Tag Archives: Pediatrics

A.W.O.L. in the Hospital

Ask any new parent to part with her baby in the hospital for even a few moments and it’s likely to set in motion a mental high-speed, Guy Ritchie-like montage, complete with squealing tires, deranged abductors, and shadowy baby-sale rings. (Well, it did for me.)

When it comes to why children go A.W.O.L. in the hospital, however, researchers say we want to look a little closer to home.

It turns out that some parents are taking off the ID bands used to keep track of their child in the hospital.

Photos by Patrice Wendling

A learning collaborative of six hospitals found that the overwhelming (90%) reason for pediatric ID band failure was that the band was simply not in place. The most frequent reasons were that it fell off, was taken off by the parent or the patient, or was put on another object such as a crib,  Dr. Shannon Phillips and her co-authors reported at Pediatric Hospital Medicine 2011.

“A lot of times, the patients had been at the hospital for a long time and the parent would say ‘Everyone knows my child’or ‘I’m always here at the bedside,’ co-author Dr. Michele Saysana explained. “Many of the parents were taking [the ID band] off, but when we educated them on the importance of keeping the ID band on, they had a better understanding.”

In addition to family/patient education, the collaborative staged other interventions including educating front-line staff on the importance of correct ID bands as a safety strategy; conducting audits, often by night nursing administrators; and changing to softer ID bands, including luggage tag-type bands in some NICUs.

“In bigger systems with adults, you must have different bands,” said Dr. Saysana, who directs the pediatric hospitalist program at Riley Hospital for Children in Indianapolis. “The one-size-fits-all doesn’t work for the little guys.”

Dr. Michele Saysana

Post-intervention, the collaborative saw a 13% absolute reduction, corresponding to a 77% relative reduction, in pediatric band failures between September 2009 and September 2010. Their goal had been to reduce errors across the collaborative by 50% in 12 months.

The keys to sustaining this kind of success?

“The lessons learned are having leadership be involved, having continuous audits, and just doing education every time you catch something,” she said.

—Patrice Wendling

Leave a comment

Filed under Emergency Medicine, Hospital and Critical Care Medicine, IMNG, Pediatrics

Survival of the Abstinent Teen

Image courtesy of Wikimedia Creative Commons

Having a daughter who’s a “band nerd” may be music to a parent’s ear in more ways than one.

A new survey of 282 adolescent girls aged 12-21 reports that participation in band is significantly associated with current sexual abstinence.

The researchers came to the project with high hopes that potentially intervenable factors such as higher academic achievement, greater involvement in activities, and open family communication about sexual activity would be positively associated with abstinence.

That didn’t really play out, author and fourth-year medical student Kathryn Squires said at the recent meeting of the North American Society for Pediatric and Adolescent Gynecology.

There was no difference in GPA, involvement in sports, or most curricular and non-school-related activities between sexually active and abstinent teens.

Sexual activity, however, was associated with the typical risk factors of age of at least 18 years, having a job, having an increased number of boyfriends or an older recent boyfriend, and risky peer behaviors.

Positive influences on abstinence in all age groups were: participation in band, participation in school clubs, having abstinent friends, and personal and peer avoidance of alcohol and drugs, reported Ms. Squires and her colleagues at Washington University in St. Louis.

So what is it about band that helps adolescents elect to remain sexually abstinent?

Was the study group somehow unique? Not likely. When surveyed during 2008-2009 at a scheduled gynecologic visit with her parent present, 68% of participants reported being abstinent. This falls roughly in line with the 2009 Youth Risk Behavior Surveillance Survey, in which 46% of high school females reported ever being sexually active.

Is it the music? Not likely. Marching bands, like the one at the University of Michigan, are side-stepping the likes of John Philip Sousa today in favor of such hipsters as Lady Gaga.

Is it the geek factor?

“We had a lot of other what could probably be considered geeky things on there, like the newspaper, and those didn’t seem to make a difference,” Ms. Squires said. (I take umbrage at this remark, but then I grew up thinking Woodward & Bernstein were cool.)

“Maybe band is just more involved, but then sports are more involved too, as far as practices. So I don’t think it’s the time commitment.”

Having had any number of band nerds in our house over the years, I asked my two college daughters about the finding. After the giggling stopped, they suggested that band members, quite simply, are a very tight-knit group of kids. I wouldn’t assign a P value to this anecdotal info, but there’s something to be said for having a posse of friends to turn to when an adolescent considers taking that first step toward sex.

For physicians disinclined to advise parents to push their kids towards the tuba or trombone, Ms. Squires points out that ages 15-17 appear to be a critical period in which teens value their parents’ opinion the most, and it makes the most difference in delaying sexual initiation. “So that might be a good time for parental involvement or a medical intervention,” she said.

That said, I’m not so sure there’s ever a bad time for parental involvement, but then I didn’t ask my girls about that.

By Patrice Wendling

Comments Off on Survival of the Abstinent Teen

Filed under Family Medicine, IMNG, Obstetrics and Gynecology, Pediatrics, Primary care

Pediatricians Lead the Way in Asthma Care

Busy physicians know that they can only do so much individually. Some health care problems are systemic issues. It takes a lot of people working together to tackle those. It takes a village, if you will.

Dr. Peterson (Photo by Sherry Boschert)

Individual pediatricians have been leading the way in developing some very encouraging collaborative, community-based programs to bolster “medical homes” for children, and especially to improve asthma care. Dr. Tom Peterson has championed one such project in Grand Rapids, Mich. It has brought more financial resources to physicians while decreasing children’s emergency visits by 12% and reducing hospitalizations by 14%. It’s been so successful that other counties in Michigan are copying it. See my full story for more.

Dr. Peterson modeled the Children’s Healthcare Access Program in Grand Rapids after a similar program that was started at Denver Children’s Hospital. He told me that in all the initiatives like this that he’s aware of, the effort starts with the actions of a single pediatrician who gets the ball rolling.

It takes a village, but it starts with individuals. Hats off to the docs who find time to take care of patients and to address the systemic needs. 

—Sherry Boschert (On Twitter @sherryboschert)

1 Comment

Filed under Family Medicine, IMNG, Internal Medicine, Pediatrics, Uncategorized

Going Postal

 What’s delivered by the U.S. Postal Service, but can’t fit into a letter or package?

The untold hope that a bone marrow match can bring to patients with leukemia, lymphoma and other life-threatening blood diseases.

Since holding its first drive in Baltimore in 1997, the Postal Service has become the largest contributor to the National Marrow Donor Program’s Be The Match Registry, adding more than 40,000 potential donors to the nonprofit registry.

Postal workers comprise the second largest civilian workforce in the country, and perhaps more importantly, one of its most diverse. Offering free tissue type-testing to its employees, their spouses and dependents is one way of harnessing that diversity and leveling the playing field for patients with blood diseases.

About 70% of patients do not have a donor in their family, and only 7% of potential donors on the national registry are African American, according to the NMDP.

In hopes of improving awareness, the NMDP has tapped larger-than-life basketball star Shaquille O’Neal , while its fundraising arm gave the Postal Service its first-ever “Rod Carew Award for Leadership” in recognition of saving more lives – 80 – than any other business organization in the country.

Not bad for a group of workers that have been the butt of jokes for years and frequently endure our ire this time of year.

Anyone interested in becoming a potential bone marrow or cord blood donor can contact the registry at: www.marrow.org.

Patrice Wendling (on Twitter @pwendl)

Leave a comment

Filed under Family Medicine, Hematology, Hospital and Critical Care Medicine, IMNG, Internal Medicine, Medical Genetics, Oncology, Pediatrics, Transplant Medicine and Surgery

Pediatricians Should Ask About Domestic Violence

Like it or not, journalists sometimes must act as media sheriffs, enforcing the order in which stories will appear. We say, in essence, “This news cycle ain’t big enough for the both of ya.” Probably too often, the sensational story wins out over the story about a more common problem that’s just as important.

This may have happened when the American Academy of Pediatrics published a clinical report in May 2010 on the need for physicians who see children to ask their parents or caretakers about “intimate partner violence,” another term for adult domestic violence that also encompasses violence from partners who live outside the home. The lead author of that report, Dr. Jonathan D. Thackeray, says it didn’t get the attention it deserved because it was overshadowed by the simultaneous publication of the Academy’s policy statement on ritual genital cutting of female minors.

Photo by flickr user taberandrew (Creative Commons)

The Academy gave Dr. Thackeray a speaking slot in a plenary session at its recent national meeting in San Francisco, which might generate some of that attention his report didn’t received. I don’t know the exact numbers, but I’m betting that intimate partner violence is a more widespread problem in the United States than is ritual genital alteration. One study found that at least 16 million U.S. children were exposed to adult intimate partner violence in the previous year, and at least 7 million were exposed to severe intimate partner violence.

Besides putting children at risk for harm, that violence can have long-term effects, other studies show. Adults who report childhood exposure to intimate partner violence in the family are three times more likely to report sexual abuse, five times more likely to report physical neglect or abuse, and six times more likely to report emotional or substance abuse.

Don’t get me wrong — I think the policy on ritual genital cutting is important too. I’m just glad to see both of these reports get the attention they deserve.

–Sherry Boschert

Leave a comment

Filed under Family Medicine, IMNG, Pediatrics, Uncategorized

Caffeine with Your Energy Drink, Kid?

The light bulb went off in Dr. Michele LaBotz‘s head soon after she watched a TV reality show in which a mother encouraged her 6-year-old daughter to down three cans of Red Bull energy drink before a competition. Dr. LaBotz was laughing about this example of bad parenting with the mother of a high-school-age girl who then admitted that her daughter was “down to two cans a day” of Red Bull.

Image courtesy of flickr user Mike Licht, NotionsCapital.com (Creative Commons)

That prompted Dr. LaBotz to take a closer look at use of these stimulant-containing drinks and at a related category — sports drinks — and to talk about them at the annual  meeting of the American Academy of Pediatrics. I’ve always been acutely sensitive to caffeine, so my nerves started buzzing just listening to her.

There are no standard definitions, but energy drinks are beverages containing carbohydrates, stimulants, and other ingredients — Red Bull being the 800-pound gorilla on the $11 billion market in energy drinks. Sports drinks are beverages containing some combination of carbohydrates and electrolytes — with Gatorade claiming 75% of the market share.

The “crime” is that these products are found side-by-side with products categorized as food, which are subject to stricter safety standards, Dr. LaBotz said.

Red Bull contains 80 mg of caffeine per 8-ounce can, more than twice as much as in two 12-ounce cans of Coca-Cola. Other brands package themselves in larger sizes to get around caffeine regulations or condense into super-caffeine “energy shots” containing 200-350 mg caffeine per 1-2 ounces. The larger 16-ounce size of SoBe No Fear, for example, contains 174 mg caffeine, roughly equivalent to a Starbucks Grande Mocha, except that No Fear also contains guarana, a plant extract that packs another 40 mg of caffeine per gram of guarana.

Photo by flickr user rynosoft (Creative Commons)

Young athletes start off using them because they think they’ll improve performance in sports or other parts of their lives. New data from a randomized, double-blind, placebo-controlled study that will be published in the December issue of the Journal of Alcohol & Drug Education says that reality is flipped. Sport psychology consultant Conrad Woolsey, Ph.D. and his associates will report that energy drinks make users feel like they’re doing better even though they’re making more mistakes on tests of coordination and multidimensional skills.

Sports drinks are a bit more benign but unnecessary and too often take the place of healthier alternatives, potentially depriving young athletes of the nutrients their bodies need to prepare for or recover from exercise. The only time they may be convenient is during exercise lasting longer than an hour, when kids need more fluids, and the bright colors, sweetness and saltiness of sports drinks may entice them to stay hydrated.

Do you know the healthy alternatives to recommend to young athletes instead of sports or energy drinks, or how to talk to them about all this? Dr. LaBotz likes the Academy’s “Sports Shorts #6” on Nutrition and Sports, and the useful handouts available from the U.S. Anti-Doping Agency such as the Joy of Sport.

And while she urges physicians to take a strong stand against child and adolescent use of energy drinks, she suggests not over-playing the dangers of caffeine, especially when talking to parents who may be regular caffeine users themselves. “I think we lose a lot of credibility if we overstate the risk,” she said.

–Sherry Boschert (on twitter @SherryBoschert)

1 Comment

Filed under Family Medicine, IMNG, Internal Medicine, Pediatrics, Sports Medicine, Uncategorized

For Parents Who Worry about Newborns and Cyberspace

Registration packets were bulkier than usual at the American Academy of Pediatrics national meeting this year because they contained complimentary copies of two new books that comprised an interesting juxtaposition. Both were published by the Academy.

First is the updated, second edition of Heading Home with Your Newborn: From Birth to Reality (September 2010). Two pediatricians who also are moms (Dr. Laura A. Jana and Dr. Jennifer Shu) offer information and advice aimed especially at first-time parents who may be feeling curious, anxious, inadequate, and just plain tired as they bring their new baby home and enter a life of day-to-day care for this new little being.

The book includes fresh sections on vaccines, choosing a child care provider, early learning, car seats, safe sleep, cord blood, postpartum depression, vitamin D, organic formulas, disposable vs. cloth diapers, newborn hearing screening, what to keep in your medicine cabinet, and more.

It’s a lot for new parents to take in. And that’s only the beginning — in the blink of an eye, parents will be moving on to the second book, CyberSafe: Protecting and Empowering Kids in the Digital World of Texting, Gaming, and Social Media (October 2010). Every young kid today is what author and pediatrician Dr. Gwenn Schurgin O’Keeffe calls a “digital native” — someone who has never known a world without the Internet, social networking sites, mobile communication technologies, gaming, virtual worlds, texting, and sexting.

The teasing and bullying that many kids experience in the “real world” has followed them into cyberspace. One in five kids will experience online abuse by the time they are in high school, Dr. O’Keeffe notes. I’ve seen this first-hand since my nephews got me onto Facebook and allowed me to Friend them. (Digital immigrant, c’est moi.) I’ve seen some kids taunting and bullying others in their posts.

But you know what? I’ve also seen kids stick up for each other, perhaps more so online than they would have in person. And when one kid vented about his frustrating family and said he would run away from home, his peers rallied around him and encouraged him to think more calmly.

Parents need to know that no matter where their kids will be, they need to be involved, whether it’s in school, on the playground, or on their cellphones, MySpace or Twitter. CyberSafe can help them and their kids be cyber-smart.

–Sherry Boschert (@sherryboschert on Twitter)

Leave a comment

Filed under Family Medicine, IMNG, Pediatrics

Does Adenovirus 36 Infection Cause Childhood Obesity?

Findings from new a study of Southern California children support the idea that a viral infection may play a role in causing or contributing to obesity. 

Reported in the Sept. 20, 2010 online edition of Pediatrics, researchers led by Dr. Jeffrey B. Schwimmer, associate professor of clinical pediatrics at University of California, San Diego, studied 124 children aged 8-18 years in primary clinics in San Diego for the presence of antibodies specific to adenovirus 36 (AD36), which is the only human adenovirus currently linked to human obesity. 

Of the 124 children 67 (54%) were defined as obese based on a body mass index in the 95th percentile or greater (Pediatrics Sept. 20, 1010 [Epub doi:10.1542/peds.2009-3362]). Of these 124 children 19 (15%) had neutralizing antibodies specific to AD36. A whopping 78% of these AD36-positive children were obese. 

On average, children who were AD36-positive weighed almost 50 pounds more than their peers who were AD36-negative. In addition, obese children who were AD36-positive infection weighed an average of 35 pounds more than obese children who were AD36-negative. 

“Many people believe that obesity is one’s own fault or the fault of one’s parents or family,” Dr. Schwimmer commented in a prepared statement about the study (a downloadable video of Dr. Schwimmer highlighting the findings is also available). “This work helps point out that body weight is more complicated than it’s made out to be. And it is time that we move away from assigning blame in favor of developing a level of understanding that will better support efforts at both prevention and treatment.” 

— Doug Brunk (on Twitter@dougbrunk)

Leave a comment

Filed under Allergy and Immunology, Endocrinology, Diabetes, and Metabolism, Family Medicine, Gastroenterology, IMNG, Pediatrics, Primary care

FDA Keeps the Cough Syrup on the Shelf

Courtesy of Flickr user Editor B (CC)

Remember when you couldn’t get your kids to take cough syrup?  These days, they seem to be turning to it … to get high. Kids are stealing cough medicine off the drugstore shelves to get a very untasty high from the key ingredient dextromethorphan (DXM), prompting the Drug Enforcement Administration to ask the Food and Drug Administration to consider scheduling DXM-containing products under the Controlled Substances Act.

Yesterday, an FDA advisory committee voted against letting some bad apples make the rest of us get a prescription or have to sign a pharmacy-counter registry, in an effort to stop coughing when stricken with a cold. According to the National Survey on Drug Abuse, about 3.1 million young people aged 12-25 (5.3%) had ever used an OTC cough and cold medication to get high and nearly 1 million (1.7%) had done so in the past year.

Many panel members expressed concern that it is unclear how state law would play into access to the proposed schedule V status for DXM. While schedule V is the least restrictive category under the federal Controlled Substances Act, individual states could opt to require a prescription or pharmacy registries for these drugs—significantly limiting legitimate access to DXM-containing medications.

The recommended therapeutic adult dose of DXM is 10-30 mg every 4-8 hours.  Based on a quick YouTube search, a 4-oz bottle of Robitussin—hence the street term robotripping—seems to be the favored dosage for the average teen. Not that I participate in or condone substance abuse, but cough syrup seems like an unpleasant way to go about it…starting with taste.

Courtesy of Flickr user sniggitysnags (CC)

Humans have likely been looking to get high since, well, since before we were human. This made me wonder what other weird things have been used in the quest for a high…and this sounded like a job for the kids’ other favorite mind-altering substance, the Internet.

In no particular order, the Internet says that you can get high from nutmeg, inhalants (spray paint, nail polish remover, lighter fluid, glue, marking pens, etc.), digital drugs (“i-dosing” off of droning mp3 files), and choking.

Of course, just because the Internet says you *can* doesn’t mean you should.

—Kerri Wachter, @knwachter on Twitter

1 Comment

Filed under Drug And Device Safety, Family Medicine, IMNG, Internal Medicine, Pediatrics, Primary care

Video of the Week: Gastric Band Improves Metabolic Risk Factors in Obese Teens

Increasing rates of obesity — particularly in children and adolescents — have health professionals scrambling to find ways to fight growing waistlines.  Dr. Kirk Reichard talked with our reporter Diana Mahoney, at the annual meeting of the American Society for Bariatric and Metabolic Surgery, about how gastric band surgery could be a potential solution.  He presented data on significant improvements in metabolic measures in 17 morbidly obese teens who underwent the surgery using an investigational device.

While these kids really are sick, they benefit probably more greatly from the lap band — or from any bariatric procedure perhaps — even than adults.  We know that kids will go on to be obese adults, if they’re obese kids. They will go on to have cardiac problems.  So our bias is that the younger we fix these problems, the more healthy they’ll be later.

You can see more great medical news videos by checking out our new Internal Medicine News Web site.


Filed under Endocrinology, Diabetes, and Metabolism, Family Medicine, Gastroenterology, Internal Medicine, Pediatrics, Primary care, Surgery, Video