Archive for the ‘In the news’ category

Be wary of infant jewelry and lead poisoning

September 5, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

A recent story reported by the CDC reminds us of a few important lessons about teething, lead, and the kind of jewelry you buy at craft shows. A mom had purchased a handmade “homeopathic magnetic hematite healing bracelet” from an artisan at a local craft show. Her 9 month old daughter wore it on her wrist, reportedly to help with teething symptoms, and occasionally chewed on it (as babies are known to do.) She was found on routine screening to have a blood lead level about 10 times the safe upper limit of safety.

Lessons to learn:

Babies really shouldn’t wear jewelry at all (they look good without it!) Some bling is probably OK (like small earrings), but you have to be sure they’re not made with lead. That’s because anything on a baby or near a baby will end up in the baby’s mouth. Seriously, everything.

This particular bracelet was triple-dangerous. Looking at the photo, it was made of little beads strung together, which apart from their poisonous lead content were a potential choking hazard. And: magnets are a very bad thing for kids to swallow, because they can glom onto each other in clusters, or even while pinching a piece of intestine. Magnets are less likely to make their own way out without causing big-time tissue damage. No lead, no beads, no magnets!

Babies should especially never wear any kind of jewelry around their necks. Even a small tug on a necklace can close off the airway and kill a baby. That includes those trendy amber teething necklaces, which are both a choking and strangulation hazard. There are media reports of deaths from those things. Look out for long cords or straps on pacifiers, or cords on window blinds or binoculars or anything else thin and round and shaped in a loop. Anything that could wrap around a neck can strangle a baby and needs to be cut to pieces or kept very far away.

And: teething. Most babies experience teething with no symptoms whatsoever – the only way you know, with most babies, is that you see teeth poking out. An occasional baby might have some fussiness with teething, and you can treat them with love and cuddling, maybe a teething ring, or some acetaminophen if needed. There is no great plague of terrible symptoms of teething that need constant treatment, especially not with dangerous things. Teething is just another thing most parents do not have to worry about.

Other dangerous teething “cures” have included “homeopathic teething tablets” which contained poison, and benzocaine-containing teething gels (now mostly off the market) that caused a potentially fatal blood disorder. The sad thing here is that none of these were ever really needed – they’re marketed based on fear of a normal, harmless condition. Don’t waste your money, or endanger your child’s health, on jewelry or potions to treat teething.

Advertisements

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.

26

Expired Epipens are better than nothing

May 15, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

A small study published this month showed that most Epipens retain their potency for at least 4 years after their expiration date. That’s no guarantee, of course. I’d still recommend as a “best practice” that families replace them as they expire. But it’s reassuring to know that they’ll usually be effective even when expired. And using an expired Epipen is almost certainly better than using nothing when there’s a life-threatening allergic reaction.

It’s a simple enough study. Over 2 weeks, families attending a clinic in California were asked to donate expired Epipens for analysis. They collected 40 devices that had expired up to 50 months before the study, and used state-of-the-art chemical analysis to determine the potency of the medication in the vials. None of them looked discolored or unsafe. All of the pens that had expired up to 2 and half years ago had at least 89% of their original potency, and even most of the older ones remained in the 85% range. Though overall the dose potency slowly deteriorated, all of these devices would have still been helpful to treat an anaphylactic reaction.

A few small previous studies reached similar conclusions in 2015 and 2000. Though these studies looked at the Epipen brand of auto-injectors, it’s likely that studies of similar or generic products would yield the same results.

The authors of the study aren’t recommending that families hoard Epipens, or delay replacing them – but they do point out that their findings support further studies to extend the labeled shelf life of these products. And if an expired Epipen is all you’ve got, it’s probably OK to use it as long as it’s not obviously broken or discolored.

To help keep your Epipens in good shape, store them somewhere relatively cool (not cold), and away from light, preferably in the original packaging. Do not leave them in your car in the summer. Epinephrine is a finicky sort of chemical, and light and heat will speed its deterioration. Although you can hold on to expired Epipens as a “backup”, it’s best to replace them so you’re 100% sure that you’ve got what you need when you need it.

 

Simplified CPR – without mouth-to-mouth – can save children’s lives

May 1, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

Quick action is essential if someone has a sudden cardiac arrest. You might be in Target, or on a bus, or in a classroom when someone nearby just drops to the ground. Or maybe you’re boating, and you help pull a drowning victim out of the water. What do you do next?

CPR training is a great way to learn the steps, and I strongly encourage it for all parents and everyone else. But we know that many bystanders are unable to perform CPR when it’s needed. There’s panic and indecision and trying to remember what to do. To make it more possible for anyone to help, the old-school ABCs of CPR (Airway, Breathing,  Circulation) have been simplified. The current recommendations for CPR in most situations is just a few steps:

  1. Check if the victim is OK. Ask “Are you OK?” and give a little shake. If the person doesn’t respond, you need to act quickly.
  2. Call for help or call 911.
  3. Start pushing the middle of the chest down, over and over, fast and hard, until help arrives. If someone can bring over an automatic defibrillator, use it.

Those are all the steps. Rescue breathing has been deemphasized (it can still be used by trained people, if CPR is prolonged, or in some other situations.) Checking pulses and breathing isn’t necessary. It turns out that doing something (calling for help and starting chest compressions) is better than doing nothing.

However, there’s been some concern that compression-only CPR may not be as effective for children. Kids don’t have the same kind of arrests as adults (they’re much less likely to have a heart attack, for instance.) A new study from Japan shows that compression-only CPR is probably about as effective as traditional CPR in children – and it’s far better than doing nothing.

In Japan, all out-of-hospital arrests are recorded in a tracking database. Researchers looked at all of these events from 2011 to 2012 in children from age 1 to 18 (infants less than 1 were excluded.) This was at a time when compression-only CPR was being promoted for use by bystanders in Japan. Data had been collected regarding whether CPR was performed, and what kind; and the study authors tracked down all of the child victims to see how they were doing 1 month after their event. A good outcome was considered to be living with with normal or nearly normal neurologic function.

Overall, 2,157 children experienced a cardiac arrest over 2 years. The most common causes were from drowning and trauma. About ½ of the time, no CPR was performed; among the 1,150 who received CPR, 733 had compression-only CPR. The authors were then able to compare the outcomes.

The overall chance of a favorable outcome for all of these children was 10% (which is about what we’d expect for out-of-hospital cardiac arrests.) When the causes and severity of the arrests were controlled, conventional CPR provided a 18% good outcome, compression-only CPR 16%, and no CPR 4%.

So: doing anything was far better than doing nothing at all. It’s still unclear what the “best” CPR for children should be, and further studies will likely work that out. But we know now that simple, compression-only CPR is about as good as full-scale, mouth-to-mouth+compression CPR. If you’re not sure what to do, just push on that chest, fast and hard, until help arrives.

The best way to learn CPR is a hands-on, in-person course with a qualified instructor. There are some good alternatives if you’re in a hurry. The CPR anytime course can teach you the basics online in about 20 minutes. If you don’t have the time for that, watch this brief video about compression-only CPR. Remember, you don’t have to remember everything, and you don’t need to be perfect. Call for help, and then push – hard and fast. You can save a life.

Vaccinations are the best immune booster

April 26, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

The human immune system is an amazing thing. There are thousands of microorganisms – millions, maybe – that are lurking out there, eager to make you sick. You breathe them in. They’re in every bite of food, and all over your hands when you rub your nose. We live in constant bombardment.

And they’re sneaky, too – with changing DNA and proteins to fool us. We’ve got soap and water and some pretty good antibiotics to fight them off, but, really, the vast majority of the work to keep us healthy is done by our own immune systems.

Wouldn’t it be nice to give your immune system a boost, to help it fight off infections? We know moderate (but not heavy) exercise can help, as can a good night’s sleep. What about those “immune booster” vitamin packs they sell? Hint: there’s a reason they say right on the package that they don’t prevent or treat any disease. Save your money.

Another idea: you can just get sick, and at least the next time around your immune system can recognize the germ and fight it off more effectively. Of course, you have to get sick first to enjoy those benefits. And some of those sicknesses can be pretty serious. Or might kill you. Still, no pain no gain, right?

Wrong. There’s a great way to get a real immune boost – a way to help your own immune system, or that of your children, fight off diseases without having to get sick first. They’re vaccinations. They give your immune system a glimpse, a quick safe view, of an infection in a way that won’t make you sick, but will still teach your immune system to recognize the infection if you ever have to fight it off. It’s the best way to prepare your immune army for battle against the infectious enemy, in a way that’s almost risk-free.

Get your sleep and exercise, and eat tasty, home-made foods. Grow a vegetable garden. Hug your kids. Sing like no one is listening, and dance like no one is watching. And vaccinate, too.  These are all great ways to keep your children happy, healthy, and safe.

National Infant Immunization Week Blog-a-thon with woman holding baby. #ivax2protect

Breastfeeding and vaccinations protect your baby in different ways

April 24, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

“Since I’m nursing my baby, she’s getting all of the antibodies in my breast milk. Doesn’t that protect her the same way vaccines do?”

There are antibodies in breast milk, and they can help protect your baby from some kinds of infections. But those kinds of antibodies are different from the ones your baby will make herself after vaccinations. Breastfeeding contributes to one kind of protection, but the protection from vaccines is more powerful and longer-lasting.

Antibodies (also called “immunoglobulins”) are proteins that are part of your immune system. They work by attaching to invading microorganisms and viruses, which helps signal your immune system to attack. Antibodies have to be specific to each kind of infection—one antibody doesn’t fight multiple germs—and your immune system learns how to make different antibodies based on your body’s exposures to infections.

There are two ways for your baby to get antibodies. She can get them passively, from mom, either across the placenta or via breastmilk. Both are important. Placental antibodies are IgGs, which circulate in the blood. These kinds of antibodies help fight off invasive diseases. After a baby is born, placental IgG antibodies fade away over several months. Moms can boost their own ability to give these IgGs by being vaccinated, themselves, during pregnancy (that’s why moms should get influenza and pertussis vaccines while they’re still pregnant.) Breast milk contains a different kind of antibody, IgAs, which aren’t found in the blood. They are a part of intestinal and respiratory mucus, protecting people from infections before they get to the blood. The effect of these IgA antibodies in breastmilk is especially important in the developing world, where safe water and food is harder to find, and where moms have especially high titers of their own antibodies from ongoing infectious exposures.

The other way for babies to get antibodies is to make them on their own. To learn to do this, they must either be exposed to the infection, or get an immune-boosting “glimpse” of the infection by receiving a vaccine. That’s the point of vaccines: to allow someone to make their own strong, protective antibodies without the risk of having to suffer through the disease. These antibodies, made after “active immunization”, are of very high titers and are long-lasting – in some cases, for a lifetime. They’re much more protective than the passive antibodies gained across the placenta or through breast milk.

Bottom line: families can help protect their babies from infection in many ways. Sick people should be kept away from newborns. Moms should get their own recommended vaccines. Nursing can help (though in the developed world, the impact of nursing on infections is modest.) And babies should get their own vaccines, as recommended, on schedule, to get the best possible protection.

National Infant Immunization Week Blog-a-thon with woman holding baby. #ivax2protect