Archive for the ‘In the news’ category

Avoiding medication dose errors in children

August 21, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

The thing about medicines: they’re real bio-active substances. They do stuff. Some good stuff, and some bad stuff too. Every medicine (or, really, anything you put in your body that has any biologic effect at all) is also potentially going to have side-effects or adverse drug effects, too. To maximize the good, and minimize the bad, you’ve got to dose medications correctly.

So it’s chilling and discouraging to learn that in a recent study of 300 parents prescribed children’s liquid medications out of Emergency Departments in Philadelphia and New York, about 40% of the time the dose was misunderstood or given incorrectly. That’s a huge number of incorrect doses, and probably contributes to the 10,000 poison center calls made about children’s medicine doses to poison centers each year. Doses were twice as likely to be incorrect if the instructions were given in teaspoons or tablespoons, because those units aren’t necessarily understood correctly by everyone.

The authors suggest that children’s liquid medicines always be dosed in milliliters, and that parents be given a correct-unit-dosing device (like a syringe) marked with the exact dose. Those are good ideas. Parents should not be ladling medicine into their kids from a kitchen spoon—that’s just too inexact, and depends too much on what kind of spoon and how high you fill it. Dosing syringes can be standardized to measure the right amount, and don’t spill medicine all over the place when you’re trying to get them into Junior’s mouth.

When your child is prescribed a medication, make sure you know the correct dose, and the correct way to give the dose. Any questions? Ask your doctor or pharmacist. If you’re going to give your child medicine, you ought to do it right.

MMR litigants’ new target: their own lawyers

July 17, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

This would be funnier if it weren’t so sad.

Back in 1998, British gastroenterologist Andrew Wakefield published The Study That Started It All: 12 children he claimed had developed autism as a result of the MMR vaccine. Since then, that execrable “study” has been shown to have been an “elaborate fraud”, with findings faked to support Dr. Wakefield’s own patent application for a competing vaccine. He was also collecting payoffs from plaintiffs’ attorneys suing vaccine manufacturers. It was, simply, always about money.

Now, a British gentleman who was the first plaintiff in a huge, failed class action lawsuit is suing his own attorneys—really, the attorneys hired by his family—for pursuing a claim based on bad science, bilking the British government out of millions of pounds.

Matthew McCafferty, who developed autism three years (!) after receiving the MMR vaccine, is now suing his attorneys for “unjust enrichment as officers of the court by litigating a hopeless claim funded by legal aid by which you profited.” The class action lawsuit fell apart in 2003, after Wakefield’s research was fully discredited (he later lost his medical license because he lied and took advantage of vulnerable children.)

McCafferty’s attorney said:

“The original MMR vaccine litigation was supposed to be worth billions in compensation, not mere millions, but it cost millions in legal aid,” Shaw told the Times. “There was also a huge personal cost for the families involved – all the raised hopes and expectations, driven by the irresponsible media frenzy based on an unsubstantiated health scare and junk science. Not one penny in compensation was obtained for any child. The families are now just beginning to recover and take stock. They are scrutinising the actions of their former lawyers and medical advisers.”

It was supposed to be worth “billions.” Again, it was always about the money. It was never about the health of children.

And yet, here we are. Vaccine-preventable diseases are roaring back. Parents are fearful of one of the safest, most effective public health interventions ever developed. And, the biggest losers of all, millions of families affected by autism, distracted by false hope, lured into distrust by charlatans taking advantage of their children for profit. Just imagine:  if not for all of this manufactured, fake vaccine-worry, how much more progress we could have made developing a better understanding of the real causes of autism, and the best ways to help identify and treat it.

The evidence for the safety of vaccines and the lack of any connection with autism is overwhelming. I suppose the lawyers will continue to fight over the money. Can the rest of us move along now, and work together towards actually helping children?

You and I are your child’s drug dealers

July 7, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Doing drugs no longer requires a dealer on the street corner.

Between the late 1990’s and 2010 sales of narcotic pain medicines quadrupled in the United States. Hydrocodone use increased by 280%, methadone by 1300%, and oxycodone by 900%. As the consumption of these medicines increased, so did ER visits and deaths from overdose– up by about 500%.

A whole lot of these medicines are not going to medical use. And a lot of the abuse is by our children.

And our kids, they know where to get these medicines. 10% of 8th graders and 45% of 12th graders believe they’re easy to obtain. Pain medicines are kept unsecured and unmonitored in about 75% of homes with teenagers. And over 50% of teens who abused narcotic prescription drugs say they got them from their own friends or family, just by opening a pill bottle, usually in their own homes.

Doctors and parents are both to blame. They get the drugs from us. We need to do a better job protecting our own children.

Doctors need to prescribe carefully, and keep track of refills. Pain has to be treated with more than just narcotics (though narcotics have to be part of the treatment of almost all serious pain.) We need to be careful to look for the early signs of dependence, which can develop into addiction and abuse.

Parents, grandparents, and neighbors need to lock up and keep track of these medications. Pain meds, ADHD meds, any kind of meds– they all can be abused. Set a good example by always using medications as directed.

“Leftovers” should be safely discarded, never hoarded. The best way to discard most medications is in your household trash, mixing the pills or liquid into something unpalatable, like coffee grounds or kitty litter. The FDA advises that some medications are best flushed down the toilet, including most narcotics. Alternatively, some pharmacies and doctors are happy to take back unused medicines to put with medical trash for incineration. (We may not legally be allowed to collect “controlled subtances,” including painkillers and ADHD medications.)

Medications, especially narcotics used for pain relief, are a crucial part of the relief of real suffering for many people. But there’s no doubt that a lot of the narcotics prescribed in the US are being abused. You owe it to your kids– don’t become their drug dealer. Keep those medicines safe.

Water versus diet beverages: What’s best for weight loss?

June 16, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

A new study gives some support for the use of artificially sweetened drinks as part of a weight loss program for adults.

Researchers randomized 303 adults (mostly women, with an average age of 48) into two groups during a 12-week weight loss program. Both groups received the same behavioral weight loss strategies, but one was told to drink only water. The other group was encouraged to drink non-nutritive, artificially sweetened beverages like diet sodas, iced tea, and flavored water (none with more than 5 calories per serving.)

The average weight loss was better in the diet drink group than among those drinking only water—9 versus 13 pounds. And the people drinking diet beverages were less likely to report feeling hungry than those drinking only water.

Now, all of the study participants were enrolled in a comprehensive weight loss program, and this study only looked at a short-term, 12 week outcome. Diet soda alone is unlikely to help anyone.

There’s some fine print, too. This study was fully funded by “The American Beverage Association”—an organization, I think, that would benefit from increased sales of diet drinks. And 2 of the 9 authors of the paper received consulting fees from The Coca Cola Company. That doesn’t mean that the study is tainted or invalid, but it does mean that we ought to see some collaborative evidence before suggesting that dieters routinely drink Diet Coke or Crystal Light. For now, I’ll suggest that most children stick with water.

Infant recliners kill babies

June 9, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Last time I objected to an infant recliner, I got all sorts of colorful comments*. I was even accused of having a “personal vendetta” against one of them, because I said that they’re not appropriate or safe to use as routine sleepers for babies. Of course, most of the time, having your baby sleep semi-upright in a cushy sling will probably work out fine. Most of the time. Until it doesn’t.

The “Nap Nanny”, sold between 2009 and 2012, was one of those baby recliner-things. It was sold as a way to help babies sleep. Predictably, what happened happened: babies died. Six of them became entrapped or otherwise suffocated in the “Nap Nappy,” or in another version called the “Nap Nanny Chill.” It was recalled last year, but they’re still out there and in use. Another baby just died in it.

We know the safest way for babies to be put down to sleep is flat on their backs, on a firm surface. Not semi-upright, or in a sling-shaped thing. Once babies can roll over on their own, they should be allowed to do so, without straps or other devices to hold them in place. I don’t know how all of the babies died in the Nap Nanny, but the most recent case I linked to seems to have involved entanglement in the straps.

Using a recliner or car seat or similar device as a routine sleep positioner is a mistake. It will probably work fine, most of the time—very much like driving with your child in your lap instead of a car seat. Or not getting vaccines on time. Those decisions, most of the time, will work out fine. Until they don’t.

*Most of the comments objecting to my last article on sleep positioning were from families with babies had specific medical diagnoses, and were told to use a reclined position for sleeping by their docs. I’m not addressing babies with special situations or diagnoses here—I’m talking about ordinary, healthy babies.

 

Got Iodine? An essential nutrient for pregnancy and beyond

May 29, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Iodine is kind of like your pinky finger. You don’t think about it much, but you’d sure miss it if it wasn’t there.

Historically, iodine deficiency caused a swelling of the thyroid gland in the front of the neck, called a goiter. (You will notice we did not link to a Google image search of that term.) The thyroid gland is the only human tissue that requires iodine, which is a necessary component of thyroid hormone. Not enough iodine in the diet means that the precursor molecule of thyroid hormone builds up in the gland, which can grow to quite an impressive size. (Made ya click! But we still didn’t link to a goiter image. We’ve got class, here.)

Insufficient iodine does more than swell up the front of the neck. It also causes low thyroid hormone levels, which can affect the growth and cognitive development of babies and children—even unborn children. And it turns out that pregnant women, in particular, may not be getting enough iodine to keep their babies safe.

In a statement released this week, the American Academy of Pediatrics had underscored the importance of iodine supplementation in pregnant and nursing women.  They estimate that only ~ 15% of this at-risk group gets adequate supplementation, which is putting many babies at risk.

Iodine is found in many foods, including saltwater fish, shellfish, soy products, and many diary products. But for most of us on a diet that doesn’t rely on seafood, the main source of dietary iodine is table salt. Ordinary table salt is almost always “iodized,” meaning fortified with iodine. But salt used in mass-production of processed foods, pickling, and canning is not iodized, and the kosher salt preferred by foodies isn’t, either. Many people may not be able to rely on ordinary salt in the diet to provide iodine, especially those at the most risk for health problems from iodine deficiency.

If you’re pregnant or nursing, you ought to be taking a prenatal vitamin daily. Make sure the one you’re taking contains iodine. It’s a cheap, simple, safe step that might just save your own neck, and your baby’s brain too.

Football and your child’s brain

May 20, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Eat your vegetables. Be good to your momma. Change your underwear.

Good, solid advice. Maybe we need to add: “Don’t damage your brain. You’re going to need it someday.”

More and more evidence is accumulating that football, or at least football as it’s currently being played in high schools and colleges, is causing irreversible brain damage. The latest study was published in JAMA this week. Researchers looked at 25 collegiate football players (who had played in high school), and compared both brain imaging and cognitive performance with students who hadn’t played college. They correlated their findings with the number of years of football experience, and the number of recalled concussions.

Bottom line: concussions correlate with a loss of brain volume in the hippocampus, an area of the brain involved with memory recall and the regulation of emotions. Not only were concussions correlated, but  the number of years playing football also correlated with this change in MRI scans and with deficits in cognitive testing, including tests of reaction time and impulsivity.

The study itself wasn’t large, and relied only on the students’ recall of concussions. And it does not establish causality—maybe people with smaller hippocampi are more attracted to football, or tend to have more concussions (though no other research suggests this). Still, studies like this add to the considerable evidence that the kind of high-impact head trauma that occurs during football is causing real damage to real brains.

What can we do about it? There are steps individual families can make to protect their own children, especially by recognizing and treating concussions when they occur. Beyond that, we’ll have to see if coaches, athletes, and families are willing to risk brain damage to continue traditional football programs. Are the benefits worth the risk? It’s time to talk about it.


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