First pediatric auditory brain stem implant lets child "hear"

Wow, this is quite an incredible story on CNN. 3-year-old Grayson Clamp is the nation's first child to receive an auditory brain stem implant. This boy was born without a cochlear nerve, so a cochlear implant didn't help him. He couldn't hear anything until he recently had surgery for an auditory brain stem implant.

Grayson now wears an external speech processor containing a microphone and he also has an external battery that powers the auditory brain stem implant. Doctor's aren't sure "what" he hears, but we know that he is capable of hearing sound.

Back in January, the FDA approved clinical trials for auditory brain stem implants.

Pediatrics 2040: Trends And Innovations for the Next 25 Years

Don't miss this exciting event this fall:

Pediatrics 2040: Trends And Innovations for the Next 25 Years
October 3 - 5, 2013

Disney’s Grand Californian Hotel & Spa
Anaheim, CA


The current myriad of challenges such as cost containment, care fragmentation, healthcare reform, access to subspecialists, escalating costs and knowledge escalation face today’s pediatricians and pediatric subspecialists as well as hospital administrative leadership.

The emerging medical and technological advances as well as trends in the care of children in the coming era is covered in a comprehensive three-day academic program for all involved in the care of children for the next 25 years.

Learn more about this conference here.

What do we know about Asperger syndrome?

The medical community has only recognized Asperger syndrome as its own distinct medical entity since 1994. Most clinicians consider Asperger syndrome to be in the autism spectrum disorder (ASD) or pervasive developmental disorder (PDD). Currently, the medical community does not have a clear consensus on the exact ways to define Asperger disorder and how to distinguish it from other autistic disorders.

The DSM IV describes Asperger disorder as a child with atypical social development (impairment in social interaction) with no delay in language or cognitive development. The child may have restricted, repetitive and stereotyped patterns of behavior, interests, and activities.

If a clinician suspects Asperger syndrome, the child should be referred for evaluation by a developmental-behavioral pediatrician, a child psychiatrist, a child neurologist, or a neuropsychologist with expertise in autism spectrum disorders.

Speaking of autism, we know that mobile tablets like the Apple iPad have been beneficial for kids with autism. You can read about that here.

President Clinton speaking about health care at #DellWorld 2012

Today at Dell World, Bill Clinton went on stage and spoke to the audience about the evolution in technology. Roughly 20 years ago when he took office (1993 to 2001), the average cell phone weighed 5 pounds. He sent 2 emails during his presidency.

Technology has advanced considerably since then, hasn't it?

Now, at the age of 66, Clinton is busy with the Clinton Foundation - set up to improve global health, strengthen economies, promote healthier childhoods and health and wellness, and protect the environment.

Here at Dell World, Clinton spoke about the childhood obesity epidemic that is being fought through better nutrition and changes in dietary habits. He spoke about the advances in pediatric cancer research that are possible due to collaborative data sharing. He mentioned the Health Matters conference that's organized by the Clinton Foundation.

Clinton also spoke about global economic issues around inequality, the importance of non-zero-sum, and how the future depends on creative networks of cooperation. He also entertained the audience by wearing some stylish cowboy boots, thus proving that he's a real cowboy.

Bill Clinton will be speaking at HIMSS 2013, so I look forward to seeing him again in a few months.

July is Juvenile Arthritis Awareness Month

Juvenile arthritis (JA) refers to any form of arthritis or arthritis-related condition that develops in children or teenagers who are less than 18 years of age. Approximately 294,000 children under the age of 18 are affected by pediatric arthritis and rheumatologic conditions.

Learn more by visiting the Arthritis Foundation.

Children’s Hospital Boston reaches Stage 7

HIMSS Analytics Honors Children’s Hospital Boston with Stage 7 Award

The HIMSS Analytics Stage 7 Award honors hospitals that operate in a paperless environment and represent best practices in implementation of the EMR

CHICAGO (December 7, 2011) - HIMSS Analytics announced Children’s Hospital Boston received its Stage 7 Award. The hospital will be recognized at the 2011 Annual HIMSS Conference & Exhibition on Feb. 20-24, 2011 in Orlando, Fla. The award represents attainment of the highest level on the EMR Adoption ModelSM (EMRAM), which is used to track EMR progress at hospitals and health systems. As of November 2010, HIMSS Analytics had recognized 52 hospitals, or 1 percent of the more than 5,000 hospitals in the HIMSS Analytics Database, with its Stage 7 Award.

Prevention of Streptococcus pneumoniae Infections in Infants and Children

The other night, my wife and I were talking about the "Policy Statement—Recommendations for the Prevention of Streptococcus pneumoniae Infections in Infants and Children: Use of 13-Valent Pneumococcal Conjugate Vaccine (PCV13) and Pneumococcal Polysaccharide Vaccine (PPSV23)." This was published earlier this year (May 24, 2010) by the American Academy of Pediatrics.

I don't think many health care professional realize that the updated recommendations call for a supplemental dose of PCV13 for children ages 14 to 59 months who have already received a complete PCV7 vaccination. That's right. Even if those children have received a complete PCV7 vaccination, they qualify for a supplemental dose of the newer PCV13. It's time to take some of our kids back to the doctor so that they can get this supplemental dose. I'm sure they're going to love us for that. Maybe we'll have to give them some ice cream for being a good sport and enduring yet another shot at the doctor's office.

Committee on Infectious Diseases "Policy statement -- recommendations for the prevention of Streptococcus pneumoniae infections in infants and children: use of 13-valent pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23)" Pediatrics 2010; DOI: 10.1542/peds.2010-1280.

Chewable Lipitor for kids in Europe

Chewable Lipitor. Can you imagine? Should kids be taking statins? As our nation faces an obesity epidemic, we're seeing all types of lipid disorders in children and young people are dying from heart disease. Some kids have genetic conditions that predispose them to hypercholesterolemia, so it's really not based on their diet or exercise patterns. But for the rest of the kids out there who are living with elevated cholesterol levels, should they be taking a chewable statin so that they don't have a heart attack or a stroke as a teenager?

The European Union recently approved a chewable form of Lipitor for kids.

Soon, kids at school will need to pull out their pill boxes at lunch time. Let's hope they don't trade their pills like their lunch box snacks.  I wonder what the television commercials will be like if we see direct-to-consumer ads for chewable pediatric Lipitor someday.

Baby gate gets recalled (Babies R Us)

Yesterday, I got an e-mail from Babies R Us notifying me that a baby gate has been recalled. Fortunately, this gate is in my garage so I need to take a look to see if it's one of the ones recalled. The recalled item was an Evenflo® Top-of-Stair™ Plus Wood Gate. 
http://www1.toysrus.com/safety/729186.cfm

Earlier this week, I wrote about a CNN story (Are infant slings causing baby deaths?) and I discussed how some baby slings may be causing death/harm. Some of these slings have been recalled.

We live in a world where new products are constantly being invented. Can we trust these consumer products? How safe are they? Over the past few years, I've had all sorts of items recalled. Baby cribs. Laptop batteries. Baby gates. Toys. The list goes on and I can't even keep up with all of these things.

To research recalled products, make sure to visit: http://www.recalls.gov

Are infant slings causing baby deaths?

I actually bought a baby sling for my wife a few months ago. She tried it for a day and didn't like it, so I returned it to Babies R Us. It's hard to imagine what it must be like to grieve the loss of a baby.

There's a story on CNN titled, "Grieving mothers blame baby slings for infant deaths."  Here are the story highlights:

• Two mothers blame Infantino "SlingRider" for their infants' deaths in 2009
• Infantino issued a recall Wednesday of two baby slings, offering replacement slings
• Recall includes more than 1 million slings sold in U.S., Canada, Europe
• U.S. Consumer Product Safety Commission says it identified 14 deaths with sling-style carriers

According to the article: Earlier this month, the U.S. Consumer Product Safety Commission issued a warning about the use of certain baby slings, saying it had identified 14 deaths with sling-style carriers, most of them in children younger than 4 months. On Tuesday, Health Canada issued a joint statement with the agency, saying three of the deaths appeared to occur in one of Infantino's slings.

Graco Recalls Strollers Due to Fingertip Amputation

WASHINGTON, D.C. - The U.S. Consumer Product Safety Commission, in cooperation with the firm named below, today announced a voluntary recall of the following products. Consumers should stop using recalled products immediately unless otherwise instructed.


Name of Product: Graco’s Passage™, Alano™ and Spree™ Strollers and Travel Systems
Units: About 1.5 million
Manufacturer: Graco Children’s Products Inc., of Atlanta, Ga.
Hazard: The hinges on the stroller’s canopy pose a fingertip amputation and laceration hazard to the child when the consumer is opening or closing the canopy.
Incidents/Injuries: Graco has received seven reports of children placing their fingers in the stroller’s canopy hinge mechanism while the canopy was being opened or closed, resulting in five fingertip amputations and two fingertip lacerations.
Description: This recall involves Graco Passage™, Alano™ and Spree™ Strollers and Travel Systems with the following model numbers and specific hinge mechanisms:

Model Numbers
6303MYC, 6303MYC3	7240DNB, 7240DNB2 7240MKL2, 7240MKL3	7F02GLM3
6320IVY, 6320LAU	7241DDH2, 7241DHO3	7F04TAY3
6330CAP, 6330THR, 6330THR3	7255CLP, 7255CLP2, 7255CRA2, 7255CRA3, 7255CSA3, 7255GPK3, 7255GRN, 7255GRN2, 7255JJB3, 7255ORC2, 7255WLO2, 7255WLO3	7F07EMA3
6F00QIN3, 6F00RRY3	7256CLO2, 7256SPM2, 7256SPM3	7F08DSW3, 7F08LAN3
6F03GLN3	7260BAN, 7260BAN2, 7260BAN3, 7260MRA2, 7260MRA3, 7260PKR, 7260PKR2	7G00DLS3, 7G00DLS4
6G10CSE3	7270BIA, 7270BIA2	7G01CRL3
7235GGA, 7235GGA2	7E01JON2, 7E01JON3	7G04KRA3
7236CDR2	7F00LPE3, 7F00RSH3	7G05GPR3, 7G06WSR3
7237HOL2, 7237HOL3	7F01FOR3	7G07ABB3, 7G07BAT3

Graco manufactured two different styles of hinge mechanisms for these stroller models. Only strollers or travel systems with a plastic, jointed hinge mechanism that has indented canopy positioning notches (see photo below) are included in this recall. The recalled strollers were manufactured between October 2004 and February 2008. The model number and manufacture date are located on the lower inside portion of the rear frame, just above the rear wheels.
Sold at: AAFES, Burlington Coat Factory, Babies “R” Us, Toys “R” Us, Kmart, Fred Meyer, Meijers, Navy Exchange, Sears, Target, Walmart and other retailers nationwide from October 2004 and December 2009 for between $80 and $90 for the strollers and between $150 and $200 for the travel systems.
Manufactured in: China
Remedy: Consumers should immediately stop using the recalled strollers and contact Graco to receive a free protective cover repair kit.


Click here for full details from the U.S. Consumer Product Safety Commission.

Health Insurance Companies should be required to Reimburse for “Virtual Office Visits”

This is a guest post by Tessa G. Lebinger, M.D. If you're interested in submitting a guest post, please contact me.

Health Insurance Companies should be required to Reimburse for “Virtual Office Visits”

I am a Pediatric Endocrinologist who for more than 10 years has utilized e-mail as a supplement to office visits in the management of children with diabetes. Patients send me records of their blood sugars, food intake, insulin, and exercise along with comments and questions and I e-mail back recommendations and answers. I have provided this service for free because insurance companies do not reimburse patients for “Virtual Office Visits”. If the patients were to come into my office with their logs and receive the same advice “face-to-face” from me, medical insurance companies would pay for these services as a routine office visit.

Frequent adjustment of the treatment plan is necessary for children with diabetes whose needs are constantly changing. Although they should be seen in person a few times a year to evaluate their growth, physical development, and have their thyroid glands examined, many children need to have their insulin doses revised much more frequently than this. E-mail is the perfect way to provide this comprehensive care in between office visits. This is good for the children because they don't miss school and good for the parents because they don't miss work. For families who live a long distance from a Pediatric Endocrinologist, communication by e-mail can save them the inconvenience of frequent, long trips.

Diabetes is a chronic disease which if not properly controlled can lead to life threatening complications. Patients with diabetes have the ability to collect an enormous amount of information themselves through frequent self- monitoring of their blood sugars at home, but they often need professional advice to adjust their insulin based on these results. Patients with other chronic diseases like hypertension or asthma also have the ability to collect data such as blood pressure readings and peak flow measurements (an indication of lung function) at home. Many of these individuals can also benefit from “Virtual Office Visits” to facilitate frequent fine tuning of their medications.

There is a growing trend towards providing health services online for an increasing number of both acute and chronic disorders. Many healthcare providers already offer advice by personal e-mail. As more physicians implement electronic medical records, they will have the capability of secure online written communication with their patients that will automatically be recorded in the medical record. Private companies are entering the market of facilitating web-based “Virtual Office Visits”, either in “real time” utilizing audiovisual teleconferencing or with a short delay through secure online messaging. “Virtual Office Visits” may take place between individuals and their own personal healthcare providers or, with some services, patients can request a “Virtual Consultation” any time of day from an independent physician who is on call. Often laboratory tests can be requested and prescriptions ordered online.

Clearly, not all symptoms and diseases can be managed online. If a patient is having chest pain or severe abdominal pain, he/she needs to be examined in person. However, most medical questions that are typically asked over the telephone can both be submitted and answered by e-mail – without playing “phone tag”. With audiovisual conferencing capabilities, more extensive evaluation of the patient can be performed.

A “Virtual Office Visit” does not require the services of a medical assistant or secretary and does not need to be done during office hours or even in a medical office. Therefore the cost is usually significantly less than that of a traditional office visit. Many patients are willing to pay out of pocket for the convenience of these “Virtual Visits” and some large employers are subsidizing e-Consultation services for their employees to decrease absenteeism. A few health insurance companies have recently started to pay for “Virtual Office Visits”, but most don't yet.

In my opinion, insurance companies should be required to reimburse for these services. Healthcare Providers incur medical liability every time they give medical advice, whether face-to-face in the office, over the phone, by fax, or by e-mail. If they incur liability, they should receive compensation for their services and time.

I propose mandatory reimbursement for “Virtual Office Visits” as part of health care reform.

This guest post was written by Tessa G. Lebinger, M.D., Pediatric Endocrinologist and Medical Writer, Baltimore, MD

References:

• American Diabetes Association Website - http://www.diabetes.org/
• Children with Diabetes Website - http://www.childrenwithdiabetes.com
• Wikipedia article about blood glucose meters - http://en.wikipedia.org/wiki/Glucose_meter

When babies don't sleep...

When babies don't sleep, parents don't sleep. That's been the story of our lives for the past few years as we've been raising young children. When babies sleep well, it's a wonderful thing! Some babies are natural sleepers while others seem to struggle with insomnia. Proper sleep hygiene can make a big difference when it comes to sleeping babies. Many of these same sleep hygiene principles also apply to toddlers, kids, and even adults. I hardly ever have trouble falling asleep, but I know many people who seem to always struggle with insomnia (including our kids). 

Sometimes, we use a sound machine in our baby room to produce white noise. We don't live in a large city where you have street noise entering the home. We also don't live near large busy streets, so it's actually fairly quiet inside every room. We're surrounded by woods, so it actually feels like you're in the forest and it can get pretty loud because of all the insects singing at night. I don't know that any white noise machine can effectively drown out the symphony of humming insects on a summer night. Maybe we need to get a few different a few different sound machine devices. You'd think that with all the advances in technology we've seen over the past few decades, we'd have some really efficient baby sleeping machines out there.

There are many books out there on the topic of infant sleeping. These books offer contrasting views on sleep training methods and we probably read all of them when we had our first baby. If you're a parent, how did you sleep train your baby? I know a handful of really lucky parents who had babies that didn't need much sleep training because they naturally fell asleep and stayed asleep effortlessly.

1 in 110 U.S. children had autism in 2006

We probably all know someone who has autism. We also probably all know a parent who has a child with autism.

According to a new report published by the Centers for Disease Control and Prevention (CDC), 1 in 110 U.S. children had autism in 2006. The Autism and Developmental Disabilities Monitoring Network has improved our ability to monitor the epidemiology of autism. Autism covers a spectrum of disorders ranging from autistic disorder, or classic autism, and the two milder forms: Asperger's syndrome and atypical autism called Pervasive Developmental Disorder - Not Otherwise Specified (NOS). That phrase NOS almost reminds me of the term "idiopathic." It doesn't have the same meaning, but these non-specific terms in the world of healthcare reminds all of us that we still have so many unanswered questions about medicine.

NOS = why shouldn't something be specified?
Idiopathic = there must be a reason, even if we don't really know what that reason may be.

When it comes to autism, things can get quite heated and emotional. There are some people who strongly believe that vaccines have contributed to the increase in autism. Others blame different environmental factors. Some simply think we're doing a better job identifying children who have autism, so the prevalence hasn't truly increased - it's just a reflection of increased recognition and diagnosis. They argue that in the past, children with autism simply weren't detected. They flew under the radar. Do you believe that?

One of the most significant gaps that prevents us from effectively answering this question is the paucity of autism research. Parents simply are not willing to allow their children to participate in research. How else will we discover what's causing autism in these young ones?

Baby is 1 week old and life is good (picture)

Our baby is a week old and life has never been better. This baby is a sleeper! She just eats and sleeps. I've been told that I was like that when I was a baby. Eat and sleep, eat and sleep. Don't you wish that all babies were so easy? Our newborn is the easiest baby we've ever had!

So, although we're more sleep deprived that usual, we're not nearly as deprived as before. I'm still able to keep up with some blogging (albeit not as much as before) and my wife is enjoying her maternity leave. It's so great to have friends and family around to help with things around the house. Here's a picture of our baby being held by her older sister.

Asian babies and infant jaundice

You've probably guessed that I'm Korean based on my last name Kim. Well, Asian babies frequently have problems with infant jaundice (or newborn jaundice, neonatal hyperbilirubinemia, etc.). This is nothing new in our family. Our first baby (full term) had jaundice and our new baby (who was also full term) also has jaundice. This is probably nothing serious, but it can be a hassle when you have to go back to the hospital (especially during flu season). So, I'm heading to the hospital to get her bilirubin levels checked today. Hopefully, she won't need a bili light like the baby in this picture.

H1N1 vaccine now approved for infants and children

According to the FDA, the CSL Limited’s 2009 H1N1 influenza vaccine may now be used in infants and children over 6 months in age. Talk with your health care provider to see if your children should receive the H1N1 vaccine.

“Because children are among those most vulnerable to the 2009 H1N1 virus, having a broader range of children’s vaccines available is an important step in responding to the H1N1 outbreak,” said Margaret A. Hamburg, M.D., commissioner of food and drugs.

To read the FDA update, click here.

ASCO/Children's Oncology Group (COG) Symposium in Dallas

Today, the 2009 ASCO/Children's Oncology Group (COG) Symposium is taking place in Dallas, Texas. The theme this year is titled, "21st Century Challenges to Pediatric Oncology Drug Development." Speaking of drug development, I know so many kids who are now living as cancer survivors. It's quite amazing when you think about the fact that these children would not have survived when you compare pediatric cancer treatment options from twenty or thirty years ago versus today. Thanks to modern medicine and advances in cancer research, many children live into adulthood as cancer survivors - cured from their illnesses.

It's quite exciting to see all the advances in oncology drug development. Ten or twenty years from now, we will look back and remember that we had so few options to treat cancer.

Do your children need ADHD medications?

Kids are hyper, aren't they? They also have really short attention spans, don't they? Did you catch the CNN story titled, "Does your child need ADHD drugs?" If you're not a healthcare professional, can you evaluate whether your children (who have ADHD) should be taking medications for their ADHD? What do we (as healthcare professionals) really understand about ADHD? We certainly know a lot more than we did 10 or 20 years ago. However, we probably also have a lot more to learn about the brain.

My concern with this CNN story is that parents (or children) may read this and decide that they may want to perform a little experiment and stop taking their ADHD medications. In this example, the girl eventually told (or confessed) to her parents that she had intentionally stopped taking her meds. But what if your child does the same thing and never tells you? Physicians don't generally recommend that children with ADHD should be making decisions about stopping medications. Who likes taking medications? I don't.

The CNN story also points to the dangers associated with free drug samples. You're not going to find free drug samples of cheap, generic drugs. Instead, you get samples of the latest and greatest. What happens when the samples run out? You end up paying for the latest and greatest instead of paying for cheap generics. For some families, that may not be a big deal. For others, that could become a significant financial strain. So do your children need ADHD medications? If so, which drugs are the best options?

Did you know that Consumer Reports has a list of ADHD drug recommendations? I love Consumer Reports, but should they be making such medical recommendations when ADHD therapy really needs to be tailored for each individual? These types of reports could mislead parents and children, so although they may be helpful for some, they could also confuse or mislead others. At the end of the day, I hope you're working with a really good healthcare professional who can explain why you (or your child) may need ADHD medications.

Gross Pediatric Health Conditions

CNN has a better title. "The four grossest kid health problems"

They list these 4 conditions:

1. Pinworms
2. Lice
   
3. Ringworm
4. Scabies

Notice the "infectious disease" theme here? I don't think ringworm is that bad, but the other three can be quite nasty. Of course, you're not going to see other exotic parasitic conditions here in the U.S. However, go on a medical missions trip to a developing nation and all of a sudden you'll see all sorts of worms, including: Trichuriasis (whipworm), Ascariasis (my favorite), Necator americanus (hookworm), Strongyloidiasis (threadworm), Trichinella (not Trichomoniasis which is an STD), and Wuchereria bancrofti (OK, maybe this is really my favorite, but I've never personally seen someone with Elephantiasis).

So why do kids get all these wonderfully gross infections? Much of it boils down to sanitation and hygiene. If they're exposed to infected kids at day care or school, then there's a greater risk. At the end of the day, it's important that kids wash their hands using soap and water and that they bathe regularly. Sounds pretty basic, doesn't it?