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Posts for: March, 2014

By contactus@napeds.com
March 26, 2014
Category: In the News
Tags: Untagged

Children watching more TV tended to get less sleep

March 10, 2014 / Author: Tara Haelle / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(dailyRx News) It may be tempting to park a child in front of the TV for a couple hours a day. But that peace and quiet may backfire if the child sleeps less at night.

A recent study found that the more TV preschool children watched during the day, the less sleep they generally got at night. The study looked at preschool-aged and elementary-aged children and was based on parents' observations.

The authors concluded that limiting the hours children spend watching TV may be best for their sleep schedules.

"Limit your child's hours watching TV."

The study, led by Marcella Marinelli, PhD, of the Center for Research in Environmental Epidemiology in Barcelona, Spain, looked for links between how much TV children watched and how much sleep they got.

The researchers analyzed the data provided by the parents of 1,713 children in three Spanish cities.

Parents tracked their children's average hours watching TV each day when the children were 2 and 4 years old in two of the cities. The parents of the children in the third city tracked their kids' hours of daily TV time when their children were 6 and 9 years old.

The parents also reported how many hours of sleep their children got each night on average.

The researchers found that both boys and girls who spent more time watching TV tended to sleep for shorter periods of time.

During the first collection of data, when the children were younger, those who watched at least 1.5 hours of TV a day slept less compared to children who watched less TV.

During follow-up when the children were older, some who had previously watched TV for less than 1.5 hours were now watching it at least 1.5 hours a day or more.

These children also were found to be sleeping for shorter periods of time than their peers who were still watching TV less than 1.5 hours a day.

Then the researchers compared each hour of television watching to each hour of sleep across all the children to see if there was a link.

They found that the two were linked, even on weekends and after taking into account other factors that might influence sleep.

The more TV the children watched, the less sleep they got, even after considering any attention deficit hyperactivity disorder symptoms in the children and their levels of physical activity.

The researchers also considered the parents' mental health, the mother's IQ, the mother's physical health, the parents' level of education and the parents' marital status, but none of these factors changed the results.

"Children spending longer periods watching television had shorter sleep duration," the researchers wrote. "Parents should consider avoiding long periods of daily television exposure among preschool and school-aged children."

William Kohler, MD, the medical director of the Florida Sleep Institute in Spring Hill, Fla., said the study may have been more helpful if the authors had reported both the hours of sleep the children got and the hours of TV the children watched.

Nonetheless, he said, the study offers an important takeaway.

"The bottom line still is that diminished quality or quantity of sleep can lead to cognitive or behavioral problems," he said. "Anything that interferes with getting that sleep, such as the TV watching reported in this article needs to be eliminated or reduced."

The study was published March 10 in the journal JAMA Pediatrics. The authors reported no conflicts of interest.

The research was funded by the Spanish Ministry of Health, the Carlos III Institute of Health, the Generalitat de Catalunya-Consell Interdepartmental Research and Innovation Technology, the Generalitat Valenciana Health Department, the European Union, the European Commission, the Roger Torné Foundation, and the Caixa Fellowship of the Fourth Call for Aid to Research in Neurodegenerative Diseases.


By contactus@napeds.com
March 20, 2014
Category: In the News
Tags: Untagged

Docs oppose retail-based clinics for kids' care
Michelle Healy, USA TODAY12:02 a.m. EST February 24, 2014

Pediatricians' group says retail-based clinics are not ideal for providing regular, permanent care for kids' health issues.

  •  The AAP policy statement opposes the use of retail-based clinics for kids' regular health care
  •  Pediatricians say their expertise and the medical home should be the standard of care
  •  There are just over 1,600 retail-based clinics in 39 states and the District of Columbia

Families often turn to retail-based health clinics such as CVS' MinuteClinic, Walgreens' Healthcare Clinic or Kroger's The Little Clinic when a child is sick or needs shots. But the nation's largest group of pediatricians opposes such facilities for children's primary care, saying they do not provide the high-quality, coordinated preventive health care kids need.

In an update to its 2006 policy statement, released Monday, the American Academy of Pediatrics says that retail-based clinics (RBCs) are "an inappropriate source of primary care for pediatric patients, as they fragment medical care and are detrimental to the medical home concept of longitudinal and coordinated care." A medical home refers to a central provider who coordinates a child's medical care.

Although the basic message and stand from the academy have not changed since the 2006 statement, "the number of clinics has grown and they are used much more," says pediatrician James Laughlin, lead author of the statement and medical director for pediatrics at IU Health in Bloomington, Ind.

"If these entities are going to take care of children, there should be certain standards adhered to in terms of communicating back to the pediatrician or having some sort of relationship with a pediatrician locally so that a child can be referred back to their pediatrician for ongoing care."

Continuity of care is of particular concern because a child may be seen in a clinic earlier in the day, but if a related situation arises late in the evening or during a clinic's off-hours, "they traditionally don't have any kind of after-hours availability," says Laughlin, adding that AAP encourages its members to provide accessible hours and locations as part of a medical home.

Filling a gap when a child's pediatrician is unavailable is a primary service provided by the clinics, says Tine Hansen-Turton, executive director of the Convenience Care Association, the trade group representing the clinics.

"They are a more convenient option for parents with sick children rather than the alternative, which is often waiting for an appointment while the child is sick or spending hours in a high-cost emergency room for a minor pediatric complaint."

Unlike free-standing urgent care clinics, RBCs are located within stores, almost exclusively use nurse practitioners or physician assistants to provide care, and offer a limited range of services.

Currently, there are just over 1,600 RBCs in 39 states and the District of Columbia that have served more than 20 million consumers to date including children, according to Hansen-Turton.

About 20% of the patients seen at MinuteClinic are children, says Andrew Sussman, president of the largest chain of retail-based medical clinics in the U.S. with 815 clinics in 28 states and the District of Columbia. It expects to add 150 new clinics this year.

"MinuteClinic adheres to the principles (the AAP) outlines," says Sussman, a physician who previously practiced internal medicine. "We are very supportive of the medical home and the important role that the pediatrician plays, and we really see ourselves as complementary and supportive of that role."

He notes, for example that it uses evidence-based guidelines when determining what care to provide, automatically provides parents of pediatric patients with a list of pediatrician referrals if they don't have a medical home, and, with the parent's permission, sends a note about the care it provided back to the family pediatrician.

"Increasingly that's done electronically," says Sussman, adding that it has official clinical affiliations with 30 major health systems across the country, including UCLA Health, Cleveland Clinic and Emory Healthcare.

"We agree that the pediatrician should be the quarterback of the team, but we also think there's an important role for walk-in-care that's low cost and evidence-based," he says.

Finances are addressed in the AAP statement, which notes the importance of the medical home in ensuring "that pediatricians and other primary care physicians receive adequate compensation for the continuous, coordinated, and comprehensive health care that they provide."

"It's important to recognize the expertise of pediatricians, because that's what they do 100% of the time," says Laughlin. "I think there are instances where it is reasonable to use a retail-based clinic, such as if you're traveling or if you have a time crunch and you feel like that's where you need to go to get immediate care. But make sure that the information from that visit gets transmitted back to your pediatrician because the medical home is the optimal standard of care for pediatric patients," he says.

As a reminder NAP has extended hours Monday –Friday till 8 pm and we are open all day on Saturday and Sunday.


By contactus@napeds.com
March 13, 2014
Category: In the News
Tags: Untagged

Vaccines Prevent Millions of Infections, Save Billions in Costs: CDC

But messages about immunization benefits often don't achieve intended goal, researchers discover
By Serena Gordon
HealthDay Reporter

MONDAY, March 3, 2014 (HealthDay News) -- Childhood vaccines have the potential to prevent 42,000 early deaths and 20 million cases of disease among Americans born in a given year, according to a new analysis.

The investigation of children born in 2009 found that vaccinations save billions of dollars in both direct and indirect health care costs. But in a second study, researchers also discovered that efforts to educate parents about the effectiveness of vaccines are falling short.

Both studies are published online March 3 and in the April print issue of Pediatrics.

In one study, U.S. Centers for Disease Control and Prevention researchers looked at nine vaccines on the routine childhood immunization schedule. Implementing the schedule for babies born in 2009 resulted in a cost savings of nearly $69 billion, said Shannon Stokely, associate director for science in the immunization service division of the CDC.

"The childhood immunization program is a highly cost-effective program that's saving lives," said Stokely.

For every dollar spent on the routine immunization program, $10 was saved, the study found.

"The last time this type of analysis was done was in 2001. At that time, for every dollar spent, $16 was saved," said Stokely. She said higher vaccine prices and a larger infant population reduced the cost savings in the latest analysis.

Since the last analysis, three new vaccines were added: hepatitis A, rotavirus, and a vaccine to protect against certain types of pneumonia, meningitis and ear infections -- the pneumococcal vaccine.

A vaccine expert who was not involved with the study, Dr. Kenneth Bromberg, director of the Vaccine Research Center at the Brooklyn Hospital Center in New York City, said it's clear that vaccines save lives.

"This study looks at the economic costs of the disease, and vaccines pay just based on that. But we also have to remember the quality-of-life benefits, and the value of a life saved that can't be measured," Bromberg said.

The second study, conducted online, found that current public health messaging doesn't change existing parental attitudes about vaccines. The existing approach may even increase some misconceptions or make parents less likely to consider immunizations.

For this study, researchers surveyed more than 1,700 parents across the United States. Parents were randomly assigned to see one of four vaccine-related messages, or assigned to a group that was given a message having nothing to do with vaccines.

One vaccine-related message explained that there was a lack of evidence that the measles, mumps, rubella (MMR) vaccine causes autism. Another message provided information about the dangers of the diseases prevented by the MMR vaccine. A third message had a mother talking about her infant's battle with measles that included hospitalization. The fourth message featured pictures of children with vaccine-preventable illnesses.

The study found that none of these messages increased parents' intentions to vaccinate their children. Explaining the lack of evidence for a connection between the MMR vaccine and autism did reduce misconceptions among all parents, but decreased the intent to vaccinate in parents who had the least favorable attitudes toward vaccines.

Parents shown images of children with disease were more likely to believe there was a link between autism and vaccines, while those who read the mother's story about her child's measles increased their belief that vaccines cause serious side effects.

"Current public health communications about vaccines may not be effective," wrote the study's authors. They said more study of pro-vaccination messaging is needed to determine an effective way to communicate with parents about vaccine benefits and safety.

"Horror stories never work," said Bromberg. "What's important is to have an ongoing relationship with your child's pediatrician. When trust is there, communication can be more open and effective. With more time to present a message, there may be more positive outcomes.

"And you probably need different approaches for different individuals," added Bromberg.

But the message of vaccine benefits is reaching most parents. "The number of kids that have received no vaccines is less than 1 percent. And for most vaccines, the rate of vaccination is very high. Vaccination is the norm in the U.S.," noted Stokely.

More information
Learn more about how vaccines are developed from the U.S. Centers for Disease Control and Prevention.

SOURCES: Shannon Stokely, M.P.H., associate director for science, immunization services division, U.S. Centers for Disease Control and Prevention; Kenneth Bromberg, M.D., director, Vaccine Research Center, and chairman, pediatrics, The Brooklyn Hospital Center, New York City; April 2014, Pediatrics

Last Updated: Mar 3, 2014


By contactus@napeds.com
March 07, 2014
Category: In the News
Tags: Untagged

Sound machines for babies: Too loud? Too close?
By Elizabeth Landau, CNN
updated 2:41 PM EST, Mon March 3, 2014

STORY HIGHLIGHTS

  •    Many parents use noise machines to help their babies sleep
  •    A study says some of them may be too loud and too close
  •    The noise should be as loud as "a soft shower," one pediatrician says
  •    Volume matters more than duration, says another expert

(CNN) --Parents: You want your baby to sleep soundly so that you can sleep too, right?

So maybe you bought a machine that will play soothing sounds in the nursery. And maybe you crank up the volume so that your kid doesn't hear sirens outside or household noises.

But how loud should these machines be? How long should you keep them running? Should you put them close to your baby's ears, or on the other side of the room?

A new study in the journal Pediatrics suggests that some noise machines have the ability to produce sounds so loud that they exceed safe levels for adults, let alone infants, and therefore could potentially damage infants' hearing and hinder auditory development.
dangerous

However, it's important to note that the goal of the study was to measure the maximum effective output levels -- not to observe direct effects on children. Experts disagree on what recommendations should be given on using these machines.

"These machines are capable of delivering enough of a dose over a period of time to theoretically cause hearing loss, but that's not been tested," said the study's senior author Dr. Blake Papsin, who is affiliated with the University of Toronto and the Hospital for Sick Children in Toronto.

Researchers tested 14 infant sleep machines at maximum volume, analyzing the noise level production from distances of 30, 100 and 200 centimeters. The 30-centimeter measurement resembles a typical distance from a baby's head to the crib rail; 100 centimeters would be near a crib and 200 centimeters would be across the room from a crib.

The particular machines are not named in the study, but researchers said they are "widely available in the United States and Canada." Papsin declined to reveal which products were used.

These machines play a total of 65 different sounds, including white noise, "nature" sounds, mechanical sounds and heartbeat sounds.

Hands-off approaches OK for sleepless infants, study says

Hospital nurseries and neonatal intensive care units have set a noise equivalent of 50 decibels on average over the course of an hour, according to the study. Canadian and U.S. occupational health and safety authorities have recommended a workplace limit of 85 decibels over eight hours for adults.

Three of the infant sleep machines in this study had outputs greater than 85 decibels, which exceeds that recommendation. Additionally, if these sound devices were played continuously for an eight-hour period, the researchers wrote, "infants would be exposed to sound pressure levels that exceed occupational noise limits" for that time period for adults.

The study authors recommend manufacturers be required to limit maximum sound output levels of such machines, print warnings about noise-induced hearing loss on the packaging and include a timer that would shut the device off after a given period.

They also recommend families place these infant sound machines as far away as possible from the infant -- never on the crib rail or in the crib, the study said. The machines should be played at a low volume and for a short time, study authors say.

But wait a minute! Don't we want unwanted noises blocked from infants' ears all night long?

Dr. Harvey Karp, pediatrician and author of books including "The Happiest Baby on the Block" and "The Happiest Baby Guide to Great Sleep," says he has concerns about some of the study's conclusions.

It's true that intensity of sound is important to consider, he said. Concretely, parents should look to make these machines as loud as "a soft shower," he said, and keep them at least a foot (30 centimeters) away from the child's head.  But as far as only using an infant sleep machine for a short time, that recommendation is misinformed and is" not supported by the data in the study," he said.

Karp instead recommends keeping the noise going for the entire duration of sleep, because otherwise the baby will have more disturbances in the middle of the night.  "The white noise is there as a continual presence, just like a teddy bear," Karp said. "It's like a teddy bear of sounds."

Papsin stands by the opposite recommendation in the study, saying that using infant sleep machines over eight-hour stretches is not supported by scientific evidence.

Dr. Harvey Karp: Sleeping babies and kids make happy parents.    Karp points out the Pediatrics study did not directly address this question with data, nor does it give an overall assessment of risk. Papsin and colleagues were not able to give an estimate of how those risks would weigh against the benefits of the noise devices, either.

The Juvenile Products Manufacturers Association, a trade organization representing manufacturers of 95% of prenatal to preschool products, responded to the study in a statement: "JPMA encourages parents to follow manufacturer guidance and instructions, and to use products as designed and intended. The safety and care of children is JPMA's highest priority."

So what's a parent supposed to do?  There just hasn't been a lot of research into this question of what effect these infant noise machines have, says Patti Martin, director of audiology and speech pathology at Arkansas Children's Hospital.

Her bottom line: The issue with the machines is how loud they are, not the amount of time they are used. She also likes the idea of keeping the machines out of the crib because closer noises sound louder to the developing auditory system.  An infant's ear canal is smaller than an adult's, so in babies higher-frequency sounds are amplified, the study said. Evidence from animal studies suggests that risk for age-relating hearing loss may result from early exposure to noise.

Low-pitched, rumbly sounds are better for a baby's sleep, Karp says, as they are "reminiscent of the experience in the womb." Exposing the infant to very loud sounds in short spurts is fine -- a baby's own cry is 10 times louder than a hair dryer! -- but for promoting sleep, he says, aim for softer and lower-pitched.  Of course, there are other ways to soothe your child to sleep, such as swaddling or holding a baby close, Martin says.

Depression and baby sleep: Vicious cycle?  No one knows the long-term implications of masking environmental sounds in infants, in terms of how they will learn later in a noisy environment, Martin says.

On the other hand, a good night's sleep for baby is critical for the health of both parent and child.

"From a safety issue, from a nutrition issue, from a growth issue, all of those sorts of things -- sleep is critical for them," she says. "There will always be a group of babies that require a little extra something."


Kids' Checkups Should Include Cholesterol, Depression Tests, Doctors Say

HIV screening also recommended under revised American Academy of Pediatrics guidelines
By Serena Gordon
HealthDay Reporter

MONDAY, Feb. 24, 2014 (HealthDay News) -- Doctors should test middle school-age children for high cholesterol and start screening for depression at age 11, according to updated guidelines from a leading group of U.S. pediatricians.

Doctors should also test older teens for HIV, the AIDS-causing virus, the revised preventive-care recommendations from the American Academy of Pediatrics say.

The new screening schedule provides "the recommended content for a well-child visit," said Dr. Joseph Hagan, co-editor of the guidelines. "Some changes are small, some will get people's attention."

The changes attempt to address several pressing health issues affecting U.S. families today. The nation's obesity epidemic means that children are developing high cholesterol levels -- a risk factor for heart disease -- at earlier ages. And depression is linked to higher risk for teen suicides and murder.

"One in five kids will, at some point in time, meet the criteria for depression," said Hagan, a professor in pediatrics at the University of Vermont College of Medicine.

Here are the most significant changes to the guidelines, published online Feb. 24 in the journal Pediatrics:

·         Depression screening at ages 11 through 21. If depression seems likely after asking suggested questions, doctors should assess its severity and make appropriate referrals to a social worker or psychologist for further evaluation and treatment. In some cases, a pediatrician might prescribe antidepressants, said Hagan.

The key question to ask parents of a child diagnosed with depression and suicidal thinking is if they have firearms in the home. "If the answer is yes, you have to ask parents to please remove the firearms to someone else's home," he said. "Do not try to lock them up. Or keep the ammunition separate from the gun. A smart, determined adolescent will get to them."

·         Cholesterol screening between ages 9 and 11. Hormonal changes make it difficult to get an accurate cholesterol reading during adolescence, so the doctors' group recommends screening before puberty's onset.

Lifestyle changes, rather than medication, usually will be recommended to control elevated cholesterol levels, thus reducing potential heart risks, Hagan said. These include eating healthier foods and getting more exercise. A cholesterol screen at this age also can catch cholesterol conditions that are passed down from parents, Hagan said.

·         HIV screening between 16 and 18 years old. The earlier you diagnose someone with HIV, the sooner essential treatment starts, said Hagan. New medications can keep someone symptom-free for many years. "By diagnosing early, we can change the course of the disease," said Hagan.

·         Critical congenital heart disease screening for all newborns. An oxygen saturation test called pulse oximetry should be performed on all newborns. Hagan said this is already the standard of care; the academy just formalized the recommendation.

·         No Pap smears and checking for precancerous cervical changes in girls before age 21. Research showed that it was "not unusual to find abnormalities," said Hagan. The problem was, those abnormalities often never amounted to anything serious. But additional tests, such as biopsies, were frequently done, needlessly raising costs and anxiety.

Because the new recommendations "were carefully vetted for the presence of medical evidence, most insurers already cover them," Hagan said. And they are also covered under most plans in the Affordable Care Act.

The updates didn't come as a surprise, said one children's doctor.

"Many of these changes were ones we anticipated," said Dr. Kristin Hannibal, clinic director of the Primary Care Center at Children's Hospital of Pittsburgh. "The major stumbling block is always how do we take these recommendations and implement them across the board."

Formalization of the recommendations will make it easier to obtain insurance reimbursement, Hannibal said.

Hagan said that parents should feel empowered to ask their pediatricians if they're following the Bright Futures guidelines.

"If a practice isn't following the guidelines, parents can encourage them to do so," suggested Hagan.

More information

Learn more about what to expect at well-child visits from the U.S. National Library of Medicine.

SOURCES: Joseph Hagan, M.D., co-editor, Bright Futures Guidelines for Health Supervision of Infants, Children and Adolescents, American Academy of Pediatrics, and pediatrician and professor, pediatrics, University of Vermont College of Medicine, Burlington; Kristin Hannibal, M.D., clinic director, primary care center, and interim clinical director, child development unit, Children's Hospital of Pittsburgh; March 

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