Entries for August 2009

"Sexual behavior in children" is a phrase guaranteed to make most parents break out in a sweat, particularly when the children in question are 2 to 6 years old. But after my own initial freakout, I found the new clinical report from the American Academy of Pediatrics actually reassuring. It gives doctors and parents a clear sense of when a child's sexual behavior may signal physical or sexual abuse, and when it's normal—giving a parent the chance for a little lesson on appropriate behavior.

But first, the freakout. Here's the list of what the pediatricians say is normal, common sexual behavior in 2- to 6-year-olds:

Kids are going back to college this week, and swine flu is, too. The University of Kansas has already reported cases on campus, as have other schools. Parents can be forgiven for thinking, "Yikes!" But schools have been busy getting prepared over the summer, presuming that the new H1N1 flu virus will be a serious factor in the fall. The federal government has been busy, too, with new advice for parents and students on what they should do to survive swine flu on campus. It's a "don't panic" approach that aims to keep campus life as normal as possible until more drastic measures are needed.

I don't have college-age children, but I teach at Johns Hopkins University, and the school has already told us to be prepared for teaching online if the pandemic gets worse this fall. I hope it won't come to that. Colleges will participate in giving the vaccine when it becomes available (and people under age 25 are a group the Centers for Disease Control and Prevention consider a priority to get the shot), but that won't be until October or November. For now, students can minimize their risk by:

If your 13-year-old seems superhyper today, it may not just be the ginormous Frappuccino he had for lunch. More and more kids are abusing ADHD stimulant drugs, which are easy to get from friends at school—or from a friend's medicine cabinet. I don't yet have children old enough to make this a worry (though my 13-year-old nephew is all about those Grande Frappuccinos). So I asked Jennifer Setlik, an assistant professor of pediatrics at Cincinnati Children's Hospital who has researched the increase in ADHD stimulant drug abuse, what parents should do to minimize the risk.

"Parent should be aware of exactly what medications their children are prescribed," Setlik says. "They should know the risks and benefits of the medication, when the child is taking it, and how long the prescription should last." That's a good start.

The questions I asked at my daughter's well-child doctor visit this week were not happy ones: They were all about what to do if the swine flu pandemic gets much worse this fall and she becomes sick. I asked for a prescription for pediatric Tamiflu. Not going to do it, the nurse practitioner said. She told me to be alert for a sudden fever and cough and to come in for a rapid Type-A flu test if symptoms occur. If the test is positive, my daughter will be put on an antiviral drug such as Tamiflu.

I left the pediatrician's office just as worried. A neighborhood mom who is an intensive-care nurse had just told me that day that she's been caring for a previously healthy 24-year-old who has spent the past month on a ventilator after coming down with swine flu. While most children and young adults have been recovering quickly, every parent's nightmare is that his or her child will be the one who becomes deathly ill. Watchful waiting doesn't offer much reassurance.

I cringed when I read the headline about the use of antibiotics in children dropping pretty sharply, because my daughter had just finished taking a course of medication that I wasn’t sure she needed. This was a kid who, though happily playing, had had a troublesome cough for weeks. My husband and I were worried, and after multiple doctor visits, when the doctor suggested antibiotics, I didn’t argue. Now, the kid is still playing, and the cough is still there. We were back at the doctor again yesterday, and the consensus was to watch and wait to see what’s going on.

We parents are doing a better job of not demanding antibiotics for every childhood illness, according to the study in this week’s Journal of the American Medical Association, which found that antibiotic prescriptions for upper respiratory infections (including ear infections) dropped 36 percent from 1995 to 2006 in children under age 5. In recent years, the federal Centers for Disease Control and Prevention and medical societies have put a big effort into trying to convince parents that antibiotics often don’t help with children’s colds and ear infections, particularly the very common otitis media with effusion.

These are anxious times, and for many of us parents it's easy to translate that anxiety into pushing our children to learn more, better, faster. I just read a delightful "Whoa, there!" from Alison Gopnik, a professor of psychology at the University of California-Berkeley who studies how small children learn. Her view: Babies are smarter than you think. They might even be smarter than you.

Babies think differently from us, and that's a very good thing, Gopnik says. They notice everything, particularly what's new and surprising. We adults, alas, ignore all that exciting stuff to stay focused on what's useful, whether it's finishing the report at work or buying the groceries. Neuroscientists increasingly believe that many of the big differences between baby and grown-up thinking arise from differences in brain structure and function. Babies' brains have many more neural connections than adults'. As children mature, brain connections become more specialized, particularly in the teenage years, when unused brain connections are pruned to create an adult brain that's a fast, efficient thinking machine.

Parents of teenagers know how important texting and social networking sites like MySpace, Bebo, and Facebook are to the over-13 set. But if we think we know what our kids say and do on the sites, we're kidding ourselves. My 13- and 14-year-old nephews kindly remind me more often than I'd like of my cluelessness, and a new survey confirms that I'm not the only parent who has no idea.

Common Sense Media, a nonprofit that tracks children's use of media, commissioned a poll of teenagers and their parents this spring. It turns out that teens are way more active online that most parents realize:

We're well into back-to-school prep, buying glue sticks and comparing lunchboxes. But this year, the process is a bit out of the ordinary. It includes getting up to speed on what our family should do if my child gets swine flu. Last spring, the federal government ordered schools to close if they had a student ill with the new H1N1 flu. Flu experts expect there will be many more H1N1 flu cases this September and October, ahead of the beginning of the usual annual flu season. School-age children are much more likely to get the new flu than are adults, because they have no immunity. We parents need expert advice right now if we're going to be ready for this new back-to-school drill. September is less than a month away!

New flu guidelines from the federal Centers for Disease Control and Prevention cut parents a bit of a break. Because many of last spring's flu cases were mild, the feds decided it makes more sense to keep schools open when students have swine flu. Here's the gist of the new flu rules:

Dangerous medical errors are a big problem in our healthcare system, and children aren't immune. In every 15 hospital visits, one child is harmed by a medication error, according to a 2008 study by the National Initiative for Children's Health Care Quality. We all like to think that won't happen to our child. But it certainly could. My family made a visit to the children's hospital ER last weekend after my 6-year-old choked on a bite of peach. A simple X-ray confirmed that the peach bite had moved along, and we were out of there in two hours. But it's easy to see how a longer stay with more complex treatments could really increase the odds of dangerous errors, despite the good intentions of doctors and nurses.

So when I saw the press release about a new program on hospital safety for children, I sat up and paid attention. It's a child-centered version of the "Speak Up" program from the Joint Commission on Hospital Accreditation. The message: Parents need to closely monitor a child's medical care and speak up whenever anything seems amiss. Easier said than done, I know, especially when it comes to things like asking nurses and aides if they've washed their hands. But research shows that keeping a close eye on care and questioning decisions that don't seem quite right really do reduce the risk of dangerous medical errors.

Here are key points for making a hospital visit as safe as it can be:

It's hard to imagine an 8-month-old baby being clinically depressed, but Rahil Briggs has seen it. Briggs, a child psychologist at Montefiore Medical Center in New York, treats tiny babies who have "flat affect"—no joy in the things that a baby would normally delight in, such as playing with parents or discovering a new toy.

If this shocks you, you're not alone. Many pediatricians aren't aware that depression can be a problem for very young children. Many parents aren't, either. Count me among them. I called Briggs to find out how we parents can tell if a young child is depressed, as compared with the annoying whining I get from my 6-year-old when the laces on her sneakers don't line up properly.

"Depression as a young child can spark long-term problems with social and emotional development," said Briggs, who directs the Healthy Steps early intervention program at Montefiore. And preschoolers who are depressed are more likely to be depressed one and two years later and to not snap out of it, according to new research from Washington University in St. Louis. In other words, this is real clinical depression. But Briggs says many people are surprised at that. "There are still people who say, 'What are you talking about? Is this a baby on the couch?' "

Right after I coated my kid with SPF 70 sunscreen and dropped her off at camp this morning, I picked up the newspaper and read: "Millions of Children in U.S. Found to be Lacking Vitamin D." Sunscreen was listed as a main culprit for the deficiency, which can put children at risk of developing high blood pressure, high blood sugar, heart disease, and weak bones. Yikes! I've been slathering on sunscreen so my pasty-white kid doesn't get skin cancer. But heart disease doesn't sound good, either.

The fact that increasing numbers of American children are lacking in vitamin D isn't new, but this latest report is the first nationwide assessment of D intake among kids, based on federal data. Nine percent of children up to age 21 were found to be seriously deficient in D (defined as less than 15 nanograms per milliliter of blood, a level at which a child might get bone-warping rickets). Another 61 percent, while they had higher blood levels of D (15 to 30 nanograms per milliliter), still had higher blood pressure and lower levels of good cholesterol. Girls, teenagers, and children with darker skin are more likely to be lacking. The main culprits? More time indoors with video games and computers; less milk, which is fortified with vitamin D; and sunscreen.