PediaCast 160 * Meningitis Vaccine, Radon, Homeschool

Posted by Dr. Mike on April 27, 2011

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Do you have questions about The Toxic Substance Control Act, exam room chaperones, the meningitis vaccine, flame retardant chemicals, or radon? Listen as Dr. Mike talks about these topics and more, and discusses homeschooling with two special guests in the studio.

Topics

The Toxic Substance Control Act
Exam Room Chaperones
Meningitis Vaccine
Flame Retardent Chemicals
Radon
Homeschooling

Transcript

Announcer: Bandwidth for Pediacast is provided by Nationwide Children’s Hospital for every child, for every reason.

[Music]

Announcer: Welcome to Pediacast, a pediatric podcast for parents. And now, direct from Birdhouse Studios, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello, everyone and welcome to Pediacast. It is a pediatric podcast for moms and dad. And we are coming to you from the campus at Nationwide Children’s Hospital.

It’s Episode 160 for April 27th, 2011 and we’re calling this one "Meningitis Vaccine, Radon and Homeschool". Of course, those of you who are familiar with the program know we're going to cover lots more topics that just those three. We’ll give you the rundown here in just a couple of minutes.

First, I wanted to remind you about the “Miracles at Play” campaign that we have going on right now at Nationwide Children's. For more information on that, just go to miraclesatplay.org. The basic gist of it is this: we just want you to help us earn $100,000 for the hospital.

What is it exactly we’re going to do with the money. Well, it all goes to helping kids. So it helps us take care of kids. It helps with the research end in coming up with new therapies and treatments for children.

So it’s just a way that you can support Nationwide Children’s. It doesn’t cost you a thing, only a couple of minutes of your time. So, if you go to miraclesatplay.org, there’ll be a place there for you to sign up with your email address. And I can promise you that we don’t send your email address to anyone else. We don’t sell it and we don’t spam you. You just get information now and again on child health topics – good stuff.

02:13

So if you would please support the hospital here, just go to miraclesatplay.org. Couple of other ways that you can do this, if you go to our Facebook page or our Twitter page and if you like us on Facebook or follow us on Twitter, then that’s another way that money can be donated to the hospital.

Again, it doesn’t cost you anything. To make it really easy for you, if you just go to pediacast.org and go to the Show Notes for Episode 160, we’ll have links to miraclesatplay.org, our Facebook page at Nationwide Children’s and our Twitter page which is nationwidekids. Again, if you like us on Facebook, follow us on Twitter or sign up with your email at miraclesatplay.org, each time you do one of those three things, we get a dollar donated to the hospital.

So right there, you can help us earn three dollars by signing up for Miracles At Play, liking us on Facebook, following us on Twitter. I know it’s getting old, saying the same thing, but we’re trying to get to $100,000 and we’re not quite there yet. If you have done it, thank you. If you haven’t though, really it will take like three minutes of your time to sign up for all three of those.

OK, exciting times here at Nationwide Children’s and for Pediacast. Our studio space is complete. So, we are actively scheduling interviews. I know I’ve been hinting at those for quite some time now. But we have the first one today.

We have a little bit of an atypical start for you. Instead of having a pediatric specialist or a parenting expert as the first guest in the brand new studio, I thought it would be appropriate to invite children into the studio for our very first interview. So later on the show, we’ll have a chat with a couple of school-aged kids on the topic of homeschooling to get their impressions on what it’s been like, what they like about it, what they don’t like, and generally how it’s going.

04:11

So that’s coming up, if you’re interested in homeschooling and getting the low-down from a kid’s perspective. We’ll have that in our interview segment coming up a little while later.
But first, we’re going to be talking about toxic substance – actually, The Toxic Substance Control Act. It’s not been updated since 1976 and the American Academy of Pediatrics has so much wise words to say about that.

Exam room chaperons, doctors plus teenagers in the exam room, should they be alone? We’re going to discuss that.

Also, the meningitis vaccine, the FDA has lowered the age of approval. So we’re going to talk about who should get the meningitis vaccine and when.

Also, flame retardant chemicals, they’re actually showing up in our children’s blood. Is it a bad thing and, you know, what’s the alternative? So we’re going to discuss that.

We had a listener call in and asked a great question about radon. So we’re going to tackle that topic.

Also, calling kids by their names and an infant who is not crawling.

And then, we’ll wrap things up with my interview with a couple of homeschooling kids from the new studio here on the campus of Nationwide Children’s.

Don’t forget, if there’s a topic you would like us to discuss or o you have a question for us, it’s really easy to get a hold of me. Just go to pediacast.org and click on the Contact link. You can also email pediacast@gmail.com or call the voiceline at 347-404-KIDS. That’s 347-404-5437.

I want to remind you that 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, call your doctor and arrange a face-to-face interview and hands-on physical examination. The show should never be a substitute for doing that.

06:05

Also, your use of this audio program is subject to the Pediacast Terms of Use Agreement, which you can find at pediacast.org.

And with all that in mind, we will be back with News Parents Can Use right after this break.

[Music]

Dr. Mike Patrick: Our News Parents Can Use is brought to you on conjunction with news partner Medical News Today, the largest independent health and medical news website. You can visit them online at medicalnewstoday.com.

The American Academy of Pediatrics is calling for an overhaul of the nation’s chemical management policy. Why? Because they believe the current system fails to protect women and pregnant women who just happen to be the two populations most vulnerable to hazardous chemical exposure.

Over the past few decades, tens of thousands of new chemicals had been introduced into the environment, often in extremely large quantities. But the primary federal law that governs chemical management in the US, the Toxic Substances Control Act has not undergone any meaningful revisions since it was first passed in 1976. And since that time, the Act has only been used to regulate five new chemicals.

In a new policy statement, "Chemical-Management Policy Prioritizing Children’s Health" published in the upcoming May 2011 issue of the Journal of Pediatrics, the AAP recommends that chemical management policy be substantially revised to consider the consequences on children and their families.

So what changes should the US government consider? Well, the policy statement goes on to make these specific recommendations: the regulation of chemicals must be based on evidence but decisions to ban chemicals should be based on reasonable levels of concern rather demonstrated harm. That makes sense. I mean, do you want to wait until there's actual harm done? If you have reasonable level of concern, maybe you should act before the harm is seen.

08:24

Any testing of chemicals should include the impact on women and children including potential effects on reproduction and development. Chemicals should meet safety standards similar to those met by pharmaceuticals or pesticide residues on food. There should be post-marketing surveillance of chemicals and EPA must have the authority to remove a chemical if needed. Federal funding should be provided for research to prevent, identify and evaluate the effect of chemicals on children's health.

Other groups including the American Medical Association, the American Public Health Association and the American Nurses Association had all independently recommended changes to the Toxic Substances Control Act.

So, this is a point long overdue and well taken. The FDA has a strong track record of protecting children from dangerous pharmaceuticals but the EPA has dropped the ball in offering similar protections for hazards in the everyday environment of children and not-yet-born babies. But you can make a difference. So please consider contacting your representatives and senators and urging them to support needed reform to the Toxic Substances Control Act.

And we'll have some resources for you in the Show Notes at pediacast.org. I have a link to the original 1976 EPA Toxic Substance Control Act, the scanned version. There were no PDFs back then. So this is a copy of the original Act. Kind of cool, just for nostalgia sake. If you want to see what types that looks like from an old typewriter, you can check that link out. It actually is a PDF but it's a scan of this original document.

10:01

There's also a link to the American Academy of Pediatrics' policy statement, "Chemical- Management Policy Prioritizing Children's Health". That does contain the full text of the group's recommended changes. And then, I put links to both the US House of Representatives and the US Senate where you can easily look up your congressman or senator and contact them regarding this issue.

OK, moving on from government advocacy to chaperons in the examination room – not the smoothest transition, I realize, but that's all I have for you today, folks. The use of chaperon during a physical examination of a pediatric patient should be a shared decision between the patient and the pediatrician.

In the revised American Academy of Pediatrics policy statement, use of chaperons during the physical examination of the pediatric patient – which is also in the May 2011 issue of the Journal of Pediatrics – they looked at issues of patient comfort, privacy and confidentiality. If the patient is old enough to understand, the purpose and content of the examination, it should be communicated clearly to the patient and parent in advance. If any part of the exam is physically or psychologically uncomfortable, every effort should be made to alleviate the discomfort, which may include using gowns or drapes to protect privacy.

A chaperon is recommended during female breast exam, genital exams, or anal rectal exams and should be preferably a nurse or medical assistant, not a friend or family member. However, offices are not required to have a chaperon. In certain situations, a chaperon may not be present because of a patient's choice or a chaperon from the office is not available.

Pediatricians should develop their own office policy on the use of chaperons in the office. And, they should document it in the patient's medical record if and why they are unable to follow their office policy.

This is two-way protection folks. I understand that the main goal here is the patient's comfort and well-being. And these are very, very important. But there are also cases of fraudulent abuse allegations against practitioner, so medical chaperons in the room during these sensitive examinations, especially of teenagers, is important.

12:15

So parents and teenagers, expect them. And providers, you should develop a written office policy regarding the use of chaperons and then, stick with that policy. And if you're going to deviate from your office policy, then document why in the medical record.

Bacterial meningitis is a very serious and spreadable disease, especially amongst babies and toddlers. In an effort to combat this ailment, the Food and Drug Administration has approved the first vaccine to prevent a particularly severe form of bacterial meningitis in children under one year of age.

Menactra which is an immunization used for a long time in children above the age of two has now been approved for use in children as young as nine months. Meningitis occurs when bacteria from an upper respiratory infection enters the blood stream and it is highly contagious. Even though rates of meningitis are low in the United States, infants and toddlers are particularly vulnerable.

Menectra was originally approved six years ago for use in individuals ages 11 and up, and was approved three years ago for children as young as two. The form of meningitis in question is caused by a bacteria called meningococcus and it can develop in just a few hours or a few days. Even with proper care, the FDA says up to 15% of people who develop bacterial meningitis would die from the infection and another 25% will suffer complications such as permanent brain damage or hearing loss.

The classic symptoms of meningitis, high fever, headache and stiff neck may be difficult to detect and can be absent in really small children. According to the Centers for Disease Control and Prevention, infants with meningitis may appear slow or inactive, have vomiting, be irritable, or feed poorly. They may also suffer seizures.

Dr. Karen Midthun, director of the FDA Center for Biologics, Evaluation and Research said the highest rate of meningococcal disease occurs in children under one year of age. With today's approval, Menactra can now be used in children as young as nine months of age to help prevent this potentially life-threatening disease.

14:15

So here's an and coming way to protect your young child from these particular form of bacterial meningitis. Now, why do I say up and coming? Well, the FDA has approved Menactra down the age nine months but the American Academy of Pediatrics and the Centers for Disease Control have not issued recommendations for routine use of this vaccine in babies. So many physicians will be leery of adding this to the already crowded infant immunization schedule until official recommendations come down from the American Academy of Pediatrics and the CDC. Plus, without these organizational stamps of approval, many third party insurers will be reluctant will be reluctant to pay for Menactra that's given to babies.

So there's more information that come with this as experts at the AAP and CDC examine the issue of baby Menactra. And if and when the official word comes down to add this routinely to the immunization schedule, Pediacast listeners will be among the first to know.

I also want to point out very quickly, if you do look at the CDC guidelines for Menactra, it does mention that younger children… No, can be considered for younger children if they are particularly high-risk for developing meningitis and particularly, those kids who have suppressed immune systems or don't have a functioning spleen, that sort of thing.

So, you know, even though we say, "Well, it's not recommended under the age of two." Yeah, there may be some instances where some doctors now will start to use it even without official word from the American Academy of Pediatrics adding it to the immunization schedule. We're just saying, the FDA is saying it's approved. From their point of view, it's approved for down to nine months.

And so, if you’re going to be going in for your ninth month well checkup or your 12th month well checkup, you might want to bring it up. Say, "Hey, I heard the FDA the baby meningitis shot, are you giving it yet? And if not, when? And why? And who you're waiting to hear from?" And all those things. So, all these things are definitely coming into play.

16:16

All right, moving on, blood levels of polybrominated diphenyl ethers, otherwise know as PBDEs among Mexican-American children living in California are considerably higher than in Mexican children who live across the border, in Mexico. This was recently revealed in the journal "Environmental Health Perspectives" by researchers from the Center for Environmental Research in Children's Health at the University of California-Berkeley. As background information, the authors explained the PBDEs, which are used as flame retardants in a wide variety of products, including upholstered furniture, child car seats, crib mattresses and carpet pads, these chemicals have been found to be higher among kids living in California than in other parts of the United States and in Mexico.

The research team set out to determine what impact immigrating from Mexico to California had on Mexican children's blood level of PBDEs. They compared PBDE concentrations among 264 first generation Mexican-American children aged seven years with 283 children aged five years who were raised in Mexico from birth and still live in Mexico.

Researchers found that PBDE serum concentrations among the Californian Mexican-American kids were three times higher that their mother's level when they were pregnant. PBDE serum concentration among the California Mexican-American kids were seven times higher than kids born, raised and still living in Mexico. Such factors as how long the pregnant woman had lived in California, whether the child was breastfed, or how long the child was breastfed had no impact on the results.

18:00

The experts believe that post-natal exposure is what determines these children's PBDE serum concentrations. In their abstract in "Environmental Health Perspectives", the authors conclude Latino children living in California have much higher polybrominated diphenyl ethers serum levels than their Mexican counterparts. Giving the growing evidence documenting potential health effects of PBDE exposure, the levels in young children noted in the study potentially present a major public health challenge, especially in California.

In addition, as PBDEs are being phased out and replaced by other flame retardants, the health consequences of these chemical replacements should be investigated and waived against their purported fire safety benefits. Polybrominated diphenyl ethers are organobromine compounds. Humans use them as flame retardants.

[Laughter]

Dr. Mike Patrick: I like how the story puts it, "Humans use them as…" You know, like animals aren't using them. I'm sorry. Humans use them as flame retardants in a wide range of products, including airplanes, automobiles, building materials, electronics, furniture, plastics, polyurethane foams and textiles. Health hazards associated with PBDE have attracted recent attention as links have been shown to reduce fertility in humans, as well as thyroid problems.

So, this really boils down to another risk-benefit analysis, folks. I mean, this is something we talk about often on Pediacast. Is the risk of health problems from PBDE exposure worth the benefit that the chemical provides? And, how many kids truly have health issues related to PBDE exposure? Not just what theoretically what could those chemicals do but what health problems do kids truly have. What's the rate of thyroid problems and infertility when kids grow up from exposure to these flame retardants chemicals? What do these health issues really look like?

20:00

And, what health issues are associated with other flame retardants? So, if you're going to take the PBDE out and use something as a flame retardant, what health effects could that have? Do we make our children more healthy or less healthy if we use the alternatives? And, how many children would have had serious complications or died from burns if flame retardant materials weren't used at all? How many burn complications and deaths were seen in the kids living in Mexico compared to the Mexican-Californian children?

These are all questions I think we have to ask. And they are questions which do not currently have concrete answers. But this study is a great first step in looking into these issues and determining if we should take a different approach to flame retardants and burn prevention.

All right, that wraps our News Parents Can Use. We will be back. We're going to answer your questions right after this.

[Music]

Dr. Mike Patrick: OK, first up in our Listener Segment is Jessica. Jessica said, "Hi, Dr. Mike. I have listened to your shows since my son was born almost three years ago."

And we're like old friends, Jessica. Thanks for sticking around with us. And we do have lots of listeners out there who've been with us since we started the show five years ago. And I just want to… Just a special shoutout to the original crew out there who's still sticking with us. We really appreciate your loyalty to the program.

OK, Jessica goes on to say, "I'm so excited you're back on the air, back in Ohio, and part of Nationwide Children's. What an exciting opportunity for you and your family."

"I have a question for you. My husband and I are looking to finishing off our basement and just had a radon test done. Our results were 12.4 picocuries per liter and the recommended level is less than four. I work from home and my son who is almost three, and I also have a nine month old girl in the house. This finding makes me nervous that my children had been exposed to this on a daily basis. Even though we have spent most of our time on the main level, I feel the radon level on the main level must be high as well."

22:28

Is there any research done on this and how this could affect their growing bodies? We have lived in the home for two years. Obviously, we're going to take action on this and get it fixed as soon as possible. But we'd still like to understand how radon affects young developing bodies. Thank you for any information you can provide. Sincerely, Jessica."

Well, thanks for the question, Jessica. So radon, particularly those of you who live in locations where you have basements, I'm sure it's something that you've heard about, thought about – really kind of been in the news recently. Less so in places like Florida, you know, where there are no basements for the most part. Radon can still be an issue even in houses built on a slab foundation, so you don't have to have a basement to have radon problems. But, you certainly hear about it more in locations where you have basements.

So, what exactly is radon. Well, it's a radioactive, colorless, odorless, tasteless gas. So in other words, it's the gas that you're not going to be aware of in any way and it's radioactive. Isn't that lovely? It occurs naturally as a decay product of uranium.

So how does a gas, decaying from uranium, that's radioactive, end up in your house? Well, uranium as it turns out is an element found abundantly in the earth's crust. So there's lots of it, down in the ground, under your house, surrounding your basement. Beneath the slab floor of your house, there is uranium there.

Now, it may not be the kind of uranium that they're going to be able to ore and to purify for nuclear power plants or to make nuclear bombs, but it is uranium. And it's underground, and in the rocks and around your homes, everywhere around the earth's crust. So, uranium is there and it’s decaying and it’s turning into radon, which is the radioactive gas. If there's an abundance of uranium in the ground, it follows, there's going to be lots of radon gas being produced.

24:33

So then, how does that radon gas get into your house? Well, it seeps into cracks in the concrete slabs, cracks in concrete block wall, through construction joints, gaps around service pipes, cavities inside the wall and even through the water supply. So, it gets in pretty easily.

Now, radon is a dense gas . In fact, it’s one of the densest of all gases. So once it gets inside, it tends to settle in the lowest level of your house, because it's heavier than the surrounding air. And, it will be in the highest concentration where you have enclosed spaces with poor air circulation. This is why radon is measured in basements, if you have one, because that's where the highest concentration is likely to be found.

So, how do we measure the amount of radon gas that gets into your home? Well, the radon gas itself is not the issue. It's the amount of radiation exposure that the radon is causing. So that's really what we measure, radioactivity levels. The unit of measurement that you talked about, Jessica – picocuries – that's a measurement of radiation in your home.

The unit is named after Madam Marie Curie who discovered the first radioactive element, which was radium. And her story is actually quite interesting. It's sort of beyond the scope of our discussion here. But if you'd like to know more about her and the discovery of radium, I have put a link for you in the Show Notes that goes to a page at the American Institute of Physics and they have a whole biography of Madame Curie.

26:07

It's interesting. You probably heard that name before. If you've never checked it out, please do. It's interesting. I don't know, I'm kind of a history buff, so I like that sort of thing, anyway. Some of you may be in the same boat.

OK, so we've established that radon can get in homes, particularly in basements, and we can measure the amount of radiation that it's producing. So the next question becomes how is radon dangerous to your health? How much is too much and how do you get rid of it?

Well, radon is dangerous to kids and adults alike. Now, exposure in kids is a little more concerning because they have a longer lifetime for the exposure to continue and eventually cause a problem. Like any other form of radiation, the primary health issue is cancer and in particular, lung cancer, because your breathing this heavy gas into your lungs and it's dense and it tends to congregate in the depths of your lungs and stay there. So, it's not displaced by air very easily since it's so heavy. And then, the radiation from that gas can have its effect deep down in the lung.

Now, in simple terms, radiation damages the DNA that's in your cells and that leads to the formation of cancer-causing cells. So lung cancer is our biggest concern in both kids and adults.

So the next question becomes how much is too much? This is a little bit hard to figure out with traditional scientific studies. Because you don't want to do a prospective study where you intentionally expose people to various levels of radioactive gas and then, follow them along and see how many of them have lung cancer and how many of them die from their lung cancer. That would not really be a popular research study, right?

So you basically have to look at people with lung cancer. Try to find out what kind of environments they were around, go to where they live, check out the radon level and really do more a retrospective-type study. So the government has done that and looked into it. And so, the EPA has some guidelines on how much is too much.

28:16

Now, if you're a smoker, the combined effect of radon and smoking is very dangerous. And if you're a non-smoker, the risk of radon causing lung cancer is reduced compared to if you're a smoker but it's not eliminated.
So let's talk numbers. Jessica, you said your basement has a radon radiation level of 12.4 picocuries per liter.

According to the EPA, they don't actually have some numbers for us at the level of 12. So we're going to look at the level of 10. So it's a little bit below your level of 12.4, Jessica. But at the level of 10, if your radon radiation is 10 and you were to expose a thousand smokers to this level of 10 over the course of their lifetime – so it's in their house. It's not constant but they're exposed to it a great deal and you did that over the course of your lifetime – about 150 of those thousand would get lung cancer. To put that in perspective, that's about 200 times the risk of dying in a house fire.

Now, let’s look at non-smokers, if you took a thousand of them, and again you expose them to a level of 10 over the course of their lifetime, instead of 150 , about 18 out of that thousand would get lung cancer. And that's about 20 times the risk of dying in a house fire.

So to me, it's a pretty high risk. Now, how do you reduce the level and reduce the risk. Well, the answer is with a radon mitigation system. And this is simply a system that improves air circulation in the lower levels of your home. Since radon is a dense gas, if you blow out air from the lower levels of your home to the outside, then that's going to be replaced with air from the upper levels of your house which has less radon, less radioactivity, less risk.

30:07

Notice I say, less radon, not no radon. So it's often unrealistic to expect to be able to achieve a radon radiation level of zero. But we do want to get it down to a more reasonable risk by blowing air out of the lower level of the house to the outside. So that then, the upper air with less radon in it replaces that lower air. And that's what the radon mitigation system does.

The EPA says a level of 2 or less is best. But they also recognize that this is not always possible. And often, it's not possible. So they use 4 as sort of a cut-off recommendation even though they would prefer levels more around 2. But really at 4, there's still risks.

So what is the risk at the level of 4 and what are the risk at the level of 2, just to give us some comparisons? Well, let's look at those 1,000 smokers again. If you have a level of 4 in your house, in the basement, of those thousand smokers, about 62 of them would get lung cancer which is five times the risk of dying in a car crash during the course of your lifetime. If you have a level of 2, then 32 of those thousand smokers would get lung cancer, which is six times the risk of dying from a poison ingestion.

Hey, these are the EPA comparisons, by the way, not mine. So I take no credit and no responsibility for these comparisons.

OK, let's look at the non-smokers now. So take a thousand non-smokers, expose them to a level of 4 and you can expect about 7 of them to get lung cancer. But that's about the same risk as dying in a car crash during your life. And at level of two, you would expect about four of those thousand non-smokers to get lung cancer from a radon level as low as two. That's about the same risk as a dying during your life from poison.

So a couple of unsettling observations, in my opinion: first, you aren't going to get the radon risk down to zero. And that's life, folks. I mean, it's unsettling but it's true. We all have to live with that. Well, you know, you could build a tree house and live in the tree house. But then, you got other problems. A big wind can come along and your house falls and you die that way. I am being silly here. I mean, there are ways to make it zero. But if you want a house on the ground, you'll probably not going to get it to be zero. It's one of the risks of living in a house.