child's health depends significantly on the care and guidance you offer during his early years. By taking your child to the doctor regularly for preventive health care visits, keeping him safe from accidents, providing a nutritious diet, and encouraging exercise throughout childhood, you help protect and strengthen his body.
• Help your child foster positive relationships with friends, siblings and members of the community.
• One of your most important gifts as a parent is to help your child develop self-esteem. Your child needs your steady support and encouragement to discover his strengths. He needs you to believe in him as he learns to believe in himself. Loving him, spending time with him, listening to him and praising his accomplishments are all part of this process.
• Don't forget to say, "I love you" to children of all ages!

Of course, these tips don't just work on Valentine's Day. Showing your kids you love them, spending quality time with them, and using effective, non-violent discipline techniques are good things to learn to do every day of the year.

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The Indiana measles outbreak continues to grow and is shaping up as one of the larger outbreaks of the last few years. And since the Indiana State Department of Health reports that "additional cases are being investigated," it doesn't sound like this outbreak is over yet.

Starting with four cases, including one that exposed up to 200,000 people at the Super Bowl Village to measles, there are now at least 10 cases of measles in Boone and Hamilton Counties in Indiana.

Not surprisingly, none of the infected children or adults were vaccinated against measles.

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We have heard a lot about drug shortages lately, mostly as they relate to the shortage of medicines to treat ADHD.

It turns out that plenty of other medicines are in short supply too.

According to the FDA, there were at least 178 drug shortages in 2010, which is up from 61 drug shortages in 2005. And there were at least 220 drug shortages in 2011.

The number and types of drugs that are in short supply has made this issue grow way beyond having to call around to pharmacies and find your child's Ritalin or Adderall. Some of the drug shortages involve critical drugs to:

• treat cancer
• provide parenteral nutrition
• treat debilitating diseases or conditions

That doctors and hospitals will soon run out of a drug to treat children with acute lymphoblastic leukemia (ALL) is a perfect example of how these drug shortages have become such a big problem. The drug, methotrexate, is "an important component of modern treatment for ALL as well as a number of other hematologic malignancies."

Fortunately, something is being done about the drug shortages. President Obama signed an Executive Order directing the FDA to "take steps that will help to prevent and reduce current and future disruptions in the supply of lifesaving medicines." The resulting Interim Final Rule from the FDA will work to ensure "that the FDA and the public receive adequate advance notice of shortages whenever possible," which will hopefully give them time to prevent a shortage.

The Department of Justice is also investigating to see if drug shortages have led to price gouging or stockpiling of important drugs.

Hopefully these steps will help to make sure that no patients miss out on any life-saving drugs.

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It is a common complaint that kids don't get enough sleep these days.

Surprisingly, it may have always been a complaint, even before the days of kids having TV sets in their rooms, cell phones, and iPods.

A new study that will be published in the March issue of Pediatrics, "Never Enough Sleep: A Brief History of Sleep Recommendations for Children," found that the amount of sleep that kids get decreased by about 0.73 minutes per year since 1897. Surprisingly, the age-specific sleep recommendations also decreased by about 0.71 minutes each year, but was still about 37 minutes greater than however long kids actually slept.

I wouldn't put too much into this though.

Some of the biggest differences were in the earliest studies, from 1897 to 1905, which suggested that toddlers get 16 to 17 hours of sleep. Even then, sleep recommendations for school age children and teens were surprisingly about the same as today.

The study is kind of interesting to read, but shouldn't be used as the basis for any theories for the rise in ADHD or any other condition. As the authors clearly state in their paper, "it is acknowledged that there is almost no empirical evidence for the optimal sleep duration for children," so all of the different recommendations were not necessarily made because any one had better insights into children's sleep habits than another. They could have just taken a survey of how much kids were sleeping and added "an extra allowance based on the assumption that they were not getting enough."

So why would younger kids have been put to sleep earlier 100 years ago? What else were they supposed to do?

When you really look at it, there are so many co-founding factors, how can you directly compare a child born today with one born 115 years and say they would even require the same amount of sleep?

It would be interesting to look at how improved nutrition, protection from infections, and overall improved health, etc., could have caused a decreased need for sleep for infants and toddlers over the years. And how did the implementation of child labor laws, which came under federal regulation for the first time with the 1938 Fair Labor Standards Act, affect how much sleep kids got or needed?

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In response to the 200,000 who may have been exposed to the person with measles at the Super Bowl Village in Indianapolis last week, the American Academy of Pediatrics is reminding people "of how important it is to maintain high immunization rates against vaccine-preventable diseases."

"Measles spreads so easily that just being in the same room with an infected person can cause an un-immunized person to become infected," states Robert W. Block, MD, FAAP, president of the American Academy of Pediatrics. "You simply cannot predict when you or your child will come into contact with someone who has a vaccine-preventable disease. That's why it's so important to make sure your family is vaccinated. We hope that high immunization rates will protect those in the crowd at Indianapolis."

Children should be vaccinated against measles:

• at age 6 months if they will be traveling out of the country
• at age 12 months (routine age for first dose of the MMR vaccine)
• at age 4 to 6 years (routine age for second dose of the MMR vaccine) - or earlier if traveling out of the country

"The vaccine is very effective, which is why we don't see many cases of measles in the U.S. today," said Dr. Block. "But the virus is still out there, and people who are not immunized -- including infants who are too young to be immunized -- are at risk. Measles can be deadly. High rates of immunization in the community help to slow the transmission of diseases like measles, protecting everyone."

There were over 220 cases of measles in the United States last year - the most in 15 years. Let's not see any more records in 2012. Get your kids vaccinated against measles and other vaccine-preventable diseases.

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What's the first thing that you think of when you hear COPPA?

Is it the Children's Online Privacy Protection Act, a law that helps protect the personal information of our kids when they go online?

If so, did you know that COPPA is 13 years old, was passed in an internet age before cookies and other tracking technologies were being used, and doesn't cover teens, who frequently use social networking sites, like Facebook?

To help protect our kids from new and emerging health and safety concerns on the internet, the American Academy of Pediatrics strongly supports the Do Not Track Kids Act of 2011, which will help to update and strengthen privacy protections for children and teens by:

• better informing users and increasing transparency by explaining what type of information websites collect and what they do with it
• increasing accountability by requiring consent before personal information is collected by websites, either from parents (for younger children) or by teens themselves
• creating a "Digital Marketing Bill of Rights for Teens" that in addition to other things, will create an "Erase Button," so that things teens post don't have to stay online and follow them forever

While no privacy protection law will likely ever be perfect, as kids can enter fake ages when they sign up at websites and too much privacy protection can limit how much kids can take advantage of good things on the internet, the Do Not Track Kids Act of 2011 is a good step towards making our kids a little safer online.

Learn more about the Do Not Track Kids Act and urge your representative to become a cosponsor and get it passed. Unlike SOPA and PIPA, which recently got a lot of negative attention, the Do Not Track Kids Act of 2011 is a bill with bi-partisan support.

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Getting hit by a car that had run a stop sign while your child is waiting for the school bus is truly a freak accident. It is hard to prepare for that one. Many of these other types of accidents are tragedies that happen week after week though and can be prevented.

Spread the word about back-over accidents, falling televisions, and water safety to help prevent these types of accidents:

• a 2-year-old in Chicago who was in critical condition after a 29-inch TV fell on her as she tried to climb on a dresser
• a 3-year-old who drowned in a backyard in-ground swimming pool after he wandered out of his grandfather's house in Gainesville, Florida
• a 1-year-old in Chicago who died when a 50-inch TV fell off its stand and on top of his head
• a 13-year-old from Kaukauna, Wisconsin who suffered a severe head injury and required emergency surgery after a ski accident - he wasn't wearing a helmet because it wasn't cool, but now has to wear one every day to protect the area of his brain where they had to remove a piece of his skull to relieve the swelling of his brain
• a 4-year-old in Dallas, Texas who died after getting accidentally run over by his mother as she backed out of the driveway of his grandmother's house, where she had dropped him off
• a 2-year-old who drowned in a pool in Huntsville, Alabama
• a 3-year-old walking on the beach with his family in Galveston, Texas who died when a large piece of drift-wood rolled down a sand dune and hit the boy
• a 15-year-old from Green River, Wyoming who died after falling from a cliff along the Green River. He had been throwing rocks to the river below when he fell.
• a 4-year-old who died when an ATV rolled over on top of him in Rhame, North Dakota
• an 8-month-old in Dallas, Texas who is in critical condition after slipping under the water during a bath
• a 7-year-old who was struck and killed by a car while waiting for a school bus in Montrose, Minnesota

Accidents are the leading cause of death for children. Keeping your kids safe doesn't mean you have to turn into a helicopter parent or put your kids in a bubble, but it can help to follow common sense child safety advice and learn about some of the more common hidden dangers.

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