Health and Development of Children
Younger than Age 2
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A study published in the July 2002 issue of the Archives of Pediatrics
and Adolescent Medicine confirms suspicions that a common antibiotic
can cause a serious condition in very young infants.
Infantile hypertrophic pyloric stenosis (IHPS) occurs when the muscle
surrounding the outlet from the stomach becomes overgrown and obstructs
the passage of food into the intestines. The condition, which usually
arises in the first three to five weeks of life, causes projectile vomiting.
This can lead to dehydration, weight loss, and electrolyte imbalances
that affect kidney function. Physicians have long believed that exposure
to the antibiotic erythromycin is related to the condition.
To investigate the link, researchers tracked the antibiotic use and
IHPS occurrence in over 314,000 infants between 1985 and 1997. Of the
7,138 infants given prescriptions for erythromycin within the first 90
days of life, 804 were diagnosed with pyloric stenosis. Further analysis
showed that while infants younger than two weeks old were rarely given
erythromycin, those who were exposed within the first two weeks of life
were eight times as likely to develop IHPS as an infant who had not received
the drug during this time. Babies who received erythromycin after the
first two weeks did not appear to have an increased risk for the condition.
Physicians commonly use erythromycin to treat infants with illnesses
such as respiratory and ear infections, whooping cough, and conjunctivitis.
The results of this study suggest the risks and benefits of erythromycin
need to be carefully weighed — and perhaps other antibiotics tried
— before it is prescribed for use in infants younger than two weeks.
October 2002 Update
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Immunizations for 2002
Vaccinations against childhood illnesses are arguably one of the most
significant medical achievements of the twentieth century. One hundred
years ago, approximately half of all children born in the United States
died before the age of 5, many of them from diseases that today can be
prevented by vaccines. With proper immunization, the number of cases
of these diseases has been reduced dramatically.
Although no new vaccines have been added to the 2002 recommended childhood
immunization schedule, this year's schedule highlights vaccines for pre-adolescents
and "catch-up" vaccines for children who have fallen behind
the currently recommended schedule.
In addition, due to unusual national shortages of the pneumococcal and
diphtheria/tetanus/pertussis vaccines, the 2002 immunization schedule
also includes a link to information from the Centers for Disease Control
(CDC), which explains the necessary modifications to the recommended
schedule for these vaccines. These vaccine shortages will hopefully only
Please discuss your child's immunization history with the doctor to
insure that his or her immunizations are up to date in accordance with
the current 2002 Recommended Childhood Immunization Schedule, approved
annually by the CDC, the American Academy of Pediatrics, and the American
Academy of Family Physicians. For additional reliable and up-to-date
information about vaccines and their importance, visit the National Immunization
Program website at http://www.cdc.gov/nip or
the American Academy of Pediatrics website at http://www.aap.org/.
April 2002 Update
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New Information on Sudden Infant
Sudden Infant Death Syndrome (SIDS) is the most common cause of death
in infants from one to six months of age, peaking between ages two and
four months. For a number of years, pediatricians have recommended putting
babies to sleep on their backs to prevent SIDS, and studies have proven
that this position reduces babies' risk. The "Back to Sleep"
campaign has led to changes in infant sleep position specifically,
a decrease in the amount of prone (on the tummy) sleeping and, subsequently,
a statistically significant decrease in the incidence of SIDS. Unfortunately,
doctors still don't know for sure what causes SIDS and how best to prevent
A new study from the University of Washington, published in the December
2001 Journal of Pediatrics, has found additional risk factors
for SIDS. Researchers found the risk of SIDS was increased for infants
weighing less than 5 ½ pounds, infants born to mothers who smoked,
infants born to unmarried mothers, black infants, and infants who received
limited prenatal care.
While research on the causes of SIDS continues, these findings can help
doctors advise parents about reducing their baby's risk. Similarly, this
information should help doctors increase public awareness about the importance
of prenatal care.
If you have an infant at home, do all that you can to prevent SIDS.
- Put your baby on his or her back to sleep.
- Use a firm, snug-fitting mattress, and a crib that meets federal
- Do not put soft bedding (pillows, comforters, sheepskins, and
bumpers) or stuffed animals in your baby's crib.
- Dress your baby and adjust the room temperature so that he or
she is warm, but not hot.
- Never smoke around your baby (or during pregnancy).
March 2002 Update
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Young Children Need Seat Restraints
on Flights, too.
Although child safety seats are mandatory for all children less than
40 pounds riding in automobiles, there are no such laws for children
riding in airplanes. Children younger than 2 years of age are not required
to be strapped in for take off or landing on commercial aircrafts. Indeed,
they are most likely to be found being held by a parent on their lap.
The American Academy of Pediatrics (AAP) has recently published recommendations
encouraging regulations requiring all passengers to be properly restrained
during flights. Similar to Child Safety Seat laws for automobile passengers,
the AAP recommends infants less than one year old or less than 20 pounds
ride in rear facing seats properly installed in an airline seat. A forward-facing
seat should be used for children at least one year old and weighing 20
to 40 pounds. Safety seats should not exceed 16 inches in width to fit
into commercial aircraft seats. Children weighing more than 40 pounds
can be secured safely using a seat belt in a traditional manner used
by older children and adults.
While parents may be tempted to hold an infant on their lap rather than
to purchase a separate seat, these new regulations encourage safety over
expense. Passengers can always ask if discounted seats for infants and
children are available for their destination and flight.
January 2002 Update
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Home Monitors and SIDS
Sudden Infant Death Syndrome devastates some 3,000 families each year
in the United States. To prevent such tragedies, many babies are sent
home with expensive monitors. But a new study, the Collaborative Home
Infant Monitoring Evaluation (CHIME), suggests the cardiorespiratory
events these machine track are common and may not necessarily be signs
of impending SIDS.
Although researchers aren't certain what causes SIDS, some think prolonged
apnea (periodic cessation of breathing) and bradycardia (slower heart
rate) may precede the fatal event. So it's become customary for parents
to use home monitors with the hope they'd be alerted of such problems
before it's too late. The devices are traditionally recommended for preterm
infants (£ 34 weeks gestation), siblings of SIDS, and for infants
who've previously experienced an apparent life-threatening event requiring
mouth-to-mouth resuscitation. To investigate whether these infants are
actually at an increased risk for apnea and bradycardia, CHIME monitored
1,079 children during their first 6months.
During the 718,358 hours of home monitoring, no deaths occurred, but
at least one bout of apnea and/or bradycardia occurred in 41% of the
children, including healthy full-term babies. Only preterm infants were
at an increased risk of extreme events that lasted longer than conventional
alarm standards. But this added risk vanished before they reached the
age when SIDS is most common.
The results suggest these cardiorespiratory events are common and aren't
immediate precursors to SIDS. The researchers also noted that conventional
devices might have missed many of the events recorded using the highly
sensitive monitors used in the study. While the effectiveness of home
monitors remains unproven for preventing SIDS, there's no doubt they
can provide the peace of mind many parents need. But the best advice
to avoid putting infants to sleep on their stomachs, using soft bedding,
and exposing them to cigarette smoke.
August 2001 Update
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Early Childcare and Communicable Illnesses
All kids get sick, but young children in day care are at increased risk
The National Institute of Child Health and Human Development recently
examined rates of ear infections, gastrointestinal tract illnesses, and
upper respiratory tract infections in children participating in the Institute's
Study of Early Child Care. The study is following 1200 children from
birth to age three in ten locations across the county. The researchers
found the rates for each illness were higher for children in day care
than for those reared exclusively at home during the first two years
of life. But this difference disappeared by the time they were three
The number of hours per week children spent in day care generally had
little to do with their likelihood of getting sick. Instead, the great
the number of children enrolled in a facility, the greater a child's
risk of illness. But being sick more frequently didn't have developmental
consequences. Some parents felt that sickly children had increased behavioral
problems, but this was likely the result of increased stress.
July 2001 Update
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Study Shows Fish Consumption Protects Against Stroke,
But FDA Suggests Pregnant Women Should Take Caution
A large study in the Journal of the American Medical Association (JAMA)
recently showed that regularly eating fish might protect against ischemic
stroke, which is the most common type of stroke. Numerous studies have
already shown an association between fish consumption and a reduced risk
of heart disease. But there is a caveat. The Food and Drug Administration
(FDA) recently warned that pregnant women and women who are of childbearing
age who may become pregnant, should avoid certain types of fish that
contain high levels of mercury, which may be harmful to their unborn
Results of the Nurses' Health Study, published in the JAMA article,
involved nearly 80,000 women. It showed that women who ate fish two to
four times a week had a 48% lower risk of ischemic stroke the
kind caused by blood clots than women who ate fish less than once
per month. Even women who ate fish only once a week or less had a risk
reduction, but it was not statistically significant. These results held
true primarily among women who did not regularly take aspirin, which
prevents the formation of blood clots. Omega-3 fatty acids, the protective
substances found in fish, reduce levels of fats related to cardiovascular
disease and help prevent blood clotting. Dark, oily fish such as mackerel,
salmon, and sardines are a good source of omega-3 fatty acids.
Although pregnant women need not give up fish and its beneficial
health effects altogether, they should be careful about what types
of fish they eat. The FDA has advised that pregnant women and those who
may become pregnant stop eating shark, swordfish, king mackerel, and
tilefish. These large, long-living fish contain hazardous levels of methyl
mercury, a form of mercury that can accumulate in a woman's body
and affect the developing central nervous system of an unborn child.
This can lead to babies with slower cognitive development. As an extra
precaution, the FDA advised that nursing mothers and young children also
avoid these fish. Mercury gets into both fresh and salt water through
Some critics feel the FDA's mercury warnings are not strong enough. A
report by the National Academy of Sciences suggested the exposure limits
for mercury should be four times stricter.
While this controversy remains unresolved, the FDA encouraged pregnant
women to continue to eat a variety of other fish, containing very low
levels of mercury, as part of a balanced diet. Among other health benefits,
the fatty acids in fish enhance brain development. According to the FDA,
women can safely eat up to 12 ounces of fish per week. Fish that contain
low levels of mercury include shellfish, canned fish, smaller ocean fish,
and farm-raised fish. Women who eat fish caught by family or friends
should contact their local health department for advice on the safety
of fish from local waters.
May 2001 Update
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Good News for Breast-Fed Babies
Breast-feeding has been linked to many advantages, including fewer earaches,
colds, and asthma attacks. Now, a large trial involving almost 16,500
mother-infant pairs has shown even more benefits of breast-feeding. The
study demonstrated that long-term, exclusive breast-feeding significantly
decreases the risk of gastrointestinal tract infections and atopic eczema
during a childs first year of life.
Published in the Journal of the American Medical Association,
the study involved mothers from the former Soviet republic of Belarus.
To avoid a conflict of interest, given the advantages of breast-feeding
that are already established, the program studied mothers who breast
fed for a long time compared to mothers who breast fed for a short time
then switched to bottle feeding. Some hospitals were randomly chosen
to promote breast-feeding, through programs involving counseling from
doctors and midwives; other hospitals, which served as a control group,
provided the usual obstetric care. After 12 months, nearly 20% of the
infants who were part of the breast-feeding program were still nursing,
compared to 11.4% of the control group.
In the first year, only 9% of the infants in the breast-feeding program
had one or more gastrointestinal infection compared to about 13% of the
control group. In addition, 3% of the breast-fed infants developed atopic
eczema (a scaly, allergy-associated skin irritation), compared with 6%
of the other babies.
The World Health Organization recommends only breast milk for the first
four to six months, and recommends that breast-feeding (in combination
with formula) continue until 2 years of age. The American Academy of
Pediatrics recommends breast milk alone until 6 months, and breast-feeding
plus formula until 12 months old. This study suggests that breast-feeding
exclusively for the first year could provide greater health benefits
to the child.
February 2001 Update
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Age-Appropriate Safety Seats
for Young Children Can Significantly Reduce Risk for Serious Injury
Studies have shown that when it comes to child car safety, any restraint
is better than none. But new research illustrates, for the first time,
that choosing the appropriate restraining device child safety
seats for children under age 4 and booster seats for children ages 4
and older rather than seat belts can significantly further reduce
your child's risk of injury.
Researchers from The Children's Hospital of Philadelphia and the University
of Pennsylvania School of Medicine studied insurance reports of car crashes
involving children ages 2 through 5, then followed up with telephone
interviews of the driver of the accident vehicle and the parents of the
children involved in the crash. The investigators found that, compared
to children in child safety seats or booster seats, children wearing
seat belts at the time of the crash were 3.5 times more likely to suffer
a significant injury. Significant injuries were defined to include internal
organ injuries and most fractures, among other things. In addition, children
wearing seat belts were 4.2 times more likely to have a significant head
injury, such as a concussion or more severe brain injury, than children
wearing age-appropriate restraints.
You can use the following criteria to improve your child's safety. Children
who are at least one year old and weigh more than 20 pounds should be
placed in a forward-facing child safety seat in the rear of the vehicle.
Children who are at least 4 years old and weigh 40 pounds or more should
ride in a belt-positioning booster seat that uses the vehicle's lap and
shoulder belts. Your child is ready to use the vehicle's lap and shoulder
belts when the lap belt rests low and snug across the hips and the shoulder
belt doesn't cross the face or the neck.
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Tobacco Smoke Can Trigger Childhood Asthma
A new study further highlights the need to eliminate children's exposure
to tobacco smoke. After evaluating a random sampling of about 40,000
children between the ages 6 and 7 and 13 and 14, researchers in Italy
determined exposure to the secondhand smoke of at least one parent increased
a child's relative risk of asthma.
The children's parents were surveyed about their smoking habits and
the respiratory health of their children. Children in both age groups
who were exposed to secondhand smoke from both parents were more likely
to have asthma. Having a mother who smokes was a slightly stronger predictor
than having a father who smokes.
These results bolster previous research that has linked exposure to secondhand
smoke in the home to childhood asthma. Restricting smoking to outside
the home doesn't seem to help either. A 1997 study in California found
that even if their parents smoked outside, children hospitalized for
acute asthma took longer to recover when discharged than children whose
parents did not smoke. Tobacco smoke clings to hair and clothes fibers,
so even if the activity itself takes place away from child, the child
can still be exposed to secondhand smoke.
For more information about asthma, see page 505 of the Family Health
Guide. For tips on how to quit smoking, see page 57.
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Less Painful Newborn Circumcision
Each year, millions of newborn males undergo circumcision. Their facial
expressions and crying indicate that circumcision causes immense pain,
yet many physicians do not administer anesthesia or pain medication for
this procedure. In part, this is because many doctors are unfamiliar
with the use of such medications in infants and are concerned about possible
A number of interventions can help reduce the pain of circumcision.
Dorsal penile nerve block (DPNB), lidocaine-prilocaine cream (a mixture
of local anesthetics), sucrose, and acetaminophen are each individually
safe and effective but do not completely eliminate pain in all infants.
Another approach is to use the Mogen clamp, which is associated with
less pain than the Gomco clamp.
In an effort to minimize the pain of circumcision, researchers conducted
a study on 86 infant males to assess the efficacy and safety of a combination
of interventions. Fifty-seven infants were circumcised using the Mogen
clamp and a combination of analgesics that included acetaminophen, lidocaine-prilocaine
cream placed on the penis, gauze embedded with sugar and dipped in grape
juice placed in the mouth, and an injection of DPNB. Researchers videotaped
the infants during the procedure and assessed pain by analyzing facial
activity and the percentage of time spent crying. The researchers compared
the results with data from a previous study in which 29 infants were
circumcised using the Gomco clamp and lidocaine-prilocaine cream.
Results from this study suggest that circumcision with the Mogen clamp
took less time than circumcision with the Gomco clamp did (mean time
of 55 seconds compared to 9 minutes, 37 seconds). Infants in the combination
group had less facial activity indicating pain and cried for a smaller
percentage of time than the infants in the single intervention group
did. Furthermore, 46% of the infants in the combination group did not
cry at all during the procedure and 12% cried less than 10% of the time.
Infants in the combination group did not experience any adverse effects.
Facial activity and crying was not eliminated in all infants treated
with the combination of interventions, yet researchers do not know if
these responses were due to the pain of the procedure or the discomfort
of restraint. This study demonstrates that circumcision with the Mogen
clamp and combined analgesia is safe, takes less time, and substantially
minimizes pain. Parents of male infants and the physicians performing
circumcisions should consider this approach.
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Fighting Sudden Infant Death Syndrome
By most accounts, the Back to Sleep campaign, which urges
parents to place infants on their back in order to decrease the incidence
of Sudden Infant Death Syndrome (SIDS), has been a success since its
inception in 1994. The percentage of babies most at risk for SIDS (infants
aged 8 to 15 weeks) who were placed on their backs to sleep tripled between
1994 and 1998. In addition, the SIDS rate in the United States dropped
by 38% between 1992 (when the American Academy of Pediatrics (AAP) recommended
that infants not be put to sleep on their stomachs) and 1996. However,
the campaigns ambitious goal of an over 90% compliance rate has
not been met. Thus, the campaign continues.
The concerns of parents may act as an obstacle to their placing their
infant on his or her back. These concerns, for the most part, are rooted
in unfounded fear. Many parents cite a fear that their infant will choke
as the reason that they do not place their infant on his or her back.
This fear is unfounded, according to researchers who conducted a study
that observed no increased risk of choking in infants aged 4 to 6 weeks
and in infants aged 6 to 8 months who were placed on their backs compared
with infants who were placed on their stomachs.
Placing infants on their backs significantly reduces their risk for sudden
death. Parents can further reduce this risk by doing the following, in
addition to placing their infant on his or her back:
- If you are pregnant now, be sure to get good prenatal care. Eat
well, dont smoke, and avoid alcohol. These measures help your
baby get a healthy start and reduce the chances your baby will be
born early or at a low birthweight (both of which can increase SIDS
- Once the baby is born, keep him or her in a smoke-free environment.
- Have the baby sleep on a firm mattress or other firm surface.
- Avoid putting fluffy blankets or coverings as well as pillows,
sheepskins, blankets, or comforters beneath the baby. Infants
should not sleep on a waterbed or with soft stuffed toys.
- Keep the baby warm enough, but do not allow infants to become overheated.
- Seek proper medical advice promptly if the baby is unwell.
The following Websites offer additional information:
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