Entries in Pediatrics (13)


Researchers Urge Against Use of Indoor Tanning

Cultura/Liam Norris(NEW YORK) -- More than one million people visit tanning salons in the United States every day.

Many of those that do use tanning salons are teenage girls. According to an article in the journal Pediatrics, 35 to 40 percent of white adolescent girls use indoor tanning devices. The article points out that artificial tanning increases the risks of skin cancer. The increased risk includes risk of melanoma, the most deadly form of skin cancer, and a common cancer among adolescents and young adults.

The average U.S. city has more tanning salons than Starbucks or McDonald's locations.

The rate of melanoma in women age 15 to 39 more than doubled between 1973 and 2004, according to the article. According to the authors, 25 percent of melanoma diagnoses may be attributable to tanning beds. The article also urges pediatricians to discuss the dangers of the life-threatening practice with families.

Researchers also suggested spray tanning as a potential alternative which does not include the same health risks as tanning beds.

President Obama's health care overhaul implemented a 10 percent tax on indoor tanning in 2010. Several states and medical organizations have moved to ban minors from tanning in tanning salons.

Copyright 2013 ABC News Radio


One Family, Five Heart Transplants

Stacy and Jason Bingham(HAINES, Ore.) -- Stacy and Jason Bingham of Haines, Ore., already had endured the arduous transplant waiting list until their oldest daughter, Sierra, now 12, found a match for a new heart.

Now, they may have to face four more rounds on the list. All five of their children have been diagnosed with genetic heart abnormalities.

For now, only one of the four additional children, who is being cared for at Lucille Packard Children’s Hospital in Palo Alto, Calif., has been placed on the transplant list. But if all five of the Bingham children receive new hearts, it will be the most heart transplants ever performed for a single family.

More than 3,000 adults and children are waiting for a heart transplant, a minority of whom are children, according to the Organ Donation and Procurement Network. An estimated 400 children undergo heart transplants each year.

Longer survival on the waiting list and a better prognosis post-transplant are some reasons why many children like the Binghams can expect to be treated successfully, according to Dr. Francis Fynn-Thompson, surgical director of the heart transplant program at Boston Children’s Hospital, who is not affiliated in the family’s care.

“Compared to a decade ago, we have options to bridge between heart transplants,” said Fynn-Thompson. “If a child’s heart gives out, we can put them on a device that can act like a heart in the interim.”

Children waiting for a heart transplant face the highest risk of dying compared to a child waiting for any other organ, according to study Fynn-Thompson and his colleagues published in 2009 in Circulation.

“The smallest hearts are the hardest to find,” said Fynn-Thompson.

For child recipients, the ordeal doesn’t end once the new organ has been located and transplanted. The surgery is followed by a lifetime of immunosuppressive medications to counter any possible side effects, including organ rejection. Unlike adult organ transplants, a child-size organ needs to be able to grow as the patient grows.  The child eventually transitions from a pediatric to an adult heart transplant cardiologist.

However, unlike an adult, many infants can be transplanted across blood types because they haven’t developed the antibodies, allowing for most infants to be transplanted without having to wait for a match.

The prognosis for heart transplant recipients are among the best compared to previous years. The six-month heart transplant survival rate increased from 86 percent in 1999 to 91 percent in 2009, according to the Scientific Registry of Transplant Recipients and the Organ Donation and Procurement Network annual data report.

“Our expectation is that their survival will be well beyond 10 years,” said Fynn-Thompson.

Seventy percent of children with heart transplants are alive after 10 years and 50 percent are alive after 15 years, he said.

While pediatric heart transplants are limited by an uncontrollably small donor pool, Fynn-Thompson said the focus should be on helping children who are on the list live longer while they wait.

“Devices like the Berlin heart and other assisting devices coming down the pike are applicable to children,” said Fynn-Thompson.

It’s these methods that can help one child, even five in one family, live long enough before given the heart they need, he said.

Copyright 2012 ABC News Radio


Law Offers Drug Companies Vouchers in Exchange for New Cancer Drugs for Kids

Nancy Goodman/Kids v. Cancer(WASHINGTON) -- President Obama signed a bill Monday that will provide incentives to drug companies to research and develop drugs for rare diseases.

The Creating Hope Act grants pharmaceutical companies that create drugs for diseases like childhood cancers a voucher giving speedier review of any other drug they submit for approval.

The Oval Office signature was a hard-fought victory for children like Mollie Ward, 11, who survived a rare form of pancreatic cancer thanks to an experimental drug, and for other families who have fought childhood cancers.

Nancy Goodman, founder of Kids v. Cancer, which is devoted to pediatric cancer research, lost her son Jacob Froman, 10, to a rare form of brain cancer nearly four years ago.  He’d been diagnosed at the age of 8.

She was instrumental in getting the bill passed. She and others said that drug companies had little financial incentive to develop new treatments because childhood cancers are so rare.

“The reason I started working on the Creating Hope Act was that I found very early on that there are just very few drugs to treat kids with cancer,” she told ABC News. “We created a big, fat carrot. The carrot is a voucher.”

While 50 new drugs for adult cancer have been released in the last 20 years, just one expressly for pediatric cancer has gotten initial Food and Drug Administration approval, doctors say.

The track record for drugs for other pediatric rare diseases is even worse.

“The reason that companies don’t make pediatric drugs is all market force driven,” said Dr. Henry Friedman, an neuro-oncologist at Duke University Medical Center. “Companies have an obligation to their shareholders to make money. The pediatric diseases by and large are such low numbers. …The incentive to make pediatric drugs is very small.”

Goodman said the measure was smart legislation and an attempt to ensure that more families don’t experience what she has.

“I don’t think the American public realizes how devastating pediatric cancer is,” she said. “It’s far worse than any other adult cancer. There’s something unfair and unjust about the death of a child.”

Copyright 2012 ABC News Radio


How Do Docs Prescribe Kids’ Meds? Guess 

Comstock/Jupiterimages/Thinkstock(BOSTON) -- The last time your doctor gave you a prescription, it likely came with specific information on the correct and safe dosage to take, determined from years of clinical trials. But when kids need certain prescription drugs, such as statins, morphine, anesthetic or the asthma drug prednisone, doctors sometimes have to guess how much to give them based on the child’s weight.

The reason, described in a report published Tuesday in the Journal of the American Medical Association, is that about half the prescription drugs commonly given to children have no information on appropriate pediatric doses on their labels.

Researchers from the U.S. Food and Drug Administration studied drugs listed in the Physicians’ Desk Reference, the bible of FDA-approved drug labeling, and counted the number of drugs that came with guidance for use in children, including the appropriate dosage.  Of 461 drugs in the PDR that were for children, 231 had the adequate information doctors would need to prescribe the drug to a child.

For the 105 brand-new drugs approved by FDA between 2002 and 2008 that could potentially be used in children, 43 had pediatric information on the labels.

“You can’t get a product approved in adults without studying how it affects them first,” said Dr. Dianne Murphy, one of the study’s authors. “But children are routinely being given products that are not studied in them.”

The study is part of an effort to increase awareness that prescription drugs are often not tailored to kids’ unique biology. In April, Harvard researchers reported that four out of every five children hospitalized in the U.S. are treated with drugs that have never been tested in children and are FDA-approved only for adults.

For newborns, the picture is even grimmer.  About 90 percent of drugs have never been tested for use in infants.

Dr. Florence Bourgeois, the author of that study and an assistant professor of pediatrics at Harvard, said that about 60 percent of common conditions such as asthma and lower respiratory infections occur in children, but only 12 percent of the clinical trials currently testing drugs look at how they work in children specifically.

So when kids need these drugs, their doctors usually just have to guess how much to give them, usually gauging it against their weight. But kids are not just little adults. The way the liver, kidneys and other organs work to metabolize drugs is far different in early life.

“In some instances, extrapolating adult drug dosage to children might be appropriate, but again, without specific trials to assess that, we simply don’t know,” Bourgeois said.

Experts said testing drugs in children is simply more complicated and costly for drug companies. Clinical trials of children have their own ethical issues and often the science used to study adults doesn’t apply to children. For example, it’s difficult or impossible to get infants and children to breathe into a spirometer to study their asthma.

But alarming as it may seem to parents with sick kids, the situation used to be a lot worse. Dr. Daniel Frattarelli, chairman of the American Academy of Pediatrics’ Committee on Drugs, said even though half of drugs have dosage information for children, it used to be that only about 20 percent did.

The improvements are largely the result of two laws, passed in the late 1990s and early 2000s. The Pediatric Research Equity Act allows the FDA to require drug companies to do additional testing of their products on children if the drug is likely to be used widely in pediatrics. The Best Pharmaceuticals for Children Act gives incentives for drug companies to test their products on children, such as giving them an additional six months of marketing exclusivity.

Both laws are up for congressional reauthorization in 2012, and experts say they are essential to getting more information about appropriate dosage of drugs in children.

Copyright 2012 ABC News Radio


Black Children Less Likely to Get Pain Meds in ER

Hemera Technologies/Thinkstock(BOSTON) -- Black children seen in the emergency department for abdominal pain are less likely to receive pain medication than white children, according to a new study.

The research, which also found that black and Hispanic children were more likely to experience an ER stay longer than six hours compared to white children -- even when the same tests were ordered -- raises questions on how race may affect hospital care when it comes to the youngest patients.

The study was presented Saturday at the Pediatric Academic Societies (PAS) annual meeting in Boston.

Lead study author Dr. Tiffani J. Johnson, pediatric emergency medicine fellow at the Children's Hospital of Pittsburgh, says she has a strong interest in improving the quality and equity of care that kids receive in the ER.

"If we don't recognize disparities, we're never going to be able to close the gaps," says Johnson.

Johnson and colleagues used data from the CDC's National Hospital Ambulatory Medical Care Survey, which included more than 2,000 children from 550 hospitals who visited the ER for abdominal pain between 2006 and 2009.

Black children were 39 percent less likely to receive pain medications compared to white children with similar medical situations. When their pain was severe, rated 7 or higher on a pain scale from 0 to 10, an even larger disparity was observed.

Research shows children are always at greater risk to be under-treated or mistreated compared to adults because of their limited ability to communicate how they feel.

Past research has shown that race can affect the way that adults express their pain. A 2002 study published in the International Journal of Intercultural Relations found that black patients were less likely to disclose the fact that they were in pain than their white counterparts. When they did discuss their pain they were less likely to describe its intensity.

And doctors might also be less skilled in recognizing the pain of certain races. Specifically, doctors were almost twice as likely to underestimate the pain of black patients compared to other ethnicities in a 2007 study from the University of Tennessee College of Medicine.

Whether either of these findings applies to pain in children is simply not known. Johnson says we need additional studies to find out exactly what factors lead to variations in care.

Copyright 2012 ABC News Radio


Nickelodeon Responds to 'SpongeBob' Claiming Harm to Preschoolers

Thos Robinson/Getty Images for Nickelodeon(NEW YORK) -- A senior vice president for Nickelodeon is calling foul on a new study out Monday that suggests preschoolers’ attention spans are hindered from watching certain cartoons such as SpongeBob SquarePants.

In an interview with Nightline, Jane Gould, the senior vice president of Consumer Insights for Nickelodeon/MTVN Kids and Family Group, said the study, which was published in the journal Pediatrics, didn’t include enough kids in its sample size and that SpongeBob wasn’t an appropriate choice.

The researchers, led by University of Virginia psychologist Angeline Lillard, randomly assigned 60 4-year-olds to three activities: drawing freely with markers for nine minutes; watching a slower-paced, PBS cartoon for that time; or watching SpongeBob SquarePants. Researchers said they chose SpongeBob for its frenetic pace: The show switches scenes on average every 11 seconds, as compared with the PBS cartoon, which switched only twice a minute.

“It made me scratch my head and feel confused,” Gould said. “I couldn’t understand the logic of including a program like SpongeBob, which is expressly designed to entertain 6-to-11-year-olds and have that program be compared to a slow-paced educational program for preschoolers. SpongeBob is not designed to educate preschoolers. It’s designed to entertain kids.”

Gould added that the kids who did participate were not from ”a diverse enough background to represent the country.”

After watching the programs, the preschoolers were asked to do four different “executive function” tasks that test cognitive capability and impulse control, such as counting backwards, solving puzzles, and delaying gratification by waiting to eat a tasty snack until told to do so. Compared with those who were drawing and those watching PBS, the SpongeBob kids performed significantly worse on the tasks, the researchers said.

“When you look at what was shown to them, they saw nine minutes of a program,” Gould said. “There wasn’t even closure offered to the children who saw the program.”

She added that another bias in the study was that researchers polled parents about their children’s behavior before their kids participated.

“What really surprised me was that these researchers asked parents first to report back on their kids, and answer whether their kids, in essence, have a normal or ordinary attention span,” Gould continued. “You are going to find very few parents who are going to say, ‘You know what, I don’t think my kid has a good attention span.’”

Copyright 2011 ABC News Radio


Pediatricians Suggest 'Media Diet' for Obese Kids

Digital Vision/Thinkstock(WASHINGTON) -- Childhood obesity has become an epidemic in America -- with 17 percent of children aged two to 19 obese, according to the Centers for Disease Control and Prevention.

That's more than three times as many as in 1980.

That huge increase has families, doctors and the government looking for ways to curb the problem. A report released Monday by the American Academy of Pediatrics has a new suggestion: ban companies from advertising junk food during children's television programs.

The AAP has long called for parents to put their kids on a "media diet." Studies have shown that watching TV or surfing the Internet displaces more physical, healthy pursuits, and people tend to snack more on junk foods with low nutritional value when they're in front of the TV. Recent research also shows screen time interferes with kids' sleep, itself a risk factor for obesity.

Now the organization is going a step further by calling on Congress to ban fast food and junk food ads during shows directed at kids.

Dr. Victor Strasburger, the pediatrician who authored the statement, says it's "time for Congress to man up against the food industry," by instituting a ban. He explains that years of studies have shown that kids are psychologically defenseless against advertising, that they don't understand the selling intent of ads, and that the current voluntary regulations aren't enough.

Keith Ayoob, a pediatric nutritionist and director of the Nutrition Clinic at the Albert Einstein College of Medicine, says a ban on fast food advertising might happen, but it probably won't make much of a difference: "There was kids' TV before there was an obesity crisis. They advertised sweet, high-calorie food for kids, but nobody cared until obesity became an epidemic."

Ayoob also questions how the government will determine what foods and companies would not be allowed to advertise if ads for junk food were banned. "It's not like it's tobacco. It's food."

Dr. Strasburger says a ban on junk food advertising to kids isn't the only and final solution, and TV itself isn't to blame for the obesity epidemic. Still, he says, the "least healthy foods are being advertised on television most heavily to our kids. It's a contributing factor we can easily do something about."

The AAP has a few other suggestions for parents. Keep TVs and computers out of kids' bedrooms -- that makes it easier to regulate how much time they spend in front of the screen. The AAP recommends limiting screen time to no more than two hours a day, and not right before bed.

Ayoob explains, "If kids aren't allowed to sit in front of a TV for hours, they will have to do something else. Six hours of screen time is equal to six hours of bed rest. Obviously, that's not something that we recommend for kids." Dr. Strasburger also says parents should watch TV with their kids, so they can teach them about advertising and healthy eating habits, despite what they see in the ads.

"When kids spend seven hours a day watching television or on the computer, it's time to think about how that influences them," Strasburger says, "and how we can do the best in homes and at an institutional level to give our kids the best chance in life."

Copyright 2011 ABC News Radio


Report Ranks Nation's Children's Hospitals

Ryan McVay/Thinkst(NEW YORK) -- U.S. News and World Report on Tuesday released its fifth annual rankings of "Best Children's Hospitals" -- the nations' top hospitals for pediatric specialties including cancer, cardiology, neurology and orthopedics. "Honor Roll" hospitals that excelled in four or more specialties are:

1. Children's Hospital Boston
2. Children's Hospital of Philadelphia
3. Cincinnati Children's Hospital Medical Center
4. Texas Children's Hospital, Houston
5. Children's Hospital Colorado, Denver
6. Johns Hopkins Children's Center, Baltimore
7. Seattle Children's Hospital
8. Children's Hospital Los Angeles
9. Children's Hospital of Pittsburg of UPMC
10. New York-Presbyterian Morgan Stanley-Komansky Children's  Hospital
11. St. Louis Children's Hospital-Washington University

A place on the list, which is determined by the responses of 1,500 physicians who were asked where they would send the sickest kids, is a badge of honor for hospitals.

"The list is a huge deal, even though we all know it's somewhat of a popularity contest," said Dr. Marie Savard, a Philadelphia internist and ABC News medical contributor. "We all understand that great hospitals don't always get on that list for various reasons. But just because your hospital's not on the list, don't assume it doesn't meet the criteria."

Savard, who is also a patient's rights advocate, said hospitals that tailor treatments to the specific needs of each patient and coordinate care with teams of experts from admission to beyond discharge get top scores.

The types of procedures offered and safety records influence hospitals' rankings, as well as the quality of doctors they attract. And at a time when everyone has money on the mind, value matters too.

"Everybody is looking at value, especially in this day of health care reform and limited dollars," Savard said. "Is the hospital using money wisely?" In other words, "Are we getting the biggest bang for our buck?"

Copyright 2011 ABC News Radio


Chronic Fatigue Syndrome Frequently Undiagnosed in Teens

Creatas Images/Thinkstock(UTRECHT, Netherlands) -- More common in adults, chronic fatigue syndrome in teens is often overlooked, according to Dutch researchers.

Dr. S.L. Nihjof, a co-author on the report, published in the journal Pediatrics, notes that general practice doctors generally do not diagnose teens due to its rarity among them.  It is often passed off as tiredness typical of busy or active teens.

"Fatigue is a common complaint among adolescents, with a good prognosis," Nijhof said.  "Chronic fatigue syndrome is much less common, but with serious consequences."

In their analysis of medical data and a national survey looking at newly diagnosed chronic fatigue patients, the researchers found that about 1 in 900 teens developed chronic fatigue, a much smaller number compared to adult cases.

But, the researchers say, nearly 75 percent of the teens were not diagnosed by a a general physician.  Instead, they found that most cases had been diagnosed by a pediatrician or other health care provider.

As a result of the illness, 90 percent of teens with the condition miss a significant amount of school (as much as 15 percent), according to the national survey.

Dr. Nancy Klimas, director of the Chronic Fatigue Center at the University of Miami Miller School of Medicine tells HealthDay News, that parents should be attentive to their teens for potential chronic fatigue.  She notes that the condition can often occur after mononucleosis infections, particularly if teens return to school and other activities to quickly.

Copyright 2011 ABC News Radio 


New Guidelines Proposed for Assessing and Resuscitating Children

Ryan McVay/Thinkstock(OXFORD, England) -- After a review of 69 studies including 143,000 children, researchers say the guidelines for pediatric heart and breathing rate reference ranges should be updated.

Dr. Matthew Thompson of the UK's Oxford University and colleagues suggested new reference ranges that are used for assessing and resuscitating children.

The new reference ranges show that a child's respiratory rate from birth to early adolescence decreases, with the sharpest decline occurring under the age of two.  Median breaths per minute fell from 44 at birth to 26 breaths per minute at age two.

The median heart rate in children also climbs from 127 beats per minute at birth to a maximal 145 beats per minute at one month.  By age two, the median heart rate decreases to 113 beats per minute, according to the researchers.

The researchers concluded that the guidelines should be changed due to the differences between the existing published guidelines and the findings of their recent review.

"Our centile charts of respiratory rate and heart rate in children provide new evidence-based reference ranges for these vital signs," they wrote in the report published in the March 15 online edition of The Lancet. "We have shown that there is substantial disagreement between these reference ranges, and those currently cited in international pediatric guidelines."

They add that the current reference ranges should be "updated with new thresholds on the basis of our proposed centile charts," particularly in cases where the differences between their charts and the current ranges are so large that many children are not likely classified correctly.

Copyright 2011 ABC News Radio 

ABC News Radio