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

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

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

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

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

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 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

–  David Epstein, MD

Some mothers produce so much milk that their baby can’t drink it all.  Have you ever wondered how to give it away?  Perhaps there’s a baby who could really use it.

Now, there’s a way to donate it.  “MilkShare” is an organization dedicated to uniting babies in need with a breastmilk donor.  One of my patients alerted me to this resource; she has donated milk for two families, and she’s found it to be a rewarding experience.

Donors are not expected to be reimbursed for the milk itself, but you can be reimbursed for equipment and shipping costs.  (Selling the milk itself is forbidden by the site.)  The recipient is also responsible for any costs for testing the milk.

Click HERE to see the MilkShare website, and find out more.

– David Epstein, MD

The safety issue relates to the way that the safety belts themselves restrain the child.  In order for the belt to restrain the child without causing injury, the belt must nestle against the child’s bones, rather than soft tissue.

Delaware law (click here for interesting info) requires kids to be in their car seats while travelling until the 8th birthday, or 65 pounds, whichever comes first.  But following this rule does not guarantee safety, especially for smaller kids, because of the geometry of safety belts.

To convince yourself (and your child, if she is agitating to get rid of the booster seat), you can try this test:

Let your child (over 8 years old and 65 pounds) sit in the back seat of your car, with just a seat belt on.  Drive around the block once or twice, then park in your driveway.  BEFORE the kids get out of the car, go to the back seat and check the position of the seat belts on the child’s body.

The lap belt should strike the child’s lower hip bones.  And the shoulder belt should be laying across the hard clavicle (collar bone).  If the lap belt has slipped up across the soft tissues of the belly, or if the shoulder belt lays across the soft tissues of the neck, then it is not safe for the child to be transported this way: in an accident, the safety belts themselves could cause soft tissue damage.  The purpose of the booster seat is to raise the child, so that the safety restraints are in the proper position.

Frankly, I think the only reason that a child would want to get rid of a booster seat is to think of themselves as more “adult”.   But the booster seats let the kids see out the car window better!  My daughter, who was rather petite, needed to use a car booster seat until she was almost 10.  When she complained, I performed the demonstration above, and she quickly understood the need.

(For information about car seats for younger kids, click here.)

–  David Epstein, MD