Playing It Safe

ToyAssocLogo_PMS

We all know that toys are fun. From building blocks and dolls, to puzzles and action figures, toys bring laughter and learning to kids of all ages and are a critical component of their healthy development. But as a member of the medical community (and in many cases, also a parent, grandparent, or caregiver) you may find yourself wondering from time to time if children’s toys are truly safe. The good news? Toy safety is a top priority and year-round commitment that is shared by industry, government, medical professionals, and child development experts. read more

Management of Aggression in Emergency Departments is more than just PRNs

Anik Jhonsa, MD

In recent years pediatric emergency departments have seen a dramatic rise in the number of children and families presenting seeking mental health treatment.  As a child and adolescent psychiatrist primarily working in the emergency room, I’m often asked by my Emergency Medicine colleagues to develop an “agitation plan” for patients who are deemed at risk of acting out in an aggressive manner.  Most often these requests tend to focus on the PRN medication plan should a child become aggressive or upset.  However, most successful agitation plans begin well before any medication needs to be administered. read more

Infant Respiratory Distress with Hypotonia: Casting a Broad Differential

Dr. Anya Kleinman

Case Presentation:

Two-month-old male presented with unknown duration of respiratory distress. He had been “breathing fast since birth” with no acute fevers, vomiting, or sick contacts. Review of systems is notable for diffuse muscle weakness and chronic coughing with feeds. Developmental history is significant for lifelong decreased movement and inability to lift head when prone. No family history of motor delay or decreased tone.

Vitals: afebrile, HR 163, RR 68, PO2 92%. Patient is ill-appearing with minimal response to tactile stimuli. The evident tachypnea is associated with increased abdominal muscle use with retractions and grunting. Neurological exam has open, flat, anterior fontanelle with profound head lag and “frog-legging” of lower extremities. Deep tendon reflexes cannot be elicited. Skin exam is negative for rashes or hematomas. read more

Peanuts and Choking

Dr. Tamara Willoughby

Recently, the lay press reported a promising breakthrough in decreasing the frequency of peanut allergies in children at high risk for peanut allergy by early introduction of peanuts. (1)  In the study “peanuts” were introduced to infants between the ages of 4 and 11 months. (1)  The research shows promise to combat the increasing prevalence of peanut allergy in Western countries. (1) Although, not discussed in news reports, the peanut product given to infants in the study was not whole peanuts.  Infants were given “Bamba,” a peanut butter flavored puffed maize product. (1) Some news reports, although not all, discussed that early introduction of peanuts should be done under a physician’s care. The general public should also be reminded about the choking risk of peanuts especially in children 3 and under and that babies in this study were not given whole peanuts.   Choking is a leading cause of mortality and morbidity in children 3 and under with food, toys and coins most often the culprits. (2) Small children are vulnerable to choking in many ways.  A child’s airway occludes easily with small objects because of the small diameter of the airway and young children often can’t cough with enough force to dislodge a foreign body. (2) Additionally until molars erupt, children are unable to sufficiently chew food into smaller portions adequate for swallowing. (2) Finally, even though children at age 3 to 4 have molars, they are still learning to chew and are easily distracted which can lead to choking. (2) Approximately 1 child every 5 days in the United States dies from choking on food. (2) High risk foods for choking include hot dogs, hard candy, peanuts, nuts and seeds, whole grapes, raw carrots, apples,  popcorn, marshmallows, chewing gum and globs of peanut butter. (2)  In conclusion,  lets take this opportunity to educate the public regarding choking risks in children along with enthusiasm for promising  research on peanut allergy prevention. read more

Kids are smoking again…and a social media battle boils over whether e-cigarettes are a solution or a new path to an old problem.

Chair Michael H. Greenwald, MD

After years of steady decline in smoking among young people, we are now seeing a significant rise in the use of e-cigarettes or “vaping.” In December the AAP, AAFP, ACP, and ACOG joined the AMA in issuing a public statement of support for a Surgeon General report highlighting the increased use and dangers of e-cigarettes in young people.  At the same time there is a widespread counter message seen in advertisements and social media claiming the benefits of e-cigarettes and attacking the efforts of the CDC, Surgeon General and FDA.  All physicians should become educated about the issues and be prepared to discuss them with their patients.  What are the facts? read more