The American Academy of Pediatrics recently doubled their recommended daily amount of vitamin D for our kids – and many kids weren’t getting enough even before this change. The more closely we look at vitamin D, the more we learn about how important this sunshine vitamin is to both short and long-term health for children. I’m happy to see the new level at 400 IU.
A preliminary study presented at the 2008 annual meeting of the American Academy of Allergy, Asthma, and Immunology found that children with low levels of vitamin D have a higher chance of asthma attacks. The results support other research that looks at how vitamin D might help prevent or reverse asthma and eczema. Other studies suggest that adequate vitamin D might slash the risk of diabetes as well as some cancers and neurologic diseases.
What should we do? Since 2002, chronic prescription medication use in children 5 to 19 years old has skyrocketed, according to a study in the November 2008 Pediatrics. Leading the way, prescriptions for type 2 diabetes in kids have more than doubled, with the highest rise in girls aged 10 to 14. Asthma medication use is up more than 46 percent, ADHD medication use up more than 40 percent, and cholesterol medication use up by 15 percent, all in a very short time. Blood pressure medication use and anti-depressant use are also up since 2002. The increases are seen in both boys and girls, but are accelerating faster in girls (about twice as fast with antidepressants and ADHD medications, about three times as fast with type 2 diabetes). What’s causing these dramatic rises? Why are they faster in girls? I suspect we are seeing the effects of a combination of factors: the diseases becoming more common, the diagnoses becoming more likely to be considered, and treating kids’ chronic conditions with prescription medications becoming more likely when a diagnosis is made.
Like other pediatricians across the United States, today I received an E-Breaking News Alert from the American Academy of Pediatrics concerning news about bisphenol A (BPA), a chemical used in many hard plastic products (including baby bottles and sippy cups) and in the lining of many metal cans (including cans of infant or toddler formula). Now the panel of independent experts convened by the FDA has sharply criticized the previous FDA announcements that BPA is safe for infants and children in common exposure amounts. I agree with this criticism, and while there are many questions that still remain about the effect of BPA on kids, I can’t see a scientific basis for declaring it safe. I recommend that parents take prudent steps to decrease their children’s BPA exposure, such as breastfeeding, using BPA-free bottles, cups, teethers, etc., such as those made by BornFree*, and if formula is used, choosing powdered formula where practical (the BPA is more likely to contaminate a liquid), and avoiding heating any BPA-containing container. I also recommend avoiding phthalates and PVC in plastics. For more information, check out Raising Baby Green.
Think twice before picking up that remote if someone in your home has a cold! Researchers from the University of Virginia, armed with DNA swabs, did a CSI-like evidence hunt in the homes of 30 people with early cold symptoms. Where did they find the virus? The most reliable spot was on salt and pepper shakers, found on every single one tested. The virus was also found on 80 percent of bathroom faucet handles, 75 percent of dishwasher handles, 60 percent of remote controls, 57 percent of refrigerator handles and phones, 33 percent of doorknobs, and 23 percent of light switches. Next, the researchers tested to see if the virus would stick to the fingers of healthy folks when they grabbed a handle, answered the phone, or flicked a switch – 48 hours after the virus was left there. More than half the time it could be found on their fingertips. This is further evidence that the chain of infection often goes from nose to hand to object, then from object to hand to nose, mouth, or eyes. Cleaning you hands is one of the best ways to break the chain. Continue reading »
Thomas Jefferson had a radical notion: When the people are well-informed, they can be trusted to govern themselves. This powerful idea worked to end our rule by the King, but at the time it didn’t apply to slaves; it didn’t apply to women. It STILL doesn’t apply to patients.
I like that he used the word trust, by the way, perhaps the most used word at this conference. It isn’t just something we need to get from people in order to succeed. Trust is a two-way street. So is satisfaction.
In my lifetime, the primary focus of healthcare has moved, first from the hospital to the outpatient visit (”let’s do all we can to take care of people as outpatients”), then from offices and clinics to the home (most health decisions are made at home, often at the home computer). Today health is mobile; it is moving from the home to wherever people are. In other words, we are at the beginning of patient-centered medicine…
When the American Academy of Pediatrics came out with their recommendation against cold medicines for children under the age of 6, parents started searching for alternatives. The good news is that families have a number of alternatives to traditional over-the-counter decongestants, antihistamines and cough suppressants.
It’s worth remembering that what we think of as cold symptoms are mostly tools the body uses to get rid of the virus. A low-grade fever is inhospitable to many viruses and activates our immune system. Congestion is the dilation of blood vessels, bringing needed supplies to the scene of the battle. Mucus traps virus particles and starts moving them away. Coughing and sneezing forcefully eject the virus from the body. Fatigue helps you get the rest you need to heal. The goal of any treatment is to gently do what it takes to make a child comfortable while the body does its healing work.
Last year an advisory panel of independent experts convened by the FDA recommended that the FDA ban popular over-the-counter oral decongestants, antihistamines and cough suppressants for children under the age of 6 with colds. Recently large drug companies have voluntarily decided to advise parents not to give these medicines to kids under 4.
I agree with the American Academy of Pediatrics, many medical experts and many consumer advocates who support this ban. It’s not that we want to remove effective remedies for young children with colds. The problem is that they have not clearly been proven to be better than a placebo at treating cold symptoms at that age. These medicines were originally approved by the FDA based on studies conducted in adults. It turns out that children’s bodies before puberty behave differently than adults. These medicines appear to be both less effective and more risky.
Today at our annual meeting in Boston, the American Academy of Pediatrics doubled the recommended amount of vitamin D that children get each day to 400 IU, in response to mounting evidence of the life-long health benefits of getting plenty of the sunshine vitamin. I applaud this move, and have felt for some time that the old 200 IU recommendation was too low. Taking the vitamin daily will be important for many kids, because they do not get enough from their sun exposure and diet. Over the summer, research showed an astonishing forty percent of healthy babies and toddlers were not getting enough – and the same was true of American teens. The more closely we look at vitamin D, the more we learn about how important this sunshine vitamin is to both short and long-term health for children. Exciting research has linked getting abundant vitamin D to helping to prevent asthma, eczema, diabetes, and cancer – among other things. It’s become more difficult to get enough vitamin D in recent years because kids spend more time indoors, wear more sunscreen (appropriately), eat less tuna (because of mercury concerns), and drink less vitamin D-fortified milk (in favor of sweetened drinks with less nutrition). It would take a quart of milk a day to get the levels now recommended.
I just heard from Gary Kreps, Professor of Health Communication at George Mason University and e-patient pioneer, reporting about drastic cutbacks to the Cancer Information Service programs. Excellent up-to-date information is an important foundation for Participatory Medicine. The National Cancer Act mandated that the National Cancer Institute provide the latest cancer information to the general public. To do this, NCI should be expanding the Cancer Information Service, not slashing its programs. The CIS has been an invaluable resource for many of us.
We are in an economic time when any discretionary spending should be considered very carefully. But new cancer diagnoses will continue, in good times and in bad. We will need to spend money on this problem one way or another. I suspect that widely disseminating the best information on prevention, diagnosis, and treatment of cancer is one of the most cost-effective investments we can make in this area. If you agree, you may want to help mobilize congressional support.
By the way, for those of you who know Gary, he is in Milan for the month teaching a seminar on Communication and Cancer at the University of Milan. He is an expert on the research surrounding the impact of the major cancer information deficits in our society, and surrounding the power of quality information to improve outcomes. If you haven’t had a chance to hear him speak, do.
At Farm Aid 2008, Willie reminisced about his growing up in Abbott, Texas, where his family grew some of their own food in a small garden. He sees the local community model from his childhood as a workable solution to many of our larger problems of today. While I don’t see the short-term promise of ethanol crops that Willie does, I do see that choosing organic foods can reduce our oil dependence by eliminating the oil-based pesticides and oil-based fertilizers — up to forty percent of the oil used on conventional farms. I love Willie’s idea of doing locally what we can do well locally, while at the same time benefiting from the larger global community for things that we do better together. Here’s two minutes of Willie Nelson on the past and the future:
Is a ceiling fan for the nursery a great baby gift? I love finding simple ways to protect kids, and fans may be exactly that – a way to protect babies from one of parents’ greatest fears: sudden infant death syndrome, or SIDS. Thankfully, SIDS cases have already dropped by more than half since 1992, to only about 1 in 1900 babies. Even though SIDS is now uncommon, it remains the leading cause of death in babies after the first weeks of life and a gaping tragedy for the families who experience it. The big drop in SIDS over the last 15 years has been attributed to the campaign to have babies sleep on their backs. The theory goes that when babies sleep on their tummies carbon dioxide may pool around their nose and mouth; re-breathing this carbon dioxide may be the trigger for SIDS. This is consistent with observations that SIDS is more common with soft bedding and when the baby’s head is covered during sleep. Others are concerned that fumes, including secondhand smoke, may play a big role in triggering SIDS. If either idea is right, gently improving room ventilation could make a big difference. Continue reading »
There is an intense ongoing debate about the safety of bisphenol –A, or BPA, an ingredient found in many plastic products including many baby bottles and reusable water bottles. BPA acts like a hormone in the human body. More than 90 percent of us do have small amounts of BPA in our bodies. On the one hand, the plastics industry and the FDA assure parents that BPA is safe. They have no concern, even for babies, at the doses we are commonly exposed to. Meanwhile, scientists in another part of the federal government, NIH’s National Toxicology Program and the Center for the Evaluation of Risks to Human Reproduction, do have some concern that these low doses affect “the brain, behavior, and prostate gland in fetuses, infants, and children at current human expo¬sures to bisphenol A.” They also think it possible that BPA is causing lasting changes in girls’ breasts and that it is causing an earlier age of puberty for girls who are exposed as fetuses, babies, or children “at current human exposures to bisphenol A.” Many scientists and Continue reading »
