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The Great American Smokeout: Why We Need to Clear the Air…for Our Children’s Sake

I am pleased to note that November 18th is the 35th anniversary of the American Cancer Society’s Great American Smokeout. That said, I have to admit that the existence of this day also makes me a bit sad. Sad because people still smoke. Sad because even those who don’t – including children – are nevertheless at risk. And most of all, sad because smoking is both deadly and powerfully addictive.

The fact of the matter is that despite decades of clear messages about the risk of cigarette smoking, there’s still more than enough smoke to go around. So much so that the FDA has now decided to resort to more drastic, scare-tactic measures, since high taxes and an ever-present surgeon general’s warning that “Smoking causes lung cancer, heart disease, emphysema, and may complicate pregnancy” hasn’t sufficed. Soon, fully half of each entire cigarette pack will be required to show grim images of what smoking actually does to you, with images of diseased lungs, toe tags and body bags up for consideration.

As a pediatrician, of course, my focus is on helping insure that all babies are born healthy; that all children are raised in environments that are nurturing, healthy and safe; and whenever humanly possible, keeping kids from trying out risky behaviors for themselves. Unfortunately, smoking puts children in the direct line of fire on all three fronts.

While getting people to stop smoking (or not to start in the first place) can be admittedly challenging, it is my sincere hope that it’s possible. Whenever anyone is faced with having to change a habit or behavior because it’s “good for them” – whether it has to do with losing weight, exercising more, improving one’s diet, or quitting smoking – they first have to want to change. I hope that a closer look at some compelling dangers our children face from cigarette smoke will provide added motivation to help clear the air of cigarette smoke once and for all.

  • Babies are at risk, even before they are born. According to the March of Dimes, expectant mothers who smoke are at greater risk for pregnancy complications including bleeding, serious problems with the placenta, and even stillbirth. Babies born to mothers who smoke are at greater risk for being born prematurely, being low birthweight, having birth defects such as cleft lip/palate, and a whole list of other serious health problems.
  • Sudden Infant Death (SIDS). According to the American Academy of Pediatrics, maternal smoking during pregnancy has emerged as a major risk factor in almost every study of SIDS and several studies also suggest that smoke in an infant’s environment after birth poses an added risk.
  • Breathing problems and increased infections. The EPA estimates that as many as 300,000 children under 18 months of age get bronchitis or pneumonia resulting in thousands of hospitalizations each year just from exposure to secondhand smoke….and this is only the tip of the cigarette iceberg. Children who are exposed to cigarette smoke also get more ear infections, and breathing problems include everything from coughing, wheezing, bronchitis and pneumonia to an increased risk of developing asthma, or more frequent and severe asthma attacks for those kids who already have asthma.
  • Smoke lingers. Smoking in a different room or away from your child may lessen the exposure a bit, but not enough to protect them. No amount of exposure is safe. Even when cigarette smoke is delivered secondhand, the end result is still dangerous exposure.
  • Glorified images of cigarette smoking are influencing our children. Most parents are unaware of the fact that despite all the known dangers of smoking, a CDC report reveals that more than half of PG-13 movies in 2009 still contained images of tobacco use. While you may be understandably tempted to say “so what?” this statistic becomes far more frightening when partnered up with the CDC’s statement that “exposure to onscreen smoking in movies increases the probability that youths will start smoking.” In fact, there are pediatricians who consider images of smoking in movies “the single biggest media risk to young people.” Yet Hollywood still allows for paid placement of cigarettes in movies. For anyone still tempted to blow off the impact that smoking in the movies has on children, I suggest you find out more at Smoke Free Movies.
  • Teens are still being tempted. When it comes to protecting kids from the dangers of cigarette smoke, we’re up against some very powerful forces: The addictive nature of tobacco makes it very difficult to quit once someone starts, and the continued portrayal of cigarettes as sexy and powerful in everything from celebrity magazines to movies serves as a powerful lure for our children. It’s no wonder that an estimated 20 percent of high schoolers smoke, and 4000 US teens each day still opt to gain firsthand experience of cigarettes’ harmful effects by trying out smoking for the first time.

Like elsewhere around the country, the good news is that if you want to quit, there are people, organizations and resources right here in Nebraska that are ready, willing and able to help you – from a free confidential Nebraska Tobacco Quitline (800-784-8669) to online support at QuitNow.ne.gov.

Whether you decide to take the first step for yourself, or for your children, you can start by joining Tobacco Free Nebraska, the American Cancer Society and Nebraska’s Department of Health and Human Services’ efforts as part of Thursday’s Great American Smokeout.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Life-Saving Safe Sleep Tips for All Parents & Caregivers

Of all the topics I routinely discuss with parents, sleep has to rank right at the top of the list. This shouldn’t come as a big surprise, given that a good night’s sleep (or the lack thereof) can have a significant effect on just about everything else we do. When it comes to children’s overall health and well-being, it’s hard to sleep through all of the studies that reinforce that teenagers need more sleep (9 hours a night as compared to 8 for adults) in order to perform well at school, and that plenty of nighttime sleep (on the order of at least 10 hours a night) appears to be as important for keeping obesity at bay in young children as diet and exercise.

What I want to discuss today, however, isn’t just children’s need for an adequate amount of sleep, but the importance of safe sleep. While there are certainly aspects of safe sleep that apply to older children (bunk beds spring to mind), safe sleep has held a particularly prominent place in the national parenting consciousness every since the 1990s when the identified link between belly sleeping and Sudden Infant Death Syndrome (SIDS) led the American Academy of Pediatrics to recommend back sleeping in 1992. This was followed in 1995 with the official launch of the Back To Sleep Campaign.

While over a decade of subsequent parent education efforts have resulted in a dramatic increase in the number of back-sleeping babies (from 25% in 1992 to 85% in 2008), recent years have brought no additional increase in back sleeping. In fact, we may have started to backslide when it comes to insuring babies’ safety while sleeping. In the course of little over a single devastating month back in Feb/March of 2008, six babies died in Douglas County alone – all classified as SIDS attributed to bed sharing and suffocation.

While any increase in infant deaths is concerning, to say the least, the good news is that we know a great deal about what we need to do to keep babies safe while sleeping and reduce their risk of SIDS. The much larger task at hand is simply to make sure that all new and expectant parents and infant caregivers know the most effective ways to create safe sleep environments for babies.

This is the challenge being addressed in a new National Safe Sleep Education Campaign by the US Consumer Product Safety Commission, the American Academy of Pediatrics and Keeping Babies Safe. Their latest recommendations for providing a safe sleep for all babies include:

  • Place infants to sleep on their backs
  • Use a firm, tight-fitting mattress
  • Never use extra padding, blankets or pillows under baby
  • Remove pillows or thick comforters
  • Do not use positioning devices – they are not necessary and can be deadly
  • Regularly check cribs for loose, missing or broken parts or slats
  • Do not try to fix a broken crib
  • Place cribs or playpens away from windows and window covering cords to avoid fall and strangulation hazards
  • Place baby monitor cords away from cribs or playpens to avoid strangulation

These life-saving safe sleep tips can also be found in the campaign’s newly released 7 minute video, narrated by renowned journalist Joan Lunden and available for viewing or download on the AAP’s HealthyChildren.org and on the Keeping Babies Safe website. Additional information about safe sleep can also be found on in the newly revised 2nd Edition of my book, Heading Home With Your Newborn (AAP, Sept 2010), and on the Nebraska Department of Health & Human Services Website.

Originally posted on Omaha World Herald’s Live Well Nebraska

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Coughs, Kids & Vaccines: Why parents are the key to silencing the sounds of pertussis!

You really don’t have to listen very hard to hear the sounds of the season – the rustling of fall leaves, the weekend cheers of husker fans, and lawnmowers out for one last run before being swapped out for snow blowers. But if you ask me, the most noticeable sounds this time of year are all of the coughs, sniffles and sneezes that predictably make their annual show of force during cold and flu season. For parents and pediatricians alike, these are familiar sounds that we learn to live with and treat as needed. This year, however, we are hearing a lot more than usual about another sound – a sound for which we should all be listening carefully: the sound of pertussis.

Perhaps you’ve heard of pertussis – also commonly referred to as whooping cough – from your pediatrician. Some of you may remember reading about it each time you received the standard set of vaccine information sheets describing each of your child’s scheduled immunizations, since the DTaP (the “P” part referring to pertussis) vaccine is routinely given.

Chances are that if you’ve been following the national news lately, however, you may have also heard that there’s a pertussis outbreak in California. In the world of infectious diseases, let me assure you that California isn’t very far away from Nebraska, and this outbreak is not just another news story about an isolated incident hundreds of miles away. The spread of pertussis in California is, in fact, proving to be the worst outbreak in 60 years, having already claimed the lives of 10 infants under the age of 3 months. If that’s not a reason to stop and take notice, I don’t know what is.

The fact of the matter is that pertussis is caused by one of the most contagious bacteria we know. The infection can start out seeming like a common cold, but over the course of a couple of weeks manifests itself as an escalating cough which then turns into coughing episodes sometimes severe enough to result in vomiting or the characteristic “whoop” sound that represents the dramatic effort to draw air back into the lungs.

While adults typically experience weeks (if not months) of a cough that just won’t go away, they don’t often “whoop” like kids do. Neither do babies under 6 months of age – a fact that increases their risk of life-threatening illness or death at a time when they can’t yet be vaccinated (under 2 months) or haven’t developed full immunity (under 6 months of age). Unable to draw air back into their lungs, babies may gasp, gag, or simply stop breathing altogether – making them the most vulnerable at a time when they are also the most at risk.

As someone committed to helping insure the health and well-being of all children, I’ve therefore pulled together some very important facts about whooping cough, who is at risk, and what each of us can do to prevent the spread of pertussis in hopes that we protect all of Nebraska’s children and adults against a sound you never want to hear at any time of the year….the sound of a young child with pertussis.

Make sure your child is up to date on his/her shots. DTap is recommended at 2, 4, 6 and 15-18 months, and again at 4-6 years. The best time to get your child protected against pertussis is the first day your child becomes eligible for each recommended immunization.

Get your adult tetanus booster. Immunity to whooping cough doesn’t last forever. Any adult (or teen) who doesn’t remember getting a pertussis booster shot, or hasn’t had one since they were immunized as a child needs to get vaccinated. The fact of the matter is that babies too young to be protected by the vaccine rely solely on all of us to not expose them. Sadly, an estimated 3 out of every 4 babies with life-threatening pertussis infection got it from a loved one. Prevent this from happening by rolling up your own sleeves, getting an adult booster shot, and doing your part to limit the spread of pertussis.

Be on the lookout for pertussis and contact your doctor or your child’s pediatrician with any concerns. It’s all too easy to mistake pertussis for the common cold at the outset of the infection, and while people are contagious for up to a month, antibiotics are of little benefit after the first week or so. Half of babies with whooping cough end up needing to be hospitalized.

Listen to the sound of pertussis. If my blog hasn’t already convinced you, or you simply want more information, watch my recent pertussis-focused CNN interview with Kiran Chetry on American Morning, go to www.soundsofpertussis.com and let Jeff Gordon of NASCAR fame convince you, or simply listen to what a baby with pertussis sounds like .

Now let’s all commit to doing everything we possibly can to silence the sounds of pertussis.

Originally posted on Omaha World Herald’s Live Well Nebraska

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The Importance of Early Literacy: Why We Need to Commit to Closing Nebraska’s Reading Gap

I recently learned the results of Nebraska’s first statewide reading assessment. I must admit that the test itself didn’t actually catch my attention until I received my own children’s scores in the mail. As a long-standing early literacy advocate and someone who read literally tens of thousands of pages aloud to my children even before they could read for themselves, I am proud to report that all three scored very well.

Unfortunately, I find it difficult to celebrate my own children’s reading success in light of how the rest of our state’s children scored. Sure, results released in August revealed that nearly 70 percent of Nebraska’s third through eighth grade and 11th grade public school students scored in a range that met or exceeded expectations, but that 70 percent doesn’t tell the whole story.

Last Friday, Joe Dejka and Paul Goodsell shared the rest of the story with Omaha World Herald readers in their article, Reading gap called troubling. In it, they paint a much more dismal picture, simply by offering a more detailed look at the test results: Fewer than half of Nebraska’s Hispanic, black and American Indian students can read proficiently – a number that is in stark contrast to the three out of four white students taking the same test. When poverty was factored into the equation, low-income students also were found to have scored significantly lower than their more well-to-do classmates (on the order of 53 percent compared to 80 percent, respectively).

So why should you or I find the results of Nebraska’s first statewide reading assessment so distressing? In addition to the obvious racial, ethnic and socio-economic disparities, the fact of the matter is that the ability to read matters. A lot. Learning to read, learning to love to read, and the ability to read well all play a fundamentally key role in children’s future school and life success. In fact, it is often said that children spend the first several years learning to read, and the rest of their lives reading to learn. Yet Nebraska is not the only state with a reading gap, as an estimated 34% of American children enter kindergarten without even the basic language skills needed to learn to read, and fewer than half of parents read to their young children daily.

Now for the good news: we already know what works when it comes to preparing America’s youngest children to succeed in school, thanks in no small part to the efforts of Reach Out and Read. By partnering with doctors who prescribe developmentally-appropriate books, encourage families to read together beginning at birth, and advise parents about the importance of reading aloud – this national non-profit organization now offers us all an effective, evidence-based model that reaches nearly 4 million children each year, with a particular focus on those living in poverty.

As a pediatrician who had the good fortune to train with one of the founders of Reach Out and Read nearly two decades ago and has championed the cause ever since, I hope you’ll not only commit to helping your own children learn to love to read, but also commit to helping close Nebraska’s reading gap.

The following are a few simple but important Reach Out and Read tips to help get all children started on the path to lifelong learning and success:

  • Host a book-themed baby shower.
  • Make reading books to your child a part of your daily routine.
  • Make reading fun: hold your child on your lap when you read stories together, point to the pictures, let your toddler fill in the ends of your sentences, and be willing to read the same book (or page) over and over again.
  • Ask your two-year old questions about the story.
  • Relate what you read to your child’s own experiences.
  • Visit reachoutandread.org to find out more about the developmental milestones of early literacy, recommended book lists, and information about Reach Out and Read programs right here in Nebraska.
  • Consider supporting organizations such as Reach Out and Read and play a role in helping all children reach their full potential.           

Originally posted on Omaha World Herald’s Live Well Nebraska

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Katy Perry, Elmo & Sesame Street: An Important Discussion about the Sexualization of Girls

For anyone who may have missed the recent parenting news of the day, pop superstar Katy Perry recently taped a guest appearance on Sesame Street in which she was filmed running from Elmo in a short little low-cut dress and veil. Her yet-to-officially-air frolic with Elmo and friends quickly made its way to You-Tube, triggering a virtual firestorm of national media attention and the subsequent cancellation of the episode’s airing. The fundamental question being raised? Whether Perry’s revealing attire was inappropriate for children’s television.

After listening to one too many national commentators conclude that we’ve all become too prudish as parents and asking, “what’s the big deal?” I feel compelled to stop everything else I’m doing to help parents raise happy, healthy children and answer this admittedly rhetorical question. The fact of the matter is that while it may be superficially amusing to deem this “Cleavagegate” and laugh at the resulting Saturday Night Live skit of Perry donning a breast-emphasizing Elmo t-shirt, there’s something very, very fundamentally wrong about our culture’s acceptance of a scantily-clad 20-something year old female flaunting her highly sexualized assets on what is arguably America’s last bastion of wholesome children’s television.

While I’ve just outed myself as what some would call a prudish parent, I guarantee you I’m not alone in my beliefs. As parents, I strongly believe we need to avoid being lulled into complacency while our children are being steadily fed a media diet of increasingly sexualized images. While sexual well-being is an unquestionably important part of healthy development, a 2007 national report from the American Psychological Association’s Task Force on the Sexualization of Girls concluded that sexualization of girls and women is both pervasive and has wide-ranging negative effects.

So what’s a parent to do? First and foremost, don’t trivialize all of the messages our youngest girls are getting – all of which repeatedly and cumulatively teach them that what really matters is how “hot” they look. You can also take the following steps, adapted from the APA Task Force Report, to teach girls from a very young age to value themselves for who they are, rather than how they look.

  • Tune in and talk to your children. Pay attention to what they’re seeing on TV, in magazines and in the world around them. Discuss what they see in such a way that they learn that looks aren’t the most important quality.
  • Question choices. Don’t hesitate to discuss clothing choices with your daughters so they understand why too short, too revealing, and/or too tight just isn’t appropriate.
  • Speak up. Commit to noticing disturbing images and influences, and then speak up and discuss them with your children. Don’t be afraid to say no to your children, or to any products, campaigns or companies that send the wrong message(s).
  • Educate. Many parents simply aren’t comfortable talking about sexuality with their children, but it’s important. I suggest checking out So Sexy So Soon  and From Diapers to Dating to get yourself started.

While I wish that this was all there was to be said on the subject, the sexualization of girls will inevitably continue to be a force to be reckoned with. And it seems that Katy Perry and her wardrobe choices are here to stay – now reportedly being given a warm welcome by The Simpsons.

While that may be true, we simply don’t have to sit back and allow our children to watch! As parents, we really do have the power to raise our children with respect and a healthy body image, so long as we start by acknowledging that it really is a “big deal”!

Originally posted on Omaha World Herald’s Live Well Nebraska