So Many Decisions - Vaccines and Your Child

Your head spins with the number of decisions associated with becoming a parent that never entered your mind before this eventful time. Decisions range from choosing your baby's name, choosing healthcare, choosing childcare, choosing diaper type to choosing the pattern on your baby's sheets. So many decisions!  While I can't help you with the decision to decorate the walls with sailboats or safari animals, I can assist you with education about vaccine safety.

I spent the late 1990's and early 2000's counseling appropriately concerned parents about vaccines as a result of the inaccurate study which was published in 1998 in the Lancet medical journal. This study, conducted by Dr. Wakefield, suggested that the Measles-Mumps-Rubella (MMR) vaccination was related to the development of autism.
By the start of 2010, I observed that new parents were not as familiar with this horrendous study which had parents' head spinning at the start of the 21st century. Recent events suggest that a review of the history of the source of the inaccurate connection between the MMR and autism would be beneficial.
The article below is a wonderful summary of events at the time of the study which will aid your understanding of the issue.
At the end of the study, I have added a link to a site with FAQ's about vaccines and your child.
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The MMR VACCINE and AUTISM: SENSATION, REFUTATION, RETRACTION, and FRAUD
T. S. Sathyanarayana Rao and Chittaranjan Andrade1
In 1998, Andrew Wakefield and 12 of his colleagues[1] published a case series in the Lancet, which suggested that the measles, mumps, and rubella (MMR) vaccine may predispose to behavioral regression and pervasive developmental disorder in children. Despite the small sample size (n=12), the uncontrolled design, and the speculative nature of the conclusions, the paper received wide publicity, and MMR vaccination rates began to drop because parents were concerned about the risk of autism after vaccination.[2]
Almost immediately afterward, epidemiological studies were conducted and published, refuting the posited link between MMR vaccination and autism.[3,4] The logic that the MMR vaccine may trigger autism was also questioned because a temporal link between the two is almost predestined: both events, by design (MMR vaccine) or definition (autism), occur in early childhood.
The next episode in the saga was a short retraction of the interpretation of the original data by 10 of the 12 co-authors of the paper. According to the retraction, “no causal link was established between MMR vaccine and autism as the data were insufficient”.[5] This was accompanied by an admission by the Lancet that Wakefield et al.[1] had failed to disclose financial interests (e.g., Wakefield had been funded by lawyers who had been engaged by parents in lawsuits against vaccine-producing companies). However, the Lancet exonerated Wakefield and his colleagues from charges of ethical violations and scientific misconduct.[6]
The Lancet completely retracted the Wakefield et al.[1] paper in February 2010, admitting that several elements in the paper were incorrect, contrary to the findings of the earlier investigation.[7] Wakefield et al.[1] were held guilty of ethical violations (they had conducted invasive investigations on the children without obtaining the necessary ethical clearances) and scientific misrepresentation (they reported that their sampling was consecutive when, in fact, it was selective). This retraction was published as a small, anonymous paragraph in the journal, on behalf of the editors.[8]
The final episode in the saga is the revelation that Wakefield et al.[1] were guilty of deliberate fraud (they picked and chose data that suited their case; they falsified facts).[9] The British Medical Journal has published a series of articles on the exposure of the fraud, which appears to have taken place for financial gain.[10–13] It is a matter of concern that the exposé was a result of journalistic investigation, rather than academic vigilance followed by the institution of corrective measures. Readers may be interested to learn that the journalist on the Wakefield case, Brian Deer, had earlier reported on the false implication of thiomersal (in vaccines) in the etiology of autism.[14] However, Deer had not played an investigative role in that report.[14]
The systematic failures which permitted the Wakefield fraud were discussed by Opel et al.[15]
IMPLICATIONS
Scientists and organizations across the world spent a great deal of time and money refuting the results of a minor paper in the Lancet and exposing the scientific fraud that formed the basis of the paper. Appallingly, parents across the world did not vaccinate their children out of fear of the risk of autism, thereby exposing their children to the risks of disease and the well-documented complications related thereto. Measles outbreaks in the UK in 2008 and 2009 as well as pockets of measles in the USA and Canada were attributed to the nonvaccination of children.[7] The Wakefield fraud is likely to go down as one of the most serious frauds in medical history.[9]
Scientists who publish their research have an ethical responsibility to ensure the highest standards of research design, data collection, data analysis, data reporting, and interpretation of findings; there can be no compromises because any error, any deceit, can result in harm to patients as well harm to the cause of science, as the Wakefield saga so aptly reveals. We sincerely hope that researchers will keep this ethical responsibility in mind when they submit their manuscripts to the Indian Journal of Psychiatry.
Indian J Psychiatry. 2011 Apr-Jun; 53(2): 95–96
VACCINE AWARENESS LINK
http://www.texaschildrens.org/…/cen…/vaccine-facts-and-myths

New Safe Sleep Guidance

Adorning the nursery with crib bedding in pretty patterns and snuggling together on a sofa for a Sunday afternoon nap sound dreamy, however, both events can and have led to your worst nightmare as a parent, SIDS. New SAFE SLEEP GUIDANCE includes having your baby sleep in your room but in their crib for the first year. Since the 1994 recommendation to put babies "back to sleep", the SIDS rate has had a notable decline. Still 3500 infants die annually due to SIDS. Studies suggest that following the additional recommendations below may lessen the number further. Please remember to follow these recommendations for EACH and EVERY SLEEP even ones on sleepy Sunday afternoons.

Updated safe sleep guidance warns against using soft bedding, sofa sleeping
By Alyson Sulaski Wyckoff, Associate Editor

Most pediatricians know what makes a safe sleep environment for babies. But parents still are attracted to elaborate bedding and plush accessories — all the accoutrements experts say have no place in an infant’s crib.

That’s one reason new AAP safe sleep guidelines released today include basic recommendations from the past plus new warnings about increased risk of sudden infant death syndrome (SIDS) from use of soft bedding and the dangers of babies sleeping on couches and armchairs.

Nineteen evidence-based recommendations (see below) aimed at protecting infants up to 1 year of age are featured in SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment, an AAP policy statement and technical report from the Task Force on Sudden Infant Death Syndrome. They are available at http://dx.doi.org/10.1542/peds.2016-2938 and http://dx.doi.org/10.1542/peds.2016-2940and will be published in the November issue of Pediatrics.

The guidance, updated from 2011, considers data from 63 new studies as well as a recent AAP clinical report on the benefits of skin-to-skin care for newborns (http://bit.ly/2cKSXck).

Safe sleep recommendations include placing infants on their backs to sleep; using a firm sleep surface; room sharing without bed sharing; avoiding exposure to smoke, alcohol and illicit drugs; breastfeeding; routine immunization; and using a pacifier.

SIDS facts

Every year, about 3,500 infants die from sleep-related deaths. Soon after the Back to Sleep campaign debuted in 1994, the SIDS rate declined, but it has leveled off in recent years. Ninety percent of cases occur before an infant turns 6 months of age, with peak incidence between 1 and 4 months.

Most parents know the importance of placing babies on their backs to sleep; the focus now is on the total sleep environment.

“I think the back-to-sleep message has gotten out loud and clear,” said Rachel Y. Moon, M.D., FAAP, lead author of the statements and chair of the task force. “When you ask parents, almost every parent knows — whether they are doing it or not is a different thing. We have been less successful at getting people to not sleep with their babies … and much less successful in getting the soft bedding away from babies.”

Dangers not intuitive?

Unfortunately, there is a sense that bed-sharing and soft bedding are protective, Dr. Moon said.

“For the soft bedding, everybody thinks if it’s soft, then it can’t hurt the baby. But soft bedding is actually really a problem because it’s so soft they sink into it. People will often use pillows to ‘cushion’ the babies, and babies sink into them. …That’s very dangerous.”

It’s similar with bed-sharing, she said. “Some parents also think if baby is right next to them, they can tell if there is a problem … and protect the baby.”

Other messages

Michael H. Goldstein, M.D., FAAP, a neonatologist and task force member, reminds parents of the “ABCs”: A for the baby sleeping alone, B for back-sleeping and C for sleeping in an uncluttered crib (or play-yard or bassinet).

“Outside of these, one of the biggest things I would really like to see people take away from the updated recommendations is that no matter what, babies should never sleep on a couch, especially with another person,” Dr. Goldstein said. Babies can get wedged between the adult and the cushions.

The policy also warns of the dangers of parents falling asleep while feeding the baby, and it provides broad guidelines to minimize risk in that situation.

If babies are swaddled, it’s essential to place them on their backs, Dr. Moon said. If placed on their stomachs, they can’t move and have no defense mechanism. When babies look like they are starting to roll, they should no longer be swaddled.

Breastfeeding, along with the use of a pacifier after breastfeeding is established, also is a key recommendation. “We don’t know if people realize that (by breastfeeding) you reduce the risk of SIDS about 50%,” Dr. Goldstein said.

Parents also are advised to be vigilant about environments out of the home. A study in the November issue of Pediatrics found out-of-home settings are more likely to have certain risk factors for sleep-related deaths, including prone placement for sleep and location in a stroller or car seat instead of a crib or bassinet (Kassa H, et al. Pediatrics. 2016;138(5):e20161124, http://dx.doi.org/10.1542/peds.2016-1124). More education is needed for caregivers.

Sometimes caregivers — and others — associate longer sleeping with happier babies and that is another misconception, according to Dr. Moon. It’s normal and appropriate for newborns to wake up a couple of times during the night, especially if breastfeeding, said Dr. Goldstein.

Families may be confused by the proliferation of “SIDS-prevention-type” products, but no product prevents SIDS.

“What concerns me,” said Dr. Moon, “is that a lot of parents think there is a proactive agency that checks all of these products before they go on the market, like an ‘FDA’ for (SIDS) products. But there isn’t.”

2016 safe sleep recommendations

1. Place infants on their back to sleep (supine) for every sleep period until they are 1 year old. This position does not increase the risk of choking and aspiration.
2. Use a firm sleep surface.
3. Breastfeeding is recommended.
4. Infants should sleep in the parents’ room, close to the parents’ bed but on a separate surface designed for infants, ideally for the first year, but at least for the first six months.
5. Keep soft objects and loose bedding out of the infant’s sleep area.
6. Consider offering a pacifier at naptime and bedtime.
7. Avoid smoke exposure during pregnancy and after birth.
8. Avoid alcohol and illicit drug use during pregnancy and after birth.
9. Avoid overheating and head covering in infants.
10. Pregnant women should obtain regular prenatal care.
11. Infants should be immunized according to the recommended schedule.
12. Avoid using commercial devices that are inconsistent with safe sleep recommendations, such as wedges and positioners.
13. Don’t use home cardiorespiratory monitors as a strategy to reduce SIDS risk. 
14. Supervised tummy time while the infant is awake can help development and minimize positional plagiocephaly.
15. There is no evidence to recommend swaddling to reduce the risk of SIDS.
16. Health care professionals and staff in newborn nurseries and neonatal intensive care units as well as child care providers should endorse and model recommendations to reduce SIDS risk.
17. Media and manufacturers should follow safe sleep guidelines in messaging and advertising.
18. Continue the Safe to Sleep campaign, focusing on ways to further reduce sleep-related deaths.
19. Research and surveillance should continue on all risk factors.

Source: http://www.aappublications.org/news/2016/10/24/SIDS102416

No More Codeine for Cough!

I emphatically support the announcement by the American Academy of Pediatrics that urges the DISCONTINUATION of CODEINE CONTAINING COUGH SUPPRESSANTS in children. I have never been a fan of Over the Counter (OTC) cough and cold medicines and prescription medicines containing codeine are even further down on my list of useful medications. OTC cough medicines often make kids wired and do not help the cough. This just results in a coughing kid swinging from the chandelier instead of just a coughing kid. Codeine containing medications may decrease the cough reflex, but cough is a good thing to stir up those germs inside and get them out of there!

More seriously, some children breakdown codeine quickly and get minimal relief and in other children it stays around too long and can suppress the respiratory drive.

For more details, please see the article below from www.healthychildren.org

Codeine Too Risky for Kids, AAP Urges Restrictions On Use

The American Academy of Pediatrics (AAP) is urging parents and health providers to stop giving codeine to children, calling for more education about its risks and restrictions on its use in patients under age 18. A new AAP clinical report in the October 2016 issue of Pediatrics, “Codeine: Time to Say `No,’” cites continued use of the drug in pediatric settings despite growing evidence linking the common painkiller to life-threatening or fatal breathing reactions.

An opioid drug used for decades in prescription pain medicines and over-the-counter cough formulas, codeine is converted by the liver into morphine. Because of genetic variability in how quickly an individual’s body breaks down the drug, it provides inadequate relief for some patients while having too strong an effect on others. Certain individuals, especially children and those with obstructive sleep apnea, are “ultra-rapid metabolizers” and may experience severely slowed breathing rates or even die after taking standard doses of codeine.

Despite these well-documented risks and with concerns expressed by groups including the AAP, the U.S. Food & Drug Administration and the World Health Organization, the drug still is available without a prescription in over-the-counter cough formulas from outpatient pharmacies in 28 states and the District of Columbia. In addition, according to the AAP report, it still is commonly prescribed to children after surgical procedures such as tonsil and adenoid removal. More than 800,000 patients under age 11 were prescribed codeine between 2007 and 2011, according to one study cited in the AAP report. Otolaryngologists were the most frequent prescribers of codeine/acetaminophen liquid formulations (19.6 percent), followed by dentists (13.3 percent), pediatricians (12.7 percent) and general practice/family physicians (10.1 percent).

The new clinical report outlines potential alternatives to provide pain relief in children but acknowledges that relatively few safe and effective drugs are available for pediatric use.

“Effective pain management for children remains challenging,” said the report’s lead author, Joseph D. Tobias, MD, FAAP, “because children’s bodies process drugs differently than adults do.”

The AAP report, published online Sept. 19, calls for improved education of parents and health providers about the risks of codeine use in children and formal restrictions of its use in children, as well as further research on safe and effect pain treatment in children.

Published 9/19/2016 12:30 AM

LOOK BEFORE YOU LEAP - THE NUMBER of TRAMPOLINE PARK INJURIES HAS JUMPED!!

A study published in Pediatrics, September 2016 issue shows:
*Trampoline Park Related Injuries requiring Emergency Department visits jumped from 581 visits in 2010 to 6,932 in 2014. 
*Trampoline Park Related Injuries resulted in more hospital admissions when compared with Home Trampoline Injuries during this time.
*Home Trampoline Injuries still occurred at the same rate during this time period - 91,750 injuries per year!
*Trampoline Park Injuries are most commonly sprains and fractures of the lower extremities. Children less than 6 years of age more often sustained fractures than sprains when they injured their legs.
*Home Trampoline Injuries include a greater number of upper extremity and head injuries because of falling off the trampoline.

In 2011, about 35 to 40 trampoline parks existed in the United States, as compared with 280 in 2014. The International Association of Trampoline Parks estimates that five or six new parks open every month. As trampoline parks increase in popularity, injuries are increasing accordingly. The safety rules and regulations are not the same at each park. Some parks allow flips while others don't. Some parks allow more than one child jumping at a time while others limit it to one child. Some parks reserve areas for smaller children, others don't. When there is a group on a trampoline, the smallest child is most likely the one that is injured.

An AAP policy statement on trampoline safety recommends against children’s recreational trampoline use, but states that if they are used, safety measures should include constant adult supervision, adequate protective padding, one jumper per trampoline at time, and avoidance of flips/somersaults.

"Can I Play a Video Game?" - Let's do something together instead!

Incredible things happen when you answer "Let's do something together, instead." to the question "Can I play a video game?" It is so rewarding, refreshing and invigorating. Keep it positive. Keep it simple. Keep it fun. Keep it you and your child.

Is Your ADHD Child Addicted to Video Games?

How to break the cycle of video game "addiction" in children with ADHD.
by Larry Silver, M.D.

Video games are fun and exciting, and they can, occasionally, be educational. Gaming can improve eye-hand coordination, and may foster positive social interactions. Children with little athletic interest or ability have an opportunity to compete in a different way, and to form friendships with like-minded gamers.

But as time that was previously spent on sports, studies, or other peer activities is replaced by solitary gaming, video games can become an 'addiction.'

Recent surveys show that children spend an average of 49 minutes a day on these games. If a child’s video-game console is in the bedroom, play time increases dramatically, to nearly three hours. Parents may unwittingly contribute to the problem, if they rely on handheld games to keep their children quiet during endless car trips or the long, unstructured days of summer.

In recent years, I’ve spoken with many parents who are looking for ways to wean their kids from the screen. Here’s what I tell them.

Understand the appeal

Video games hold special attractions for children with ADHD. A child who’s bothered by distractibility in the real world may be capable of intense focus, or hyperfocus, while playing. Nor is hyperactivity a problem; a child can hold the controllers and stand or pace back and forth in front of the TV as he plays.

For children who struggle with social skills, or lack the skills to play team sports, these games entertain and level the playing field. Computer games are emotionally safe. When a child strikes out in a baseball game, he’s doing it in front of a crowd of peers. But when he makes a mistake while playing a video game, no one else has to know.

Video-game errors aren’t circled in red ink by teachers, either. In fact, making mistakes helps the player improve. By trial and error, he learns the specific action needed to advance the next time. There is satisfaction in steadily improving and, ultimately, winning, with no chance of failing or being teased.

Set boundaries

Any parent of a young ADDer knows that children with ADHD often lack the capacity for self-regulation. This is particularly true when it comes to pleasurable activities that invite and reward hyperfocus. Thus, parents must be the ones to set and enforce limits — especially with children who have already become used to video-game overuse.

Both parents must first agree on a set of rules. This task is often the hardest. How long can our child play on school nights? Must homework be done first? Chores? How about on weekends? Which games are forbidden entirely (see “Kid-friendly Content,” at left)? If our child wants to play Internet-based games, which sites are OK?

Sit down with your child to discuss the rules and explain how they’ll be enforced. Let’s say, your daughter is allowed to spend 30 minutes playing computer games on school nights. She can begin playing only after she’s finished her homework (and you’ve looked it over and helped her pack it in her bookbag) and completed her chores (and you’ve checked them off on her chore chart). Then announce that the rules start now.

Video Games and ADHD Kids

Enforce the rules

At first, you may have to lock up the game or otherwise make sure that the game and its controls are physically unavailable when gaming is off-limits. When he’s allowed to play, you can hand them over and remind him, “You’ve got 30 minutes.”

When playtime begins, set a timer—a visible timer, such as the TimeTimer (timetimer.com), may be especially effective. Then, step in with periodic warnings: “You have 15 minutes left,” “Ten minutes to go.” When time’s almost up, announce, “You can play for five more minutes. Then it will be time to save your game. I’ll give you a few more minutes while I wait here.”

If your child does well with the time limit for several days in a row, consider tracking his progress and awarding a few extra minutes at week’s end. Emphasize that, as he demonstrates greater responsibility, he’ll earn greater privileges.

If, on the other hand, your child continues to play, despite your step-by-step warnings, do not shout or disconnect the power or get into a wrestling match to take back the equipment. Such approaches will only escalate anger. Instead, calmly remind him of the rules.

Then announce that, for each minute he continues to play, one minute will be subtracted from the time allowed the next day. If you check on him after lights out and find him playing the game under the covers, he might lose the privilege for several days.

Once you get the game controls back, lock them up again. When he regains the privilege to play, ask, “Would you like to try following the rules again?”

Offer alternatives

Once you’ve reduced the time your child spends playing video games, find other ways for him to occupy his time — no small feat when school’s out.

Search out an activity he can feel successful at, one that taps into his strengths and talents. If team sports are difficult, look into a sport that emphasizes individual performance, such as swimming, martial arts, golf, bowling, or gymnastics.

Or look into non-competitive group activities offered in your area, such as an arts-and-crafts class, a summer drama troupe, or a nature club. And remember that few children enjoy anything more than a one-on-one summer outing with mom or dad.

Source: http://www.additudemag.com/adhd/article/3589.html