Posts Tagged ‘Children's Health’

Dogs a huge help for special needs kids

Monday, May 9th, 2011

Dogs and kids just seem to go together. Whether it’s running around the yard and roughhousing or just sitting quietly watching TV together on the sofa, dogs seem to gravitate toward kids. For some special needs kids, however, dogs are more than just a friend and play buddy; they are actually a daily caregiver.

The idea of service dogs for disabled children is a little-known yet burgeoning niche in the world of special needs. Everyone knows about service dogs for the blind. I have to admit that until recently, I had never even considered service dogs for other disabilities, let alone children. Then a friend of mine whose son is autistic mentioned that she was thinking about getting an autism service dog for her son. I was puzzled. Her son suffers from sensory processing disorder so I didn’t understand what a dog would be able to do for him. Kids with autism usually don’t have physical handicaps. But as I talked to her and started reading up on the topic, I found that well-trained dogs can be a huge help to autistic kids, as well as kids with other disabilities.

For autistic children, service dogs don’t offer specific physical assistance, but are highly trained in behavior disruption, which is a major component of autism. As any parent of an autistic child can tell you, behavior disruption is common. It can be different triggers for different children, but the common denominator is that something (usually something benign to most of us) sets off what we laypeople would call an emotional or physical meltdown. This can be a mild tantrum or can be a full-blown one complete with collapsing on the floor and shrieking. Trying to calm an autistic child in the throes of such a meltdown can be a major challenge. It turns out that a dog trained to recognize such behavior and engage the child is a highly calming influence on the child. The dog essentially soothes the child and comforts him or her, shortening the duration and severity of the meltdown, and also cutting down on the number of meltdowns. Rather than getting overly focused on whatever it is that is bothering him or her, the child seems to focus on the ever-present dog and can bypass what otherwise might trigger a reaction.

The dog also gives other support that is less tangible but equally important – giving the child something to focus on if distracted, providing companionship, and assisting with developing friendships with other children. Special needs children are sadly often excluded by so-called normal children which can add a tremendous feeling of isolation for such children. Having a service dog helps break the ice with new kids and provides a constant companion when other children are not around.

Physically, a service dog also helps protect the child and keep him or her safe. One major concern with autistic children is that they are easily distracted and may not think as logically as other children.  They are more prone to wandering off in public because they get distracted by something and follow it, even if it takes them into traffic or near a dangerous body of water.  They may decide to leave the house alone for no apparent reason, even in the middle of the night. Service dogs are trained to restrain the child and act as a second pair of eyes on the child, which is a huge asset to the parents.

Legal fight over service dogs in school

A great piece of news recently came out of Oregon involving an autistic boy named Scooter Givens and his service dog, Madison. For years, Scooter’s parents fought their son’s school for the right to have the dog attend school with him under the ADA (American with Disabilities Act). The school fought back. Finally, the school backed down and agreed to at least try to allow Scooter to bring Madison to school with him. They are starting with part-time hours and working up to full days. If Madison can keep Scooter from having meltdowns, it should be a win-win for both the school and the family.

Cost and Availability

Service dogs are not cheap, nor are they readily available. A well-trained dog can cost  upwards of $20,000, depending on the level of training that is required (which is why my friend is not heading out this weekend to buy one). While this may seem excessive, the cost is actually justified when you realize that it can take six months or more of intense work  to properly train a service dog. That is months of food, shelter and paying a trainer to spend  hundreds of hours training each dog, as well as the additional training time when the dog is matched with the family. It is a labor-intensive process. However, there are ways to meet the cost. Many training facilities seek outside funding to help defray the costs of training, which lowers the ultimate cost to the family. Some families will actually do fundraising themselves to try to pay their portion of the cost. Even with this approach, however, the sad fact is that service dogs are unfortunately out of reach for a large number of people, especially when you consider the other high costs of raising a special needs child.

Other disabilities:

In addition to autism, service dogs are trained to care for people with other disabilities – deafness, mobility issues, and one that I found absolutely fascinating – seizure disorder. Dogs are trained to assist people who suffer seizures by getting the telephone and medicines, and keeping the person physically safe during a seizure. Some dogs can even go so far as to anticipate an oncoming seizure and alert the person to lay down in a safe position before the seizure starts. How the dog knows this is anyone’s guess. So far, science has been unable to explain it. Some researchers theorize that during the earliest phase of a seizure, the person’s electrical brain activity subtly changes a person’s odor which the dog detects. Dogs have a sense of smell that is 300 times stronger than what we have. While this may be the explanation, no one knows for sure so it remains a fascinating mystery.

If you are interested in a special needs dog, there are a number of organizations out there for you to consider. Here are just a few:

4 Paws for Ability:  http://www.4pawsforability.org/

North Star Foundation:  http://www.northstardogs.com/autism.shtml

Dogs for the Deaf:   http://www.dogsforthedeaf.org/index.php

Have any of our readers had any experience with special needs dogs?  I would love to hear your stories.

 

Photo from staplenews.com

 

 

Budget Crisis Avoided, But What About the Babies? Can They Live With $504 Million Less in Funding?

Wednesday, April 20th, 2011

Let’s start here:  The Federal Government Shutdown has been avoided.  Federal workers and government contractors that depend on a functioning federal government can breathe a deep sigh of relief.  As the hysteria subsides and we return to business as usual, we should ask ourselves – “Are we really returning to business as usual?”  When it comes to your health and more specifically, the healthcare that you and your baby receive, the answer very well may be a resounding “NO.”

How It All Happened

I suppose I should set the stage for you, in case you missed the hand-wringing and other hysterics.  The two houses of Congress are divided.  As is par for the course, Democrats profess that one course of action is correct and Republicans declare that another course is more appropriate.  A budget needs to be in place for the government to function, yet the two political parties couldn’t come to an agreement.  A shutdown of the federal government was promised if a compromise was not reached.  The American public held its breath—or protested.  At the 11th hour, cuts were made, backroom deals were struck, and Washington spoke:  there will be $38 billion dollars trimmed from the federal budget.  On a positive note, federal agencies will remain operational until the end of September. Reason to cheer? Maybe. Before we break out the party hats and noise makers, let’s take a look at how healthcare fared.  The following areas are among those cut:

-         Special Supplemental Nutrition Program for Women, Infants and Children (WIC):  $504 million

-         Community Health Centers:  $600 million

-         Substantance Abuse & Mental Health Services Administration:  $45 million

-         Infectious Disease prevention:  $277 million

Total:  $1.426 Billion.  Yes, billion, with a “B”!

WIC, Babies, Community Health & Death

Women, Infants and Children, otherwise known as WIC, is a program that provides food for poor women and children up to the age of five.  WIC’s mission statement is “to safeguard the health of low-income women, infants, and children up to age 5, who are at nutritional risk by providing nutritious foods to supplement diets, information on healthy eating, and referrals to health care.” WIC gives targeted nutritional supplementation to help prevent birth defects and developmental problems caused by malnutrition.  It also provides information on healthy foods and referrals for medical care, according to the program’s website.

The WIC program gave out about $7 billion in food grants to states in 2010. There were nearly 8.9 million households receiving WIC benefits at the end of 2010, according to the Department of Agriculture. Locally, on an annual basis, Maryland WIC serves over 130,000 women, infants and children each month.  More than 151,000 pregnant and breastfeeding women, infants, and toddlers benefit from the program in Virginia.  Despite the number of women, infants and children assisted by the program, the recent budget compromise promises to slash $504 million in funding. The startling aspect is the number of women and children that are eligible but for one reason or another are not enrolled in the program. There is an estimated 43 percent of women and children, who are eligible for benefits but aren’t receiving them.  The cuts to funding will effectively foreclose their opportunity to receive benefits. At risk and in need, they will have to look elsewhere.  Sadly, many will not.

In addition to the significant cuts to WIC’s budget, the budget for community health centers would drop by about $600 million, affecting access to basic health services for approximately 5 million low-income Americans, according to the National Association for Community Health Centers. By 2015, according to NACHC, the reduction could undermine health centers’ capacity to provide services to 40 million people.

But what does it mean?

It is 2011.  My computer, cell phone and other gadgets all confirm that we are soundly within the confines of the 21st century. While we can certainly live with the fact that automobiles do not take flight a la The Jetsons, what is troubling is that we are continuing to battle fetal death in the United States.  Around 2.6 million babies are born with no signs of life after 28 weeks’ gestation – which defines a stillbirth. Undoubtedly, most of these stillbirths take place in developing countries.  Nonetheless, in the world’s wealthiest nations around 1 in every 300 babies are stillborn.  In 2005, data from the National Vital Statistics Report showed a US national average stillbirth rate of 6.2 per 1000 births. In fact, of the world’s most advanced economies, the United States has the highest infant mortality rate.  In Maryland, a preliminary report from the Department of Health and Mental Hygiene (DHMH) shows that Maryland’s infant mortality rate is 7.2 infant deaths per 1,000 live births.

The major causes of stillbirths—complications during labor, maternal infections, hypertension, diabetes, and fetal growth restriction—aren’t too different from the major causes of maternal or neonatal deaths. Among the most fundamental ways to prevent stillbirths and fetal death is to improve basic and comprehensive emergency obstetric care. Providing pregnant women folic acid supplements, preventing disease, and improved detection and management of infection during pregnancy are simple ways to ensure babies are born healthy.

According to WIC, numerous studies have shown that pregnant women who participate in WIC have longer pregnancies leading to fewer premature births; have fewer low birth-weight babies; experience fewer fetal and infant deaths; seek prenatal care earlier in pregnancy and consume more of such key nutrients as iron, protein, calcium and vitamin C. That being said, the budget negotiations resulted in drastic cuts to a program effective at reducing harm to the nation’s most vulnerable?  Oh, boy.

With the exception of a short stint as a student legislator in high school and college, I do not have meaningful experience in the political arena.  I will not pretend to have significant insight into what it takes to balance a federal budget.  As a lay person, what I can do is look at the statistics and read the reports.  The numbers and reports tell me that in the 21st century America, a scary number of its children are being harmed by the preventable.  On top of that, the funding—the lifeblood—that sustains the programs aimed at reducing the problem just took a devastating blow. Will the programs designed to help our most vulnerable continue to operate? We can only hope.   At least, for the sake of the children. So please excuse me if I don’t put on my party hat and celebrate the $38 billion in budget cuts. I haven’t found a cause for celebration just yet.

Agree or disagree? That’s why the comment section is below. Let me know if you have your party shoes on.

 

Clinics and Emergency Rooms: Helpful or Barriers to Good Pediatric Care?

Friday, April 15th, 2011

Image from: denverpost.com - (Photo: istock.com | Photo illustration: Linda Shapley, The Denver Post )

In my last post, I discussed the idea of a medical home and the comprehensive healthcare it is meant to provide. For families for whom insurance, work scheduling or other demands make seeing a doctor during regular office hours difficult, many turn to retail based clinics or emergency rooms to fill-in and provide care. Whether this is in addition to or instead of a primary care provider, it is a reality that many families are using clinics and emergency rooms to fulfill at least some of their healthcare needs.

The difficulty with receiving care in these settings, as opposed to a true medical home, is that the health care providers in these settings do not have a complete medical history or record. Each time there is a problem, a different health care provider is likely to provide care and therefore, the continuity of care is lost. Moreover, if there is a bigger problem or a bigger picture issue for the patient or family, the health care provider is really not able to help make the diagnosis and assist in formulating a care plan. Recently, I have come across a number of interesting articles,which examine some of the other pitfalls of using retail clinics or emergency rooms for care, particularly for children. Their observations and opinions are well worth sharing.

In a recent blog article on kevinmd.com, Dr. Roy Benaroch discusses a variety of reasons why – for good pediatric care – you should avoid retail clinics . He highlights the potential conflicts of interest that exist when a clinic is within a store that also sells prescriptions. He defines good pediatric care as:

Care that looks at the whole child, the whole history, and the whole story. To do a good job I have to review the history, the growth charts, the prior blood pressures, the immunization records, and more. Good care means I’m available for every concern—not just the sore throat, but the “Oh, by the way…” worries that are often more significant than the current illness. Things like “He’s not doing so well in school,” or “I think he looks clumsy when he runs,” or “What am I going to do about these headaches every day?” Every encounter is a catch-up on problems and concerns from before, to be reviewed and updated. Children are growing and developing, and every encounter is a snapshot of their over all well-being that can only make sense if it can be placed into a continuous album. At the retail-based clinic, the encounters are just a quick toss-off: an opportunity for genuinely improving health that’s thrown away.

He also points out the need for providers to be specialized in pediatrics and to be up-to-date on current medical recommendations. Providers in these clinics may be generalists and not up-to-date in the specifics of care for children.

A recent article in the New York Times highlights one potential hazard for children visiting emergency rooms for care – the increased use of CT scans. The article reports that the use of CT scans for children visiting emergency rooms has increased fivefold between 1995 and 2008, such that almost six percent of children visiting the emergency room for care are now receiving the scans. There are benefits and detriments to this increase:

…advances in the technology had resulted in improved image quality that can greatly aid diagnosis of childhood ailments. But the scans expose patients to high levels of ionizing radiation that can cause cancer in later years, and radiation is even more harmful for children than for adults.

The New York Times article goes on to explain that risks are low and the patients who need the scans should receive them. However, it raises an important question in my mind.

The article states that the scans are most often given for “children arriving with head injuries, headaches or abdominal pain.” Certainly, there are plenty of times when a child may visit an emergency room for a true emergency and a CT scan, if warranted, should be done without delay. But, I wonder whether there are also situations in which a child may be visiting an emergency room because of a headache or abdominal pain, which has been persistent and would likely receive a different approach to treatment if first presenting in the child’s medical home rather than an emergency room. In that setting, would a doctor, with the child’s complete history and without other emergencies pressing, chose alternative diagnostic options before ordering a CT scan. The CT scan might still be warranted, but perhaps not as frequently. I am not a medical professional and would not question the judgment of a medical professional, but generally speaking, the value of consistency of care with a primary provider seems prudent whenever it is an available option.

From a personal perspective, I understand that even parents who are the most attuned to the desire for continuous care may waiver when faced with a child in pain during off-hours. Parents who are unable to get their child to the doctor during work hours or whose child suddenly has pain at 9 pm (or 3 am) are faced with an unfortunate decision. While I certainly would take my child to an emergency room for a true emergency, I have chosen many times to wait for our doctor’s office to open in the morning rather than take them to a 24 hour clinic for a non-emergency case of extreme ear pain or similar problem. It is horrible to wait those hours with a child in discomfort; however, I know that in the morning a doctor who has the complete history of the problem will then address the problem. Just this week, I was grateful – again- that we are lucky enough to have a primary care pediatrician, who knows our child,  is comprehensive enough to care for our children, and by seeing “the big picture” can coordinate care immediately with specialists whenever that is warranted.

To me, a physician I can trust, coupled with great practice management, is essential to a pediatric practice where I can feel comfortable taking my kids.  What are some of the things you most value? What about adult primary care providers – are you using clinics and emergency rooms for your primary care or do you have and prefer the continuity of care provided by your personal primary care physician?

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 daily struggle of raising a disabled child

Thursday, February 24th, 2011

Parents must cope with daily concerns of special needs children

Like many parents, I am blessed to have healthy children.  I take it for granted that my kids are smart, active, well-adjusted.  I don’t even have to think about their health other than the occasional cold or earache or sprained ankle. Others are not so fortunate.

This past weekend I was reading in Maryland Family Magazine an article about a local college professor who wrote a book about raising a son with severe autism.  After writing the book, he assumed that a major publisher would have interest. He ended up being turned down by some agents who told him that without a happy ending or a cure, there was no way they could market the story. Apparently, the public wants stories about disability to have a Hollywood ending. (A publisher finally did come along that agreed to publish the book).

This, in turn, made me think of a good friend of mine (I’ll call her Jane), who has a disabled son (autism spectrum) in addition to three normal children. I hesitate to use the words normal and disabled for two reasons:  1) we live in a politically correct world where deciding what label to apply to anything means stepping into a social minefield; and 2) on the spectrum of mental or physical ability, it can be difficult to say what exactly is normal versus abnormal. I never want to suggest that children with limitations are abnormal. Some parents even bristle at the term “disabled.” Others use the more cumbersome term “neurotypical” rather than the term “normal.” You can see that it can be hard to discuss the topic of disability when we don’t even have terms we can all agree on.

Jane and I often discuss our kids and parenting. She has been very candid with me in describing how incredibly hard it is to raise a disabled child. She believes that no one really wants to hear the negative side of raising a child with special needs. Like the publishing agents that the professor encountered, some people only want to hear about the inspirational side of the story. Truth is, there is not always a happy ending or miracle cure when raising a disabled child, be it autism or cerebral palsy or paraplegia. These are life-long disabilities. There are happy moments, of course, as well as accomplishments both major and minor, but for parents raising a disabled child, it is a daily struggle to make sure that the child gets the medical care and therapy and attention that he or she needs. Parents undertake this monumental and thankless task not because they hope for some Hollywood ending, but because they love their child and they do what they need to do, even if they never knew they had such strength and determination in them.

It’s not all negative, of course. Jane tells me all the time how much she loves her son and how he has taught her so much about herself and about life. She says she cannot imagine who she would be without her son. At the same time, however, she also feels a lot of pain and loss and regret about what she and her family have had to sacrifice in order to care for her disabled son. The daily struggle can truly be overwhelming at times. Jane believes that parents often feel unable to express these feelings for fear of being branded a less-than-stellar parent. As she told me, “There isn’t a safe place to express one’s own doubts about being able to effectively take care of another person who requires so much care. It’s daunting, hard and stressful and for some reason it’s not completely OK to admit that.”  Jane is careful about the sentiments she expresses in public versus those she tells to her friends:

There is the aspect of autism that you are allowed to talk about versus not allowed. I’m allowed to admit it’s hard, but I can’t really say how hard or I’m too negative. I’m just supposed to say it has changed my perspective and I’m blessed.  It has changed my perspective but I’m not blessed. Shut up about being blessed.

While disabilities are all different and every parent’s story is unique, there is a common thread that runs through them all – raising a disabled child takes its toll on the parents and the family as well as the child. The challenges can be enormous. Some of the more common challenges include:

  • Financial:  Finding ways to afford medical care, therapy, services;  working with insurance companies and various state agencies;
  • Educational:  Struggling with teachers and school administrators to make sure that your child is getting an appropriate education and Individualized Education Program or IEP.
  • Medical:  Finding doctors who are willing to take the time to listen to your concerns and diagnose your child; getting referrals to specialists; sorting through the myriad hoops of insurance; finding therapies that work for your child;
  • Social:  The loss of normal everyday activities like going out to dinner, taking trips, seeing friends; not having anywhere to turn to talk about what they are going through.
  • Marital:  A couple often experiences difficulty because of all the other stresses that are created by having a disabled child, as well as the substantial time investment that is required.
  • Family: Other children in the family can be affected because mom and dad have to devote so much time to the disabled child and because the family’s usual routine and activities are disrupted; money can often be tight.
  • Psychological: Many mothers experience feelings of guilt, wondering if it was something they did during pregnancy that caused their child to have this disability.
  • Legal: Figuring out what rights you and your disabled child have, what services you are entitled to.

I can’t say enough about those parents who take on these challenges on a daily basis.  It is difficult to even imagine the level of devotion and commitment that is required.  I welcome all parents to share their stories — the good and the bad — so that the rest of us can try to better understand the reality of raising a disabled child.  In future blogs I will talk about some of these challenges in more detail and where parents can turn for assistance.

Image from metroparent.com

Cyber-bullying: With digital age comes digital crime

Friday, November 12th, 2010

Update (Brian Nash): This morning, May 23, 2011, I saw a tweet linking to news that First Lady, Michelle Obama, is joining Maryland’s Judge O’Malley and Lt. Gov. Anthony Brown in a visit this week to a local Maryland school, Central Middle School in Edgewater, to get the word out on an anti-bullying campaign.

Great work and an important message that needs to keep being delivered! The President and First Lady are using Facebook to get their anti-bullying message out there as well.

Wanting to do my (little) part in getting this message out there, I thought I’d re-post this blog from last November for those who may have missed it on the first time. Spread the word; let’s give a hand to all who work so hard to rid society of this dangerous blight.

Original Post:

Digital media is everywhere, and social networking is totally “in” among our youth as well as adults.  As with every advancement in technology, one is faced with the new problems that accompany that technology. With the advent of personal computers, “hacking” became the big cyber-crime followed by sexual predation.  There have been a multitude of movies in which the plots focus on computer-hacking or on-line dating, and there are plenty of songs referencing cell phones and on-line technology.

We are in the digital age, and with that we are experiencing new and more ominous digital crime that is involving our youth and resulting in the premature death of beloved children.

October, 2006, Megan Meier (age 14) committed suicide after being bullied on MySpace by a supposed friend and the friend’s mother.  In June of 2008, Tomohiro Kato rented a truck and drove into the crowded “geek district” of Tokyo where he proceeded to stab 17 unknown people, killing 7 and injuring 10, because he was being harassed on-line for his ideas and electronic postings on social websites.  This year, beginning in January, a beautiful 15 year-old Irish immigrant, Phoebe Prince, committed suicide after being blatantly harassed by her peers, both outwardly in school and on-line, in Massachusettes.  Two months later, on March 21, 2010, Alexis Pilkington (17yrs) committed suicide after being harassed on a social networking site; she was a good student and soccer “star” in Long Island who had received a college scholarship for soccer.  On September 9, 2010, Billy Lucas, a 15-year-old Indiana student, committed suicide after being blatantly harassed on-line and in school for presumed homosexuality.  The most recent case involved a Rutgers University student, Tyler Clementi (18yrs); he committed suicide after his college roommate illegally videotaped a homosexual encounter and posted it on the internet.  These are a few of the more publicized cases, but, cyber-bullying is much more pervasive in our youth.

Each of these cases represents an unnecessary loss of life prompted by children or young adults, facilitated by the use of digital technology.  The hatefulness and utter meanness of the offending children is astounding.  Bullying has been around for ages, and unfortunately, it is part of human nature, evolution and survival of the fittest.  The problem has become the pervasiveness of digital media in our lives, the anonymnity allowed by it and the ease and speed of which information can be disseminated world-wide.  It used to be that the bullying could be left on the playground at school, and/or that school administrators were more apt to intervene if approached with the problem; neither of these conditions seem to exist anymore.  Compound these issues with the virtual isolation these digital media promote, the often-times dysfunctional family unit (divorce, re-marriage, single-parenting, and even the need for both parents to work full-time), the relative independence of our youth, and the relative insensitivity of our youth to violence and sexually explicit material.

Steve Williams posted an article about Billy Lucas’ death on the organization, Care 2 Make a Difference (www.care2.com) which sited the following statistics related to suicide from the Trevor Project:

  • In the United States, more than 34,000 people die by suicide each year (2007 Centers for Disease Control and Prevention, CDC).
  • Suicide is the third leading cause of death among 15 to 24-year-olds, accounting for over 12% of deaths in this age group; only accidents and homicide occur more frequently (2006 National Adolescent Health Information).
  • Suicide is the second leading cause of death on college campuses (2008 CDC).
  • For every completed suicide by a young person, it is estimated that 100 to 200 attempts are made (2003 Youth Risk Behavior Surveillance Survey).
  • Lesbian, gay, and bisexual youth are up to four times more likely to attempt suicide than their heterosexual peers (Massachusetts 2007 Youth Risk Survey).
  • More than 1/3 of LGB youth report having made a suicide attempt (D’Augelli AR - Clinical Child Psychiatry and Psychology 2002)
  • Nearly half of young transgender people have seriously thought about taking their lives and one quarter report having made a suicide attempt (Grossman AH, D’Augelli AR - Suicide and Life Threatening Behavior2007)
  • Questioning youth who are less certain of their sexual orientation report even higher levels of substance abuse and depressed thoughts than their heterosexual or openly LGBT-identified peers (Poteat VP, Aragon SR, et al – Journal of Consulting and Clinical Psychology2009)

Children in this age group, despite their outward mature appearance in today’s world, remain emotionally and intellectually immature.  The teenage human body goes through enormous hormonal changes during this period which compounds emotional lability.  The onslaught of hurtful and demoralizing comments, whether by text-messaging, emails, or social networking sites, can be quite devastating to one’s sense of self and integrity.  The speed at which such information, whether true or false, can disseminate and build momentum amongst peer groups can become overwhelming for the immature psyche, while suggestions to “kill yourself” or threats of murderous intent might just push that individual “over the edge”.

Just last week, Medscape posted an interview with  Gwenn Schurgin O’Keeffe, MD, FAAP, (a pediatrician, health journalist, chief executive officer of Pediatrics Now (www.pediatricsnow.com), an online health and communications company, and the author of Cybersafe: Protecting and Empowering Digital Kids in the World of Texting, Gaming and Social Media ). In the interview, Dr. O’Keeffe defined cyber-bullying, offering suggestions for parents and even medical health providers for monitoring child behaviors and usage of these digital medias, as well as the effects on the individual’s psyche.  Legislation is being discussed on ways to punish these crimes, but the first-line protection begins in the home.  The Massachusettes Attorney General’s Office also displays a page on its website devoted to the topic; it is unclear whether this appeared before or after the Phoebe Prince tragedy, but it is there nonetheless.  One can only hope that changes can be made before those suicide statistics increase exponentially.

I leave you with one of my childhood teachings that I only wish was held in high regard in today’s society:  ”If you cannot say anything nice, then don’t say anything at all.”

Related Post (update):

I also came across a post entitled Stopping Cyberbullying: Who’s Responsible? – Interesting read!

Credit to news.cnet.com for photo

New First-Of-Its-Kind Study: 70,000 Children Injured Annually by Medical Devices

Thursday, July 29th, 2010

A new first-time study of injuries suffered by children as a result of medical devices has produced some startling statistics. “More than 70,000 children and teens go to the emergency room each year for injuries and complications from medical devices,” according to an article in The Washington Post, which highlights a study just published by the American Academy of Pediatrics.

Although the study points out that only 6% of all of these injuries required hospitalization, the fact remains that there is still a very large number of children that suffer injuries due to medical devices.  Some injuries are due to malfunction and misuse, while others are from very dangerous events, such as “puncture wounds from hypodermic needles breaking off in the skin while injecting medicine or illegal drugs”. According to the The Washington Post article:

The most serious problems involved implanted devices such as brain shunts for kids with hydrocephalus (water on the brain); chest catheters for cancer patients receiving chemotherapy at home; and insulin pumps for diabetics. Infections and overdoses are among problems associated with these devices.

In addition, the article touches on a recent trend that has come with medical advances: home health care, for such treatments and procedures which previously required longer and more extensive hospital stays:

Dr. Steven Krug, head of emergency medicine at Chicago’s Children’s Memorial Hospital, said the study highlights a trade-off linked with medical advances that have enabled chronically ill children to be treated at home and live more normal lives.

Home care can be challenging for families; Krug says he has seen children brought in because catheters were damaged or became infected.

“Health care providers need to be aware of these kids and their devices and how to recognize or diagnose” related problems, Krug said.

All of this being said, the article suggests that the Food and Drug Administration may soon become more involved, due to the nature and extent of these injuries to children:

The researchers are working to determine how and why the injuries occurred and also are examining the prevalence in adults. Those efforts might result in FDA device warnings, depending on what they find, said study co-author, Dr. Brock Hefflin.

Hefflin and lead author Dr. Cunlin Wang work in the FDA’s Center for Devices and Radiological Health. They note there has been recent concern about medical device safety in children, particularly since many devices intended for adults are used in children.

We leave you with this conclusion, as stated by the American Academy of Pediatrics:

This study provides national estimates of pediatric medical device-associated adverse events resulting in emergency department visits and highlights the need to develop interventions to prevent pediatric device-related injuries.

Is this an adequate response?  What do you think?

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!

Deaths of Infants in Cars Increasing with Summer Heat; Important Safety Reminders!

Monday, June 28th, 2010

The Associated Press (AP) has just posted a troubling article, one that should grab the attention of every parent who has a child that uses a car seat.

Unfortunately, with the summer comes the heat.  Already this season, we are seeing high temperatures that are matching or breaking records in the Mid-Atlantic Region.  It is with this in mind that we share excerpts from the AP article that we want you to remember, especially when transporting the ‘precious cargo’ that sometimes falls asleep in the back seat of a car:

Safety groups such as Kids and Cars and Safe Kids USA urge parents to check the back seat every time they exit the vehicle and to create a reminder system for themselves.

Some parents leave their cell phone or purse on the floor near the car seat to ensure they retrieve it along with the child. Others remind themselves by placing a stuffed animal in the car seat when the child isn’t using the seat and putting the toy in the front seat when the child is tucked in the car seat.

Unfortunately, not all parents are using these and other simple measures, to remember to never leave a child unattended in a vehicle.  Accidents happen, yes; unfortunately, these accidents can turn deadly when a child is trapped in a car in the intense heat.  As the following tragic scenario illustrates, the temperature in the car in this devastating loss was not survivable:

In Portageville, Mo., 2-year-old twins Allannah and Alliya Larry were found dead in their grandmother’s car on June 16 as temperatures pushed into the mid-90s. New Madrid County Sheriff Terry Stevens said the children apparently got into the unlocked car on their own and were locked inside the vehicle for two hours.

When investigators arrived, he said, the temperatures inside the car had surpassed 140 degrees.

The number of heat-related deaths of children in cars is dramatically increasing, so much so that “the government’s highway safety agency issued a consumer advisory this week that included a warning for parents not to leave children unattended in or near a vehicle.”

We leave you with these sobering statistics, including research done by Jan Null, an adjunct professor of meteorology at San Francisco State University:

The spate of deaths in June has caught the attention of safety advocates because July tends to be the most deadly month for children trapped in hot cars. With a week left in June, the number of deaths has already surpassed the previous record of 17 fatalities from January to June 2009, according to Null’s data.

In 2005, when Null counted a record 47 child hyperthermia fatalities, only 12 of the deaths occurred through the end of June.

Since 1998, Null has documented 463 child deaths involving heat exhaustion inside cars and trucks. Safety advocates said the deaths have been more prevalent since the mid-1990s when parent-drivers were required to put their children in the back seat, where they are safer in transit but more likely to be forgotten.

Please take precautions to make sure that you do not leave any child in your vehicle unattended for any length of time.

Child Safety Tips: As mercury goes up, so do safety risks for kids!

Wednesday, June 2nd, 2010

By picpoke.com

Yes, it is really getting hot out there this week!!!  Coming from Florida to DC last year, I thought “OK, so it will not get nearly as hot up here, or at least not as early in the summer.”  Yes, I was wrong.  This thought brought me to thinking about some of the fun things to do in the summer, but also the dangers for our little ones during this time if we are not extra careful.  Lo and behold, I found this article today, courtesy of the Dallas Morning News and reprinted by the Kansas City Star:

Emergency-room professionals have their own name for the long, lovely, lazy days that kids look forward to in summer: trauma season. Because that’s when hospitals see a spike in drownings and heat-related accidents.

The article discusses several myths and related facts associated with those myths.  Here are a few samples from the article:

MYTH: Pool parties are safe as long as adults are around.

FACT: Many drownings happen when adults are close by. The problem is too much commotion. The key is to have a designated adult watching the water because that is where the danger is. The pool should be free of excess toys that can block the view of the water.

MYTH: Floaties keep little ones safe in the water.

FACT: Floaties are designed for fun, not safety. They give a false sense of security, can deflate and can slip off.

MYTH: The kids will be fine in the pool for the short time it takes to answer the phone or get a cold drink.

FACT: In a minute, a child can go under water. In two or three minutes, the child can lose consciousness. In four or five, the child could suffer irreversible brain damage or die. According to the Centers for Disease Control and Prevention, drowning is the second-leading cause of unintentional, injury-related death for children 1 to 14 years old, second only to car and transportation-related accidents.

The article states several other myths and facts, which include the hazards of leaving children unattended in cars and car seats, as well as sun exposure and dehydration.  We encourage you to read the article in its entirety.  Let’s all have a safe summer out there, please!!