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Your Child

What to Do If Your Child Is Choking

2.30 to read

It’s more common than you probably think. On average over 12,000 children a year, under the age of 14, are treated in hospital emergency rooms for food-related choking. That’s about 34 kids a day according to a new study.

The most common choking hazards appear to be hard candy, followed by other types of candy, then meat and bones. The study noted that most of the young patients were treated and released, but around 10 per cent were hospitalized.

"These numbers are high," said Dr. Gary Smith, who worked on the study at Nationwide Children's Hospital in Columbus, Ohio.

What's more, he added, "This is an underestimate. This doesn't include children who were treated in urgent care, by a primary care physician or who had a serious choking incident and were able to expel the food and never sought care."

The estimated 12,435 children ages 14 and younger that were treated for choking on food each year also doesn't include the average 57 pediatric food-choking deaths reported by the U.S. Centers for Disease Control and Prevention annually, the researchers noted.

Smith and his colleagues analyzed injury surveillance data covering 2001 through 2009.

They found that babies one year old and younger accounted for about 38 percent of all childhood ER visits for choking on food. Many of those infants choked on formula or breast milk.

Children who choked on hotdogs, nuts and seeds were the most likely to be hospitalized.

"We know that because hot dogs are the shape and size of a child's airway that they can completely block a child's airway," Smith told Reuters Health, noting that seeds and nuts are also difficult to swallow when children put a lot in their mouths at once.

Supervision is the most important choking prevention. Parents or guardians should make sure that a small child’s food is cut up into manageable bites that can be easily chewed and swallowed. An example might be grapes and raisins. A whole raisin is probably okay to be given to a toddler, but a grape should be sliced.

What should you do if your child is choking?

For children ages 1 to 12:

1. Assess the situation quickly.

If a child is suddenly unable to cry, cough, or speak, something is probably blocking her airway, and you'll need to help her get it out. She may make odd noises or no sound at all while opening her mouth. Her skin may turn bright red or blue.

If she's coughing or gagging, it means her airway is only partially blocked. If that's the case, encourage her to cough. Coughing is the most effective way to dislodge a blockage. If the child isn't able to cough up the object, ask someone to call 911 or the local emergency number as you begin back blows and chest thrusts. If you're alone with the child, give two minutes of care, then call 911.

On the other hand, if you suspect that the child's airway is closed because her throat has swollen shut, call 911 immediately. She may be having an allergic reaction to the food.

Call 911 immediately is your child is turning blue, unconscious or appears to be in severe distress.

2. Try to dislodge the object with back blows and abdominal thrusts.

If a child is conscious but can't cough, talk, or breathe, or is beginning to turn blue, stand or kneel slightly behind him. Provide support by placing one arm diagonally across his chest and lean him forward.
Firmly strike the child between the shoulder blades with the heel of your other hand. Each back blow should be a separate and distinct attempt to dislodge the obstruction.

Give five of these back blows.

Then do abdominal thrusts

Stand or kneel behind the child and wrap your arms around his waist.

Locate his belly button with one or two fingers. Make a fist with the other hand and place the thumb side against the middle of the child's abdomen, just above the navel and well below the lower tip of his breastbone.
Grab your fist with your other hand and give five quick, upward thrusts into the abdomen. Each abdominal thrust should be a separate and distinct attempt to dislodge the obstruction.

Repeat back blows and abdominal thrusts Continue alternating five back blows and five abdominal thrusts until the object is forced out or the child starts to cough forcefully. If he's coughing, encourage him to cough up the object.

If the child becomes unconscious If a child who is choking on something becomes unconscious, you'll need to do what's called modified CPR. Here's how to do modified CPR on a child:

Place the child on his back on a firm, flat surface. Kneel beside his upper chest. Place the heel of one hand on his sternum (breastbone), at the center of his chest. Place your other hand directly on top of the first hand. Try to keep your fingers off the chest by interlacing them or holding them upward.

Perform 30 compressions by pushing the child's sternum down about 2 inches. Allow the chest to return to its normal position before starting the next compression.

Open the child's mouth and look for an object. If you see something, remove it with your fingers. Next, give him two rescue breaths. If the breaths don't go in (you don't see his chest rise), repeat the cycle of giving 30 compressions, checking for the object, and trying to give two rescue breaths until the object is removed, the child starts to breathe on his own, or help arrives.

A good rule of thumb for parents and guardians is to take a CPR class. Many hospitals and clinics also offer classes on what to do if your child is choking.

Sources: Genevra Pittman, http://www.reuters.com/article/2013/07/29/us-choking-food-idUSBRE96S04K20130729

http://www.babycenter.com/0_first-aid-for-choking-and-cpr-an-illustrated-guide-for-child_11241.bc

 

Your Child

Heavy Metals in Children’s Toys

Two years after Congress passed a law setting comprehensive limits on lead in children's products, the government needs to address other heavy metals in such products, the American Academy of Pediatrics (AAP) testified Thursday morning.The American Academy of Pediatrics is urging Congress to address the heavy metals in children’s products.

Two years after Congress passed a law setting comprehensive limits on lead in children's products, the government needs to address other heavy metals in such products, the American Academy of Pediatrics (AAP) testified Thursday morning. As a result of lead limits established by the Consumer Product Safety Improvement Act (CPSIA) of 2008, manufacturers have begun adding cadmium, a known carcinogenic, to children's products, said Dr. H. Garry Gardner before a Senate Commerce subcommittee on consumer protection.

"This is clearly a case of abiding by the letter but not the spirit of the law — Congress hardly intended for companies to substitute one poison for another," Gardner said. The AAP recommended that eight heavy metals in American Society for Testing and Materials's voluntary toy safety standards should undergo rigorous review by the Consumer Product Safety Commission (CPSC). Any standards issued as part of the review should apply to all children's products and not just toys, the AAP said. The AAP also asked the CPSC to consider requirements for secure closures on devices containing small, powerful magnets that can result in major damage to the esophagus and possibly death. Nearly 8,700 "button battery" incidents were reported between 1990 and 2008, of which 62 percent involved children under the age of six, Gardner testified. What are heavy metals? Heavy metals are individual metals and metal compounds that can affect people’s health. In very small amounts, many of these metals are necessary to support life. However, in larger amounts, they become toxic. Some toxic chemicals to be aware of are Arsenic, Beryllium, Cadmium, Lead, Mercury, Hexavalent Chromium. Although it’s not listed as a toxin on the sites that test toys, some scientists and pediatricians suggest avoiding bottles and dinnerware made with Bisphenol-A. Inexpensive jewelry made in China appears to take the lead in toys with toxic metals. Consumer Reports offers these tips for avoiding heavy metals: -Don't allow children to have or play with cheap metal jewelry. -Take an inventory of your children's toys and check them against the recall list at www.cpsc.gov, which has photos and descriptions of products recalled for lead or cadmium. Also check the list if you're buying used items. -Consider do-it-yourself test kits, which can be useful though limited screening tools. -Don't drink from garden hoses, which might contain lead that can leach into water. As a precaution, wash your hands immediately after handling power cords, extension cords, and even strings of holiday lights. For a list of toys that have been tested for toxic chemicals and found free from heavy metals check out http://www.healthystuff.org/departments/toys/product.least.php?rank=none

With Holiday shopping already underway, make sure the toys you give to the little ones in your family are safe.

Your Child

PetSmart Expands Fish Bowl Recall Due to Lacerations

1:30

PetSmart is expanding its recall of fishbowls after several injury reports.

The glass fishbowls can crack, shatter or break during normal handling, posing a laceration hazard to consumers.

This recall involves the 1.75-gallon glass fishbowl that is shaped like a brandy snifter. These fishbowls were sold under the Grreat Choice or Top Fin brand names with SKU number 5140161 and UPC code 737257187092. The SKU and UPC codes are printed on a white sticker on the bottom of the fishbowl.

PetSmart has received 20 new reports of the glass fishbowl breaking during normal use, including 14 additional reports of cuts to fingers and hands. Seven cuts required stitches and three others required surgery for lacerated tendons.  

About 81,300 of these fishbowls were sold exclusively at PetSmart stores and online from March 2010 through September 2013 for about $20.

This recall comes on the heal of a previous recall involving the Top Fin Betta Bowl Kit.

Bowls can break, crack or shatter with normal use.

The Top Fin Betta Bowl Kits with LED Lights include a 0.6-gallon glass betta bowl and a base with an LED light. The plastic bases come in black, blue, pink, purple and silver. The following UPC numbers are located on the packages of recalled items.

Colors:

Black- UPC: 73725752848

Blue- UPC: 73725747577

Blue- UPC: 73725747577

Pink-UPC:  73725747595 

Purple            - UPC: 73725752855

Silver- UPC: 73725747598

The firm has received seven reports of incidents, including five reports of cuts to fingers and hands.

About 148,000 bowls were sold in the United States.

The fishbowls were sold exclusively at PetSmart stores nationwide and online at www.petsmart.com from September 2013 through October 2015 for about $25.

Consumers should immediately stop using the fish bowls and return the fish bowl to any PetSmart store for a full refund. Use caution when handling the fish bowl for return due to the hazard. 

Source: http://www.cpsc.gov/en/recalls/2016/petsmart-expands-recall-of-fish-bowls/

Your Child

AAP Recommends HPV Vaccine for Boys

2.00 to read

In 2006 the American Academy of Pediatrics (AAP) recommended that girls, ages 11-12, receive the human papillomavirus (HPV) vaccine. HPV can cause cervical cancer, and girls have been the prime focus for the vaccination.

The AAP has published new guidelines for the use of the HPV vaccine and now recommends that adolescent boys also receive the vaccine. The vaccine has been available to boys for two years but Tuesday’s vote was the first to strongly recommend routine vaccination.

The new recommendations were prompted by evidence that the HPV vaccine is effective as a treatment against genital warts in both males and females. HPV infection has been associated with an increased risk for not only cervical, but anal and some throat cancers as well.

The AAP recommends that the vaccine be administered at 11 to 12 years of age in both boys and girls. Their rationale is two-fold: First, the vaccine is most effective if it is administered before the individual begins engaging in sexual activity, mainly because the vaccine is inactive against HPV strains acquired before vaccination. Second, children mount the most robust antibody responses to the vaccine when they are between the ages of 9 and 15 years.

Two HPV vaccines are currently available in the United States, but there are differences in their approved indications. Quadrivalent HPV vaccine (HPV4, Gardasil, Merck) is the only vaccine approved for use in boys.

Bivalent HPV vaccine (HPV2, Cervarix, GlaxoSmithKline) is only approved for use in girls; HPV4 is also approved for girls.

Some of the updated AAP recommendations are:

  • Girls aged 11 to 12 years should be routinely immunized using 3 doses of the HPV4 or HPV2 vaccine, administered intramuscularly at 0, 1 to 2, and 6 months.
  • Girls and women aged from 13 to 26 years who have not been previously immunized or who have not completed their vaccinations should finish the series.
  • Boys aged 11 to 12 years should be routinely immunized with HPV4, using the same schedule as for girls.
  • Boys and men aged from 13 to 21 years who have not already been immunized or who have not completed their vaccines should finish the series.

Some health insurance policies now pay for the vaccine. If you do not have insurance and your child is not eligible for free immunizations, the HPV vaccine is expensive. Check with your pediatrician about your area’s cost.

The recommendations are published online and in the March print issue of Pediatrics.

There is a lot of online information available on HPV and the vaccine; some is very helpful and some can be unreliable. If you have concerns or questions, please talk with your pediatrician.

The vaccine is recommended for adolescents who are not yet sexually active. Many young people believe that oral sex is safer than vaginal sex and some believe that oral sex is not sex at all. A sharp rise in throat cancer among younger men has been linked to HPV. Vaccines can protect males and females against some of the most common types of HPV that can lead to disease and cancer, but they do not treat or get rid of existing HPV infections.

For more facts on the HPV vaccine and HPV in general, check out the Center for Disease Control and Prevention’s website at: http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-faqs.htm

Sources: http://www.medscape.com/viewarticle/759223  http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-faqs.htm

Your Child

Overweight Pals Eat More When They’re Together

Overweight children and teenagers may eat more when they have a snack with an overweight friend rather than a thinner peer, a new study suggests. The findings, reported in the American Journal of Clinical Nutrition, highlight the role of friends' influence in how much kids eat and, possibly, in their weight control.

The study involved nine-to 15-year-olds. Researchers found that all kids, regardless of their weight, tended to eat more when they had the chance to snack with a friend than when they were with a peer they did not know. But the biggest calorie intakes were seen when an overweight child snacked with an overweight friend. It's not surprising that children eat more when they are with friends instead of strangers, according to lead researcher Dr. Sarah-Jean Salvy, an assistant professor of pediatrics at the State University of New York at Buffalo. The same pattern has been found in adults, Salvy said. This, she explained, may be partly because people are more self-conscious around strangers, and partly because friends act as "permission-givers." For the study, Salvy and her colleagues had 23 overweight and 42 normal-weight children and teens spend 45 minutes with either a friend or an unfamiliar peer. Each pair was given games, puzzles and books for entertainment, along with bowls of chips, cookies, carrots and grapes. Overall, the researchers found, pairs of friends downed more calories than did unacquainted pairs. And overweight friends consumed the most — 738 calories, on average, versus 444 calories when an overweight child was paired with normal-weight friend. Normal-weight kids consumed an average of about 500 calories when paired with a friend, regardless of the friend's weight. When it comes to children and teens, it's known that many follow their friends' lead in deciding whether to smoke or drink. The current findings, Salvy said, suggest that kids' eating habits are also "largely determined by their social network." The good side of that, according to Salvy, is that helping one child make healthy changes may end up influencing his or her friends as well. She said her research interest now is to see whether there is in fact such a "contagion effect" on friends' eating habits.

Your Child

Powerful Narcotic Approved for Children

1:45

OxyContin is a powerful narcotic that is typically prescribed for adults who are in moderate to severe pain. It’s an opioid, similar to heroin that is the long-released formula of oxycodone. It can be highly addictive and is tightly regulated as a prescription.  For people who suffer from chronic or severe pain it is a potent drug that offers temporary relief.

The Food and Drug Administration (FDA) has approved limited use of OxyContin for children as young as 11 years old. Children with moderate pain are sometimes prescribed smaller doses of morphine or non-opioid drugs. Fentanyl patches (Duragesic) , a synthetic opioid analgesic, is prescribed for severe pain relief to children.

Dr. Sharon Hertz, director of new anesthesia, analgesia and addiction products for the FDA, said studies by Purdue Pharma of Stamford, Connecticut, which manufactures the drug, "supported a new pediatric indication for OxyContin in patients 11 to 16 years old and provided prescribers with helpful information about the use of OxyContin in pediatric patients."

Because of OxyContin’s highly addictive properties, it is popular among addicts and drug dealers. Five years ago, Purdue reformulated the drug to make it more difficult for patients or users to crush the pills for a quick high.

Hertz noted that the FDA was putting strict limits on the use of OxyContin in children.  Unlike adults, children must already have shown that they can handle the drug by tolerating a minimum dose equal to 20 milligrams of oxycodone for five consecutive days, she said.

"We are always concerned about the safety of our children, particularly when they are ill and require medications and when they are in pain," she said. "OxyContin is not intended to be the first opioid drug used in pediatric patients, but the data show that changing from another opioid drug to OxyContin is safe if done properly."

 Parents, understandably, are concerned about giving their child such strong medications. Addiction and overdose are the two main worries parents specifically express when faced with the possibility of their child being put on these types of drugs. However, when children are given opioids to relieve pain, they are not seeking the "high" associated with the medication, they are given the medication in safe, consistent and controlled amounts. Generally, children look forward to reducing or stopping the medication as this indicates improvement in their pain control.

If children develop a physical dependence over several weeks, easing off the medication gradually as the pain diminishes can prevent withdrawal symptoms. Physical dependence should not be confused with addiction.

Overdose is extremely rare in children taking opioids for pain relief. If overdose does occur, it can be treated with an antidote called naloxone.

Children as well as adults sometimes need a strong drug to ease or stop severe pain associated with disease or surgery. The approval of limited OxyContin use for children gives them the benefits of pain relief when overseen and provided by the physicians in charge of their care.

Sources: M. Alex Johnson, http://www.nbcnews.com/health/health-news/fda-approves-oxycontin-children-young-11-n409621

Michael Jeavons, MD, http://www.aboutkidshealth.ca/en/resourcecentres/pain/treatment/pages/opioids-safety-and-side-effects.aspx

 

Your Child

Concussions May Last Longer in Girls

2.00 to read

New research suggests that girls who suffer a concussion may have more severe symptoms that last longer compared to boys.

No one seems to know why there is a difference, but other studies have come to the same conclusion.

"There have been several studies suggesting there are differences between boys and girls as far as [concussion] symptom reporting and the duration of symptoms," said Dr. Shayne Fehr, a pediatric sports medicine specialist at Children's Hospital of Wisconsin.

In his new study, Fehr also found those differences. He tracked 549 patients, including 235 girls, who sought treatment at a pediatric concussion clinic.

Compared to the boys, the girls reported more severe symptoms and took nearly 22 more days to recover, said Fehr, also an assistant professor of pediatric orthopedics at the Medical College of Wisconsin.

In the new study, Fehr tracked patients from 10 to 18 years old. All were treated between early 2010 and mid-2012. Each patient reported on their symptoms, how severe they were and how long it took from the time of the injury until they were symptom-free.

Girls reported more severe symptoms and took an average of 56 days to be symptom-free. In comparison, the boys took 34 days. Overall, the time to recovery was 44 days when boys and girls were pooled.

The length of time it took for patients to fully recover from concussion is quite a bit longer than people usually think.

"Commonly you hear that seven to 10 days [for recovery] is average," Fehr said.

The patient’s who were part of this study went to concussion clinics, so their injuries may have been more acute.

Fehr did not find age to be linked with severity of symptoms. Most of the injuries -- 76 percent -- were sports-related, with football accounting for 22 percent of the concussions.

The top five reported symptoms were headache, trouble concentrating, sensitivity to light, sensitivity to sound and dizziness. Boys and girls, in general, reported the same types of symptoms, Fehr said, but the girls reported more severity and for a longer time period.

Fehr will present the findings at the American Medical Society for Sports Medicine this week. Studies presented at medical meetings are typically viewed as preliminary until published in a peer-reviewed journal.

Whether it’s a boy or a girl that suffers a concussion, it's important to be seen by a doctor and not return to play prematurely, which can be dangerous or even fatal, according to the American Academy of Pediatrics.

Anyone with a history of concussion is also at higher risk for another injury.

Source: Kathleen Doheny, http://www.webmd.com/brain/news/20140410/girls-suffer-worse-concussions-study-suggests

Your Child

Tragedy & Children

1:45 to read

Thanks for all the wonderful comments about my recent interview on CNN with Vinnie Politan. If you missed it, the topic was talking to children who may have witnesses a traumatic event.  Unfortunately, as you are well aware, there are numerous tragic and traumatic events which occur across our country (and around the world) and at times, children may be witnesses to these events.  With that being said, how do you discuss these tragedies with a child?

As an example, the tragic death of an acrobatic airplane pilot at the Kansas City air shows last week. Many, including children of all ages, viewed this event.  I think the most important thing to remember when talking to a child about a trauma or tragedy is to use words that are appropriate for the child’s age and vocabulary and to acknowledge your own feelings as well.  They need to know that you too were scared, sad, upset or anxious about the event. Ask them how they felt and listen to the words that they use as you may use those words again when talking to your child.

While every child is different you can often follow their cues as to how much and how detailed a discussion to have, and when and how to bring the topic up again. Some children are talkers and want to discuss things at length, while others may be quieter and take some time to absorb the information. Don’t force the discussion.  A parent knows their children and the discussion may/will be different for each child and will be further impacted by their ages.

For young children, it is also important to let them know that “Mommy and Daddy” are there and will take care of them and protect them, but at the same time bad things sometimes happen. That is why parents take precautions and are responsible (like holding hands when crossing the street, or wearing a helmet etc).But, if something does happen it is so important to validate your child’s feelings while at the same time teaching your child coping skills and resilience.  

If your child does view a traumatic event it is not unusual for them go through a period when they are afraid of separation, or have nightmares etc. They sometimes develop somatic complaints like tummy aches, headaches, and non specific complaints of “I just don’t feel well”. This is normal, but you should watch for a child who seems to “be stuck” with symptoms long after the event. In some cases a professional therapist may be helpful.

Lastly, don’t let them revisit the event. By that I mean keep the TV off for awhile, and monitor the internet so they are not watching constant images of the same event (like the falling of the twin towers on 9/11). With so many amateur videos of traumatic events being shown “on screen” 24/7 if your child sees these images over and over, it is as if they are reliving the experience each time.  It sometimes may feel as if we become addicted to watching it.  It was nice “in the olden days” when there were not constant images on screen to remind us of a picture that often fades in our own minds.

That's your daily dose for today. We'll chat again tomorrow.

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Your Child

Asthmatic Kids Breathe Easier With Smoke-Free Air

For children with asthma, reducing exposure to environmental tobacco smoke greatly decreases their chance of an asthma flare-up, hospital admission or ER visit.

A new study shows that for children with asthma, reducing exposure to environmental tobacco smoke greatly decreases their chance of an asthma flare-up, hospital admission or emergency room visit. "We found this to be true when the child's exposure (to second-hand smoke) decreased, even if the decrease did not mean completely eliminating their exposure," said Dr. Lynn B. Gerald of the University of Arizona in Tucson. "Any reduction in environmental tobacco smoke exposure seems to greatly benefit these children."

Dr. Gerald's team looked at the association between changes in environmental tobacco smoke exposure and childhood asthma-related illness in 290 asthmatic children enrolled in a clinical trial of supervised asthma therapy. The average age of the children in the study was 11 years and 80 percent had moderate persistent asthma. At the beginning of the study, 28 percent of caregivers reported that the child was exposed to second-hand smoke in the home and 19 percent reported exposure to smoke outside the home only. At a follow-up interview, 74 percent of caregivers reported no change in the child's exposure to second-hand smoke, 17 percent reported less exposure, and 9 percent reported increased exposure. According to the report, which is published in the medical journal Chest, children who had any decrease in exposure to second-hand smoke over the course of one year had fewer episodes of poor asthma control, made fewer respiratory-related trips to the emergency room and were less apt to be hospitalized than children who had the same or increased exposure to second-hand smoke. "We were not surprised by the findings but we were surprised by the magnitude of the benefit that decreasing smoke exposure appeared to have," said Dr. Gerald. She said doctors can use this information as another "teaching point" for caregivers and parents of children with asthma. Dr. Gerald and her colleagues also concluded given that the majority of second-hand smoke exposure in the home is due to parents smoking, "the most effective environmental tobacco smoke reduction strategy may be to provide smoking cessation interventions to parents and possibly other household members."

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What do the new concussion guidelines mean to young athletes?

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