Archive for the ‘American Academy of Pediatrics’ Category

Autism and Wandering – a constant struggle

Wednesday, August 3rd, 2011

I have written before in this space about special needs children, including children with autism. This week I want to turn my attention to one aspect of autism – wandering – and some of the ways parents and schools are trying to keep kids safe. Wandering is something I really had not heard of before, but I’ve since learned that it is a serious danger to children with autism or other cognitive deficits. It is also a major source of stress to parents who are constantly worried about their child wandering off.

All children have a tendency to wander away from their parents at times. When my daughter was two, I lost her at Sports Authority. I thought she was standing right next to me while I was looking at something, then I looked down and she was gone. After a few frantic minutes – and with the quick help of the store employees – we found her all the way on the opposite side of the store looking at balls. She was perfectly fine, but it was terrifying for me.

For reasons that are not well understood, children with Autism Spectrum Disorder (ASD) tend to wander more than non-autistic children. As reported by the Child Mind Institute and others, a recent study by the Interactive Autism Network has finally tried to quantify what has traditionally been more anecdotal evidence about wandering.

According to the responses from more than 800 parents, roughly 50 percent of children between the ages of 4 and 10 with an ASD wander at some point, four times more than their unaffected siblings. The behavior peaks at 4, almost four times higher than their unaffected siblings, but almost 30 percent of kids with an ASD between the ages of 7 and 10 are still eloping, eight times more than their unaffected brothers and sisters.

Autistic children seem to wander for two basic reasons. One is to find something they like, such as their favorite pond or playground; and one is to get away from something they don’t like such as a stressful school environment. It’s not really running away, at least as that term is usually used to describe a child who decides to leave home because of some real or perceived injustice at home. A majority of parents in the study described their child as happy and focused when they wandered off. It is usually a matter of the child being drawn to something that he or she likes. One child referenced in the Child Mind story had a fascination with exit signs. One day at school, the boy wandered off through the woods toward the highway to find his favorite exit sign. Thankfully, a good Samaritan picked-up the boy and returned him to where he belonged.

The danger for children is very real. While concrete statistics are difficult to come by, drowning seems to be the biggest danger (there are some who believe that autistic children are drawn to water). Children can also wander into traffic. Of course, when any small child wanders alone there is the risk of getting lost or being abducted. To further complicate matters, thirty-five percent of families in the study reported that their child is never or rarely able to communicate basic identifying information such as name, address and phone number. This obviously makes it harder for a wandering child to get back home. Even older or more high-functioning children may – due to their social anxiety – be reluctant to seek out help or cooperate with someone who is trying to intervene.

Wandering represents a challenge to schools because it can be very difficult to monitor a child all day long, especially during class changes and recess. The problem, however, also occurs at home. Wandering occurs not just during the day; night-time wandering is an especially big fear for parents of autistic children. Some children have been known to get up in the middle of the night, undo the deadbolt on the front door, and walk-off into the night. The terror of finding your child gone in the middle of the night is unimaginable. Some parents have installed deadbolts higher up on the doors, some have installed alarms that go off if the door is opened. Some parents have gone so far as to have their children wear tracking devices that send out a signal that can be pin-pointed. While all of these techniques can help, there are no sure-fire methods of preventing wandering. It is a constant worry for parents.

The autism community has taken action by getting the Center for Disease Control’s safety subcommittee to assign a specific medical code for wandering, which will be in conjunction with the diagnosis of ASD. By doing this, it is hoped that doctors will more readily recognize wandering as a legitimate diagnosis that they can address with the parents or other caregivers (the new code applies to adults with ASD as well). The American Academy of Pediatrics is also preparing a fact sheet to educate doctors on the topic so that they can better work with parents to try to reduce the incidence of wandering. The new code may also make it easier for parents to seek reimbursement from their insurance companies for alarms and tracking devices, and it may make it easier for parents to argue to their schools that a one-on-one monitor is needed as part of the child’s Individualized Education Plan (IEP). The new code takes effect in October 2011.

Lori McIlwain, Chairwoman of the National Autism Association, recently discussed how to deal with wandering:

The best overall strategy is a multi-tiered approach, which includes educating the child about safety and dangers using whatever means of communication works, including social stories, language and/or visual prompts. It’s also important that caregivers—and schools—work to understand what is causing, or contributing to, the wandering or bolting behaviors so that any triggers may be addressed or eliminated.

Have any of our readers had any experience with wandering? I’d like to hear your stories as to how you deal with it and how it affects your life.

Related Nash and Associates Links:

Dogs a Huge Help to Special Needs Kids

The Daily Struggle of Raising a Disabled Child

Many Parents Still Believe Vaccines Cause Autism

 

 

Photo courtesy of: Issueswithautism.com

Newest Word on Crib Safety: Ban the Bumpers?

Tuesday, June 14th, 2011

Which crib bedding would you choose? Aesthetic or safe?

In the newest topic regarding crib safety, Maryland is considering regulations to ban the sale of crib bumpers. For many years, more and more emphasis has been placed on infants sleeping in safe cribs without any additional “stuff” in them. This has included the elimination of lots of former nursery staples. Baby blankets, stuffed animals, pillows and other loose items have been banned from the crib by safety experts for years. As requirements for cribs have required slats that are closer together, the utility of using a bumper to help a child from getting stuck between crib slats has been eliminated. More recently, the Consumer Product Safety Commission has developed even newer crib safety standards, including eliminating the use of drop-sides, and warned against the use of sleep positioners. Yet, despite the advice to put babies to sleep only on their backs in cribs empty of everything except a well fitting mattress and fitted sheet, many parents and caregivers persist in using other items in cribs. Now, with an increasing number of deaths associated with crib bumpers, Maryland is considering a stronger stance.

Danger of Crib Bumpers

The concern about crib bumpers is that there have been infant deaths associated with suffocation or strangulation and the use of crib bumpers. Some of the deaths are directly attributable to the bumpers (for instance a child found with their head wrapped in the ties of the bumper or their face pressed into the side of the bumper), while others are only potentially related to the bumper use but not definitively so (for instance, children whose death are classified as SIDS, but where bumpers were in use in the crib at the time of death and may have been a contributing factor in the death). This makes the discussion of the dangers muddy – with manufacturers claiming that bumpers are safe and advocates warning against their use to protect against suffocation.

Potential Ban on Sale of Bumpers

When the Baltimore Sun reported on the potential regulations, they mentioned something that gave me pause. They explained that if Dr. Sharfstein, secretary of the state Department of Health and Mental Hygiene, does decide to regulate this issue, the regulations will impact only the sale, not the use of the bumpers. While this makes sense from a policy perspective, the goal is not to punish parents who may not be aware of the safety risks, and from a enforceability perspective, the state cannot possibly enforce a regulation that requires knowledge of whether bumpers are being used in individual homes, the regulation of the sale of the item is going to have some drawbacks.

Will a State Ban Save Lives?

So here are my questions. Will regulations against the sale of these bumpers in Maryland make any difference in saving lives? In this day of internet shopping and wide availability of items through catalogues and easy interstate travel, are Maryland families going to forgo the crib bumper because they cannot be purchased in the local baby store, or are they still going to be buying the bumper with a set of nursery items on Amazon or through a national baby store? Will Internet or national companies without a store presence in Maryland be punished for selling a bumper to a person with a Maryland address? If so, then perhaps the word will get out that these items are dangerous and should not be used. If not, will parents even realize that the goal of the regulation is actually to curb the use of the bumpers. Either way, I guess that by decreasing the number of bumpers in Maryland homes, safety will be increased and perhaps over time, awareness will be increased and other states may follow suit.

Getting the Word Out

My other concern is that if there are parents who are still using bumpers, blankets or other items in their babies’ cribs, is the issue one of parent education? Perhaps the real emphasis needs to be on wider parental awareness of the safety issue. There are lots of great resources available to learn how to put infants to sleep safely:

httpv://www.youtube.com/watch?v=VNekf5P9_Yg&feature=youtu.be

Since the early 1990s, the emphasis has been on having infants sleep on their backs. This has lead to a dramatic decrease in SIDS deaths since that time. The “Back to Sleep” campaign began in 1994 and continues to this day.  However, when reading a 2005 paper from the AAP, I was surprised to read that SIDS deaths are more likely to occur when a baby who is used to sleeping on their back is placed to sleep on their stomach. This suggests that education needs to be of all potential caregivers since an occasional babysitter, grandparent or child care provider who is unfamiliar with the recommendations and the child’s normal sleep position may place the child to sleep on their stomach and cause real risk.

AAP has made many recommendations since 2005 including that children sleep in cribs with only a fitted sheet and without any additional soft bedding. These recommendations have varied somewhat over time on the use of bumpers and sleep positioners. However, the overall advice seems to remain the same – eliminate all soft bedding items. Despite these recommendations, there are still images in popular media of nurseries complete with cribs with soft bedding.

What changes are still needed?

What changes are needed to get the word out? Do you think that there needs to be a stronger effort to change the marketing images for infant products? Do you think that a ban on the sale of bumpers will have a significant impact on child safety? What about an education campaign focusing on caregivers, grandparents and day care providers?

Related Posts:

Over Two Million Cribs Recalled…What About Yours?

Infant Safety – drop-down crib hazard; CPSC issues recall

Generation 2 Worldwide and “ChildESIGNS” Drop Side Crib Brands Recalled; Three Infant Deaths Reported

Consumer Product Safety Commission vows to crack down on defective cribs – washingtonpost.com

 

Images from: sidscenter.org, potterybarnkids.com

What is a “medical home”? Do your children have one?

Thursday, April 14th, 2011

Image from www.hi-consulting.net

What is a “medical home”? Do you feel like you or your children have a medical home? Is it one that feels comfortable and accessible and all of the things the term “home” implies?

A couple of years ago, I was involved in some policy work surrounding the idea of the medical home and how to better ensure that children in Baltimore City had a medical home. When I first became involved in this project, I thought I understood the concept of a medical home, but I could not really define it. Working with a group of professionals from medical, public health and policy backgrounds, we spent several months furthering our understanding of what is a “medical home” before we could determine how to measure if children had adequate medical homes.

Today, I am not going to delve into that kind of detail about this topic. However, I thought it might be interesting to think about the concept of a medical home and some of the benefits and potential challenges this poses for families.  In this post, I’ll provide some definitions of “medical home” and provide some information about how many children are receiving care in a medical home.  I’ll address this topic in a future post about alternative health care locations.

I think that the idea of a medical home speaks to an often forgotten concept in providing the best health care with the fewest mistakes – consistency of care from a committed health care provider. The National Center for Medical Home Implementation, which is “a cooperative agreement between the Maternal and Child Health Bureau (MCHB) and the American Academy of Pediatrics (AAP)”, has a website full of information about the medical home. Their definition of medical home is:

A family-centered medical home is not a building, house, hospital, or home healthcare service, but rather an approach to providing comprehensive primary care.

I think that this is a great overview of the concept. The definition continues:

In a family-centered medical home the pediatric care team works in partnership with a child and a child’s family to assure that all of the medical and non-medical needs of the patient are met.

Through this partnership the pediatric care team can help the family/patient access, coordinate, and understand specialty care, educational services, out-of-home care, family support, and other public and private community services that are important for the overall health of the child and family.

The American Academy of Pediatrics (AAP) developed the medical home model for delivering primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective to all children and youth, including those with special health care needs.

I think that we all hope that our health care is provided in a comprehensive way such as is described by this definition. However, too often, we all know that medical care is provided in a more complex web of services in which the patient or patient’s family is left to coordinate care. This reality is even more vivid for those families who are uninsured or under-insured and are not able to receive all of their care from a primary care provider who is able to best coordinate their care.

An article in Bloomberg Business Week reports that a new study found that “Children who have a “medical home” – that is, a pediatrician or nurse they see regularly who offers comprehensive care — are more likely to have their medical and dental needs met…” However, the article goes on to say that children “…who have a chronic condition or special need and require the most care” are the least likely to have a medical home. The article states that only 57% of children in this country “…received care in medical homes in 2007…”  The study also found that:

Younger children were more likely to have a medical home than older children.

There were racial and ethnic disparities as well: White children were the most likely to have a medical home, while Hispanic children were the least likely, followed closely by black children.

Mothers without a high school education were significantly less likely to report their children had a medical home, as were the poor, non-English speaking families and the uninsured.

About 61 percent of children whose parents said they were in excellent or very good health had a medical home, compared to 35 percent of kids in fair or poor health.

These children, who are most likely to need a medical home, are the least likely to have one. This is despite research, and common sense, showing that medical homes are able to provide better health care at lower cost. The Bloomberg article says that  “[c]hildren without a medical home were three to four times more likely to have an unmet medical or dental need, according to the study, published online March 14 in the journal Pediatrics.”  Additionally, “[c]hildren who received care in medical homes were also more likely to have annual preventive medical visits, the study found.”

As I was reading these statistics, I was imagining the children without a medical home as children who often used clinics or emergency rooms for their health care. However, the Bloomberg article says that the study found that

…nearly all children — 93 percent — had a usual source of care, and about the same number had a personal physician or nurse. About 82 percent of parents said they had few problems obtaining referrals, 69 percent said they received help with coordinating care when needed and 67 percent said they received family-centered care.

But only 57 percent of parents reported that the health care their children received met all of those criteria — the definition of a medical home.

It is the comprehensive care provided by all of the elements of the medical home that create the best results in terms of patient care and cost savings. It is this combination that is lacking in many providers of pediatric care.

Do the members of your family receive their care in a medical home? Could you answer yes to all of the questions above defining a medical home? Is this important to you? What would make it easier for you to receive this kind of care for yourself or your child?

 

4 Tips for Car Seat Safety

Wednesday, March 30th, 2011

Image from www.baby-safety-concerns.com

Most parents now know that car seats are essential for young children riding in cars. In today’s post, I am going to provide some updated information and lesser-known tips that might help keep your kids safer in their car seats. Does all of this matter? I think so. A recent article on healthychildren.org says that deaths in motor vehicle crashes are still the leading cause of death for young children:

While the rate of deaths in motor vehicle crashes in children under age 16 has decreased substantially – dropping 45 percent between 1997 and 2009 – it is still the leading cause of death for children ages 4 and older. Counting children and teens up to age 21, there are more than 5,000 deaths each year. Fatalities are just the tip of the iceberg; for every fatality, roughly 18 children are hospitalized and more than 400 are injured seriously enough to require medical treatment.

So how can you keep your children safer?

1. Keep Children Rear-Facing As Long As Possible

Parents often switch their toddlers into forward facing seats on or around their first birthdays. For many years, the AAP and others have recommended that children remain rear facing until they were at least 1 year old and 22 pounds. Many parents and caregivers thought that this meant that this was the appropriate age and weight to turn children around. I know plenty of parents who were elated to turn their children’s car seats around so that their kids could “see something” or so that their legs would not be cramped. Unfortunately, this is just not safe.

The new AAP recommendations, released last week, are grounded in safety research and the advice that many car seat advocates have emphasized for years. These recommendations call for children to remain rear facing as long as possible – at least until they are two years old and often beyond. A recent New York Times article explains that a 2007 study from the University of Virginia found “…that children under 2 are 75 percent less likely to suffer severe or fatal injuries in a crash if they are facing the rear.” That is a pretty compelling statistic.

I am excited about this new recommendation because I hope that it will encourage parents to consider keeping their children rear facing for much longer. I have kept both of my children rear facing far beyond their first birthdays.  In fact, my two year old is still happily rear facing. We have a car seat that allows rear facing until 45 pounds and my daughter is only about 23 pounds now. I doubt that she will stay rear facing until she is 45 pounds, but she will certainly stay that way for as long as possible.

My decisions were based on both safety and selfish reasons. First, the selfish reason: my first child was a kid who would sometimes fall asleep in the car on long trips. I realized that once we faced him forward his head would hang uncomfortably if he fell asleep and he would be much less likely to rest comfortably then rear facing when he was reclined enough to slumber with full support to his head and neck. Second, the safety reason is that we have relied on the assistance and expertise of Debbi Baer when installing our car seats for several years. Ms. Baer, “a labor and delivery nurse in Baltimore who has been a car safety advocate for children for more than 30 years,” is quoted extensively in the New York Times article (http://www.nytimes.com/2011/03/22/health/policy/22carseat.html), along with her daughter “Dr. Alisa Baer, a pediatrician at Morgan Stanley Children’s Hospital in New York.” Dr. Baer told the Times “she felt so strongly that if a parent wants to install a forward-facing seat for a child younger than 2, “I tell them, ‘If you really want to make a stupid decision for your child, you can do it, but I’m not going to help you.’ ”” Her mother’s attitude seems from our experience to be the same!

2. Don’t Rush Any of the Transitions – Car Seat to Booster to Seatbelt

In the The New York Times article , the AAP policy’s lead author says

“Our recommendations are meant to help parents move away from gospel-held notions that are based on a child’s age,” Dr. Durbin said. “We want them to recognize that with each transition they make, from rear-facing to forward-facing, to booster seats, there is a decline in the safety of their child. That’s why we are urging parents to delay these transitions for as long as possible.”

Therefore the same prudence should apply in making the transition from car seat to booster and ultimately to a regular seat.

The National Highway Traffic Safety Administration has created a nice flyer about the new recommendations.

The advice seems to boil down to a few key elements.

  • Keep kids rear facing as long as allowed by the seat.
  • Forward facing children should be in a 5-point harness as long as the seat allows
  • Only transition to a belt-positioning booster when children have outgrown the car seat with a harness
  • Keep kids in a belt-positioning booster until they are at least 4 feet 9 inches tall and 8-12 years old

3. Skip the Coats – Cover Kids Instead

Winter weather creates another potential danger about which many parents are unaware.  One of the keys to car seat safety is having straps that fit snuggly on the child. If kids are dressed in bulky winter clothing – particularly puffy type coats – those clothes can compress in an accident and leave the straps too loose for kids to be safety secured. To counter this dangerous possibility, most car seat experts recommend that parents always remove winter coats before strapping their children into a car seat. Instead, they recommend placing a coat or a blanket on top of the child after the child is safely and snuggly secured in the car seat. This way, the child stays warm without having any risk of the straps being too loose. If this seems to be a hassle, there is a whole group of both small and commercial companies and individuals out there who make poncho type coats that can be pulled up for the child to be strapped in safely. It is also a good idea to be in the habit of checking the snugness of the straps every time you strap your child.  For more details about winter coats in cars, check out this article.

4. Check the Installation!

All of the suggestions above are critical for safety, but none more so than making sure that your car seat is installed properly in the first place. If the car seat is not installed safely, having the child in the correct seat and having the child buckled properly will not be of nearly as much help. It is a commonly quoted statistic that 70% or more of children are not properly restrained. The good news is that help is available. At seatcheck.org you can find a listing of places near to you where you can get free or low cost assistance in properly installing your car seat. These experts can also check to make sure that the seats you have already installed are installed properly.

You may also want to watch this video from Dr. Alisa Baer, “the Car Seat Lady” -

httpv://www.youtube.com/watch?v=ULJ8Vx79Vv4&feature=player_embedded

Do you have other safety tips for car seats?  If so, share them with the rest of us!

Study Warns of Many Parents “Undertreating” their Kids for Pain

Tuesday, July 20th, 2010

USATODAY has recently posted an article on-line, regarding how prevalent the undertreatment of children is when it comes to follow-up medical care after an injury or surgery.

As more and more hospitals send children home fairly quickly after surgery – many within hours after an outpatient procedure – it falls on parents to monitor and control their child’s pain.  This can be frightening for some parents, confusing to others, or a combination of both.  As a result, many parents just flat-out refuse to give pain medication to their kids.  What percentage of parents don’t give adequate pain relief through medication to their children?

In a study of 261 children, 24% of parents gave either no medication or a single dose, even though 86% of parents reported that their child was in “significant pain” on the first day after surgery, according to the study of children ages 2 to 12 published in October in Pediatrics. Doctors typically advise parents to give pain relievers every four hours as needed.

What makes the issue of pain involving children even more challenging is that it is not always easy to tell whether a child is in pain or to what extent.  What are some of the signals that a child is in pain? Here’s some insight:

Recognizing and treating pain in children can be a challenge. Unlike adults, kids may not cry or complain when in pain, says Lisa Humphrey, Medical Director of the Pediatric Palliative Care Program at Rainbow Babies & Children’s Hospital in Cleveland. Instead, kids may show these symptoms:

• Refusing to eat or drink.
• Becoming quiet, withdrawn.
• Having trouble sleeping.
• Becoming fussy.
• Showing other changes in mood or behavior.

It is also suggested that doctors do more than just write a post-procedure prescription and then hand it to the child’s caregiver. Pediatrician Zeev Kain, Chairman of Anesthesiology at the University of California-Irvine, encourages doctors to take an active role in advising and guiding parents in the aftercare of their little ones:

“[D]octors give parents relatively little information about how to care for these young patients,” Kain says. “It’s not enough to hand parents a prescription,” he says. “Doctors and nurses need to make sure parents will actually give the medication.”

“Without such guidance, parents who are afraid of medication side effects often intentionally withhold medication,” he says.

Once a caregiver is educated and knows what to do and how to do it, then there is the issue of having the child actually take the medicine. What if they are fussy, don’t like the taste, or simply will not listen?  Dr. Humphrey provides one answer:

Parents also can request that children try a dose of medication before leaving the hospital, to make sure they are willing to swallow it.

Dr. Mark Brown, an ear, nose and throat specialist in Austin, provides another:

If children don’t like the taste, parents can ask pharmacists to create alcohol-free versions, which are more palatable, says Mark Brown, an ear, nose and throat surgeon in Austin. Many pharmacies are now willing to add a child’s favorite flavor, such as orange or grape.

So, the next time the doctor hands you that prescription for your little one, and your mind starts to race with questions about dependency, side effects, or issues involving how to administer the medication, there is one thing you can do before the doctor turns to leave to see the next patient: ask for help and guidance!

Child Health: Labels Urged for Food That Can Choke

Thursday, May 27th, 2010

Earlier this year, we posted a blog on our website in regard to the American Academy of Pediatrics (AAP) policy statement in regard to the prevention of choking among children.  Earlier this week, the New York Times featured an in-depth story on an issue that is very much a part of this policy statement:  food choking hazards among small children.  The article discusses the advocacy efforts to place warning labels on foods, which pose a choking hazard to small children, as well as the proposition that small children should not be allowed to eat certain foods at all.  The article starts with an all too familiar setting that ended in tragedy:

On a July afternoon in 2006, Patrick Hale microwaved a bag of popcorn for his two young children and sat down with them to watch television. When he got up to change the channel, he heard a strange noise behind him, and turned to see his 23-month-old daughter, Allison, turning purple and unable to breathe.

As a Marine, he was certified in CPR, but he could not dislodge the popcorn with blows to her back and finger swipes down her throat. He called 911, but it was too late: by the time Allison arrived at the hospital, her heart had stopped beating. An autopsy found that she had inhaled pieces of popcorn into her vocal cords, her bronchial tubes and a lung.

Does this story make you think twice before giving your little ones popcorn?  On a personal note, I called my wife immediately after reading this story, and we discussed the fact that we should no longer allow our son, who is now two and a half, to have any popcorn. Ironically, she was on her way to take him to a movie that was going to be serving….you guessed it, popcorn.

Now, some of you may say “Well, little kids can choke on anything.”  Well, that is true.  However, there are some foods that pose an increased risk of choking.  Consider the dynamics of how a small child eats, as well as the size of their airway:

Children under 4 are at the highest risk, not only because their airways are small (the back of a toddler’s throat narrows to the diameter of a straw) but also because of the way their eating abilities develop. Front teeth usually come in at 6 or 7 months — so babies can bite off a piece of food — but the first molars, which grind food down, do not arrive until about 15 months, and second molars around 26 months.

“Between the ages of 3 and 4, they’re developing their ability to chew adequately and prepare for swallowing,” said Dr. Nisha Kapadia, a pediatric resident at Johns Hopkins Children’s Center.

When young children chew foods like peanuts, raw carrots and popcorn, some is ground down and some is not, and they tend to swallow unchewed bits of food that can block the airway or be inhaled into the bronchial tubes and lungs.

This concern and the tragic deaths associated with this concern have prompted several organizations to propose various options to attempt to prevent these injuries and deaths.  One such organization is the Center for Science in the Public Interest:

Some advocates say the government should put hazardous foods off limits to young children.

“The F.D.A. needs to set a uniform standard for cautionary information on food that should not be consumed by children under 5,” said Bruce Silverglade, legal director of the Center for Science in the Public Interest, an advocacy group that lobbied unsuccessfully in 2003 for a bill to require the Food and Drug Administration to develop food labeling regulations.

Where this debate will end up, we don’t know.  However, to think that in 2001 there were 17,500 children 14 years old and younger treated in emergency rooms for choking, with 60% of those events caused by food, there must be a way to create a safer environment for our children when they are eating.  Any suggestions?

UPDATE: AAP Compromise Statement on Female Genital Cutting – RETRACTED!

Tuesday, May 25th, 2010

Please see UPDATE at end of article!

On April 26,2010, the American Academy of Pediatrics (AAP) issued a new policy statement seen by many as essentially advocating the practice in this country of female genital mutilation (FGM)[sometimes  this 'tradition' is referred to as female genital cutting (FGC) as well].  In pertinent part, the policy advocates for “federal and state laws [to] enable pediatricians to reach out to families by offering a ‘ritual nick’,” such as pricking or minor incisions of girls’ clitorises.

Yes, I said this was issued by the American Academy of Pediatrics. How, in the world, you ask, could such an august body promote such a misogynistic practice?

For those who may not be familiar with this barbaric (you fill-in the other adjectives – the list is simply too long) ‘ritual,’ a recent online article by PRNewswire sets the chilling background of this controversy.

FGM is a harmful traditional practice that involves the partial or total removal of the female genitalia and is carried out across Africa, some countries in Asia and the Middle East, and by immigrants of practicing communities living around the world, including in Europe and the U.S.  It is estimated that up to 140 million women and girls around the world are affected by FGM.

Putting aside my personal opinions regarding the overall chauvinistic cultures of – to name a few – Africa, Asia and the Middle East, what would motivate any culture to engage in such a ritualistic practice?

In an NPR interview of Professor of Law, Cleveland-Marshall College of Law, Cleveland State University, Dena Davis, on May 14, 2010, Professor Davis,  a consultant to the AAP and the lead author of the policy statement, the ‘rationale of this ‘tradition’ is explained.

RAEBURN: Do you have a sense I’m just I can’t help but interrupt. Do you have a sense of why in these cultures, there may be different reasons, but why this is done or what is supposed to be the benefit of it?

Ms. DAVIS: Right, it’s a wide array of things. On a positive side, it’s seen as a growing-up ritual, as a celebration of ethnic or national identity. It became politically important as a response to colonization, for example, but it’s also done to remove sexual pleasure from women so that they can be controlled, to guarantee women’s virginity so that they are marriageable and to protect the family’s honor.

So just how did this ‘celebration of ethnic or national identity’ work its way to our shores? How did it conceivably become a part of a policy statement by the AAP?

Professor Davis offers the following explanation:

Ms. DAVIS: Well, I want to start by reiterating what you already said. The statement ends with four recommendations, and none of those mention this compromise. The recommendations are that the American Academy of Pediatrics opposes all forms of female genital cutting that pose risks of physical or psychological harm, encourages its members to educate themselves about the practice, recommends that members actively seek to dissuade families from carrying out harmful forms of FGC and recommends compassionate education of the parents of patients.

Having said that, the controversial part, as you made mention, is a discussion toward the end of the possibility of pediatricians offering what would literally be a nick. And in the statement, we analogize it to ear piercing.

And the idea here was that we knew that some pediatricians in Seattle a number of years ago who had a good relationship with the Somali immigrant community around their hospital had been asked by mothers of girls for this kind of compromise. And they had gone down the road of – they’d had meetings with mothers and so on, and they were about to do that…

RAEBURN: So this was mothers from some of these cultures where this is practiced had suggested that…

Ms. DAVIS: Right, were Somali immigrant mothers.

RAEBURN: Okay, so it was their idea?

Ms. DAVIS: Well, I’m not sure whose idea it was, but they embraced it to the extent that they held off on doing something worse until the doctors could get set up to start offering this. But before that could happen, Congresswoman Pat Schroeder wrote to tell the hospital that it would be criminal under her new law that had recently passed in Congress.

The concern is that we know that in many cases, when pediatricians turn down parents, girls are taken back to Africa for the worst possible procedures done, you know, with no painkilling and no, you know, no infection control and extremely severe forms of these procedures where girls’ labia are scraped away, for example.

And there’s really that’s very difficult to stop…

The uproar from this AAP statement advocating a ‘compromise’ – ostensibly premised on the concept of the ‘lesser of two evils’ – comes from virtually every group in this nation.  One I quite frankly didn’t anticipate was posted by Jihad Watch: “[T]here are those four words of the Hippocratic oath that the American Academy of Pediatrics seems to have forgotten: First do no harm. And if it is supposed to be harmless, let the AAP doctors line up forthwith for their own “ritualized nick.” The comments to this posting by Jihad Watch, which refers to this practice as being “primarily enforced in Muslim countries, ” are also quite revealing. One person identified as ‘Ccoopen’ had this to say:

I’m not sure why this is listed under dhimmitude, considering that FGM is not Islamic. Sure, it is practiced by Muslims, but it is not a Muslim practice. It is a cultural practice which predates Islam by hundreds, if not thousands of years. In fact, the majority of practitioners in Africa are of the African Tribal religions, not Muslim. While it is a horrific practice, it doesn’t need to be tied to Islam since it has nothing to do with Islam, but with culture.

For those who have dedicated their life’s work to obtaining equality among the sexes, the AAP’s attempt at a ‘neutral’ statement of compromise has been vehemently rebuked:

“Encouraging pediatricians to perform FGM under the notion of ‘cultural sensitivity’ shows a shocking lack of understanding of a girl’s fundamental right to bodily integrity and equality,” says Taina Bien-Aime, executive director of the human rights organization Equality Now. “If foot-binding were still being carried out, would the AAP encourage pediatricians to execute a milder version of this practice?”(See “An End to Female Genital Cutting?”) See our source – Time online article.

In its online posting, Time, a partner of CNN, reports (as do many others) reports a legislative twist to the timing of the AAP’s policy statement:

On the same day the AAP published its new recommendation, the Girls Protection Act, which would make it illegal to take a minor outside the U.S. to seek female circumcision, was introduced in Congress. “I am sure the academy had only good intentions, but what their recommendation has done is only create confusion about whether FGM is acceptable in any form, and it is the wrong step forward on how best to protect young women and girls,” said one of the bill’s sponsors, New York Representative Joseph Crowley, speaking to the New York Times. Davis counters that such a law would be extremely difficult to enforce.

So where do you stand on the issue? Has the AAP done more harm than good? Is the ‘compromise simply dangerous folly or adoption of ‘the lesser evil’ for the safety and well-being of these children? You be the judge. Share with us and our community of readers your reaction.

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UPDATE: in response to my posting this blog on Twitter, one person using the Twitter name kvetchingguru brought to my attention a posting which is a ‘call to action.’ It is entitled “Urgent Alert: Call on the American Academy of Pediatrics to retract their endorsement of Type IV FGM.” A form letter is made available and the names of the Executive Director/CEO of AAP, the Chair of AAP and the President and CEO of the American Board of Medical Specialties are provided.

As I wrote earlier today, this ‘endorsement’ in any fashion – call it ritual snip or piercing – has created a groundswell of reaction.

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UPDATE: May 27, 2010

It appears that the uproar reported in this article has taken its toll.

The American Academy of Pediatrics has retracted its policy statement on female genital cutting after sparking controversy by apparently endorsing the illegal practice of “ritual nicks” to forestall more extensive mutilation.

“The AAP does not endorse the practice of offering a ‘clitoral nick,’” according to a new statement by the organization’s board of directors. “This minimal pinprick is forbidden under federal law, and the AAP does not recommend it to its members.”

The following from the AAP president about says it all:

In a new statement, AAP president Judith Palfrey, MD, of Harvard Medical School, clarified the academy’s position. ”Our intention is not to endorse any form of female genital cutting or mutilation,” she said. “We retracted the policy because it is important that the world health community understands the AAP is totally opposed to all forms of female genital cutting, both here in the U.S. and anywhere in the world.”

The source for these quotes: medpagetoday