Category Archives: Children (0-5 years)
For children, stress can come from sources inside and outside the family. It was recently documented that nearly two out of every three children in the United States have witnessed or been victims of violence in their homes, schools, or communities. That’s a staggering statistic when we consider the well-established link between children’s exposure to stress and their long-term mental and physical health outcomes.
Indeed, we know that early exposure to adverse experiences can change the way that our brains develop and function. We also know that exposure to adversity increases the likelihood that children will develop psychosocial problems, like depression, aggression, and other antisocial behaviors. There is even evidence that exposure to stressors in childhood increases the likelihood of having heart disease and cancer in adulthood!
About 19 in every 100,000 American children under the age of five suffers from an inflammatory illness called Kawasaki Disease (KD) that can cause irreversible damage to the heart. If diagnosed early, it can usually be treated effectively, and children can be returned to health in just a few days. But between 10 and 20 percent of treated patients suffer from a persistent fever, or one that recurs after treatment, and they are at elevated risk of developing coronary artery aneurysms. A new study, led by Robert Wood Johnson Foundation (RWJF) Harold Amos Medical Faculty Development Program Scholar Adriana H. Tremoulet, MD, MAS, and published yesterday in The Lancet, offers new hope for patients with KD.
The symptoms of KD include prolonged fever associated with a rash, swollen neck glands, red eyes, swollen red lips, a condition physicians call strawberry tongue, and swollen hands and feet with peeling skin. Current treatment is infusion of intravenous immunoglobulin (IVIG) and aspirin. The IVIG carries the pooled antibodies from the blood plasma of more than 100,000 donors, and in the KD patient, it decreases the inflammation that causes heart damage. The treatment usually works, but some patients’ IVIG-resistance puts them at greater risk and in need of further treatment.
Tremoulet, a pediatric infectious disease specialist at Rady Children’s Hospital in San Diego, conducted a Phase III trial in which a synthetic antibody called infliximab was added to the standard IVIG and aspirin treatment. While the protocol did not affect the patients’ resistance, it had important positive results. “In our study,” Tremoulet said, “we demonstrated that a single dose of infliximab is safe in children with Kawasaki Disease and that this treatment reduced the inflammation in the body overall as well as in the arteries of the heart faster than just using standard treatment with intravenous immunoglobulin.”
Katherine A. Auger, MD, MSc, a pediatrician in the Division of Hospital Medicine, Department of General Pediatrics at Cincinnati Children’s Hospital Medical Center, is an alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program.
A 2006 recommendation from the Centers for Disease Control and Prevention (CDC) that all adolescents receive vaccines for pertussis, also known as whooping cough, is having a positive impact. A new study that I led shows it is associated with lower rates of infant hospitalizations for the respiratory infection than would have been expected had teens not been inoculated.
The study, published in Pediatrics, found that the CDC recommendation led not only to a significant increase in vaccination rates among teens, but also to a reduction in severe pertussis-related hospitalizations among infants, who often catch the disease from family members, including older siblings.
Quick thinking and a lucky coincidence saved a toddler’s life, and the incident is serving as a powerful reminder about the need to train parents and other caregivers about what to do when children choke.
Maja Djukic, PhD, RN, a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar and assistant professor at the New York University College of Nursing, was rollerblading near her home in Connecticut this fall when she heard screaming. Djukic raced to the scene to find a one-year-old boy limp and turning blue. The boy’s father was calling 9-1-1 while him mother tried, unsuccessfully, to clear his air passages. Djukic was able to do so; she had the child breathing by the time an ambulance arrived. He has fully recovered.
In “Keeping Little Breaths Flowing,” Jane E. Brody of the New York Times wrote about the incident, noting that “few parents of newborns are taught how to prevent choking and what to do if it occurs.” Brody’s two-part piece on cardiopulmonary resuscitation (CPR) concludes with “How CPR Can Save a Life,” in which she focuses on resuscitating adult victims of cardiac arrest.
By Santa J. Ono and Greer Glazer
Santa J. Ono, PhD, is president of the University of Cincinnati. Greer Glazer, PhD, is dean and Schmidlapp professor of nursing at the University of Cincinnati College of Nursing, and an alumna of the Robert Wood Johnson Foundation Executive Nurse Fellows program. This piece first appeared in the Cincinnati Enquirer; it is reprinted with permission from the newspaper.
The children of poor Cincinnati neighborhoods are 88 times more likely to require hospitalization to treat asthma than their peers across town. That’s an urban health disparity born of unequal access to the kind of consistent, attentive, high-quality health care that renders asthma a controllable condition.
In academic medicine, we chart the credentials of our staff and the test scores of our students. We tout the wizardry of the medical technology we bring to bear on exotic maladies. But too often we lose sight of the fact that the ultimate test of an academic medical center isn’t what’s inside the building, it’s what’s outside. If we are improving the health of the communities we serve, then we are truly succeeding.
By that score, we are falling short.
Sheryl Magzamen, PhD, MPH, is an assistant professor in the College of Veterinary Medicine and Biomedical Sciences at Colorado State University and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2007-2009). She recently published two studies exploring the link between early childhood lead exposure and behavioral and academic outcomes in Environmental Research and the Annals of Epidemiology. She discusses both below.
Human Capital Blog: What are the main findings of your study on childhood lead exposure and discipline?
Sheryl Magzamen: We found that children who had moderate but elevated exposure lead in early childhood were more than two times as likely as unexposed children to be suspended from school, and that’s controlling for race, socioeconomic status, and other covariates. We’re particularly concerned about this because of what it means for barriers to school success and achievement due to behavioral issues.
We are also concerned about the fact that there‘s a strong possibility, based on animal models, that neurological effects of lead exposure predispose children to an array of disruptive or anti-social behavior in schools. The environmental exposures that children have prior to going to school have been largely ignored in debates about quality public education.
It’s made of glass, and it glows and changes colors—but it’s not a crystal ball. It’s an “orb” and it’s poised to revolutionize the way providers assess and treat pain in premature infants.
Martin Schiavenato, PhD, RN, a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar, has invented a revolutionary tool to assess pain in premature infants and potentially protect them from its negative developmental effects.
The glass orb translates behavioral and physiological signs of pain in infants—such as body gestures and physiological signals like heart rate metrics—into a “real time” visual display of pain levels. It changes color depending on the subject’s pain levels, giving clinicians readouts on infant pain.
Sammy Zahran, PhD, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar (2012 - 2014). He is assistant professor of demography in the Department of Economics at Colorado State University, assistant professor in the Department of Epidemiology in the Colorado School of Public Health, and co-director of the Center for Disaster and Risk Analysis at Colorado State University. This blog is based on his study: "Linking Source and Effect: Resuspended Soil Lead, Air Lead, and Children's Blood Lead Levels in Detroit, Michigan."
RWJF Health & Society Scholars lead the field of environmental health. This is part of a series highlighting their 2013 research.
Human Capital Blog: Tell us about your recent study, published in Environmental Science and Technology. What questions did you set out to answer? And what did you find?
Sammy Zahran: We sought to understand a mysterious statistical regularity in blood lead (Pb) data obtained from the Michigan Department of Community Health. The dataset contained information on the dates of blood sample collection for 367,800 children (<10 years of age) in Detroit. By graphing the average monthly blood Pb levels (μg/dL) of sampled children, we found a striking seasonal pattern (see Figure 1). Child blood Pb levels behaved cyclically. Compared to the reference month of January, blood Pb levels were 11-14 percent higher in the summer months of July, August, and September.
February is National Children’s Dental Health Month, so the Human Capital Blog reached out to John Gusha, DMD, PC, a 2003 Robert Wood Johnson Foundation (RWJF) Community Health Leader, to learn more about children’s oral health. As project director of the Central Massachusetts Oral Health Initiative, Gusha mobilized dozens of dental societies and non-profit groups to provide dental care for low-income residents of Worcester County. Although funding for the Oral Health Initiative has ended, many of the programs Gusha helped create are still in place.
Human Capital Blog: What spurred the Central Massachusetts Oral Health Initiative? What made you aware of this need for oral health care in your community?
John Gusha: There was a special legislative report in 2000 that described disparities in access to oral health care for low-income populations. It raised a lot of questions about what we could be doing in the community and in the dental society to address these gaps. We got funding from the Health Foundation of Central Massachusetts, which also saw this as a critical need for our area, to launch the initiative.
HCB: Tell us about the school-based programs you put in place.
Gusha: The decay rate in Worcester County schools was very high—more than one-third of the students had active decay in their mouths. It was especially prominent in schools with high numbers of free and reduced price lunches, where students came from low-income families that are more likely to be using Medicaid. These students didn’t have access to care and weren’t getting the preventive services they needed.
We started a school-based program that is now in place in more than 30 Worcester County schools. Dental hygiene students from a local community college provide fluoride varnishes, cleanings and other preventive services to students, and the University of Massachusetts’ Ronald McDonald “Care Mobile” visits schools to offer the same services. Community health centers also participate in these programs by adding dental to their school-based health centers. In the past you could go to schools and provide services, but Medicaid rules didn’t allow you to get reimbursed. We were able to help get those rules changed so the program could become sustainable.
HCB: You also had a role in creating a dental residency program and training primary care providers to screen for oral health needs.
Gusha: We wanted to better integrate dentistry into medicine. The University of Massachusetts was the administrator of our program, and the team there developed a dental residency program at the medical school. The University had no classes in oral health before this. The local hospitals were in desperate need of professionals with this kind of training, particularly in emergency rooms. The Medicaid population was presenting there frequently for treatment because they had nowhere else to go, and people with other issues like cardiac problems or cancer needed clearance on their oral health in order to proceed with treatment.
The residency program is still in place at our two local community health centers, and it’s grown now to include education for other disciplines.
In May, the U.S. Department of Housing and Urban Development (HUD) awarded a multi-year grant to an asthma prevention and treatment program run by 2008 Robert Wood Johnson Foundation Community Health Leader Ray Lopez of New York City. Lopez is the director of environmental health services at the Little Sisters of the Assumption Family Health Service in New York’s East Harlem. The grant award is shared with the New York Academy of Medicine.
Ray Lopez: Our mission is to serve children in East Harlem by helping their families treat and prevent asthma incidents. Asthma rates are unusually high in New York City in general, and the problem’s even more acute in Harlem, the South Bronx and Central Brooklyn where there are all kinds of environmental factors in children’s homes. We’re focused on children in public housing, where there are a number of problems. A lot of the apartments have mold that has grown as a result of leaks, and they’ve also got a lot of cockroaches, and mice, which all contribute as well. What we do, and what this grant will help us do a lot more broadly, is to get treatment for the kids, but also to go into their apartments and get to work on reducing the environmental factors. Sometimes that means identifying moisture sources and safely cleaning the mold. Sometimes it means pressing the city’s housing authority to do major work. Sometimes it involves teaching the adults in the family about the safe use of pesticides and cleaning products. For each family we visit, we work with them to create an individualized service plan, and then we focus on remediating the asthma triggers.
Teaching is a major part of this, too, and the plan is to teach by showing and doing. Families are enrolled with us for a year, and by end of year, we hope they will have accumulated skills to manage these problems on their own in the long-term. It’s a three-year project, in all: two-plus years working with the families, and then a final phase that consists of data analysis and policy initiatives led by the New York Academy of Medicine.
HCB: And then what’s the plan with the data and the analysis?
Lopez: The plan is to build the business case for this kind of intervention, and then to persuade insurance companies and providers that it’s worth the investment to them to spend a little money up front to prevent asthma incidents, rather than paying for them in the emergency room.