Wilmington, DE-based KidsHealth.org, the widely respected children’s health and development website, has issued its annual list of “Kids’ Health Issues to Watch.” For this annual forecast, the physicians and editors at KidsHealth reviewed health issues affecting children and families to identify important trends for the year ahead.
Like its sister organization, the A.I. duPont Hospital for Children, KidsHealth is affiliated with the Nemours organization. Here are the five 2012 children's health trends that KidsHealth has spotlighted.
Issues to Watch in 2012
- Helping Teens Take Charge of Their Health Care
- The Risks of Postponing or Avoiding Vaccinations
- The Rise of Eating Issues and Disorders
- Prenatal Surgery: Helping Babies Before Birth
- Mobile Health Apps: Choosing Wisely
Helping Teens Take Charge of Their Health Care
Preparing kids for independence and adulthood brings many challenges for parents — teaching teens to drive, negotiating later curfews, researching colleges, discussing tough topics, to name just a few.
Among these hurdles is helping teens start managing their own health care. It can be hard to let go — after all, mom and dad have been handling the doctors' appointments, prescriptions, immunizations, and countless other medical concerns since their kids were born.
But it's important to guide teens toward taking on this responsibility. After all, parents won't always be around to manage their children's health care — and in most cases, once their kids become adults, legally they won't be allowed to.
And keep in mind that the decisions made in the teen years about things like alcohol, drugs, healthy eating, exercise, sex, and smoking can have long-term consequences — even if teens feel invincible. Becoming more invested in their own health care lets teens learn more about and understand the potential outcomes of choices they make now.
At what age are teens able to start taking some control? It can vary: factors like a teen's maturity level, health issues, and ability to keep track of the details all play a role, as does a parent's willingness to relinquish control.
So, how can parents start handing over the reins? It can begin by talking about medical topics in age-appropriate ways with their kids; for instance, discussing medications they take and why, or teaching kids with chronic conditions ways to help care for their medical equipment. Maybe your teenage son or daughter is ready to handle filling and refilling his or her own prescriptions.
It's important for moms and dads to let their adolescents have some private time to talk with the health care provider. During puberty and the teen years, kids are likely to have questions or issues that they're not comfortable discussing with a parent in the room. (But be assured that a doctor who feels that a patient who might be at risk for self-harm or harming another will alert a parent.)
If you think your child might need additional help with teen issues, consider having your son or daughter meet with an adolescent medicine specialist. These doctors not only are well-versed in the care of teens' physical health problems but also have additional training in helping their patients deal with risky behaviors and mental health concerns.
It's also wise to talk about health insurance and medical records to older teens. Although young adults can stay on their parents' plan until age 26 under the health care reform bill, many will be on their own well before that — and eventually all will have to know how to navigate the insurance system and keep track of their records.
The Risks of Postponing or Avoiding Vaccinations
When it comes to immunizing their kids, increasing numbers of parents aren't just consulting their pediatricians for advice — they're also paying heed to rumors and advice spread online through websites, message boards, and blogs. And conversations with other parents at dinner parties or playdates can be enough to instill doubts about vaccine safety or the necessity of giving multiple vaccines in one shot.
Even when the science or sources behind anti-immunization stances are proved unreliable or even completely discredited, it can be difficult for some parents to accept that vaccines are safe. And sometimes other personal or religious beliefs persuade parents to skip immunizations.
As a result, health officials are seeing alarming rises in preventable diseases. The Centers for Disease Control and Prevention (CDC) has reported hundreds of U.S. measles cases in 2011, the largest number in 15 years. Most of these occurred in people who were not immunized against measles.
Much of the controversy about vaccines stems from the now-debunked 1998 study that tried to link autism to the MMR vaccine that protects against measles, mumps, and rubella (German measles). Study after study has found no scientific evidence that autism is caused by any single vaccine, combination vaccines (like the MMR vaccine), or the mercury-containing preservative thimerosal, which was once widely used in many childhood vaccines but has since been eliminated.
Indeed, the journal that originally published the 1998 study retracted it and called the findings "a deliberate fraud." And the doctor behind the study lost his license. But the study and the attention it received influenced parents worldwide and contributed to a decrease in immunization rates. Indeed, recent polls indicate that 1 in 4 parents still think vaccines are linked to autism.
Some parents wonder why their kids need immunizations if many of the diseases they protect against are no longer commonly seen in the United States. But the fact is that infectious diseases that are rare or nonexistent here (because of immunization programs) are still huge problems in other parts of the world.
If immunization rates drop among U.S. kids, an outbreak could be an airplane flight away if a disease is introduced by just one unimmunized person (as in 2007 when a 12-year-old boy from Japan came to the United States for the Little League World Series and passed measles on to others).
It's also important to understand the concept of "community immunity" (or "herd immunity") which is when the majority of a population is immunized against a contagious disease, thus providing little opportunity for an outbreak. A single person's chance of catching a disease is low if everyone else is immunized. But each person who isn't immunized gives a highly contagious disease one more chance to spread.
People who can't receive certain vaccines (such as infants, pregnant women, and those with compromised immune systems) are also protected when most of the population is immunized. So when parents decide not to vaccinate their kids, they not only put them at risk, but also others who cannot be vaccinated.
Many parents worry about their children (especially infants) getting too many shots in one visit. They feel it might be "overwhelming" to the child's "immature" immune system. This prompts them to request delaying or postponing some immunizations so that the shots could be more spaced out or given one at a time. A recent online survey shows that more than 1 in 10 parents use alternative immunization schedules that don't adhere to the recommendations of health experts.
Yet, the truth is that there is no evidence to suggest that childhood vaccines can overload a baby's immune system. On the contrary, babies are exposed to numerous bacteria and viruses on a daily basis — so much so that the added exposure from the vaccines is simply a drop in the bucket.
Similarly, giving "simultaneous" vaccines (more than one shot at the same time) or "combination" vaccines (more than one vaccine in a single shot) has not been shown to produce any different effects than giving them separately. But it does allow for immunizing kids as quickly as possible so that they are protected during the vulnerable early months of their lives. And fewer office visits can be less traumatic for a child and can save the parents both time and money.
Opinions differ on how strongly doctors should adhere to the standard vaccination schedule. Some pediatricians will try to accommodate a parent's fears and thus go against their own best medical advice in order to keep the peace.
The Bottom Line
Immunization is the best way to protect kids from preventable diseases. A series of simple shots given from infancy to the teen years can fend off many major illnesses in millions of kids. The only time it's safe to stop vaccinations is when a disease has been totally wiped out worldwide, as in the case of smallpox.
If you search online for health information, make sure it comes from reputable websites and legitimate sources. Keep in mind that many studies are poorly conducted and inconclusive, and often cannot be replicated by other scientists. Yet, once the information is posted online, it takes on a life of its own and is shared and quoted widely — often without a knowledgeable expert to refute false claims.
And take random opinions with a grain of salt. Some people talk about "toxins" (like mercury or aluminum) or overwhelming an infant's immune system, and many even believe that the diseases are safer than the vaccines meant to prevent them. In truth, the risks of serious reactions to vaccinations are extremely small compared with the health risks associated with the often-serious diseases they can prevent.
So if you see, hear, or read about side effects or downsides of immunization, speak with your doctor.It's important to get all of the facts before making a decision to delay or skip an immunization — a choice that could affect not only your kids' health but that of others.
The Rise of Eating Issues and Disorders
Seeing the rail-thin models who strut down catwalks at fashion shows, you might think that eating disorders like bulimia or anorexia mostly affect women whose livelihoods are based on being thin.
But more and more, these problems are affecting people from all walks of life — and, unfortunately, many of them are kids. Of the almost 24 million Americans who suffer from an eating disorder, 95% are between 12 and 25 years old.
Experts report that more than 50% of teenage girls use "unhealthy weight control behaviors such as skipping meals, fasting, smoking cigarettes, vomiting, and taking laxatives."
But these disorders are not just a "girl problem" — 1 in 10 cases now involve males. Guys often develop problems with eating as a response to sports or fitness — for instance, developing bulimia to reach a certain weight for wrestling or swimming. Recognizing and diagnosing eating disorders in young men can be difficult due to the perception that these are "female" problems and the shame they might feel at having a condition associated with girls.
Eating disorders — primarily anorexia (self-starvation), bulimia (bingeing and purging), and binge eating (uncontrolled consumption of large amounts of food) — typically begin in the teen years and can be easy for some kids to hide. Compulsive exercise can accompany an eating disorder, so parents might attribute a teen's lean and toned build to that and not realize disordered eating is also part of the problem. In these instances, both components — the undereating and overexercising — are attempts to gain control over complicated feelings and emotions.
So how can parents spot an eating disorder and help their child recover and have a healthy relationship with food? Be aware of the physical clues — like extreme weight loss; obsessing over food portions, calorie counts, and weight control; fear of weight gain; social withdrawal; excessive exercise; regular trips to the bathroom right after eating; use of laxatives, diuretics, or enemas; and wearing baggy clothes to hide his or her physique.
If you think your son or daughter might have an eating disorder, it's important to get help right away. People with eating disorders can become seriously ill and even die. Doctors, mental health professionals, and dietitians can help a teen get treatment, recover, and develop healthy eating (and exercise) habits.
To help "inoculate" kids against developing a problem in the first place, parents can take the lead by setting a good example. Be sure to:
- Serve and eat healthy foods in recommended portions
- Don't put your own body down or focus on flaws
- If you're overweight, find healthy ways to achieve weight loss
- Make regular exercise a family affair
- Encourage everyone in your family to focus on their strengths
Prenatal Surgery: Helping Babies Before Birth
Operating on a baby before birth may seem like science fiction, but prenatal surgery is becoming more and more common in special pediatric programs throughout the United States.
Since prenatal surgery was first pioneered in the 1980s, it's become an important way to correct certain birth defects that could be severe (and in some cases fatal) if babies were born with them unrepaired.
Prenatal surgery (also called fetal surgery or fetal intervention) most often is done to correct serious problems that can't wait to be fixed, like certain heart defects, urinary blockages, bowel obstructions, and airway malformations.
Some of the greatest successes have come from correcting spina bifida (an often disabling spinal abnormality in which the two sides of the spine fail to join together, leaving an open area). A recent landmark study reports that kids with spina bifida who received fetal surgery typically are more likely to walk, less likely to have serious neurological problems, and less likely to need a shunt to drain brain fluid.
So how does prenatal surgery work? The most common types are:
- Open fetal surgery: In this type of procedure, the mother is given anesthesia, then the surgeon makes an incision in the lower abdomen to access the uterus (as would be done during a Cesarean section). The uterus is opened with a special stapling device that prevents bleeding, the fetus is either partially or completely taken out of the womb, surgery is done, then the baby is returned to the uterus, and the incision is closed. Open fetal surgery is performed for problems like spina bifida and certain other serious conditions. The mother will be in the hospital for 3-7 days and will need a C-section to give birth to the baby (and any future children).
- Fetoscopic surgery: This minimally invasive type of procedure, often called Fetendo fetal surgery, is more common than open fetal surgery. Small incisions are made and the fetus is not removed from the uterus. The surgeon uses a very small telescope (called an endoscope) designed just for this kind of surgery and other special instruments to enter the uterus and correct the problem. Fetendo is most useful for problems with the placenta, such as twin-twin transfusion syndrome in which one identical twin grows at the expense of the other because of abnormal blood vessel connections in the placenta they share.
- Fetal image-guided surgery: Some fetal surgery is done without an incision to the uterus or use of an endoscope. Doctors use ultrasound to guide them as they perform "fetal manipulations," such as placing a catheter in the bladder, abdomen, or chest. The least-invasive form of fetal surgery, it's not used for serious conditions that require open surgery.
The benefits of prenatal surgery don't come without risks, though. Chief among them are premature births and problems with the incision site. Moms who have fetal intervention are closely monitored for preterm labor and receive medications to control it. Still, for many parents and their babies, fetal surgery is a true medical miracle.
Mobile Health Apps: Choosing Wisely
A barky cough, a blotchy rash, a sudden fever — when kids develop symptoms like these, many parents no longer just call their pediatrician for help and advice. Many also look for health information online. And, more and more, their sleuthing is done via smartphones and tablets, which has given rise to health-specific apps.
There's a lot to like about these convenient, user-friendly, often free tools. You can keep a BMI calculator at your fingertips, download an app that helps you stay with your exercise program, or look up healthy recipes as you grocery shop.
And of course, this kind of access and convenience can really make life easier for parents. Want to know if there are any lice outbreaks in your area? How about an easy way to track daily allergy reports? What are the signs of seasonal allergies? What immunizations do kids need and when? There are apps for that — and a whole lot more!
But there can be downsides, too. It's fairly simple to design and release a health-related app that seems "official" — but did that prescription drugs informational app come from medical experts, a pharmaceutical company, an ad agency, or an ill-informed (if well-intentioned) consumer?
It's important for parents to take note of where this portable health information is coming from. Just as you would vet a website to make sure it's run by reputable health experts, make sure your apps are credible, accurate, and up to date.
But most important — no app (or website) is a substitute for a doctor's advice. Any time your child has symptoms of a medical condition or problem, contact your health care provider. And even when your kids are well, it's your doctor who you'll work with to keep them on track for checkups, immunizations, and growth milestones.
Looking for an app to help you understand common childhood infections? The free KidsHealth iPhone app — "Is It Contagious?" — covers 85+ childhood conditions and explains how they spread, how they're treated, and much more.
