Category Archives: Pediatric care
The American Academy of Pediatrics (AAP) met in San Diego this week for the group’s annual meeting. Key issues addressed included car seat safety for newborns, care for immigrant children, reducing poverty and young children’s exposure to media.
A study presented at the meeting found that most newborns leave the hospital with their car seat incorrectly installed, posing a risk of injury or death. A trained installer hired by the researchers observed 300 parents and babies about to leave the hospital, noting mistakes such as harnesses that were too high and clips fastened incorrectly. The technician made adjustments before the families left the hospital.
“Car safety seats can be difficult to use correctly for many families, and we need to provide the resources and services they need to help ensure the safest possible travel for newborns and all children,” said Benjamin Hoffman, MD, FAAP, lead author of the study “Unsafe from the Start: Critical Misuse of Car Safety Seats for Newborns at Initial Hospital Discharge.”
AAP released its first media policy urging parents to limit screen time for kids in 1999. That recommendation was solely about television, and since then AAP policies have proliferated. Dimitri Christakis, MD, MPH, and Donald Shifrin, MD, both members of the AAP Council on Communication and Media, debated touchscreen use by toddlers.
“Touchscreens are merely a platform. If a toddler watches a movie on an iPad, it’s no different than watching a movie on a DVD player,” said Christakis. “However, tablets also can be used to read books to children, and high-quality apps are similar to toys. Therefore, the AAP needs to consider how these devices are used instead of discouraging their use across the board.”
Oral health received some recent attention with the passage of a law in California that allows dental hygienists to perform some procedures under the supervision of a remote dentist checking in via video screen. The goal is to improve the oral health of kids in that state. Other states are watching the rollout in the hopes of implementing similar programs.
With that same goal in mind, the Ad Council and dozens of partners have just launched a new series of quirky public service announcements (PSAs) aimed at getting kids to brush their teeth twice a day, two minutes each time. The PSAs highlight how teaching kids to brush their teeth is far easier than other lessons parents impart, including cooking, manners and getting dressed.
The PSAs will appear as television, radio, print, outdoor and digital ads, and can also be found online. Campaign partners include the American Dental Association and the American Academy of Pediatrics. Ad Council spokeswoman Ellyn Fisher said the campaign is timed to coincide with Halloween—“as kids get ready to dig into their candy bags.”
A recent Ad Council survey found that three quarters of parents said their kids often forget to brush their teeth. The survey also found that while it’s estimated that children miss more than 51 million school hours each year due to dental-related illnesses, parents rank their children’s dental health as a low priority relative to other health issues, such as nutrition or cold and flu season.
The new PSAs are available in both English and Spanish and direct viewers to the campaign’s website, where parents and children can watch the videos—all 2 minutes in length, or the exact amount of time they should spend brushing their teeth. More than 1.7 million people have visited the website since its launch in 2012. A 2013 Ad Council survey showed that in one year, English-speaking parents reported that their children were significantly more likely to brush twice a day (55 percent in 2013, up from 48 percent in 2012) and significantly more likely to brush for two minutes each time (64 percent in 2013, up from 60 percent in 2012). Spanish-speaking parents also saw significant increases in brushing twice a day, from 63 percent in 2012 to 66 percent in 2013; 77 percent reported kids brushed for the recommended two minutes 2013, up from 69 percent in 2012.
“We’ve had some extraordinary success with this campaign so far,” said Fisher, “But we have a long way to go to make brushing for 2 minutes, twice a day a social norm.”
This week, NewPublicHealth will run a series on new and creative public health campaigns that aim to improve the health of communities across the country through the use of public service announcements, infographics and more. Stay tuned to learn more about a new campaign each day.
In an effort to reduce missed school days, theEnvironmental Protection Agency (EPA), in partnership with the Ad Council, has launched a campaign to teach parents how to prevent asthma attacks in kids by identifying common asthma triggers. The “No Attacks” campaign urges parents to learn how to control factors that make a child’s asthma worse, use asthma medicines effectively and recognize when to call the doctor.
Asthma affects nearly 9 million U.S. children, with poor and minority children suffering a greater burden from the disease. Asthma can be especially serious in kids because of their small airways.
Through a series of Public Service Advertisements (PSAs) featuring a rock band of puppet characters called the “Breathe Easies,” the campaign includes online videos, radio spots and online banners (available in English and Spanish) with songs about asthma triggers at home, at school and outside. These entertaining messages inform viewers about how to prevent asthma attacks by cleaning up mold, vacuuming regularly and eliminating smoking at home; making sure their child’s school has a plan for controlling cockroaches and other pests, banning furry class pets and minimizing the use of chemical irritants in cleaning products, air fresheners and pesticides; and postponing outdoor sports and other high-energy activities to avoid exposure to high air pollution levels.
“Too many Americans, particularly children, minorities and people living in poverty, suffer from asthma, spending their time at doctor visits and hospitals instead of at school, work and play,” said Janet McCabe, acting assistant administrator for the EPA’s Office of Air and Radiation. “By working with the Ad Council and other partners in communities across the country, we can make a real difference in the lives of millions of Americans dealing with asthma.”
Asthma causes U.S. children to miss 14 million school days each year, which is especially worrisome because more frequent school absences are consistently linked with worse academic performance. The good news: “School absences due to asthma can be avoided by appropriate asthma management, including appropriate use of medications and reduced exposure to triggers,” noted a report from the U.S. Centers for Disease Control and Prevention. Since there’s no cure for asthma, preventing attacks—by reducing exposure to environmental triggers and using medications appropriately—is the primary focus of treatment.
The new PSAs stem from The Childhood Asthma Campaign, which was first launched by the EPA and the Ad Council in 2001. Since the debut of that campaign, the percentage of parents who feel they can make “a lot of difference” in preventing asthma attacks has risen from 49 percent to 67 percent, according to the Ad Council’s tracking surveys. The hope is that the new PSAs will improve that percentage even more.
Earlier this month, following the heatstroke death of a Georgia toddler who was left in a sweltering car for hours, Tennessee became the first state in the nation to pass a law that specifically protects people from liability for forcibly breaking into cars and rescuing kids they think are at risk of heatstroke. The law requires those individuals to call 911 first and follow instructions.
Many states have Good Samaritan laws that may protect people in such instances, but the specifics vary from state to state, according to Cristina M. Meneses, JD, MS, a staff attorney with the Network for Public Health Law’s Eastern Region. A recent Today show poll found that 88 percent of the 44,000 people asked would break into a car to rescue a child they thought was in danger, but specific laws can increase the response—and potentially remove penalties—while raising awareness of the issue. More such laws could soon follow. Janette Fennell, founder and head of KidsAndCars, a nonprofit based in Kansas City, Mo., which advocates for laws that will protect kids from heat in vehicles, said she’s received inquiries from two states about those laws since Tennessee’s law was passed. Another set of laws that KidsAndCars tracks are those that penalize adults for leaving kids in cars. Nineteen states currently have such laws on the books.
“It’s a good deterrent for anyone who might think, ‘Oh, I’ll just leave them in the car for a minute,’” said Fennell, “because it’s often that minute that turns into much longer and results in injury or death.”
According to the National Highway Traffic Safety Administration (NHTSA), more than 40 kids—often under age 2—die each year of “vehicular heatstroke.” Seventeen U.S. kids have died after being left or trapped in car since the beginning of 2014. Fennell and other experts say many people just don’t realize how quickly temperatures can climb in a car, even if the window is cracked open a bit—when outside temperatures are in the low 80's, the temperature inside a vehicle can reach deadly levels in only 10 minutes, even with a window rolled down two inches. Children's bodies, in particular, overheat easily; and infants and children under four years old are at the greatest risk for heat-related illness.
NHTSA research shows that heatstroke deaths and injuries often occur after a child gets into an unlocked vehicle to play without a parent or caregiver's knowledge. Other incidents can occur when a parent or caregiver who is not used to transporting a child as part of their daily routine inadvertently forgets a child sleeping in the back.
Last week, KidsAndCars launched a petition drive to encourage NHTSA to require technology in all cars that would remind a driver that there is a child in the back. There are devices parents can install, but a 2012 study by NHTSA found that none that the agency studied were consistently effective.
“You get a warning if you don't buckle your seatbelt, leave a car door open, your gas is low or you leave your headlights on,” said Fennell. “If a child is left behind then you absolutely need a warning.”
Guidelines from NHTSA and other safety experts aimed at never leaving a child unattended in a car include:
- Make a habit of looking in the vehicle—front and back—before locking the door and walking away
- Ask childcare providers to call if a child doesn't show up for care as expected
- Put items in the back seat you’ll have to retrieve such as a purse or briefcase, or put a stuffed animal in sight of the driver to indicate there’s a child in the car.
Earlier this week the American Academy of Pediatrics (AAP) hosted a daylong Symposium on Child Health, Resilience & Toxic Stress in Washington, D.C. that brought together federal government officials, national thought leaders and medical professionals to discuss the emerging science of toxic stress.
According to the AAP, science shows that adversity experienced in childhood has long-lasting physical and emotional effects that have come be known as "toxic stress.” Toxic stress can occur when a child experiences chronic adversity without access to stable, supportive relationships with caring adults. These adverse childhood experiences can include physical and emotional abuse; neglect; exposure to violence; food insecurity; and economic hardship. An AAP 2011 policy statement found that toxic stress can affect a child's brain development and lead to the presence of many adult diseases, including heart disease, cancer, chronic lung disease and liver disease.
“[Currently], there are more randomized trials for leukemia than for effects of stress on children,” said James S. Marks, MD, MPH, senior vice president of the Robert Wood Johnson Foundation, at the symposium. “This is about more than our children—it’s about our future as a people and a society, and the earlier you invest in children the better the return to society and to those children and families.”
During the symposium, the AAP announced the formation of the Center on Healthy, Resilient Children to launch in the next year or so, which will be a national effort coordinated by the AAP and many partners to support healthy brain development and prevent toxic stress. In addition to prevention efforts to keep children healthy, the Center will focus on ways to help pediatricians and others identify children who have experienced adversity and toxic stress and ensure they have access to appropriate interventions and supports.
"Pediatricians envision a world in which every child has every opportunity to become a healthy, successful adult," said James M. Perrin, MD, president of the AAP. "Achieving this will require strong, sustained investments in the health of the whole child, brain and body. It will require building upon our existing work and forging new partnerships across sectors and fields of expertise.”
NewPublicHealth spoke with Perrin following the symposium
NewPublicHealth: How familiar are pediatricians with the evidence surrounding the burden and response to toxic stress in children and families?
James Perrin: I think there is increasing awareness of toxic stress in pediatric practice, not only in community practice, but in our specialty practices, too. I think people are recognizing how critically important toxic stress is to the developing child and developing brain. And the increasing science in this area has been incredibly helpful for us to understand the potential permanent effects of toxic stress. But we also want to focus on positive ways to affect brain development. Reading to children, for example, affects brain development and brain growth in positive ways.
NewPublicHealth continues a new series to highlight some of the best public health education and outreach campaigns every month. Submit your ideas for Public Health Campaign of the Month to email@example.com.
Recent dental surveys find that less than half of children in America brush their teeth twice a day and research shows that dental decay is the most common chronic childhood disease in the United States.
To encourage kids to brush their teeth, the Ad Council recently launched a neat mobile app aimed at bringing public service announcements (PSAs) right to where they can be most useful—in this case, the bathroom sink. The new PSA is called “Toothsavers” and it's designed to encourage kids to brush their teeth for two minutes, twice a day.
The back story of Toothsavers is that an evil sorceress has cast a wicked spell, leaving everyone’s mouths to rot and be overrun by cavities. Now it's up to little toothbrushers to help Toothy and the Toothsavers save everyone's teeth!
Kids use the app to swipe and tab in order to brush and scrub away the spell for each of the kingdom’s denizens, including the Dragon, Little Red Riding Hood and the Pirate. And for every few days a child brushes their own teeth for two minutes, twice a day, they unlock a new character on the Toothsaver game. Brush for 30 days and kids get the chance to defeat the evil sorceress herself.
Features of the app include:
- 10 different two-minute animations to add some fun to daily tooth brushing
- 10 cartoon teeth that move on the screen when activated by a voice
- An interactive map to chart daily tooth brushing
- Parents can connect on Facebook and post whenever their child reaches a brushing milestone
Toothsavers is a program of the Partnership for Healthy Mouths, Healthy Lives, a coalition of 36 oral health organizations including the American Dental Association. The campaign’s goal is to motivate parents to take action to reduce their children’s risk of oral disease by making sure their kids are brushing their teeth for two minutes, twice a day. Toothsavers is the first mobile app to be entirely created by the Ad Council. “The game represents a huge milestone for us in our efforts to use gaming and mobile technology to effect social change,” said Ellyn Fisher, Vice President, Public Relations and Social Media.
With the passage of the Mental Health Parity Act and the implementation of the Affordable Care Act (ACA), behavioral health experts are pushing to improve the quality of that care so that people seeking help—some for the first time—receive evidence-based care that best suits their individual needs. As part of that conversation, the U.S. Senate Health, Education, Labor and Pension committee held a hearing this week on mental health treatment trends in the United States.
Sen. Tom Harkin (D-Iowa) the committee chair opened the hearing by “pointing to disturbing new trends [including]...significant increases in the prescribing of psychotropic medications, while the use of behavioral and psychological treatments among children and youth has increased only slightly, and has actually decreased among adults.”
According to committee research on recent use of psychotropic drugs, use of antipsychotic medications has increased eight-fold among children and five-fold among adolescents, and has doubled among adults between 1993 and 2009.
The key witness at the hearing was William Cooper, MD, MPH, a professor of pediatrics and health policy at the Vanderbilt University School of Medicine who conducts population-based studies of medication use in children. Cooper told the committee about a nine-year-old boy he treated for weight gain—which turned out to be a side effect of a psychotropic drug the child had been prescribed by a primary care provider given for disturbing the classroom. No mental illness diagnosis had been made for the child, and no mental illness was detected after evaluation at Vanderbilt.
Cooper said that in recent years the United States has seen a tremendous increase in the numbers of children diagnosed with mental health disorders.
“Whether this is a result of increased awareness, improved diagnosis, or other factors is not clearly understood,” said Cooper, who added that “while we must acknowledge that a part of the increase could be due to over-diagnosis, there is no disputing the fact that a large number of children and their families suffer significantly because of mental illness.”
Furthermore, added Cooper, given the fact that suicide is the second leading cause of death for children ages 12-17, “tragic consequences of childhood mental health disorders highlight our sense of urgency in addressing this important problem.”
Cooper added that treating mental health disorders can be challenging and that 50-75 percent of the care for children with mental health disorders occurs in primary care settings “making it critical that consultation and communication between primary care professionals and experts in mental health be enhanced.”
Significantly, Cooper told the panel that despite guidelines, much of the mental health care for children occurs in a manner “inconsistent with optimal practice,” including:
- Use of medications for diagnoses for which there is little evidence of benefit.
- Use of multiple medications at the same time, especially among particularly vulnerable children such as children in foster care, where a recent study found multiple psychiatric medications in up to 75 percent of children being treated.
- Use of medications alone without proven psychotherapies.
Cooper attributed the problems to several factors, among them:
- Many general practice doctors are unaware of current mental health treatment guidelines.
- Inadequate mental health resources to provide best treatments.
- Too few professionals with training in providing mental health care to children.
- Barriers to treatment, including cost or the need to travel long distances.
- Stigma associated with mental illness, which may reduce families’ willingness to acknowledge a mental health disorder and seek treatment.
The HELP committee plans to hold additional hearings to address mental health issues. Other attention to the issues addressed at the hearing include a recent meeting in Washington, D.C. among professionals who conduct psychiatric clinical trials. They stressed the need to involve patients and families more in trial design and access, as well as to work with trial designers on mental health needs not currently being met.
The Substance Abuse and Mental Health Services Administration, a federal agency, recently announced several new funding grants to help individual groups facing mental health concerns including:
- A grant program for residential treatment of pregnant and postpartum women.
- A grant program to expand and sustain comprehensive community mental health services for children and their families, in order to improve behavioral health outcomes for children and youth with serious emotional disturbances, as well as improve the health and well-being of their families.
- A grant program to provide tribal and urban American Indian and Alaskan Native communities with tools and resources to plan and design a holistic, community-based coordinated system of care approach to support mental health and wellness for children, youth and families.
Read more about mental health on NewPublicHealth.
In reaching teens, crisis hotlines have had to adapt not only to what they say, but how they say it. While counseling teens by phone is still the dominant method of communication, texting has become a popular way for teens to contact crisis centers in their times of need. A recent story in The New York Times takes a look at what Crisis Text Line and other centers have accomplished in the field of helping teens using their preferred medium of communication.
For troubled teens, texting offers a critical element of privacy if they feel threatened by someone nearby and allows them to look and feel more natural if they are in a public space. Benefits for crisis counselors include the ability to deal with more than one person at a time and to introduce experts into the conversation without a lapse in contact. Organizations such as Crisis Text Line that offer text counseling report receiving messages from teens who might not have otherwise contacted the hotline by phone. People who text hotlines for help receive the same services as callers—risk assessment, emotional validation and problem solving—but the interactions are often longer and more direct than phone calls.
In addition to offering an effective way to communicate with teens, texting provides data and trends about people in different types of crises. “My dream is that public health officials will use this data and tailor public policy solutions around it,” says Nancy Lublin, founder of Crisis Text Line. The organization plans to compile the data and make it available to the public this spring.
The use of texting has extended beyond crisis centers. The four largest phone companies in the United States recently promised to make 911 texting possible by May for local response services that request the option.
Read more at The New York Times.
Preterm babies are born at a higher rate in the US than in 130 other countries, including many poorer nations, according to a report released today, Born Too Soon: The Global Action Report on Preterm Birth, published by the March of Dimes and almost fifty other groups, including the World Health Organization.
Preterm birth (birth before 37 weeks completed gestation) is the leading cause of newborn death in the US—nearly half a million US babies are born too early each year. Babies who survive an early birth often have breathing problems, cerebral palsy, intellectual disabilities, and other lifelong problems. Even babies born just a few weeks early have higher rates of hospitalization and illness than full-term infants, and the costs exceed $26 billion each year. “While our country excels in helping preemies survive, we have failed to do enough to prevent preterm births and help more mothers carry their babies full-term," says Jennifer L. Howse, president of the March of Dimes.
The report also highlights health disparities for newborns in the US. The rate of preterm births for African American mothers is 18 percent; the rate for white mothers is 11 percent.
Worldwide, the new report finds that 15 million babies are born preterm each year, and more than one million die due to preterm complications. Of these babies, the report notes, three-quarters could be saved if current cost-effective interventions were made more widely available. Those interventions, according to Dr. Howse, include:
- Giving all women of childbearing age in the U.S. access to health care, including adolescents, and including care before, between, and during pregnancy
- Behavioral changes to reduce the risk of an early birth, such as not smoking during pregnancy
- Progesterone treatments for women who have had a previous preterm birth
- Better management of fertility treatments that result in multiple births
- Hospital quality improvement initiatives to reduce early inductions and Cesarean deliveries before a full 39 weeks of pregnancy unless medically necessary
“This report underscores the need for action to reduce premature birth in the U.S., and state and territorial health officials have a critical role in championing and implementing proven solutions,” says David L. Lakey, M.D., president of the Association of State and Territorial Health Officials and Commissioner of the Texas Department of State Health Services. “Interventions that promote full term, 39-week pregnancies and improve the health of babies can significantly reduce health care costs.” Reducing preterm births is Dr. Lakey’s Presidential Challenge during his term as ASTHO president.
In February, the Department of Health and Human Services announced “Strong Start," an initiative that includes funding for enhanced prenatal care and hospital quality improvement programs. And the March of Dimes has launched its “Healthy Babies Are Worth the Wait” campaign to let women know that if their pregnancy is healthy, it’s best to wait for labor to begin on its own rather than scheduling a delivery. Elizabeth Mason, MD, director of the Department of Maternal, Newborn, Child and Adolescent Health for the WHO says model practices in other countries that have reduced preterm births include creating medical homes for expectant mothers, reducing hospital infection rates and both prenatal care and care throughout a pregnancy to monitor for concerns.
Christopher Howson, PHD, Vice President for Global Programs at the March of Dimes Birth Defects Foundation, says the current worldwide rate of preterm births could be halved by 2025 if the recommended interventions are carried out. “That is eminently, eminently feasible,” says Howson.
Bonus Reading: For a state-by-state breakdown of preterm birth rates within the U.S., see the March of Dimes 2011 Premature Birth Report Card online at marchofdimes.com/prematurity.
The National Highway Traffic Safety Administration has launched a new website, Parents Central, that will, quite frankly, help save children’s lives. The site offers frequently updated safety information for kids in cars—from the newborn firstborn to the teen homecoming queen—as well as safety guidance for travel of all kinds including bicycling, walking and riding the bus to school.
Last month’s Vital Signs report from the Centers for Disease Control and Prevention provides a critical evidence base for parents, and health care professionals, to book mark and follow Parents Central. The April report showed that child injury death rates dropped nearly 30 percent from 2000 to 2009, with a significant part of that decline coming from a 41 percent drop in motor vehicle crash deaths in children over the past decade. Safety measures that have reduced deaths in car crashes include use of child safety seats and booster seats, and more widespread adoption and the strengthening of graduated driver's licensing systems for teenagers.
While you’re on the Parents Central site, NHTSA resources well worth the look include guidance on choosing and installing car seats, the agency’s new campaign to prevent child heatstroke deaths in cars, and tips for staying safe when transporting kids in multi-passenger vans—especially as summer camps and trips start up.
Bonus Reading: Read about Operation Hang Up, an initiative in New York State this past weekend that had police officers aggressively ticketing drivers on their cell phones.