Category Archives: Family health

Hand sanitizers: read the label

Today’s Health Matters guest writer Mylan Blomquist, a senior at Barry Goldwater high school, decided to get to the bottom of how hand sanitizers work, and which ones are most effective.    

As a high school student with a lot of obligations, I’m somewhat of a hand sanitizer connoisseur.

I’ve always carried a portable sized gel hand sanitizer around with me, hoping that it is effective in fending off illnesses that would force me to miss school. It seems like everyone else has one in their school bag, too, with a variety of scents and fun holders.

Recently, I received an assignment from my senior IB biology class –to design and carry out lab research on a topic of my choosing. I was about to stress over this, thinking about how hard it would be to come up with my own unique topic.

But I soon realized the answer has been hiding in all my purses, backpacks, and pockets for years! Continue reading

Understanding pediatric sudden cardiac arrest (SCA)

Would you recognize the warning signs of pediatric sudden cardiac arrest (SCA)? If not treated in minutes, SCA can result in death.

In a new policy statement to be published online on Monday, March 26, the American Academy of Pediatrics (AAP) provides guidance for pediatricians on underlying cardiac conditions that may predispose children to SCA.

Although the risk for SCA increases when children with underlying cardiac disorders participate in athletics, SCA can occur at very young ages and also when a child is at rest.

Research supports the need for a SCA registry, says the AAP. A registry would help experts gain a better understanding of the nuances of the condition.

Plus, many cardiac disorders are known to be genetic, so the evaluation of family members, even if asymptomatic, could be a critical step in the overall diagnosis of disorders predisposing to pediatric and young adult SCA.

We asked Arizona Pediatric Cardiology Consultants (APCC), members of the Arizona Chapter of the American Academy of Pediatrics, to weigh in on what parents need to know about SCA.

How common is SCA?  

According to the Centers for Disease Control, each year 2,000 individuals less than 25 years of age will die suddenly with the majority of these having a cardiac etiology.

What causes SCA?

Pediatric sudden cardiac arrest and sudden cardiac death can occur with various types of cardiac causes, including conditions in the heart muscle (such as hypertrophic cardiomyopathy), unusual positioning of a coronary artery, or an electrical disturbance within the heart. (Long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia).

More on genetic cardiac conditions from the Sudden Arrhythmia Death Syndrome Foundation (SADS)

How are family members evaluated, and what symptoms may be indicators that a child is pre-disposed to this? 

Signs that may suggest an increased risk for SCD include fainting or seizure with exercise, excitement, or startle, significant dizziness with exertion, unusual and consistent shortness of breath or chest pain with exercise.

If a family member has died suddenly or unexpectedly at a young age, has unexplained seizure disorder, died at a young age from a heart problem, or has a history of fainting, then screening is appropriate.

How do doctors determine if a child is at risk? What tests are performed?

Evaluation by a pediatric cardiologist will include a thorough individual and family history, ECG, physical exam and perhaps an echocardiogram, an exercise stress test, and genetic testing if necessary.

Would automatic external defibrillators (AED) on playing fields and in schools help?

A great majority of these deaths relate to a life-threatening arrhythmia, ventricular fibrillation. CPR and use of an AED may be life saving.  AEDs are often found in airports, casinos, and government buildings.

However, there is no law in Arizona currently requiring AED within schools, recreational sports fields, or other private facilities.

Are efforts being made to increase the availability of AEDs?

The decision about whether to have an AED on location is left up to the individual organization.  APCC’s electrophysiologists are making an effort to educate schools, sports organizations, and families regarding the importance preparation to prevent SCD.

The role of an ECG in all sports physicals remains a debated topic within the United States.  It is, however, very important to ask specific questions (use the attached screening tool) for risk factors and then refer to a pediatric cardiologist for further assessment.

What should parents or caregivers do if they believe a child might be at risk?

Once an individual is identified as having any of the conditions listed above, it is very important for first degree relatives to also be evaluated by a pediatric cardiologist even if they are not experiencing symptoms.

Sudden Cardiac Death is devastating to not only the families of those affected but to the communities in which they live.  Educating  families, schools, sports leagues, and primary care providers about quick and effective screening for children at risk for SCD is a first step in prevention.

Increased community awareness and the availability of AEDs in schools and sporting venues will help avert a tragedy.

Karen S. Eynon, RN, MSN, CPNP, MATS,  compiled these answers with support from Mitchell Cohen, MD, Andrew Papez, MD, and Jennifer Shaffer, RN, MS, CPNP, all of Arizona Pediatric Cardiology Consultants along with information from SADS.org.  

Check with your child’s physician if you are concerned about risks for SCA.

More from Parent Heart Watch, a network of parents and partners dedicated to reducing the effects of SCA.

 

New findings on what may lead kids to binge drinking

A recent study published by the American Academy of Pediatrics found that that the more exposure teens had to alcohol use in movies, the more likely they were to binge drink.

The age, affluence and rebelliousness of the teens did not seem to matter. And this pattern was observed across cultures in countries with different norms regarding teen and adult alcohol use and drinking culture.

What can parents do to make sure kids don’t pick up the cues from the many movies out these days that show alcohol use? And what are some ways that parents can prevent a child from binge drinking?

Dr. Dale Guthrie, a pediatrician in practice at Gilbert Pediatrics, says communication is the key.

Guthrie, who serves as vice president of the Arizona Chapter of the AAP, encourages parents to stay involved — and to make sure to meet and know their children’s friends, from the early days of pre-school right on through high school.

More tips from Dr. Guthrie on how to help prevent your child from using alcohol and other drugs:

  • Know where your teen is at all times.  Teens may act as if they don’t like it but teens are actually more secure knowing their parents care enough to know where they are and what they’re doing.
  • Consciously and genuinely praise your teen for something good he does every day.
  •  Make sure she knows she can talk to you about anything, at any time, if it is important to her and that she won’t be interrupted judgmentally with a lecture.
  •  Remember you are his parent, (not his best friend, afraid to step on his toes) and offer advice when requested and at opportune teaching moments in short phrases, not long lectures which are tuned out anyway.
  •  Better yet, ask inspired questions of your teen—the kind which help her arrive at the correct solution.
  •  Attend movies with your teen and then ask open-ended questions about what he thought about it.
  •  At a nonthreatening time, (not right as your teen is headed out to a movie), sit down as a family and discuss what are your family goals and standards.  As part of that, set family standards for what types of movies you will view and which are beneath your family standards.
  •  When your teen returns from being out with friends, it is helpful to have a “check-in” with parents.  If the tradition has been set that he will give parents a hug (or even a kiss) no matter what time he returns, parents will know more about what he’s been doing  just by being close to him, listening and observation.

Parents of younger children might not be thinking about the teenage years, but is there anything they can do to lower the risk that their child will abuse alcohol down the road?

Will your six-year-old become a teen drinker?

One very simple way is for parents to make sure they truly listen to their child right from the start.

Guthrie says that children need to feel that what they say is of prime importance to their parents. “Then when she has something really serious to discuss, he adds, “she will feel comfortable coming to you.”

Modeling healthy behaviors themselves, and engaging kids in conversation at opportune moments (short snippets in lieu of lengthy lectures) are other ways parents can make a difference, says Guthrie.

RAK Archives: Talking to teens about alcohol poisoning

More on talking to kids about drugs and alcohol, and upcoming Parent Workshops from the Partnership for a Drug-Free America, Arizona Affiliate

Snoring linked to behavior problems in children

Children who snore or who have other sleep-related breathing problems are more likely to have behavioral problems years later, says a new study to be published in the April 2012 issue of Pediatrics.

Researchers asked a group of parents about their children’s snoring, mouth breathing, observed apnea and behavior, starting at age 6 months and then periodically until age 7 years.

By age 4, the children with sleep-disordered breathing were 20 percent to 60 percent more likely to have behavioral difficulties. By age 7, the likelihood jumped to 40 to 100 percent.

The worst symptoms were associated with the worst behavioral outcomes, meaning that the kids who faced more serious sleep-related breathing problems also tended to be more likely to struggle with behavior issues.

Study authors conclude that sleep-disordered breathing early in life can have a strong effect on behavior later in childhood.

Kids who have these difficulties may miss out on critical periods of brain development that researchers believe take place during deep sleep.

The study findings suggest that these symptoms may require attention as early as the first year of life.

Dr. Mark Brown, pediatric pulmonologist at the University of Arizona College of Medicine, and a member of the Arizona Chapter of the AAP, weighs in on kids and snoring:

 When should a parent be concerned about snoring?

  •  When a child can be heard snoring outside of their room.
  • When a child has disrupted sleep with short “pauses, snorts, or gasps” in their sleep.
  • If the child is having behavioral problems, a short attention span and problems at school.
  • If the child, especially an older child, frequently falls asleep during the day (i.e. in the car, during a TV show or movie, while reading).
  • In severe cases, there can be difficulty with weight gain or obesity, or high blood pressure.

Is a little light snoring okay?

Light snoring without any of the above associated signs/symptoms may be “normal.” If there is any concern, the parent should consult with their child’s primary care physician.

How do you know when snoring needs medical attention?

 If any of the above signs/symptoms are seen or if the parent is unsure about the significance of their child’s snoring they should consult with their child’s primary care physician.

RAK Archives: More on the consequences of too little sleep, and what families can do about it.

RAK Resources on respiratory issues: Take a Deep Breath by Dr. Nina Shapiro

Find out what technicians at the Sleep Center at Cardon Children’s Medical Center learn by watching children sleep:


What to ask a pediatrician about breastfeeding

Exclusive breastfeeding for about the first six months of a baby’s life is best for baby, says the American Academy of Pediatrics, in a statement that reaffirms AAP policy.

The AAP wants parents to think of breastfeeding as not just a lifestyle choice, but as an investment in the short- and long-term health of their newborn.

Part of the pediatrician’s job is to encourage and support breastfeeding — as well as convey the health risks of choosing not to breastfeed.

Laurie Jones, MD, IBCLC, with her son and daughter

Laurie Jones, MD, IBCLC, one of the few pediatricians who is also a board certified lactation consultant, and a member of the Arizona Chapter of the AAP, developed a strong interest in breastfeeding after her daughter, now three, was born.

Things didn’t start out so well, says Jones, who says she almost quit on day 11. “I was a mess from exhaustion and pain and feeling like a failure. Nothing feels worse than not being able to feed your baby.”

But Jones was lucky — she found help from a skilled lactation consultant who she says “changed everything.  My husband and my mother also gave me encouragement and support in those tough first weeks.”

Getting that breastfeeding relationship on track, says Jones, “changed my life and my career forever. I took steps to become a lactation consultant in the year and a half following her birth.”

In her pediatrics practice, Jones fills a gap that she thinks has been lacking—an understanding of the critical interaction between mother and infant as part of the physician’s complete care of the patient. “Watching the baby get on the breast and observing a feed is critical to assessing a newborn or infant. I don’t feel that I have completely examined an infant until I see the baby nursing.”

Jones says that the subject of breastfeeding has been lacking in medical education. She’s out to change that. One tool she uses is a new AAP breastfeeding curriculum. She teaches medical students and residents about breastfeeding techniques, and works with the St. Joseph’s Pediatrics Breastfeeding Clinic.

In her practice, Jones provides extra-long appointments for new moms who need help. Her practice encourages mothers to nurse in the waiting room and also during painful procedures such as vaccinations.

Jones says she discusses the nursing relationship at every well visit until the child or mother chooses to wean, and supports extended breastfeeding as recommended by the AAP, the Centers for Disease Control, and the World Health Organization.

“I love helping mothers get past breastfeeding hurdles, and seeing them reach their goals, says Jones. “Nothing makes me happier than to see a mother leave my office with her breastfeeding problem solved. I can relate to so many of the issues they are dealing with because of my own experience with my two kids.  I feel like I am in the trenches with them!”

Jones says that parents should select a pediatrician who understands and supports breastfeeding and does not routinely supplement infants with formula.  Ask in advance for a clear explanation of any medical reasons for giving formula.

What should an expectant mom ask a prospective pediatrician about breastfeeding? Tips from Laurie Jones, MD, IBCLC:

  • How long do you recommend a child be breastfed?
  • Do you routinely supplement breastfed babies?
  • Do you have an IBCLC in your office?
  • Do you have a resource list for breastfeeding help if I need it?
  • Is anyone on your staff specially trained to help breastfeeding mothers?
  • Do you encourage mothers to nurse in your waiting room?
  • Do you have handouts or other support materials for breastfeeding mothers?
  • Do you encourage mothers to nurse if they desire while the baby has shots or other procedures?
  • When do you recommend solids be introduced?
  • When do you recommend a child be weaned from breast milk?
  • Do many of your patients reach the recommended 12 month mark for breast feeding?
  • Do you use the 2010 CDC growth charts based on breastfed infants?
  • Do you offer formula bags to your breastfeeding patients?
  • Does the office display formula brochures or formula bags in the front office area or exam rooms?
  • How do you feel about extended nursing and child-led weaning?
  • What resources do you use to check if a drug is safe in breast milk?

Helping children with gender identity disorder (GID)

Children who are persistently uncomfortable with their gender who display strong and consistent cross-gender behaviors may be experiencing gender identity disorder, or GID.

A new study to be published in the March 2012 issue of Pediatrics found that children who do not receive medical treatment or counseling for GID can be at high-risk for certain behavioral and emotional problems.

Researchers found that of the 97 patients younger than 21 years who met the criteria for GID, 44 percent had a prior history of psychiatric symptoms, 37 percent were taking psychotropic medications, and 21.6 percent had a history of self-mutilation and suicide attempts.

Study authors advocate for early evaluation of children exhibiting GID, but treatment with medications should not be started until they reach puberty.

Why would a child be uncomfortable with his or her gender?

Pediatric surgeon Kathy Graziano, M.D., of Pediatric Surgeons of Phoenix, treats patients who are born with reproductive anomalies.  She says that one reason is that some girls are exposed to excess hormones at birth, and are born with male-looking parts. And some girls are born without some parts, like a vagina or a uterus.

Those are relatively rare conditions, says Graziano, who is a member of the Arizona Chapter of the American Academy of Pediatricians (AzAAP). “But there is a condition, also rare, in which a child is born with all the “right” reproductive organs but identifies with the other gender.”

This is known as gender identity disorder, gender dysphoria or gender incongruence. “This is a problem for the child and the parents from early on.”

Graziano recalls meeting — and being inspired by — a patient who always knew that she was a boy.

“She dressed as a boy, insisting on wearing a boy’s bathing suit for example, as early as anyone could remember,” says Graziano.  “She only once wore a dress…at her sister’s wedding.”

Then, in middle school, she became deeply depressed — and even suicidal.

The patient and her family attended counseling. That’s where she was able to admit that she wanted to be a boy, says Graziano. “The family took an accommodative approach.  They allowed her to change her name to a male name and act in society as a boy.  They sought surgical solutions for her to start transforming her anatomy.”

This was slow-going, says Graziano, since in this country there have been few surgical interventions for children under the age of 18.

Graziano says that the patient ultimately started a support group for other adolescents with gender identity issues. She entered college as a male, although not anatomically.  “Her story is a success in that her family’s intervention saved her life.”

There is also a therapeutic approach to treat, and try to reverse, gender identity disorder when it is recognized early, adds Graziano, but research on the success of these two approaches is lacking.

Pediatricians dealing with these issues should screen for depression and intervene as soon as possible. Parents who suspect that a child is dealing with GID should talk to their child’s physician.

“The most important thing,” says Graziano, “is to focus on the mental health of the child and the family.”

Pediatricians and parents should consult with experienced mental health professionals for children and adolescents experiencing gender-related issues. When patients are sufficiently physically mature to receive medical treatment, they should be referred to a medical specialist or program that treats patients with GID.

Resources for parents

Central Arizona Gender Alliance

TransYouth Family Allies

Hearing loss in newborns and toddlers: when to worry

According to the Arizona Department of Health Services, approximately 300 newborns each year in the state have an inherited disorder that could be identified through screening.

Hearing loss is the most common of these disorders.

Babies born in hospitals are screened for hearing loss within the first few hours after birth.

Watch a newborn hearing screening at Cardon Children’s Medical Center/Banner Desert Medical Center

If a baby doesn’t pass the initial test, parents need to make sure they return for a repeat screening two to four weeks later, says Patty Shappell, AuD., CCC-A, an audiologist with Neonatology Associates, Ltd.

“Parents may get home and think the baby is responding normally, says Shappell, “but they still need to have a follow-up evaluation to assess hearing and rule out even mild or unilateral hearing loss.”

What happens if screening results are not within the normal range? Read about Brooke Gammie’s journey after her daughter, Payton, did not pass her newborn hearing screening.

For babies born outside of a hospital, screenings are available at outpatient clinics such as Neonatal Associates. Most insurance companies, including AHCCCS, cover the costs of the screenings.

What do babies miss if they are born with even a mild hearing loss? Hearing acuity directly affects the development of speech and verbal language skills. A baby with hearing loss, even during the first year, can be short-changed in his or her social, emotional, cognitive and academic development.

Diagnosis and early intervention are critical during the first year for the child with any degree of loss.

 How do you know if your baby is at risk for hearing loss?

Risk factors for hearing loss, according to the Arizona Department of Health Services include:

  • Babies who stay in the NICU for more than 5 days
  • Babies who have had an infection before or after birth such as CMV, herpes, rubella or meningitis
  • Babies who have a family member with hearing loss from birth or childhood

Follow-up with a physician is critical for babies at risk as it is possible that they may pass a hearing screening at birth but will still need more testing later.

New parents, says Shappell, should be sure to talk to their baby’s doctor and make an appointment with a pediatric audiologist or hearing specialist for further testing.

Normal milestones for the first year:

By 2 months of age a baby with normal hearing should be able to:

  • Quiet when hearing a familiar voice
  • Make sounds like ahh and ohh

By 4 months of age a baby with normal hearing should be able to:

  • Look for sounds with his eyes
  • Make sounds like squeals, whimpers or chuckles

By 6 months of age a baby with normal hearing should be able to:

  • Turn his head toward a sound
  • Make sounds like ba-ba, ma-ma, da-da

By 9 months of age a baby with normal hearing should be able to:

  • Imitate speech sounds made by others
  • Understand no-no or bye-bye
  • Turn his head toward a soft sound

By 12 months of age a baby with normal hearing should be able to:

  • Correctly use ma-ma or da-da
  • Respond to singing or music

Still, it is important to remember that babies with mild hearing loss may also be able to do these things.

During the second year, parents should continue to monitor any changes in a child’s development.

Candice L. Grotsky, Au.D., a Cigna audiologist who practices at the Stapley Hearing Center in Mesa, says that by twelve months to two years, children should still be turning to sounds from either side and “look up or down” for a sound if it comes above or below them.

They get better at  “localizing” or turning directly to a sound the older they get assuming hearing is normal and there are no developmental delays,  she adds.

Grotsky says that in toddlers, hearing loss is often caused by ear infections.  She says that most parents seem to know “when something is wrong” and bring their child in for testing.

“Maybe speech is delayed or mushy sounding, maybe speech was progressing well and all of a sudden stopped or regressed,” she says. ” Sometimes the child doesn’t respond if you are behind them and make a sound or noise.  These are all clues that hearing loss could be present.”

Grotsky says that most of those children in the age range of 2-4 years that she sees are coming in for the first time  — and it is usually a speech delay that prompts parents to seek testing.

If you suspect for any reason that your child — at any age — is having difficulty hearing or seems to be delayed in speech or in any other area, talk to your child’s physician.