Archive for June 2012

Monthly Archive

Affordable Care

It’s hard to write about anything else today with news from The Supreme Court: the decision to uphold the Affordable Care Act. As a pediatrician and mom this isn’t about politics for me. It’s about the assurance that pediatric patients (my children included) can get the care they need. And that we work to make care affordable. Below are a few thoughts & quotes that have helped me understand how the decision will affect care for our children in the United States.

First off, more children will have access to health care. Children will maintain insurance for longer periods of time. And children who have congenital and chronic health conditions won’t lose their care. The majority ruling preserves key child health provisions including the law’s protections against pre-existing condition exclusions. Dr Robert Block, President of the American Academy of Pediatrics said:

Since the Affordable Care Act took effect, millions of children with pre-existing conditions gained health care coverage; 14 million children with private insurance received preventive health services with no co-pay; and 3.1 million more young adults gained coverage through their parents’ plans. These are just a few of the law’s investments in child health, with many more set to take effect over the next few years as affirmed by today’s decision. Read full post »

Don’t Be Shy About Food Allergies

Food allergies have more than doubled in the developed, Western World over the last 50 years and the reasons remain unclear. Yet recent data finds 8% of children in the US with a food allergy with 1/3 of those children at risk for severe or life threatening reactions. A Pediatrics study published today has some sobering news about our ability to protect children from allergic ingestions. When it comes to allergies and deadly reactions 2 things are necessary:

  1. Avoidance of known triggers/allergens.
  2. Treatment of anaphylaxis (severe reactions) promptly with epinephrine.

Trouble is, children get exposed to known allergens by mistake and people are often nervous or unsure about how and when to use an Epipen (epinephrine in a pre-measured syringe). All parents/caregivers/teachers/coaches need to practice use of an Epipen & refresh why/when to administer it to an allergic child.

 The Study:

  • Researches followed over 500 infants and young children allergic to milk and eggs (and many to peanuts) between 3 and 15 months of age. During the 3 years of the study, the majority of children (72%) had an exposure to an allergen that caused a significant reaction. Of the allergic reactions, 42% were reactions to milk, 21% to egg, and just under 8% to peanut. Reactions were most severe when a child was exposed to peanut, followed by milk, and then egg.
  • Over 1/2 of the ingestions occurred after a non-parent adult offered an allergic food. Read full post »

Your Friend’s Pool: Drowning Risk

New research shows that there is a 6-fold increased risk for drowning when at the pool of a friend or relative.* Something about being at the home of a friend or relative may change the way we supervise our children. In the Florida study, 79% of patients that were seen in an ER for drowning accidents were at a home pool.

We also know that young children under age 5 drown more in home swimming pools than anywhere else. Anyone can drown in any body of water. But more than anything else I can say, know that children are more vulnerable to drowning due to their size, maturity level, insatiable curiosity, swimming skill level, familiarity with water, and communication skills. Babies and children can drown in any collection of water over 2 inches deep. The Florida research also shows that where we are and who we’re around while swimming may change levels of supervision and distraction.

Plan Ahead When Children Swim in Pools:

  1. Never let anyone swim alone.
  2. When swimming, young children need constant eyes-on, non-distracted supervision. Put down the book, put down the cell phone, and put down the alcohol. As best you can, focus only on your children. There are too many tragic stories of quick phone calls and book chapters that have left children unprotected. If you’re at a party, designate one adult to provide constant supervision.
  3. Know about safety equipment present at the pool, watch for risks from entrapment around drains, pool covers and pool equipment, and have a phone nearby. Call 911 immediately if you’re concerned about a potential drowning accident — seconds matter.
  4. Enroll your children in swimming lessons and update their skills every single year. However, never trust swimming lessons to be protective for drowning. Your supervision is paramount. I’ll post more on this next week.

Drowning injuries and deaths are preventable but often silent and quick. Young children under age 5 drown more than any other group, but nearly 1000 children die annually from drowning.

 Resources on Drowning Prevention

*When I say “drowning victims” in the video, I didn’t mean to imply all those patients in the study died. Of the 100 study subjects with drowning accidents, only 10% had life-ending drowning accidents. Fortunately, 90% of the patients that presented to the ER after a drowning accident survived and had full neurologic recovery.

Father’s Day: Two Wheels Of Their Own

We had a marvelous Father’s Day weekend. On Saturday we started a Dad-coached soccer team with some friends which was surprisingly successful. And then on Sunday, we completed our first-ever family bike ride on the Burke-Gillman trail. Everyone had two wheels of their own, including Grandma. Although O ended up in the ditch at one point after steering off-course, it was an injury-free ride and we proclaimed it a success. I think we all felt really grown up. We gave my husband a mixture of homemade gifts (paintings) and then a trite, expected one (a necktie). We played ball in the yard, pulled weeds from the grass, and Jonathan got a bit of time to himself for a run. When we went out for Italian food and ordered Shirley Temples we formally celebrated the fortune of having a father parenting so actively in our lives. The boys began the day with exclamations and closed it with a final, “Happy Father’s Day” after the lights went out. It was then that I realized it’s prime time for this holiday in our home.

I get that Father’s Day isn’t this Hallmark in everyone’s home and I certainly understand it won’t always be like this. These manufactured holidays bring up thoughts of the tension and distance many of us feel from our own fathers. I also think about my friends and patients who have lost their fathers and those children who are separated from their fathers due to work, military commitments, or unique family circumstances. Last week one of my colleagues pointed out that children had eras in their lives where Father’s Day was on the map; young children adore and celebrate but then retreat as we’d expect during the late school-age years. “They tend to check back in during young adulthood,” he said.

And it got me thinking: is there a way to keep the intimacy of preschool-parenthood alive? Read full post »

Understanding Risks For SIDS

New research helps clarify ways we can reduce risks for Sudden Infant Death Syndrome (SIDS) or Sudden Unexplained Death in infancy. A recent Pediatrics study found that the convergence of risks (see diagram below & listen to video) for infants is meaningful–reducing number of risks may reduce SIDS deaths. Avoiding multiple and simultaneous SIDS risks may help– especially for babies who are vulnerable due to family history, genetics, prematurity or prenatal exposures. Further, research published the same month in The American Journal of Public Health (April 2012) confirms that sleep environment hazards (co-sleeping, soft sleeping surfaces, shared sleep surfaces with people or animals) contribute to SIDS. 70% of infants who died from SIDS were sleeping in a surface not intended for infant sleep (adult bed, couch, chair) and 64% of infants who died were sharing a sleep surface, with half sharing with an adult. We can decrease SIDS risk by controlling our baby’s environment, knowing their vulnerabilities, and sharing what we know. Put babies on their backs without soft bedding (bumpers/pillows/blankets) in their own crib until 1 year of age.

Read full post »

“Stronger,” I Missed You

I was just about to update the blog with a post detailing some new data on reducing SIDS. And then some information on tantrums and some thoughts on storing vaccines safely. And I will, later this week, but my heart is really here:

After a precious, busy day back in clinic today with my patients and staff, I am delighted to tell you that tonight I discovered “Stronger” back up on Youtube where it had been suspended for some time. As it returns to the public sphere, I re-viewed the video twice.

I had absolutely nothing to do with the making of this video, I’m just a faithful fan. The origination of this video stems from some strong patients, some very thoughtful artists, some college students, and a stellar network of families, staff ,and clinicians willing to share a bit of their intimate experience in health care. And their immutable strength.

Watch it again, too.

Some clips from the making of the video (seconds 16 through 44 are particularly endearing).

Here’s Kelly Clarkson’s video response.

Every Illness A Love Story

One magical thing I see while working in health care is the love story. Each and every child who encounters a diagnosis or illness spawns a collection of love stories around them. The stories come spontaneously from parents, siblings, friends, nurses, doctors, community, and peers. It all happens organically and sometimes it happens without notice. Babies cling to their parents when they ache; parents cling to their children when they worry. And the acknowledgement of mortality can stun us into living in the present moment–a miraculous gift. With the onset of an illness or injury, a series of love stories begin in earnest around every child as we all seem to fall in love again.

It may be innate, I think it’s impossible to stop these love stories from unfolding when a child is ill.

A physician colleague once pointed out to me that only two things bring you to the doctor: one, anxiety about an illness (or wanting to prevent one) and two, pain. With children, when either (anxiety or pain) are present, a love story erupts around them. Immediately and passionately, those who care for children and witness their lives will work tirelessly to ease pain and suffering. In it, their love unfolds.

I’ve just realized a love story is always a part of the history of present illness. Here’s why: Read full post »