Our Work In Action
What does the AAP really do? Where does the work of AAP show up in all our communities?
You may hear these questions a great deal from friends, patients, even colleagues. Sometimes the work and campaigns from AAP are obvious and sometimes they're not. If you look closely enough, just under the fibers in the fabric of our communities, you’ll notice the impact of all of the AAP campaigns right there. Last year when Disney agreed to not have actors smoke cigarettes in movies, that was our work in action. Every time you hear a group talk about helping kids watch TV less and move more, that’s our work in action. The list is endless!
We’re out hunting for examples to help you look within the fabric fibers of your community. The better we all see the hidden messages around us, the easier it will be to counsel our families on the resources available to them.
If you find an example of Our Work In Action, I’d love to know!
Current Articles:
National Outside Week: A Sign Of Our Times
Cyber Bullying
Parents and the OTC Cold Medicine Recall of 2008
Parents Should Parents and Schools Should Teach
AAA and Hertz Join Together for a Unique Booster Seat Campaign
National Outside Week: A Sign of Our Times
John E. Moore, MD, FAAP; Carilion Clinic Chief of Pediatrics; Botetourt Pediatrics Associates, Roanoke, VA
For most American adults, memories of childhood are inexorably linked to thoughts of being outside. Long afternoons on the ball fields, lazy days riding bicycles with neighbors, or aimless hours spent walking down dirt lanes with friends are some of the visions that come easily to mind when we remember our youth. Most children in America today, however, experience the world more though computer or television screens rather than live. For them, outside time is a luxury and rarity rather than a daily and necessary occurrence.
American children are unquestionably becoming more inactive and sedentary. Rather than the hours of unstructured free play central to childhood in earlier decades, youth today rely more on electronic entertainment. Over-reliance on technology is cutting our children off from their own development as well as a healthy interaction with the world around them. Without free play, children will not be able to develop true creativity and freedom of expression. Without free play, children are losing their sense of appreciation of the greater natural world around them.
This cultural trend has definite impacts on their health and fitness which we as pediatricians see on a daily basis. Physical fitness levels are decreasing, and obesity has become a nationwide epidemic. Data from the CDC show that approximately 17 percent of American children meet the strict diagnostic criteria for obesity and many more are overweight. More and more children are diagnosed with adult problems like diabetes, hypercholesterolemia, and hypertension.
In an effort to reverse this trend, the American Academy of Pediatrics along with many local organizations has begun to emphasize the importance of regular outside activities. In fact, the week of September 24-30 was recently designated as "Take A Child Outside Week." Since it’s beginnings in North Carolina last year, this concerted effort to stimulate outside time has spread to include more than 250 community organizations in much of the United States and Canada. During that week, parents are encouraged to take a hike with their children, take them to a local playground, or play sports with them for at least 30 minutes per day.
The "Take A Child Outside Week" campaign’s emphasis mirrors the Academy’s position on physical exercise and the importance of free play. In addition to last year’s Pediatrics clinical report on the importance of free play by Kenneth Ginsberg, MD, several policy statements and position papers re-emphasize the importance of daily physical exercise. Members of the Academy are strongly encouraged to mention daily exercise for children, encourage free play, and to also counsel patients and parents to increase their daily exercise as well. These recommendations are geared towards reducing the unwanted health consequences of inactivity and the subsequent increase in obesity, diabetes, and hypertension.
With a little emphasis and well-placed encouragement, it is hoped that we as pediatric professionals can encourage children to be at least slightly more active and as a result healthier and happier than children are currently. Until then, the formal campaigns must continue in our communities and in our offices. That is the only way to help our families understand that a health child must include physical activity and free play.
Cyberbullying - Jeff Hutchinson, MD, FAAP, FSAM; Adolescent Medicine Specialist, Washington, DC
"I have a secret about you, and once I put it on my homepage you can’t do ANYTHING about it!"
Most medical students, interns and residents have a social network page like "Facebook" or "MySpace". For most adults social networking is just another way to share and stay in touch. For teens these networks are just as influential as any social group at school and can cause just as much stress. While cyberbullying is the new kid on the block, it happens and is slowly getting national attention. In June of 2008 Missouri outlawed cyber bullying in response to the suicide of Megan Meier (www.cnn.com/2008/TECH/07/01/cyberbullying.ap). Pennsylvania has passed a law that requires schools to have written policies about bullying to include internet bullying. Other states may follow these examples with legislation to addresses bullying in real-life and on-line. However, internet regulation opponents site free speech as the greater right and maintain that there are already laws which prohibit threatening speech.
The AAP policy statement on school-based mental health discusses the need for support and prevention of mental health issues including depression that may result from bullying. The extent of cyberbullying is unknown, yet the prevalence of electronic media use is undeniable. Traditional bullying is public by nature: a fight after school; a shove in the hallway; or giggles and whispers. Because electronic bullying can be completely private, such as writing an e-mail or sending dozens of text messages this form of bullying deserves the same attention as traditional bullying, perhaps more.
Few people over 35 have any personal experience with cyberbullying and may miss the opportunity to discuss it. Old problems surface with new technology. As providers, we often address safety and bullying, but we should include questions about social networks, e-mail and text-messages into the evaluation. Because there are dozens of social networks from "BlackPlanet" to "Vampirefreaks" don’t assume young people are only on “MySpace”. Better questions about social networking and computer use are, "What do you do on-line?" and "Is your profile public or private?"
As a society, we have to determine the line between free speech and harassment and the proper responses to young and old users. The first step to addressing any problem is recognizing the problem, and the extent of cyberbullying is unknown. Like many other health related behaviors, if parents, providers and teachers don’t ask the questions, we won’t find out the answer until after another tragic story like Megan Meier’s.
Parents and the OTC Cold Medication Recall of 2008
Vandana Y. Bhide, M.D.
The 2008-2009 cold and flu season has arrived! Last year, the American Academy of Pediatrics recommended against the use of over the counter cold and cough medicines in children under the age of six. Reasons cited for avoiding these agents included toxicity of the medications as well as their lack of efficacy in decreasing the severity or duration of cold symptoms.
In fact, studies have shown that OTC cold medicines are associated with tachyarrhythmias, seizures, apparent life-threatening events and even death. We know from experience that children, especially those under the age of two, can be easily overdosed with these medications because of care-giver error with actual dosing or difficultly using measuring devices. Many parents are also unaware that many combination cold formulations contain an antipyretic agent creating further potential for hepatotoxicity and nephrotoxicity if combined with additional doses of antipyretics such as acetaminophen or ibuprofen.
In response to last year’s AAP statement, the Food and Drug Administration released an advisory statement in January 2008 cautioning against the use of over the counter cold and cough remedies in children under the age of two. Decongestants, expectorants, antihistamines and antitussives are included in the list of agents to be avoided. The FDA also noted that most of the cold and cough medication ingredients have not been tested in children, and that is inappropriate to extrapolate usage of these agents in adults to children. In response, many pharmaceutical manufacturers voluntarily removed from the market cold medications used in children under the age of two. A complete list of agents to avoid can be accessed at http://www.aap.org/new/kidcolds.htm. Safer options to alleviate the symptoms of an upper respiratory viral infection include the use of honey, chest physiotherapy, cold mist vaporizers and saline nose drops.
While many parents are embracing this voluntary recall, many parents still have to be convinced and as health care providers we have to continue to educate parents to the dangers of using these medications in children. We have to continue to warn them that the use of these products in adults does not extrapolate to the use of the same product in children. And, we have to be clear that a child’s illness will not be shortened by using any over the counter medication because there is no cure for a cold or a flu.
The removal of OTC cold medications is a dramatic example of the American Academy of Pediatrics’ Work in Action to promote child safety on a population scale. Previously, parents were not clearly hearing from their pediatricians the message that these agents were both ineffective and unsafe, especially when advertising of these over the counter cold medicines gave the opposite message. Now, parents are hearing, and heeding, this safety message a bit more than before with the result being more lives of kids are being saved.
Parents should parent and schools should teach
Jeff Hutchinson, MD, FAAP, FSAM; Adolescent Medicine Specialist, Washington, DC
No one argues with the basic fact of what parents and schools should do. The controversy arises when individual beliefs and customs are added to the equation. For better or for worse, the pregnancy of Governor Palin’s daughter has brought teen pregnancy back to the front page of newspapers. The national spotlight highlights the emotion that teen pregnancy brings; having the discussion without emotion is like baking without heat. We all have our biases and beliefs, but as health care providers we should be aware of the information that is available and whether the information is based on fact.
In April 2008, Dr. Blythe gave a testimony before the committee on oversight and government reform on behalf of the AAP concerning abstinence only education. (http://www.aap.org/advocacy/washing/Testimonies-Statements-Petitions/04-23-08-Blythe-Testimony-House-OGR.pdf) To paraphrase, Dr. Blythe stated that abstinence is the healthy choice but is difficult to maintain. There are several strong advocates of abstinence only education such as Leslee Unruh and the Abstinence Clearinghouse site. On the opposite end of the sex education spectrum, there are websites directed at young people that use humor to discuss sex in sometimes graphic terms. The “Midwest Teen Sex Show” sounds like a pornographic site but uses crude humor to illustrate sexuality points as does the Planned Parenthood’s site: TakeCareDownthere.org. Humor and frank discussions of sex may be the backlash to inadequate sexuality education or the result of popular culture’s desire to shock. The AAP has a more neutral educational website dedicated to sexuality http://www.aap.org/healthtopics/sexuality.cfm which uses an educational approach more familiar to providers.
The best educational method lies somewhere in between the abstinence-only education and the shock and awe method. Parents need to have the discussions with the pre-teens and teens and accurate information has to be available to those who need it. Parents may worry what school is saying but they need to know what their friends and what the internet are saying.
While pediatricians are in an ideal position to help parents be prepared to tackle this tough topic with their children, all too often it doesn’t get the attention it deserves in our offices and communities. The bombardment of stories in the press of celebrity teen pregnancies as well as the Massachusetts Gloucester pregnant teens is our wake-up call to action!
As providers, we can help parents start the sexuality conversation by asking if they have had “The Talk” yet. We can encourage them to discuss current events. We can remind them that the computer should be in a common area so inappropriate or offensive sites are recognized immediately. As providers, we can also advocate for schools to use evidence based education while realizing the emotional charge that comes with sex education. We can encourage parents to parent and schools to teach, providing both groups with the best information we have available. We can stand up in our own communities as leaders and let our voices be heard. Governor Palin has her opinion but she is not an expert in health. It’s time we fight back against all celebrity opinions that may mislead and confuse the families we care for by being brave enough to do what we can in our own communities to get the health information in families ears that will keep their kids healthy and safe.
AAA and Hertz Join Together to Publicize the Importance of Car And Booster Seats, Corinn Cross, MD, FAAP
The AAP has long advocated the proper use of car and booster seats for the important reason that they save lives. There has been great community support for this initiative from car seat safety checks to a variety of online awareness campaigns. One of the newest campaigns was a recent partnership between AAA and Hertz Car Rental Agency called "Don't Take A Vacation From Your Car Seat" developed to underscore the importance of properly restraining infants and children in car and booster seats any time a family is on the road.
The need for campaigns promoting the proper and consistent use of car seats is indisputable. Motor vehicle accidents continue to be the leading cause of death in children. In 2005, 1,335 children under the age of 14 died from motor vehicle accidents and another 184,000 were injured which averages to 4 deaths and 504 injuries a day, according to the Centers for Disease Control.
Surprisingly, car seat laws vary widely by state as this link illustrates. To add to the confusion, many parents don't realize that they are required to abide by the car seat laws of the state in which they are driving.
Pediatricians are in a unique position to help clarify this confusion by reinforcing the need for parents to look into the car seat laws of states they are planning on visiting and to always default to the AAP’s car seat and booster seat guidelines if in any doubt. Parents should be reminded that the car seat and booster guidelines keep kids in booster seats for longer periods of time than we used to in the past (until kids are 4’9 which usually coincides with when they are around 8-12 years of age). The AAP has published a Car Seat Safety Guide for Families. You can find more information here.
Travel today does have some obstacles in it that often makes it prohibitive for parents to bring important extras from home such as car seats. Partnerships such as the recent Hertz-AAA eliminate those often unavoidable obstacles so families can keep their kids safe even when away from home. Through the program, AAA members were eligible to receive up to two complimentary car or booster seats when renting a car from Hertz. According to Deanna Zagin of AAA, the campaign has been well received by AAA members and feedback thus far has been very positive. Although, the campaign officially ended on September 30, 2008, AAA members, as well as members of other participating associations, such as the American Medical Association, are always entitled to receive one complimentary car or booster seat when renting a car from Hertz.
Pediatricians would be wise to use vacation and holiday times to remind parents that although they properly restrain their children at home, using a booster or car seat on vacation is equally important. Pediatricians can also provide a service to their patients and increase parental education on car seats by disseminating information about local and community car seat campaigns through whatever media venues they have available to them.
All pieces edited and reviewed by Gwenn Schurgin O’Keeffe, MD, FAAP, COCM Web site and Blog Editor-In-Chief, September 22, 2008
