E-cigarette use is growing among teenagers. Vaping is on the rise among high-school students in particular, with rates increasing steadily each year. I still think of e-cigs as the gateway to the gateway drug. In my experience, teens remain confused. They hear about health benefits (harm reduction) in adults and they may think that confers safety. In addition, some teens have reported to me they have heard it will improve their sports and school performance.
Nope. No data to show e-cigs are good for anything in teens, in fact we know nicotine increases HR and BP which in the end could decrease sport skills. Just a teaspoon of liquid nicotine can be lethal to a young child and we know nicotine can have lasting adverse consequences on teen brain development. Becoming addicted to nicotine (the big worry with teen use) could have secondary health effects leading athletes to cigarettes which we know won’t improve their talent on the field.
Rates of e-cig use rose from 4.7% in 2011 to 10% in 2012, now a recent Pediatrics study of 1900 high-schoolers in Hawaii shows 29% have tried e-cigarettes. Only 15% of the same group reported trying a cigarette. These e-cigs are getting around.
It’s not just use among teenagers that’s cause for concern. Young children living with or near nicotine may be at highest risk from e-cigs due to their curiosity and lagging judgment and ultimate exposure. The first child death related to exposure of liquid nicotine was reported last week. A child in NY has died from exposure to liquid nicotine after officials have been warning of the risks from sales lacking regulation. The risks are being felt everywhere as the rates of calls to poison control rose from 1 report in September of 2010 to 215 calls in February of 2014. This NY death represents an enormous tragedy for this family but also for our ability to prioritize safety over sales. We can’t forget that the flavored nicotine used in e-cigs appeals to many senses in a toddler exploring their environment. Dr Alexander Garrard, Clinical Managing Director of the Washington Poison Center said, “The products smell very sweet, akin to a jolly rancher so they’re enticing to a number of different senses in kids. The packaging is very colorful as well.” All these things draw a child to experiment and possibly ingest.
Protecting children from this toxin, I would say, is a true failure of pediatric public health.
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A Seattle high school recently announced a minor outbreak of whooping cough: 13 students were diagnosed with laboratory-confirmed pertussis. None of the teens are contagious as of today, but it poses an interesting question about protecting our children and communities. A health advocate and friend on twitter suggested a savvy reminder: we can help teenage babysitters get up to date to protect young babies and children. Yes! Is it our parental responsibility to make sure babysitters, nannies or even sweet grandmas are properly vaccinated? Should it be the question we ask before we inquire if they’ve completed CPR training? Perhaps.
It’s hard enough to ask grandparents and friends to vaccinate or “cocoon” to protect our youngest and most vulnerable. It may be a challenge with the neighbor babysitter as well. I’d suggest just saying, “Hey, did you get your 11 year-old shots and your flu vaccine this year?” Thing is, one hurdle may be that your 15 year-old sitter may not know if they’ve had their teen pertussis shot. As a reminder, all children are given immunizations for whooping cough (DTaP) at 2, 4, 6, and 15 months. They then receive another dose at age 4. Then a tween booster dose (the Tdap shot) at age 11 years.
Many children prepare for the big job of babysitting by taking classes. At Children’s our next Better Babysitters class is November 22nd. I’m working to ensure that instructors make sure they help teens determine if they’re up-to-date on immunizations during the course!
- Highly contagious bacterial infection (pertussis) of the nose and throat causes “whooping cough.”
- Easily spread by coughing and sneezing. Symptoms appear 7-10 days after exposure (on average)
- Symptoms differ by age, babies & young children may have severe coughing spells or even pauses in breathing. We worry most about newborns, young infants under 2 months of age but also consider babies under 6 months of age “high-risk.”
- Adults and older children could have fever, runny nose and bad cough that progresses into coughing fits, “whooping” sounds with cough, or even a cough that lasts over 100 days (even if treated). Treatment prevents spread, not the cough.
Is Whooping Cough Serious?
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The 2nd recreational pot store opened in Washington State recently while store #3 opens later this week. Pace will quicken with several more stores expected to open by year-end. This puts parents and pediatricians in our state in a unique situation (shared only with Colorado) as we’re tasked to explain to children and teens the dangers of legalized drugs used by adults. However, the complexity extends even to those of us with young children. Growing concern (and evidence) finds accidental ingestion of pot among children, often in the form of edibles, is also accelerating. Online in social channels I’ve heard some argue that marijuana legalization is to be thought of like alcohol but the packaging and delivery of the drug really are far different.
Marijuana Use By Teens Still Illegal Yet Common
- Nearly half of all teens have tried pot by the time they finish high school while almost 1/4 of all high school students report having used marijuana in the past month. That’s pretty common.
- 35 different marijuana-infused food & beverages have been approved by WSLCB (cookies, trail mix, peanut brittle, gummy bears, and chocolate bars for example). Often the packaging for these products looks as attractive as a fruit roll-up or delicious candy bar typically marketed to children.
- There have been 68 pediatric marijuana exposures voluntarily reported to Washington State poison control already this year. Because reporting isn’t mandatory this is potentially an underestimate of the number of children exposed to marijuana accidentally.
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infographic from OTCsafety
I’ve been lucky enough to interact with teens on a regular basis for my entire career. As a previous middle and junior high school teacher, people often express pity when they hear I taught middle-school, as if teens are “too” tough, histrionic, and irresponsible to have wanted the job. I really did want the job. I love the drama and rate of change during adolescence. In my experience I see teens take on huge responsibility, make good choices, care deeply about their family and friends, and work diligently to improve their world. Their interest and work on evolving into an ideal self is captivating. Most teens are highly motivated. Many are over-extended because they are so committed. Lazy teens just aren’t the norm…
Sometimes teens get a bad rap. Sometimes they make choices without thinking of the consequences too. That’s normal when you’re still developing. Those mistakes pave the road of opportunity for us to give teens information that keeps them safe.
October is a lot of things (more on that this month) but know it’s National Medicine Abuse Awareness Month and there’s a big push to both educate parents on signs of over-the-counter (OTC) medicine abuse and encourage parents to talk with teens about the risks of using medications as recreational drugs.
Thing is, approximately 1 in 25 teens reports abusing excessive amounts of Dextromethorphan (DXM) to get high. DXM is a safe ingredient found in more than 100 OTC medicines. It’s typically found in cough suppressants or medicines for cough and colds. Because it’s a stimulant, when DXM is consumed in excess it can cause a rapid heart beat, vomiting, stomach pain, hallucinations, confusion, and loss of motor control. It also can induce a high — hence why teens experiment with it.
1 in 3 teens know someone who has abused OTC cough medicine to get high. Consider asking at home what your kids know. Read full post »
It’s 2014 and it’s a reality that you can protect a child, teen or young adult from a cancer-causing virus with a series of just three shots. About 79 million Americans are currently infected with Human Papillomavirus (HPV), a virus that can cause warts but also lead to cancer (anogenital and/or throat cancers). Most data find 14 million new people are infected with the virus every year. Most of the time, HPV enters our body and our immune system gets rid of it on its own, however sometimes HPV causes trouble at the cellular level. Fortunately there’s a safe and effective way to stop the spread of HPV, prevent some strains of the virus from ever causing cellular changes in our body and ultimately prevent the related cancers it triggers: the HPV vaccine.
HPV Vaccine Is Safe
The HPV vaccine isn’t really “new” anymore. Between June 2006-March 2014, approximately 67 million doses of HPV vaccines were distributed. The vaccine is made from one protein from the HPV virus, designed to trigger a protective immune response; the vaccine cannot cause HPV infection or cancer. A recent study by Pediatrics found the HPV vaccine to be not only effective, but long-lasting. The study followed vaccinated girls and boys for eight years and showed evidence of durability; the HPV-antibodies remained at high levels over the years after immunization. Read full post »
Over the past decade mounting evidence finds that teens are chronically sleep deprived and subsequently suffering significant health effects. Chronic sleep deprivation is becoming the norm for our high schoolers and is known to cause both mental and physical health challenges. In fact The National Sleep Foundation found that over 85% of high schoolers aren’t getting the 8-10 hours of sleep they need while over 50% of middle school students are already falling behind in their zzzzz’s.
The evidence is in: teens who don’t get enough sleep can have academic challenges, an increase risk for sleepiness-caused car accidents, inattention, risk for overweight, risk for anxiety, greater use of stimulants like caffeine or prescription medications, and mood disorders.
This is a biology thing not a laziness thing. That teenager who can’t get out of bed until 11am on the weekends is just tired and trying to catch up! Puberty changes all sorts of things in our life, one major biologic shift occurs in the brain as children morph into adults. Around the age of 12, instead of naturally falling asleep at 8 o’clock like children in middle childhood, tweens and teens’ sleep cycle shifts about 2 to 3 hours making it a real challenge to fall asleep prior to 10 or 11pm. That means those teens up and awake until 11pm are really just acting their age.
The causes of sleep loss for teens are complex. Early school start times, use of electronics, smartphones, and tablets interfere with sleep as do homework, extra-curricular activities, and sports. But so do misperceptions — the same research that found over 85% of HS students weren’t getting enough sleep also noted that >70% of parents to those tired teens felt their child was getting enough sleep! We have to make sleep a priority in our homes. Read full post »
On Sunday night I left the house for a quick run. It was 9:20pm. It’s been years since I ran in the dark and likely a decade or more since running at night made any sense in my life. As every parent knows, we’re jailed in our houses around 8pm when the kids go to bed — if exercise hadn’t yet happened it gets pushed off until “tomorrow.”
Sunday night the Fitbit was 100% of the driving force behind me putting on my running shoes. I was about 500 steps shy of my 10,000 step goal and couldn’t go to bed, in good faith, that close to success (see image below).
Crazy or perfect? I wear 2 devices now. This month I added a Fitbit to my wrist; I’d already been wearing my Shine for a year or so and had certainly had seem improvements in self-awareness, a better understanding of my sedentary days at work, and the rewards of having daily data about my movement. I exercise a lot more now compared with a year ago. The reasons are multi-factoral of course (turning 40, losing loved ones, craving exercise) but the device has unequivocally helped. Adding the Fitbit to my wrist was designed to help hone an understanding for the level of consistency 2 devices can have (on the same person). The other reason was Fitbit would allow me to “compete” and/or compare daily totals with my husband. This is 40, my friends.
No question that in short order the Fitbit has helped me understand the difference between my movement and my activity, something I’d not really spent time on previously. For example, Sunday was a day of housekeeping. I’d moved around all day doing errands, going to store to buy hangers, cleaning the closet, goofing around with the boys, but I hadn’t been out for a run or bike ride — my first glance my Fitbit was about to give me a false sense of security. I nearly got my goal (in steps) without any real, active “exercise.” Like almost 1/2 of American adults, I hadn’t gotten the 30-60 minutes of moderate-to-vigorous activity (walking briskly, running, cycling, swimming) we all crave and need. All the sudden it dawned on me — it wasn’t just the number of steps I’d had on Sunday that mattered it truly had to be about how I got them. I was 500 steps shy of my goal of 10,000 steps but the Fitbit also told me I’d only had 2 minutes, the whole day, of active time. YIPES! Read full post »
There have been 4 teen drownings around here just in the last week. I’m left with a pit in my stomach that as the sun shines and our region heats up we lose children to preventable injuries at rapid-fire pace. This happens every year; drowning is the 2nd leading cause of injury-related death in childhood (and the #1 cause of injury death in toddlers between age 1 to 4). In general there are two groups of people who drown the most: toddlers and teens. The spaces and places (and circumstances) for typical drownings for those groups are different but the foundation is the same: water, especially cold water, is always lovely on a hot day but always poses unacknowledged dangers.
This really isn’t meant to be a finger-waggy post. This is meant to inform us all with refreshers to the opportunity we all have when living near water with children in our midst. Forward these reminders to anyone you can think of who may benefit. We may never know if we prevent a death but it sure is worth the effort to keep trying…
Drowning Statistics & Risks:
- Drowning is second leading cause of injury-related death in children in our country following motor-vehicle crashes. In general, the risks come from improper attention to the risks of water, improper supervision, and surprise (i.e. the current moves faster than expected, the water is colder, the child toddles into the pool while no one sees in a matter of seconds).
- Toddlers AND teens are the most likely groups of people to drown; risks are higher for boys than for girls. Toddlers drown because of improper supervision, teens tend to drown because of improper awareness of risks. In fact it’s also where you are that matters. Data has found, for example, that you’re at a 6-fold increase risk for drowning when visiting a friend’s home with a pool.
- Cold water, alcohol & drug use (for teens or supervising adults), and distractions increase risk for a drowning or near-drowning event.
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As teens nestle into their deep, unrestricted summer sleep, let’s think clearly about setting them up for success in the upcoming school years. Today there is a pressing need for our attention and our action. An opportunity to improve the lives of teens exists this upcoming week here in Seattle and I suspect, in ways, the outcome will inform the nation. The School Board is revisiting their commitment to do an analysis of feasibility & community engagement in 2015 around start times and will discuss this next week. They’ll vote July 2nd.
Nationally, there is mounting pressure to move school start times later for middle and high-schoolers due to a known health impediment: teens don’t naturally fall asleep until around 10pm and yet need 8 1/2 to 10 hours of sleep for good health. If you do the math and consider a need to eat in the morning and commute, if school starts prior to 8am it’s unlikely teens are set-up to get the rest they need.
The far majority of high schools in the US may make it impossible for teens to get necessary sleep with an average start time prior to 8am. The CDC’s Youth Risk Behavior Survey in 2011 showed that 69% of U.S. high school students get fewer than 8 hours of sleep on school nights, and 40% get 6 or fewer hours.
I touched base with Dr Maida Chen, a sleep expert about why this movement matters so much. “I have to start by saying that it is impossible to place a ‘price’ on the health, safety and achievement of a child,” she told me. She mentioned she’d spent significant time this week documenting the evolving data and cost-effectiveness of moving school start times. She’s written, “Rational start times, which align with students’ fundamental sleep needs, are a cost-effective and scientifically robust approach to improve equity, opportunity gap, and academic achievement on a large-scale with the greatest positive impact on students at the most disadvantage.” Translation: this makes sense and will affect a large amount of teens.
We should always be driven to do what is best for the child, and not what is convenient for society. And ultimately, there’s no money that will take back the life of a child who has died in a sleepy driver related accident – a known consequence of early start times ~Dr Maida Chen
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OMG, it’s a good day for Washington. Yesterday Governor Jay Inslee signed Bill 6065 into law. Bill 6065 bans the use of tanning beds for minors in Washington State. The bill will prohibit those under age 18 the right to use an indoor tanning device. Those facilities that break the law — they’ll be fined up to $250 per violation starting in mid-June. Children and teens with a doctor’s prescription can use the tanning bed (this will happen VERY rarely). If I were able to pass for a teen (let’s be honest, that was gone years ago) I’d sign up immediately for the undercover work. I’m that fired up in ensuring this law works…
For data & numbers (if you’re looking for that) on indoor tanning risks read: Clear And Present Danger: Indoor Tanning
I’m emotional about this as a survivor of malignant melanoma. That’s why I cried when I read this news. I cry because I’m excited and overwhelmed about the hope for turning the tide on rising melanoma diagnoses in children, teens, and young women and I cry because I am also reminded by the stories of loss. I never thought my career in medicine would connect me with politics. It’s moments like this that I’m so glad our public health officials and politicians work hard. Legislation helps and does improve the chances of success for us living into old age.
I see this as a big win for public health, but also feel this as a big win for me as a mom. I really do want to survive to see my kids grow old. Just this week I had to catch my breath while reading about the death of movie star James Rebhorn. Once you’ve had cancer this happens all the time. You’re reading something seemingly innocuously and then you stumble. “Holy moly,” you think, “sorry to hear that guy died.” Then you read how he died (melanoma) and the huge lump comes into your throat. “That could’ve been me.” So many unexpected reminders of the fortune to be alive after having a skin cancer diagnosis. Read full post »