Archive for the ‘Guilt Free Parenting’ category

Support for HPV vaccination continues to grow

September 24, 2018

The Pediatric Insider

© 2018 Roy Benaroch, MD

Two new studies have added to the enormous weight of evidence in support of HPV vaccination.

From Pediatrics, September 2018, “Primary Ovarian Insufficiency and Adolescent Vaccination”. This study looked at almost 200,000 young women enrolled in the Kaiser health system from 2006 to 2014, looking at rates of ovarian failure in women who had received vaccines versus women who didn’t. The study was triggered by concerns about ovarian failure related to HPV vaccination – concerns that continue to swirl on Facebook and other social media sites. The study showed that HPV vaccine didn’t trigger ovarian failure, even after an exhaustive search allowing for an association at any time period after vaccination. It just isn’t there. And ovarian failure wasn’t caused by other teen vaccines, either.

And, from Pediatrics August 2018, “Legislation to Increase Uptake of HPV Vaccination and Adolescent Sexual Behaviors”. Another concern that’s been raised is whether encouraging HPV vaccination interferes with “safe sex” or abstinence messaging. By encouraging a vaccine to prevent a sexually transmitted infection, are we giving permission to our children to have sex? This study looked at that question through the lens of how the individual States have approached HPV vaccine legislation. Some states have passed specific laws to encourage HPV vaccines; others have not. It turns out that adolescent sex behaviors, including having sexual relationships and using condoms, isn’t affected by how strongly their states encourage HPV vaccines.

 

Neither of these specific studies is a slam-dunk – and that’s the way science can be. We accumulate more and more evidence as time goes by. But they add up to what we can say with confidence: HPV vaccines are safe, and HPV vaccines can help protect your children from cancer. It’s a compelling story, and something parents ought to feel good about. There is no reason to hesitate – make sure your children are protected and up to date.

 

Key studies on HPV vaccination

A huge, comprehensive review of studies from May, 2018 showed that “There is high-certainty evidence that HPV vaccines protect against cervical precancer in adolescent girls and young women aged 15 to 26.” (Earlier review here) This study from August 2018 documented dropping cancer rates after the vaccine was introduced. The vaccine is working, and it’s saving lives.

A 2010 review of post-licensure studies showing good safety profile, and another large study of 600,000 doses in 2011 didn’t find any important safety concerns. Another 2012 study found no significant problems after almost 200,000 doses. These are big, reassuring studies that all say the same thing: HPV vaccination is safe.

Studies showing HPV vaccines do not cause chronic fatigue, autoimmune diseases, complex regional pain syndrome or postural orthostatic tachycardia syndrome. These and other studies looking for specific diseases or conditions caused or worsened by HPV vaccines have all been reassuring – these vaccines aren’t associated with these or any other worrisome health conditions.

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Don’t waste your money on “food sensitivity” tests

September 20, 2018

The Pediatric Insider

© 2018 Roy Benaroch, MD

Ah Facebook. Where else could I stumble on a video of a baby hippo taking a bath, or Toto’s Africa performed on solo Harp? But among the shares and silliness and talent, there’s a dark side to Facebook. It’s become a fast way for quacks to push their scams and empty your wallet.

Just today in my feed I received a “promoted” post about a “Food Sensitivity Test”. I’m not going to link directly to the company – feel free to do a Google or Facebook Search, you can find them along with dozens of other companies that push a similar product. What they’re selling, they claim, is an easy, at-home test that will reveal your “food sensitivities”.  They say their test won’t diagnose allergies (which is absolutely true), but it will help you find out which foods might be causing things like “dry and itchy skin, other miscellaneous skin problems, food intolerance, feeling bloated after eating, fatigue, joint pain, migraines, headaches, gastrointestinal (GI) distress, and stomach pain.”

This is absolute nonsense. Their test can’t in any way determine if any of these symptoms are possibly related to food. What they’re testing for in your blood, they say, are IgG antibodies that react to each of 96 different foods in your body. But we know that these IgG antibodies are normal – all of us have some or most of these if we’ve ever eaten the food. IgG antibodies are a measure of exposure, not a measure of something that makes you sick or makes you feel ill. Having a positive IgG blood test for a food means that at some point you ate the food. That’s it. Nothing more.

This isn’t something that we just now discovered. IgG antibodies to food have been a known thing for many years. We know why they’re there and we know what they do. And we know testing them is in no way indicative of whether those foods are making you sick. Recommendations from the American Academy of Allergy Asthma & Immunology, The Asthma and Allergy Foundation of America, the American College of Allergy, Asthma, and Immunology, and the European Academy of Allergy and Clinical Immunology all unequivocally recommend against food IgG testing as a way to evaluate possible food sensitivities. The testing just doesn’t work to reveal if a food is making you sick.

But that doesn’t stop quacks from direct-marketing on Facebook. If you’re offered IgG-based food sensitivity testing, either through the mail, at a physician’s, or at a chiropractor or naturopath, I’ll tell you exactly what it means: Save your money and run the other way. Whoever is pushing the test is either deliberately deceiving you or doesn’t understand basic, medical-school level immunology. It’s a scam.

More details about the (lack of) science behind IgG food testing

What causes dark circles under the eyes in children?

November 6, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

Rachel wrote in a topic suggestion:

My 8 year old daughter has for years had dark circles under her eyes. What causes this? She is very healthy and hardly ever gets sick. I have ‘heard’ this can be caused by food allergies or liver problems, but I’ve been very skeptical about that.

Rachel, I see these in kids all the time. Most commonly, I think it’s just normal – especially in children with a fair complexion. It’s easier to notice these in kids with thin, light, milky sort of skin (often with light eyes and light or red hair, too.)

One medical issue that can contribute to darkness under the eyes is congestion in the veins lining the nose. This makes the blood vessels dilate and become more noticeable. You’ll see this in children with nasal allergies or “hay fever” to airborne allergens like pollen or dust or molds. That’s why these dark areas are sometimes called “allergic shiners.” If the nasal allergy symptoms are bothering the child, this can be treated by avoiding the triggers (not always easy), or nasal spray OTC allergy sprays like Nasacort or Flonase. Oral antihistamines like Zyrtec or Claritin will be less effective for nasal congestion.

I’ve also often heard that lack of sleep can cause dark circles – Google it, and there are plenty of people who say this. I couldn’t find any evidence that this is true in children, but it might be. And more sleep couldn’t hurt.

As for food allergies – you know, I wouldn’t have thought so, at least not in my experience. But this report showed that about 50% of kids who had classic GI symptoms of food allergy also had allergic shiners. So, yes, in a child who has GI symptoms of food allergies, they might get shiners too. But in a child with no GI symptoms, I don’t think allergic shiners would be a likely isolated finding of food allergy. And liver disease? No, I don’t think so. I couldn’t find any evidence for that at all, at least not in children.

So: pretty much benign, maybe related to allergies, and probably best ignored unless the allergic symptoms themselves are bothering the child. You can add “dark circles under eyes” to our ever-growing list of things parents really don’t need to worry about!

Just because a chemical is present doesn’t mean you have to worry about it

July 31, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

Advocacy groups have been busy lately with their fancy-pants chemicalz detection science instruments, and their press releases have made it into the news. But is there news here, and are these chemicals something parents really need to worry about?

First it was a big lead from the New York Times called “The Chemicals in your Mac and Cheese.” The article started:

Potentially harmful chemicals that were banned from children’s teething rings and rubber duck toys a decade ago may still be present in high concentrations in your child’s favorite meal: macaroni and cheese mixes made with powdered cheese.

Oh noes, not high levels! The chemicals they’re talking about are from a family called “phthalates,” which sounds scary and difficult-to-pronounce. (Words shouldn’t start with four consonants. On this we should all agree.) Phthalates have been in wide use for over 80 years in plastics and other compounds. Though they’re not added to cheese, they’re on the coatings of tubes and platforms and whatever else is used in the machinery to make Magic Orange Cheese Powder. Foods with a high surface area (like a powder) are going to come in more contact with it, and a teeny bit of a trace of a few molecules are going to transfer over.

Important point: these chemicals have been in our food for many, many years. What’s changed is that we’ve now got fancy equipment to measure it. The Times story is quoting a kind of press release – not a medical study, or even anything published in the medical journal. It’s a “study” done by a consortium of food advocacy groups. It’s being promoted by an organization called “KleanUpKraft.Org” (Cutesy misspellings are at least as bad as starting words with four consonants, K?) And their “high levels” are in tiny parts per billion, at levels that are very low compared to amounts that cause adverse effects in animal studies.

Just because you can detect a chemical as present doesn’t mean there’s enough of it to hurt you. Mercury and arsenic are part of the natural world around us, and any food tested with equipment that’s sensitive enough will find at least traces of these and many other chemicals. It is not possible to get the values of phthalates or arsenic or many other chemicals down to zero in our foods.

Speaking of chemicals, this week another food advocacy organization announced that they’d found traces of an herbicide (glyphosate, found in Round-Up) in Ben & Jerry’s Ice Cream. And in every flavor tested, too, except Cherry Garcia, which is kind of nasty-tasting anyway (I’m sticking with Chunky Monkey, which wasn’t even tested.) But: their press release didn’t even reveal the levels that they found, only that they found it. Maybe it was one part in a zillion. Who knows? But: Do you think if the value were genuinely high they’d hide it like this? No way. It’s there in some kind of teeny amount, and they’re trying to scare you.

Don’t fall for all of this “The Sky is Falling, There’s Chemicals in My Food” hype. Just because something is hard to pronounce doesn’t make it dangerous, and just because something is present doesn’t mean it’s going to kill you. We’ve all got enough to worry about without being scared of Mac and Cheese and Ice Cream. In fact, a little comfort food in these troubled times would probably be good for all of us. Maybe even the grumps at KleanUpKraft.org.

By the way, I don’t disagree with one thing – homemade Mac n Cheese is at least as good as that boxed orange stuff. Though sometimes, I won’t deny it, the orange stuff sure does hit the spot…

Vaxxed versus unvaxxed children: What a real study shows

July 26, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

You may have seen it on Facebook: A published study claiming to be “The First Ever” comparing vaccinated and unvaccinated children supposedly showed that vaccinated children are more likely to have a number of health problems. Let me promise you: there’s nothing to worry about here. The study is one of those garbage-in-garbage-out whackjobs that’s almost indescribably bad and unreliable. And: a much better study of the same thing – children who are vaccinated, versus children who are not vaccinated – shows that there are not any worrisome risks. The long-term health of vaccinated children is just fine, and even better than unvaccinated kids (because they don’t have to suffer through vaccine-preventable diseases.)

Let’s cover the good study, first. It was published in 2011, and tracked over 13,000 randomly selected children in Germany, tracking their health status and correlating that with their documented vaccine histories. The authors could find no examples of any increased risks of infectious or allergic diseases in the vaccinated children.

And now, this more-recent, execrable study. They didn’t use randomly selected children. What it actually compared were the 666 children of homeschoolers who chose to complete the survey (which was promoted on antivaccine websites), using their self-reports of vaccine histories and health status. Of these, 40% hadn’t been vaccinated, at least according to the surveys. No attempt was made to track who received the survey, what percentage of respondents completed it, and what kind of respondents completed it. Do you think it’s possible that a high proportion of vaccine-distrusting parents would complete a survey like this? Hint: if you did a survey of musical tastes at a Justin Bieber concert, you’re not going to find many Cab Calloway fans.

The “study” was really just a survey, and a biased one at that – a survey among people who were guaranteed to say exactly what the study authors wanted them to say. It had already been retracted, once previously (and, laughably, by a bottom-feeding journal that looks like it requires authors to pay to publish their studies. This isn’t the way legit journals work.)

Vaccines are safe, and they save lives. Make sure your kids are fully vaccinated. Don’t believe the Facebook rumors, or idiocy dressed up like science – what the real science shows is what parents should feel confident about. There’s no need to worry about vaccines.

A more detailed evaluation of this fakakta survey is here, and here’s more information about reliable vaxxed versus unvaxxed studies. Yes, they’ve been done before. Yes, they consistently show that vaccines are safe and that vaccinated children are healthy.

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What can be learn from vending machines and casinos to stop childhood whining?

December 19, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

Megan, like all parents, hates the whining and nagging:

It’s driving me crazy. My children whine and complain until they get what they want. I try not to give in, but sometimes it’s just impossible. What can I do?

(That’s an excerpt from a much longer message. You get the idea.)

Let’s look at whining from a classic behavioral approach. Stay with me, here – behavioral theory is a big part of why we do the things we do, children and adults alike. It’s worth understanding.

What we’re talking about here is called “operant conditioning.” Basically, whether people continue to do something depends on the consequences. If complimenting your spouse gets you a friendly smile or peck on the cheek, you’ll keep doing it (assuming you like smiles and kisses.) If your child’s whining means she gets what she wants, she’ll keep doing that, too. A related term is “positive reinforcement” – that’s a reward or benefit that comes after a behavior. Positive reinforcements (giving a child exactly what she wants) make it more likely that the behavior (whining) will happen again.

So: step one of dealing with whining (or many other undesirable behaviors) is to remove the positive reinforcement. But there’s a twist, here – it turns out that the schedule of the positive reinforcers can change how well it works. This might not be intuitive, but it turns out that regular, always-given, predictable positive reinforcements are not as lasting or powerful as irregular, unpredictable, changing positive reinforcers.

Think about vending machines and casinos. With a vending machine, you always get exactly what you ordered (assuming the stupid thing isn’t broken – there’s an interesting behavioral lesson about that situation, too, but we’ll save that for another time.) People who get things from vending machines are positively reinforced, but they don’t typically crave vending machines. And: when the positive reinforcement ends (say, for 1 or 2 times you don’t get your bag of Funyuns), you’ll quickly stop using the vending machine.

But at a casino, you don’t know what your reward will be, or even if you’ll get one. In fact, most of the time, you get nothing at all. But that kind of reinforcement, the “sometimes-surprise” schedule, reinforces the behavior even more effectively. Think about people pumping money into slot machines, only to get occasional, unpredictable rewards.

Let’s come back to whining. If you reinforce the whining sometimes, or in an unpredictable way (“Here! Just have the whole bag of lollopops!”), you’ll unintentionally be encouraging the behavior even more than if you always said “yes.” If Megan is serious about stopping the whining, she has to stop reinforcing it, and shouldn’t give in. Ever.

What about punishment to stop whining? A punishment is an action you take after the behavior, a consequence that’s designed to stop the behavior. It turns out that behavioral studies in animals, children, and adults show that punishment is typically only temporarily effective. Yelling at your child for whining, or restricting privileges, or some other punishment – none of these will work well. That’s like the vending machine giving you a bag of stale chips. You’ll be mad, and might avoid the vending machine for a few days, but you’ll be back. Or, imagine, if a casino sometimes just took your money away from you. That’s a valid punishment, but it doesn’t really change a behavior as well as completely stopping the positive reinforcements (in a casino, the occasional big payouts.) If the punishment of losing money at casinos actually worked, they’d all be out of business.

Sometimes, there’s more to whining than just behavior and consequences. I’d consider the child’s development and communication skills, and overall parenting style, expectations, mental health, resource scarcity — lots of things beyond behavioral theory. But a straight-up behavioral approach is sometimes the simplest, best way to get children to stop with the whining. And if it works, Megan owes me a trip to Vegas. Or at least a bag of Funyuns.

Red wine pouring into wine glass, close-up

Red wine pouring into wine glass, close-up

Homeopathic teething pills: Still poisonous

October 4, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

In 2010, I wrote about the FDA’s recall of Hyland’s Teething Tablets. It turned out that the tiny little pills, sold to allegedly help babies with teething symptoms, had measurable and potentially toxic amounts of a poisonous plant extract, belladonna. See, they were supposed to not actually have any of that, because homeopathic products aren’t supposed to have any of anything.

One principle of homeopathy works like this: by ultra-super diluting a poison, you get a cure for the poison, or at least relief of the symptoms that the poison would have caused if you ingested it. Which, of course, you shouldn’t do (ingesting the actual poison is discouraged, until it’s ultra-super diluted and isn’t there anymore. That’s what you’re paying for.) Those Hyland’s Tablets turned out to contain the poison that wasn’t supposed to be in there. Oops.

By the way, it’s called “belladonna” from the Italian roots for “beautiful woman”. Belladonna comes from the nightshade plant, and this “natural” chemical will make your pupils dilate (that’s the beautiful part.) It can also cause excessive sleepiness, muscle weakness, difficulty breathing, agitation, and seizures. Those parts are less beautiful.

Last week, on September 30, the FDA updated their 2010 release, warning consumers against using any homeopathic teething tablets or gels. This includes not just Hyland’s products, but those sold at CVS and other retail and online stores.

The bottom line: if they’re manufactured correctly, homeopathic products don’t contain any active ingredients at all. There is nothing in there that could possibly help with teething or any other condition. Oh, sure, there may be other things added to homeopathic products to make you drunk, but that’s not the point. Homeopathic products should be as safe as drinking a little water or swallowing a tiny little sugar pill—because that’s exactly what they’re supposed to be, a little vial of water or a tiny little placebo pill.

That’s if they’re made the way they’re supposed to be made. But homeopathic products, like all of the other alt-med goodies sold next to the real medications, aren’t regulated. There’s no guarantee of purity, and no guarantee that what’s on the label is on the bottle. You’re paying for what you hope is a bottle of literally nothing, but you might accidentally get something that can hurt you.

Funny world, isn’t it? Can you imagine someone complaining to the manufacturer that their placebo was contaminated with a biologically active substance that might actually have an effect on their body? Hey, I paid good money for absolutely nothing, and that’s exactly what I wanted!

Anyway: if your baby seems to be having teething symptoms, try hugs and love or a dose or two of acetaminophen. If that doesn’t help, go see your doctor (it may not be teething at all—those little babies can’t talk yet, and it’s hard to know exactly what’s on their minds. Maybe they got a glimpse of that presidential debate, and they’re understandably worried about the future.) “Homeopathic Teething Tablets” certainly aren’t going to help, and might just make your baby sick.

belladonna