September 6, 2018 – As more information about children and automobile safety is gathered and analyzed, the American Academy of Pediatrics (AAP) is becoming more convinced that rear-facing is the safest seating position for a child riding in a car.
Prior to 2011, the recommended age to transition from a rear-facing to a forward-facing car seat was 12 months old. The AAP in 2011 moved that recommendation to 24 months.
That same group – in an effort to make recommendations based on the best and most up-to-date information available – continues to monitor crash safety data and now is recommending that children ride in a rear-facing car safety seat as long as possible – up to the limits of their car safety seat.
Most rear-facing car seats have a maximum rear-facing weight in the 30 pound range – the average weight of a 3-year old. Convertible car seats – seats that can be used both rear-facing and forward-facing – have a maximum rear-facing weight in the 40+ pound range – the average weight of a 5 year old. This new information will therefore include virtually all children under 2 years of age and most children up to age 4.
Car seat product listing – a 2018 listing from HealthyChildren.org that includes a comprehensive car seat listing that includes maximum height and weight limits – the new recommendation is based on those numbers (you can also find this information in the handbook that came with your car safety seat).
August 8, 2018 – This month the American Academy of Pediatrics (AAP) published reports that bring up safety concerns about a group of chemicals commonly referred to as food additives.
These are chemicals that are very commonly used with processed foods
Chemicals of Concern
There are two types of food additives.
Direct food additives – chemicals addedduring the processing of foods
Indirect food additives – these chemicals may contact food as part of packaging or processing
Many of these chemicals have a designation known as Generally Recognized As Safe (GRAS). This GRAS designation allows many chemicals to be used without FDA approval or notification. They are designated as safe by company employees or hired consultants. In its policy statement, the AAP is recommending a reassessment of this process.
Attempting to Clarify the Concern:
The AAP has produced two documents to add some clarity and direction toward reducing possible risks:
Practical Steps: Reduce Exposure to Chemicals of Concern
Frankly, it is difficult to avoid some of these chemicals completely. Here are known practical steps to reduce exposure (as published in the above AAP Policy Statement):
Prioritize consumption of fresh or frozen fruits and vegetables when possible, and support that effort by developing a list of low-cost sources for fresh fruits and vegetables.
Avoid processed meats, especially maternal consumption during pregnancy.
Avoid microwaving food or beverages (including infant formula and pumped human milk) in plastic, if possible.
Avoid placing plastics in the dishwasher.
Use alternatives to plastic, such as glass or stainless steel, when possible.
Look at the recycling code on the bottom of products to find the plastic type, and avoid plastics with recycling codes 3 (phthalates), 6 (styrene), and 7 (bisphenols) unless plastics are labeled as “biobased” or “greenware,” indicating that they are made from corn and do not contain bisphenols.
Encourage hand-washing before handling foods and/or drinks, and wash all fruits and vegetables that cannot be peeled.
We welcome summer, and – with summer – we welcome a new summer website banner picture: “Welcome” we say to ‘three children at the pool with a pink floaty’.
A few things going on this summer at Raleigh Children and Adolescents Medicine:
CHECK UPS: Did you know that your teenage child’s well visit (a.k.a. “checkup” or “complete physical”) meets the requirements for participating in school sports? At that visit, we can complete your child’s school sports form (and in Wake County that will cover the next 13 months of athletic participation). If you need a form completed and you have already had a check up this year – no worries – we can complete that form based on information gathered at that visit. There is no need for a ‘Physical’ at an Urgent Care or a Pharmacy Clinic. Just send us your school’s sports form with your portion already completed. You can drop it by, mail it, or send it to us through your email or fax.
NEW PEDIATRICIAN joining RCAM! Dr. Emily Rossbegins August 1st. More about Dr. Ross later, but we are excited for her to join the RCAM-ily for the next 40 or so years (imagine the stories she will tell at RCAM’s 90th anniversary).
ePRESCRIBING MEDICATIONS that previously required a hand-delivered, paper hard copy: For over 10 years, we have been able to send most prescriptions electronically directly to your pharmacy. This practice reduces transcription errors and typically is more convenient for our patients. However, certain medications have continued to require a paper hard copy that must then be hand-delivered to the pharmacy. The Pediatricians at RCAM are currently working through the authorization process for sending these prescriptions electronically. We are happy to offer a service that improves patient safety and convenience.
PAYMENTS THROUGH THE PATIENT PORTAL: Do you prefer electronic bill paying? Coming in July, payments on your account will be able to be made electronically through our Patient Portal.
CHINI WAPI DONATIONS: Many will recall Dr. Rick Gessnerand his family spent 2 years on a medical mission in Kenya. His daughter Anna returns there this month and she has been collecting women’s underwear to distribute to women there living in prisons or remote tribes. You may have seen signs in our office about her trip. She collected more than 800 pairs. We estimate 200-250 were donated by families at RCAM. Thank you for your contributions.
And now, what would summer fun be without your pediatrician there to remind you about safety?
A brief video from the AAP about sun protection:
If you like lists (I know you are out there), here are some tips from the AAP’s website: healthychildren.org: Summer Safety Tips
Finally, from our local paper, The News & Observer, here is a video about what to do should you find yourself in a rip current. A terrifying thought, but more proof that having the right information can save your life:
RCAM hopes your family makes memories of a summer full of good health and good play!
January 12, 2017 – Recently, the American Academy of Pediatrics (AAP) came out with some updated and expanded safe sleep recommendations.
They list 19 recommendations for a safe infant sleeping environment and it is definitely worth taking a look at the details.
The 19 recommendations for a safer infant sleep environment:
Small detail: The 19 recommendations are listed with their strength of recommendation at the bottom of this post
Some detail: A listing that includes brief explanations is found here.
More detail: The official AAP policy statement is found here.
Lots of detail: The AAP technical report is found here.
What your pediatricians at RCAM think about these new safe sleep recommendations:
1. New recommendations reflect the best information available now
First of all, we don’t shy away from new recommendations. Not at all. That is one of the strengths of medicine.
We know that we don’t know everything, and there is a vast and constant pursuit of better information. When more complete, up-to-date knowledge about how to keep our children healthy comes available, we want to incorporate it into what we do.
That is why it is okay that we sometimes hear grandmothers say, “That’s not what I was told when you were a baby.“
Medicine strives to recommend based on the best information available now.
2. Old habits are sometimes hard to kick
It has taken us a few months to comment as a practice because these 19 recommendations include some real game changers.
For example, consider #4 below: “Room-sharing with the infant on a separate sleep surface is recommended” (for the first 6-12 months).
As a practice, we have generally agreed that establishing a healthy, through-the-night sleep pattern is greatly aided by the move of your infant into a separate room. But, some studies have shown a 50% reduction in the incidence of Sudden Infant Death Syndrome (SIDS) in infants who room-shared (not bed-shared) for the first 6-12 months. That is what I mean by a game changer.
There are 19 recommendations. No one will be perfect and follow all of them 100% of the time for the first 12 months of life (if your child has ever fallen asleep in their car seat and you didn’t as quickly as possible move them to a firm, flat surface, then you haven’t followed all the recommendations all the time).
However, it is important that we assess what we do and change our habits to be as safe as we can with out most valued members of society – our children.
3. Some old habits do not need to change
Back to sleep for every sleep is still very important for a safe infant sleep environment.
Summary of Recommendations With Strength of Recommendation
The list below comes from the AAP (link). The linked article provides more information along with references with each recommendation. The recommendations are grouped based on the Strength-of-Recommendation Taxonomy (SORT) for the assignment of letter grades to each of its recommendations (A, B, or C).
A-level recommendations (Level A: There is good-quality patient-oriented evidence.)
Back to sleep for every sleep
Use a firm sleep surface
Breastfeeding is recommended
Room-sharing with the infant on a separate sleep surface is recommended
Keep soft objects and loose bedding away from the infant’s sleep area
Consider offering a pacifier at naptime and bedtime
Avoid smoke exposure during pregnancy and after birth
Avoid alcohol and illicit drug use during pregnancy and after birth
Pregnant women should seek and obtain regular prenatal care
Infants should be immunized in accordance with AAP and CDC recommendations
Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS
Health care providers, staff in newborn nurseries and NICUs, and child care providers should endorse and model the SIDS risk-reduction recommendations from birth
Media and manufacturers should follow safe sleep guidelines in their messaging and advertising
Continue the “Safe to Sleep” campaign, focusing on ways to reduce the risk of all sleep-related infant deaths, including SIDS, suffocation, and other unintentional deaths. Pediatricians and other primary care providers should actively participate in this campaign
B-level recommendations (Level B: There is inconsistent or limited-quality patient-oriented evidence.)
Avoid the use of commercial devices that are inconsistent with safe sleep recommendations
Supervised, awake tummy time is recommended to facilitate development and to minimize development of positional plagiocephaly
C-level recommendations (Level C: The recommendation is based on consensus, disease-oriented evidence, usual practice, expert opinion, or case series for studies of diagnosis, treatment, prevention, or screening.)
Continue research and surveillance on the risk factors, causes, and pathophysiologic mechanisms of SIDS and other sleep-related infant deaths, with the ultimate goal of eliminating these deaths entirely
There is no evidence to recommend swaddling as a strategy to reduce the risk of SIDS
Note: “patient-oriented evidence” measures outcomes that matter to patients: morbidity, mortality, symptom improvement, cost reduction, and quality of life; “disease-oriented evidence” measures immediate, physiologic, or surrogate end points that may or may not reflect improvements in patient outcomes (eg, blood pressure, blood chemistry, physiologic function, pathologic findings). CDC, Centers for Disease Control and Prevention.
November 14, 2015 – The American Academy of Pediatrics provides some ideas for talking to your child in a time like this – when we all become a witness to tragedy like the news that came from Paris last night.