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- information about the lack of evidence that the MMR vaccine causes autism
- Written information about measles, mumps and rubella
- Pictures of children with measles, mumps and rubella
- "A dramatic narrative about an infant who almost died of measles."
- I use those minor visits to update medical care and check in with families. Once we've figured out that it's an ear infection or a cold or strep throat or whatever, I take a step back and make sure there's nothing else the child needs. We go over the medication list, see if anything needs refilling. We check the immunizations. We see if they are due for any blood tests. We talk about ongoing problems, like asthma or school problems, and follow up on any visits with specialists. These visits for minor problems help me keep the overall health care on track.
- Every visit is important when it comes to building relationship. Not only do I use visits for minor things to keep health care on track, I use them to get to know people--and help them get to know me, so that they will trust me and want to tell me things when the moment comes (not at all a gimme--it takes work on my part). They are also invaluable for helping families learn how to take care of sick children--and how to prevent illness and injury.
- Sometimes a minor thing isn't so minor. That swollen knee isn't such a big deal--unless you look back and see that it's part of a pattern of swollen joints, in which case it might be arthritis. That fever is no big deal--unless the child has been having frequent fevers and isn't growing well, in which case it could be time to do some tests. That ear infection isn't a big deal either--unless you look back and see that it's one of several in the past few months, meaning it's time to see the specialist. If people go to a RBC, that context is lost. As good as the practitioner at the RBC might be, they don't have the whole record--and they don't know the child and family.
- The medical record gets fragmented. I do get faxes from RBC's (I have no way of knowing if I always get them, of course), but not in real time--and once I do get them, they get scanned into the "Outside Medical Records" section of the record (because that's what they are), not the section where people are most likely to look for ongoing problems and recent visits.
- They make it harder to build a "medical home". The ideal way to deliver health care is through a one-stop shopping model, where families can turn to their doctor for all aspects of medical care. For all the reasons above, RBC's make that tougher.
It's a question I've been thinking about recently: should all kids learn to code?
Getting extra vitamins sounds like a good idea, right? After all, vitamins are important--so why not add them to foods and take multivitamins? Actually, it's not always a good idea at all.
The manufacturers of Uncle Ben's Flavor-Infused Rice learned this the hard way when 34 students and 4 teachers in Katy, Texas experienced burning rashes, headaches and nausea after eating the rice. Similar incidents happened in Illinois and North Dakota.
The rice has been recalled.
The likely culprit? Vitamin B3, otherwise known as Niacin, that was added to the rice.
Niacin is important for our digestive system, our skin and our nerves. Not getting enough of it causes a condition called pellagra, with digestive, skin and mental problems. But getting too much of it can cause high blood sugar, liver damage, ulcers and skin rashes. And even at regular doses people can get "flushing," when the skin turns red and feels hot and tingly.
This is likely what the people who ate the rice experienced. Luckily, it isn't serious; it generally goes away within an hour or two.
Niacin isn't the only dietary vitamin or mineral that can cause problems. More isn't always better.
In 2012, vitamins were the fifth most common poison exposure for children less than 6. Overdosing on iron can be especially dangerous. And since children's multivitamins are generally designed to look and taste good, it's not uncommon for kids to think of them as candy--and eat way too many.
Recently, the Annals of internal Medicine published an editorial about how studies show that taking a multivitamin doesn't prevent chronic conditions in adults. They called it a waste of money. But still, it's a huge business--and companies like Uncle Ben's win customers by touting that they add vitamins to their products.
Many parents I talk to see multivitamins (or vitamin-enriched foods) as a way of being sure that their picky eaters get the nutrients they need. Which is understandable and commendable--but not the best way to think about vitamins or nutrition.
The best, safest and healthiest way to get vitamins is from the foods that naturally contain them. For niacin, the best sources are meats, legumes and nuts. Basically, if you eat a varied diet, including meat, seafood, dairy, legumes, whole grains, fruits and vegetables, you will get the vitamins and minerals you need (you can get what you need without animal products, but it takes a bit more work). Not only that, you're more likely to be healthy in general.
While some people do need extra vitamins and minerals in their diet, most don't (check with your doctor to see if you or your children do). It's not a shortcut to health--and, as those teachers and students in Texas can tell you, there can be real downsides.
Of course I was psyched to hear that as of October 1, CVS won't be selling tobacco products anymore. After all, every year 443,000 people die prematurely from smoking or exposure to secondhand smoke. But when I read the message from the CEO on their website, it annoyed me. It said: "The sale of tobacco products is inconsistent with our purpose--helping people on their path to health."
If that's their purpose, they've got a whole lot more work to do.
Don't get me wrong. This is fantastic news. Anything we do that makes it harder for people to get cigarettes is great--and when a chain as big as CVS sets an example like this, well, there's always a chance that others will follow.
But...it's a stretch for CVS to say that their products help people on the path to better health.
I was in CVS the other day. I had a list of random things I needed to buy that afternoon, and one of them was lemon juice. Hey, I thought, maybe they have that here. I spent a long time looking at all of their food products, because given that they sold vinegar, garlic powder (and various other spices) as well as assorted condiments, I kept thinking that the lemon juice had to be there somewhere. It wasn't--but there were plenty of processed foods, chips, sugar-sweetened beverages, sugary cereals and other foods I beg my patients not to eat. And then there were two aisles full of Valentine's Day candy, not to mention all the candy by the register...According to the Surgeon General, 300, 000 people die every year because of obesity--and many more suffer from complications such as diabetes or heart disease. I know, an occasional can of soda or bag of chips isn't going to make you fat or kill you. But honestly, the vast majority of the food and snacks in CVS was unhealthy. Not what you'd expect if your purpose were to make people healthy.
- Not installing it tightly enough. It shouldn't move more than an inch either way.
- Using both the seatbelt and the LATCH system to hold it in. It's tempting, but it's not a good idea.
- Not using the top tether. It matters.
- Installing it at the wrong angle. That matters too.
- Not following instructions exactly (that whole lack of engineering degree problem).
- Fatigue. It's normal for kids to be tired sometimes--we all have tired days. But if your child always seems to be tired, despite getting enough sleep, and especially if they look pale, that's not normal.
- Weight loss. Kids should steadily gain weight as they grow. It's normal to lose some weight during an illness, and children who become much more active may lose some temporarily also, but any persistent weight loss in a child isn't okay. There are lots of other conditions besides cancer that can cause it, but it definitely warrants a call to the doctor.
- Lots of new bruises. It's especially concerning if you can't explain them. We also get worried about tiny bruises, little dot-sized red spots we call petechiae. There are non-cancer reasons for bruises and petechiae, but it's a good idea to get your child checked out.
- Lumps and bumps and swellings that don't go away. It's very common for kids to have swollen lymph nodes in the neck, especially during cold and flu season. And sometimes a knee can be swollen after a bump. But any big lumps or bumps or swellings that are big or don't go away should get reported to the doctor.
- Pain that is severe or doesn't go away. Aches and pains are part of life--and childhood, too. But if pain is severe, or doesn't go away (even if it's not severe), it could be a sign of a problem, including cancer. You should especially be concerned about pain that wakes a child from sleep or makes them stop doing things they normally enjoy doing.
- Neurologic symptoms. These include dizziness, weakness, vision problems, trouble with balance or coordination, memory problems or speech problems. Basically, if your child starts doing something unusual, or has trouble doing something they've always done with ease, that's not normal. Again, it may not be cancer--but it should never be ignored.
- Frequent vomiting. There are lots of things that can cause this, but always let your doctor know if it's happening, especially if your child has headaches, too--and make sure that you figure it out.
- Frequent fevers and/or infections. It's totally normal for kids to have several illnesses with fever every year, especially during cold and flu season. But if your child is getting sick all the time, or having unexplained fevers, talk to your doctor about whether doing some more tests would be a good idea.
50 years after the first report warned us about the dangers of tobacco, the current Surgeon General has issued a new report, telling us it's even more dangerous than we realized.
- eye degeneration
- birth defects
- a higher risk of tuberculosis
- ectopic pregnancy
- erectile dysfunction
- liver and colorectal cancer
- rheumatoid arthritis
- immune problems
- Talk to your kids, early and often, about the dangers of all forms of tobacco and nicotine. Have rules and expectations--and consequences if they use any. Find out if their friends smoke, because it makes it more likely that they will start. For more information and for ideas on what you can do, visit the Smoking and Tobacco page of the website of the Centers for Disease Control and Prevention.
- Support any legislation or initiatives that make it more difficult for people to smoke, especially youth.
- Support funding for anti-tobacco initiatives. Whatever they cost, it's going to be way less than $289 billion.
- Create a comprehensive definition of tobacco products. It's not just e-cigs--there are all sorts of "emerging tobacco products" that sometimes sneak under the legal radar.
- Restrict sales to minors. Seems like a "duh" thing to do, but until you make the law, anybody can go buy the stuff.
- Restrict manufacturers from distributing samples of tobacco products. E-cigarettes come in flavors like chocolate and bubble gum. Handing them out could be like handing out candy...and a bad habit is begun.
- Prohibit the use of smoking and electronic cigarettes in places where the smoke-free workplace law applies. Let's get rid of the loopholes. And truly, we don't know that the vapor from e-cigarettes is safe, even if it isn't the same as regular cigarette smoke. For all we know, it's got its own set of toxins.
Did you know that Martin Luther King is the only non-president to have a day commemorating him?
- A show about kids who smoke a lot of weed, drink, or use other substances. I have various patients who experiment with this stuff, thinking that they can handle it and that it's not such a big deal. I think it would be really useful for them to see how lives can unravel.
- A show about teens who have experienced unhealthy dating relationships. I once saw a survivor of domestic violence talk to a group of high school students, and they were clearly mesmerized--and visibly shaken--by her compelling story of how what seemed like a perfect relationship with the perfect guy went terribly wrong. If we could get more teens to hear these stories, we could help them see the signs, and ask for help, before it gets dangerous.
- A show about victims of bullying. Lots of teens think of bullying as drama, no big deal, and think that the victim should just, well, ignore it or get over it. Maybe if they could really see and understand what it feels like to be bullied, they would think twice before they made that mean offhand comment. And maybe they would be more willing to stand up to bullies.
A study recently published in the journal Pediatrics says that actually, we do need to worry.
Researchers looked at information from emergency room visits across the country. They found that between 2001 and 2008, more than 7 million children ages 5 to 19 were treated for injuries they got at school (about 12 percent of all injuries in that age group). But here's what's scary: 10 percent of those injuries were intentional--the kids were hurt by someone on purpose, not by accident.
The injuries aren't all minor, either. Some are just bumps and bruises, sure, but there were a significant number of fractures--and brain injuries.
These intentional injuries are more common in boys--and, what is particularly scary is that boys are more likely to get beat up at school than outside of school. (Girls are more likely to be hurt intentionally outside of school). This is especially true of middle school students--which reminded me of the time when my daughter's middle school friend was taken under the bleachers and beaten because he is gay.
We talk a lot about cyberbullying, and it's true that it's a dangerous thing and on the rise--but this study makes it clear that plain old schoolyard bullying is still happening.
So what can we do?
Well, all schools should have anti-bullying policies and programs--and good supervision on school grounds. If parents don't know what the policies, programs and supervision are at their child's school they should ask--and if they aren't in place, they should speak up and make sure they get put into place.
Parents also need to work with their own children to help prevent them from becoming either victims or bullies. A lot of that has to do with how children are doing emotionally and socially, and parents should always talk to their pediatrician if they have any concerns. But there are also strategies we can teach children to help them handle those dicey school moments. The American Academy of Pediatrics (AAP) suggests that parents teach their children to ACT CALM.
If they are mad, they should:
Acknowledge angry feelings
Calm down (breathe deeply, count to 10, listen to music)
Think and Talk (think about the problem and ways to fix it, talk with someone about how they are feeling)
If someone starts a fight, the child can be the one to stay calm:
Calm down (keep a safe distance away, take deep breaths, stay alert)
Avoid (avoid returning insults, avoid other kids who may want to fight)
Listen (to what other kid is saying, try to understand what they really want)
Move on (find a way to solve the problem without fighting, or just walk away)
To learn more about the study and for links to other resources about violence against children and keeping kids safe, visit healthychildren.org.
How smart are you when it comes to being safe in the cold? See how you do on this quiz:
True or False: When going outside in cold weather, it's best to wear multiple layers of loose-fitting clothing, rather than one layer of heavier clothing.
Answer: True (starting you off easy here). Layers help keep the heat in. For inner layers, wool, silk or polypropylene are better than cotton. Hats are key, mittens are better than gloves, and it's important to have a scarf or mask for your face.
True or False: If you are sweating when you are outside in the cold, that's good--it means you are nice and warm.
Answer: False. Perspiration is how your body cools off--you'll just end up colder. Ditch a layer.
True or False: If your kids are bundled up, it's fine to let them play outside.
Answer: Depends--on the temperature, and wind chill. I'm all about getting kids outside, even in the winter. But frosbite can set in very quickly--and exertion in really cold weather can stress the body further. When the weather gets very cold (it's hard to give an exact temperature, because the wind chill affects it as well), you should really limit the time your children spend outside. If they go out, bring them in as soon as they start shivering--and if they get wet.
Which of the following are signs of frostbite?
a. Very red skin
b. White, gray or yellow skin
d. Pain and stinging
Answer: b and c. Certainly if the skin is getting really red (or there's any pain) it's time to get out of the cold, but frostbitten skin is pale and numb. It's the numbness that can be a problem--sometimes people don't even realize they have frostbite!
Which of the following should you do if you suspect frostbite?
a. get somewhere warm immediately
b. rub the skin
c. use body heat to warm the area, or run it under warm (not hot) water
d. use a heating pad
Answer: a and c. Don't rub the skin, as it can do more damage--and using a heating pad when skin is numb can lead to burning. If you are worried about frostbite you should also call your doctor for advice.
Which of the following are signs of hypothermia?
b. drowsiness, less energy
d. slurred speech, memory loss
e. all of the above
Answer: e. Remember, it doesn't have to be extremely cold for hypothermia to set in, especially if a person gets wet. And the confusion/drowsiness part can make it hard for people to realize that they are getting into trouble.
If you suspect hypothermia, you should:
a. Get somewhere warm immediately
b. Take the person's temperature
c. Stick the person in a tub of hot water
d. Use warm blankets and give them something warm to drink.
e. Warm up their hands and feet first.
Answer: a, b and d. Obviously, getting out of the cold is the first step. But for warming, think dry--which also includes getting the person into dry clothing if they are wet. So warm blankets are good (an electric blanket is great if you have one), maybe lots of them. While hands and feet may feel really cold, you want to warm the core first--and drinking something warm, like cocoa (stay away from caffeine) can help warm the insides too (one big caveat: don't make people who are extremely sleepy drink--they might choke). The reason taking the temperature is a good idea is that if the temperature is 95 or below that's dangerous--and a reason to get medical attention. If you ever aren't sure what to do, call your doctor.
To learn more about cold weather safety, including lots of great information about how to prepare for storms and keep your pipes from freezing, check out the Center for Disease Control and Prevention's Extreme Cold guide.