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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).
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.
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:
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?
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
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, 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:
The American Academy of Pediatrics now recommends that boys ages 11 or 12 receive the HPV vaccine in a three-dose series, which can be started as early as 9 years old.
How do you explain what the HPV vaccine is to a nine-year-old boy?
Well, that’s up to parents to decide.
So you will have your facts straight, however, we asked Michelle Huddleston, M.D. a member of the Arizona Chapter of the American Academy of Pediatrics, to explain why the HPV vaccine is on the schedule for pre-teen girls, and now boys, too.
Vaccines are designed to prevent diseases, says Dr. Huddleston, who practices at Phoenix Children’s Hospital. This vaccine is no different.
The HPV vaccine provides protection from certain subtypes of the HPV virus long before boys and young men (and young women) become engaged in any type of sexual activity.
HPV transmission can happen with any kind of genital contact and intercourse isn’t necessary, adds Dr. Huddleston, who says that many people who have HPV infection are without signs or symptoms and unknowingly pass the virus to their partner.
The HPV vaccine is most effective in the pre-teen age group producing higher antibody levels than in older patients. So, that’s why the vaccine is on the schedule for pre-teen boys and girls.
Talking about the purpose of the vaccine might be a conversation starter for a talk about sex. Dr. Huddleston says that although feeling nervous about broaching the subject with kids is fairly common, she suggests that as parents, we should try to consider sexuality a normal topic of conversation.
“Certainly by the time your child starts to exhibit the physical changes of puberty, questions will start to arise,” says Dr. Huddleston. “Be certain to listen, answer honestly and by approachable. You may start the conversation by asking, ‘What do you know about sexuality?’ and see where the conversation leads.
Dr. Huddleston recommends www.youngwomenshealth.org as a good resource for parents as they prepare to talk to kids about sex.
Another update on the vaccine schedule is the age at which the meningococcal vaccine can be given.
Children as young as 9 months can get the vaccine if they are residents or travelers to countries with epidemic disease or at increased risk of developing meningococcal disease, says the AAP.
Routine immunization with the meningococcal vaccine should begin at 11 through 12 years with a booster dose administered at 16 years of age.
So who is at greatest risk for developing meningococcal disease? And what is it, exactly?
Children who do not have a spleen, have an abnormally functioning spleen or certain immune disorders are at increased risk of developing meningococcal disease, says Dr. Huddleston.
Teenagers are at increased risk of developing meningococcal disease by being in crowded places, living in close quarters, sharing drinking and or eating utensils or having a run-down immune system.
Meningococcal meningitis and septicemia can present with flu-like symptoms and patients can die within 24 hours.
And, speaking of flu, there’s one more update on the vaccine schedule.
For children aged 6 months through 8 years, the influenza vaccine should be administered in two doses for those who did not receive at least one dose of the vaccine in 2010-11, says the AAP.
Children who received one dose last season require one dose for the 2011-12 influenza season.
Questions about vaccines or this most recent schedule revision? We list resources below, but any parent who is unsure of what a vaccine is for or when it should be given to a child should check with the child’s health care provider.
More resources on vaccines:
Plenty of parents drive children other than their own in carpools, but according to new study findings published in the February issue of Pediatrics, they don’t consistently use booster seats for these “guest passengers.”
In this particular study, about three-quarters of the 4- to 8-year-olds using a seat
belt were doing so in accordance with the laws in their state. But state laws don’t always comply with the national recommendations.
National recommendations encourage the use of booster seats until a child reaches 57 inches, the average height of an 11-year-old.
State booster seat laws were associated with higher safety seat use, regardless of the carpooling factor, even though half of parents admit to not knowing the age cited in their state booster seat law. Another 20 percent guessed incorrectly.
So, take a guess. What’s the law for booster seats in Arizona?
Arizona is one of only 3 states that currently does not have a law requiring children to be restrained in a booster seat, says Sara Bode, M.D., a pediatrician and Arizona AAP member who practices at Phoenix Children’s Hospital. Current law only requires car seats for children 5 years or younger.
Part of the lower incidence of use may be due to a lack of state booster seat laws, says Bode. There is a current house bill this legislative session that has passed initial committee hearings. House Bill 2452 would mandate booster seats for children up to age 8 or until they are 4 feet 9 inches tall.
Booster seats are just as important as infant and toddler seats, says Bode. They allow correct positioning of the seat belt across the chest and hips.
Kids can easily slip out of a seat belt during a crash or can suffer serious or fatal injuries to the neck and abdomen. In her work at Phoenix Children’s, Bode has seen many children who have experienced trauma from a motor vehicle injury.
“I personally have taken care of a family who suffered from a motor vehicle crash,” says Bode. “Their 5 year-old wasn’t properly restrained. As a result, she suffered a serious abdominal injury requiring surgery and a prolonged hospital stay.”
Kids who are seated in a booster seat in the rear of the car are 45% less likely to be injured in a crash as compared to those using a seat belt alone, according to data gathered by SafeKidsUSA, a nationwide network of organizations working to prevent unintentional childhood injury.
Study authors conclude that social norms may play a big role in booster seat use, too. As far as carpools go, there are inherent difficulties with the transfer of car seats between parents and carpool drivers, says Bode. It’s just one more thing for parents to do during a busy time of the day.
How do we change the social norm? Bode suggests that daycares and schools could play a large role in educating parents on the importance of use as well as providing expectations for proper restraint, and a designated area to store booster seats during the school day.
Plenty of community resources are available to help parents use booster seats properly. Check out our RAK Car Seat Safety Local Resource Page here.