Child Health Alert Newsletter March 97

Child Health ALERT

Volume 15 A Survey of Current Developments Affecting Child Health Care March 1997

One-Shot Treatment For Ear Infections

Ear infections are the most common illnesses that lead to visits to health care providers. By their first birthday-, nearly two-thirds of children have had a middle ear infection (called otitis media), and by age 3, almost half of all children have had three or more infections. The most common treatment involves antibiotics, and these are usually given in oral doses over 10 days. However, researchers have been investigating other ways to administer antibiotics, and researchers from Boston University recently suggested that a single injection may be as effective as 10 days of oral antibiotics.

The doctors studied 484 children, ages 3 months through 3 years, with ear infections; the children were treated, on a random basis, with either a single intramuscular injection of the antibiotic ceftriaxone (known also by the brand name Rocephin) or 10 days of the oral antibiotic trimethoprim-sulfamethoxazole (brand names Bactrim, Septra, and others) given twice daily. Over the four weeks following their diagnosis, the children were examined three times.

By the second week, the percent of children who were considered cured of their ear infections were about the same (80% of those who got the shot, 82% of those who got oral medication). As far as side effects of treatment were concerned, 8 % of the children who got the shot had pain at the injection site, but none of them had a complication. On the third day, parents reported diarrhea to be more common (24%) in the children who had gotten the shot than in those who gotten the liquid antibiotic (917c). The diarrhea was generally not considered serious.

The authors conclude that in the patients they studied, the single intramuscular antibiotic injection "as as effective in treating ear infections as the more commonly used 10 day course of oral antibiotics. (Barnett ED et al: Pediatrics, pp. 23-28, January, 1997)

COMMENT: At first glance it would seem that the "single shot" approach is the way to go, and it does have lots of advantages. The most obvious, of course, is that parents and health care providers don't have to worry about whether the child gets the full course of treatment. A shot is also usually cheaper than 10 days of antibiotics. In studies conducted by some of these same researchers, parents seemed to prefer the shot to 10 days of trying to remember to give two doses a day to a child who often put up lots of resistance. However, the authors are careful to point out that the parents who were willing to have their children enroll in these kinds of studies were probably more likely to favor a shot over liquid antibiotics in the first place.

Since the cure rates were about as close to each other as they could be, many parents might ask whether there's any reason not to treat all children with injections? Clearly, there are some children and parents for whom a shot is simply too painful or traumatic. In addition, the diarrhea rates were more than twice as high among children who got the shot, and that may be troubling to some.

Finally, though serious adverse reactions are very rare, some reactions require stopping the drug treatment, which can't be done if an antibiotic has been given by injection and remains in the bloodstream for days following the shot.

As with so many treatment decisions, some parents will prefer the option of a shot, while others may prefer the oral medication; in addition, there may be medical considerations related to a child's illness or underlying condition that may prompt the health care provider to choose one approach over another. Whatever decision is made, it's nice to know there's yet another approach to treating the all-too-common problem of ear infections in children.

READER'S MAILBAG

Is Fumigation A Way To Head Lice?

Q: Recently, we had an epidemic of head lice at our school, and a number of parents insisted that the school be fumigated. Is fumigation something that should be used to control epideMics of head lice in schools or homes?
- Anonymous, New York, NY

A: This is a common question about a common problem. To get an expert's perspective, we contacted Deborah Altschuler of the National Pediculosis Association. She confirmed that many parents and school officials embrace the misguided notion that calling the exterminator for head lice is the responsible thing to do.

To understand whether fumigation has a role, we must first understand that head lice are human parasites that cannot survive with out a blood meal. Unlike other pests such as fleas and ticks, head lice cannot thrive off the auman host. This is an important public health question as schools and child care centers are often pressed to fumigate for lice by parents and staff who do not have these facts.

Regardless of how long they may or may not live off the human their host, our concern should focus on the risks versus the benefits for the population of children who occupy the areas that are to be sprayed.

There is absolutely no scientific basis to spray for head lice in the home or school environment. In fact, the National Pest Control Association's own directive states that head lice do not qualify for pesticide extermination measures.

An even closer look at the question reminds us that children bring their own individual health vulnerabilities to the school setting. Too many members of the school population may be on medication or suffer from asthma, allergies, epilepsy, or other medical conditions that may make them more at risk from possible effects of pesticide exposures. The same applies to their adult teachers and care providers.

As a society we are learning to avoid the indiscriminate broad-based use of pesticides. We teach children to avoid areas where pesticides signs are posted. We appreciate the importance of avoiding pesticides whenever it is possible and ,certainly when they are unnecessary. Therefore, we would never want to broadcast a pesticide into a human environment when there is a safe, economical, and effective alternative- -especially when you can vacuum instead!

The frequent occurrence of head lice among schoolchildren means, among other things, that many of these children may unfortunately have already had direct and repeated exposures to pesticidal lice shampoos and sprays. Altschuler encourages school and child-care administrators to stand their ground against spraying, explain why, and encourage everyone to vacuum instead. (Readers may be interested in NPA's website at http://www.headlice.org )

CHILD SAFETY

Does Bedsharing Prevent Sudden Infant Death Syndrome?

In the past few weeks, a number of news reports have cited two recently published medical reports that seem to suggest that bedsharing (where mother and infant sleep in the same bed--also called "co-sleeping") may prevent sudden infant death syndrorne--(SIDS). --The news stories were based on release from the journal "Sleep" which published the two studies.

In one study, researchers evaluating babies and their mothers in a sleep laboratory found a number of differences among babies who were sleeping with their mothers. For example, bedsharing babies did not sleep as deeply and were easier to arouse than infants who slept alone.

The other study, by the same group of researchers found that bedsharing infants were more likely to sleep in positions other than on their stomachs. (Press Release: Sleep, Rochester, Minnesota; January 3, 1997)

COMMENT: This report received a lot of publicity around the middle of February, but the message was unfortunately incorrect. The press release did state that "the conclusions are completely theoretical, the researchers caution", but the news reports didn't usually make that distinction. We think it's important for readers to place these findings in perspective.

We know a lot about certain factors that can reduce the risk ol SIDS. For example, infants who sleep face down have a much higher risk, and as a result there have been public health campaigns in many countries encouraging parents to put their children to sleep on their backs. Just that kind of campaign in the U.S., called "Back To Sleep", has resulted in substantial changes in infant sleeping-position, so-that most babies no longer are put to sleep on their stomachs. At the same time, there has been a substantial drop in the number of SIDS cases in the U.S.

Other factors, such as the mother's smoking or the use of soft bedding material (like sheepskins or bean-bag type materials) have also been shown to increase the risk of SIDS, so health experts also encourage parents to avoid smoking and to avoid using soft bedding material.

However, contrary to the recent news reports, bedsharing has not been shown to reduce the risk of SIDS. The arguments suggested in those reports were strictly theoretical, and theoretical arguments for bedsharing decreasing SIDS risk can be matched by equally convincing theoretical arguments for how it might increase the risk.

Scientific research has pointed out a number of factors that can reduce the risk of SIDS. The fact is that whatever benefits bedsharing may have (such as encouraging breast feeding) we simply don't know whether it actually may decrease the risk of SIDS.

PARENT/CHILD

Twins On The Increase

Over the 15 years between 1980 and 1994, the number of twin births in the United States increased by 42%, according to a recent report by the U.S. Centers for Disease Control and Prevention (CDC). These increases are important because twins are at increased risk for a number of complications. such as prematurity and low birthweight. To see how the rates of twin birth varied by different states, the CDC examined U.S. birth certificates from 1992 through 1994.

During this recent 3-year period, twin births accounted for 2.4% of all live births. Rates were highest for Connecticut, Massachusetts. New Jersey, Rhode Island, Illinois, Michigan, New York, Delaware, Ohio, and Maryland. In general, rates for states in the South and West were considerably lower than the overall rates, and the states with the lowest rates of twins were New Mexico, Idaho, Utah, Montana, Arizona, and Wyoming.

In an editorial comment, the CDC points out that much of the increase in twins is due to the increasing use of treatments designed to improve fertility (such as medications and procedures like in-vitro fertilization). These treatments are well known to increase the likelihood not only of twins but of triplets, quadruplets, and other multiple births. (Morbidity & Mortality Weekly Report, pp. 121-125, February 14,1997)

COMMENT: This report, published on Valentine's Day, will probably confirm what child care providers have been observing for years--twins are on the increase, and many of the twins are the result of wider use of fertility treatments. Sometimes it's useful to know that what we think we're seeing is indeed real!

PRODUCT SAFETY

Glasses And Eye Protection

It's been estimated that 90% of eye injuries related to sports or work could be prevented by the use of proper eyewear. However, using the wrong eyeglasses can actually increase the risk of eye damage, since a simple impact--if it shattered the lens--could result in a complicated and perhaps permanent eye injury. To see how well various eyeglass lenses might protect against injury, researchers tested a variety of lenses that are commonly used in different eyeglasses.

They tested seven lens types made for standard glasses that met U.S. American National Standards Institute (ANSI) Z80 standards for such glasses. The lenses were tested by shooting them with air gun pellets, golf balls, tennis balls, lacrosse balls, and baseballs, and measuring the impact these objects had on the lenses.

Based on hundreds of tests, the authors found that certain lenses shattered when hit with these objects; those that failed were lenses made from glass, allyl resin plastic, and high-index plastic. On the other hand, polycarbonate lenses resisted the impact of all the objects shot at them.

These findings suggest that current standards need to be re-evaluated. The authors point out that, based on this testing, some lenses that are thought to offer protection may not, while others--such as polycarbonate lenses--appear to offer good protection. While not suggesting that everyone switch glasses to polycarbonate lenses, they recommend that impact-resistant lenses should be used for daily-wear, but where sports or other activities pose a greater hazard of injury, it's best to increase the level of protection by using more effective lenses. (Vinger PF et al: Journal of the American Medical Association, pp. 142-144, January 8, 1997)

COMMENT: It's important to keep this report in perspective. The authors designed their tests to simulate a tennis ball or other object hitting the lens at very high speed, as might be encountered in a game with a direct hit to the eye. This is not usually the situation children encounter in a classroom or other routine activities, which is why the researchers suggest that current impact-resistance standards may offer enough protection for everyday activities.

However, if a child engages in sports or other activities where an object can hit the lens at high speed, it's not enough simply to be wearing glasses that are considered to be "impact-resistant". In more risky settings, we agree with the authors that the level of protection needs to be increased by using lenses that have proven impact protection--such as polycarbonate lenses that are often found in sports glasses.

ENVIRONMENT

Beware Of "Take-Home" Lead Poisoning

Lead poisoning can seriously affect the development and behavior of children. Though most cases of lead poisoning come about from children being exposed to lead-containing paint or dust particles, researchers recently reminded us that there are other ways that children can come into contact with potentially toxic amounts of lead.

They describe a 6 year-old boy who had a blood test for lead because he had shown symptoms of poor attention span, restlessness, and difficulty functioning in school. The test results showed that his blood lead levels were increased, but when levels were obtained from the parents, the father's values were about three times higher. Investigation found that he was heavily exposed to lead at his work in a battery reprocessing plant, where he had not received training in proper safety measures. It was concluded that the child's lead exposure had come from his father's bringing lead home on his clothing. The father's job was changed to remove him from working with lead, and he was also treated for lead poisoning; after the father was no longer bringing lead home from work, the child's lead levels dropped over the-next 10 months, and so did the mother's. (Gerson M et al: American Journal of Industrial Medicine, pp. 507508,1996)

COMMENT: Many people would not suspect that a parent can bring enough lead home on his or her clothes to pose a risk to their child (and other family members), but this problem has been known to doctors and other health experts for some time. It may not be the leading cause of lead poisoning in children, but it's certainly one worth knowing about and preventing.

Parents who work in jobs that involve high amounts of lead should be particularly mindful of the need to follow strict safety precautions so they don't risk causing "take-home" lead poisoning; the types of jobs with high lead levels include radiator repair, lead batteries, brass/copper foundry and casting, gun firing ranges, ceramic tile and pottery, construction (painting and demolition), and secondary lead smelting.

PRODUCT RECALLS

Recalls: Dairy Queen Toy Water Batons...

International Dairy Queen, of Minneapolis, MN, is recalling 150,000 toy water batons distributed with kids' meals. When a child sucks or chews on the baton's end-cap, the cap can come off and release small plastic balls from inside the baton; the end-cap and the balls present a choking hazard to young children. The baton is a clear plastic rod, 9 inches long, with glitter and blue, purple, and green balls floating in water inside the baton. There are purple caps at each end, and "Dairy Queen" is printed on the rod. They were distributed with kids' meals nationwide from June through October of 1996. Consumers should return the batons to a local Dairy Queen store; the stores are offering a free kids' meal or ice cream sundae for each baton returned. For more information, call the company at 1-800 956-9565.

... Toy Telephones...

Dolgencorp, Inc., of Scottsville, KY, is recalling over 70,000 "Kids Phone Beeper Combo" toys; they present a choking hazard because the telephone antenna and pieces of plastic around the antenna base can break off. The toy cellular phones, packaged with a beeper, sold for $5 in Dollar General stores in the central U.S. from mid-August to mid-September 1996. The phones should be returned to Dollar General store for a refund; for more information, call Dolgencorp's Ken Smith at 502 237-5444, ext 5326.

... And Animated Santa

PriceCostco is recalling over 65,000 of its 30 inch tall Deluxe Animated Santa with Light and Music because of reports that they have overheated and melted, which may be caused by a defective capacitor. The Animated Santa was sold at Costco and Price Club U.S. warehouse stores between August 5, 1996 and December 20, 1996 as item number 63404. The recall
does not apply to any other animated Christmas items sold in PriceCostco warehouses. Consumers should return the Santa for a full refund to the store where purchased; for questions, call the company at 1-800 774-2678.

(Reports from the U.S. Consumer Product Safety Commission, Washington, DC 1-800 638-2772)