The Kidfixer Newsletter

A quarterly newsletter from Doctors Mesibov, Altman, Jacobs & Neustein            Summer 2019

 


Vaccines and Autism

From the National Institutes of Health




Study after study has found no link between autism spectrum disorders (ASD) and the measles-mumps-rubella (MMR) vaccine—or any vaccine for that matter. Yet many parents still refuse or delay vaccinations for their young children based on misplaced fear of ASD, which can be traced back to a small 1998 study that’s since been debunked and retracted. Such decisions can have a major negative impact on public health. With vaccination rates in decline, we’ve recently seen the resurgence of measles and other potentially fatal childhood infectious diseases.


Among the parents most likely to avoid getting their kids vaccinated are those who already have a child with ASD. So, it’s especially important and timely news that researchers have once again found no link between MMR vaccines and ASD—even among children known to be at greater risk for autism because an older sibling has the developmental brain disorder.


In a recent study published in JAMA, an NIH-funded team analyzed health insurance claims for more than 95,000 children, ages birth to 5, plus their older siblings. More than 1,900 of the children studied had an older sibling with ASD, which is known to place them at greater risk of being diagnosed with ASD themselves.


Overall, about 1 percent of the children were diagnosed with ASD during the time period studied. The rate was significantly higher—nearly 7 percent—among the children with an older sibling with ASD, but the risk did not increase if they had received the MMR vaccine. In fact, in families that had an older child with ASD, a vaccinated younger sibling was actually somewhat less likely to receive an autism diagnosis.


Current U.S. recommendations call for two doses of MMR vaccine in children at age 12 to 15 months and then again at age 4 to 6. Given the distressing resurgence of measles in California and elsewhere, and this new study showing once again the lack of any connection of MMR vaccine and ASD, it’s more critical than ever that parents protect their children against measles and other infectious diseases by staying current with vaccinations.


The consequences of not vaccinating children are serious. Measles can lead to ear infections, pneumonia, seizures, brain damage, and even death. Furthermore, parents have a responsibility not only to their own children, but to the community—it’s only by achieving a very high level of population immunity that outbreaks can be prevented. That’s particularly crucial for those children with cancer and other diseases that cause immunosuppression. They cannot be vaccinated and depend on the so-called “herd immunity” of the community for protection against a potentially fatal infection.



Vaccines and Autism II

With and Assist from webmd


The recent frightening epidemic of measles throughout the U.S. is the unfortunate result of some very troubling and incorrect ideas about the relationship between the measles vaccine and autism. As the newspapers and TV news people remind us, these false ideas can have some very serious consequences. Measles is NOT a harmless disease.


The research is clear: Vaccines DO NOT cause autism. More than a dozen studies have tried to find a link. Each one has come up empty.


MMR Vaccine Controversy


The debate began in 1998 when British researchers published a paper stating that the measles-mumps-rubella (MMR) vaccine caused autism. The study looked at only 12 children, but it received a lot of publicity. At the same time, there was a rapid increase in the number of kids diagnosed with the condition.


The paper’s findings led other doctors to do their own research into the link between the MMR vaccine and autism. At least 12 follow-up studies were done. None found any evidence the vaccine caused autism. In fact, the journal that published it eventually retracted it. That meant the publication no longer stood by the results.


There were other problems, too. For example, investigators learned that a lawyer looking for a link between the vaccine and autism had paid the lead researcher more than £435,000 (equal to more than a half-million dollars).


Thimerosal Controversy


A year after the British study, fears about a possible vaccine-autism link shifted from MMR to a substance used in some children’s vaccines. It was called thimerosal, and it contained mercury. That’s a metal that’s harmful to the brain and kidneys at high levels. Doctors used thimerosal to prevent the growth of bacteria and fungi in vaccines.


There was no evidence that the small amount used in the medicines caused harm. Still, it was taken out of most children’s vaccines by 2001 at the urging of the American Academy of Pediatrics and the U.S. Public Health Service.


To see if thimerosal was linked to autism, researchers studied children who received vaccines that contained it. They compared them to kids who received vaccines that didn’t. The CDC conducted or paid for nine different studies looking at thimerosal and autism. It found no link.


What’s more, autism diagnoses continued to rise after vaccine makers took thimerosal out of almost all childhood vaccines.


What About All Vaccinations Combined?


Researchers have also looked to see if all the vaccines required before age 2 somehow together triggered autism. Children receive 25 shots in the first 15 months of life. Some people feared that getting all those shots so early in life could lead to the development of autism.


But the CDC compared groups of children who received vaccines on the recommended schedule and those whose vaccines were delayed or didn’t get them at all. There was no difference in the autism rate between the two groups.


In short, vaccines do not cause autism, and withholding vaccines from children out of fear of autism is, as can be seen by the latest sad cases of measles-related illnesses, very dangerous.



Choking Prevention




When children begin crawling, or eating table foods, parents must be aware of the dangers and risks of choking. Children younger than 5 years can easily choke on food and small objects.


Choking occurs when food or small objects get caught in the throat and block the airway. This can prevent oxygen from getting to the lungs and the brain. When the brain goes without oxygen for more than 4 minutes, brain damage or even death may occur. Many children die from choking each year. Most children who choke to death are younger than 5 years. Two thirds of choking victims are infants younger than 1 year.


Balloons, balls, marbles, pieces of toys, and foods cause the most choking deaths.


Dangerous foods

Do not feed children younger than 4 years round, firm food unless it is chopped completely. Round, firm foods are common choking dangers. When infants and young children do not grind or chew their food well, they may try to swallow it whole. The following foods can be choking hazards:


  1. Hot dogs

  2. Nuts and seeds

  3. Chunks of meat or cheese

  4. Whole grapes

  5. Hard, gooey, or sticky candy

  6. Popcorn

  7. Chunks of peanut butter

  8. Raw vegetables

  9. Fruit chunks, such as apple chunks

  10. Chewing gum

Dangerous household items

Keep the following household items away from infants and children:

  1. Balloons

  2. Coins

  3. Marbles

  4. Toys with small parts

  5. Toys that can be squeezed to fit entirely into a child’s mouth

  6. Small balls

  7. Pen or marker caps

  8. Small button-type batteries

  9. Medicine syringes

What you can do to prevent choking


   •    Learn CPR (cardiopulmonary resuscitation) (basic life support).

  •    Be aware that balloons pose a choking risk to children up to 8 years of age. • Keep the above foods from children until 4 years of age.
 

  •    Insist that children eat at the table, or at least while sitting down. They

should never run, walk, play, or lie down with food in their mouths.
   

  •    Cut food for infants and young children into pieces no larger than one-half

inch, and teach them to chew their food well.
      

  •    Supervise mealtime for infants and young children.
       

  •    Be aware of older children’s actions. Many choking incidents occur when

older brothers or sisters give dangerous foods, toys, or small objects to a

younger child.
        

  •    Avoid toys with small parts, and keep other small household items out of

the reach of infants and young children.
        

  •    Follow the age recommendations on toy packages. Age guidelines reflect

the safety of a toy based on any possible choking hazard as well as the

child’s physical and mental abilities at various ages.
       

  •    Check under furniture and between cushions for small items that children

could find and put in their mouths.
       

  •    Do not let infants and young children play with coins.




Traveling with Your Child: Short Trips & Long Treks





Whether it’s a Sunday car ride to Grandma’s house or a holiday vacation to the Bahamas, traveling with children can be fun, if challenging. Traveling with your kids is also a great way to build strong family bonds, since you are “forced” to spend more time together than you would on days where work and school limit your parent-child interaction. With summer break upon us, it’s a good time to take a look at some of the issues associated with traveling with a child.


Motion sickness


Motion sickness is a common condition, especially in kids, over 50% of whom tend to make their parents’ car smell a bit -- cheesy.


What is it? Sufferers become dizzy, nauseous, vomit and suffer from a variety of other symptoms after traveling in a car, boat, train or airplane.


What causes it?  Differing theories have suggested different causes for motion sickness, but most experts agree that, at least in part, it is due to a difference in signals coming to the brain from the eyes and inner ear. For example, getting dizzy or nauseous while watching a panoramic movie or playing a video game occurs because the eyes say “We’re moving,” while the inner ear says “This child’s head is steady, so we must be still.” It is likely that neurotransmitters (brain chemicals) such as histamines and serotonin, are involved in this process as well. Certain factors seem to predispose a child to motion sickness. Why do some kids vomit all over their parents’ new sedans while others can draw, read and watch videos without so much as a burp?Although some people simply never develop motion sickness (roller coaster champs) and others become nauseous at the mere mention of an amusement park (never say the words “Palisades Amusement Park” to me. Oy!), there are certain factors which predispose kids to motion sickness. Specifically, as per expert Dr. William Stauffer, motion sickness is more common:


• Between the ages of 4 and 10

• In girls than in boys (with lots of exceptions)

• With noxious stimuli: Strong smells, cigarette smoke, etc.

• After eating a high-calorie or dairy meal

• With motion that is low-frequency, like the movement of waves in a boat

• With hormonal factors, such as a menstruating girl or someone taking birth control pills.


What does it look like? Symptoms of motion sickness in kids include:


• Unsteady gait: This is the most common symptom in younger children, many of whom do not experience nausea or vomiting. Look at a child after a ride on the Super Duper Looper and you’ll see a super duper wobbly gait.

• Nausea and vomiting: Don’t look too closely!

• Vertigo: The sensation of spinning or a feeling that the child (or room) is moving

• Pallor

• Cold sweats


How is it treated? Once the ride is over, there’s not much a parent can do about motion sickness, so to help prevent this annoying condition (and to keep your nice new car smelling fresh), consider the following preventative strategies, as recommended by Doctors Stauffer and his associates in Contemporary Pediatrics:


• Medication: Most medications that treat motion sickness neutralize the effects of neurotransmitters. Make sure you speak to your doctor before using any of the drugs mentioned below (and before using any medication). Drugs that can be safely used in most (but not all) young children include dimenhydrinate (brands include Dimentabs, Dramamine, Dramilin) and diphenhydramine (Benadryl), which are available as pill, chewable and liquid. Both of these drugs work best when given 1/2 to 1 hour before travel and both may be accompanied by sleepiness and dry mouth. For most children, giving 1/2 milligram per pound of weight (up to 50 mg) is an effective dose. Although other medications, such as meclizine (Antivert, Bonine) and scopolamine (Hyoscine, Transderm Scop) work for a longer period of time, they are not approved for children under 12 years of age.


• Herbals: Ginger root is one herbal remedy that appears to have some effectiveness in preventing motion sickness. Available in candies, teas, capsules and powders, ginger usually is given in a dosage of 100-125 mg in children age 6-12, and in half that dosage for kids from 3-6. Oh, and by the way, most gingerales have no ginger root!


• Other strategies:

• Before travel, eat only a light meal, low in fat and dairy.

• Encourage your child to look out the front window, not the side window. Those rapidly-passing trees and buildings are a recipe for dizziness.

• Keep the car cool (open the window or put on the air conditioner).

• Put away books and video games. Some children tolerate videos while driving; others do not. If little Felix is one of those who tend to get sick when watching TV in the car, save Where’s Nemo for the hotel room.


Flying


Kids love plane trips, and most of them find enough to look at to keep them happier than their seat-clutching parents. Nevertheless, here are some tips for making that airplane trip easier for everyone:


• Food: Some airlines have meals for young kids, but call ahead to double-check your airline’s policy. Bring along some snacks, just in case.

• Permission: If only one parent is flying out of the country with a child, many airlines require a notarized letter stating that both parents give permission for the child to travel.

• Fly at night: A night flight, if convenient, might ensure better sleep, for both you and your child.

• Flying with a cold: To minimize that uncomfortable ear popping that’s exacerbated when we fly with a cold, instill a drop or two of Children’s Neosynephrine nose drops (or a spritz of the spray) in each nostril as the plane is preparing to take off and land. Also, allow Felix to drink or chew something during ascent and descent; the swallowing will minimize pressure changes.

• Bring the car seat for small children: Make sure that your safety seat is Federal Aviation Administration (FAA)-approved.


Overseas travel


A long trip sometimes means more opportunity for crisis. Before you and Felix head for Borneo, prepare:


• Medication: Bring along any medication that Felix regularly uses. If he is a wheezer and requires a nebulizer, bring it with you, along with the medication that is used in the nebulizer. If he has a skin condition and uses a special ointment, bring that as well. If you’re going for more than a few weeks, bring along his vitamins. If Felix gets frequent ear infections, you might want to ask your doctor to write a prescription for a medication that works well for him, and that he takes without too much of a fight. That way you won’t be at the mercy of an unfamiliar pharmacy.


• Immunizations: Make sure that he’s up to date on his regular vaccines, such as DTaP, polio and so on. There are some countries for which special immunizations are recommended. For example, a typhoid vaccine is recommended before traveling to certain underdeveloped countries. Travel to other countries requires malaria prophylaxis. Such recommendations change depending upon what outbreaks are occurring at a particular time. How is one to know what is needed? The best policy is to get in touch with the Centers for Disease Control and Prevention (CDC), either through their Web site’s travel page or by phone (888-?232-?3228), a few months before you travel and then again within one month of travel.


• Insect repellent: If you’re off to a place with lots of creepy-?crawlies, bring along an insect repellent with 20-30 percent DEET, the most effective insect repellent.

• Sunblock: Pack a block with an SPF of at least 15.

• Traveler’s diarrhea: Travel to many countries involves a risk of traveler’s diarrhea, a bacterial infection of the intestines. In such areas as Central America, Africa, the Middle East and Asia, stick to bottled water and eat only fruits that can be peeled. Avoid salads and uncooked vegetables, as well as ice cubes, all of which can be contaminated. Your doctor may suggest a specific antibiotic (such as Bactrim or Septra) to treat the bacteria that cause traveler’s diarrhea.

• Passport: Your child will need his own passport.


Choosing a location for the family vacation


Do you remember the old Chevy Chase movie, Summer Vacation? Fortunately, none of ourfamily vacations were that disastrous, but there were places we selected that might have been mistakes (one particular camping trip comes to mind, where temperatures dropped into the twenties and my kids and I left Mom alone in the tent while we squeezed into the warmer hatchback). Although any vacation spot can have unexpected problems, and although a family can become closer even on a somewhat unpleasant trip, keep these factors in mind before you pack everyone into the family “truckster” and head out for “WallyWorld”:


• Try to find a spot where Mom and Dad will be happy: You guys count, and you certainly deserve (and need) that vacation just as much as little Felix and Felicia. If you’re miserable, then your tempers will be short and the vacation is sure to be a bust no matter how many rides or video game arcades there are for the kids. Keep in mind that you don’t have to select Disney World or Seven Flags for every trip. There are plenty of vacation spots that are less hectic and better suited to parental relaxation, but which are still kid-friendly. Choosing an island vacation, for instance, which may be exactly what Mom and Dad need, is perfectly okay if there are activities for children. Many resorts feature pools with slides, game rooms, arts and crafts, child-geared water sports and even “day camps” to keep Felix and Felicia occupied while you soak up some sun and read a few pages of that novel that’s been sitting on your night stand for the past six months. Many hotels even have reliable baby sitters, so that you can sample a bit of nightlife.


• Find a spot where your kids will be happy: There are many kid-friendly resorts, but there are also many where bringing along the little ones is discouraged. Most hotels will tell you if they’re “primarily for couples,” a phrase to interpret as “keep the kids home.” Also, keep your child’s particular interests in mind when making vacation plans. If Felix loves beaches and water sports, he’s bound to be happy if he can snorkel or explore the beach for seashells. If Felicia likes the snow, finding a place where ski instruction is available is a pretty good guarantee that she’ll be happy.


• Get the kids involved in planning: The fun of a vacation can be extended by involving the kids in preparations. Get books from the library or Google the website of the place you’ll be visiting and do a little research. With a little effort you usually can find some historical or cultural facts to make the trip not only more fun but a learning experience as well (just don’t use the words “learning experience” -- a certain turn-off). An island vacation can be more than just five days of swimming and eating, especially if there’s a bit of rain forest or some other educational sites nearby.


Leaving your child behind when you take your hubby-wife vacation


Traveling alone is always an option, as long as you’ve got someone responsible at home to keep an eye on Felix and make sure that he doesn’t get into trouble. For vacation travel, you’ll get a much-needed break. For business travel, leaving your child home is often your only option. Don’t feel too guilty, either. This is one more time where a child is forced to learn a bit of independence. Handling a week or two with “only” Gramps or a nanny around can make Felix feel like a big boy and instill added confidence. Let’s consider a few issues before you take off for that long-overdue romantic getaway:


• Choose a care-giver wisely: Selecting someone to care for your precious little Felix is critically important. Add to the usual importance of a good care-giver the fact that you will be more than a few minutes away and your decision is now crucial. Remember, just because you trust someone to clean your house, that doesn’t necessarily mean you can trust that person to watch your child when you’re away. Good housekeepers aren’t necessarily good “kidkeepers.” It’s also not satisfactory to say that, although you’re a little unsure about the care-giver you’ve chosen, Grandma and Poppa are just a few miles away. That distance can seem like hundreds of miles in an emergency. Assume that there will be a problem so that you will be prepared if it arises.


• Prepare your child: The separation will be much easier for your child if his parents have left him with a care-giver many times in the past. If, on the other hand, you’re a two-parent, one-worker family, and you rarely leave your child with a sitter, then it would be a good idea to “practice” separation for a few weeks before you leave on your trip. Leave Felix with a sitter or with a relative a couple of times before you leave, so that he’ll build the confidence of handling separation.


• Prepare your care-giver: Leave your care-giver with the following information:


• A phone number where you can be reached, including country codes if you’re traveling overseas

• The phone numbers of any friends or relatives who live nearby

• Your pediatrician’s phone number, along with directions to his office and your child’s essential medical history, including allergies.

• Your medical insurance card

• The phone number and address of a nearby pharmacy

• Police, fire and poison control numbers

• Access to a car or the phone number of a taxi, car service or a friend who can drive

• Any medications that your child might need, along with any other health devices, such as inhalers or nebulizers

• Your child’s favorite books, videos, games or toys

• Your child’s favorite foods and snacks

• A signed letter from you giving permission for your care-giver to okay any emergency procedures


Try to keep in contact, either by phone or e-mail, with your child. Hearing Mom or Dad on the phone might bring tears but, ultimately, it’s still reassuring to the lonely child. Also, expect a bit of a cold shoulder for a short time after you return. Kids are smart about instilling guilt, and many will use this as a way of getting added privileges or loosening discipline. The best way to reassure your child that things are back to normal is to resume his regular routine and enforce his usual limitations.


Bon voyage!