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

Kid’s “Hypoallergenic” Products May Cause Allergic Reactions

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When a child has eczema, doctors often recommend that parents purchase hypoallergenic ointments, creams or lotions to ease the suffering from dry, inflamed skin.

However, according to a new study, many products labeled as hypoallergenic contain ingredients that can cause allergic reactions.

The Federal Drug Administration (FDA) does not regulate the “hypoallergenic” label, said Carsten Hamann, a medical student at the Loma Linda University School of Medicine in California and the lead researcher on the study.

“Kids who have eczema or atopic dermatitis use more lotions and creams and ointments, etc. Ostensibly, their caregivers who purchase these products to use on the kids' skin, give preference to products using these meaningless marketing terms,” Hamann told Reuters Health in an email.

Hamann and his colleagues tested products that might be used by kids with eczema, which affects 17.8 million people in the U.S., according to the National Eczema Association. Patients have patches of red, itchy skin, often on the arms, legs, cheeks, and behind the ears.

Doctors often advise people with eczema to apply moisturizer to the affected areas.  People with eczema tend to have a higher risk of so-called “contact allergies.” That is, they may have allergic reactions to substances that come in contact with their skin, including fragrances, preservatives, and other kinds of chemicals.

Researchers tested 187 cosmetic products found in 6 different stores in California, to see if they contained any of the 80 most common known allergens.  All of the products were specifically marketed as being safe for use by children and labeled as “hypoallergenic”, “ dermatologist recommended/ tested”, “fragrance-free,” or “Paraben free.” Most people assume that these types of products are actually designed to help people who have sensitive skin.

But, researchers found that 89 percent of the products contained at least one allergen, 63 percent contained two or more, and 11 percent contained five or more. The average number of allergens per product was 2.4, the researchers reported in the Journal of Allergy and Clinical Immunology.

Preservatives and fragrances accounted for 58 percent and 29 percent of the allergens, respectively. These ingredients often irritate a skin condition.

Ten percent of the products contained methylisothizolinone, a preservative that is about to be banned in the European Union because it can cause severe skin irritation, according to the researchers.

“It would be very difficult for even the most caring, intelligent and well-read parent to know the names of 80-plus allergens and their synonyms, let alone compare that list of allergens to a 15-plus long ingredient list on the back of a pediatric product,” Hamann said.

Dr. Michael Arden-Jones, a skin disease specialist at the University of Southampton in the U.K., said that defining something as an allergen can be complicated.

“Almost any chemical compound could be implicated as an allergen, so it is almost impossible for a cream to be truly non-allergic,” he told Reuters Health. “Thus, as there is no true ‘hypoallergenic’ cream, there is no agreed meaning of ‘hypoallergenic.’”

Skin experts say that ointments are generally the safest products for kids who have eczema. Creams and lotions contain water and therefore must contain preservatives, making them more likely to contain allergens. Prescription moisturizers are typically reliable. Products with artificial coloring or fragrances or do not have the ingredients listed on the box should be avoided.

The National Eczema Association reviews products and offers the “NEA Seal of Acceptance” for those that do not include known irritants. Depending on the product, the NEA Seal of Acceptance™ Review Panel considers testing data on sensitivity, safety, and toxicity, as well as the ingredients, content, and formulation data. There is a tab on the website dedicated to information on child eczema in infants to older children. Their website is: http://nationaleczema.org.

Sources: Madeline Kennedy, http://www.reuters.com/article/2014/11/21/us-eczema-products-safety-idUSKCN0J529L20141121

http://nationaleczema.org.

Your Toddler

Toddler Snoring May Indicate Behavioral Problems

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Everyone snores at one time or another, even babies. Most of the time we have an occasional snort... maybe three or four. Children may snore because they have a stuffy nose, a cold, allergies or enlarged tonsils, but persistent snoring could indicate more.  

According to a new study focused on two and three year olds, persistent snorers are more likely to have behavioral problems such as hyperactivity, attention issues and depression.

Researchers studied 249 mother-child pairs and found the children who snored at both age 2 and age 3 were nearly 3.5 times more likely to have signs of behavioral issues when compared with those who did not snore at these ages, or who only snored during one of those years. Mothers were asked to report how often their child “snored loudly.”

The children were divided into 3 categories:

Non-snorers – those who snored less than once a week.

Transient-snorers – those who snored more than 2 times a week at age 2 or 3, but not both.

Persistent-snorers - those who snored more than 2 times a week at ages 2 and 3.

All the children were assessed for behavioral problems based on the Behavior Assessment System for Children, an extensively validated behavior questionnaire.

Among the children who snored at both ages, 35% showed signs of behavioral problems. Only 10% percent of non-snorers and 12% of transient snorers showed behavioral problems.

The findings show the importance of getting good sleep, the researchers said.

"We know that if you take away naps for preschoolers, and then give them challenging tasks, they're grumpier," said lead study author Dean Beebe, director of the neuropsychology program at Cincinnati Children's Hospital Medical Center.

From a neurological standpoint, lack of proper sleep inhibits the development of pathways between neurons in the brain, Beebe said. "We're talking about a brain that is constantly remodeling through early childhood, with connections being strengthened and weakened," he said. Fixing the underlying cause of snoring can help to reverse these effects, but because parents don't realize the problems with snoring, it often goes untreated.

Experts have also noted that many parents think that snoring is a sign of a deep restful sleep when in fact, it's often just the opposite. 

Dr. Sangeeta Chakravorty, director of the pediatric sleep evaluation center at Children's Hospital of Pittsburgh, wasn't surprised by the findings. "Snoring impacts sleep, and sleep loss impacts behaviors," she explained.

But, she noted that the study wasn't able to determine whether the behavior problems were just because the children were tired, or if their snoring was significant enough to cause a chronic lack of oxygen, because the study only included information from the children's mothers. There were no objective data, such as oxygen levels throughout the night.

Chakravorty added that snoring in this age group is actually common. She said enlargement of the adenoids was the biggest cause of snoring, followed by enlarged tonsils. Nasal allergies can also cause snoring, as can abnormalities in the facial structure or the structure of the airway. And obesity can cause snoring in children like it does in adults.

Researchers also found that persistent children snorers were more likely to have been exposed to environmental tobacco smoke, and come from lower socioeconomic households.

Both experts recommended bringing up any persistent snoring with your child's pediatrician. "If you hear your child snoring more than three to four times a week in the absence of an upper respiratory infection [cold], and it lasts more than a month, seek help from the pediatrician," Chakravorty said.

The study was published in the journal Pediatrics.

Sources: http://www.msnbc.msn.com/id/48648962/ns/health-childrens_health/#.UCqmK46f_zJ

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http://health.usnews.com/health-news/news/articles/2012/08/13/snoring-toddlers-may-have-more-behavior-problems

Your Toddler

“Late-Talkers” Can Catch Up

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Parents of children who are "late-talkers" may have no reason to worry says a new study. Do you have a toddler that isn’t talking as much as you think he or she should? There’s no need to worry according to a new study

A study recently published in the journal Pediatrics says 18 percent of children have a language delay. Parents should not be overly concerned that late-talking at age two years will result in enduring language and psychological difficulties for the child," Dr. Andrew Whitehouse, an associate professor and of developmental psychopathology at the University of Western Australia in Subiaco. Researchers followed children who were part of the Western Australian Pregnancy Cohort Study, including 1,245 children whose speech was not delayed: they were using at least 50 words and could string two or three words together in a phrase, and 142 who had not reached this milestone. The children were tracked through age 17. The Child Behavior Checklist, also based on parental report, was used to measure behavior by parent report and to measure child and adolescent behavior during follow up at 2-years-old, 5-years-old, 8-years-old, 10, 14, and 17. At age 2, the children identified as “late-talkers” were more likely than other toddlers to have behavioral problems. But there was no difference between the groups at ages 5, 8, 10, 14 and 17. The study looked at survey results filled out by parents on more than 1,400 two-year olds, born between 1989 and 1991. The researchers found that one of 10 kids was a late-talker, and these kids tended to act more introverted and displayed more emotional problems. Dr. Whitehouse suggests that frustration may be at the root of the behavioral problems, and as the child develops better communication skills, the frustration eases or goes away. Children usually can form meaningful words by the age of 18 months. Between the ages of 2 to 3 years old, children should be saying new words each month and using two-word sentences, such as "more juice." Some children are late talkers because of hearing loss, cognitive impairment, speech disorder, language disorder, autism, or other considerations. If your child is a late talker it’s important to have your pediatrician check for possible medical causes. Still, for many it is simply a developmental stage with no long-term adverse effects.

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

Got Water?

Too many children are getting much of their water from sweetened beverages rather than plain old H2O, the researchers found. The study also revealed that those who drink water consume fewer sweetened beverages and eat fewer high-calorie foods.Children in the United States are not drinking as much water as they should, and the deficiency can have far-reaching implications, a new study suggests.

"Even mild dehydration can affect physiological function, and cause fatigue, muscle weakness, headaches and dry mouth," said Samantha Heller, clinical nutrition coordinator at the Center for Cancer Care at Griffin Hospital in Derby, Conn., who was not involved in the study. Impaired cognitive and mental performance are also linked to inadequate hydration, said Heller. According to the study, published in the October issue of the American Journal of Clinical Nutrition, depending on age-only 15 to 60 percent of boys, and 10 to 54 percent of girls drink the minimum amount of water recommended by the U.S. Institute of Medicine. Too many children are getting much of their water from sweetened beverages rather than plain old H2O, the researchers found. The study also revealed that those who drink water consume fewer sweetened beverages and eat fewer high-calorie foods. The research looked at the water intake of 3,978 boys and girls, aged 2 to 19 years, who had been included in a national nutrition study from 2005 to 2006. The investigators found that water intake from all sources varied by age: 2 to 5 year-olds drank 5.9 cups a day. 6 to 11 year-olds got 6.8 cups, and 12 to 1-year-olds consumed 10.1 cups daily. Girls generally drank less than boys. The findings also suggest that kids of all ages are more likely to drink beverages, such as sodas, tea or milk, and not water at mealtime. Water makes up 55 to 75 percent of total body weight, said Heller. "We cannot live without water for more than a few days because our bodies cannot store water. Thus, it is essential we replace the water our bodies lose every day." Heller, a nutritionist and dietitian, advises starting children on water early. "Give them water instead of sweetened beverages during the day and between meals," she said. To make it more appealing, put sliced cucumbers, oranges, lemons or strawberries in ice water, she suggested.

Your Toddler

Preschool Lunch Isn’t Always Nutritious

Parents may be sacrificing nutrition by giving their children the food they like when packing their preschoolers lunch. That's one of the conclusions of a new study in the January 2009 issue of the Journal of the American Dietetic Association. The study found that 71 percent of packed lunches didn't have enough fruits and vegetables and that one in four preschoolers didn't get enough milk with lunch.

"What we found primarily was that parents weren't sending in as many fruits and vegetables and whole grains as they should, and the number of milk servings was low, too," said study author Sara J. Sweitzer, a registered dietician and a doctoral candidate at the University of Texas at Austin. The study was triggered by a recent change in Texas day-care regulations that allow day-care programs to stop providing meals and snacks. A subsequent survey found that about half of child-care centers in two Texas counties had chosen to do just that. But they survey also reported that directors of those centers said that children were being given chips, prepackaged lunches and "junk food" by their parents. Vegetables, fruits and whole grains were rarely included. To determine whether or not these results were true, Sweitzer and her colleagues interviewed the parents of 74 children from five day-care centers. All of the children were between three and five years old and most were white and from families headed by two adults. The children's lunches were observed for a three-day period so the researchers could accurately assess the nutritional content. 67 percent of the parents interviewed said they packed nutritious food, even though they thought their child probably wouldn't eat them. 63 percent said they packed foods they knew their child would eat. Milk was available at the child-care center, but the child had to request it. According to the study, only 29 percent of the packed lunches contained adequate fruits and vegetables and only 20 percent of the children had a milk serving at lunch. 11 percent didn't get enough whole grains. "Fruits and vegetables and whole grains need to be presented on a regular basis," said Sweitzer, adding, "With chronic disease issues such as type 2 diabetes on the rise, this becomes a very key time to educate this child about nutrition." The easiest thing to do, she suggested, is to pack up some of the previous night's dinner to be reheated in a microwave, which is usually available at child-care centers.

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Your Toddler

Small Children and Rx Poisoning

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Most small children who are poisoned by an adult’s prescription medication do not get it from a secured cabinet but rather from a purse, countertop, sofa cushion, floor or other easy-to-see place in the house.

The medications that are dangerous enough to send a child to the emergency room usually belong to a mother or grandparent according to a report released by the non-profit group Safe Kids Worldwide, based in Washington D.C.

Kids "are getting medications from Mom's purse and Grandma's pillbox," says Rennie Ferguson, a researcher for Safe Kids.

Ferguson examined 2,315 emergency department records on children 4 years old and under that were compiled by the Consumer Product Safety Commission (CPSC) in 2011.

67,000 children visited emergency departments in 2011 after accidental exposure to one or more medications.

The report notes that such cases have grown by 30% in the last decade amid a growing number of prescription and non-prescription medicines in the home. While ER cases dropped slightly between 2010-2011, the difference was not statistcally significant.

Where are children finding unsecured medicines? When examining the cases, the researchers noted that when a source was recorded:

-       27% came from the floor or had been otherwise misplaced.

-       20% came from a purse, bag or wallet.

-       20% had been left out on counters, dressers, tables or nightstands.

-       15% came from a pillbox or bag of pills.

-       6% came from a cabinet or drawer.

-       12% came from other places.

The medications belonged to adults in 86% of cases, the report adds. Moms (31%) and grandparents (38%) were the most common sources.

Because small children tend to put anything and everything in their mouths, an accidental poisoning can happen quickly while someone is distracted or out of the room.

The new data suggests that small children infrequently get into medications that are properly stored.

Many times people think they will forget to take their meds if they do not see them. If you have small children in the house, or ones that visit, store the medicines in a secure cabinet and set your watch or cell phone alarm to remind you to take them.

Make sure you do not leave medicines in a coat pocket or purse where children can find them. Also, you should speak up and ask that medications be stored away when your children visit the homes of grandparents, other relatives or friends. If you feel awkward in bringing up the subject, you can always mention that your child is at a very curious stage where they get into everything. It’s absolutely true – small children are curious about everything and they seldom understand which things are dangerous and which ones are not. It’s much better to be safe than sorry.

If you think a child has taken a medication that is not meant for them, the best thing to do is to call the National Poison Help Line at 1-800-222-1222.  The line is open 24 hours a day.

If your child is exhibiting acute signs of being poisoned call 911 first.

Symptoms of poisoning may include:

-       Seizure

-       Stop breathing

-       Change in cognitive abilities

-       Nausea

-       Vomiting

-       Drowsiness

-       Stomach pain

Check to see if you can find any loose pills or bottles around the child so you can determine what he or she has taken.

Prescribed medications can be necessary and effective for a host of illnesses or conditions. Many households have at least one prescription medicine in the home at all times. But there are many things parents and other caregivers can do to minimize risks, says Kate Carr, Safe Kids president and CEO. The first is to store medications out of sight and out of reach — "up and away" in the catchphrase of an ongoing medication safety campaign led by the Centers for Disease Control and Prevention. Up and away, easy to remember - easy to do.

Sources: Kim Painter, http://www.usatoday.com/story/news/nation/2013/03/20/children-medication-poisoning/1998237

 

Your Toddler

Replace Recalled Brand With Generic

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For the time being, Frattarelli suggests parents look for generic versions of the medications, which are just as effective as name brands. "It's really just a difference in flavor or packaging," said Frattarelli, who heads the American Academy of Pediatrics' Committee on Drugs. "Sometimes they are almost indistinguishable.”What to do? When kids begin sniffling, the first thing many parents reach for is Children's Tylenol. But that option is not available since a massive recall last year.

Nine months later, the Johnson & Johnson unit that was responsible is still ironing out its problems, and there's little indication of when parents will be able to turn to the brand. But medical experts say that when it comes to treating sick kids, there are still plenty of options. "The nice thing about this situation is that there are other alternatives to name brands," said Dr. Daniel Frattarelli, chairman of pediatrics at Oakwood Hospital in Dearborn, Michigan. The recall was announced last April 30 by Johnson & Johnson's McNeil Consumer Healthcare division. More than 50 variations of the company's liquid products for infants and children were pulled from shelves, including certain types of Tylenol, Zyrtec, Benadryl and Motrin. In all, 136 million bottles of medicine were recalled — the largest withdrawal of children's medications from the market in U.S. history. The products were recalled after a U.S. Food and Drug Administration inspection of the Fort Washington, Pa., plant where McNeil manufactures them. Investigators found a host of problems, and company executives acknowledged that some of the medications "may contain a higher concentration of active ingredient than is specified; others may contain inactive ingredients that may not meet internal testing requirements; and others may contain tiny particles." The company added that although there were no reports of adverse medical effects from the recalled products, customers should nevertheless stop using them. The plant in question has been shut since April, and additional recalls of children's Tylenol and Benadryl, as well as various adult products, continued through the end of 2010. It's still unclear when McNeil children's products will be back on store shelves. Assessments of the Fort Washington plant and others are continuing, company spokeswoman Bonnie Jacobs said. She added that "McNeil will take whatever steps are needed" to correct their continuing problems, including, if necessary, more recalls. For the time being, Frattarelli suggests parents look for generic versions of the medications, which are just as effective as name brands. "It's really just a difference in flavor or packaging," said Frattarelli, who heads the American Academy of Pediatrics' Committee on Drugs. "Sometimes they are almost indistinguishable.” The simplest way to find a generic version of a medication is to look for one with the same active ingredient, he said. Children's Tylenol contains acetaminophen, and children's Motrin contains ibuprofen. Both are used to treat aches and pains and to reduce fevers. Generic alternatives also are available for the allergy medications Zyrtec and Benadryl, said Dr. Stanley Fineman, president-elect of the American College of Allergy, Asthma and Immunology. Zyrtec contains a long-acting antihistamine called cetirizine, which helps relieve symptoms like runny noses and itchy eyes, noses and skin. The active ingredient in Benadryl is diphenhydramine, which addresses the same symptoms but can cause drowsiness, Fineman said. Parents should not give kids partial doses of adult medications, doctors warn. Even with medications for infants, it's important to adhere to the age limits printed on the packaging. For instance, acetaminophen should be given only to children who are at least 3 months old. "If you have a young child under 3 months who has a fever, that's not a situation where you want to give them something to block the fever and call it a day," Frattarelli said. "A fever under 3 months needs to be evaluated."

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What's the best way to get your baby to sleep through the night?