Death from chicken pox declined 88%, from 4.1 in ten million people to just 0.5 per ten million.  The study by the CDC was published in the August 2011 issue of the AAP journal Pediatrics, comparing death rates in the early ’90′s (before introduction of the vaccine) to the mid-2000′s.

This improvement occurred with a single injection.  Subsequently, a 2-dose regimen has been introduced, because other research has shown that 5% of children don’t achieve proper immunity to chickenpox from a single injection.

So we can expect even better numbers, the next time the numbers are run!

–  David Epstein, MD

There are some surprises.  Using plug-in outlet covers?  Most adults don’t plug them back in.  Video monitors?  There are reports of kids getting strangled on the cords.

But some old suggestions are still valid.  The best way to start babyproofing is to get down on your hands and knees, and look for trouble at your child’s level.  Then fix it.

–  David Epstein MD

For decades, cough and cold medications were sold freely, over the counter.  Drug stores and pharmaceutical companies sold brands like Dimetapp, Pediacare, Delsym, Robitussin, and many others; there was a huge market for these medications, and companies competed fiercely.  They contained antihistamines, decongestants, and sometimes acetaminophen or other fever reducers.

Parents relied on these medications to suppress the cough and congestion from colds and viruses.   However, it’s been hard to prove that they actually work.  And there were so many kinds, and so many dosing regimens, that occasionally parents would be confused into administering an incorrect dose; on occasion, a child would suffer.

A few years ago, the FDA took these medications off the market for kids under 4 years old, citing the health risks and lack of proof of efficacy.  The FDA also discourages using the prescription version of these medications, although some are still available.

But if your child is suffering from cold and cough symptoms, some simple remedies can still help.

Run a vaporiser in the child’s room at night. (In winter, a steam vaporiser will make the room less clammy than a cold-water humidifier.)

Hot tea, especially with honey (buckwheat if you can find it), is helpful for cough.

And lots of fluids will help suppress a cough, and make a sick child feel better.

You can find more suggestions in this handout; click here to read more.

–  Dr. Epstein

The move is aimed at prescription medications that contain Chlorpheniramine, Brompheniramine, Phenylephrine, Dextromethorphan, Guaiafenesin, Pseudoephedrine, and a couple of similar ingredients.

I have prescribed these medications for my patients for many years, and never heard of any serious problems.  Unfortunately, they will no longer be available.  There may be other medications that I can substitute, but I suspect that they may be in short supply until their manufacturers can catch up with the demand caused by their competitors being knocked off the market.

This move does not affect the over-the-counter cold and cough medications still available that contain the same ingredients.  You can still buy Pediacare, Delsym, and several other medications that are sold to treat the symptoms of upper respiratory infections.  But the FDA also changed the labeling on these medications several years ago, to remove recommendations to use these medications for kids under 4.

To see the FDA’s list of newly banned prescription cough medications, click here.

To read my usual recommendations for treating the symptoms of the common cold, click here to be transferred to our practice website.

–  David M. Epstein, MD

Over a thousand mothers and their infants on an Indian reservation were studied.  Infants whose mothers received flu vaccines were 40% less likely to catch influenza themselves, and 40% less likely to be hospitalized for it.

The effect of fathers’ flu shots on the health of their infants was not studied, but one can assume that it would benefit the kids as well.

Since 1997, experts have recommended that pregnant women should be given flu vaccine.  But acceptance of this advice has been very slow.  Many of the families in my practice are happy to have the infants vaccinated, but the parents are reluctant to be vaccinated themselves.

But, as an accompanying editorial says: “Maternal influenza vaccination targets 2 high-risk groups with 1 vaccine dose – we can’t afford not to act.”  Perhaps this study will reassure these parents, and encourage them to get their own flu shots every year!

–  David Epstein, MD

Archives of Pediatric and Adolescent Medicine.  Vol 165, No. 2, Feb 2011, p. 104-111.

A study presented this week at the American Stroke Association International Stroke Conference (ISC) suggests a 61% increase in stroke for people who drink diet sodas regularly.  (Click here to read more.)

Does diet soda cause stroke?  Or does the association merely mean that people who choose diet soda also have other lifestyle habits that predispose to cardiovascular disease?

My view is that this study’s results are most likely due to an association with lifestyle habits.  The study authors tried to control for such associations, but that’s hard to do in a questionnaire-based study like this one.  I’d have guessed that if drinking diet soda caused stroke and heart disease, we’d have noticed it before now.  But I don’t agree with the American Beverage Association that this makes the study meaningless.

People who choose diet sodas don’t usually do so because they prefer the flavor to sugar; often they are trying to counterbalance other issues, such as obesity, which are already known to be related to stroke and heart disease.

Especially for children, my concern is that diet sodas may reinforce kids’ preference to drink other sweetened beverages, like juices, sports drinks and sugary sodas, which are clearly associated with obesity.

The best use for diet sodas for kids is probably for children whose weight is a concern, as a temporary or infrequent stepping stone to teach better lifestyle habits.  Diet sodas may not be harmful themselves, but it’s better to teach kids to drink water or milk.

But now, we read in the news that the Institute of Medicine is about to publish a rebuttal to some recommendations for super-high doses.  (Click here for the Washington Post article, or here for the New York Times report.)

In fact, as far as I can tell, there’s not much disagreement between the Institute of Medicine and the AAP’s recommendations.  IOM recommends that all infants receive 400 International Units (IU) per day, and children over 1 year should receive 600 mg; the AAP recommends 400 IU for all infants and children. The AAP and the IOM agree that there is little evidence to support recommendations for huge doses of vitamin D (2000 IU or more).

Breast milk contains little Vitamin D, so all infants who get most of their milk from breastfeeding should be given Vitamin D supplement drops (with iron if possible).  For older kids, cow milk is fortified to give 400 IU per quart; so unless the kids drink a quart of milk every day, they need other sources as well, so I recommend daily vitamin supplements for them as well.  (Any brand-name or store-brand kids’ vitamin supplement will do; look for ones that also contain iron.  I’d stay away from any supplement made in China!)

So I still recommend once-daily vitamin supplements (with iron) for all children.  Don’t be put off by the news reports this week; the IOM is simply debunking claims for mega-doses of Vitamin D.

–  David Epstein, MD

Here’s how the survey is performed.  Researchers associated with the CDC made random calls to thousands of households (73,000 for this survey), and asked the parents a series of questions about the health of members of the house.

Childhood ADHD was one of the conditions they asked about.  The researchers asked if the child had “ever” been diagnosed, if he was “currently” diagnosed, and if the child was currently on medication.  The survey data was based solely on these randomized calls; no medical records were examined, and no independent assessment of the patients were made.

This week’s newspapers are stressing the “9.5%” number.  Headlines say “One in ten American children has ADHD.”  But what does this mean?  The excitement stems partly from the perception of an increase; in the past, most studies have found that 5% of American children have ADHD.  Delaware’s numbers are the 4th-highest in the country.  But does this make sense? How could the rate of ADHD double in just 4 years?

Certainly, the sense of acceptance of a diagnosis of ADHD in parents and health professionals is increasing.  And treatment with medication is better accepted, due to shifting social acceptance, adn decreasing side effects and cost.

But frankly, I doubt that there has been an increase in the actual, biological prevalence of the symptoms of ADHD.  A close look at the CDC’s data supports such skepticism.  Although parents said that 9.5% of their children “had ever” been diagnosed with ADHD, only 4.8% were actually being treated with medication, a small increase from the 4.3% rate reported in 2003.

The 4.8% figure much more closely matches other studies, which have reported a stable 5% incidence of ADHD for many years.

Clearly, ADHD is a debilitating problem for a significant number of children.  Treatment with medication can give dramatic relief, in my experience and in many studies.  But I doubt that the CDC’s most recent report reflects an actual increase in the problem.

Click here to see the CDC’s data.

Click here for more information about how I diagnose and treat ADHD.

–     David Epstein, MD

“Iron deficiency is one of the most common problems among children, but it’s frequently not detected, and it has long-term health implications for children’s development and behavior.”

We test kids for iron deficiency anemia (and lead poisoning) at 1 year of age, but not all cases of iron deficiency are caught (especially if not accompanied by frank anemia).  It would be better to prevent deficiency by ensuring adequate iron intake, especially from food containing iron, but apparently relying on diet has not been sufficient.  And doctors don’t agree about whether to supplement all children routinely.

So, in October, the AAP issued new guidelines for routine iron supplementation:

- Term, healthy infants have sufficient iron for the first 4 months of life. Because human breast milk contains very little iron, breastfed infants should be supplemented with 1 mg/kg per day of oral iron beginning at 4 months until iron-rich complementary foods (such as iron-fortified cereals) are introduced.

- Formula-fed infants will receive adequate iron from formula and complementary foods. Whole milk should not be used before 12 months.

- Infants ages 6 to 12 months need 11 mg of iron a day. When infants are given complementary foods, red meat and vegetables with high iron content should be introduced early. Liquid iron supplements can be used if iron needs are not met by formula and complementary foods.

- Toddlers ages 1 to 3 years need 7 mg/day of iron. It’s best if this comes from foods, including red meats, iron-rich vegetables, and fruits with vitamin C, which enhances iron absorption. Liquid supplements and chewable multivitamins can also be used.

- All preterm infants should have at least 2 mg/kg of iron per day through 12 months of iron, which is the amount of iron in iron-fortified formulas. Preterm infants fed human milk should receive an iron supplement of 2 mg/kg per day by 1 month of age, and this should be continued until the infant is weaned to iron-fortified formula or begins eating complementary foods that supply the 2 mg/kg of iron.

By comparison, it’s worth noting that adult women should receive 18 mg iron/day, through menopause.

How often do kids receive the recommended amounts of iron, solely from the diet?  Judging by the rate of defiency, apparently not often enough.  So what’s a parent to do?

I recommend for our patients:

- Breastfed infants should receive iron, along with Vitamin D supplements, starting at 2 weeks.  (“Trivisol with Iron” is a good brand.)

- Solid food should be introduced by 6 months of age.  If meats are not introduced by 6 months, then vitamins with iron, such as Trivisol or Polyvisol with Iron, should be given.  (These vitamins also contain Vitamin C, which helps iron absorption.)

- All kids should start whole milk at 12 months (unless it’s prohibited by allergy or family social values).  Since infant formula is not given past 12 months, I think all kids benefit from a daily vitamin supplement with iron, unless they eat lots of meat.

- Kids should be tested for anemia and lead poisoning at 12 months of age, and perhaps at 24 months as well.

Patients often ask what brand of vitamins to buy.  For me, it doesn’t matter; drug store brands are reported to be just as efficacious as “Flintstones” or other brands.  Check the label, to be sure that the supplement contains the ingredients you seek.

–  David Epstein, MD

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