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Healthy Children

with Steven Parker, MD

This blog is now retired. Dr. P passed away on Monday, April 13, 2009. The WebMD Community will dearly miss his kind, caring, and often humorous manner.

Monday, April 13, 2009

Passing of an Expert & Friend

It’s with great sadness that we announce that Dr. Steven Parker died unexpectedly this morning. Dr. Parker was an example of the passionate practitioner who brings not only knowledge but care to patients and readers. As WebMD’s expert pediatrician, he provided information and support to countless expectant and new parents. Our hearts go out to his wife, Karen, his family and friends. You can share your messages of condolence and support here.

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Posted by: WebMD Blogs at 3:00 pm

Thursday, February 12, 2009

Who Are Your Children’s Role Models?

I am shocked – shocked! – that Michael Phelps smoked dope at a fraternity party. Who does he think he is? Doesn’t he know he is a role model to our kids? I wanted my kids to be him and then he goes and pulls this stunt!?

Actually, what I am really shocked about is the ridiculous brouhaha this has generated. Let’s face it, his behavior is not at all unusual for his age (in the only phrase from George W that I’ve appropriated: “When I was young and foolish, I was young and foolish.”). Of all his potential misdeeds, this seems a minor transgression indeed.

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And, anyway, who says he is (or should be) a “role model”? The dictionary defines a role model as “a person whose behavior, example, or success is or can be emulated by others, especially by younger people.”

Let’s face it folks, your kids have no chance of becoming Michael Phelps, unless they too have a body like a torpedo, outsized hands and feet like a pizza pie, the wherewithal to swim for 13 hours a day, 7 days a week, a coach who will devote his life to their success, etc.

I work in the inner-city of Boston. Who are the role models of many of the kids I see? Mostly rappers and basketball players. Yet the odds of actually making it in life as one of those is zero. It’s completely unrealistic and misguided in its values and what they can accomplish in life. Why their heroic 6th grade math teacher is never mentioned is a source of great sadness to me because, with some hard work and motivation for school success, they could actually become that math teacher.

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Here‘s where you parents come in. Much like talking to your kids about what’s on TV and what values it promotes, so too do you need to address this question of what kind of people we admire in life and why.

Sure, Michael Phelps did a very cool thing and loves his mother, but what about someone who has devoted her life to helping others, someone who started a successful small local company, someone who is really smart and worked hard in school to succeed, someone who teaches.

You get the idea. If you don’t push for alternative role models, who will? Surely not the media who are financially committed to hawking celebrities as the royalty of our culture.

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I want to close this screed on a scary note.

I do know with 100% certainty at least one or two people who, no matter what, will surely serve as important role models in your kids’ lives. That would his/her parents. Yes I am talking about you!

Many parents think they are teaching their kids by their discipline methods or rules of the house, etc. But we humans – and that includes your kids (at least most of the time) – learn mainly from what is called “incidental learning,” that is, learning on the fly, learning by observing and interpreting and making meaning of what is going on around them all the time.

Be afraid, be very afraid: your kids are observing you and eventually will judge what kind of a role model you are based on how you behave, your relationships with others, how loving and caring you are, and how mean and selfish.

Some of you lucky ones will be 100% positive role models for your kids (don’t count on it), some will be 100% negative (I hope not), but most of you will be a mix of good and bad, with some traits that your kids will want to emulate and carry on to the next generation and some that your kids will reject and be glad not to pass on to their kids.

So the next time you are thinking about Michael Phelps and his bong, better to think of your own behavior and what lessons your kids are deriving from it day after day, year after year, generation after generation.

Related Topics:

Posted by: Steven Parker MD at 7:00 am

Thursday, January 22, 2009

Faith Healing and Children

Some stories just break your heart on every level, like this tragic one. But most don’t also make you so mad you could spit. Here’s what happened:

Kara Neumann, 11 years old, was getting progressively, inexorably sicker. Despite a powerful thirst and hunger, she seemed to be wasting away to nothing. Over time she was becoming weaker and weaker. Despite nutritious food, she continued to fail. Eventually she was too weak to get out of bed. She became confused, then lethargic, then comatose. Then she died.

Many of you probably recognize the classic symptoms of untreated diabetes and diabetic ketoacidosis. It’s an easy diagnosis to make and, had she been properly diagnosed, she would have been treated with fluids and insulin, and gone on to have a nice long life.

But that is not what happened. Instead, her pious parents – who strongly believed that only God and prayer can and should heal – never brought her to medical attention, even as they profoundly and urgently and continuously and lovingly prayed for her recovery.

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Now the state of Wisconsin is prosecuting the parents for “reckless endangerment.” Each .faces up to 25 years in prison. Apparently, the critical legal issue is whether the parents knew it was a “life-threatening” condition (really, how could they not?). Their lawyers contend the state is unjustly violating their right to religious freedom.

To put this in context: Over 300 children (that we know of) have died in the past 25 years because of medical neglect due to parental religious beliefs.

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On two occasions during my pediatric training, I cared for Jehovah’s Witness kids who required major surgery. Turns out this was a fairly common event and we knew just what to do. Parents were informed that surgery could only be done with the option of a blood transfusion if needed. They refused. We then went to a local judge and got a court order / permission to transfuse blood if need be. Surgery went ahead.

I have to say, on both occasions I got the impression the parents were relieved to cede authority to us to save their child’s life. They didn’t have to violate their religious percepts – after all, Dr. P was the one who would go to hell if blood products were administered! But neither did they have to worry that their child would die for want of blood.

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What’s your take on this? Isn’t this a free country? Wasn’t it founded on religious freedom? How can we then deny parents their right to practice their religion in the way they choose? How dare the state intervene into the lives of families in such an intrusive way?

Here’s my view. As an adult you have the right to believe anything you want and, as long as those beliefs don’t impinge on the rights or well-being of others, you have the right to freely act on those beliefs. You can act against your own self interest, even do things that are clearly self-destructive. That is your right, boneheaded as you might be.

But you do not have the right to use those values and beliefs to harm a child – especially your own – who cannot decide for herself. You do not, for example, have the right to impose cruel physical punishment, even if your beliefs dictate you should do so. You do not have the right to have your child avoid all educational programs in the hope of isolating her from the temptations and misguided beliefs of this wicked world.

And, most assuredly, you do not have the right to endanger her health and well-being and very life to conform with your beliefs.

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In short, as a parent you have the right to make a martyr of yourself, but you do not have the right to make martyrs of your kids.

I feel bad for Kara’s parents. I really do. They have lost a child – the very worst thing that can happen in this life, At the same time, if I’m honest, I want to throttle them for their reckless, stubborn abandonment of their ever weakening child. Jail or no, now they will have to live with the awful knowledge that her death was their fault.

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Read the entire New York Times‘ article, Trials for Parents Who Chose Faith Over Medicine.

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Posted by: Steven Parker MD at 12:03 pm

Thursday, January 15, 2009

When Your Child has the Misery

It’s a sight sure to pierce the very heart of any parent.

Your little bundle of joy, Pookie, is sick: snorting, spewing, coughing, miserable. She looks up at you with those big, limpid, trusting, bleary, red eyes: What’s wrong with me, Mommy? Help me! Fix it!

Then, when miraculous relief is not forthcoming, reproach: Why aren’t you making me feel better? Why are you letting me down when I love and trust you so? What kind of a Mommy are you?

The urge is overwhelming: Don’t just stand there, do something!

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But what, exactly?

How about a cold medicine? Whoops, no go. Cough and cold preparations are no longer prescribed for children under 4 years because of rare but potential significant side effects. And, to be honest, they never did work well anyway. Scratch the cold medicines.

How about good old Tylenol or Motrin? Well, no. They are only useful for pain and fever, neither of which Pookie has. They wouldn’t do anything useful (except to give the illusion of doing something to make things better).

I’ve got it! Good old Vapo Rub! Great idea. Except, as you probably just read, there was a recent case report of a problem with an 18 month old infant who was hypersensitive to camphor oil and had breathing problems because of its administration under her nose. Plus, the stuff is pretty useless, except to stink up the joint.

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Here’s the sad, hard, inconvenient truth: there are some negative experiences in life from which you will be unable to protect your kids – the misery of a bad cold being one of them. The desire to do something – anything - is strong but, as we’ve learned, that can sometimes lead to side effects that are far worse than the ‘disease’.

As physicians, we take the vow: “First do no harm.” That goes for you parents also.

Actually, I’m not convinced this is even bad news. Like all of us, children need to learn to cope with adversity, to feel lousy but then to endure the misery and emerge unscathed, perhaps even stronger, on the other side. That successful sense of mastery will serve your child well when other adversity strikes (as it inevitably will) and she instinctively knows: I will get through this OK!

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But there is an even more important lesson that is often learned: the magical healing love and support of wonderful caregivers. Perhaps Mom was ineffectual at making it better right away but, during my miseries, she provided me with a powerful, comforting cocoon of warmth, of support, of care, of love.

When we ourselves have the misery, who among us – no matter what our age or station in life – doesn’t ache for Mommy to soothe a fevered brow and offer hot soup and a knowing hug and a sympathetic gaze, just as she so memorably and lovingly did all those years ago.

For many, the tender ministrations of our parents during illness is one of the most enduring and beautiful and powerful of our childhood memories. Be sure your kids have a bunch of them and you will, in fact, have really done something of earthshaking importance during their misery, something that far transcends the quick fix of an ineffectual medication, something that cuts to the heart of a parent’s love.

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Posted by: Steven Parker MD at 7:30 am

Monday, January 5, 2009

Dr. P’s Top 10 Pediatric Stories of 2008

Is it possible another year has passed? Here, in no particular order, are 10 pediatrics stories that caught my eye in 2008:

1. New recommendations for lipid screening and treatment in kids.
Perhaps in response to the epidemic of childhood obesity, the American Academy of Pediatrics has significantly revised its recommendations on the screening and treatment of kids for high cholesterol and blood lipid (fat) levels.

Basically they are recommending that your pediatric provider order blood tests for these levels starting at age 2 years, and then every 3-5 years thereafter if you have a positive family history for high lipid levels or early heart disease, or if such history is unknown, or if your child is overweight. That turns out to be a majority of kids!

However, what has generated a lot of controvery was their recommendation that – if diet and exercise fail to lower the levels to an acceptable range – cholesterol and lipid-lowering medications be used in children, as early as age 8 years. As you might guess, I have an opinion on this New Cholesterol Guidelines for Kids. Stay tuned for where all this goes in the next few years.

2. Cough and cold medicines get the axe for infants and toddlers.
I’ve long contended that cough medicine is essentially useless and cold medications are not much better. What I wasn’t aware of until this year were the numerous incidents of these over the counter cough and cold preparations causing harm to infants and toddlers (often due to giving too high a dose. After all, “If a little is good, a lot is better”, right?). Here are my appreciative comments on this change: The FDA and OTC Cold Medications for Infants.

So it’s now no longer recommended to use any of these medications for children under two years of age. Stick to old stand-bys: a humidifier/vaporizer, elevating the head of the bed, honey after age one year for cough and, of course, chicken soup and TLC.

3. New ways to lower the risk of SIDS
Earlier in the year I alerted you to a study showing that pacifier use seems to significantly cut the risk of Sudden Infant Death Syndrome (SIDS). Now comes another potential low-tech way to decrease the risk even more: running a fan in the bedroom. In this study, a fan in the bedroom seemed to also cut the risk of SIDS by 70% (perhaps because it prevents the baby from sleeping too deeply).

So now the list on how to decrease the risk of SIDS includes “back to sleep”, pacifiers, a fan in the bedroom, not too soft mattresses, no dolls in the crib, not too hot a temperature in the bedroom, and, I’m sure, more to come. I so would love to see the last of SIDS in the world. It is such a cruel event.

4. Probiotic “friendly” bacteria safe in pregnancy and for infants
It’s always nice when research confirms what you have been preaching. In 2007, despite scant evidence, I came out for giving infants and kids “friendly” probiotic bacteria under certain circumstances.

This year another study showed that feeding normal infants these bacteria was safe and also seemed to increase resistance to respiratory infections during the first 2 years of life! During the 6-month intervention, antibiotics were prescribed less often than in the placebo group (23% vs 28%) and respiratory infections occurred less frequently in the friendly bacteria group.

5. Honey is the best cough medicine.
OK, if cough medicine is useless, does anything help? A neat little study this year showed that good old buckwheat honey did help in children over 1 year of age. Try it.

6. Eating breakfast reduces weight gain in adolescents
Could my (and everyone else’s) mother have been right? Is breakfast the “most important meal of the day”? I don’t know about that, but a recent study did show that adolescents who eat breakfast aren’t nearly as overweight as those who skip breakfast. The reasons for this association are not clear.

Given this study and others showing children who have breakfast are better able to concentrate at school, let’s go with mom on this one: have a good breakfast! (Timlin MT et al. Breakfast eating and weight change in a 5-year prospective analysis of adolescents: Project EAT (Eating Among Teens). Pediatrics 2008 Mar; 121:e638.

7. On the road to a malaria vaccine
I hate mosquitoes, but for the wrong reasons No doubt, so do you. The most important reason to loathe mosquitoes is their transmission of malaria, arguably the worst disease on the planet. Every year over 500 million people contract malaria and 1-3 million die, the majority of whom are children in sub-Saharan Africa.

But just a few weeks ago, a vaccine with about 50% efficacy to prevent malaria (not great but much better than anything else) was reported. You know how much I love vaccines. Now it looks like we may soon be getting the upper hand on banishing this horrid disease from the lives of the world’s poorest children.

8. Stem cells created from normal skin cells
2008 was a great year for stem cell research. Two research teams were able to take skin cells from patients suffering from a variety of diseases and reprogram them into stem cells. This may avoid the need to use the controversial embryonic stem cells all together.

The newly created stem cells can hopefully then be induced to assume new identities and serve as major tools for understanding how diseases arise and develop. Eventually, when scientists master cellular reprogramming so that it is more finely controlled, efficient and safe, patients may someday be treated with healthy versions of their own cells.

9. Five-in-one vaccine developed
The first “five in one” vaccine (“Pentacel” – diphtheria, tetanus, pertussis, polio, hemophilus influenza) has been developed. This means fewer shots and less cost. And, yes, combination vaccines have been shown to be just as effective and no more prone to serious side effects than the single, double or triple vaccines were.

Pentacel still has to be administered in four separate doses, three times between the ages of 2 and 6 months, then
again between 15 and 18 months – but it cuts down by 30% on the 23 injections toddlers under 18 months normally receive.

10. Prenatal maternal blood test for Down Syndrome
A new genetic test may be able to pick up Down syndrome in the fetus with a simple blood sample from the mom-to-be. Because small amounts of fetal DNA enter the mother’s blood stream, the test is designed to detect abnormally elevated levels of chromosome 21 in the mother’s blood, which would indicate a baby with the syndrome. This would be a far less invasive and safer way to diagnose this common parental concern.

11. Enjoy your kids! All the best from Dr. P for a happy and fulfilling 2009 for you and your family!
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Posted by: Steven Parker MD at 10:00 am

Wednesday, December 10, 2008

PROJECT GOOD HEART 2008: Teaching Your Kids the True Spirit of the Holidays

Somehow, not only Christmas, but all year through,
The joy that you give to others is the joy that comes back to you.
And the more you spend in blessing the poor and lonely and sad,
The more of the heart’s possessing returns to you glad.

- John Greenleaf Whittier

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As if you needed more proof that economic times for families are tough and likely to get tougher, consider this: in this 2008 holiday season, the average American consumer plans to spend about 1/2 of what they spent last year ($431 versus $816) on gifts (that still totals about $100 billion dollars nationwide).

Your kids will be, of course, still excited to get their presents, which are – let’s face it – pretty much the meaning of Christmas and Chanukah for most of them (and most of us).

I’m no Grinch, but what if each of us were to donate to charity a mere 10% of our intended expenditures on presents? That would amount to $10 billion dollars. And what might that teach our kids?

That’s why I’d like to encourage you to sign on to our PROJECT GOOD HEART, in which you donate to a charity (of your child’s choice) the money that you would have spent on one of his/her presents.

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Here’s how PROJECT GOOD HEART works:

  • Explain to your kids (over the age of 5-6 years or so) that instead of one gift you would have given them, they are to chose a charity to donate whatever dollars that present would have cost.
  • Talk about the reasons charities exist and why empathy towards people less fortunate is a family value (“Remember when we saw those people on TV who lost their homes?”).
  • Discuss with them the various kinds of charities and how they help those less advantaged in many ways.
  • Ask them what kind of help they would like to give: for food? shelter? medicine? toys? books? For kids their age? needy families? victims of disasters or war? the poor? endangered animals? the environment?
  • Encourage them to put themselves in another’s shoes: “If our family was unlucky and lost a lot of the things we now have or we were victims of a storm or a war, how would you want others to help us?”
  • Guide the discussion: “Sure, Billy, buying a lot of Twinkies for a homeless family is a great idea and would make them happy for a short minute, but can you think of other ways to help them?”
  • But, remember, in the end, it’s their donation and their charity. Let them choose.
  • On Christmas or Chanukah, give them a Project Good Heart card (you can print the logo above) that says, “X dollars donated by Billy to the ABC charity, where it will be used to ___. Thanks, Billy!”

Perhaps, one day, when the latest toy is rusting in the basement, your kids will remember their charitable gifts as having best taught them the true spirit of the holidays.

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The fragrance always stays in the hand that gives the rose.
- Hada Bejar

HAPPY HOLIDAYS FROM DR. P

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PROJECT GOOD HEART logo by my colleague, friend and collaborator on PROJECT GOOD HEART, Jack Maypole, MD.

If you’d like some information and guidance on worthwhile charities, here are some good web sites to guide your discussion and help make a choice:

** Read about some families’ experiences with PROJECT GOOD HEART from last year. I’d love to hear from you about what your family does and learns from PROJECT GOOD HEART 2008.

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Posted by: Steven Parker MD at 10:03 am

Monday, November 17, 2008

Let Them Eat Cake!

Billy sits in his 3rd grade classroom, happily munching on double Dutch chocolate cake with creme frosting.

Suddenly the door to the classroom is kicked open. Five policemen rush into the classroom and surround Billy. “Kid, we have a report you brought a toxic substance into the school and, even worse, are inciting other children to ingest it, much to their peril.”

Billy starts crying, “But it’s my favorite cake and it’s my 8th birthday and I brought enough for everybody.’

“Sorry, kid. We will have your cake analyzed at great taxpayer expense, but clearly you have violated the new statute of the State of California’s school nutritional standards which forbids any snacks during the school day containing more than 35% sugar by weight or 35% of their calories from fat or more than 10% of their calories from saturated fats. Kid, it’s the slammer for you. The good news is that you can eat all the cake you want in jail!”

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OK, I made up this scenario, which hasn’t taken place – at least not yet. But the law and its standards are real. I learned of it in a newpaper article about school bake sales being banned in California (http://www.nytimes.com/2008/11/10/us/10bake.html?_r=2&ref;=health&oref;=slogin&oref;=slogin).

Should you have a mistrust of agents of the government getting it right, here is exhibit #1,098,765. First, start with an excellent idea: food offered to kids while at school should be healthy, low in saturated fats and junk food and refined sugar, high in nutrition and fiber, etc.

So far so, good. The initiatives to make school breakfasts and lunches healthy are truly laudable. Banning soda and other junk drinks – instead offering only water and 100% juices – is the right thing to do. Trying to teach proper nutrition and eating habits is an appropriate role for schools where, after all, kids are eating 1-2 meals / day.

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But, as often happens, the well-meaning authorities don’t know where to stop. Banning cake sales? Does anyone believe that by banning bake sales from the premises, children will come to abhor cake and ice cream and all junk food, and live happily ever after in tofu & bok choy heaven?

Not me. Let’s deconstruct the article:

Misstatement #1:
Banning junk food from schools “will do for junk food what smoking bans and taxes did for cigarettes.” Forgive me, but what a dumb analogy. There is no inborn pleasure or motivation to smoke, but there certainly is to eat and for foods high in fats and sugar to be especially appealing. If the goal is to make kids hate cake and ice cream, lots of luck fighting city hall. In fact, I’d argue that, in the long run, prohibition only increases their allure, so that the deprived child may even want it more than s/he would have otherwise.

Misstatement #2:
You’re teaching them eating habits for life.” I have to say, there is no good research relating early eating habits to those in later life (except in extreme cases). Having watched a lot of kids grow up for a long time, I’m quite skeptical of this truism. The reason to promote healthy eating habits is to keep your kids and their arteries healthy, at least for the 18 years or so in which they are (sort of) in your clutches.

Misstatement #3:

I don’t think all celebrations need to be around food.” It is this attitude which led to the described “Healthy Halloween vegetable platter” for kindergartners, a “celebration” which must have bordered on child abuse in my book.

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A decade ago, when I was co-authoring Dr. Spock’s book, he came out strongly against cow’s milk for kids over age 2 years. It was a major bone of contention between Dr. Spock and me (guess who won). Aside from there being little to no credible evidence to ban milk from the diets of children, the idea of a childhood without ice cream was unthinkable to me.

I can’t help but believe that – aside from legitimate health concerns – the zealots are in some way anti-pleasure meanies (much like H. L Mencken’s definition of puritanism: “The haunting fear that someone, somewhere, may be happy.”). The answer is to teach moderation and smaller portion size, not a blanket prohibition of some of life’s great delights – cake, ice cream and, yes, even the occasional Twinkie.

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Posted by: Steven Parker MD at 3:15 pm

Tuesday, November 4, 2008

A Cure for Infantile Cerebral Palsy?

While researching my previous post on the pros and cons of banking your baby’s cord blood, I happened upon the stories of two infants whose cerebral palsy seemed to improve after they received an injection of their cord blood stem cells. (Amazing Recovery Attributed to Cord Blood; Girl’s Own Cord Blood Gives Her Parents Hope

The stories were as dramatic as they were heartrending. Each told of almost miraculous improvement following the experimental treatment: the utterance of the first word, more awareness of surroundings, improved muscle strength, and (for me, most touching of all) parents reporting: “He also began to laugh at about a week after the infusion. He never laughed before; he would just kind of screech.”

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These stories could not help but fill me with great hope. Could cord blood stem cell injections actually improve a previously ‘incurable’ condition like cerebral palsy? It would literally be a dream come true, especially for a developmental pediatrician like me.

Yet, despite these compelling stories, I still opted not to recommend privately banking your baby’s cord blood. Why not? Shouldn’t these tales seal the deal and mandate, if you can afford it, that you privately bank your baby’s cord blood for a rainy day?

The problem is – as I have learned from long experience – often the most compelling story doesn’t withstand close scrutiny and turns out to be a false lead, a flash-in-the-pan, offering unjustified hope to despondent families or, even worse, a way for true-believer charlatans to make a buck off parents desperate to find a cure for their child.

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Let me explain further why in this case I refused to jump on the bandwagon:

  • Usually, only positive stories are publicized. Infants for whom the stem cells did nothing don’t make it to the media’s radar screen, so you never read about them. That’s why you always need to ask, when hearing of miraculous cures “How many kids did this not work for?”
  • It could have been a coincidence. Yes, it sounds like these two children benefited, but do we really know it was from the stem cells? That can only be proved by scientific studies showing it was due to the injection (and not something else that happened around the same time).
  • The “placebo effect” has to be considered. If we think and pray something will help, we tend to interpret what happens in a positive light. Believing is seeing. That’s why the improvement needs to be documented, not just by hopeful parents, but by objective observers who may not even know if the child received the treatment or not.
  • The progress, even if real, could be short-lived. Are these children continuing to improve? Have they regressed and lost any of the initial skills? Only studying them over time will tell.
  • We need to watch for negative side-effects that only show up later. Sure, we think one’s own stem cells should be trouble-free, but until it is put to the test, we don’t really know. First, do no harm.
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So, call me a Grinch, but until there is a published, peer-reviewed, proper scientific study, I’m reserving judgment and not allowing these stories to change my attitudes.

I know this caution drives some parents crazy or even makes them angry with me, but alas, I’m old enough to have been through about 100 “cures” for autism which, despite their compelling stories at the time, never panned out and only led to more heartache and expense.

From where I sit, it is an egregious sin to offer families false hope that is cruelly dashed over time, rather than impatiently but prudently waiting for the scientific evidence to come in.

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Posted by: Steven Parker MD at 7:00 am

Monday, October 27, 2008

Should You ‘Bank’ Your Newborn’s Cord Blood?

As if life weren’t complicated enough, many expectant parents are now being confronted with a wrenching question: to bank or not to bank? If you haven’t dealt with this question, let me explain.

Turns out that the umbilical cord blood has a goodly store of stem cells, those magical immature cells which can reconstitute a bone marrow as part of transplant treatment (e.g., for leukemia, sickle cell or some metabolic diseases). To date close to 7,000 umbilical cord transplants have been successfully performed, with excellent results.

Or perhaps one day they might be cajoled into transforming into any manner of needed tissues – nerve cells, skin, intestines, ears. The medical community is justifiably excited about the potential for these cells to be used in the future to cure a variety of diseases.

So the idea is to “bank” (meaning, freeze) these cells from the cord blood and save them for a rainy day when they might be needed to work their magic.

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There are two kind of cord blood banks: public banks that, following a thorough screening process, make your baby’s stem cells available to anyone who is luckily a match and might need it.

And there are private, for-profit banks that store the cells specifically for your baby or for a family member. The cost is about $1,000-$1,500 for the initial procedure and then about $100-150 / year to keep it on ice.

Perhaps you read about or were offered these options when you had your baby. The private bank is an appealing idea. If, someday in the future, your infant (or a close relative) were to contract a disease that required a transplant, a perfect (or close to perfect) match could be obtained. Who would not, for a mere few thousand dollars, want to protect their child from some future catastrophe with such “biological insurance”?

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Not me. Here’s why:

  • The odds of the cells actually being useful some day are very very low – variously estimated at 1 in 1,000 (the odds of dying in a fire), up to 1 in 80,000 (the odds of dying from lightning strike), to 1 in 200,000 (the odds of dying from an asteroid hitting you).
  • It’s expensive.
  • It’s not clear how effective the stem cells might be after being frozen for a very long period of time.
  • By the time they might be needed, other ways to derive stem cells from our bodies may exist, so the newborn stem cells would not even be necessary.
  • If the cells are to be used to cure a genetic disease, these same cells will contain the genetic defect and may not be appropriate treatment.
  • What happens if the banking company goes out of business?

On the plus side:

  • It makes sense to do so when there is a sibling with a medical condition that could benefit from a stem cell transplant.
  • Who knows what advances in the future might render these stored cells useful to your now adult or aged baby?

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Dr. P Opines
Banking cord blood is akin to purchasing lightning insurance. Sure, it’s not impossible it might be helpful some day, but really the odds are very slim.

And, if let’s say one in 50,000 infants will actually benefit from doing so, that leaves 49,999 cord blood specimens languishing in the freezer, making a profit for the freezing company, when they potentially could have been used as a match for a needy fellow human.

About 4,000,000 babies are born each year in the U.S. whose precious cord blood is discarded with the garbage. If parents agreed to bank their cord blood in public banks, the chances of everyone – including your family members – finding a much needed match someday would greatly increase. It’s an example of doing something for the greater good that also benefits the individual.

So I vote NO to private banking (except for the immediate benefit of an ill family member). Instead, take the $3,000 you would have spent and invest it over the next 18 years to pay for your baby’s college education, for which, I hope, the odds are much better than someday needing a stem cell transplant.

And a big YES to public banking of your baby’s precious cord blood, as precious a gift as s/he may ever give.

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If you are interested in donating your baby’s cord blood to a public bank and for heartwarming stories of how such donations have helped others, check out National Marrow Donor Program: Donate Cord Blood.

For the position of the American Academy of Pediatrics on this, see Cord Blood Banking for Potential Future Transplantation

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Posted by: Steven Parker MD at 3:30 pm

Monday, October 13, 2008

Got Vitamin D?

Vitamin D is the new vitamin du jour. This week, the American Academy of Pediatrics Committee on Nutrition doubled its recommended intake of vitamin D from 200 to 400 IUs (international units)/day.

Why the change? I wrote about this 2 years ago (Vitamin D, Infants and Teenagers) and, as far as I can tell, it’s not because there have been any new important studies.

Rather, it has just gotten clearer that vitamin D is good stuff; that when taken in infancy and childhood it promotes strong bones lasting into adulthood; that it may play a role in preventing such nasty adult diseases as diabetes and cancer; that it may bolster the immune system; and that it can lower the rate of hip fractures in the elderly (yes, Lord willing, some day your little one will be an old coot). Not bad for a long ignored vitamin!

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At the same time, low vitamin D levels have been documented in about 40% of infants, children, and teenagers. Why?

  • It’s well established that breast milk often doesn’t contain enough vitamin D to meet these requirements. This can be especially problematic in the dark winter months and with dark skinned infants (whose skin pigment repels the sunlight needed to make vitamin D in the body).
  • To ingest the new recommended amount of vitamin D, a child would have to drink about a quart of vitamin D-enriched milk a day (or, to reprise an old childhood nightmare, a teaspoon of cod liver oil). Lots of luck!
  • Most teenagers aren’t getting nearly enough vitamin D and there is reasonable evidence that adult bone hardness is related to vitamin D and calcium intake during the growth spurt of puberty.
  • People with darker skin or those who take their doctor’s advice and avoid direct sun exposure, also can’t make enough vitamin D (it’s estimated you need 10-15 minutes of direct exposure without sunscreen a few days per week to do so – much more if your skin is dark).

In fact, many argue that 400 IUs is still too low a dose for older kids. I think they are right: it really doesn’t make sense that the recommendation is 400 IUs / day for everybody, whether you are a 6 pound baby or a 160 pound teenager. My guess is that in a few years they will bump up the recommendations for bigger kids, so stay tuned.

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FAQs: What to make of these new guidelines?

Should I give my child vitamin D supplements?
Consult your pediatric provider about this, but I vote yes to 400 IUs /day, unless it’s clear your child is getting enough through his/her diet and/or sun exposure (or unless s/he needs more due to a chronic disease or medication).

What if my infant is breast fed?
Then it’s all the more important to add a daily supplement of vitamin D to avoid the problems associated with inadequate intake and poor sunlight exposure.

What if my baby is formula fed?
In that case there is no need to supplement since all formulas sold in the United States contain extra vitamin D.

How will I know if my baby might have rickets?
Rickets – due to inadequate vitamin D over a long time – causes soft bones. Mostly it is seen in dark-skinned, breast-fed babies with little direct sun exposure who are not taking supplemental vitamins. Rickets is diagnosed by an X-ray, at which time there may be excessive bowing of the legs and/or swelling of the wrists and ankles.

Should I give more than the recommended 400 IUs?
Vitamin D is great stuff, but there is an important catch: Too much can be harmful. Unlike vitamin C which is just peed out if taken in excess, vitamin D is stored in our fat tissues. Too much can lead to an overdose and serious medical problems, so it’s important to strike the right balance. 400 IUs may still be too little in older kids and teenagers but, until we know more, I’d err on the side of too little, rather than too much.

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Dr. P’s Bottom Line
I think vitamin D supplementation is a good idea for infants, children, and teenagers. 400 IUs extra/day appears safe and may have important short-term and long-term benefits for your child. I say, go for it!

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Posted by: Steven Parker MD at 12:41 pm

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