Daily Archives: January 17, 2011

Could your breastfed or premature infant be iron deficient?

Iron deficiency in babies and toddlers is getting increased attention. Studies have shown that up to 15 percent of babies and toddlers don’t get enough iron. This can lead to long-term developmental problems, even in babies who aren’t deficient enough to become anemic.

New guidelines from the American Academy of Pediatrics recommend supplements for some babies, especially breastfed babies aged 4-6 months and preterm babies.

When a supplement is needed, consider using a plain iron drop such as Fer-In-Sol or a combination product such as Poly Vi Sol with Iron for breastfed babies to provide both iron and vitamin D.

Keep in mind that iron concentration can vary from product to product.

New Practice Guideline Takes Aim at Pain of Childhood Immunizations

Pain surrounding childhood immunizations can have long-term consequences, including preprocedural anxiety and needle fears in both the child and parent. Worse yet, these consequences can lead to avoiding immunizations altogether.

As a result, Dr. Anna Taddio, of the Hospital for Sick Children in Toronto and the “Help Eliminate Pain in Kids” panel (the HELPinKIDS panel), an interdisciplinary panel of experts from Canada, have developed an evidence-based clinical practice guideline for reducing pain associated with childhood immunizations.

The panel believes that minimizing pain during childhood vaccination is important to help prevent these issues and there’s a need for clear guidance to address this “important public health issue.” So, they have published a summary of their guidelines in the Canadian Medical Association Journal (CMAJ). Here are the details from Reuters Health:

The HELPinKIDS panel evaluated 71 relevant studies including 8050 children and formulated a clinical practice guideline based on the “3-P” approach to pain management, including pharmacologic, physical and psychological strategies.

The scope of the guideline was limited to acute pain and distress at the time of vaccine injection in children 0 to 18 years old and is “generalizable to healthy children receiving immunization injections worldwide,” the authors say.

Several of the strategies found to be effective in relieving distress and pain of injections and recommended in the guideline can be implemented immediately, the authors say.

These include:

  • positioning the child upright when administering vaccines,
  • injecting the most painful vaccine last when multiple injections are being administered,
  • providing tactile stimulation, and
  • performing intramuscular injections rapidly without prior aspiration.

Dr Taddio and colleagues write that “about one-third of vaccinators do not perform aspiration, and there have been no documented harms caused by omitting this step.”

Other evidence-based pain-relieving strategies contained in the guideline may require some planning or additional resources, or both, on the part of healthcare providers and children and their families. These include:

  • breastfeeding or administering sugar water (for infants) and
  • applying a topical anesthetic and
  • psychological interventions such as distraction (for children of all ages).

The authors acknowledge in their report that “at present, the optimal pain-relieving regimen for nullifying pain, rather than simply diminishing pain, is unknown.” They say additional research is needed to determine which pain-relieving regimens reliably prevent pain in children of different ages.

New vaccine administration technologies such as microneedles and needle-free administration techniques, such as nasal sprays, hold promise for reducing pain associated with vaccination administration.

Untreated teens with ADHD at risk behind the wheel

Teenaged boys are more likely than any other drivers to have car accidents, and a diagnosis of attention-deficit hyperactivity disorder (ADHD) increases their risk even further, a new study finds. Looking at more than 3,000 teenaged boys who had been in car accidents, a group of Canadian researchers found those who had been diagnosed with various forms of ADHD were more than a third likelier to be involved in a car accident than teenaged boys without ADHD.

In my book, Why ADHD Doesn’t Mean Disaster, I discuss how teens with ADHD who are not treated are far more likely to be involved in risky behavior than teens without ADHD. Signed copies of the book are on clearance sale now and are available in softcover and hardcover versions.

ADHD

Here are the details on this new study from Reuters Health:

“If teenagers with ADHD brought their risk down to that of normal teens without ADHD, that might have prevented about 1 in every 20 crashes we observed in our study,” Dr. Donald Redelmeier at the University of Toronto told Reuters Health.

The key element here is probably “distraction,” Redelmeier said in an interview. People with ADHD often struggle to maintain focus and one lapse can have a major impact behind the wheel, he said. “A couple moments of inattention can really change your life forever.”

Reporting in the journal PLoS Medicine, he and his colleagues also found that teens with ADHD were more likely to get injured in accidents even if they were pedestrians. Here, too, distraction probably plays a role, Redelmeier said, perhaps if teens step into oncoming traffic without paying attention.

Other distractions – such as talking on the phone and texting – have been shown to increase the risk of accidents.

To investigate whether internal distractions from a hyperactive brain also had an effect, the researchers reviewed medical records on 3421 teenaged boys hospitalized following car accidents (whether or not the teens were at fault), and compared their health history to 3812 boys admitted to have their appendix removed, serving as controls.

The team found that 22 percent of the teens in accidents had been diagnosed with a form of ADHD, versus only 17 percent of controls. Boys with ADHD were 37 percent more likely to be in an accident, relative to boys without the diagnosis.

The same trend was equally present in teenaged girls. Teenaged boys are already more likely than any other group to have accidents and having ADHD is not as risky as, for instance, drinking alcohol while driving, Redelmeier noted.

But with an estimated 10 million vehicles involved in crashes in 2008 in the U.S., even a small impact on accident risk involves many people, he noted. Although many of the included teens were presumably being treated for their ADHD, the treatment itself is probably not at fault, Redelmeier noted — other research that tested driving ability in a simulated condition has found that people with ADHD taking medication were better behind the wheel, not worse, he said.

The most important steps teenagers (particularly those with ADHD) can take to stay safe behind the wheel include avoiding speeding as well as alcohol, minimizing distractions, using a seatbelt, keeping a safe distance from other cars and obeying doctor’s orders, Redelmeier said. Of course, parents can’t prevent their teenagers with ADHD from driving, but it makes sense to take extra precautions in this group, the researcher suggested.

For instance, some licensing authorities require drivers to indicate whether they have conditions that may impair their performance, such as epilepsy and diabetes. “All we’re suggesting is they add one more medical condition onto that already existing list of conditions,” Redelmeier said.