Archive for the ‘parentlng’ Category

Shaken Baby Syndrome – What We All Should Know To Prevent Child Abuse

Wednesday, April 6th, 2011

Shaken-Baby Syndrome - image: mydochub

Some people should think twice before becoming a parent.  According to the Medical Examiner’s Office in Hampton, Virginia, Natalynn Hamrick died on February 3, 2011 from a brain injury after being shaken by her mother. Natalynn was only eleven months old. Her mother, who is now the subject of a criminal investigation, reportedly told the police that she shook Natalynn while trying to put her in the car seat.

Believe it or not, there is an actual syndrome that describes what happened to Natalynn. It’s called Shaken Baby Syndrome (SBS, also referred to as “Abusive Head Trauma” ) – “a form of physical child abuse that occurs when an abuser violently shakes an infant or small child, creating a whiplash-type motion that causes acceleration-deceleration injuries.”

The injury usually ensues as a result of very violent shaking, which then produces an accelerated rotational movement of the head.  This type of movement may cause the brain to move/rotate within the skull cavity, resulting in trauma to brain tissue.  There may be associated bleeding around the brain caused by torn blood vessels. The bleeding usually leads to pulling within the skull (i.e., subdural hematoma), which in turn can cause additional brain injury by exerting pressure on the brain and causing it to move or herniate.

Diagnosing less severe cases of SBS can be difficult because the child may not initially manifest any signs or symptoms. Radiographic studies may be used to diagnose bone fractures or brain bleeds. An important external manifestation could be bleeding in one or both eyes. The pupils may be blown and/or unresponsive. The following are some additional signs and symptoms:

  • Lethargy / decreased muscle tone
  • Extreme irritability
  • Decreased appetite, poor feeding or vomiting for no apparent reason
  • Grab-type bruises on arms or chest are rare
  • No smiling or vocalization
  • Poor sucking or swallowing
  • Rigidity or posturing
  • Difficulty breathing
  • Seizures
  • Head or forehead appears larger than usual or soft-spot on head appears to be bulging
  • Inability to lift head
  • Inability of eyes to focus or track movement or unequal size of pupils

Some of the long-term consequences of SBS include:

  • Learning disabilities
  • Physical disabilities
  • Visual disabilities or blindness
  • Hearing impairment
  • Speech disabilities
  • Cerebral Palsy
  • Seizures
  • Behavior disorders
  • Cognitive impairment
  • Death

Babies are more prone to develop SBS symptoms because their heads are relatively large when compared with the size of an adult head (i.e., on average a baby’s head represents about 25%of his/her total body weight).  Additionally, babies have relatively weak neck muscles that we not fully capable of supporting the head. Also, a baby’s brain is not fully developed, making it more susceptible to traumatic injury.

The following  prevention measures can easily be implemented to reduce the possibility of SBS injuries:

  • NEVER shake a baby or child in play or in anger. Even gentle shaking can become violent shaking when you are angry.
  • Do not hold your baby during an argument.
  • If you find yourself becoming annoyed or angry with your baby, put him in the crib and leave the room. Try to calm down. Call someone for support.
  • Call a friend or relative to come and stay with the child if you feel out of control.
  • Contact a local crisis hotline or child abuse hotline for help and guidance.
  • Seek the help of a counselor and attend parenting classes.
  • Do not ignore the signs if you suspect child abuse in your home or in the home of someone you know.

April is the National Child Abuse Prevention Month. If you suspect that a child is being abused, be proactive and take steps to allow for timely intervention.  Share your knowledge about SBS with your friends and family because no child should ever have Natalynn’s fate.

The Week in Review: did you miss last week’s posts on health, safety, medicine, law and healthcare?

Sunday, April 3rd, 2011

Last week we launched the first in a series called The Week in Review. We hope you enjoy this project as a way to catch-up on what  you may have missed in the world of health, medicine, patient safety, law and healthcare. Now for our second installment.

 

Yesterday is history. Tomorrow is a mystery. And today? Today is a gift. That’s why we call it the present.”

Inspirational  Quote from Babatunde Olatunji


 

We started the week with Part I in a series of posts intending to explore the issue of whether the ever-growing and expanding advances in medical technology are really accomplishing their goal – or what should be their goal: more efficient, effective and safe delivery of medical care.

The author, Brian Nash, poses the question, “What has technology done to improve healthcare?” Answering in part his own question, he states:

The answer, in short, is – some amazing things and some not so amazing things have taken place in terms of technological advances in healthcare. Unfortunately, as we will explore in this series, some of these technological advances have led to some catastrophic results for patients. One need look no further than how the medical institutions rushed to implement the newest, shiniest and “best” radiology machines and through their haste left in their wake scores of maimed and dead patients.

Read more – Medical Technology and Patient Safety: EMR’s, COW’s, iPads, etc – are they really doing the job?

 

Wednesday’s post by Sarah Keogh explored an often discussed but apparently not always heeded message about car seat safety. Sarah offers some “tips” and suggestions on how to implement simple safety steps to decrease the likelihood of injuries to children while in our cars. She reported -

A recent article on healthychildren.org says that deaths in motor vehicle crashes are still the leading cause of death for young children.

Don’t let this message go unheeded. These are not Sarah’s “tips and tricks” but those of experts in the field of child safety.

Read Sarah’s piece – 4 Tips for Car Seat Safety.

 

The end of last week brought an “interesting” piece by Mike Sanders, also a lawyer with our firm, concerning a so-called study suggesting a possible link between religious activity and obesity. This wasn’t – Mike is quick to point out – a “theory” of his. This was a posting he saw and just couldn’t stop himself from writing about.

While I am usually reluctant to belittle medical research, this study really has me scratching my head and asking, “Who cares?” Before anyone decides to skip church this weekend, let’s look at the details of the study.

Makes one wonder what it takes in today’s world of instant news, internet publishing and blog posting (hmmm), to “get published” as a study.

Read Mike’s piece entitled Can Religion Make You Fat?

The Week Ahead

This coming week will have among its postings Part II in the series about Medical Technology and whether it is doing its job of advancing the safe delivery of healthcare to our population. We’ll start with a topic that is near and dear to all in the healthcare industry – EMR’s – better known as Electronic Medical Records. Sounds like a good idea – right? Since we live in a world of computers, radio buttons and drop down boxes and way too many of us in the field of medical malpractice litigation have made too many visits to the eye doctor from having to reading hand-written medical charts – why wouldn’t this be the next best thing to sliced bread? Well – read Part II coming this week.

We also plan on posting some information and analysis of a medical/anesthesia procedure – the epidural – that thousands of women have every day of every week throughout this country and the world. Well, are they really as safe as some would have you believe? Stay tuned and read our upcoming post.

There are likely to be even more goodies on health, law, patient safety and healthcare in next week’s The Eye Opener from Nash & Associates.

 


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!

Decreasing Obesity Risks in Children: Another Benefit of Breastfeeding

Friday, March 25th, 2011

Image from fooducate.com

In the United States today, one of the major health problems is obesity. The CDC reports that “[i]n 2009, only Colorado and the District of Columbia had a prevalence of obesity less than 20%.”  The number of both adults and children who are obese is huge and continues to rise dramatically.  The CDC website provides maps that show just how prevalent this problem is in our country. Particularly troubling is that “[t]hirty-three states had a prevalence equal to or greater than 25%; nine of these states (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, and West Virginia) had a prevalence of obesity equal to or greater than 30%).  This represents an enormous number of people in our country who are at risk for major health complications, such as “cardiovascular disease, certain types of cancer, and type 2 diabetes.”

While there has been an emphasis in our country on various ways to decrease these obesity statistics (including improving nutrition and increasing exercise), I wonder whether additional emphasis should be paid to children being given a great start to health. A recent article in the Baltimore Sun caught my attention. The article explains how diabetic moms, including those who had gestational diabetes during pregnancy but are not otherwise diabetic, are both more likely to give birth to a larger than average baby and also how their child is “more likely to become obese in childhood.”  The good news, the article explains, is that:

…a new study says that if you breastfeed your baby for at least six months, your child will be no more likely to put on weight than those whose moms are not diabetic.

This is just one more example of how breastfeeding for at least six months can dramatically improve your child’s chances of lifelong health.  Through breastfeeding alone, these moms can erase the increased risk that these children will become obese.

What they found appears to be a real advantage for breastfeeding: If the babies had been breastfed for six months or more, children born to diabetic moms looked nearly the same as the children of non-diabetic moms. And they were no more likely to be obese.

On the other hand, children who were breastfed for less than six months — and who had been exposed to diabetes in the womb — had significantly higher BMIs, thicker waists and stored more fat around their midsections than the other children in the study.

While I was excited to read about one more reason to support breastfeeding, I was concerned about whether this is a realistic choice for many families in our country.  Many moms who are committed to breastfeeding their children and who are successful at the start, do not continue breastfeeding for at least six months. The CDC Breastfeeding Report Card for 2010 says that “…3 out of every 4 new mothers in the United States now starts out breastfeeding… However, rates of breastfeeding at 6 and 12 months as well as rates of exclusive breastfeeding at 3 and 6 months remain stagnant and low.”  The national average is that while 75% of moms have breastfed, only 43% are breastfeeding at all at 6 months and only a mere 13.3% are exclusively breastfeeding at 6 months.  At 3 months, a time when infants would not have started solid food, only 33% of moms are still exclusively breastfeeding.  This means that there is a large drop off from what moms do when their babies are born and what they are doing by the time their babies reach 3 months.

However, the study about diabetes found that at least six months of breastfeeding was essential in protecting these kids from the increased risks of obesity. From both personal experience and anecdotal evidence, I suspect that many families are facing hard decisions about employment and breastfeeding. I suspect that a significant part of the large drop off between the numbers of moms’ breastfeeding at birth and those breastfeeding exclusively at 3 months has to do with employment. Given that the US lags so far behind other countries in paid parental leave, most moms have no choice but to go back to work full-time by the time their infants are 3 months (if not earlier).  Many moms face no choice at that point but to stop or severely limit breastfeeding, as few employers offer the time, space or scheduling to truly make moms successful at the difficult job of trying to pump while working.

I believe that the health care costs of treating individuals with obesity and all of the associated health problems should be examined against the costs of providing more complete support to new families.  What do you think?  Could employers better support breastfeeding in an attempt to increase the number of healthy children whose risks of obesity are lowered? Do you think that lack of paid leave or increased support in the workplace for breastfeeding is really the reason for decreased breastfeeding or are there other factors at play?

 

 

Smoking and Secondhand Smoke Increase Risk for Birth Defects and Stillbirth – Even before pregancy

Thursday, March 17th, 2011

Photo courtesy of Impact Lab

Recently, I came across several news articles regarding risks that can lead to birth defects.  While it has long been known that smoking during pregnancy is not healthy for the mom or her developing baby, a new study is showing that a mom who smokes during pregnancy creates a huge risk of heart defects in her baby.  A Reuters article explains that the potential for harm caused by smoking during the first trimester of pregnancy, a time when many women may not even realize they are pregnant, is significant:

Specifically, women who smoked early in pregnancy were 30 percent more likely to give birth to babies with obstructions in the flow of blood from the heart to the lungs, and nearly 40 percent more likely to have babies with openings in the upper chambers of their hearts.

While smoking later in pregnancy can also cause birth defects, it is the critical period in early pregnancy when organ development occurs that causes the risk to be so significant at that time.

The Reuters article goes on to explain that the new study, in the journal Pediatrics, does not explain precisely why smoking so dramatically increases the risk of heart defects. However, given the risk, women not smoking before or during early pregnancy could decrease the number of children born with these defects.

A news release from the CDC adds that this study and other research suggest that if women quit smoking before or very early in pregnancy, they could avoid as many as 100 cases of the obstruction type of heart defect and 700 cases of abnormal openings in the upper heart chambers each year in the United States.

This is yet another great reason for woman to quit smoking as soon as possible and certainly before trying to get pregnant.

Secondhand Smoke Risks to Your Baby

We cannot let spouses, partners or other people in the mothers’ lives off the hook when it comes to smoking cessation.  A blog article on The Chart from CNN discusses a new study, also from the journal Pediatrics, which gives a convincing argument why woman must avoid secondhand smoke during and even before pregnancy.  The “[r]esearchers found exposure to secondhand smoke increased a non-smoking pregnant woman’s [chances] of having a stillborn by 23 percent, and increased the risk of delivering a baby with birth defects by 13 percent.”  The article went on to explain that the risk of having a stillborn or delivering a baby with birth defects is almost as large for a woman who does not smoke but is exposed to secondhand smoke as for a woman who smoked herself.  The risks of having a stillborn are increased 20-34% when the mother herself is the smoker and the risks of birth defects are increased by 10-34%.

Aren’t these compelling reasons to continue to work hard as a society on prevention and smoking cessation for the young?  It is too late to wait until child-bearing age when women may already be causing unnecessary harm to their unborn children before they know they are pregnant or by sharing their lives with individuals, who are not able to quit smoking fast enough to prevent harm before conception or during early pregnancy.

5 Questions to Ask Your Obstetrician Before You Go to the Hospital

Wednesday, March 9th, 2011

Having our baby

Once the special moment comes for you to go to the hospital to deliver your baby, there’s so much that goes on that it just may not be the best time to remember questions you wanted to ask your obstetrician. I’ve been there four times – so, as they say, been there done that! I’ve also had a number of cases that made me stop and think – “I wonder if some of the issues that my clients encountered could have been avoided if they had asked some questions before they wound-up in labor in hospital?” As you can well imagine, that is perhaps not the best time for a Q and A session.

This past weekend, I posted somewhat of a survey on our Facebook Page and Twitter asking our friends, fans and followers what questions they wished they had asked their obstetricians before they arrived at the hospital. I also have a number of moms, who work in our law office; so I put the question to them as well. The responses received provided some interesting food for thought, which I thought I might share with those about to have their baby.

Who will be delivering my baby?

This was one of the most frequent questions making the list. A number of women complained that they wish they had known that their primary obstetrician was not going to be the delivering doctor. Turns out that physician was being covered the day/night these moms delivered. While they may have met all the members of the practice (if it was a group practice), they were not particularly happy when their primary obstetrician wasn’t there for the delivery. The problem is compounded when their primary obstetrician was off and being covered by someone they had never met before. Suggestion: find out as best you can what the chances are that there will be coverage by someone you’ve never met before you arrive at the hospital. You may want to make an appointment to meet that potential covering physician if this is a concern.

When will I see my obstetrician at the hospital?

One of the cases we are handling somewhat arose from a situation that raises this as an issue. You get to the hospital, you’re admitted, you’re placed in bed, monitor attached – you’re good to go. But – where’s your doctor? Does he/she even know you’re there? When is your obstetrician coming to see you? Several of the women who responded said this was a real concern and wished they had discussed this with their doctor before they sat in bed waiting and waiting for their doctor to arrive. They also wondered – if there was no direct phone call before going to the hospital, just how could they be sure their doctor was notified that they had arrived. In one instance, one obstetrician claimed she didn’t know the patient was even in hospital for more than 4 hours! This woman had to undergo an emergency C-Section when the doctor allegedly figured out she was there. Suggestion: confirm with the hospital staff after you arrive that your doctor has been notified that you have arrived and ask when you might expect for your doctor to arrive and examine you.

Who will be doing the circumcision of my baby boy?

A number of parents indicated that while they had discussed whether their newborn son would have a circumcision, it hadn’t crossed their minds to ask – “Who will be doing the procedure?” If this is an important consideration, and you would like an answer not only as to “who” but “what experience” they have, think about covering this with your obstetrician beforehand. While some physicians are very good at performing this procedure, others are not so good. There have been a number of infant penile injuries that we have happened in the hands of – well let’s say – less than skilled physicians.

What will happen if for some reason I require general anesthesia but I’ve recently had a meal?

One of the common orders for a patient who will undergo general anesthesia is that they be NPO (nothing by mouth – liberal translation) for hours prior to surgery. While you may have planned to have an epidural or natural childbirth, some conditions involving you and/or your baby (non-reassuring fetal heart tracing, placental abruption, etc) can occur that may change the “plan” and require that you undergo a different form of anesthetic management. Suggestion: if such a situation should arise, you will be seen by an anesthesiologist first. Perhaps you will have a discussion about possible alternatives for anesthetic management, but I can virtually assure you, that will not be the best time to have a coherent, meaningful discussion. Some have suggested, based on their experience, that asking for and having a meeting with anesthesia personnel before going to the hospital for delivery is time well spent. You can usually have such appointments made through your obstetrician’s office and have a meaningful discussion of the various alternatives, risks and complications at that time.

How long will the effects of my epidural anesthetic last after delivery?

It’s been pointed out to me that while some hospitals have discontinued the practice of providing pain relief (analgesia) post-partum by use of PCA (patient controlled analgesia) pumps, some hospitals still continue that practice. Regardless of what the hospital’s practice may be, there is usually a very consistent practice/protocol for when a woman who has had an epidural should be discharged from a recovery room/area. This is when she is able to bend her knees, move her hips and flex her feet in both directions. Suggestion: ask your obstetrician what his/her practice is for providing you pain management/relief after you deliver your baby. Will you have an epidural running to provide that relief? When should you expect to get return of your ability to use and feel your legs? Don’t guess – you could suffer what is known as a prolonged block, where the anesthetic, for various reasons, is taking too long to wear-off and affecting your neurological functioning. If your obstetrician doesn’t know, then consider talking to specialist in such pain relief techniques – the anesthesiologist at the hospital where you will be delivering your baby. While you’re there, you may also want to discuss what the risks, benefits and complications of epidural, spinal and general anesthesia are so that you are aware of these issues in advance.

What suggestions do you have?

This is only a partial list of a number of suggestions made by our readers and staff. What suggestions do you have? If you have already been through childbirth, are these matters or issues you wish you had discussed before you went to the hospital? If you are about to have your first child, are these issues, concerns or questions you might share? We – and our readers – would really like to hear from you. There is no substitute for experience – or so they say.

Image by corbisimages.com


Join the conversation!

Facebook Twitter LinkedIn RSS