Child Health ALERT

Volume 16 A Survey of Current Developments Affecting Child Health Care May 1998

Animals In Schools: What Are The Risks Of Infection?

Children consider pets a welcome addition to their school, but most teachers and parents are aware that certain animals carry viruses, bacteria. and other potential infections. Many might wonder, therefore, whether it's safe to have animals in school classrooms. To help provide some perspective on this issue, Dr. Richard Adams, Director of Health Services for the Dallas Public Schools, offers a brief description of the infections that might be carried by animals kept in schools. He makes it clear, from the beginning, that he strongly supports having animals in schools because of their clear educational value.

What animals are most likely to be found in classrooms? In Dallas. the most common ones are fish, some tadpoles and crayfish, but birds or reptiles are avoided. Over 250 different species of mammals are also in classrooms, including gerbils, hamsters, mice, rabbits, and rats (mice are the largest group).

According to Dr. Adams, the animals posing the greatest risk are reptiles (especially turtles), because they carry salmonella; wild or stray animals, because they are at high risk for rabies; and baby ducks or chicks, because they carry salmonella and campylobacter. Dr. Adams also points to the little known fact that ringworm can be transmitted from guinea pigs and rabbits. Among the "safest" animals in schools are mice, hamsters, gerbils, rats, and rabbits. Though hamsters and gerbils tend to bite more than the others, none of these species transmits rabies. "Almost any animal that is laboratory-bred and cage-raised is safe", he notes; those obtained from established biologic supply houses are not known to have problems, but neither do the animals come with certification that they are healthy.

Dr. Adams urges that children be taught proper hygiene around animals, such as frequent handwashing after handling them (and always before eating), "no fingers in the mouth", and "no kissing the animals" or coming in contact with animal feces. Also, human food should not be allowed in the room where animals are kept, and it's wise to check for student allergies before bringing animals into the classroom. (Adams RM: Pediatric Infectious Diseases Journal, February, 1998, pp. 174-176)

COMMENT: Here is yet another situation where frequent and proper handwashing can make a real difference in the health of children, their care providers, and their parents. For that reason, this issue of CHILD HEALTH ALERT includes an insert from our "Healthy Handwashing" Coloring Packet. It is designed to be reproduced. Information on how to order the coloring packets is also included.

CHILD SAFETY

Trampoline Injuries: A Soaring Problem

The trampoline was very popular in the 1950s and 60s, but because of serious injuries (including paralysis and death), their sales and use declined substantially. However, a new study indicates that in recent years, both trampolines and serious injuries have made a comeback. Using data from emergency departments collected by the U.S. Consumer Product Safety Commission, Dr. G.A Smith examined recent trends in trampoline-related injuries.

From 1990 through 1995, emergency rooms recorded 249,400 trampoline-related injuries to children under the age of 18. Over these 6 years, the number of such injuries each year doubled. Of note, 93% of injuries occurred at home.

Injuries to the arms and legs were the most common, occurring among children of all ages and accounting for more than 70% of all injuries. Face injuries occurred in I I%, and head and neck trauma involved 10%. Each year, about 1400 children needed to be admitted to the hospital--that is, just over 3% of all the children who were seen in the emergency room; the vast majority of these (83%) were for fractures or dislocations.

Dr. Smith points out that in 1977, the American Academy of Pediatrics urged that trampolines be banned from schools and competitive sports, leading most U.S. schools to heed the advice and the largest U.S. trampoline manufacturer to quit the business by the end of the 1970s. However, the AAP and others later softened their recommendations, suggesting the devices might be used with certain precautions in schools, though the AAP remained opposed to their use at home.

Dr. Smith argues that precautions are often not followed, and even when they are, serious injuries can result. Spotters can't prevent injuries that occur when children collide, nor can they prevent injuries that occur out of their reach (such as in the middle of the trampoline).

As one explanation for the dramatic increase in trampoline-related injuries, Dr. Smith points to the fact that backyard trampolines have become widely available in sporting goods stores, and can be purchased for less than $250. One leading manufacturer reports that sales increased about 5-fold, roughly over the same years as this study. Given the annual numbers of injuries and the soaring increase observed over recent years, Dr. Smith states that "children should not use trampolines at home. The sale of trampolines for private recreational use should be stopped, and a trade-in campaign should be conducted nationally to decrease the number of existing backyard trampolines." (Smith GA: Pediatrics, March, 1998, pp. 406-412)

COMMENT: This report is important, bringing to our attention what appears to be a soaring problem. Though the fad of trampolines in the 60s and early 70s did indeed decline, Dr. Smith points out that sales have rebounded strongly in recent years. Many parents might have assumed that improvements in the trampolines have made them safer, but whatever safety features might have been added, they have not prevented injuries from falls off the trampoline, collisions with other children, or a wide range of other injuries--all of which have come back in frightening numbers.

And perhaps most disturbing, the vast majority of injuries occur on (and off) backyard trampolines, where precautions are least likely to be followed. In addition, children want to have friends on the trampoline with them, but this only increases the injury risk. Based on the alarming trend in injuries, parents should be made aware that "trampolining" (as distinct from the trampoline itself), whether for recreation or sports training, is a major hazard for children of all ages.

ENVIRONMENT

Spring, Gypsy Moths, Acorns, And Lyme Disease

Because of recent news reports, parents might be wondering whether they should be more careful about Lyme disease in seasons following heavy crops of acorns. Though it sounds odd, there's a reason for it. A study published in a prominent science journal pointed out that in eastern U.S. oak forests, acorns are a critical food for white-footed mice, which feed on gypsy moths, and the moths eat the oak leaves. Acorns also attract white-tailed deer which, along with the mice, carry ticks which carry the bacteria that cause Lyme disease. Therefore, these authors reason that large numbers of acorns will attract animals that carry Lyme disease, so the risk of Lyme disease will be increased. (Jones CG et al. Science, February 13, 1998, pp. 1023-1026)

COMMENT: While this study received lots of news coverage, most reports didn't include a caution, published in the same issue of the journal (News/Comment by Kaiser J. Science, February 13, 1998, pp. 984-985). Other experts point out that the situation may be more complicated, since things like rainfall and competing insects might affect the number o ticks that actually carry the Lyme disease bacteria. So while the theory about acorns and Lyme disease is interesting, we think that parents and others who care for children in areas where Lyme disease is known to occur should use the same careful precautions, however large the acorn crop might be. As we've noted before, these precautions include being careful about walking in areas where deer and ticks are common, using insect repellents, and conducting careful "tick checks" every evening.

RESOURCES

Healthy Newsletters

Twice a year, Bridge Communications publishes an attractive and informative series of Healthy newsletters. They are written for parents and care givers of children in three age groups--pre-K, 4-5, and 6-8. The newsletters are designed to improve the health of families and can be ordered in bulk for distribution in schools, districts, and institutions. For sample copies of the spring, 1998 issue (one sample for each age group), send a self-addressed #10 (business) envelope with a $.55 stamp to Bridge Communications, 1450 Pilgrim Road, Birmingham, Ml 48009. More information-can also-be obtained from their web site, http://bridge-comm.com

Healthy Handwashing Hint

When it comes to handwashing, how long is long enough? It's hard for young childrern to continue washing their hands for more than a few moments, but one suggestion may help--have the children wash their hands for as long it takes them, to sing the "Happy Birthday" song! (Healthy Beginnings, Fall, 1997, p. 3); for further information on this publication, see above.

Readers are invited to offer any helpful ideas that they use to make handwashing a frequent and pleasant routine. Send your ideas to "Handwashing", CHILD HEALTH ALERT, P.O. Box 610228, Newton Highlands, MA 02461. If we publish your idea, we'll send you a complimentary "Healthy Handwashing" poster as well as a "Healthy Handwashing" Coloring Packet!

INFECTIONS/ILLNESS

Too Many Antibiotics For Colds And Other illnesses

Antibiotics are important medications that can cure certain infections, and just about everyone, at one time or another, has been treated with these valuable drugs. However, there is growing concern that antibiotics may be used too often, particularly for conditions that won't benefit from such treatment -- such as the common cold. To see how often doctors prescribe antibiotics for illnesses like the common cold, researchers examined results of a 1992 survey of physician office practices. There were 531 office visits for children under age 18 who were diagnosed as having a cold, an upper respiratory infection. or bronchitis. Antibiotics were prescribed for 44% of the children with common colds, 46% of those with upper respiratory infections, and 75% of those with bronchitis.

Antibiotics were prescribed more often for children between the ages of 5 and 11 years, and pediatricians were about half (57%) as likely to prescribe antibiotics as nonpediatricians. (Nyquist A-C et al: Journal of the American Medical Association, March 18, 1998, pp. 875-877)

COMMENT: Antibiotics are extremely important and useful medications for treating illnesses caused by bacteria and certain other germs. Unfortunately, they simply don't work for illnesses caused by viruses, and what is disturbing about the results of this survey is that physicians were prescribing antibiotics for colds, upper respiratory infections, and bronchitis--which in the overwhelming majority of cases are caused by viruses, not bacteria.

In the past, inappropriate prescribing of antibiotics was thought to be a waste of money and put children at risk for side effects to a medication they didn't require in the first place. In more recent years, however, another risk of widespread antibiotic use has become clear-- by being repeatedly exposed to various antibiotics, bacteria are becoming resistant to these medications. There have already been a number of situations where a serious bacterial infection couldn't be cured even by a number of different antibiotics, and this problem will only increase if patterns of antibiotic use don't change.

Doctors are now being encouraged to only use antibiotics when they will really make a difference--such as when a child has a bacterial infection. However, doctors have often been pressured by worried parents to use an antibiotic "just to be safe". That kind of use won't help a child get through her cold, but it may put her at serious risk, because the antibiotic that is overused today may be ineffective at a later time, when the child has a bacterial infection that requires an effective antibiotic. To bring the problem of antibiotic resistance under control, both physicians and parents will need to be more careful about when antibiotics are used.

CHILD DEVELOPMENT

Mary Ucci:
Helping Children Cope With Personal And Public Tragedies

The recent tragedy in Jonesboro, Arkansas, has once again forced adults to try to explain the unexplainable and offer young children reassurance and comfort. When events like this occur, we need to keep in mind that TV news is not geared to the sensibilities, developmental levels, and needs of young children. For this reason, the daily news is not appropriate for preschoolers (and perhaps older children as well). Protecting young children from watching the news, however, will not necessarily prevent them from hearing the news, so parents, educators, and child development specialists can follow certain guidelines that will help them deal with children's feelings and needs at these frightening times.

First, children have limited abilities to understand their world, let alone the implications of terrible events. They understand the here and now, but may not understand the far reaching effects. For this reason, it's important to state facts clearly and simply; children can only interpret things in light of their own experiences. As an example, if preschoolers should inadvertently hear about Jonesboro, one might say that "Four children and a teacher were killed in Jonesboro", rather than trying to explain details of what went on or trying to explain the complex nature of the situation. The next step depends on the child's response. It's important to wait for that response, because it will guide what you say next. Even inquisitive children can only manage limited amounts of information, so try to avoid saying too much--but always tell the truth. Don't be surprised if you find yourself repeating things you've said.

Second, acknowledge the child's feelings. If a child expresses horror or fear, acknowledge it by something like "Yes, what happened really was scary." There will be some children who don't react verbally, but their silence doesn't mean they are unaffected. Watch for non-verbal signs of distress, such as behavior changes or artwork portraying related events.

Third, it's important to keep the event in perspective for the child. He needs to be reassured that tragedies are rare occurrences, that they're unlikely to happen to him, and that, most importantly, an adult will always be there to take care of him.

We can offer children many kinds of information about what has happened, but let's not forget that materials that soothe are equally important to a preschooler (and every other child). I find, for example, that soft music, sensory materials, and warm drinks are some things that can bring comfort to the children.

When dealing with youngsters who are affected by tragedy, we should keep in mind that children are so much more than just their problems, and that experience with sorrow, however painful, is part of what makes us fully human. By anticipating their developmental needs and by providing support and sensitivity, adults can help children learn to cope with all that life offers.

Mary Ucci, who is Educational Director of the Child Study Center of Wellesley College, writes this periodic column of various issues related to child care; she welcomes questions from readers, which she will answer as space permits. Questions should be sent to her c/o CHILD HEALTH ALERT, R 0. Box 610228, Newton Highlands, MA 02461.

"Healthy Handwashing" Poster Available

When it comes to handwashing, readers tell us over and over how useful and attractive they find our "Healthy Handwashing" Poster!

It seems that almost every week we hear a news report or medical study that describes how large numbers of infections in children could be prevented by something as simple as frequent and proper handwashing. In fact, when it comes to preventing infections, particularly in child care settings, there's probably nothing more effective than routine handwashing by children and the adults who care for them.

Our readers tell us that they have put our "Healthy Handwashing" Posters near sinks, in bathrooms, in food preparation areas, and where pets or animals are kept. The posters are published in full color on 18 x 22 inch heavy glossy paper. They are available at $7 for one and $5 each for additional copies (postage and handling included). Special prices apply to requests for 35 or more posters. An order form is included with this issue, or you can contact CHILD HEALTH ALERT for more information.