Delaware Modern Pediatrics Blog

It’s not just “selective hearing!”  True hearing loss in teenagers has become 30% more common.

A survey performed back in 1988-94 found that 15% of American teens suffered hearing loss, even if slight.  Bu a repeat study in 2005-6 showed that the percentage has risen to almost 20%, a 1/3 increase.

Hearing loss is 50% more common in poor families.  More than half the time, it is one-sided, and involved high-frequency sounds.

No one is sure why so many teens are losing their hearing.  It’s surprisingly difficult to prove that loud music (iPods, etc.) are the cause, although an Australian study showed a 70% increase in risk of hearing loss from using “personal stereo devices.”

But my view is that it’s worth the easy action, to protect kids’ hearing.  You can set a “loudness limit” on an iPod, and set a password to block resetting it.  (Click here to read how.)

Click here to see my previous post about hearing loss.

Click here to see a video about the research.

Click here to find the research article:
JAMA, August 18, 2010 – Vol 304, No. 7, p 772-778.

–  David Epstein, MD

Did you just bring your newborn home?  You might feel a bit overwhelmed.  Night feedings, unwanted advice, and the sense of being on-call “24-7″ can be exhausting.

The last thing you need is to be worried that jaundice in your newborn will make everything worse.  If jaundice is a concern, please have a look at this handout that I just posted.  Click here to read it!

–  David Epstein, MD

The American Academy of Pediatrics has released professional TV and radio “spots”, encouraging parents to have their children vaccinated on time.

The ads recall a time when many children were crippled or killed by contagious diseases.  Grandparents hold their own young grandchildren, while talking about members of their own families who died or were crippled by illnesses that nowadays we rarely experience.  Vaccinations that we routinely administer to our patients are highly effective at keeping children safe from these dangerous diseases.

To view these ads, click here.

–  Dr. Epstein

One of my patients is entering college this fall, and he wants to play football.  He called our office this week to tell us that his college now requires all athletes (regardless of ethnic background) to have a routine blood test to screen for Sickle Cell Trait.  He asked us for a lab order.

Frankly, I had never heard of such a thing.  But it turns out that in 2008 the NCAA did formally recommend universal screening for Sickle Cell Trait (click here), because of several unexpected deaths during strenuous practice over several decades.  There have been 8 cases reported in the past 10 years.  All the deaths related to Sickle Trait occurred during conditioning exercises, not during games or scrimmages.  (Click here to read a report in the New York Times.)

Many colleges now require all their student athletes (not just African-American football players) to have a blood test for sickle trait before joining the team.  The test requires a doctor’s order at a medical lab, just like any blood test.

The cost may not be covered by insurance.  We called a couple of labs and asked what they charge:
LabCorp:  $82.00 test + $16.00 lab draw = $98.00 total
Quest:  $35.90 test + $15.90 lab draw = $51.80 total

The recommendation for universal Sickle testing has some detractors.  There is no evidence that discovering a student with a positive test has actually saved a life, or altered any training regimens; in fact, 4 of the 8 sickle-positive athletes who died in the past 10 years were already aware of their status before their death.  And mandated testing might lead to discrimination against athletes with Sickle Trait, even though Sickle Trait does not appear to affect game-time performance or safety.

But, in any case, we will be happy to help you comply with this recommendation.  Let us know if you need a blood test order.  If the test is positive, we’ll discuss it with you; and in any event, everybody (regardless of blood test status) should stay hydrated during strenuous exercise!

–  David Epstein, MD

A new study, published June 16 2010 in JAMA, suggests that Lung Cancer occurs only half as frequently in people who have higher blood levels of B6.

The protective effect of Vitamin B6occurred in smokers, as well as those never exposed to smoke.

I have started recommending multivitamin supplements more frequently for my patients, because of recent findings that Vitamin D levels are associated with cardiovascular health and immune function (click here to see my previous post).  This study lends more support for that recommendation.  Listen to your grandma; give your kids their daily vitamins!

–  David Epstein, MD

A new study suggests a link between pesticides and ADHD.  Kids with high urine organophosphate levels are twice as likely to have some symptoms of ADHD.  Click here for the study, published in the May 2010 issue of Pediatrics.

Is this true?  It’s hard to know.  The data are 5-10 years old, and appear to be culled from a database collected for another purpose.  And the “diagnosis” of ADHD was made using a “structured parent interview” by phone, not a previously standardized questionnaire.  The kids were never examined, nor were school reports included, as would usually be the case for diagnosing ADHD.

In any event, I don’t think a parent could do much about this, other than washing fruits and vegetables before serving them.  There’s no point in routinely testing ADHD patients for organophosphate poisoning.

I was interviewed by WDEL radio about this topic.  To hear the interview as a .mp3, click here.

–  David Epstein, MD

Nowadays, we have all absorbed the idea that the overuse of antibiotics may be causing bacteria to become resistant.  But does this mean that we should avoid using antibiotics to help people with a documented infection?  Probably not.

In the past, antibiotics were prescribed freely.  In the 1990’s, a study in JAMA showed that half of all antibiotic prescriptions in America were written for adults with viral infections.  Doctors have learned to reduce the unnecessary use of antibiotics for mildly ill people; this educational effort continues.

But still, antibiotics are dumped into our environment by the ton, every month.  Where does it come from?

One source of antibiotics in our environment is animal feed.  Antibiotics routinely have been added to the food of animals being grown for food.  While this practice increases the weight and yield of animal meat, and helps keep beef, pork, and chicken prices low, it also contributes over 30% of the annual burden of antibiotics into our environment and water supply.

Another big source of antibiotics is in consumer products, such as antibiotic soap, lotions, and laundry detergent.  The addition of antibiotics has been shown not to reduce the transmission of disease; the proper use of soap without “antibacterials” works just as well.  But this practice adds 40% of the annual load of antibiotics into our environment.

Naturally, we don’t prescribe antibiotics unless there’s a clear need.  But there’s also no need to fret that the appropriate use of antibiotics for documented infections is causing antibiotic resistance; there are plenty of other ways we could avoid this serious problem.

–  David Epstein, MD

Excellent parenting books are available from the American Academy of Pediatrics.  Click Here to see the entire list.

The “classic” in this series is “Caring for your Baby and Young Child, Birth to Age 5″.  The advice is reasonable, easy to read and follow.   (It’s not alarmist, unlike the “What to expect …” series which I do not recommend.)

–  David Epstein, MD

Most of the families in my practice accept the usual recommendations for routine immunization.  They do so because they understand the benefits, and they can ignore the unfounded fears that some people promote.

Routine vaccination prevents illness.  Another recent study has confirmed the value of these shots.  In the June 2009 issue of Pediatrics, doctors in Denver, Colorado investigated 156 cases of clinically proven whooping cough (Pertussis) in children, ages 2 months to 18 years.  When compared with kids who received the standard immunization schedule, children of “refusers” were much more likely to get sick from whooping cough – 20 times more common!

This study demonstrates two things.  First, vaccines prevent illness (not surprisingly).  Second, these kids didn’t get much protection from “herd immunity.”  They weren’t protected by the fact that other kids in their community had been immunized.

Bottom line: don’t delay!  Get your kids vaccinated according to the recommended schedule.  If you have questions, I’d be happy to discuss them with you.

–  Dr. Epstein

http://pediatrics.aappublications.org/cgi/content/abstract/123/6/1446

Rotarix vaccine has been found to contain an extraneous virus.  Fortunately, the “extra” contaminant is unlikely to cause a problem.

Rotarix vaccine protects babies from infection with Rotavirus, an intestinal virus causing vomiting and diarrhea which can be severe.  Since the introduction of Rotarix (and a similal vaccine, RotaTeq, from another manufacturer), rates of infection and hospitalization from Rotavirus infection have dropped significantly.

The contaminant is a virus that infects pigs and other animals, but not people (as far as we know).  There have been no reports of illness, and I have heard no complaints from my patients about side effects from Rotavirus vaccine.  However, it is possible that the current batch of Rotarix may eventually be recalled.  (Currently, doctors are being asked to refrain from using their stores, but we’re not yet being asked to return it to the manufacturer.)

For more information, please see the “News” section on the front page of our website,  www.dmpKids.com.

–  David Epstein, MD