Child Health Alert February 96

Child Health ALERT

Volume 14 A Survey of Current Developments Affecting Child Health Care February 1996

Electric Fields And Childhood Cancer: The Evidence Gets Weaker

It’s been over 15 years since researchers first suggested a link between exposure to high-current residential electric power lines and the development of certain cancers in children. Now, two new studies of brain tumors in children have been published, and both found little evidence to support such a link. One, from Los Angeles, found no overall association with measured electrical fields, though the authors point out that their study did not measure high or very high electrical fields, so it’s possible that some effects of such fields could have been missed. (Preston-Martin S et al: American Journal of Epidemiology, January 15, 1996; PP. 105-119)

In the second report, researchers from Seattle found study results that “do not support the hypothesis that exposure to magnetic fields from high-current power lines, electric heating sources, or electric appliances is associated with the subsequent occurrence of brain tumors in children.” (Gurney JG et al: American Journal of Epidemiology, January 15, 1996; pp. 120-128)

COMMENT: One of the major controversies in recent years has been the debate over the health effects of electric power lines and other sources of electric fields, such as electric appliances. We’ve been following the issue over many years, and the latest studies only reinforce the fact that the debate is far from over. The earliest studies that suggested links between various sources of electric fields (such as power lines and appliances) raised considerable alarm, even though some of the researchers who conducted these studies made it very clear that their findings were preliminary and needed to be confirmed in other studies.

These latest reports from respected researchers don’t settle the question, since there are good studies on both sides of the debate. From the standpoint of the health risks of electric fields, these different findings indicate that the debate will continue, but they also mean that if there are harmful effects from electric fields, those effects are likely to be smaller than the original reports suggested.

This controversy also has a message about how we should interpret new and alarming reports from scientific studies. As one expert pointed out in an editorial comment accompanying the above studies (Poole C: American Journal of Epidemiology, January 15, 1996; pp. 129-132), most medical journals publish articles only after they have passed review by independent experts; for this reason, the media and public tend to think that if findings are printed in a respected medical journal, they are therefore true.

As Dr. Poole points out, this isn’t so--being printed in a journal only means the report is worth being evaluated by the broad range of scientists who read the journal. The real critical review actually begins when the article is first published. And however much we would all like scientific questions answered quickly, especially when they concern the health of our children, the process of reaching the truth takes time, because the truth only becomes clear when a number of studies consistently point to the same finding. Understanding this process should help child care providers and others concerned with child health interpret reports that appear almost every day in newspapers, magazines, and on radio and TV.

CHILD SAFETY

Inflatable Snow Tubes: Fun To Ride, But Use Caution

The unusually early and frequent snowfalls in many parts of the country have given children a wonderful opportunity to go sledding, so it is not surprising that there have also been an unusual number of sledding injuries this year. Some accidents may result from so many children taking part in this activity, but another possible factor is the use of inflatable snow tubes as sleds. These tubes, which resemble automobile inner tubes, would seem to be quite safe, since they are light and soft. However, emergency room physicians are reporting that these tubes may be far less safe than they appear, and we therefore asked Dr. Michael Shannon for his perspective on this issue.

DR. MICHAEL SHANNON

COMMENTS: Over just the last few weeks, our emergency room at Children’s Hospital in Boston has seen an epidemic of serious sledding injuries. Many of the children were using inflatable snow tubes at the time of their accidents, and we worry that parents may not recognize that these innocent appearing sleds may pose some unexpected hazards.

First, because they are circular, the tubes cannot be steered, so children riding them have no choice but to go wherever the sled takes them--which can mean into trees, walls, and other obstacles. Second, the tubes move surprisingly quickly on icy or even hard-packed snow, and though the ride is exciting, the speeds can be dangerous; they also may go further than expected, taking children into ponds or roads. Finally, the fact that the tubes are air-filled makes them act like a trampoline--the end result is that when children hit a bump or mogul, the tube tends to send them into the air like a missile!

Children don’t have to be denied the fun of using these tube-sleds, but for the sake of safety, parents should understand the cautions that these sleds require. They are best used when snow has first fallen and is loosely packed. However, they are particularly risky when snow is hard-packed or icy, because that is when they move the fastest and furthest--and when making a child airborne can be most dangerous. Even in soft snow, jumps that might carry the child higher than four feet should be avoided. In addition, because the tubes cannot be controlled, children need to be instructed to be extra careful when using these sleds.

Other safe-sledding rules involve common sense:
        • avoid crowded hills;
        • check hills for both visible and hidden obstacles and bumps;
        • use the “buddy” system;
        • make sure that adults are always in supervision.

It’s worth considering another point: head trauma continues to be a major cause of serious injuries, so we should start to encourage children to wear ski, hockey, or bicycle helmets when sledding. We know this may be an “uphill” battle because of negative peer pressure, but we should remember that only a decade ago children were almost universally reluctant to use bike helmets. Perhaps the trend can be accelerated if a major manufacturer began promoting “Mortal Kombat” (or the equivalent) sled helmets!

(Dr. Shannon is Associate Chief of Emergency Services, Children ‘s Hospital, and Associate Professor of Pediatrics, Harvard Medical School, Boston)

DIET & NUTRITION

Effect Of Sugar On Children’s Behavior And Cognition

Over the past 20 years, parents, teachers, and health care providers have been debating whether sugar might have an effect on children’s behavior. Because of the continuing debate, researchers have again looked at the scientific studies that have been conducted on this subject, and they have attempted to come to some conclusion based on this information.

They identified 16 such studies and, after taking into account a number of factors, concluded that “...sugar does not affect the behavior or cognitive performance of children.” The strong belief of some parents that sugar has such effects, they say, may be due in part to the fact that both sugar consumption and behavior problems are common in children, and it would not be unusual for the two to occur together simply by chance. The authors note, however, that “a small effect of sugar or effects on (particular) children cannot be ruled out.” (Wolraich ML et al: Journal of the American Medical Association, November22/29, 1995, pp. 161 7-1 621)

COMMENT: It was exactly two years ago that we reviewed this question when we described an excellent study by the above authors, who found no effect of either dietary sugar or aspartame (NutraSweet) (see CHILD HEALTH ALERT, February, 1994). The current analysis didn’t provide any new data, but rather took previous studies and combined their results. What we said two years ago is much the same as what the above authors said in their recent report, so we think it’s worth restating some of those points:

First, results to date reinforce the fact that what we think may produce effects on children’s behavior may not always be correct, and we have to be willing to test our beliefs in carefully conducted scientific studies. What is clear from this (and some previous) research is that careful scientific testing shows that sugar, and aspartame, don’t have harmful behavioral or cognitive effects in the large majority of children.

Second, because the studies involved relatively few children, they can’t rule out the possibility that a small proportion of children, perhaps I to 5%, may still be affected by sugar in some way. If parents or teachers feel a particular child is sensitive to sugar, this situation should be handled carefully, since sugar-free diets can be very difficult on children and their families. It’s important for parents to consult with a health care provider, so the child can be tested with a carefully designed elimination diet and behavior can be evaluated in reasonably objective ways. Because of the burden of a sugar-free diet, there should be good evidence that sugar is indeed a problem before a decision is made to change the child’s diet.

This report adds to the growing scientific evidence that sugar doesn’t have to be avoided in children’s diets out of fear that it will alter their behavior. Of course, too much sugar is bad from the standpoint of nutrition and dental health, but common sense says an occasional candy bar hardly poses a risk to a child’s well being.

MEDICATION

Does Ritalin Cause Cancer?

For the third time in as many months, parents of children treated with Ritalin (methylphenidate) may be worrying about their children’s use of this drug. In the last two issues, we’ve written about Ritalin abuse by college students and inappropriate prescribing of the drug to children who did not have attention deficit hyperactivity disorder (ADHD) (CHILD HEALTH ALERT December 1995 & January, 1996); this time, the report concerns a link between Ritalin and cancer, which will undoubtedly make many parents extremely worried.

Government researchers fed high doses of methylphenidate (up to 30 times the typical human dose) to mice for two years, and a small number of male mice that received the highest doses developed liver cancer. The mice also had a somewhat increased frequency of noncancerous liver tumors. Female mice did not develop cancer, nor did rats in another experiment.

Ritalin’s manufacturer, Ciba Geigy Corporation, added the findings to the medication’s information sheet and recently mailed letters to 10,000 doctors who prescribe Ritalin, notifying them of the potential though questionable risk. While the U.S. Food and Drug Administration felt physicians and parents should have the new information, FDA data show no increase in liver tumors over the past 20 years; that cancer typically strikes children under 4 years of age, and Ritalin is not generally prescribed for children younger than 6. (New York Times, January 13, 1996)

COMMENT: These have been tough weeks for parents of children on Ritalin and other brands of methylphenidate. The question is, how should this latest information be interpreted?

First, tumors were not found in rats. Second, when one conducts hundreds of studies on a large number of drugs, it would not be surprising to find, by chance, a small increase in tumors in one experiment. Third, the study apparently found the excess only in mice fed doses 30 times greater than the typical human dose Fourth it is known that mice develop liver tumors in response to a number of drugs; even if methylphenidate did increase the risk of liver tumors in mice, it is unclear whether these data mean anything about effects in humans.

For these reasons, we agree with Dr. Murray Lumpkin, FDA’s deputy drug director, who stated that while the finding may represent a signal, “it’s not enough of a signal that we think kids should be taken off the drug.”

Childhood Ear Infections

Ear infections are an exceedingly common problem among children under the age of five, and they are the number one problem that causes parents to take their children to see the doctor. This fact may offer small comfort to parents whose children suffer repeated infections, but a new publication may help increase understanding about what causes these infections, how they can be identified, and how they can be managed.

Part of a series called “Rx: Required Reading”, “Childhood Ear Infections” is a 24-page illustrated booklet that is a useful resource for parents and others who care for children. What makes this booklet particularly helpful is that it was written by parents in consultation with medical experts in the field. By providing information that parents would most likely want (including a question and answer section), “Childhood Ear Infections” will increase understanding about this common and troublesome condition.

This and a companion booklet, “Childhood Ear Tubes" are each available for $4.95 (MA residents add 5% tax) plus $1 shipping.

We apologize for the difficulty, but this paragraph was accidentally removed from our file, it will be corrected within a couple of days

New York is recalling about 1,000 children’s “Sewing Boards” because young children may strangle on the removable string. The wooden boards, measuring 7.5 inches in diameter and .25 inches thick, were sold in three styles: fish, cars, and beach balls. The designs painted on the boards are combinations of yellow, red, white, green, blue, and black. The toys are packaged with a string which measures at least 42 inches in length, and which can be woven through holes along the edge of the board. The toys were sold nationwide at FAO Schwarz stores for $12 from 1992 through November 8, 1995. Some of the cards packaged with the boards stated that they were appropriate for children one year old and above, when in fact they are appropriate for children over three years of age. For more information, consumers should contact FAO Schwarz at (800) 400-4326.

I ...“GymRattle”...

The Gymboree Corporation, of Burlingame, CA, is recalling almost 3,000 “GymRattle” infant rattles sold nationwide at Gymboree stores from July 26 through November, 1995. The rattles could come apart during use, releasing a small rattle bell and small wooden pieces that could pose a choking hazard to young children. The wooden rattle measures 4.5 inches long, has a multicolored, cylinder-shaped cage with a small silver bell inside and a circular wooden handle. A tag reads in part “GYMBOREE... Gym Rattle...Crafted in solid maple wood...Recommended for ages 3 to 18 months...” The rattles sold for about $8; those sold before July 26 are not recalled. Consumers should return the rattles to the Gymboree store where purchased for a full refund; for more information, call (800) 222-7758.

...Mountain Bike Frame...

Raleigh USA of Kent, WA, is recalling about 300 Technium MT 400 bicycle frames and 24 Technium FT 500 bicycle frames because they can fracture. There have been at least two incidents in which frames have cracked or broken, causing injuries ranging from cuts and bruises to broken bones. Bicycles with these frames were sold nationwide between January and December 1993 for about $500 to $700; the MT 400 is red and black, and the FT 500 is black and white. Consumer

We apologize for the difficulty, but this paragraph was accidentally removed from our file, it will be corrected within a couple of days.

Accoutrements of Seattle, WA, is recalling over 120,000 Squeak Pickle toys and over 25,000 Squeak Kangaroo and baby kangaroo toys because the squeaker device can separate from the toys, posing a choking hazard for young children. The Squeak Pickles, item S877, were sold individually from bags of 12 labeled in part “***The Coral Line***Accoutrements*** Not for children under 3***Made in China.” The green rubber pickles are 3.5 inches long. The rubber Squeak Kangaroo and baby kangaroo toys, item 9394, were sold as a set in a box labeled in part “***Great motherhood***For ages 3 and up***Sqeaking*** Kangaroo***Made in China*** S.D.S. Toys***” The grey and black kangaroo measures about 5 inches tall, and the baby kangaroo, which fits into the larger one’s pouch, measures about 1.5 inches tall. The pickle toys were sold nationwide at various stores for about 35 cents each between August, 1991 and November, 1995. The kangaroo toys were sold from May, 1990 through November, 1995 for about $2.50. Consumers should return the toys to the place of purchase for a full refund or call (800) 886-2221.

Unsafe Car Seats

The National Highway Traffic Safety Administration announced a recall of over 15,000 rear-facing Dreamride Ultra infant car seats because they tipped too far toward the front of the car in crash tests. The recall is for model 02-179, manufactured from April 8, 1994 through June 15, 1995. Parents with these car seats are urged to contact Cosco, the manufacturer, to receive a reinforcement kit. Until the seat is fixed, a government official recommended that parents who do not have a suitable replacement seat continue to use the Dreamride Ultra model. To contact the manufacturer, call (800) 314-9327.

Clarification: The carbon monoxide detectors listed in the Product Recall column last month were never sold by Revco Drugstores, according to a spokesman for that company. The detectors were manufactured by Revco Products of California, not connected with the drugstore chain.