Thursday, October 23, 2014

Discussing Weight-Management With Latino Families in the Pediatrician's Office

Pediatrics Editorial Board Member Terrill Bravender MD, MPH, shares his expert perspective on a new article from our December issue. To learn more about Dr. Bravender and his work in adolescent medicine, check out his bio on our Contributors page.

By: Terrill Bravender, MD, MPH

"What's on your plate?"  USDA nutrition initiative  in Spanish.
Photo by the USDA via Flickr
The long-term health implications of childhood obesity are clear: type 2 diabetes, sleep apnea,
orthopedic complications, hypertension and other cardiovascular conditions among others. It is also clear that one component of the public health approach to childhood obesity is involvement of the primary care physician. It is important for primary care providers to review growth charts, identify children who are overweight or obese, screen for medical complications, and develop intervention plans for these children.

Latino children have particularly high rates of obesity, and non-English-speaking and immigrant Latino children have poorer health care access compared to US-born English-speaking Latino children. But once Latino children come into the doctor’s office, what kind of care do they receive? While physicians’ use of body-mass index (BMI) growth charts and identification of obese children has improved over the past 10 years, has it improved for Latino children? And once obese Latino children are identified, what kind of counseling do they receive?

These are the questions asked (and answered) by Dr. Christy Turer and colleagues in the December issue of Pediatrics (doi: 10.1542/peds.2014-1282). The researchers at University of Texas Southwestern Medical Center video/audio taped encounters between physicians and 26 Latino families with overweight or obese children between the ages of 6 and 12.

While it was encouraging that 81 percent of families were told of their child’s overweight status, only about half were helped to develop a weight management plan. Concerningly (but not surprisingly), language barriers played an important role. A number of physicians in the study were Spanish-proficient, so the non-English speaking status of the patients did not play much of a role.

However, language incongruency did play a role: for instance, when physicians and families did not speak the same language, using a growth chart to illustrate the child’s weight status was only used 13 percent of the time; when they spoke the same language, the growth chart was used 83 percent of the time.

The global increases in childhood obesity rates have many social and environmental causes, and the problem will continue to require a multifaceted approach. Identification of at risk children and office-based counseling is one small part, but the least we can do as physicians is to systematize our approach, and work to provide the highest level of care to all of our patients regardless of language status. This is a challenge for sure, but one that certainly can be met.

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Tuesday, October 21, 2014

Parental Desensitization to Sex and Violence in the Movies

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by Brandon Kowitz via Flickr
Ever go to a movie loaded with violence, profanity, and sexuality and express surprise when you find out it’s a PG-13 and not an R-rated film? Do you think that you are sure PG-13 movies of the past never had as much sex and violence as they do now?

If so, you are not alone, but you may be victim of a desensitization phenomenon affecting parents who allow their children to attend PG-13 movies loaded with overly-graphic scenes of sex and violence that one used to attribute only to R-ratings.

Romer et al. (doi:10.1542/peds.2014-1167) set out to assess the desensitization of parents to repeat exposures to violence and sex in movies by inviting 1,000 parents of preteens and teens to view short scenes of violent or sexual content from popular movies from PG-13 or R-rated films. Afterwards, they asked the parents to determine the minimum age that a child might view that film. The more clips seen, the lower the age the parents chose for their children to view the same clips–consistent with parents becoming desensitized to sex and violence on screen.

Sadly, it may not be just parents but also the raters of films who are becoming desensitized and allowing younger children to attend more violent and more sexual films than ever before. This is an important study to read about and then share with your patients.

If you want some perspective on what this study suggests, consider the commentary by Dr. Jeanne Van Cleave (doi:10.1542/peds.2014-2803) that accompanies this study.

By the way, did you know there are now websites that tell parents just how much sex and violence and profanity appear in films? If not, you should know about such sites so you can direct parents of pre-teen and teenage patients to them so they are more aware of what their younger children might be exposed to when they go to the movies. Your ticket to this provocative early-released study from our journal awaits. So make some popcorn, click the link, and learn more.

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Monday, October 20, 2014

Every Eight Minutes: Young Children and Out-of-Hospital Medication Errors

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by Taki Steve via Flickr
Ever get a call from a family concerned that their child just ingested a medication that they should not have? I can’t imagine that there is a pediatrician in practice who has not received such a call weekly, if not daily. So just how common are out-of-hospital medication errors? What types of medications are usually involved, and why do these events occur?

May et al. (doi:10.1542/peds.2014-0309) extracted some interesting findings from the US National Poison Database System for US children less than 6 years old from 2002 to 2012 and discovered the magnitude of this problem is larger than you might think.

For example, did you know that every eight minutes a child experiences an out-of hospital medication error? And while the good news is that cough and cold medication ingestions have decreased over the past 10 years or so, analgesic ingestions have gone up along with a host of other medications.

To find out more about what children are ingesting in the home and what might be done about this, I’d prescribe reading a good dose of this article. Follow up by checking to make sure you or your staff have adequately counseled your patients regarding appropriate preventive steps to reduce the high rates of medication errors occurring in children in this country.

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Thursday, October 16, 2014

Off-Hours Admission to Pediatric Intensive Care and Mortality

Pediatrics Editorial Board Member Joann Schulte, DO, MPH, shares her expert perspective on a new article from our October issue. To learn more about Dr. Schulte, check out her bio on our Contributors page.

By: Joann Schulte, DO, MPH

Photo by Philip Dean via Flickr
Timing counts, especially for critically ill children admitted to pediatric intensive care units (ICUs). The time of day and day of the week are important, as is the kind of illness encountered, the staffing numbers and experience levels of the ICU. All are factors that can shape a child's outcome and determine whether he or she survives to go home.

New research published this month in Pediatrics (doi: 10.1542/peds.2014-1071) found off-hour admissions were associated with a decreased risk of mortality, but morning admissions were associated with an increased likelihood of death. The study was based on a retrospective cohort, assembled using information from a database containing data from 234,192 admissions to 99 hospitals between January 2009 and September 2012. The study ICUs represent about 30 percent of the pediatric ICUs in the United States. The team at Wake Forest University in North Carolina, headed by Dr. Michael McCrory, used a primary outcome of ICU death and defined off-hour admissions as any occurring after 7 p.m. and weekends as Saturday and Sunday.

Other factors associated with an increased risk of mortality included neonatal and infant ages, trauma admission and transfer admissions from inpatient locations or other ICUs. The authors said additional work is needed to evaluate why the morning time period was associated with the peak morality in this study.

This study is important because it adds information about factors associated with leaving the pediatric ICU to go home. So what should this article tell you as a general pediatrician or as a sub-specialist who might have a patient admitted to the ICU? And if you’re practicing in an ICU, what should you tell the referring physician or patient’s parents?

If you’re the referring physician, perhaps you ought to ask about the 24/7 coverage of the ICU and how it is staffed. Does your patient admitted to the ICU have specific issues or parameters or labs that are especially important to monitor no matter what time of day it is? If you’re the ICU physician, has your unit done any monitoring to know temporal patterns of mortality among patients?

This Pediatrics article presents evidence that physicians, no matter what their practice area, need to understand more about the content of care their patients receive day or night in an inpatient setting—in this study, one that focuses on critical care.

Obesity and Interpersonal Dynamics at Family Meals

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by Phyllis Buchanan via Flickr
We certainly run a lot of studies on the role of proper nutrition and exercise in preventing a child from becoming overweight or obese, but what about the dynamics of a family meal itself? Could certain characteristics regarding a family eating together be protective against obesity and other characteristics that contribute to excess weight gain?

Berge et al. (doi:10.1542/peds.2014-1936) performed a cross-sectional observational study in which family meals were videoed in the homes of 120 low-income and minority communities. Communication among family members and other aspects of parent-child and child-sibling dynamics were studied and compared to a child’s weight status. The results are fascinating and indicate the more positive the family dynamic around the table, the less risk of a child being overweight.

While this study cannot prove causality, it is certainly food for thought in regard to our promoting the importance not just having healthy food on the table, but the whole family being gathered together to share and support each other through conversation and other positive dynamics practiced at the family table. Read this study and learn more that you, in turn, can share with your patients’ families.

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Wednesday, October 15, 2014

Sofas and SIDS: A Dangerous Combination

Photo by stevepb via Pixabay
By: Lewis First, MD, MS; Editor-in-Chief 

Recently we received a manuscript from Dr. Rechtman et al. we found so worrisome that we are early-releasing the results of their study this week prior to official publication next month (doi:10.1542/peds.2014-1543).

The study uses data from a national database to look at infant deaths that occurred on sofas in 24 states from 2004 through 2012. The authors then compared demographic and environmental data from sofa deaths to other sleep-related infant deaths in other locations. The fact that sofas account for almost 13 percent of sleep-related infant deaths is concerning, and it’s worth knowing, and sharing with your infant patients’ parents, that these deaths are more apt to be labeled as suffocation or strangulation.

This blog post cannot do justice to the myriad of risk factors associated with infant deaths, so rather than try, check out the study and learn more. After reading this study, I hope you will agree that the sofa is off limits when it comes to safe sleep environments for babies!

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Wednesday, October 8, 2014

Is Teen Sexting a Predictor of Subsequent Sexual Behavior?

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by BdwayDiva1 via Flickr
We have published a number of recent studies on the increasing prevalence of sexting amongst teens, but have not published data on the role of active sexting (sending a nude picture) in mediating or promoting the relationship between passive sexting (being asked for a nude picture) and then going on to have intercourse. But this week, Temple and Choi (doi:10.1542/peds.2014-1974) share relevant data from a six-year longitudinal study of more than 950 high school students.

These students were asked about sexting at baseline entry into the study and one year later as well as whether sending a nude picture encouraged sexual intercourse in that relationship. The results are well worth your attention. It's interesting to note that while sexting overall was not temporally associated with risky sexual behaviors, active versus passive sexting was more associated with having intercourse over the next 12 months.

Since the study was cross-sectional, it cannot prove cause and effect, but it can still identify sexting as a key component in the ongoing sexual development of teens and potentially be considered a potential harbinger for future (if not current) adolescent sexual activity.

Do you ask your teen patients about sexting, or if their friends sext? Do you get positive responses and if so, what do you then say? We would love to hear your approach to helping teens deal with sexting. Leave a comment, send us an eLetter through our journal site, or join in the discussion via Facebook or Twitter.

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