Baby Names, Child Abuse, Vitamins, Sniff Test – PediaCast 324
Join Dr Mike in the PediaCast Studio for more News Parents Can Use. This week’s topics include baby names, child abuse & skeletal surveys, Vitamins D & K, parents & vaccines, marijuana & advertising, K2, Spice & heart injury, and a sniff test for autism.
Child Abuse & Skeletal Surveys
Vitamins D & K
Parents & Vaccines
Marijuana & Advertising
K2, Spice & Heart Injury
Sniff Test for Autism
Use of Temporary Names for Newborns and Associated Risks
Evaluation for Occult Fractures in Injured Children
Importance of Vitamin K Shot (YouTube)
Shifting Views: Parents & Vaccines (YouTube)
Synthetic Marijuana: PediaCast 206
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast. It's a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio.
It is Episode 324 for July 29th, 2015. We're calling this one "Baby Names, Child Abuse, Vitamins, Sniff Test". I want to welcome everyone to the program.
I have a News Parents Can Use edition of the show lined up for you this week, and I'll get to a complete rundown of the lineup in a moment. I gave you a little bit of a hint there with a title. But first, my family recently came across something extraordinarily cool, and I wanted to share it with you, so that if you're interested, your family might be able to find something similar in your town and neighborhood; or, if you're interested and there is not something like this in your town, and maybe you're a person interested in entrepreneurship, maybe looking for a business idea, who knows, maybe this is it.
A little bit of background first, those of you who live in the Midwest, you know what I'm talking when I say that we've had cool wet summer compare to most years, which our family has been trying to make the most of, but it's been difficult, because during the summer, we really like to get outside and do some things. We lived in Florida for a few years. We enjoy warm dry weather where we can go hiking and camping, roller coaster riding and it's been a tough year for that.
Now, combine this with another fact that you already know about my family, and that's we enjoy playing board games, card games, thinking games. You know the kind — turn off the screens, put away the phones, let's gather around the table and interact organically rather than digitally because sometimes you need that. It's refreshing.
But it's something we're more apt to do during an Ohio winter when we're stuck inside, and then the summer comes along when it's been cool and rainy. Plus, my kids are a little older now, they have summer jobs, so that's also limited our ability to embark on spontaneous one tank trips across the states. All that to say, we've had more than a few family game days and nights when we can squeeze a couple hours in.
So where am I going with this? Well, I was in the market for a new game. Something to spice up our time together, and my son likes to play Risk, which can get a bit tiresome after you've played a time or two. And he likes Axis and Allies, which is quite complex, and it takes an entire day to play. So I was looking for a game in the same genre but somewhere between the two, and I came across reviews for a World War II strategy board game called Memoir 44. The reviews were great. The game play looked varied and interesting, without being overwhelmingly complex. It looked perfect, really.
I can get it on Amazon within arrival in just a couple of days, but I was impatient. I wanted it now. I had good reasons. There was an all-day rain. My wife and daughter are both heading to work that night. Memoir 44 is a two-player game, and I was pining for some father-son time that didn't involve another round of Platoon or Mario card. And I was supporting the local economy, which is what I had to tell myself because the brick-and-mortar price would certainly be higher than what I could get online.
So I called our go-to game store and I asked if they have a copy. The guy says he just sold his last one. Seriously, he's like, "Yeah, I had one and it flew out of my hands yesterday." But, he could, of course, order a copy for me and have it in a couple of days. Well, I didn't really want to wait and pay higher prices, so I started searching in-store stock at the usual places — Wal-Mart, Target, Toys R Us, the little game stores in the local mall. Nobody has it.
I'm just about to give up when I came across a game store I hadn't heard of before. It's in the nearby suburb of Dublin. Now, honestly, I don't really remember exactly how I found this place because they don't even have a website. Might have been Google Maps search for game stores. That's how desperate I had become. I think that's probably how I found it.
So I called them up, fully expecting more disappointment. But what do you know? They have a single copy of Memoir 44, and they'll hold it for me. So I head out in the driving rain, and the crazy thing is, the store is right next to a deli that we sometimes frequent so I must have seen this store before but never really noticed it.
Well, I get inside and let me tell you, the place is a gold mine. Not only do they sell a wide variety of three-dimensional, non-digital games, but they have shelf after shelf filled with hundreds of well-kept demo games and playing tables. Lots of them, so you can go and play games to your heart's content for free.
Well, I was giddy to tell my family about this. Plus you can bring in food or you can have pizza delivered. And they have organized game nights and a backroom that you can rent with playing tables and access to other demo games if you want to host a game party on site.
OK so I'm thinking, how does a place like this stay in business? I mean there's not a lot of profit in opening your doors for free game play every day, right? So I asked how long they've been in business, and the lady tells me over a year. So, now, I'm really excited because they must be turning a little bit of a profit, which in my mind means the place will at least be around long enough to bring my family back and try some of these demo games.
That's exactly what I do, and exactly what we've done several times this cool rainy summer. And to my delight, the demo games have been in good shape will all their pieces, parts. And even though their retail games cost a little more than you'd pay on Amazon or a Big Box retailer, people come in and buy them, although you don't have to buy a game or pay a membership to feel welcome.
This place is developing a following and customer loyalty. The play tables are full in the evening. When more people come in, the owner sets up card tables and chairs. He sells light refreshments at reasonable prices, but of course, that's not paying the electric bill, so they must be selling enough games to keep the doors open, which to me is really encouraging.
Now, don't get me wrong. There's a place for digital media and network connectivity. I'm fully vested, I've been doing a podcast for nearly a decade. But you know, people need to unplug too. And it seems to me that maybe, just maybe, this is the beginning of some reasonable pushback.
So I'm thrilled I found this place, and your family can find it too, if you look at the right place in Dublin, on Bridge Street, next to Jason's Deli.
If you have a game store near you, find out if they have demo games and tables and encourage a culture of family style game play. If they don't suggest it and if you are business minded, who knows what you could do with the concept like this. Pretty cool stuff and good for friends and families and communities to gather around the table face to face, talking with each other, interacting, just another great way to put the screens down and interact. Which we love doing in the summer time, hiking and camping and roller coasting riding as I mentioned, but when it's in the 60s and raining all day, it's a little hard to do that. So this was a really great thing to find.
All right, so what are we talking about this week? Let's run through an abbreviated lineup since I've spent so much time talking about playing games in the intro.
Baby names — babies don't have an official first name until their birth certificate is filed. That creates a problem for medical documentation, especially in the newborn intensive care unit, and that can lead to medical errors. I'll explain why this is a problem, outline the scope of the problem and let you know what researchers say hospital can do about it. And to that, I'll add what parents can do about it.
Then, child abuse in skeletal surveys — this will be of interest to the pediatric providers in the crowd, but I think parents can learn from it too, especially if your young child has an unwitnessed injury. You take him to see the doctor, and the doctor's worried about the possibility of abuse. I'll try to explain why we do what we do, how parents can help the process and some numbers related to all this.
And then, vitamin D and vitamin K, these are two vitamins for which supplementation is important. I'll explain why and let you know how you can accomplish appropriate supplementation.
Parents and vaccine, the tide is turning. More parents are listening to evidence-based information regarding vaccines and you, the PediaCast audience, has played a role in that shift by supporting our show and sharing evidence-based resources. We'll look at the numbers and let you know in exactly which direction the tide is turning.
Then, marijuana in advertising — as our society gets more comfortable with marijuana, with legalized recreational use in some states and the growing demand for medical use, it's no surprise the suppliers are turning to marketing. So how does that affect our children and what can parents do about it?
And then, synthetic marijuana — also known as K2 or Spice, there's other names as well — we've talked about this before, but there's a new study out revealing long-term heart injury possibly caused by this drugs. It's a timely information for parents and providers, and I'll share it.
And then, for my final word, the sniff test for autism. Yes, you heard me correctly, the sniff test. Can the sense of smell be the basis of an early autism screening test used in young toddlers? Stick around and find out.
Don't forget, you can get in touch with me. It's really easy to do. Just head to PediaCast.org and click on the Contact link. You can also call 347-404-KIDS, 347-404-5437 and leave a message that way, if you have a topic that you like us to talk about or you have a question for me, really any comment, please feel free to touch base.
Also, I want to remind you the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your doctor and arrange a face-to-face interview and hands-on physical examination.
All right, let's take a quick break and I will be back with news parents can use, right after this.
Dr. Mike Patrick: When babies are born, hospitals often assign generic, temporary first names to infants under their care, such as baby boy or baby girl. However, these temporary names become problematic when newborns are admitted to neonatal intensive care units, also known as the NICU, where a large number of patients may have similar identifiers.
Previous studies have shown that several of the most serious medical errors reported by NICUs were due to patient misidentification.
A new study, "Use of Temporary Names for Newborns and Associated Risks," will appear in the August 2015 issue of the journal, Pediatrics, although you can view the study now online.
The study examined the impact of a more unique way to assign temporary names to newborns. This method incorporates a mother's first name into the newborn's first name, such as Wendysgirl to make the name more distinct and therefore decrease the number of wrong-patient errors.
For the study, researchers examined the patient orders that were placed on one patient, then retracted within ten minutes, then ordered for another patient within the next ten minutes. Another words, there's a good chance the order was placed on the wrong patient, with the same first name — bay boy or baby girl — and then cancelled and reordered on the correct infant.
After adopting this new and more distinct naming convention, there was a 36.3% reduction in the number of such events.
The authors concluded that the use of non-distinct, temporary first names can pose several issues, but by adopting a more distinct and personalized naming convention, the number of wrong-patient errors will decrease significantly.
So couple of points here, first for parents, you may be wondering why in the world an infant gets labeled as baby boy or baby girl in the first place, especially if you have a name picked out and you let everybody know what it is right out of the gate.
Well, the reason is this, the hospital needs a first name for the medical record the moment your baby is born. However, many parents haven't settled on a name the moment the baby is born especially in the case of an unexpected premature delivery. And, many other parents change their minds until the name is written in stone on their birth certificate, which doesn't always get filled out and filed immediately, especially when an infant needs resuscitation, critical care and or transport to another medical facility.
We can all understand the reasons for these delays. Yet, the electronic medical record needs something, and that something is usually baby boy or baby girl, which as this study points out can create confusion and medical errors when there are a whole bunch of baby boys and baby girls in the same nursery.
So what's the parent to do? Well, you can ask about the possibility of a more unique identifier. It doesn't hurt to ask and it sure makes sense. But at the end of the day, hospitals had been using baby boy and baby girl for a very long time, and your request is probably going to fall on deaf ears. Now, I know that's a pretty cynical outlook, but I think there's good chance it represents the truth.
Which leads me to the providers in the crowd, and in particular, those of you who can make a difference in hospital baby-naming policy, my plea would be this. A potential 36.3% reduction in avoidable medical error is nothing to sneeze out . There are quality assurance officers who would drool over that number, so please check out the study and present it at your next hospital quality meeting. Research like this means nothing until it's translated into practice where it can make a difference in the lives of little baby boys and little baby girls.
And to help you find the study, I will include a link in the Show Notes for Episode 324 over at PediaCast.org.
This next story is primarily aimed at the pediatric providers in the crowd because you really can make a difference in the lives of our children if you take it to heart. But I think parents will be interested in this one too, and I'll include an important nugget of related wisdom for moms and dads at the end of the story. So hang with me for a moment.
In children who are being evaluated for possible child abuse, the American Academy of Pediatrics recommends that physicians order a skeletal survey, which is an X-ray examination of the entire skeleton, to look for fractures that require a medical treatment as well as to document older fractures and other findings that are important to safeguard the well-being of the child.
Specific patterns of fractures can confirm a diagnosis of abuse. Why? Because certain fractures and patterns of fractures are extremely unlikely to happen by means of accidental trauma. An identification of these fractures and patterns of fractures in a child suspected to be a victim of abuse allows for the enhanced protection of our children.
In a new study called "Evaluation for Occult Fractures In Injured Children" which is slated for publication in the August 2015 edition of the journal, Pediatrics, but already published online, researchers found only about half of children under the age of two years with injuries suspicious for non-accidental trauma or abuse received the appropriate test, which is a skeletal survey.
This was a retrospective study in which researchers examined hospital data for children under the age of two with the diagnosis of physical abuse and for infants under the age of one with traumatic brain injury, or femur fractures.
Evaluations for occult fractures or fractures that are not apparent based on history and physical examination but can be detected on a skeletal survey were performed in only 48% of the children with an abuse diagnosis. The evaluations occurred in 51% of infants with traumatic brain injury and then 53% of infants with femur fractures. Hospitals varied substantially with regard to their rates of evaluation for occult fractures in all three groups.
The study authors conclude the data highlight missed opportunities to detect abuse and protect children.
So the standard of care in my neck of the woods is to obtain a skeletal survey in young children who are suspected to be victims of non-accidental trauma. Now why? Well, it's because you want to be able to document old fractures that were previously undocumented and patterns of fractures that are highly suspicious for abuse. You want to be able to identify those.
In this study, half of children — under the age of two, mind you — suspected of being abuse did not have a skeletal survey performed. Now, keep in mind, these are kids who are old enough to tell you what happened. I would say this in response to that number — we have to do better.
Here's my nugget for parents, if your young child has an injury and the physician or other pediatric provider tells you that the injury is suspect for non-accidental trauma or abuse, please don't put up a fuss or take it personally. Let them do what they need to do because child abuse happens in all walks of life. It doesn't matter where a child lives or who takes care of the child or what jobs the parents have or how much money the family makes.
As providers, we can't let social aspects of any kind cloud our judgment. We have to take injuries in young children that are suspicious for abuse. We have to take them seriously. And, we have to work up every child and family the same. Children are too precious for us to pick favorites.
Parents can help us with that by understanding that every child with a suspicious injury needs an appropriate workup even if it's my child, every child. If evidence of abuse is found, it doesn't mean that you are to blame. Maybe something happened to day care or preschool or the neighbor's house. Maybe your child simply had an unwitnessed accident, or maybe another child accidentally injured your child and that event was not witnessed. All these things are possible, and they happen.
On the other hand, maybe there is a pattern of abuse or neglect or preschool or neighbor's house, and unless someone asks the right questions and performs the right tests, that abuse doesn't come to light. It continues and more children are possibly injured. I know it's heavy stuff, but it happens, and to uncover it, we need to first suspect it and then look for it, and then deal with what we find head-on rather than sweep it under the rug or turn our backs.
We all have a role to play here — parents, caregivers, teachers and providers. And parents, please understand, when this happens, medical providers aren't blaming you or trying to give you a difficult time. We're just trying to do what's best for the child and treating everybody the same. Shouldn't matter if the child's grandfather is CEO of the hospital. If we suspect abuse, we need to look further. A skeletal survey rate of only 50% in kids less than two with suspected abuse, that's pathetic. We must do better.
For the providers in the audience who like to see the study for themselves, I'll put a link to it in the Show Notes for this episode, 324, over at PediaCast.org.
Dr. Mike Patrick: Currently recommended daily dietary allowances of vitamin D may be insufficient to prevent deficiency in children. This, according to Researchers at Children's Hospital of Pittsburgh and the University of Pittsburgh School of Medicine and recently reported in the Journal of Clinical Endocrinology and Metabolism.
Researchers noted that children with suboptimal vitamin D blood levels did not reach optimal levels after taking nearly twice the recommended amount of the nutrient daily for six months.
Dr. Kumaravel Rajakumar, associate professor of pediatrics at Pitt's School of Medicine and lead investigator of the study, says Vitamin D is important for calcium metabolism and bone health. It is present in a few foods — milk is usually fortified with it — and with enough exposure to sunlight, the body naturally produces it. However, vitamin D deficiency is common in the northeastern United States, especially in black children whose darker skin complexions have higher amounts of melanin, which prevents absorption of the ultraviolet light that's needed to trigger vitamin D synthesis.
Guidelines differ on adequate blood levels of vitamin D for bone health, highlighting the need for further research. Blood levels of 25-hydroxyvitamin D is the best measure of vitamin D status. For example, a blood level of 20 or more nanograms per milliliter of the vitamin is considered adequate for bone health by the Institute of Medicine, while the Endocrine Society recommends a level of 30 nanograms per milliliter for optimal bone health.
Between October and March of the years 2008 through 2011, the researchers randomly assigned 84 black children and 73 white children between the ages of 8 and 14 from Pittsburgh and Kittanning, Pennsylvania to take for six months either a daily pill of 1,000 international units IU of vitamin D3 or a placebo. They also performed periodic blood tests to record 25-hydroxyvitamin D levels and other markers of bone health.
The average vitamin D level at the initial assessment of all children, and particularly the black children, was suboptimal (meaning less than 20 nanograms per milliliter), and supplementation raised their average level to above 20 but not as high as 30. After six months of vitamin D supplementation in children with initial vitamin D levels less than 20, 39% remained below 20 and only 14% rose above 30. Other biomarkers of bone turnover remained unchanged.
Dr. Rajakumar says, "Our findings suggest that currently recommended daily dietary allowances of vitamin D of 600 international units per day may be inadequate for preventing vitamin D deficiency in children. It may be important to revisit these recommendations, especially since the higher dose of vitamin D used in this study was safe and did not appear to lead to any side effects."
So we've talked about vitamins many times on this program, and in general, we've said that as long as children are eating fairly balanced diets and don't have signs and symptoms of a particular vitamin deficiency, then even picky eaters probably get enough vitamins from our fortified food here in the United States. Vitamin supplementation above and beyond what kids get in their daily meals really is not necessary.
Now, that said, we always make an exception for vitamin D in newborns and children, especially in those with darker skin and/or in frequent sun exposure, which is a rising number of kids given our campaigns to use more sunscreen and to avoid too much skin burning and cancer causing UV light.
So here is more evidence that vitamin supplementation is important. Although it confuses the picture a bit on what blood level of 25-hydroxyvitamin D a child should maintain and how much vitamin D supplementation the child needs to achieve and maintain that level.
Best advice here, talk to your child's doctor. Get his or her take on vitamin D supplementation and ask how much your child should receive. The answer is likely going to differ, from region to region, from doctor to the doctor. It may depend on your child's skin color and possibly with their level of outdoor activity and sun exposure.
This is one of those gray areas right now, where the evidence isn't exactly clear but we're working on it. The opinion and advice of the doctor of your child that you're trusting to take care of your child, that opinion and advice is important.
If you have concerns about vitamin deficiency or that your child might be getting too much vitamin D, which is unlikely but possible. But if you and your doctor have concerns like this, blood levels can always be checked. Although in the absence of physical science of too little or too much vitamin D, checking blood levels of 25-hydroxyvitamin D isn't always necessary.
As for my own take, I think the evidence continues to support vitamin D supplementation for a wide range of children, at a wide range of ages, and especially for those with darker skin color, because again, more melanin results in less UV light absorption which equals less intrinsic vitamin D production. Till we know more, advice will vary so your best bet at this point again is to ask your child's doctor.
Another vitamin all newborn babies need is vitamin K. The evidence for this need has been clear since the 1960s and the advice from pediatricians for newborn babies to receive vitamin K has not wavered since that time. However, some parents are pushing back. Why? Because the vitamin is delivered with a shot.
Vitamin K, which has been administered to newborns in the delivery room as an injection since it was first recommended by the American Academy of Pediatrics in 1961, is vital for blood to clot normally. Despite it being given as standard medical practice since the early 60s, vitamin K-deficient bleeding is being seen more often in newborns these days compared with decades past. Emergency department physicians — including those of us here at Nationwide Children's Hospital — have recently seen several cases of intracranial (that's bleeding in the brain) due to parental refusal of the neonatal vitamin K shot.
In a case study published by Dr. Karyn Kassis in The Journal of Emergency Medicine, a ten-week-old infant presented to the emergency department with increased fussiness over a two-week period. After a thorough examination, the infant only appeared to have a pale complexion, flecks of blood in stool and pale mucous membranes. Due to the paleness of the infant, a complete blood count was obtained, demonstrating a profound normocytic anemia. Additional history and testing determined that the infant was presenting with vitamin K-deficient bleeding. Vitamin K was administered via an IV and internal bleeding stopped within 24 hours.
Dr. Kassis, an emergency medicine physician at Nationwide Children's and an assistant professor of Pediatrics at the Ohio State University College of Medicine, says, "The risk of getting a vitamin K shot is very minimal, but the risk of not getting it is very serious. Babies who don't get vitamin K can actually have silent bleeding internally, commonly in their brains. This could result in seizures, coma or even death. Parents should know that vitamin K-deficient bleeding is preventable."
A vitamin K shot is typically given within minutes to hours of birth to ensure there is enough vitamin K to prevent bleeding. Vitamin K is not sufficiently passed on by mothers to their newborns, and very little vitamin K is present in breast milk. The single vitamin K shot protects an infant until they develop enough to begin producing vitamin K and consuming vitamin K-rich foods on their own.
Symptoms of vitamin K-deficient bleeding are difficult for a parent or even a health professional to recognize in a newborn, and can include fussiness, blood in the stool and even seizures, all of which will increase as the bleeding increases. Vitamin K-deficient bleeding is preventable, and a single injection of vitamin K at birth restores vitamin K levels in the blood to normal range within an about an hour.
Dr. Kassis says, "When parents request that no shots be given to their child at birth because they are opposed to vaccines, the vitamin K shot is sometimes accidentally included in that category." However, parents should be aware that the "the vitamin K shot is an injection of a vitamin. It has no immune properties. It is purely to replace a critically important deficient vitamin."
It is also important for primary care and emergency medicine providers to remain vigilant when it comes to the vague symptoms of early stage vitamin K-deficient bleeding. Physicians who treat young infants should remember to ask parents if their child received a vitamin K shot and screen for vitamin K-deficient bleeding when appropriate.
What's the role for parents for all this? Dr. Kassis says, "I recommend that all children are vaccinated and receive all the recommended newborn shots and screening tests. Expectant parents should speak with their obstetrician or with their soon-to-be pediatrician at a prenatal appointment, for instance, regarding any questions or concerns they have about the vitamin K shot or any other immunizations."<
So there you have it, folks. The newborn vitamin K shot has been saving baby lives since the early 1960s. Let's not let it become a victim in the anti-vaccine debate, and let's not let our babies become victims of vitamin K-deficient bleeding.
Moms and dads, make sure your newborns get a vitamin K shot after birth. Pediatric providers, let's remember to advocate for vitamin K. Ask parents if their child received it and think about and look for vitamin-K deficient bleeding when we suspect it.
The good folks at Nationwide Children's have produced an educational video on the topic of vitamin-K shot. It's on YouTube, and I'll put a link to it in the Show Notes for Episode 324 over at PediaCast.org.
Dr. Mike Patrick: The vaccine debate has been front and center in recent months, and pediatricians had been more than a little vocal in social media circles regarding the tremendous benefits and extraordinarily low risk posed by vaccines.
We've turned up the volume of our messages in light of the Disneyland-associated measles outbreak. Well, it turns out parents were listening, because over the same time period that multiple outbreaks of measles and whooping cough have made headlines around the country, parents' views on vaccines became more favorable. This, according to a new nationally representative poll.
The University of Michigan CS Mott Children's Hospital National Poll on Children's Health asked parents in May how their views on vaccinations have changed between 2014 and 2015 during which two dozen measles outbreak were reported in the US, including a multi-state outbreak traced to Disneyland.
One-third of parents who participated in the poll indicated they now perceived more benefits of vaccines, while one-quarter perceived vaccines to be safer now than a year ago. One-third of parents also reported being more supportive of school and daycare entry requirements for vaccination than they were the previous year.
Dr. Matthew Davis, director of the National Poll on Children's Health and professor of pediatrics and internal medicine in the Child Health Evaluation and Research Unit at the U of M Medical School, says, "Over the last year there have been high-profile news stories about outbreaks of vaccine-preventable diseases like measles and whooping cough. These new reports may be influencing how parents perceive childhood vaccines across the country.
"For a quarter to a third of parents to say that their views on the safety and benefits of vaccines have shifted in just a year's time is quite remarkable. Parents' perceptions that vaccines are safer and offer more benefits are also consistent with their stronger support of daycare and school entry requirements for immunizations."
Parents were also asked their opinions about the risk of measles and whooping cough compared to a year ago. Two out of every five parents, or 40%, believe the risk of measles for children in the US is higher than what it was one year ago. Another 45% say the risk is about the same, and 15% say the risk is lower.
A resurgence of whooping cough and measles over the last few years has triggered a national debate over vaccinations and garnered ongoing media coverage. On June 30th, California governor, Jerry Brown signed a bill to impose one of the nation's strictest vaccination laws following the outbreak linked to Disneyland in December 2014 that resulted in over 100 cases of measles. While California dealt with their measles problem, a surge in additional vaccine-preventable disease outbreaks occurred in other regions including New York, Ohio, Michigan, and Washington State.
Dr. Davis says, "Outbreaks of disease can safely be prevented through childhood vaccination, but there are deeply-held convictions about parents' autonomy and remaining concerns among some parents about vaccine safety.
"Media coverage of outbreaks over the past year, accompanied by messages about vaccines for whooping cough and measles, may be swaying parents' opinions toward stronger beliefs in the positive aspects of vaccines. The impact of such shifts in perception will ultimately be measured by whether more parents vaccinate their kids."
So the researchers here report that the views regarding vaccines among parents is shifting toward the positive and the make some guesses as to the reasons for the shift, including media coverage of outbreaks and media coverage on the benefits of vaccines.
Since we're guessing, I'll add my two cents. I think an important reason for the shift is because folks are speaking up. It's not just the mainstream media here. Those of us who care about evidence-based medicine — and I'm talking about pediatric providers and fellow parents — it's you and me sharing evidence and contributing to the conversation day in and day out. That in my mind is what's really making the difference.
You know the Internet started the anti-vaccine movement, back when Dr. Andrew Wakefield's study on measles and autism went viral. No pun intended. Of course, you all know the story. Conflicts of interest were found along with outrageously poor study methods and fraudulent data. The study was retracted by the other authors and the journal, and Dr. Wakefield lost his medical license over the fiasco, and subsequent studies have proved his hypothesis false.
But the damage was done, and the intervening years between 1998 and 2014, those years belong to the "anti-vac-sers. We physicians did our best to evaluate and share the evidence, but we made our arguments mostly in the examination room, not online or in digital forms of public opinion.
What about the parents? Well, plenty of parents — the vast majority of parents, in fact — during those intervening years, they found evidence more important than stories and they quietly vaccinated their children while avoiding debate because the argument didn't really affect them or their family, until it did start affecting them. Until immunized children started getting measles and whooping due to the breakdown in hurt immunity caused by those not vaccinating their kids.
Regular folks have had enough, and doctors have had enough too. Only now, in 2014 and 2015, we're a bit more savvy in the use of digital and social media. I really think that the young doctors, the ones who have grown up in the digital age, they made the biggest difference, leveraging digital and social media to promote the evidence and calm their fears. Forget the mainstream media in this. It's you and me including this audience, being that voice of reason day in and day out, together we are making a difference.
So let's keep that momentum going, not because it's easy, not because we enjoy claiming credit. Let's keep it going for the wellness and good health of our kids. They are why we strive to be heard. They are the reasons that matter.
The researchers behind this study have also created a YouTube video to help explain their findings. It's a trend I really like. I'll include a link to that video, so you can share it with others in the Show Notes for Episode 324 over at PediaCast.org.
Dr. Mike Patrick: Adolescents who saw advertising for medical marijuana were more likely to either report using marijuana or saying they plan to use marijuana in the future. This, according to a new RAND study.
Investigators studied more than 8,000 Southern California middle school students and found that youth who reported seeing any ads for medical marijuana were twice as likely as peers who reported never seeing an ad to have used marijuana or report higher intentions to use the drug in the future. The study was published online in the journal, Psychology of Addictive Behaviors.
Researchers say, the study — the first to explore a link between marijuana advertising and youth behavior — still cannot directly address whether seeing ads causes marijuana use. However, the study does raise questions about whether there is a need to revise prevention programming for youth as the availability, visibility and legalization surrounding marijuana changes.
Dr. Elizabeth D'Amico, lead author of the study and a senior behavioral scientist at RAND, which is a nonprofit research organization, says "As prohibitions on marijuana ease and sales of marijuana become more visible, it's important to think about how we need to change the way we talk to young people about the risks posed by the drug. The lessons we have learned from alcohol — a substance that is legal, but not necessarily safe — may provide guidance about approaches we need to take toward marijuana."
Over the past several years, medical marijuana has received increased attention in the media and use of the drug has increased across the United States, with the number of frequent marijuana users increasing by 40% since 2006.
Advertising for medical marijuana services has appeared on billboards, in newspapers and on television and many medical marijuana dispensaries have visible storefronts, as well.
RAND researchers analyzed information collected from 8,214 students enrolled in 6th, 7th and 8th grade who attended 16 Southern California middle schools during 2010 and 2011. The students were asked each year about exposure to medical marijuana advertising, marijuana use and their intentions about whether to use marijuana in the future.
During the first survey, 22% of the students reported seeing at least one advertisement for medical marijuana over the past three months and the rate jumped to 30% the following year.
Seeing advertisements for medical marijuana were related to middle school adolescents' intentions to use marijuana and their actual marijuana use one year later. Researchers say this is a particularly important thing given that the mean age of adolescents surveyed was 13 and initiation of marijuana use during early adolescence is associated with poor school performance, neuropsychological performance deficits and further use of other illicit drugs, such as heroin and cocaine.
Researchers say they could not determine whether adolescents who were predisposed to use marijuana paid more attention to marijuana advertising or whether the advertising may have influenced adolescents' attitudes toward the drug.
Dr. D'Amico says, "Given the advertising typically tells only one side of the story, prevention efforts must begin to better educate youth about how medical marijuana is used, while also emphasizing the negative effects that marijuana can have on the brain and performance."
The findings also emphasize the need for a policy discussion about whether regulations may be needed to limit advertising about marijuana for both medical and recreational use, such as the regulations in place that govern advertising of alcohol and tobacco.
So the take-home here for parents and providers, and I like how the researchers put it, just because something is legal doesn't make it healthy or even safe and advertising only tells one side of the story. As parents and providers, it's up to us to tell the other side of the story and we have to be just as loud and just as convincing as the billboards and the newspaper ads and the television coverage.
Synthetic marijuana, known as K2 or Spice, decreases the flow of oxygen to the heart in teenagers and can cause serious heart complications. This, according to research from Children's National Health System.
The study, recently published in The Journal of Pediatrics, says decreased oxygen levels to the heart can have serious consequences in youth, from shortness of breath and chest pain to the pediatric equivalent of a heart attack.
Synthetic marijuana refers to a wide variety of herbal mixtures that produces experiences similar to marijuana. The reported prevalence of K2 use ranges from 6.5% to 12.6% in adolescents in the United States and the United Kingdom. Its use is common in Washington, DC, which is served by the Children's National Health System.
While K2 has been known to cause serious cardiac effects, including causing sudden death in adults, the data regarding the cardiac impact in adolescence has been limited. The Children's National study adds new information about caring for pediatric patients who have used K2 and raises some cautionary red flags.
Dr. Charles Berul, study author, chief of Cardiology and co-director of the Children's National Heart Institute, says the study focused on a small group of teenagers over a two-year period who showed varying degrees of cardiac injury, based on laboratory evidence of myocardial ischemia — meaning decreased oxygen delivery to the heart — that may have gone unrecognized following the K2 usage. All the patients in the study were teenage boys with a variety of symptoms including chest pain, shortness of breath, and palpitations.
He says, "Synthetic marijuana is unacceptably readily available for purchase by children and puts them at risk of serious health issues including cardiac damage."
Dr. Bradley Clark, another of the study's authors and senior cardiology fellow at Children's National, adds "We found in our data evidence of impact on the heart, likely due to an imbalance of oxygen demand and delivery. The study demonstrates the need to increase awareness. While a patient may not complain of chest pain, there still may be cardiac injury. Without the typical cardiac symptoms, he may not receive the proper prompt medical evaluation."
Dr. Clarks says, "The decreased oxygen delivery to the heart, shown by elevated blood levels of troponins, signifies cellular damage to the heart. Adults with that same phenomenon — electrocardiogram changes and elevated blood levels of troponin — are labeled with heart attacks, but we don't use the same terminology in pediatric cases.
investigators report that more study is needed to determine a causal relationship between K2 use and the cardiovascular effects. They say, "The echocardiograms, when performed, were normal, but the long-term consequences of K2 usage and myocardial ischemia are unknown and require long-term, follow-up studies."
Dr. Clark adds, "Recently, K2 usage has received substantial media coverage. The regulation of K2 has increased, but it can still be purchased at local establishments by minors and may not be picked up on a drug screen. With the potential for cardiac injury, even minor injury, these individuals need to be monitored more closely and followed after the initial event because we don't know the long term effects on these patients."
So we've talked about synthetic marijuana, including K2 and Spice on this program before, making parents and providers aware of how easily it can be obtained, some of the symptoms they caused and the difficulty in screening for their use. More specifically, we talked about synthetic marijuana in considerable detail back in episode 206 of this program, and I'll put a link to it in the Show Notes for this particular episode, 324, over at PediaCast.org.
So now, we have evidence of synthetic marijuana possibly causing long-term heart injury in kids. So it's more important than ever that parents and providers talk to their kids about this stuff because you can bet, those who are supplying K2 and Spice, encouraging your teenagers to use it, I don't think they're providing full disclosure on short-term or long-term consequences. They're drug dealers after all, or at the very least, drug use encouragers and enablers.
The heart injury link was news to me, and it's probably news to you. Our job now, as moms and dads and medical providers, is to pass that information along to our kids. And for the docs in the crowd, if you're seeing a teenager after they've used synthetic marijuana, sounds like cardiac evaluation and even longer term cardiac follow-up is a good idea, at least based on the information we know at this time.
Dr. Mike Patrick: All right, we are back. I have one more story for you, and this one is particularly interesting, I think. Imagine how you'd smell a rose. You'd probably take a nice big sniff to breathe in the sweet floral scent, right? On the other hand, walking to a porta-potty at your favorite outdoor event, and you're likely to do just the opposite, abruptly limiting the flow of air through your nose.
Well, researchers at Weizmann Institute of Science in Israel had found that children with autism spectrum disorder don't make this natural adjustment. Instead, they go right on sniffing the same way no matter how pleasant or how awful the scent.
The findings, recently published in the Cell Press journal, Current Biology, suggest that non-verbal tests related to smell might serve as useful early indicators of autism.
Dr. Noam Sobel, one of the researchers involved with the project, says, "The difference in sniffing pattern between the typically developing child and the child with autism was simply overwhelming."
Earlier evidence had indicated that people with autism have impairments in "internal action models," the brain templates that we rely on to seamlessly coordinate our senses and actions. It wasn't clear, however, if this impairment would show up in a test of the sniff response.
To find out, Sobel and his colleagues presented 18 children with Autism Spectrum Disorder and 18 normally developing children (17 boys and 1 girl in each group) with pleasant and unpleasant odors to measure their sniff responses. The average age of the child in the study was seven years. While typical children adjusted their sniffing within 305 milliseconds of smelling an odor, the researchers report, children on the autism spectrum showed no such response.
That difference in sniff responses between the two groups of kids was enough to correctly classify them as children with or without a diagnosis of autism 81% of the time. Researchers also report that increasingly abnormal sniffing was associated with increasingly severe autism symptoms, based on social but not motor impairments.
The findings suggest that a sniff test might useful in the clinic, although the researchers admit their test is not quite ready for primetime, not yet anyway.
Dr. Sobel says, "We can identify autism and its severity with meaningful accuracy within less than ten minutes using a test that is completely non-verbal and entails no task to follow." This raises hope that these findings could form the basis for development of a diagnostic tool that could be used during early toddlerhood, which allow time for more effective intervention.
However, researchers still need to see if the abnormal sniff response pattern is specific to autism or whether it might also show up in children with other neurodevelopmental disorders. They also want to find out how early in life such a test could be used. But the most important follow-up question, at least in Dr. Sobel's mind, is whether an olfactory impairment is at the heart of the social impairment in autism.
So interesting stuff, could the future of autism screening include a sniff test? Maybe. Further research and more time will tell. And that's my final word.
I do want to thank all of you for taking time out of your day to make PediaCast a part of it. Really do appreciate that.
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That's a wrap for our show today, and until next time, this is Dr. Mike, saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.
Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.