Archive for the ‘In the news’ category

Protect your kids from the “new” respiratory virus

September 10, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Facebook and other social media sites are all a-twitter (ha!) about a “new” respiratory virus, sweeping the country and sickening thousands of kids. There is something new, or new-ish, out there, and it looks like the infection can get pretty bad. But now is not the time for panic. We’ll get through this, like we get through other spikes in viral infections. With some common-sense steps, your kids will be OK.

As reported officially by the CDC this week, in the last month hospitals in Illinois and Missouri reported an increase in emergency department visits and hospitalizations for respiratory symptoms. Since then, reports of similar illness are coming in from many other states, scattered across the country. Most (but not all) of the cases with more severe illness had pre-existing lung disease (like asthma).

The illness seems to be mostly affecting children. Most cases begin with ordinary, cold-like symptoms—and it’s likely that most cases actually never develop into anything more than that. The reported cases, so far, may well be a “tip of the iceberg” effect, where only the sickest children get tested and identified. These are the kids who develop trouble breathing and low oxygen levels, and often need intensive care. It’s quite likely that most children with this infection quickly recover after a cough, sniffles, and runny nose. Of the cases reported so far, only about 1 in 4 or 5 runs a fever. Probably, most children and adults who have this infection don’t seek medical care, and very few of them (so far) are even being tested for the likely viral cause.

Most of the reported cases are testing positive for a specific virus, called enterovirus D68. That virus was first identified in California and 1962, and until now had rarely been a reported cause of illness. The enterovirus group, as a whole, contains a lot of other viruses that cause a whole bunch of different symptoms—fevers, respiratory illnesses, GI problems, heart disease, rashes, and neurologic problems. Pediatricians and others who take care of kids are used to seeing tons of enterovirus, which usually strikes in the summer, most typically as hand-foot-and-mouth disease, or as a fever. So we’re used to these kinds of viruses, even though this specific one is a newly-recognized member of the family. We’re not 100% sure, yet, exactly how D68 is transmitted, but other enteroviruses spread though respiratory drops and in stool, and can remain infectious for a long time on contaminated surfaces.

As with many viral infections, prevention is the best strategy. Common sense things can really help: keep your kids home when they’re sick, and don’t send your kids off to play with sick children. Encourage your kids to wash their hands and use hand sanitizer frequently. Get a good night’s sleep and moderate exercise. Keep your child up-to-date on vaccines—though there is no specific vaccine for this enterovirus*, bacterial and viral coinfections with influenza and pneumonia can be prevented. If your child has asthma (or any other respiratory problems), make sure that you’re keeping up with all prescribed treatments, so things are less likely to spiral out of control when an infection strikes.

If your child does get sick with cough, look out for these symptoms:

  • Having trouble breathing. You may see individual ribs poking out with each breath, or the depression at the bottom of the neck sinking in, or bobbing up and down. Children with trouble breathing usually breathe fast, and sometimes breathe noisily.
  • Having trouble speaking. If you can’t get good breaths in, you can’t typically complete sentences and talk normally.
  • Seeming listless, with low energy. Children with serious respiratory compromise may not be getting enough oxygen to their brains. They can seem “foggy” or “out of it.”
  • Drinking poorly. Younger children and babies may have a hard time eating and (especially) drinking when they’re really ill.
  • Looking blue or pale.

If you’re seeing those kinds of symptoms, take your child to the doctor right away, or head to the emergency department. Even if things don’t seem quite that bad, if you’re worried, don’t hesitate to call for help.

Most children who are getting enterovirus D68 infection will do just fine. Some of you have probably already had children with this, and didn’t even know it. Every year, we see spikes of infections like this, caused by a variety of viruses like RSV, metapneumovirus, or influenza. Though there is no specific therapy for most of these, we’re pretty good at recognizing who needs extra help, and we can provide good supportive care when it’s needed. It sounds scary when you see news of a new, bad infection—but in truth, this isn’t very different from other infections we’re used to dealing with. We need to stay vigilant and keep our eyes on whatever’s out there making our children sick, but there’s no reason to get too worked up over this latest challenge.

*Fun trivia challenge: we routinely vaccinate against one other enterovirus, one that historically caused infections in the summertime. Guess!

This was adapted from a post I wrote for my practice website.

Dr. Bob Sears says skipping vaccines is not good for public health

September 9, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

This weekend, The Los Angeles Times reported on California pediatrician Dr. Bob Sears’ role as a favorite among vaccine-fearing parents. What he tells them is absolute nonsense that he has freely admitted he made up in a Reddit interview. Now he’s let a little more honesty shine through. He told the reporter:

“I do think the disease danger is low enough where I think you can safely raise an unvaccinated child in today’s society,” he said. “It may not be good for the public health. But … for your individual child, I think it is a safe enough choice.”

I had wondered: is it possible that a board-certified pediatrician, one from a family of influential and well-known children’s health experts including Dr. William “Attachment Parenting” Sears and Dr. Jim “The Doctors” Sears, could really believe the idiocy in his own book? Now we know. Dr. Bob Sears says screw public health, screw everyone else’s children, screw your neighbors and their families. It’s fine if you skip your child’s vaccines, because for your child the risk isn’t great. That may not be good for the public, Bob says, for all of those other idiots out there—we know if people start skipping vaccines the disease will surge back. But for your snowflake, well, it’s OK. You can even picture him winking when he says it.

This is just despicable. Mendacious, vile… I’m running out of adjectives, here. Dr. Bob thinks his own special pals, his patients, the suckers who buy his books, they don’t need their vaccines—they can just hide in the herd, as long as the rest of us get our kids vaccinated. His white, affluent, Orange County kids can’t be bothered with needles. Sure, it’s no good for public health, but public health isn’t something his parents need to think about.

Dr. Bob freely regurgitates long-disproved anti-vaccine canards throughout his laughably mis-named The Vaccine Book: Making the Right Decision for Your Child. The book has sold well. He’s telling people exactly what they think they want to hear, blaming all sorts of ills on vaccines, fueling fear and anxiety and a mistrust of every legitimate health authority on the planet. They’re all wrong, he says, the CDC and the IOM and every county health officer and every single country’s health ministries and all of the pediatricians, family medicine docs, infectious disease specialists, and everyone else who’s invested their careers in protecting the public health. We don’t need no stinkin’ evidence.

He’s making oodles of money off of your fear, while freely admitting that what he’s doing is no good for the public health. Don’t forget: the public is you, your children, your family. We’re all in this together, sharing our planet and sharing these infections. You can help keep your children and communities safe by making sure your kids are vaccinated. Or you can join the “me first, screw you” brigade led by Dr. Bob.

Breastfeeding and post-partum depression: A possible cure, a possible cause

September 3, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

An August, 2014 British study comes to two seemingly opposite conclusions: in some women, breastfeeding can protect against depression; while in other women breastfeeding seems to increase the risk of depression. It all depends on what mom’s intentions had been.

The study is complicated, and has a lot of tables—but they’ve kindly made it open-access, so you can read it yourself in detail (click the Download PDF button after the link, above.) Briefly, researchers looked at about 14,000 births, and tracked measures of mental health during pregnancy and periodically afterwards. They also tracked whether women tried or didn’t try to breastfeed, and how long breastfeeding continued. And, they kept track of what women had said their intentions to breastfeed had been prior to delivery. Results were corrected for things like socioeconomic factors and the health of the baby, since we know those have a big effect on the risk of post-partum depression.

The women who didn’t intend to breastfeed, and didn’t end up breastfeeding, were used as the comparison group, and the relative risks of post-partum depression were determined. What they found was fascinating:

Among women who intended to breastfeed, and who did in fact successfully breast feed, the risk of depression was cut in half. This effect was strongest for longer-duration nursing. The authors postulate that the beneficial effect of nursing in this group was conveyed by hormonal factors released during nursing.

Unfortunately, those positive hormonal factors were not seen in all women. Among women who had planned to breastfeed, but were in fact unable to nurse sucessfully, the risk of depression more than doubled. Most women who try to nurse find nursing a successful experience, but women who don’t meet their own expectations seem especially vulnerable to depression.

And: among women who didn’t plan to breastfeed, but did in fact end up breastfeeding anyway, the risk of depression was also increased. Perhaps these women, who hadn’t wanted or planned to nurse, felt bullied or coerced into nursing?

The obstetric and pediatric communities are fully in support of breastfeeding, which offers medical and psychological advantages to most women and their babies. But we need to acknowledge that nursing can be difficult, and that women who don’t nurse are still capable, good moms—they don’t need scorn or dirty looks when they use baby formula. It’s a shame that moms who are providing love, nurturing, and good nutrition though a bottle may be at higher risk of depression. We can do better than this.

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.


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