AAP PRESS ROOM - DECEMBER 2008 MEDIA MAILING

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Information in this mailing is embargoed for release: Monday, December 1, 2008 at 12:01 am ET, unless otherwise specified.

PLEASE RESPECT THE EMBARGO DATE.

The Table of Contents (TOC) from the December issue of Pediatrics, the peer-reviewed scientific journal of the American Academy of Pediatrics (AAP), and Pediatrics electronic pages, the Internet extension of Pediatrics. These are available electronically and can be viewed at:

1. AAP clinical report on the use of complementary and alternative medicine (CAM) in pediatrics

2. AAP policy statement recommends red reflex examination for all neonates, infants and children

3. AAP policy statement on preventive oral health intervention for pediatricians

5. Altered blood pressure in preterm infants linked to SIDS risk up during first six months

7. Autistic children and their families face unmet health needs, financial challenges

Below are news releases and briefs on articles appearing in the December issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP). To receive the full text of these articles, contact the AAP Department of Communications.

Note: Please attribute the source as “the journal, Pediatrics,” when covering information from this mailing.

1. AAP CLINICAL REPORT ON THE USE OF COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) IN PEDIATRICS

A new AAP clinical report provides pediatricians with a road map to optimally assist families with the popular and growing use of complementary and alternative medicine. “The Use of Complementary and Alternative Medicine in Pediatrics,” describes CAM terminology and common therapies (such as vitamins, herbs, and chiropractic medicine); reviews related medical, ethical, insurance and research issues; provides resources; and outlines strategies for improving communication about CAM with patients and families. Complementary and alternative medicine is used by approximately 30 percent of healthy children, and more than 50 percent of children with chronic, recurrent and incurable conditions.

2. AAP POLICY RECOMMENDS RED REFLEX EXAMINATION FOR ALL NEONATES, INFANTS AND CHILDREN

A revised AAP policy statement further outlines the risk factors for potentially vision- and life-threatening eye abnormalities, and recommends that all neonates, infants and children have a red reflex eye examination. The examination, which involves using an ophthalmoscope in a dimly lit room – should be conducted before discharge from the neonatal nursery and during all subsequent routine health supervision visits. “Red Reflex Examination in Neonates, Infants, and Children,” provides illustrations of normal children’s eyes, as well as eyes with refractive errors, cataracts, foreign bodies or abrasions, and/or strabismus. A normal red reflex is present when the child’s two eyes, viewed both individually and simultaneously, have no white spots, and the same color, intensity and clarity. All infants or children with an abnormal test should be immediately referred to an ophthalmologist skilled in pediatric examinations. While all infants and children benefit from serial red reflex screening, high risk infants (with relatives diagnosed with retinoblastoma, infantile or juvenile cataracts, retinal dysplasia, juvenile glaucoma, or other hereditary vision-threatening disorders) require referral to an ophthalmologist for complete exam regardless of the findings on red reflex testing.

3. NEW AAP POLICY STATEMENT ON PREVENTIVE ORAL HEALTH INTERVENTION FOR PEDIATRICIANS

The new AAP policy statement, “Preventive Oral Health Intervention for Pediatricians,” was early-released on November 7, 2008, and will appear in the December issue of Pediatrics.

Sleep terrors, or night terrors, may be hereditary, according to the new study, “Sleep Terrors in Children: A Prospective Study of Twins.” Researchers studied 390 pairs of identical and fraternal twins from birth, and found that 36.9 percent of the twins had sleep terrors at 18 months, and 19.7 percent at 30 months. The results strongly support a hereditary link for sleep terrors, although no specific genes related to sleep terrors were identified. The study authors recommend larger research efforts to more definitively discern the relationship between genes, heredity and sleep terrors.

5. ALTERED BLOOD PRESSURE IN PRETERM INFANTS LINKED TO SIDS RISK UP DURING FIRST SIX MONTHS

Blood pressure remains low in pre-term infants during the first six months of life, possibly contributing to their higher risk of Sudden Infant Death Syndrome (SIDS). In “Blood Pressure and Heart Rate Patterns During Sleep Are Altered in Preterm-Born Infants: Implications for Sudden Infant Death Syndrome,” researchers monitored the heart rates and blood pressure of preterm and term infants at age 2 to 4 weeks, 2 to 3 months, and 5 to 6 months (preterm infants were monitored at their “term-corrected” age). Blood pressure was lower in the preterm group during both quiet and active sleep at all ages studied. In contrast, there were no heart rate differences in either group. The blood pressure of the preterm infants was lower at 2 to 3 months corrected age, compared with the 2 to 4 weeks and 5 to 6 months assessments, and was lower during quiet sleep compared to active sleep at all ages. The heart rate of preterm infants decreased with increasing age and was lower in quiet sleep compared to active sleep at 5 to 6 months corrected age. The study authors recommend additional research to determine whether preterm infants have impaired cardiovascular control during their first months of life, as this may contribute to the higher SIDS rate in preterm infants.

While 79 percent of US states reportedly collect breastfeeding data for birth certificates, or expect to do so within two years, information collection methods vary from state to state. In “Breastfeeding Status on US Birth Certificates: Where Do We Go From Here?” researchers contacted the vital statistics registrars in each of the 50 states, as well as New York City, Washington, DC, and Puerto Rico. Nearly 57 percent of the registrars were already reporting breastfeeding status on state birth certificates, although the questions used to collect the information were not standardized. While most states use the Standard Certificate of Live Birth (SCLB) breastfeeding questionnaire, six states, New York City, and Washington, DC, developed their own questions. The study authors recommend that a revised, standardized question be developed, focusing on in-hospital exclusive breastfeeding.

7. AUTISTIC CHILDREN AND THEIR FAMILIES FACE UNMET HEALTH NEEDS, FINANCIAL CHALLENGES

Children with autism spectrum disorder (ASD) in the US – living with a lifelong neurodevelopmental disorder such as autistic disorder, Asperger syndrome or pervasive developmental disorder – were more likely to have unmet needs for specific health care services, family support services, and/or delayed or foregone care, according to the new study, “A National Profile of the Health Care Experiences and Family Impact of Autism Spectrum Disorder Among Children in the United States, 2005-2006.” Researchers reviewed data from the 2005-2006 National Survey of Children With Special Health Care Needs, which included 40,000 children with special health care needs, to compare children with ASD, with children with other special health care needs and reported “emotional, developmental, or behavioral problems.” The children with ASD were more likely to live in families reporting financial problems, needing additional income for their child’s medical care, and where the parents had to reduce or stop work because of their child’s condition. More than 57 percent of families with children with ASD had to reduce or stop working because of their child’s conditions, as compared to 36 percent of families whose child had another emotional, developmental or behavioral condition or 17 percent of families with other special health care needs. Overall, the financial impacts of ASD were significantly more burdensome when the child did not have a medical home.

A new study found that many low-income parents shared similar negative perceptions regarding their interactions with and use of community health resources. In “You Get What You Get: Unexpected Findings About Low-Income Parents’ Negative Experiences With Community Resources,” researchers conducted in-depth, qualitative interviews with 41 urban, low-income parents. In general, the parents often viewed their interactions as a “series of trade-offs,” and perceived important choices as decisions between two suboptimal options. More specifically, the parents felt that engaging with community-based resources/services often meant adhering to requirements perceived as unnecessary, and in the extreme, having to adopt the value systems of others. In addition, accepting services was often perceived as a loss of control resulting in sadness, helplessness and/or stress; staff at these agencies was often viewed as judgmental, intrusive, or a cause of stress; and some services or advice were too generic and deemed unhelpful. The report findings may help improve client-staff interaction and community health facilities, and ultimately help reduce barriers to optimal care, according to the study authors.

EDITOR’S NOTE: In a related commentary, “A Possible Reason for Failure to Access Community Services,” Paul H. Dworkin, MD, FAAP, states that the findings in “You Get What You Get: Unexpected Findings About Low-Income Parents’ Negative Experiences With Community Resources,” may explain why many families who are referred to community-based programs and services often don’t receive care. The study results “remind us of the critical importance of listening to families, soliciting their opinions and concerns and engaging them as partners in care.”

Approximately half of U.S. pediatricians and family physicians who responded to a recent survey reported that their practice had delayed the purchase of specific vaccines for financial reasons (49 percent), and had experienced a decrease in profits related to vaccine administration (53 percent). In “Primary Care Physician Perspectives on Reimbursement for Childhood Immunizations,” researchers conducted a mail survey to a random sample of nearly 3,000 US pediatricians and family physicians on vaccine cost and reimbursement. More than 70 percent of pediatricians responded, and 60 percent of family physicians. Twenty percent of the physicians strongly disagreed that “reimbursement for vaccine purchase is adequate,” and 11 percent reported their practice had seriously considered halting vaccine administration to privately insured children. Although large-scale withdrawal of immunization providers does not seem imminent, the study authors recommend that efforts to address the “root cause” of vaccine-related financial pressures on clinicians be seriously considered.

EDITOR’S NOTE: In a related study, “Variation in Provider Vaccine Purchase Prices and Payer Reimbursement,” researchers found a considerable discrepancy in the cost of vaccines – from $4 to $30 per individual vaccine, in some instances – as well as a significant variation in insurance reimbursement, often related to the location and size of a practice or clinic.

EDITOR’S NOTE: In a related commentary, “Is Our Vaccine System at Risk for a Future Financial Meltdown?” Stephen Berman, MD, FAAP, states that government intervention is needed to ensure adequate vaccine reimbursement rates.

Despite dramatic decreases in the number of fatal child poisonings over the past several decades, approximately 86,000 U.S. children were treated in hospital emergency departments in 2004 after ingesting drugs, cleaning products, and/or other poisonous substances, according to a new study. In “Unintentional Child Poisonings Treated in United States Hospital Emergency Departments: National Estimates of Incident Cases, Population-Based Poisoning Rates, and Product Involvement,” researchers reviewed data from the US Consumer Product Safety Commission National Electronic Injury Surveillance System, related to unintentional poisonings in children, ages 4 and younger, who were treated in hospital emergency rooms. The review found that about 70 percent of the poisonings involved children ages 1 or 2; more than half involved boys; and 13.3 percent resulted in hospital admission. Nearly 60 percent of the poisonings involved oral prescription drugs, nonprescription drugs, or supplements. The study authors state that child poisoning remains a “serious health concern,” and that additional research is needed to better understand the circumstances surrounding unintentional poisonings, and improvements made to child resistant packaging.

The AAP is partnering again this year with the National Centers for Disease Prevention and Control (CDC) to help get the word about the importance of flu vaccination during National Influenza Vaccination Week, taking place December 8 – 14, 2008. New this year is the recommendation that all children 6 months to 18 years of age should receive a flu shot. For more information, visit the CDC Web site at: http://www.cdc.gov/flu/professionals/flugallery/index.htm

The American Academy of Pediatrics (AAP) is looking for parent and colleague nominations of pediatricians who have made a direct and profound impact on the life of children, families, or communities. Four pediatricians will be honored at, and receive paid travel and registration expenses to, the 2009 AAP National Conference and Exhibition, October 17-20 in Washington, DC. The AAP is accepting nominations online now through January 16 at: www.AAPexperieNCE.org/heroes

Winter doesn’t officially begin until December 21, but many parts of the country are already experiencing snow, cold, and more snow! Help keep your child safe and warm this winter with valuable tips from the American Academy of Pediatrics (AAP). The tips can be found in both English and Spanish at: http://www.aap.org/advocacy/releases/decwintertips.cfm

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The FAAP designation following a pediatrician’s name stands for Fellow of the American Academy of Pediatrics. Pediatricians with a FAAP designation have obtained board certification in pediatrics and made an ongoing commitment to lifelong learning and advocacy for children.