Parenting Solved

Should Children Take Cholesterol Medication?

Hold that chicken finger. The American Academy of Pediatrics today issued a fresh policy statement on the management of high cholesterol in children. Bottom line: kids from families with a significant history of heart disease should be screened between the ages 2 and 10 years. Significant elevations in a child’s lipid profile should be managed with diet for 6-12 months and reevaluated. It is recommended that kids over age 8 years with persistent elevation in LDL cholesterol as defined by the AAP’s policy be considered for cholesterol lowering medications.

But before you get that warm, fuzzy feeling that we’ve got it all figured out, here’s what we don’t know:

Does elevated cholesterol in childhood predispose to later heart disease? There are no studies proving this to be the case although we assume what applies to us applies to our kids.

What’s the long-term safety profile of statin medications (one class of cholesterol lowering drug), for example? Short-term studies look good, long-term safety isn’t clear.

Will the long-term use of cholesterol lowering medications beginning in childhood prevent adult heart disease? We just don’t know.

While the pharmacologic management of the dangerously at-risk child is more clear cut, many kids fall into the fuzzy category. And when it comes to the long-term use of medications for what is a dietary problem in many cases, we approach what could be a very slippery slope for both parents and pediatricians.

Fireworks and the Nervous Pediatrician

We spent the Fourth of July with friends. At sunset a poolside BBQ gave way to fireworks – roman candles, bottle rockets, screamers and the like.

Someone commented that I looked nervous. Couldn’t argue with that. While I grew up with my share of black cats and bottle rockets, I was a little on edge given my line of work. Most of my encounters with children and fireworks involve some type of burn or dismemberment. And watching my nine-year-old ignite the fuse of a roman candle could only give me pause. But upon becoming a father, I swore not to let my biased experiences as a pediatrician influence the normal experiences of my children. This has been a challenge at times.

Could my son have lived without the experience? No doubt. Did he have a ball? Absolutely. The best part: shouting “fire in the hole” while running from the sparkling fuse.

Maybe some memories of tweenhood shouldn’t be denied.

Parents Magazine Advocates for Children/Immunizations

I don’t see this every day: a major publication devoting significant space to tell parents precisely why children need vaccinations. Reference Parents Magazine and their July 2008 feature, Why Babies Need Shots. Their interview with Dr. Ari Brown also offers real answers to real questions. Refreshing really when you consider how often the main stream media supports the loud voice of a misinformed anti-vaccine minority peddling fear and conspiracy theories.

Hats off to Parents Magazine for using their valuable platform to help advocate for children.

Boys vs. Girls - Is One Harder to Raise?

It’s a worn out debate with real staying power: Is it harder to raise boys or girls? Paula Spencer at CNN.com resurrects this timeless parental debate and suggests that boys may be tougher than girls.

I was contacted by Houston’s KTRH news radio for a comment this morning and my view was painfully simple: there is no answer. For every parent who gushes about the ease and self-sufficiency of their daughter there’s another who curses their daughter’s high maintenance. The same can be said for boys. While gender may temper things, difficulty is ultimately child-driven and dependent on temperament and personality. The association of difficulty with a particular sex is a random event and seems to go both ways. And the role of parental disposition shouldn’t be overlooked. We’re half of the relationship that we share with our kids.

While we can’t deny the obvious differences between the sexes, their contribution to issues of rearing difficulty is overdone.

Tickling - A Cure for Constipation?

Open your mind here. I had a mother report today that she is correcting her four-year-old daughter'€™s constipation with tickling (and a healthy dose of Miralax). It seems her child is one of millions of toddlers with stool withholding, the annoying behavioral pattern of desperate stiffening and avoidance after encountering a painful turd. It'€™s a silent epidemic that I confront head-on every day.

So here's what mom does: When it'€™s clear that junior miss is passionately engaged in her potty dance (eye brows to the sky, head back, torso arched and up on tippy toes) she places her square on the pot and begins to tickle her unmercifully. And each time her daughter eliminates.

It'€™s brilliant really. What'€™s happening is the child initiates avoidance when she recognizes stool in the rectal vault. She withholds to avoid pain. Mom recognizes the cue and stimulates to the point where the child loses the iron-clad control of her pelvic floor. The laughter creates intra-abdominal pressure which exceeds the pressure of her external sphincter. Voila.

No word on the long-term effects of tickling on the toilet. But for now it represents a simple solution for one toddler in crisis.

For the record, this is my first Parenting Solved Hack.

Autism and Mitochondria - Like Two Drunks

With the thimerosal argument in the weeds and the measles connection corrupt, the Great Vaccine Witch Hunt is courting its new darling: the elusive mitochondria. And this time they have the perfect culprit. Mitochondrial disorders are poorly understood, nearly impossible to predict, hard to identify and may become most apparent during the peak vaccine age. A lot like autism. It’s the perfect storm.

Dr. Thomas Insel of the National Institutes of Mental Health put it nicely in this morning’s New York Times, “We’re talking about two things we don’t understand very well, mitochondrial disorder and autism, and putting them together,” Dr. Insel said. “It’s like two drunks holding each other up.” Aptly put.

The recent interest stems from two cases of autism in children with mitochondrial disease that were apparently precipitated by the use of vaccines. This weekend a meeting of the minds involving the FDA, NIH, CDC, HHS and others will discuss the issue.

Expect mitochondrial disease to take center stage with Hollywood and the growing grassroots network of self-proclaimed infectious disease experts determined to resurrect a cluster of childhood illnesses long since forgotten. Mercury be damned … it’s on with the show!

The image is an electron micrograph of a mitochondria courtesy of Wikipedia.

Dr. V, Are You a Militant Breast-Feeding Advocate?

One of my colleagues recently joked that I was a “militant breast-feeding advocate.” I told her that this wasn’t necessarily true but it did get me thinking.

I’m not militant about much. You would think I am if you’ve read Colic Solved. Sure I’m passionate about the recognition of acid reflux in babies but I would never put the interests of a baby behind this passion. And while I advocate breastfeeding, I do so because it represents the best nutritional substrate for babies. I don’t toe the line with breast-feeding advocacy groups peddling sociopolitical agendas – my allegiance is to children, not a cause.

I guess you could say that I’m militant about advocating for children and parents. I try to make tricky things less complicated in a way that helps empower parents. It’s what got me going with Parenting Solved.

More than militant, I guess, I’m just plain passionate.

Measles Rising - Is the Anti-vaccine Movement to Blame?

Measles is on the rise. The Centers for Disease Control reports 64 measles cases between January and April 2008, the highest number in recent years. Declining immunization rates and immigration are felt to be responsible and this has created the setting for a major outbreak.

Britain is experiencing its worst outbreak in 20 years. London's Daily Mail blames the Andrew Wakefield and his debunked vaccine claims which resulted in an 80% plummet in MMR vaccinations.

While the autism-vaccine connection has been disproven repeatedly, the prophets of the anti-vaccine movement are too caught up in their own opinions to understand that measles actually kills children. Consider this: Before introduction of measles vaccination in 1963, approximately 3 to 4 million suffered with measles annually in the United States; approximately 400 – 500 died, 48,000 were hospitalized, and 1,000 developed chronic disability from measles encephalitis.

Those who fail to immunize selfishly put your children at risk. Responsible parents everywhere should be outraged.

Image courtesy of the CDC.

Local WIC Program Goes BPA-free

Maryland’s Howard County Health Department has taken the step of providing only bisphenol A-free products to its WIC (Woman’s, Infants and Children) Program. WIC provides supplies and supplemental foods to low-income pregnant women, new mothers, infants and children under the age of 5. According to Maryland Med, Dr. Peter Beilensen, Howard County’s top health official “hopes to turn BPA into another trans fat: legal but largely shunned by the public.”

As far as I can tell this is one of the first WIC programs in the country to take a firm stand on BPA. But here’s the $64,000 question: Will the Howard County Department of Health restrict infant formulas packaged in BPA lined containers? And if you’re going to be BPA-free, how free do you need to be?

While I respect Dr. Beilensen’s stand on the issue, his department’s broad statement on BPA is as likely to fuel public hysteria as it is to positively influence the indigent children of Howard County. And while I agree with their policy as it pertains to bottles, their commitment to go BPA-free will need to address the issue of when, where and how much is too much (aka, the packaging issue) as well as the real risk of non-oral exposure. And he will inevitably need to explain to the citizens of Howard County that there are more questions to be answered before public health policy can be chiseled in stone.

Free Range Kids and America's Worst Mother

Here's a new way to look at things. Lenora Skenazy, a columnist from the New York Sun, has initiated a movement against protectionism in parenthood. She calls it the Free Range Kids movement and it’s gathering some real momentum from the looks of thing. The free range philosophy supports the belief that we should spend less time coddling and more time letting go. Labeled “America’s Worst Mom” by some, I think she may be on to something. Check it out on her blog.

My favorite quote: “Children, like chickens, deserve a life outside the cage. The overprotected life is stunting and stifling, not to mention boring for all concerned.”

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