Pediatrics

As Flu Season Continues, Symptoms to Look Out For

Many news outlets are reporting that this year’s flu season is one of the worst in recent years. It is widespread and has tragically proven fatal for dozens of children. Those of us in CHIL who work at children’s hospitals have definitely seen emergency departments swell with flu patients the past few weeks, and doctors warn that the flu may remain a major problem for some time.

 

Since 2018, it may seem difficult to believe that the flu could still be so lethal. However, it is true that children, especially ones who already have chronic health conditions, are at risk. Media outlets like the New York Times have assembled lists of symptoms to look out for in children that could signal the need to seek medical care right away. The most common causes of complications from the flu include pneumonia, sepsis, and dehydration. Warning signs that a child may need immediate medical attention include: a fever that goes away only to return, confusion, extreme pain, severe vomiting, and a tinted blue color to the skin.

 

Of course, most cases of the flu are less serious than these, and healthy children can usually get over them with medication, proper rest, and hydration. However, the article says that some doctors still recommend the flu vaccine at this point, since there are at least “several weeks” left in the season.

 

The article in the New York Times referenced here gives important information, but what was also insightful was the comment section for this piece. Quite a few comments touched on some several themes, including the importance of vaccination (and the consequences of refusing it for a child), as well as socioeconomic factors that may increase a child’s risk factors for severe flu. However, many readers agreed with the theme of the article — we need to balance finding prompt care for sick children while avoiding overcrowded emergency rooms. If emergency rooms are overwhelmed, less timely care is available for everyone. Questions that remain unanswered by this sort of advice should probably be directed to a child’s pediatrician or primary care provider.  




 

 


 

Weight, Language, and Self-Image

The language we use when talking to a child about their weight is very important. Doctors say that they themselves take great care in the words they choose when they talk to a child or their family member about weight and body mass index, even if their official classification falls under obesity.

 

The New York Times recently published a piece by pediatrician Dr. Perri Klass, who writes that physicians try to take care in order to avoid further hurting a child who may already be unhappy about their weight. A new policy statement jointly issued from the American Academy of Pediatrics and the Obesity society urges pediatricians to use seemingly neutral words instead of words like “overweight” and “fat.”

 

Past and ongoing research into the social and emotional effects of obesity agree that comments on weight can have a large impact on a child’s self esteem. According to Dr. Rebecca Puhl, a clinical psychologist who is one of the lead authors of the policy statement, “Weight is now one of the most frequent reasons kids are teased or bullied.” One of her studies followed more than a thousand teenagers into their early thirties, and found that children who were bullied because of weight were correlated with binge eating, poor body image, and eating to cope with emotions (not to mention other eating disorders). These correlations, in turn, were linked to obesity in adulthood as well. The effect was present for men and women, but more pronounced for women.

 

Dr. Puhl says that healthcare professionals might be some of the few allies overweight children and teenagers can have. After all, they are most likely teased by family members as well as their peers. Another ally that comes to mind is teachers - where appropriate, they can intervene in a bullying situation, as well as promote body positivity and physical activity.

 

We can all be allies if we understand and recognize that making comments about a weight does not encourage positive change; instead, making comments about weight can result in negative, longterm impacts. It is important to make sure that children and teens have access to healthy, positive influences for their physical, mental, and emotional health.

Children's Health, Today and Now

The New York Times wrote a piece looking back on the accomplishments and frustrations of Dr. Irwin Redlener, one of the founders of the Children’s Health Fund, who is stepping down from his administrative position this week.

 

Dr. Redlener’s team began the Children’s Health Fund in 1987 as a response to the poverty he saw in NYC. Today, it has more than 50 mobile pediatric clinics nationwide, and it is an important model for other initiatives in urban areas where poverty and systemic inequality endanger the health of children. Dr. Redlener lived his life to his word when he said, “life and work are based on a simple message: Kids can’t wait.” He points out that the consequences of failing to address a child’s health needs at each stage of development are real and irreversible. For example, failing to treat a child’s ear infection with antibiotics - a relatively simple thing to do - can lead to hearing loss in the long run, which is both a personal disability and a societal cost.

 

In NYC, the number of children living in city shelters have doubled since 1986. According to the New York Times, there are about 22,000 children living in city shelters today. This statistic has grave implications for children’s health. If these children do not have homes, their nutrition, education, and immunizations are all at risk. Economic factors have worsened the housing situation in NYC for the poor over the past few decades, and society has not come up with sufficient mechanisms to compensate for that.

 

Instead, at the national level, lawmakers seem determined to chip away at the existing social safety net even further in cuts to Medicaid under the proposed healthcare bill. Dr. Redlener told the New York Times that such cuts would leave children in more danger than ever during his career of over 30 years. He said that politicians have certainly frequently debated the parameters of what Medicaid would cover, but to gut the program as it is now being proposed had never entered the picture.

 

It is clear that we are at a critical juncture for the future of children’s healthcare, especially for children living in urban areas. Prioritizing the health of children today means preserving the societal health of the future.

 

To learn more about Dr. Relener and his work, read the full New York Times article. You can also read his upcoming book, "The Future of Us: What the Dreams of Children Mean for Twenty-First-Century America,” which will be published this September.

The Truth About Headphones

Consumers are always looking for the latest technology even when it comes to the latest audio equipment. As of late, there has been a lot of debate about the safety of headphones and earphones, and how they affect our hearing ability. A recent New York Times article discusses what this means for children’s headphones and music listening today.

 

According to a 2015 report, half of 8- to 12-year-olds in the U.S.listen to music daily, as do nearly two-thirds of teenagers. Unfortunately for them, Dr. Papsin, the otolaryngologist interviewed in the article, said “Headphone manufacturers aren’t interested in the health of your child’s ears.” Products are advertised to be noise-cancelling, “safe for young ears,” or provide “100 percent safe listening.” However, recent studies of the kinds of earphones on the market found that some of them were so unsafe that they damaged ears within minutes of producing loud music.

 

In a study to determine the relative rankings of the many kinds of earphones and earbuds available to children, researchers used two types of sounds. They used a recently released pop song and compared it to “pink noise” (usually used to test the output levels of equipment, according to the article), and found that playing the chosen pop song at maximum volume made it more likely for headphones to exceed healthy decibel levels than they did playing pink noise.

 

This means that music that adolescents prefer to play generally produce loud sound at high volume, and is impacting boys and girls alike. The gap in hearing loss rates between boys and girls is decreasing, with the rate of girls’ hearing damage catching up to that of boys. Experts agree that no headphone can replace the most effective means of controlling damage, which is adult supervision. Some practical advice from pediatricians include: “If a parent is an arm’s length away, a child wearing headphones should still be able to hear when asked a question.” In other words, according to Dr. Jim Battey, the director of the National Institute on Deafness and Other Communication Disorders, “if they can’t hear you, ‘that level of noise is unsafe and potentially damaging.’”

Forming New Year's Resolutions to Keep

Happy New Year! Many of us want to start off on the right track in the new year by making resolutions. These resolutions aren’t limited to adults; kids can make them too along with their parents and siblings! Resolutions don’t have to be notoriously difficult to keep either.

 

Many families may strive to eat healthier and get more exercise. Dr. Thomas McIerny, the former president of the American Academy of Pediatrics (AAP), pointed out the importance of these goals - they improve health and they establish healthy habits that will stay with children throughout their lives..

 

Check out the AAP’s tips for parents and kids to help you formulate healthy resolutions this year. Let’s break them down and take a look:

 

Eating:

  • Focus on developing healthy attitudes about food and where it comes from by avoiding a “clean your plate” mentality that discourages conversation about food.

  • Establish a “regular routine” of meals and snacks, and always eat meals at the table. As mentioned in our previous blog post, children who eat with family tend to experience a diverse range of foods and avoid overeating.

  • We also talked about picky eaters who can pose as a challenge to parents. But we should keep two truths in mind: when a child rejects a certain food, it’s always a good idea to try again later; parents also remain their children’s best role models.

Play:

  • Anything can become physical activity such as a walk around the neighborhood, or going out to the yard. Take advantage of this as a group.

  • Limit screen time for children. Each day brings new research that further proves that devices can distract from good sleep or ruin concentration. Televisions, phones, and video games are all ubiquitous in our daily lives, but we can take steps to limit their influence in our lives.

  • Encourage your children to participate in sports and dance teams that can introduce them to new friends while also providing physical activity.

 

Here are some tips from Stanford University’s Children’s Hospital on how to achieve these goals:

  • Make small goals: these are easier to keep, so it won’t be as discouraging if you fail to meet a very ambitious goal about a habit that takes time to develop. Establishing one activity to do each week is a great start.

  • Have roles and a buddy system: Family members can remind each other about their goals and help each other stay on track. Encourage kids to be active participants in choosing their next goal.

  • Have a rewards system: Small, non-food rewards can accumulate to bigger awards, which kids can choose for themselves (e.g. a trip to the beach or playing a favorite game).

  • Practice simple journaling: It can build awareness, according to Cindy Zedeck, director of the Pediatric Weight Control Program at Lucile Packard Children’s Hospital Stanford. Journaling can help you think about the choices you’ve made that day.

Understanding Food Allergies

We hear a lot about diverse kinds of food allergies, and whether or not they are getting more common as a whole. However, a new report published by the National Academy of Sciences says insufficient data or research methodologies make the number of people in the U.S. who actually have food allergies difficult to determine. Also, despite the general agreement among many health experts that food allergies have increased over time (and not just due to better methods of diagnosis), it remains difficult to confirm this with data.

 

According to an NPR report on this announcement, an important reason for the difficulty in getting these numbers is that it is challenging for parents to recognize and diagnose their children’s allergies. Food allergies and other conditions, like lactose intolerance, sometimes have “[overlapping] symptoms,” as explained by Dr. Virginia Stallings, a nutrition pediatrician at the Children’s Hospital of Philadelphia, for the NPR article. The difference is that food allergies can potentially be dangerous, while lactose intolerance, while very uncomfortable, does not pose an immediate danger to the person.

 

The more severe symptoms of food allergies - some examples given in the NPR report include difficulty breathing and swollen lips - should receive immediate medical attention. However, since symptoms are often milder than these, and since there is no single blood test or other procedure that precisely points out a food that a child can be allergic to, it is best to rely on expert advice to navigate the path to finding out a child’s allergy.

 

Some experts have noted that parents have their children unnecessarily avoid a food for fear of an allergy. According to a pediatric food allergy program director interviewed in the article, a common “gold standard” test that they use to diagnose a food allergy, the “oral test challenge,” is surprisingly obvious. Patients [literally] eat small portions of foods they might be allergic to, and if they start having an allergic reaction, the medical supervisor stops the test and administers treatment. Such a method might be perplexing to parents who are looking for more sophisticated science in identifying their children’s allergies, but more research is needed to develop these methods.

 

Children also sometimes outgrow their allergies, and can be determined allergy-free with the same kinds of tests. In the meantime, parents and teachers can do more to learn about children’s food allergies in case an emergency happens at home or at school when there are no nurses around. According to the article, school nurses are usually the only ones trained to administer potentially life-saving epinephrine shots in many schools. The National Academy of Sciences suggests that more school officials be trained to react to food-allergy related emergencies.

Voting: A Lifetime Habit

Election Day was already a week ago, but it’s always a good time to think about engaging with children and students about their civic duty. Research shows that voting is as much a habit as it is a privilege or a responsibility. Eligible voters who vote in their first three elections are more likely to remain lifelong voters, according to the New York Times.

 

The United States is an advanced democracy, and one in which parents have a major influence in forming their children’s voting habits. Partisan leanings aside, the act of going to polling stations with our parents on election day itself (or sending in ballots beforehand) is something that positively influences us as citizens. As an example, Dr. Perri Klass, the author of the New York Times article, said, “In fact, if you look at the American Academy of Pediatrics website for parental advice, you will be told, ‘Children do best when routines are regular, predictable and consistent.’” Voting routines are not necessarily the same thing as annual physical exams or making daily healthy decisions to eat right and getting exercise, but they are a building block for children to make empowering, healthy decisions that will last them a lifetime.

 

Although American citizens may not be old enough to vote until they are 18 years old, children can still observe how adults in their lives approach national and local elections from a young age. One  good way to teach children about voting at elementary schools where they are often doubled as polling stations every four years. In some of these elementary schools, young children can accompany their parents in these polling booths. Dr. Klass wrote that civic engagement as part of a family’s daily life - talking about politics at dinner or actively participating in student government - cements habits that stay with students as they grow up and become eligible for elections as young adults.

 

Our most recent election exposed many fault lines in the country, and has been one of the more divisive ones in recent memory. Yet the health of the voting public depends on voters who will return to the polls to vote about the issues that they care about the most, and to pass this behavior to their children. Parents may have mixed feelings about exposing their children to politics at a young age, but there is no denying that parents have a major influence in their children’s future by teaching them to voice their beliefs on the ballots at a young age.

Picky Eaters and Their Families

We may often be quick to judge a child or their parents when we see a picky eater. Picky eaters can be perceived as unadventurous or a product of poor parenting skills. However, parents of picky eaters have more to worry about than social judgement. Pediatricians say that children who develop picky eating at an early age can have growth and development problems.

Parents of picky eaters have real reason to worry about their children’s proper intake of proteins, vitamins and minerals, and vegetables. After all, a child’s appetite is a major indicator of his or her health. Picky eaters are also hard to pinpoint because they generally eat as much as other children do, and they can also be thin or overweight. This means that even though they are probably not eating properly, they are getting their caloric intake in ways that are not nutritionally ideal. Parents look to pediatricians to reassure them that their child is growing at a normal rate, which is usually the case. However, in rare instances, doctors will test for developmental disorders like autism, gastrointestinal disorders, or food allergies. These abnormalities are definitely not the norm, but even the original issue alone - pickiness - can be a cause of major stress for parents.

Here are three tips that parents can do to alleviate picky eating habits:

  • According to Dr. Natalie Muth, a pediatrician interviewed for the New York Times, it’s important to expose children to new flavors even while their mother is pregnant and breastfeeding. It is ideal for children who are starting to eat solid foods (between 6 and 18 months) to have frequent exposure to many different foods at an early age.  

  • It’s ultimately up to the child to choose what to eat. Pediatricians recommend following a division of responsibility at the table: parents can provide diverse food choices and show that other family members, including other children, are trying different kinds of food.

  • Children who are learning about tastes may exhibit some sort of neophobia - fear of the new and unknown. They may be partial to eat “white foods” such as fried foods, breads, rice, and chips. Families who cater to children who are partial to these foods by giving them separate meals from everyone else in the household are actually encouraging picky eating.  In the New York Times article, Dr. Muth suggests that one family should eat one meal together. By eating one meal as a family, children can be eased into different types of food as they watch other family members eat the same meals.

Training young children at an early age to appreciate a variety of foods will help children develop healthy eating behaviors, therefore benefiting their health in the long run. Parents can help with children’s learning process by actively engaging with them to establish a dialogue about their food preferences. That way, parents can also encourage autonomy and responsible decision-making in their children by allowing them to make healthy food choices. The act of eating itself can be an activity for the family, and a way for a child to invest in his or her future.

Accurate Dosages for Children's Cold Medicine

Cold and flu season is approaching, which means parents will soon be giving their children liquid medications to relieve symptoms. According to a study published in this month’s issue of Pediatrics, many parents make errors giving liquid dosage medication, yet research on ways to improve dosage techniques and clarifying medication labels for parents has been limited.

In their findings, a team of researchers used a randomized control trial in three urban pediatric clinics, and assigned English or Spanish-speaking parents into one of five treatment arms. After parents were separated into groups, they were asked to measure nine doses of medication by filling three different dosages using three different tools, including a cup and oral syringes with varying increments. The team found that more than 80 percent of the parents made at least one dosing error, with more than 20 percent who doubled the intended dosage amount.

Different health literacy groups also found that parents made more errors with dosage cups than they did with syringes. After all, if a cup is not held at eye level, it is easy to misread the amount of liquid actually in the cup. In addition, a higher rate of error was made when using a teaspoon-only label rather than using a mL-only label. Researchers concluded that using syringes instead of cups would improve accuracy overall, but simply replacing the tool without proper language support will not have the desired effect.

Medication for children is unique in their liquid formulation, but this poses a challenge for consistent accuracy. The FDA and the American Academy of Pediatrics (AAP) recommend the use of tools when administering children’s liquid medications, but no national guidelines for the provision of these tools to parents currently exist.

The FDA and the AAP’s establishment of these guidelines would greatly benefit parent’s health literacy, which is an important factor in their children’s health. The amount of medication they give their children is only a part of the big picture. Parents of all language and income backgrounds who work closely with their children’s pediatricians should ensure that they are using correct methods and tools for their children.

Click here to read the full study.