Entries for October 2008

Cognitive behavioral therapy can help children struggling with mental illnesses such as anxiety disorders, obsessive-compulsive disorders, and depression. But finding good CBT can be really tough, particularly since some child psychologists say they do CBT but don't really. It's a precise art.

Unlike talk therapy, cognitive behavioral therapy focuses on teaching the patient practical skills. A depressed person might get out of the house and do something enjoyable or learn to replace "I'm no good" thoughts typical of depression with "I'm pretty good at this." An anxious patient, for example, learns step by step to manage tasks that the illness has made difficult or impossible and practices those skills until they become comfortable. "One of the main vehicles in cognitive behavioral therapy for treatment of anxiety is teaching the patient how to confront what they're afraid of," says Anne Marie Albano, coeditor of a study in the online New England Journal of Medicine that showed that CBT is as good as antidepressants for treating anxiety in children and that CBT and antidepressants combined are even better. "We call this exposure."

Richard Kanowitz told me a story that is every parent's nightmare: He and his wife put their 4-year-old daughter, Amanda, to bed sick one night, and "in the morning, she was gone." Amanda had died of influenza B, the plain old seasonal flu.

The Kanowitzes had called their pediatrician that evening because Amanda was pale and sluggish. The doctor told them that if they kept Amanda hydrated she'd be OK. In almost every case, that would have been true. But children do die of the flu; 83 children died last year, and 92 percent of them had not been vaccinated. Most of them had been healthy, like Amanda.

If it seems as if way more kids have food allergies now, you're on target. The number of children diagnosed with food allergies has gone up 18 percent in the past 10 years, according to new numbers from the National Center for Health Statistics. Four percent of kids now have food allergies, or about 3 million children.

This means a lot more than just the hassle of bringing nut-free snacks to school. Food allergies land children in the hospital about 9,500 times a year. Perhaps as many as 150 people die each year from food-induced anaphylaxis, most of them teenagers and young adults. The only way to avoid an allergic reaction is to avoid the food, which can be difficult. "What you're seeing is an increase in children with food allergy and no improvement in treatment or diagnostic options," says Anne Muñoz-Furlong, chief executive officer of the Food Allergy and Anaphylaxis Network.

The earlier a teenager starts drinking and using drugs, the more likely he or she will struggle in adulthood with substance abuse, job performance, and personal relationships. But is that because troubled children are more likely to use, or because the mind-altering substances are to blame? Society all too often sends a mixed message, on one hand saying that all substance use is harmful for teens, while on the other saying that it's normal for teens to try drugs and alcohol, and most turn out OK. That makes it easy for parents to think, hey, I've got a good kid here, he'll be OK. Well, maybe not.

Knowledge is power in parentland, and here's the first solid evidence that the "no drinking or drugs" parents are right. A new study published in the October Psychological Science found that even "good kids" are more likely to end up in trouble if they start using drugs or alcohol early in life. By looking at a group of nearly 1,000 people in New Zealand who have been studied from age 3 to age 32, a group of researchers in the United States, New Zealand, and England were able to see that those who started drinking or using marijuana regularly before age 15 were far more likely to fail in school, be convicted of a crime, have trouble with drugs or alcohol, or get pregnant in their teens.

The federal government's new standards aimed at reducing the amount of lead in air are good news for children, for whom air pollution has been one of the big remaining sources of exposure to this toxic metal. Twelve states will violate the new standard, which cuts the amount of lead allowed in air by 90 percent. Alabama, Colorado, Florida, Illinois, Indiana, Minnesota, Missouri, New Jersey, Ohio, Pennsylvania, Tennessee, and Texas are the dirty dozen; they have factories, such as lead smelters or battery recycling operations, that emit lead. Children can be exposed to airborne lead by breathing particles or by touching dirt outside or surfaces inside where lead particles land, then putting their hands in their mouths.

The Environmental Protection Agency got moving because of a court order that came out of a lawsuit on behalf of people who lived near a lead smelter in Herculaneum, Mo., where children had elevated amounts of lead in their blood. "This is a big step forward for children's health," says Gina Solomon, a physician and senior scientist for the Natural Resources Defense Council, which lobbied for tighter lead controls. But, she adds, the reductions won't be fully in force until 2017, "too late for an entire generation of children." (Here's the NRDC's map showing lead-tainted sites throughout the country.)

People are puzzling over the new Vitamin D guidelines for children, and readers have sent insightful questions my way. Here's more information on the top two questions: Whether breastfeeding women can increase their Vitamin D so they don't have to give babies vitamin supplements, and why is it that living north of a certain latitude makes it difficult to synthesize Vitamin D in the skin. D is considered essential for bone growth and immune function and may play a role in preventing heart disease and other chronic diseases.

Why can't pregnant women and breastfeeding moms just increase their Vitamin D intake, rather than give supplements to babies?
The amounts that breastfeeding women would have to take is very large—more than 4,000 IU a day—if they wanted to raise the D level in their milk enough to provide 400 IU a day, according to Frank Greer, a professor of pediatrics at the University of Wisconsin who is the point man for the American Academy of Pediatrics on Vitamin D. The safety for lactating mothers of this level of vitamin D has not been established in large numbers of subjects, Greer says. Side effects could include kidney stones. Since pediatricians knew that 400 IU is safe for an infant, they went with that. For pregnant women, 400 IU a day from prenatal vitamins seems to be effective in increasing the vitamin D levels in the fetus, so 400 IU is recommended for all pregnant women.

I've written more than a few stories on how Americans are by and large lacking in Vitamin D, but wow, was I unprepared for what I heard when I asked Frank Greer how many babies get enough Vitamin D: "If it's 30 percent, I'd be surprised."

Greer should know; he leads the American Academy of Pediatrics' committee on nutrition, which just doubled its recommendation for daily Vitamin D intake in children from 200 to 400 IU a day. The docs were concerned that many children, particularly young babies, aren't getting enough Vitamin D, which is essential for absorbing calcium from food and building bones. New evidence suggests that D also plays a vital role in the immune system, and might help protect against cancer and diabetes.

Are hedgehogs really a threat to civilization? Are ferrets baby-killers? Readers responded big-time to my blog yesterday on a new study that warns parents of young children against exotic pets.

Several readers pointed out that I didn't include enough data for readers to figure out the health risk posed by different pets.

BigEd of Vermont wrote: "Why are there no references to the frequency of these problems? Another ersatz news item? Kids have had these pets for years and they have never been the source of concern before." And Will of California wrote: "Where are the numbers? What percentage of prairie dogs harbor tularemia? How many cases of tularemia have been linked to prairie dogs? How does this compare to the overall prevalence and annual incidence of the disease?"

That iguana in your son's bedroom isn't just a reptile. It's also a deadly-germ machine.

So says the American Academy of Pediatrics, which warns parents that many of the "easy" pets—the ones that don't shed, don't need to be walked, and don't throw up on the sofa—pose serious health threats to young children. Sigh. And here I was so ready to convince my daughter that lizards are almost as cuddly as a Beverly Hills Chihuahua.

I'm not alone. In the past few years, more and more families have turned to nontraditional pets, largely because they're considered easier to care for than cats and dogs. But they bring with them substantial health risks, particularly for children younger than 5.