February 24, 2012

More Treatments, Better Outcomes for Kids Born with Heart Disease

Vincent Parnell, MD

The single most common form of birth defect, congenital heart disease affects nearly one out of every 100 babies born in the United States. 

Yet our ability to detect and characterize congenital (present at birth) heart disease has improved remarkably over the last 50 years. Now, doctors can get precise information about the nature and severity of the condition via ultrasound technology as well as magnetic resonance images (MRIs) and computed tomography (CT) scanning. In 2003, the neonatal service at the Cohen Children’s Medical Center of New York helped pioneer the use of pulse oximetry to screen for congenital heart malformations before a baby gets discharged from the regular newborn nursery. It is increasingly common, in fact, for clinicians to detect congenital heart disease even months before a child is born, allowing preparation for family, adequate support at the time of birth and the assurance of sufficient resources to begin treatment immediately at birth.
 
Treatment has also progressed exceptionally, especially since the development of the heart/lung machine in the 1950s, which increased surgeons’ ability to work inside or near the heart. This allowed treatment of upwards of 150 kinds of congenital heart disease--many of which were previously barely treatable.
 
In the last 25 years, innovative cardiologists have replaced many of those original surgical treatments with interventions in the cardiac catheterization laboratory that offer at least equivalent results with the added benefits of less need for blood transfusion, less pain, small or absent incisions and quicker recoveries. When cardiac surgery is necessary, it can be done safely on younger and smaller children, allowing them to have a more normal type of heart function earlier in life.
 
Today, hospitals that help kids with congenital heart problems offer comprehensive children’s heart centers that assemble multidisciplinary specialists who work together on treatment. These include surgeons, anesthesiologists, intensive care unit specialists, highly specialized pediatric cardiologists, neonatologists, perinatologists and others, along with their trainees and the corresponding nursing expertise in each area. Full Post - to Detail View

January 30, 2012

Kids Don’t Gain Weight Just Due to Junk Food at School

Nancy Copperman, RD

Think childhood obesity is on the rise because of junk food and soft drinks at school? Think again. In fact, exposure to unhealthy food at school is not associated with chubby children, according to a new report.

Published in Sociology of Education, the study followed almost 20,000 American children as they progressed from fifth to eighth grade. It found that the type of food sold in school vending machines and stores was not related to the children’s BMI (body mass index, a measure of body fat as it relates to height and weight). This particular study found that the biggest factor influencing children’s BMI in middle school is the food preferences and eating habits they established when they were younger. However, the study did not look at what food choices the individual children made at school or at home.

While one element, such as getting rid of junk food at schools, might not make a big difference in terms of a child’s BMI, it may have a greater influence when factored into a larger nutrition education program. Improving the school food environment--vending machines, school breakfast and lunch, and classroom snacks--serves to reinforce the nutrition and health education the children receive in the classroom. The findings suggest that efforts to prevent childhood obesity require a holistic approach that involves improved nutrition and increased physical activity both at school and at home. 

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November 29, 2011

Xylitol Gum Can Help Kids Prevent Ear Infections

Mark Shikowitz, MD

Giving xylitol chewing gum to children can reduce the incidence of acute middle ear infection by about 25 percent, according to a medical study review recently published by the Cochrane Library. It appears xylitol gum works in healthy children up to 12 years in age by inhibiting bacteria, added the review’s lead author.

Chewing on gum may be a good way to prevent ear infections because it opens and closes the eustachian tubes, which link the throat to the middle ear. The advised “dosage” is two pieces, five times a day after meals for at least five minutes.

But parents should make sure that their kids don’t chew gum much more than that, since excessive gum-chewing can cause young patients to develop jaw problems. Also, be sure the gum is sweetened only with xylitol, since this natural sweetener does not cause cavities.

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November 10, 2011

Screening Teens for Drugs, Alcohol

Bruce Goldman, LCSW

All adolescents should be screened for alcohol, tobacco and other drugs every time they visit the doctor, according to a new recommendation in the journal published by the American Academy of Pediatrics.

This is an excellent and timely recommendation. It is no secret that adolescents experiment with alcohol and drugs. In fact 41.2 percent of high school seniors report past month use of alcohol with 22.3 percent reporting binge drinking in the prior month (more than 5 drinks in a row). Marijuana use among high school seniors is now more prevalent than tobacco use (21.4 percent vs. 19.2 percent). Additionally, we cannot read a newspaper or listen to a news report without hearing about the Full Post - to Detail View

November 07, 2011

ADHD Medicine Doesn’t Increase Kids’ Heart Risk

Andrew Adesman, MD

Stimulant medications are generally viewed as the safest and most effective medications for the treatment of attention deficit hyperactivity disorder (ADHD). Several years ago, concerns were raised about the possibility of a small but increased risk of sudden cardiac death among children and adolescents treated with stimulant medication for ADHD. Although subsequent analyses suggested that there is no increased risk, patients and clinicians have remained cautious about these medications from a cardiac standpoint.

In this week’s New England Journal of Medicine, a team of researchers present findings from their analysis of an extraordinarily large sample (1.2 million children and young adults) with respect to ADHD drugs and serious cardiovascular events. This new study once again fails to find an association between treatment with stimulant medication and sudden cardiac death, myocardial infarction or stroke. Although the authors acknowledge that they cannot rule out a modest increase in risk, the data are overall quite reassuring, especially considering that they did not exclude children with congenital heart disease--a group presumed to be at increased cardiovascular risk--from the analyses.

In short, this study provides additional reassurance to families and clinical practitioners that stimulant medications like Concerta, Full Post - to Detail View