Yearly flu vaccines were once recommended only for high risk children. It wasn't until the 2002-03 flu season that the Advisory Committee on Immunization Practices begin encouraging vaccination of healthy children between the ages of 6 and 23 months when feasible.
They then made a formal recommendation for flu vaccines:
- for healthy children between 6 and 23 months for the 2004-05 flu season
- for healthy children between 24 and 59 months for the 2006-07 flu season
- for flu vaccines for healthy children between 5 and 18 years for the 2008-09 flu season
Still, even with these recommendations and with flu vaccines being a part of the childhood immunization, unlike most other vaccines, flu vaccines aren't usually required for kids who attend school or daycare.
That is unless you live in Connecticut, New Jersey, or New York City, all of which do require children between the ages of 6 and 59 months to receive at least one dose of a flu vaccine each year to attend a licensed day care.
Is the requirement effective?
We are getting our first evidence in a new report from the CDC, "Impact of Requiring Influenza Vaccination for Children in Licensed Child Care or Preschool Programs -- Connecticut, 2012-13 Influenza Season,"and it looks like good news.
After instituting the new rule in 2010, among young children, Connecticut has seen:
- a large increase in vaccination rates (from 67% to 84%)
- a decrease in hospitalization rates (12%)
And since most flu deaths in kids are typically in those who have not been vaccinated, anything to help boost vaccination rates seems like a good idea. Also, in addition to being at high risk for catching the flu, young children are often thought to be among the groups who are most likely to transmit the flu virus to others.
Less flu in young kids might also mean less flu for everyone. And that is what these laws are about. According to Arthur L. Caplan, Ph.D., a medical ethicist, these flu vaccine laws are about "trying to prevent infected kids from killing or making other kids sick, especially those with asthma or immune diseases. It is trying to prevent killing grandma by infecting her, killing pregnant women's fetuses or striking dead the neighbor who is getting chemotherapy or is post an organ-transplant who encounters an infected baby or child at the supermarket, train station or movie theater."
Is your state or city planning on making the flu vaccine a requirement for attending day care or preschool?
Parents often complain about their kids spending too much time playing games on their iPads and texting with their cell phones.
Are parents using them too much too?
A new study that will be published in the April issue of Pediatrics, "Patterns of Mobile Device Use by Caregivers and Children During Meals in Fast Food Restaurants," observed caregivers eating with their children and found "a large proportion of caregivers who were highly absorbed with their hand-held devices."
This absorption with their mobile device seemed to lead the caregivers to:
- have decreased responsiveness to the child
- have decreased conversation with a passive child
- ignore their child's behaviors until it escalated and they eventually raised their voice
So while "some children accepted the lack of engagement and entertained themselves; others acted out in a bid for attention."
Have you ever seen these parents and kids in a restaurant? Has it ever been you?
The researchers do warn that "we should not draw conclusions about relationships between mobile device use and caregiver-child interaction from our results," but the study is a good reminder for all of us to take a good look at our own use (or overuse) of cell phones and other media (screen time), especially when we are with our kids.
Many people likely thought measles was getting into out of control territory when we continued to hit new records in the last few years, including:
- 220 measles cases in 2011 - a 15 year record and the highest number of cases since 1996
- 58 cases in the 2013 New York City measles outbreak - the largest outbreak since the endemic spread of measles was eliminated in the United States
- local and state public health departments spending from $2.7 million to $5.3 million US dollars to contain just half of the measles outbreaks in 2011
Unfortunately, this year is looking to be even worse considering we have already seen about 4x the number of measles cases we had seen at this point in 2011. Earlier in the week, the CDC reported 54 cases of measles in the United States - more than was reported in all of 2007 (just 43 cases all year).
The number of measles cases is likely to jump significantly though, as the latest CDC report likely doesn't include the latest measles outbreaks:
- a measles outbreak in New York City that is already affecting 7 adults and 9 children in northern Manhattan and the Bronx.
- two more cases of measles in San Diego, California which are linked to an outbreak in February, when a person exposed others at two different Naval medical facilities after contracting measles in the Philippines. The new cases likely exposed hundreds of other people at four different sites around San Diego, including an urgent-care center.
- a second case of measles in Macomb, Illinois.
- two more cases of measles in Massachusetts, this time in Middlesex County.
Why the jump in cases? The CDC puts some of the blame on unvaccinated children and adults traveling to the Philippines, where a large outbreak recently killed 23 children, but it is important to keep in mind that there are outbreaks in many other countries too.
In addition to the Philippines, there are outbreaks of measles in the Netherlands, Turkey, Italy, Germany, the UK, Vietnam, Indonesia, and Japan, too. Although Europe reported a milder measles season last year, they still had over 10,000 cases, which were complicated by 8 cases of acute measles encephalitis and 3 deaths.
Measles is a vaccine-preventable disease though. We don't have to let it get out of control. We can stop the outbreaks before we start to see even more cases and start to see more complications of measles.
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Most people welcomed the passage of the Protect Our Kids Act of 2012. Continued reports of deaths from child abuse and neglect led to many to realize that an "increased understanding of deaths from child abuse and neglect can lead to improvement in agency systems and practices to protect children and prevent child abuse and neglect."
Introduced by Rep. Lloyd Doggett of Texas, it had mostly bipartisan support and was signed into law by President Obama on January 14, 2013.
In establishing the Commission to Eliminate Child Abuse and Neglect Fatalities, the Protect Our Kids Act of 2012 will hopefully "develop a national strategy and recommendations for reducing fatalities resulting from child abuse and neglect."
With recent developments, a national strategy is certainly needed.
- Governor Jan Brewer had to recently abolish the Child Protective Services agency in Arizona after reports that more than 6,500 child abuse and neglect reports were never investigated.
- Governor Rick Scott recently had to increase funding to the Department of Children & Families in Florida after a "surge" in child abuse deaths in the state, which many people blamed on previous budget cuts.
- there was a spike in deaths of children in foster care in Texas last year, with some placing the blame on budget cuts and increased reliance on private agencies.
So what's the update? After President Obama appointed the members of Commission in September, according to the American Academy of Pediatrics, which is a strong supporter of the Protect Our Kids Act, the commission held its first meeting last week. During this meeting, "the commissioners brought in congressional staff who worked on the legislation to discuss the intent of the bill, reviewed previous federal efforts to improve federal policy responses to child maltreatment fatalities and outlined the scope of the commission's work. Over the next two years, the commission will continue holding meetings around the country as it moves forward in developing its proposals."
Among other things, child welfare experts are hoping these proposals include:
- the development of a national, multi-agency strategy for stopping maltreatment deaths.
- increasing current federal spending on child protection
- child welfare financing reform
- the development of a public education campaign to encourage public reporting of child abuse and neglect and to enlist communities in the protection of children
- the development of a model protocol to ensure civil and criminal legal proceedings related to child abuse and neglect are closely coordinated with relevant agencies
Join the AAP, the National Coalition to End Child Abuse Deaths, Prevent Child Abuse America, and other national, state, and local organizations in supporting the Protect Our Kids Act of 2012 so that more is done "to address the deaths in America of innocent children--nearly five-- every day from abuse and neglect."
You can also urge the legislators in your state to make sure everything is being done to protect kids from abuse and neglect.
In this week's Safety Roundup, stories of:
- a 5-year-old from Amarillo, Texas who unintentionally shot himself and his father at the Bass Pro Shops in Oklahoma City, Oklahoma after he got a hold of his father's gun while they were in the store's dressing room.
- a 9-year-old in Dallas, Texas who is in critical condition after she was unintentionally shot in the head in her home by a neighbor doing target practice in his back yard.
- a 12-year-old in Orlando, Florida who was unintentionally shot in the arm while she was a passenger in a car driving by a house where a man accidentally fired his .380-caliber handgun while showing a friend how to clean the gun. The surprised man than unintentionally shot himself in the leg.
- a 3-year-old in Amado, Arizona who required surgery after he unintentionally shot himself with an unsecured gun that he found in his home.
- a teenager in Seminole, Florida who was hospitalized after his 16-year-old friend unintentionally shot him in the abdomen while showing him a .22-caliber rifle after baseball practice.
- a 15-year-old in Sterling, Illinois who died after he was unintentionally shot by another teen at the home of an Illinois State Police trooper.
- a 2-year-old in Pensacola, Florida who died after she was unintentionally shot in the head in his home.
- an 8-year old in Cincinnati, Ohio who died after he was unintentionally shot in the chest by his older brother while they were playing with a gun that they thought was a BB gun.
- a 12-year-old in Danville, California who unintentionally shot himself in the arm. His parents are both Oakland Police officers.
- a 3-year-old in Slidell, Louisiana who drowned in a neighbor's pool after opening a window and getting out of his own home undetected.
- a 3-year-old in Phoenix, Arizona who drowned in the unprotected backyard pool at the home of a relative after the family lost track of him as they got ready in the morning.
- a 2-year-old in Anthem, Arizona who drowned in a backyard pool.
- a 12-year-old in Cape Coral, Florida who drowned in a canal near his home.
- a 2-year-old in Pine Hills, Florida who drowned in a pond near his apartment complex.
- a 2-year-old in Beaumont, Texas who died after he ran into the street and was hit by a car.
- a 14-year-old from Caņon City, Colorado who died when the Kawasaki Motocross bike he was driving collided with a truck.
- a 4-year-old in Nichols Hills, Oklahoma who died after he was hit by a car driven by his father who had just dropped his children off at school.
- a 4-year-old from Lufkin, Texas who died when the ATV she was riding in rolled over.
- a 17-year-old from Scott City, Missouri who died in an ATV accident.
- a 13-year-old in Paterson, New Jersey who died when a bullmastiff escaped from a fenced yard and attacked him and his friend as they walked home from school.
- a 2-year-old in Killeen, Texas who died after he was attacked by a bullmastiff that had run out of a home's garage as he walked home from a playground with a group of other children.
- a 4-year-old in Tallassee, Alabama who died while playing in her backyard when she was attacked by a large shepherd mix dog.
- a 3-year-old in High Point, North Carolina who died after being attacked by the family's pit bull.
Keep your kids safe. Not all, but many of these types of accidents can be prevented.
When did your baby start sleeping through the night?
Of all of the milestones, the time when their baby sleeps through the night is one that many parents look forward to the most. That is especially true if their baby is still waking up two or three times a night when they are five or six months old.
In addition to a bookshelf full of sleep books, there are also baby products that claim to help your baby sleep through the night. Among these baby products are the infant sleep machines, which "produce ambient noise or noise to mask other sounds in an infant's room with the goal of increasing uninterrupted sleep."
These products claim to:
- soothe crying babies into a calm and restful sleep
- provide an ideal sleep environment
- calm even the fussiest babies to sleep
Sounds great. But are they safe? The authors of a new study that will appear in the April issue of Pediatrics, "Infant Sleep Machines and Hazardous Sound Pressure Levels," found that all 14 infant sleep machines they tested exceeded 50 dBA, the current recommended maximum safe noise limit for infants in hospital nurseries.
Even when the infant sleep machines were placed at a distance of 200cm (like being across the room from your baby's crib), all but one exceeded the 50 dBA safe noise limit when it was set at maximum volume (a common recommendation). They all exceeded the 50 dBA safe noise limit at 30cm (like putting the infant sleep machine on your baby's crib rail) and 100cm.
At a distance of 30cm, three of the infant sleep machines had sound levels that were over 85 dBA, which is higher than the adult occupational noise limit!
What can exposure to these high noise levels do to your baby? The researchers of the study state that "exposure to these devices may place infants at risk of developing noise-induced hearing loss or maldevelopment of the auditory system."
They recommend manufacturer set sound limits and mandatory timers for all infant sleep machines and have some advice for parents who are going to continue to use these devices:
- Place the infant sleep machine as far away as possible from the infant and never in the crib or on a crib rail.
- Play the infant sleep machine at a low volume.
- Operate the infant sleep machine for a short duration of time.
This study brings up another issue though. Are infant sleep machines even a good idea? Keeping in mind that most parenting experts stress the importance of a good bedtime routine for a good night's sleep and that the goal of a good bedtime routine is for your child to fall asleep on his own, then an infant sleep machine might actually be something to avoid.
If your child gets used to falling asleep with the soothing sounds of a sleep machine, then he will likely fully wake up in the middle of the night when he gets into a light sleep phase and those soothing sounds aren't still playing.
Also keep in mind that infant sleep machines aren't the first baby product to get a warning like this. Remember that it wasn't too long ago that we were getting warned about other popular baby products, including crib bumper pads, baby monitors, and infant sleep positioners.
I think the take home message must now be that before adding the latest and most popular baby products to our must have lists, let's make sure they are safe.
That vaccines save lives and money is something that most health experts know well.
Another vaccine study that will be published in the April issue of Pediatrics, "Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009," simply confirms it.
More specifically, the study looked at the costs and benefits of vaccinating all children born in 2009, and following them from birth to death.
In addition to the costs of the vaccines, the study looked at how much money vaccines save by analyzing the costs of having a vaccine-preventable disease if the children were not immunized, including:
- direct medical costs associated with treating the infection
- direct medical costs associated with treating complications and consequences of the disease
- direct non-medical costs, including travel costs, special education when a child is disabled by a disease, and supplies
- outbreak control
- indirect costs from productivity losses from premature death and permanent disability
- indirect costs when parents miss work to care for their sick kids
The study found that "because of vaccination, US children born in 2009 will suffer 20,000,000 fewer cases of vaccine-preventable diseases and 42,000 fewer early deaths related to those diseases during their life-times." This would include over 27,000 deaths from diphtheria, over 1,000 deaths from whooping cough, 800 deaths from polio, and over 3,000 deaths from measles.
Saving all of those lives comes with a price. A net savings of $13.5 billion in direct costs and $68.8 billion in total societal costs. The study found that every $1 spent on vaccines results in a savings of $10.
According to the study authors, "the vaccines currently recommended for young children represent not only a major public health victory in terms of disease prevention, but also an excellent public health 'buy' in terms of dollars and cents."
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Recognizing that "throughout our Nation's history, American women have led movements for social and economic justice, made groundbreaking scientific discoveries, enriched our culture with stunning works of art and literature, and charted bold directions in our foreign policy," President Obama has proclaimed March 2014 as Women's History Month.
As we "recognize the victories, struggles, and stories of the women who have made our country what it is today," it is also a great time to recognize some of the important women in pediatrics, including:
- Dr. Elizabeth Blackwell, who became the first woman to graduate from a U.S. medical school in 1849 and then went on to study at children's hospitals in London, Scotland, and Paris, before returning to help start the New York Infirmary for Women and Children.
- Dr. Virginia Apgar, an anesthesiologist, who developed the Apgar Score in 1952, which is used to test a baby's response to resuscitation right after they are born.
- Dr. Mary Putnam Jacobi, who became the first woman to become a member of the Academy of Medicine in 1872. She also opened a children's ward at the New York Infirmary in 1886.
- Dr. Dorothy Reed Mendenhall, who was the first to recognize that Hodgkin's disease was a blood cell disorder and not a form of tuberculosis in 1901. She later did an internship in pediatrics and did research on children's health issues for the Children's Bureau in Washington D.C., including the development of growth norms and standards of child development.
- Dr. Dorothy Hansine Andersen, who was a pathologist and in 1938, became the first person to recognize that cystic fibrosis was a disease. She also helped created the first tests to help diagnose CF.
- Dr. Hattie Elizabeth Alexander, a pediatrician and microbiologist at Babies' Hospital (now NewYork-Presbyterian Morgan Stanley Children's Hospital) who developed a treatment for Hib meningitis in the 1940s that was more effective than previous treatments (pre-vaccine era). She also identified antibiotic resistance in Haemophilus influenzae bacteria, another milestone at the time.
- Dr. Helen Taussig, who helped to develop a palliative surgical treatment for babies with Tetralogy of Fallot in 1943.
- Dr. Natalia Tanner, who became the first African American fellow of the American Academy of Pediatrics in 1951 and "played a very personal role in improving underserved patients' access to healthcare and minority physicians' access to the institutions of professional medicine."
These women helped forge some of the early milestones in pediatrics.
Women's History Month is a great time to learn more about them and "the generations of women who have left enduring imprints on our history."
Rare Disease Day was first established in 2008 to help raise awareness of the nearly 7,000 rare diseases that affect millions of people, but don't get the attention or resources of more well-known diseases.
Surprisingly, rare diseases are thought to affect up to 30 million people in the United States, including about 15 million children, many of whom face problems with:
- delayed diagnosis caused by a lack of scientific knowledge of these rare diseases, each of which typically affects fewer than 200,000 people, but some which might only have a handful of diagnosed patients
- limited treatment options
- requirements for intensive physical assistance and equipment
Last year, participants in 72 countries observed Rare Disease Day with the theme Solidarity and the slogan - Rare Disorders without Borders.
This year's theme, CARE, "encourages everyone in the rare disease community to Join Together for Better Care." What are you doing for Rare Disease Day?
It seems hard to believe that nutrition labels haven't been really updated in over 20 years, when the Nutrition Labeling and Education Act of 1990 created "the food label to list the most important nutrients in an easy-to-follow format."
Sure, there have been some changes over the years, including the addition of trans fats to nutrition facts label in 2003 and better labeling of foods that might trigger food allergies in 2004, but most nutrition experts have been hoping for a major update for some time.
And now it looks like we are finally getting that big update to the nutrition label.
A proposed update to the Nutrition Facts label will:
- emphasize the number of calories and servings per container
- update % Daily Values for nutrients such as fiber and calcium
- update serving sizes
- list the amount of added sugars
- require listing of potassium and vitamin D if present
- no longer require the labeling of Vitamins A and C
Perhaps most importantly, another big change will be that "the label information on serving sizes must be based on what people actually eat, not on what they 'should' be eating." So a 20-ounce bottle of soda, which most people typically drink as one serving, would be labeled as a single serving, instead of the current more misleading multiple serving label, which can make people think that they are getting far fewer calories from the soda bottle.
The addition of dual column labels, which include per serving and per package nutrition labels would also help people understand how many calories they are getting if they sometimes consume multiple servings of a package in one sitting.
What do you think of the new nutrition facts label? Consumers will soon be able to add their own comments on the proposed changes before the new label becomes final.
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