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Your Toddler

Post-Tonsillectomy Codeine May Pose Dangers

A new report warns about the potentially deadly dangers of giving codeine to children after a tonsillectomy.  The report appears in the New England Journal of Medicine. It follows the death of an otherwise health two-year-old boy who was prescribed codeine to relieve pain from having his tonsils removed. The child, who had a history of snoring and sleep apnea, had the surgery in an outpatient clinic and was sent home, the researchers said.

Doctors prescribed codeine syrup and told the boy's mother to give it to him for pain, but two nights later, the child developed a fever and wheezing. He was found dead the next morning, according to the report. Toxicology tests showed that the mother had given the child the proper dosage, but the coroner found that the child had high levels of morphine in his system. Further investigation determined that the child had an ultra-rapid metabolism genotype, which causes the body to metabolize codeine at a faster rate than the norm. Codeine, is a narcotic used to treat mild to moderate pain and is metabolized by the body to morphine. In children with the ultra-rapid genotype, morphine can build to deadly concentrations. "The sudden death of a healthy child was quite sobering because tonsillectomies are done every day, all over North America," said Dr. Gideon Koren, a pediatrics professor at the University of Western Ontario and University of Toronto and author of the report. "And more and more of them are done on an outpatient basis, with the child going home the same day." The gene is present in slightly more than 1 percent of whites, but as many as 30 percent of people of African origin could have it. Enlarged tonsils are usually treated with antibiotics, but tonsillectomies are still used to treat sleep apnea, the study authors noted. Parents whose children are prescribed codeine should also be aware that codeine can suppress breathing, which is potentially dangerous if the tonsillectomy doesn't cure the sleep apnea. "This demonstrates the need to keep children in hospital under surveillance for at least 24 hours to see if the apnea persists," Koren said.

A new report warns about the potentially deadly dangers of giving codeine to children after a tonsillectomy.  The report appears in the New England Journal of Medicine. It follows the death of an otherwise health two-year-old boy who was prescribed codeine to relieve pain from having his tonsils removed. The child, who had a history of snoring and sleep apnea, had the surgery in an outpatient clinic and was sent home, the researchers said.

Doctors prescribed codeine syrup and told the boy's mother to give it to him for pain, but two nights later, the child developed a fever and wheezing. He was found dead the next morning, according to the report. Toxicology tests showed that the mother had given the child the proper dosage, but the coroner found that the child had high levels of morphine in his system. Further investigation determined that the child had an ultra-rapid metabolism genotype, which causes the body to metabolize codeine at a faster rate than the norm. Codeine, is a narcotic used to treat mild to moderate pain and is metabolized by the body to morphine. In children with the ultra-rapid genotype, morphine can build to deadly concentrations. "The sudden death of a healthy child was quite sobering because tonsillectomies are done every day, all over North America," said Dr. Gideon Koren, a pediatrics professor at the University of Western Ontario and University of Toronto and author of the report. "And more and more of them are done on an outpatient basis, with the child going home the same day." The gene is present in slightly more than 1 percent of whites, but as many as 30 percent of people of African origin could have it. Enlarged tonsils are usually treated with antibiotics, but tonsillectomies are still used to treat sleep apnea, the study authors noted. Parents whose children are prescribed codeine should also be aware that codeine can suppress breathing, which is potentially dangerous if the tonsillectomy doesn't cure the sleep apnea. "This demonstrates the need to keep children in hospital under surveillance for at least 24 hours to see if the apnea persists," Koren said.

Your Toddler

Toddler Sleep, Eating Problems, Often Go Together

2.00 to read

So-called behavioral insomnia, where a young child regularly resists bedtime or has trouble staying asleep, is common -- seen in up to 30 percent of children between the ages of 6 months and 3 years.

A similar percentage have problems at mealtime, ranging from being an overly "fussy" eater to having a full-fledged "feeding disorder" - in which, for instance, parents can't get their child to follow any regular eating schedule, or the food refusal affects a child's weight.

It might not be surprising to many parents that sleeping and eating issues often go hand-in-hand. But the new study, published in the journal Pediatrics, is the first to show this may be true.

Among parents of 681 healthy kids 6 months to 3 years old, Israeli researchers found that those whose child had behavioral insomnia were more likely than other parents to say their child had eating issues as well.

And parents whose children were diagnosed with a feeding disorder were more likely to say they had trouble getting their child to sleep at night.

When asked if mealtime was a "problem," one-quarter of parents of children with insomnia said that it was; that compared with nine percent of other parents.

Similarly, 37 percent of parents whose children had an eating problem said that sleep was also an issue. In contrast, only 16 percent of other parents said the same.

Young children's eating and sleeping habits are the two most common concerns parents bring to their pediatricians, write the researchers, led by Dr. Riva Tauman of Tel Aviv Medical Center.

The current findings, they say, suggest that doctors should be aware that the two issues commonly go together, and help parents find ways to manage both.

The standard way to address behavioral insomnia is for parents to change their children's nighttime routine. That usually means setting a regular bedtime and certain rituals, like reading a story, that let a young child know bedtime is coming.

With eating problems, experts generally suggest that parents try to get kids interested in mealtime from an early age -- gradually introducing a variety of healthy, colorful foods, for instance, and making the eating environment pleasant but without any distractions like TV.

The current findings are based on 58 children who had been diagnosed with behavioral insomnia, 76 with a feeding disorder, and 547 who were studied for comparison.

Parents of children with insomnia were more likely to also report feeding "problems" -- worrying, for example, that their child was not eating enough or not growing properly.

Similarly, parents of children with feeding disorders were often worried about their child's sleep; and compared with other parents, they reported that their children got to bed almost an hour later, and slept for fewer hours each night.

It's possible, according to Tauman's team, that parents of young children with feeding disorders are more sensitive to sleep issues -- and vice-versa.

But they say it's also likely that parenting practices, like a lack of consistency in enforcing rules, underlie both problems.

On the positive side, the researchers note, that means that getting help for one issue could help parents manage both.

Tips for getting your child to sleep:

Stick to a bedtime. "Don't wait until your baby is rubbing his eyes or yawning to put him to bed," says Marc Weissbluth, MD, author of Healthy Sleep Habits, Happy Child. "By then he's overtired." If you notice your child winding down at 8 p.m., make that his/her bedtime.

Get into the routine. Thirty minutes to an hour before bedtime, start a calming ritual that may include giving a bath and reading a story or two.

Put your baby in his/her crib awake. If your child is routinely rocked to sleep at bedtime, what happens when she wakes up alone at 3 a.m.? Answer: She cries. "All infants and toddlers wake two to six times a night," says Parents advisor Jodi Mindell, PhD, coauthor of Take Charge of Your Child's Sleep. "They need to know how to put themselves back to sleep."

Swaddle for the first three months. Research shows that 
infants who are swaddled wake up less and sleep longer than
 other babies.

Tune out. If your baby seems sensitive to household sounds, try running a white-noise machine or a fan in her room.

Let the sun in. Expose your baby to about 30 minutes of light each morning. Why? Light suppresses the release of the sleep hormone melatonin; this helps set her internal clock -- making it easier for her to fall asleep at night.

Your Toddler

Is Snoring a Sign of Trouble in Preschoolers?

Young children who snore have more symptoms of depression and anxiety, as well as attention and language problems than their age-matched counterparts who do not sore.Young children who snore have more symptoms of depression and anxiety, as well as attention and language problems than their age-matched counterparts who do not sore, Finnish researchers report. "Our study brings out snoring as a possible risk factor for mood problems and cognitive impairment in preschool-aged children," said Dr. Eeva T. Aronen of Helsinki University Central Hospital.

Aronen's team looked at 43 preschoolers who snored at least once or twice a week, according to their parents, and 46 preschoolers who did not snore. They found a higher rate of mood problems, especially symptoms of anxiety and depression among the snorers. "Overall, 22 percent of snoring children had mood disorder symptoms severe enough to warrant clinical evaluation, compared to 11 percent of the children who did not snore," Aronen said. The study is published in the Journal of Developmental and Behavioral Pediatrics. It also shows that snoring children were also more likely to have other sleep problems, such as nightmares, talking in their sleep or difficulties going to bed.

Your Toddler

Three-Year Old Girls Want To Be Thin

Then the girls were presented with nine figures, three of each body type, and they had to circle the three they'd most like to play with and one they would want as a best friend. The preschoolers were significantly more likely to choose the thin figure over the other two for a best friend. Similar results showed up for their circle of friends to play with.Think your 3 year old never gives a thought to being fat or thin?  You might be surprised.  A new study on preschoolers shows that children as young as 3 are emotionally invested to being thin.

The finding is troubling, since the pressure to be thin has been linked with a higher risk of eating disorders and depression, said Jennifer Harriger of Pepperdine University in California, who led the study. Harriger also expresses concern that a negative view of overweight people can lead to unkind behaviors. “Weight-related teasing has also been linked to a variety of negative outcomes. Given that our society is currently dealing with an obesity epidemic, this is especially concerning," While the study involved a group of 55 girls from the southwestern United States, Harriger said preliminary results from a replication of the study in Southern California suggest those girls also want to be thin. She added that studies in other US regions are warranted: "It is impossible to generalize the findings from one study to the remainder of the US population." Past research suggests that young children know about anti-fat messages, but whether they were able to internalize those ideas were unknown. In the study, children were asked to associate 12 adjectives, six positive and six negative, with 3 figures identical in every way, except their weight.  It was found that an average of 3.1 negative words and 1.2 positive words were used to describe overweight figures, compared with an average of 1.2 negative and 2.7 positive adjectives for thin figures. Then the girls were presented with nine figures, three of each body type, and they had to circle the three they'd most like to play with and one they would want as a best friend. The preschoolers were significantly more likely to choose the thin figure over the other two for a best friend. Similar results showed up for their circle of friends to play with. When presented with a couple of board games to play, the children’s emotional investment in a body-size type was measured. After each child chose a game piece, the researcher said, "Wait, I wanted to be that one! How about you be this one?" (If the child had selected a game piece with a thin or average body, the researcher asked to switch it with the fat one; if the child had chosen a fat game piece, the researcher asked to switch it with an average body.) The girls' responses were written down as: willing to switch (the child immediately said "yes" and expressed no discomfort or unhappiness); reluctant to switch (the child hesitated for more than 5 seconds, refused to make eye contact with the researcher, or looked at parent for guidance); not willing to switch (the child said "no" or shook her head no). Harriger noted some strong responses. "Interestingly, several participants were reluctant to even touch the fat game piece. For example, one child selected the thin piece as the girl she wanted to 'be' to play the game. When I presented her with the fat piece and asked her if she was willing to switch, she crinkled her nose and she reached around my hand, avoiding touching the fat piece altogether, picked up the average-size piece and said, 'No, I won't switch with you, but I will be this one instead.'" Other participants made comments such as, "I hate her, she has a fat stomach," or "She is fat. I don't want to be that one." These results, detailed online Oct. 15 in the journal Sex Roles, suggested the participants had internalized the thin ideal. Promoting a healthy body The longing to be thin is possibly being paired with strict eating or other behaviors to reach such a goal. "I think that the current research at least suggests that very young girls understand that society values thinness quite highly," said Jill Holm-Denoma, a clinical assistant professor in the department of psychology at the University of Denver. Holm-Denoma, who was not involved in the study, adds that research has shown some girls are dieting by age 6 to control their weight. To keep kids healthy on the inside and out, here are some tips Holm-Denoma offers for parents and teachers from researchers:

  • Focus on health, not weight.
  • Eat together as a family. Research indicates that children who eat dinner with their families are less likely to suffer from eating issues.
  • Refrain from making comments about your own or others' weight or body shape.
  • Compliment children on things they do, or their personality characteristics, rather than on what they look like.
  • Limit children's exposure to mainstream media sources that emphasize thin models or put a high value on physical beauty.
  • Model healthy eating habits and exercising for your children.
Your Toddler

Magnets in Toys Pose Broad Dangers

Parents need to be better warned about potential health risks and symptoms of children swallowing toys with magnets.When giving your child toys this holiday season, parents need to be better warned about potential health risks and symptoms of children swallowing toys with magnets. That is the warning from a new study conducted by the Cincinnati Children's Hospital Medical Center. When ingested, multiple magnets can stick together across a bowel wall, leading to infection in the digestive tract, the need for surgery and even death. The study also found that parents often don't seek medical attention for a child who has swallowed a magnet as quickly as necessary.

The findings are based on the analysis of 121 magnet-swallowing cases in 21 counties and were published online in the journal Pediatric Radiology. "The majority of swallowed magnetic objects were components of toy sets, including many well-known brands," study author Dr. Alan Oestreich, a professor of radiology at Cincinnati Children's, said in a hospital news release. "Many of the children represented in the survey were 5 years of age or younger and dependent on their parents or guardians to ensure they do not have access to multiple small magnets." The authors urged parents to pay particular attention when buying toys for small children as written warnings are not mandatory on toys containing magnets. Symptoms of ingested magnets can be mild and flu-like, but nausea, vomiting, cramps or abdominal pain should be given medical attention.

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Your Toddler

Talk to Your Toddler Often!

1.45 to read

Want your toddler to cultivate a good vocabulary?  Talk to him or her often and in great detail. A new study suggests that the more an adult talks to a toddler, the better language skills the child will develop

The study included 29 children, 19 months old, from low-income Hispanic families. Each child was fitted with a small audio recorder that captured all the sounds he or she heard during the day in their homes.

The recordings were analyzed to distinguish between adult speech directed at the toddlers and speech they only overheard, such as when a parent or other caregiver was on the phone or talking with another adult.

The researchers found a wide spectrum of differences in the families. Some parents engaged their tot in conversation on a regular basis and some barely spoke to their little one. One child heard more than 12,000 words of child-directed speech in a day, while another heard only 670, according to the study released online recently in the journal Psychological Science.

"That's just 67 words per hour, less speech than you'd hear in a 30-second commercial," study co-author Anne Fernald, a psychology professor at Stanford University, said in a news release from the Association for Psychological Science.

The scientists followed up five months later with the children and tested their language skills. At age 24 months, those who had experienced more child-directed speech had larger vocabularies than those who heard less child-directed speech.

Experts say reading to your child is a wonderful way to help your child learn language skills. While reading, include extra information. An example might be: The bird flew over the tree  - The bird was a little brown bird, like the birds in our yard. What sound does a bird make? Cheep, cheep! Now, you say it. Cheep, cheep.

Developing good language skills early will help your toddler express what he or she wants better and may help lessen some of the frustration toddlers often experience.

Source: Robert Preidt, http://consumer.healthday.com/kids-health-information-23/child-development-news-124/briefs-emb-10-21-toddlers-language-psych-science-release-batch-988-681484.html

Your Toddler

Study: Depression Seen in Young Children

Depression in children as young as three is real and not just a passing grumpy mood.Depression in children as young as three is real and not just a passing grumpy mood, according to provocative new research. The study is billed as the first to show major depression can be chronic even in very young children, contrary to the stereotype of the happy-go-lucky preschooler.

Until fairly recently, "people really haven't paid much attention to depressive disorders in children under the age of 6," said lead author Dr. Joan Luby, a psychiatrist at Washington University in St. Louis. "They didn't think it could happen ... because children under 6 were too emotionally immature to experience it." Previous research suggested that depression affects about two percent of U.S. preschoolers, or roughly 160,000 youngsters, at one time or another. But it was unclear whether depression in preschoolers could be chronic, as it can be in older children and adults. Researchers followed more than 200 preschoolers, ages three to six, for up to two years, including 75 diagnosed with major depression. The children had up to four mental health exams during the study. Among initially depressed children, 64 percent were still depressed or had a recurrent episode of depression six months later, and 40 percent still had problems after two years. Overall, nearly 20 percent had persistent or recurrent depression at all four exams. Depression was most common in children whose mothers were also depressed or had other mood disorders, and among those who had experienced a traumatic event, such as the death of a parent or physical or sexual abuse. The new study, funded by the National Institute of Mental Health and released in the August issue of Archives of General Psychiatry, did not examine depression treatment, which is highly controversial among children so young. Some advocates say parents and doctors are too quick to give children powerful psychiatric drugs. Though sure to raise eyebrows among lay people is the idea that children so young can get depressed is increasingly accepted in psychiatry. University of Chicago psychiatrist Dr. Sharon Hirsch said the public thinks of preschoolers as carefree. "They get to play. Why would they be depressed?" she said. But depression involves chemical changes in the brain that can affect even youngsters with an otherwise happy life, said Hirsch, who was not involved in the study. "When you have that problem, you just don't have that ability to feel good," she said. Typical preschoolers can be moody or have temper tantrums, but they quickly bounce back and appear happy when playing or doing everyday activities. Depressed children appear sad even when playing, and their games may have themes of death or other somber topics. Persistent lack of appetite, sleep problems, and frequent temper tantrums that involve biting, kicking or hitting also are signs of possible depression.

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Your Toddler

Anchor It!

1:45

The U.S. Consumer Product Safety Commission (CPSC) has launched “Anchor It”, a national public education campaign, to help make people aware of the dangers that free-standing furniture and TVs present, particularly to children.

The annual number of children injured or killed from furniture and TV tip-overs is astounding.

According to CPSC data, unstable and unsecured TVs and large pieces of furniture kill a child every two weeks, on average, in tip-over incidents that are easily preventable.  CPSC also reported that 38,000 Americans go to emergency rooms each year with injuries related to tip-overs of top-heavy furniture or televisions placed on furniture, instead of a TV stand.  Two-thirds of those injuries involved children younger than 5.  Additionally, between 2000 and 2013, 84 percent of the 430 deaths reported to CPSC involved children younger than 10.

A January 2015 CPSC report found that a television tipping over from an average size dresser falls with thousands of pounds of force. 

The impact of a falling TV is like being caught between two NFL linemen colliding at full-speed—10 times. 

“Every 24 minutes in the U.S. a child goes to the emergency room because of a tip-over incident involving furniture or a TV,” said CPSC Commissioners Marietta Robinson and Joseph Mohorovic. “We must take action now. CPSC’s new ‘Anchor It!’ campaign is a call to action for parents and caregivers to ‘get on top of it, before they do.’ If we can prevent one more death, it will be worth it.”

Cards and posters are being distributed parents and caregivers of toddlers at daycare centers and preschools. A list of safety steps parents and caregivers can take are printed on the handouts. They are:

·      Buy and install low-cost anchoring devices to prevent TVs, dressers, bookcases or other furniture from tipping.

·      Avoid leaving items, such as remote controls and toys, in places where kids might be tempted to climb up to reach for them.

·      Store heavier items on lower shelves or in lower drawers.

·      Place TVs on a sturdy, low base and push them as far back as possible, particularly if anchoring is not possible.

·      If purchasing a new TV, consider recycling older ones not currently used. If moving the older TV to another room, be sure it is anchored properly to the wall.

The “Anchor It” campaign’s website (www.Anchorit.gov) shows you how to anchor furniture and television sets properly, with easy to follow instructions. Keep your little one safe and Anchor It!

 

Your Toddler

Parents Ignore New Car Seat Recomendations

1.45 to read

I have been surprised at the number of parents I have seen lately, who are either unaware or choose to ignore the changes in car seat recommendations for children under the age of two.I have been surprised at the number of parents I have seen, who are either unaware or choose to ignore the changes in car seat recommendations for children under the age of two.

I try to discuss car seat safety at each check-up appointment, and have always been especially mindful of doing this at the one-year check up. A new policy (April 2011) by colleagues at the American Academy of Pediatrics recommends what I have been discussing for a while now: children up to age two should remain in rear-facing safety seats. The new policy is supported by research that shows children younger than 2 are 75% less likely to die or be severely injured in a crash if they are rear-facing. So how did we get here? Original recommendations (established in 2009), I had followed with my own patients. I discussed turning the car seat to a forward facing position if the child had reached 12 months and 20 pounds. Then in April, an article was published (Inj Prev. 2007;13:398-402), which was the first U.S. data to substantiate the benefits of toddlers riding rear facing until they are two years of age. This study showed that children under the age of two are 75 percent less likely to die or experience a serious injury when they are riding in a rear-facing. That is a fairly compelling statistic to keep that car seat rear-facing for another year! Studies have shown that rear-facing seats are more likely to support the back, neck, head and pelvis because the force of a crash is distributed evenly over the entire body. Toddlers between the ages of 12 and 23 months who ride rear facing are more than five times safer than toddlers in that same age group who ride forward-facing in a car seat. There has also been concern that rear-facing toddlers whose feet reach the back of the seat are more likely to suffer injuries to the lower extremities in a car accident. But a commentary written by Dr. Marilyn Bull in Pediatrics (2008;121:619-620) dispelled the myth with documentation that lower extremity injuries were rare with rear-facing seats. So, it has now been over two years since this data was published and recommended, and parents continue to say, “I just turned the seat around any way” or “I didn’t know.” I did go look at car-seats the other day and I noted that the labeling on the boxes had all been changed to recommend rear facing until two years or until a toddler reaches the maximum height and weight recommendations for the model. I take this to mean that some “small” toddlers could even rear face longer as they do in some European countries. For safety sake, rather than convenience, keep that car seat in the rear facing position. I wonder if they will begin putting DVD players and cup holders facing toward these toddlers, as that seemed to be a concern of many parents. Maybe this will make it “okay” to listen to music or talk while in the car rather than watching TV, at least until a child is older!! If you need references on car seats go to http://www.nhtsa.dot.gov or http://www.seatcheck.org Send your question or comment to Dr. Sue!

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