Entries for May 2009

My heart goes out to Colleen Hauser, who was near tears in Minnesota this week as she agreed to bring her 13-year-old son in for chemotherapy after the two spent a week avoiding the treatment. Reasons offered for that varied, between the Hausers’ religious faith and their son’s desire to avoid the miseries of chemo. I’ve been working on another article about how patients use the Web to find medical information, and that got me thinking about whether the Hausers might have benefited from the free expert help I've discovered is available to all parents facing agonizing treatment decisions about their children’s health.

Parents facing a child’s health emergency, as the Hausers are with Daniel’s Hodgkin’s lymphoma diagnosis, can connect with parents who have been there, too. These networks of expert parents are as close as your computer, in online patient groups. They offer hard-won wisdom and up-to-date medical information that can be invaluable to families facing tough treatment choices. “Amateur” medical information isn’t clinically tested or peer reviewed, of course, so it shouldn’t be considered a sole source. But it can serve as a guide to navigating the tsunami of information on Google and other search sites, as well as the often confusing information that patients get from their doctors.

Supreme Court nominee Sonia Sotomayor was diagnosed with type 1 diabetes when she was 8, and patient advocates have seized on her nomination as proof that diabetes is no longer a life-limiting disability. That’s the good news.

The bad news is that the number of children with type 1 diabetes continues to rise, and doctors don’t know why. A new study out in today’s Lancet projects that the number of new cases of type 1 diabetes in children under 5 will double by 2020. Yikes. That is just a projection, based on data from 17 countries in Europe, but it still has distressing implications for families in the United States, particularly since our environment and cultures are so similar. About 3 million Americans have type 1 diabetes now, and 30,000 are diagnosed each year, about half of them children.

Doctors still don’t know what causes type 1 diabetes, an autoimmune disorder in which insulin-producing beta cells in the pancreas are destroyed by the body’s own immune system, causing a lack of the hormone that makes it possible for the body’s cells to absorb glucose from food. The disease usually surfaces in childhood, as it did with Sotomayor, or early adulthood. There’s speculation that the lack of early-childhood infections somehow makes the immune system attack beta cells, or that environmental and lifestyle changes, such as the fact that children in developed countries are taller and heavier than in decades past, may play a role.

Do you know what your daughter’s online avatar looks like? If it’s sexually provocative—more Bratz than American Girl doll—it’s time for a chat. “I’m amazed at the grotesqueness of some of these avatars,” says Jennie Noll, a developmental psychologist and associate professor of pediatrics at Cincinnati Children’s Hospital Medical Center who asked 173 teenage girls ages 14 to 17 to make avatars, then rated their provocativeness—skimpy clothing, body piercings, exaggerated curves. Girls who created provocative avatars were more likely to get sexual come-ons online, not surprisingly, and also more apt to agree to an in-person encounter with someone they met online. Noll's study is published in the current issue of Pediatrics. The girls who chose provocative avatars were also more likely to be preoccupied with sex—and, Noll speculates, they might be more likely to try on the role.

Parents can use avatars as an early warning system, Noll says. “Parents should be interested and aware of how their children are presenting themselves online,” she says, and prepared to talk with them about "the implications of presenting themselves as a sexual being online.” The next step: Run through scenarios about what could happen if someone wanted to meet up in real life, and role-play how to fend off a come-on that could lead to more than they’re able to handle. Not all offline encounters end in sexual abuse or exploitation, of course. But Noll, who studies the effects of child sexual abuse, cautions that the potential is there.

Most of the teenagers with major depression never get treatment for it, according to a new federal report. That depressing news comes as no surprise to pediatricians and teens' mental-health providers, who say that many kids and parents don’t recognize depression’s symptoms. And if they do, it can be difficult or impossible to get help. This is no small problem; about 2 million teenagers experience clinical depression each year, an illness that can derail school performance and friendships and is a leading cause of teen suicide.

[Consider ways to raise kids who can cope.]

Swine flu spreads easily enough and infects enough people to spark a global pandemic, according to a new analysis by the World Health Organization’s Rapid Pandemic Assessment Collaboration. That’s the news of the day, released early by the journal Science “because it contains important public health information.” The bottom line: We’re not safe yet, despite the Monday-morning feeling that swine flu is last week’s news. This may be just the first weeks of a three-to-five-year pandemic, with wave after wave of sickness and death.

It’s still impossible to tell how bad H1N1 is going to be, the WHO team says. But by looking back at how many cases there have been in Mexico (many more than the 4,694 confirmed cases listed by WHO) and by tracking the virus’s spread through international travel, the WHO researchers were able to get a better sense of how dangerous this bug is. Here are the key numbers:

• About 23,000 people fell ill in Mexico by April 30, the scientists estimate, giving the outbreak a death rate of between 0.3 and 1.5 percent, about the same as in the 1957 global flu pandemic. By comparison, the death rate in the 1918 flu pandemic was about 2.5 percent. Mexican health officials said the two groups most likely to die were previously healthy young people who deteriorated rapidly with acute pneumonia and people with chronic health conditions such as cardiovascular disease or tuberculosis.

There’s an epidemic of childhood obesity but no agreement over what’s making kids fat. Is it eating too much junk food or spending too much time watching TV instead of exercising? Scientists have come up with a clever way to answer this question, by figuring out how many calories children and adults actually burn in the course of the day, then comparing that with how much Americans actually eat.

The comparison isn’t perfect; the calorie-burning was figured by actually testing 1,399 adults and 963 children to see how many calories they burn in a day, while the food intake was figured using the national food supply from the 1970s and the early 2000s. Researchers calculated what those adults and children should weigh today, based on the fact that people eat more on average now than 30 years ago. If the actual weights were lower than the projected number, that would mean that people now are getting more exercise than people did 30 years ago. If they weighed more, it would mean they are getting less exercise. 

Swine flu interrupted our family dinner last night but in a good way: in a robocall from the Montgomery County school district announcing that Rockville High School was reopening today, after being closed because it had one swine flu case. As of today, the federal Centers for Disease Control and Prevention has changed its advice to schools. The CDC now says schools can stay open with swine flu cases, unless there are so many sick kids and teachers that the school no longer functions. This will come as a huge relief to the many families around the country who are wondering how on earth they are going to care for healthy kids during weeks of school shutdowns.

The new keep-schools-open advice is based on growing evidence that the people who are getting swine flu aren’t getting sicker than they would from the run-of-the-mill seasonal flu. It may be that swine flu was circulating for months in Mexico and that the deaths there that freaked out infectious disease experts were really a small part of a much larger pool of mild cases.

Children who are repeatedly bullied are twice as likely to have psychotic symptoms as children who aren’t abused. And the more they’re victimized, the more likely they are to have psychiatric problems.

This may sound like just more depressing news for kids who are victims of bullying, but there’s also a ray of hope. Mental-health experts increasingly think many serious mental problems can be prevented if children are given appropriate help. So if parents realize early on that their child is being bullied, intervention may help stave off lifelong trouble.

Researchers in England asked 6,437 children about bullying and psychiatric symptoms when they were turning 13. Since age 7, the children had been part of a study in which they were interviewed and took psychological and physical tests. The researchers found that children who were bullied repeatedly between ages 8 and 10 were more likely to have psychotic symptoms such as hallucinations, delusions, or thought disorders.

No one knows if swine flu will become a horrible pandemic. That uncertainty leaves parents with worries that have no end. How can parents help themselves and their children? 

"It's calming to prepare," says Peter Sandman, a risk communications expert in Princeton, N.J., who advises government health agencies on pandemic preparations. He's also the father of three grown children.  "People need to be involved in trying to cope." And for most of us, being told to wash our hands isn't enough involvement to banish fear. Sandman told me five sensible actions that can help parents and kids feel better (see below). He also explained that children need to be told different things about swine flu, depending on their age:

Very young children pick up that parents are nervous. So parents need to acknowledge that, Sandman says. "You just want to say, 'Yeah, we're all a little nervous because there's this new flu, and nobody knows much about it yet, but don't worry, sweetheart, Mommy and Daddy are going to take care of you.'"