Category: Uncategorized

By Dr. Anisha Abraham

It is June. Exam and graduation time for many students around the world. In the Netherlands, my adopted home country, it is also the month when one of my favorite Dutch traditions occurs: graduating high school students hang flags on their houses together with their school bags to celebrate passing their exams and moving on in life. It takes a global village to raise a child, and I love that this rite of passage is celebrated in such a public way. The bag-on-a-flag marks an important milestone for young people. When I pass a home in my neighbourhood with a raised flag, I silently honor the graduate and acknowledge the many hurdles that it has taken to get to this point. How do we uphold our kids as they transition from one milestone to another? What are the skills they need to cultivate in a rapidly, changing world?……(read more)

There’s no doubt about it – we live in an age where our children’s days (and nights!) are dominated by technology, and the level of their daily media “consumption” is justifiably a top concern for parents, teachers and pediatricians.

There’s no doubt that digital media has the potential to interfere with just about all that we, as parents, hold dear – our children’s safety, their schoolwork, exercise, reading, eating and sleeping habits.

But I thought I’d share some of what’s on the horizon when it comes to the upside of digital technology and your family’s well being. Having just returned from the Fourth Annual mHealth Summit – focused on the intersect of health and technology – I can assure you that there is, in fact, an upside.

I am more convinced than ever that if mobile or digital health isn’t yet on your radar, much less your smartphone, it should and soon will be. According to Mashable, there are now more than 40,000 health and fitness apps available. I’ve selected a few to share with you, including a couple that have even earned a place on my own smartphone.

• Text4baby: With nearly half a million subscribers, this free national text messaging campaign is for anyone who is expecting or in their first year of parenthood. To sign up, text “BABY” (“BEBE” if you want the Spanish version) to 511411. Enter your baby’s due date or birthday, and voila! You’ll receive three health-related text messages a week. I participated in the creation of the actual text messages, and I can attest to the fact that they contain the most important, credible information relevant to each stage of your pregnancy or baby’s first year.

• FitBit: FitBit takes the basic concept of a pedometer to a new (albeit more expensive) level. The “Zip” device measure steps, miles, calories burned, stairs climbed and more. FitBit has also created a scale and sleep monitor (purchased separately from the Zip). The program adds fun and motivating technology in the form of a mobile app, Bluetooth connectivity and a website where you can log daily accomplishments and challenge others. I considered myself fairly fit when my 11-year-old son and I committed to wearing our Zips, but the program seriously motivated us to step up our day-to-day exercise. Just check out some of my tweets over the past year and you’ll see that I was encouraged to walk to the grocery store, forego the train in the Atlanta airport and jump on the treadmill before bedtime – just to name a few!

• Zamzee: By using the “Zamzee meter” (a $29.95 accelerometer) and a kid-safe website for tweens and teens, this company’s goal is to get kids and families moving – one step, avatar, badge and goal at a time.

• Restaurant Nutrition App (by Unified Lifestyle): This free app may change the way you order and eat at restaurants. Despite being occasionally mocked by less tech- or health-conscious friends and family, I still make it a point to pull out my iPhone and use this app to assess the nutritional details for any of the 60,000+ restaurant meals it includes.
• Band-Aid Magic Vision: What happens when augmented reality is applied to a childhood staple? Hold up your iPhone to your child’s Band-Aid and watch Kermit the frog come to life and sing with this free app. My kids are long past the age in believing that Band-Aids heal all ailments, but my parenting and pediatric instincts tell me that this app is likely to have great appeal for tech-savvy parents and Band-Aid-loving preschoolers alike. Note: App only works with Muppets Band-Aids.

Originally posted on Omaha World Herald’s Live Well Nebraska

To get right to the point, I find that the problem with vaccines (or at least writing about them) is that more people are likely to read what I’m about to write if I imply there’s a problem with them then if I were to simply state that vaccines happen to be one of the single most life-saving accomplishments of the twentieth century – appropriately credited with literally transforming the landscape of medicine.

That’s not to say that a majority of the general public doesn’t take vaccines seriously. But in this day and age – when we all reap their benefits – we perhaps run the risk of taking vaccines a bit too much for granted. After all, most parents who choose to vaccinate their children (and in many instances, even the health care providers who routinely give these life-saving immunizations) have never had to witness the devastation that vaccine-preventable diseases can and still do cause.

As a pediatrician who trained in the 1990’s, I myself have never had to care for a child with measles, witness the devastation caused by polio infection, or even watch a child struggle to breathe due to a once-common infection now easily prevented by routine Hib vaccination. With all that said, the “out of sight, out of mind” principle makes it all the more compelling and worthwhile for me to take the time to reinforce some of the most important aspects of vaccines, while also addressing some of parents’ biggest questions and concerns.

Are vaccines safe? Just like any medication, vaccines do come with their own potential side effects – each of which is clearly written out and explained on the Vaccine Information Statements (VIS) you receive every time your child is due for a shot. What’s important to remember, however, is that the serious risks of the diseases themselves (also explained on the VIS sheet) outweigh the potential side effects, and that vaccines are held to the highest standard of safety. Approving a vaccine for use in the United States can take ten or more years of testing, and even once a vaccine is made available to the general public, it is closely monitored by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) for any adverse effects. While nothing in life is 100% effective or safe, vaccines are the very best thing we have to protect ourselves and our children from some pretty devastating diseases.

Do vaccines cause autism? While the concern that autism may in some way be caused by MMR vaccination was certainly more understandable back in the late 1990’s in the years immediately following the publication of Dr. Andrew Wakefield’s now infamous (and subsequently discredited and retracted) 1998 Lancet article, we now have evidence from several studies that simply don’t support the association between autism and vaccines. Not only that, but the Institute of Medicine’s thorough and rigorous scientific review reinforced that “the evidence favors rejection of a causal relationship between thimerosal containing vaccines and autism” – a finding that was reinforced by both the American Academy of Pediatrics and the CDC.

Should you space out your child’s vaccines? As much as I understand the temptation to space out vaccines, there’s simply no evidence to support doing it. At the same time, parents and pediatricians alike need to understand that the currently recommended vaccine schedule published by the CDC each year isn’t simply made up out of thin air, but rather represents the best knowledge, science and evidence we have about what is the most effective way to protect our children. In this day and age of modern and evidence-based medicine, deciding to space out vaccines simply because it sounds like a good idea is not only bad science, but potentially puts children at risk.

Where can I find out more, accurate information about vaccines? Let me just say that the operative word in the preceding question is the word “accurate.” Almost more than any other topic I can think of, the amount of misinformation about vaccines available on the internet is all but guaranteed to invoke doubt (if not fear) amongst parents trying to inform themselves about childhood immunizations. Instead of addressing the myriad of other vaccine questions and concerns that parents have, I will instead keep this blog from turning into a novel by simply recommending the following resources for good, useful, and evidence-based information that will hopefully help you better understand vaccines and better protect your children against vaccine-preventable diseases.

• The Centers for Disease Control Vaccines & Immunizations
• The Children’s Hospital of Philadelphia – Vaccine Education Center. A huge wealth of accurate, parent-friendly information on immunizations, the diseases they prevent, and how to separate fact from fear.
• The American Academy of Pediatrics has compiled an easy-to-access one-stop-shop for vaccine information.
• Clear Answers and Smart Advice About Your Baby’s Shots. Excerpted from Baby 411, authored by colleague and good friend Dr. Ari Brown, this Q&A will provide you very clear and concise answers to your vaccine questions.
• The recently released 2^nd edition of my book, Heading Home with Your Newborn: From Birth to Reality also has an entire chapter dedicated to the subject of vaccines.

Originally posted on Omaha World Herald’s Live Well Nebraska

Given that today is the day that the American Academy of Pediatrics releases its 2011 Policy Statement on Child Passenger Safety, it seems to me a particularly good time to not only review these important car seat recommendations, but also take a quick look back to share just how far we’ve come in our efforts to keep children safe in cars.

Let me start by saying that for as long as I remember, motor vehicle crashes have been, and continue to be the leading cause of death in children. A few years after completing my pediatric training, I was tasked with writing about child passenger safety and car seats for a nationwide public education campaign. Yet despite having only just completed my pediatric training a few years prior, this was not a subject in which I was well-versed. While this may sound surprising to you given the extent to which pediatricians today are responsible for educating parents on car seats, the fact of the matter was that in the late 1990‘s, the science of injury prevention and child passenger safety was only just taking hold. At that time, it still took some convincing to keep kids properly restrained in car seats up until the age of four, while the first U.S. booster seat law (which only required extra protection for children between 40 to 60 pounds) wouldn’t go into effect for several years in Washington State in 2002.

Fast forward less than ten years, and today just about every state in the country, as well as the District of Columbia all have some form of booster seat law in place. Over the same time period, what was initially a relatively small group of trained child passenger safety professionals (I believe there were only approximately 1000 formally certified Child Passenger Safety Technicians when I got my certification ten years ago) now numbers in the tens of thousands. Not only that, but we have far more data and insight into what keeps children of all ages safest when it comes to riding in motor vehicles. Fortunately, we also have many new and improved car seats that offer the features we need to do so.

I continue to be convinced that investing the time and effort in making sure your child is properly restrained each and every time he/she rides in a car is one of the single most important things you can do as a parent to insure your child’s safety. With that in mind, I thought I’d offer you the following quick summary and explanation of the AAP’s new car seat recommendations.

Rear-facing until the age of two.  That’s right, the age of two. Not almost one, not one, but two.  Now to be honest with you, this recommendation isn’t so much a change from what I (and other trained child passenger safety professionals) have been saying since the AAP’s last set of recommendations came out in 2002. For years now we have known that it is safest to keep children facing rear-facing as long as possible within the limits of their seat – a recommendation that for many children isn’t so different from saying up to the age of two.

However, in the past the recommendation also stated that children should ride rear-facing a minimum of at least one year and 20 pounds. Instead of taking this to mean a bare minimum, parents understandably focused on the part of the sentence that said one year and twenty pounds. Given that children between the ages of one and two are at five times less risk of death or serious injury when riding rear facing, the difference between emphasizing age one and age two (and making sure you have a car seat that has higher rear-facing height and weight limits) is potentially life-saving.

Forward-facing facts. After recommending that children be turned face-forward as late as possible, the new AAP Policy also adds much needed emphasis on the fact that using a forward-facing seat with 5-point harness straps is not only the safest option for newly forward-facing children, but for as long as possible until they reach the maximum height and/or weight limits for the harness straps. While there was a time when most forward-facing seats only allowed for harness strap use up to 40 pounds, there are now seats available with harness straps that accommodate children all the way up to 65 or even 80 pounds, making the switch to a belt-positioning booster seat unnecessary (and ill-advised) until far past forty pounds.

Booster Seats until age 12. Okay, technically the policy recommendation is for children to ride in booster seats up until they reach a height of 4 feet 9 inches, but the important emphasis here is that there has long been misleading emphasis on the age of 8, whereas the new policy says somewhere between the ages of 8 and 12 years. This perception problem is understandable, given that the ideal booster seat laws all reference the age of 8.

What you need to understand, however, is that only 1 out of 100 eight-year olds reach the right height to safely use a vehicle’s lap-shoulder belt without a booster seat. The average child doesn’t reach 4 foot 9 inches until somewhere between the age of 10 and 12. Foregoing a booster seat before the vehicle’s lap-shoulder belt fits them correctly puts children at significantly greater risk of severe injuries.

Big Kids in Back. I have long been asked by parents when they can allow their children to ride in the front passenger seat. The straightforward answer is now clearly stated as age 13. But I fear that just telling parents to have their pre-teens relegated to the back seat until age 13 doesn’t quite get across the importance of this recommendation – especially since it’s not likely to be received well by many pre-teens. The somewhat harsher but data-driven answer is “when you love them 40% to 70% less.” This attention-getting answer clearly gets across the fact until the age of 13, riding in the back seat significantly reduces the risk of injury (as well as the severity of injury) in both frontal and side-impact crashes.

With all that said, I am proud to report that literally hundreds of child passenger safety professionals from around the state of Nebraska will be attending tomorrow’s annual two-day conference which includes an update on the latest AAP recommendations. Our state is truly fortunate to have hundreds of dedicated technicians who are ready, willing, and able to serve as valuable and informed resources in helping insure safe travels for all of Nebraska’s children.

I also encourage all of you to visit the AAP’s website, HealthyChildren.org – not only to directly access the new 2011 Policy Report, but also to enter the Safe Ride Sweeps car-seat giveaway. Each day for the rest of the month of March, you can enter to win a Safety 1st car seat that can help you best follow the AAP’s latest safety recommendations, courtesy of Dorel (which, for full disclosure, is the car seat manufacturing company for whom I currently consult).

Originally posted on Omaha World Herald’s Live Well Nebraska