Dr. P's 10 Best Pediatric Stories of 2006

Here, in no particular order, and admittedly arbitrary and incomplete, are Dr. P's 10 Best Pediatric Stories of 2006:

Childhood obesity rate continues to soar.
Not a month went by without some mention of this very real epidemic: 10% of American children under the age of 6 years and 6% of infants are obese (a 65% increase in the last 20 years), belly fat (yes, even the size of children's tummies did not escape researchers' relentless poking) in children increased by 65% since 1999, some toddlers are too fat to fit in a normal car seat, etc., etc. Among others, the worry is of increasing diabetes, hypertension, etc. as these kids mature and age. What to do? No magic answers, but see my blog "Overweight toddler, overweight teen? Dr. P's 8 steps to a healthier family" for suggestions.

Kids getting less exercise and are less fit.
One 2006 study demonstrated that 2 of 3 public school students in California did not achieve minimum fitness levels. Of course, this sluggliness is part of the reason for the increased obesity in all ages. But studies have also documented even toddlers are getting less exercise than they used to. Play is the work of toddlers, and we do them and our teens no favor if none of the opportunities we provide them allow for vigorous exercise (e.g., how about taking the stairs instead of the escalator?).

Stem cells help muscular dystrophy in dogs.
One of the arguments some have offered about research with stem cells is that it hasn't lead to any real treatments as yet. Of course, this is a specious argument, neglecting the fact that most revolutionary treatments first require some time of basic research before they can be clinically useful. In any event, this study speaks to the wonderful promise of stem cells. Muscular dystrophy can be an especially cruel disease, I can't wait to see a cure. I only hope the funding for stem cell research proceeds apace and that Jerry Lewis and I live long enough to see it happen.

Number of uninsured children increases for the first time since 1998.
Of the nation's 74 million children, about 8.3 million (11.3%) lack health insurance (compared to 10.8% in 2004). Of all the dumb ways for our nation to save money, not providing kids with health insurance has got to be one of the dumbest. It's a national disgrace.

The first childhood immunization that will prevent cancer unveiled.
Hurray for Gardasil, the vaccine to prevent contracting human papilloma virus (HPV), by far the most common cause of cervical cancer. Be sure have to your girls (9 years and up, and soon, boys too) receive this latest tribute to the wonderfulness of modern medicine. (For more on this, see my blog: "Cervical cancer vaccine follow-up: The good and the good.")

Signs of global warming unmistakable.
The signs and scientific evidence of global warming (or its euphemism "climate change"), alas, became more unmistakable in 2006. Now only the most knee-jerk contrarians or unrepentant capitalists can really doubt its reality. Most of us won't be around to experience its potential devastating effects, but our children and our children's children surely will if nothing is done about it. As a parent, this is a children's public health issue you can't afford to ignore.

MMR cleared as risk factor for autism.
OK, there was ample evidence of this before 2006, but a few more studies in 2006 continued to show there is no association at all between the MMR (measles/mumps/rubella) vaccine and autism. Alas, if there are environmental triggers to autism in a genetically susceptible child (and I suspect there are), we haven't found them yet. I hope we do, and soon. But, I'll tell you this: it ain't the MMR vaccine. Immunize your kids!

Superbugs emerging.
Now we seen to be paying the price for all those antibiotics prescribed for viral infections (like colds, "bronchitis", etc). New bacteria which are resistant to the usual antibiotics are gaining a stronger foothold as a cause of disease. Hopefully the drug companies will invent some new antibiotics to which the bugs are not yet resistant (at least until we overuse them). And, hopefully, your pediatrician has educated you (and him/herself) about the appropriate use of antibiotics for bacterial and not viral infections, so you don't come to expect antibiotics will help your child every time she has the sniffles or a fever.

Mumps redux.
This came out of nowhere for me: there were 6,000 cases of mumps in 2006 - mostly occurring in the Midwest, in 18-24 year olds, and clustering on college campuses (fortunately, recently vaccinated infants and toddlers were usually spared). What was learned? The immunity conferred by immunizations may wear off as a child gets older. Even in kids who received a second MMR, the effectiveness is not perfect - probably in the range of 90-95%. And, perhaps because it now occurs so rarely, we pediatricians may not diagnose it in a timely way, which then increases the transmission to others. The good news? Contracting mumps was probably prevented in 9 of 10 exposures due to immunizations. Maybe we haven't yet eradicated mumps, but we've cut it down a lot. By no means perfect yet, but still pretty good.

ADHD drugs generally effective and safe in pre-school age children.
The data on the relative efficacy and safety of ADHD stimulant medications in children 4-6 years was welcome news to a lot of us professionals and to beleaguered parents. It also raised important issues about the trend of using more and more psychiatric medications in children at younger and younger ages. This is an important and by no means settled debate (e.g., see my 2 blogs entitled "Pre-school children and Ritalin" to hear many opinions on this).

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Well that's it for 2006. It's been my privilege to share some of it with you. Here's hoping you have a wonderful 2007! Enjoy your kids!

Dr. P

Related Topics:

Obese Kids Getting Hardened Arteries

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Top 10 Health Stories of 2006

Technorati Tags: New Year, 2006, pediatrics, Children's Health

PROJECT GOOD HEART

Teaching Your Kids the True Spirit of Christmas and Chanukah

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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And now abideth faith, hope, charity, these three;
but the greatest of these is charity.
I CORINTHIANS 13:13
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This holiday season the average American consumer plans to spend $791.10* (that's about $200 billion dollars nationally). And your kids are, of course, excited to be the beneficiaries of this windfall and get a boatload of presents, which is -- let's face it -- pretty much the meaning of Christmas (and Chanukah) for most of them (and us).

I'm no Grinch, but what if each of us were to donate to charity a mere 1% of our intended expenditures? That would amount to $2 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 charity the dollars that you would have spent on one present for each of your kids.

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Here's how PROJECT GOOD HEART works:

1. Explain to your kids (over the age of 5-6 years or so) that instead of one present you would have given them, they are to chose a charity to donate what that present would have cost.
2. Talk about the reasons for charity and for empathy towards people less fortunate ("Remember when we saw those people on TV who lost their homes?").
3. Discuss with them the various kinds of charities and how they help those less advantaged in many ways.**
4. Ask them what kind of support they would like to give: for food, shelter, clothing, medicine, toys, books, etc? For victims of disasters or war or for the chronically poor? For families? Kids? Communities? Endangered animals? The environment?
5. Encourage putting themselves in another shoes: "If were 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?"
6. Guide the discussion: "Sure, Billy, buying Twinkies for a lot of kids is a great idea and would make them happy for a short minute, but can you think of other ways to better help the disadvantaged with the cost of your present?"
7. But in the end, it's their charity. Let them choose.
8. On Christmas or Chanukah, put a card in a nicely wrapped gift box that says, "X dollars donated by Billy to the ABC charity, where it will be used to ___. Thanks, Billy!"

Perhaps, one day, when the X box is rusting in the basement, these will endure as the presents that your child best remembers and appreciates as having taught them the true meaning of Christmas and Chanukah.

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

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HAPPY HOLIDAYS FROM DR. P

Logo by my colleague, friend and collaborator on PROJECT GOOD HEART, Jack Maypole, MD -- a fabulous pediatrician and brilliant cartoonist.

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* The data comes from the National Retail Federation's 2006 Holiday Consumer Intentions and Actions Survey
** In case you need some info on charities, here are some good web sites to guide your discussion and help make a choice:

JustGive.org
Charity Navigator
Network for Good

Related Topics:

• (Transcript) Naughty or Nice: Kids at the Holidays
• Don't Make Holidays A Ho-Ho-Horror

Technorati Tags: project good heart, holiday, christmas, hanukkah, charity, gifts

Illegal Families and Broken Wings

"Dr. P.," the nurse urgently beckoned. "Come have a look at this arm."

Comfortably snoozing, nude on a warmer after just having been born, was a large baby girl, her left arm hanging limply at her side.

For the past few weeks I have been the supervising pediatrician in our hospital's newborn nursery. As an urban hospital serving poor, ethnically diverse families and because it is widely known we turn no one away, many new immigrants to the U.S. choose to deliver their babies here.

I examined the infant. Indeed her left arm was limp, while her right had unrestricted movement. But otherwise she was a spectacular new human, radiating beauty and promise, as all babies do.

And she was big, almost 9 pounds. The stress of a vaginal delivery -- with the shoulder getting hung up in the birth canal as she made her laborious exit -- caused an injury to the nerves which stimulate the muscles of that arm. It's called an Erb's Palsy (or "brachial plexus injury"). The good news is that the nerve is rarely permanently damaged and typically begins to fire up again in the next weeks to months, with the arm recovering full function.

"Looks like an Erb's all right," I told the nurse (who, of course, already knew). "I'll take the baby out to her mom and go talk to the family about it."

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The room was dark and hot and close, with five or six extended family members huddled around the exhausted mom. "Hi, I'm Dr. P. I just examined your gorgeous, not-so-little girl. Congratulations. She's great and healthy. There's just one problem I want to talk to you about..."

I explained about the palsy and how it almost invariably resolved. Suddenly mom began to wail inconsolably, shaking with emotion and (it looked like) terror. "Really," I stammered. "I know you're worried, but the odds are great her arm will be just fine."

Mom kept crying and clutched her baby tightly to her chest. Eventually, one of the family members filled me in. Mom had recently come to the U.S. from a war-torn country to have her baby. In the hell that had been her life, apparently one of the terror measures by the insurgents was the threat of (and actual) disabling of the limbs of infants and children. It was called the "broken wing" campaign.

I've seen enough PTSD (post traumatic stress disorder) to recognize when an acute event triggers an incapacitating flood of horrible memories and emotions. What can you say in the face of such a story, of such an experience, of such raw hurt? "It's OK. It's OK. You're here and everyone is safe and your baby is going to be fine," I soothed lamely and left the room.

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Did I mention that the mom would be likely be classified as an illegal immigrant if she over-stayed her visa to the U.S.?

I was reminded that some advocate the arrest of illegal immigrants and would mandate that I report this mom to the immigration authorities should she stay too long so we could deport her back to where she belongs. The debate about what to do with the flood of illegal immigrants is important and complicated and excruciating -- legally, ethically, socially -- and I don't pretend to have found the right answer, the right balance.

But I realized with that mom and baby, with that story, there was no way I could ever do something to jeopardize her staying in the U.S. for as long as she wanted. And it occurred to me that it was hypocritical if I advocated harsh responses to illegal immigrants in the abstract but wilted in the face of real people, and that whatever position I held should be consistent with my feelings in that room.

And I thought and think that it must be so that wise men and women can find a fair and humane way for we lucky Americans to make room for other people who -- legal or otherwise -- seek shelter from the storm in this glorious idea of a country, where broken wings can mend and human dreams can fly.

Related Topics:

• How to Cope With Stress in a World With Terrorism
• Stress Disorder More Common in Women

Technorati Tags: newborn, immigration, healthcare