‘prevention’

All Articles tagged ‘prevention’

Fitbit Motivation, From Anecdote To Evidence

I wear both a FitBit and Shine Health Tracking Device on my wristOn 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.

Seattle Mama Doc Tweet

before and after runNo 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 »

It’s Hot Out But The Water Is Still Cold

igram lifejacket jumpThere 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.

Read full post »

CT Scans And Cancer Risk

T8--approx CT scan” Yesterday’s news,” my husband said when I shared a study published, well, yesterday. Yet what we do with yesterday’s information is of course the news today. A JAMA Pediatrics article found that the use of pediatric CT scans rose in the late 1990′s and early 2000′s. Further, research shows that these CT scans can increase risk for future cancer diagnoses. Authors calculated the risk: they estimate that for every 4 million pediatric CT scans preformed annually, some 4800 children will go on to develop cancer as a result. Like many studies published this decade, the study came with warnings for radiologists, pediatricians, and parents.  I have tips for parents and doctors included below.

CT scans use radiation and radiation exposure is linked to cancer.

That being said, CT scans also save lives and we’re learning to use them more judiciously. Since 2007, rates of CT scans in children are declining. Don’t let these risks and media reports today cause you refuse or forego diagnostic CT scans your children need. We just have to be strong advocates and smarter about how we use CT scans. Read full post »

Value Of Well Baby Check-Ups


Some new data published in the American Journal of Managed Care finds increased value in preventative well baby and toddler check-ups. Not because it keeps pediatricians busy, but really because it potentially can save suffering and hospitalizations for young children that would otherwise hopefully not occur.

A study published this month evaluated over 20,000 babies and toddlers in the Group Health network. They reviewed medical charts to study both rates of hospitalizations and rates that families showed up for their well baby check-ups. They specifically evaluated rates of hospitalizations for what they call, “ambulatory-care sensitive hospitalizations,” in which access to routine care could potentially avoid an illness developing that would require a child to be admitted to the hospital for treatment. Here’s more and how you can find low cost medical or dental clinics for yourself or your child and get help applying for health insurance:

Read full post »

Salmonella From Food, Frogs, And Fido

African dwarf frog fr CDCSalmonella infections affect children more frequently and more severely than adults. Although most salmonella infections arise from contaminated or undercooked food (chicken, eggs, beef, and dairy typically), reptiles, pet foods and now amphibians are an important source of infection to keep in mind for our children.

Today, a new study published in Pediatrics links Salmonella infections to pet frogs here in the US. This is the first study to detail amphibians as an important source of Salmonella infections. 8 tips for preventing Salmonella are at the end of this post.

New research tracked an outbreak of a particular strain of Salmonella between 2008 and 2011. In 44 states, researchers identified 376 cases of Salmonella in children and adults with an average age of 5 years. Over 2/3 (69%) of the cases were in children under age 10. The source of these salmonella bacteria was tracked to a breeding facility that shipped an aquatic frog, the African dwarf frog, to pet stores and people around the country. Although the African dwarf frogs are not always handled, many people were presumably infected from touching the frog’s contaminated water bowl or may have been infected when aquariums and equipment were cleaned in sinks also used for food preparation.
The study uncovered an important truth:

Few patients and families were aware that Salmonella could be spread from reptiles and amphibians.

Even when we parents are aware, some children still get infected. It’s essential that children who handle reptiles and amphibians always wash their hands after playing with the pets or help clean or care for their aquariums. This data hits close to home as my son had Salmonella gastroenteritis when he was just 4 months of age after a trip to Central America. Read full post »

Can Soda Companies Help Fight Obesity?

Screen Shot 2013-01-28 at 10.38.06 AMI’m curious what you think. Do you think companies that make, sell, and market soda can improve the challenges we face with obesity? I’m asking sincerely. I was struck by the Coca-Cola ad (below) recently released. I’m a pediatrician and I’ve never worked for a beverage company or any company that sells products to children. I don’t like that these companies market salty, fatty, sugary products to children. As a pediatrician, I would suggest I’m very biased. The food industry spends $15 BILLION marketing and advertising to children every year. Food advertising, directly to children, is known to increase rates of obesity. Even familiarity with fast-food ads has been found to be problematic. As parents, this isn’t hard to believe; I’ve seen my boys introduced to a product on TV and then ask for it at the grocery store. Because of my bias, I’m asking you—do you think companies like Coca-Cola and Pepsi can help?

As the obesity problem persists, strategies have turned to protocols and regulation. Today, the American Academy of Pediatrics (AAP) released it’s first policy on managing weight-related diabetes. And in the past few years, the American Heart Association released a statement asking for increased regulation on advertising high-calorie, low nutrient-dense (“junk”) foods to children. In 2006, The Institutes of Medicine (IOM) said, “Food marketing intentionally targets children who are too young to distinguish advertising from truth and induces them to eat high-calorie, low-nutrient (but highly profitable) “junk” foods; companies succeed so well in this effort that business-as-usual cannot be allowed to continue.”  Similar sentiments are shared by the American Psychological Association, the Center for Science in the Public Interest (CSPI), Children Now, the American Medical Association, and the American Academy of Pediatrics. The public, too. Last fall, the majority (67%) of international readers polled in The New England Journal of Medicine believed we should regulate sugary-beverage consumption. This on the heels of New York’s regulation banning sale of large sugary drinks. This isn’t just about a tax. Can these companies help? Read full post »

Have You Been In To See Dr. Google?

Screen Shot 2013-01-15 at 9.45.29 AMFor practicing physicians, there’s a tricky balance in believing that the internet can help save lives.

I’m a doctor who encourages families to look up health info online and one who believes technology will afford improved partnerships. Yet, when we’re in the old-fashioned exam room, there isn’t always a place for the internet. Many clinics block video-streaming sites and don’t allow for traditional email exchanges between clinicians and patients. It’s hard to “send” patients information discussed during the visit. In the 10 or 20 minutes we have together, time is precious. Truth be told, health care remains wary of doctors and patients communicating when they’re not in exam room. Most insurers won’t reimburse or pay for electronic communication between patients and their clinicians. So doctors are often forced to bring you into the office to provide expertise. New data today may help change this paradigm. Reality is, many of us are using the internet as a tool for health care.

For at least 1/3 of American adults, the internet is a diagnostic tool

Yet, it’s not just insurers who may be wary of online info. Recently I read a patient review (online) from a parent who was frustrated I’d encouraged them to read the content on this blog. The comment implied that perhaps I was “pushing it.” And that’s the tricky part–when I first started writing this blog I was bashful to mention it in clinic. I wanted patients to feel comfortable NOT pressured. But now that I have over 350 blog posts showcasing research and pediatric health information it’s tantamount that I share it.  I mean, if I’m in the midst of a 15-minute visit and we touch on topics like getting a carbon monoxide monitor, the choking game, the Tdap shot, and the effects of TV on their kid’s developing brain, how could I not augment a parent or teens’ understanding by offering more information online?

Numerous studies find that what parents learn in the exam room with doctors isn’t retained. That’s where Dr Google comes in. Read full post »

You Need A Carbon Monoxide Alarm

There’s a new law today in Washington State requiring carbon monoxide (CO) alarms in apartments, condos, and single-family residences. You should have a CO detector on every level of your home (more tips below). I know you’ve heard that CO poisoning is not only dangerous but also potentially fatal. We also often hear horrific stories of accidental deaths from carbon monoxide after natural disasters. A recent study found disaster related deaths are particularly common (your power’s wiped out so you bring in a generator or grill for heating or cooking and get exposed to CO). Using a generator indoors is the most common cause of CO poisoning, followed by use of a grill. Unfortunately, over 400 people die in the US each year from CO poisoning—all of which could be avoided with proper education and detection in the home. The odd thing is that we often get to see CO toxicity play out on our favorite television shows (think Mad Men)~ the ever-again scene where someone clogs up the exhaust pipe of a car with a banana or handkerchief and dies (or attempts to) due to the toxic fumes.

One generator running inside a home, garage, or basement creates the equivalent carbon monoxide of 6 idling cars. Precisely why a generator needs to be 20 feet from inside spaces and away from open windows/doors. Carbon monoxide is found in combustion fumes–it can be produced by cars and trucks, small gasoline engines, stoves, lanterns, burning charcoal and wood, gas ranges, and heating systems. You likely know all this. But…

The thing to know: carbon monoxide in and of itself is more dangerous to babies and young children. Infants in utero, newborns, and young children process carbon monoxide differently, have more severe reactions, and may see effects faster than adults. If you and your young child were in a room that was filling with carbon monoxide, it’s your baby or child that would suffer the consequences first. They may not know how to tell you about their complaints and if they were sleeping you may not even know. Hence all of us needing a CO detector.

carbon monoxide teaching fr CDC

The Science of Carbon Monoxide Poisoning:

The red blood cells in our blood circulate oxygen to all of our muscles and organs for survival. When carbon monoxide (CO) is in the air it can function as a disguised villain. When carbon monoxide is inhaled into the lungs via contaminated air, the red blood cell picks up the CO instead of just oxygen. Each carbon monoxide molecule that attaches to a red blood cell displaces a spot for oxygen. Therefore the circulating red blood cells go around the body without oxygen causing improper circulation. Organ failure and death can result after higher and higher level of our cells are bound to CO instead of oxygen.

The graphic is from the Centers For Disease Control (CDC)’s comprehensive review on CO poisoning.

Read full post »

Eye Candy: PODS And Capsules

Laundry and dishwashing capsules & “PODS” are all the rage. Frankly, I love them. They’re less messy, take up far less space in the cabinet, and enticing to use. Throw them in the washer without a single errant drop. They’re pretty to look at, too.

That’s the trouble though.

These PODS and capsules look more like Halloween candy than laundry detergent. But this soap [eye candy] poses a unique and dangerous risk. The film that forms the capsule is designed to dissolve quickly. Toddlers are at risk, as small children explore with their mouths not only their hands. Toddlers and preschoolers may be both drawn to the visual appeal of these concentrated capsules and to their balloon-like texture and squishy feel. I wrote (did a video) about this earlier, when WA State issued a warning to all ER doctors.

Concerns for ingestions are continuing here (nearly 3000 injuries were reported in US children between January and August, 2012) and around the world. Highly concentrated laundry detergent can erode tissues, cause swelling, and cause burns to the mouth, throat, airway, and eyes of children who touch, break open or ingest them. The majority of injuries from PODS and capsules have been due to ingestion, but there are reports of many eye injuries as well.

Curiosity rules a toddler’s exploration. Judgment lags way behind.

New information released last week in the UK helps categorize the concerns. The National Poison Information Center shared a brief where they detailed that capsules and PODS were the most commonly reported ingestions in young children over a 14-month period. A group of physicians at The Royal Hospital For Sick Children in Glasgow also authored an academic letter detailing their concerns, reporting on 5 children who had been admitted and cared for in the hospital after ingesting (eating) the PODS/capsules. Their letter highlighted:

Ingestion Injury From Detergent PODS & Capsules:

  • 5 children, between 10 and 22 months of age, were admitted to the hospital with serious injuries.
  • Injuries for the 5 children included serious swelling and damage to the throat and airway (arytenoids, glottis, supraglottis, esophagus, gastro-esophageal junction). Children demanding hospitalization varied in the care needed. One was managed with steroids and antibiotics alone, while the other 4 children demanded intensive care. Four of the 5 children needed breathing tubes, 2 of whom were on the ventilator for a week.
  • Fortunately, all children recovered from their ingestions.

Protecting Children From Detergent PODS/Capsules:

  • Young children are ruled by curiosity. Make sure that capsules and PODS are up and out of reach.
  • Don’t display them due to their visual appeal.
  • Don’t allow young children to help use the laundry or dishwashing capsules. Becoming familiar will likely cause them to want to touch, explore, and possibly gnaw on these capsules.
  • Until containers selling these products have a child safety lock/top, inform your friends and caregivers about the risk to young children.
  • With any ingestion, no matter what the size, call poison control immediately 1-800-222-1222.
  • Read more about it (including my interview) at US News & World Report or here at WebMD.
  • Print out this Poison Control fact sheet for your daycare or pediatricians’ office.

 

First Day Of School: 6 Tips For Sleep

We know children are sleeping less now than they did 30 years ago. Research studies are piling up that assimilate the ill effects of our lack of shut-eye. When children don’t get the sleep they need they suffer. And not only in the ways we may expect. Sure, they are grumpy and irritable but research also shows children who create a sleep debt also have a more difficult time completing school work, they don’t score as well on tests, they may be more distractible while having difficulty maintaining attention, and they may be at higher risk for having an unhealthy weight. Further, tired teens who are on the road driving in the early morning are at more risk for motor vehicle accidents. Data shows that more than 1/2 of all early morning accidents attributed to drowsiness occurred in drivers between 16 and 25 years of age.

Teens are potentially at the greatest risk for drowsiness because they tend to naturally fall asleep later and school start times get shifted earlier and earlier. Here in the Seattle area, many schools start at 7:30 am (school bell times). And multiple students in clinic this past week have shared with me that they are attending extra classes during “zero period” that begins at 6:30am! That means, many teens are responding to a 5:00am alarm clock. If these teens aren’t to bed until near-midnight, come October they are going be exhausted.

Typical Sleep Needs For Children And Teens

  • Preschoolers: 10-12 hours of total sleep (night time sleep + naps). Most children naturally get tired and ready for bed between 7pm and 9pm at night. Most 4 year-old phase out their nap prior to turning 5.
  • School-age children: 10-11 hours total sleep. Most children get to bed around 8pmbut as they near age 12, they may naturally “phase shift” later into the night. That means as they age and go through puberty, many tweens aren’t really tired until around 9pm or 10pm.  Puberty brings on changes to their sleep cycle and thus shifts them later.
  • 12 year-old to teens: 8 1/2-9 1/2 hours total sleep. Most teens aren’t tired until 9pm or later. To get the amount of sleep they need, you really have to help them prioritize bedtime. Between the lure of Facebook, the average of >100 text messages sent daily (!), and the academic demands of school, coupled with extra-curricular activities,  it can be tough. Learning to value sleep is life skill. If you’re having trouble getting these hours in, you’ll see your teen catch up on sleep during the weekend. This is sleep debt. They can fill the bank and replenish the sleep debt by sleeping in on weekends, but it’s imperfect. Allow them to sleep in, but help them also keep the same bedtime Friday and Saturday as best they can.

6 Tips To Help Your Child Prioritize Sleep For School

  1. Work to design and agree upon (as a family) a reasonable bed time for your child or teen. Eight o’clock for school age children and 9:30pm-10pm for teens may be most reasonable. Read full post »