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American Academy Of Pediatrics Endorses Guidelines For Checking LDL Cholesterol Levels In Kids

Why would a pediatrician draw blood from your 9-, 10-, or 11-year-old at his or her next annual wellness visit? Because the American Academy of Pediatrics (AAP) recently endorsed updated guidelines that call for checking LDL (bad) cholesterol levels in all kids between the ages of 9 and 11.

The cholesterol-test recommendation created quite a stir. But wait, there’s more. The guidelines also call for annual blood pressure checks beginning at age 3, and periodic blood sugar measurements starting between ages 9 to 11. There’s also a strong recommendation for kids and adolescents to limit sedentary screen time to two hours or less per day, and to get at least an hour a day of moderate physical activity.

The biological basis for these guidelines is that atherosclerosis (the fatty gunk in arteries that causes heart attacks, strokes, and other serious problems) starts during youth. In many cases, Read more »

*This blog post was originally published at Harvard Health Blog*

Don’t Fly Delta: Airline Runs Anti-Vaccine Videos Against Medical Advice

I’ve been following the recent Delta airlines flu vaccine kerfuffle with interest and now amazement. After running in-flight infomercials by a notorious anti-vaccine group (NVIC), the American Academy of Pediatrics alerted Delta to the faux pas with a letter from president Robert W. Block, M.D. I had assumed that Delta would be grateful for the head’s up, and would immediately remove the infomercials. Instead, they chose to ignore the letter, denying that they saw any harm in associating themselves with anti-vaccine activists. Despite the warning, they will continue to run the ads through the month of November.

Every year the influenza virus kills as many as 49,000 Americans and 500,000 individuals world-wide. According to the CDC, the best defense against these often preventable deaths is the influenza vaccine. Since viral spread is especially likely in closed quarters where air from infected individuals is recirculated (such as in an airplane) it is critical for extra precautions to be taken before and during air travel. In addition to yearly flu vaccination, the use of alcohol-based hand wipes, regular hand washing, covering one’s mouth during coughing, are recommended. Since the flu virus can live in droplets outside the body for up to 48 hours, door knobs, seat covers and tray tables can spread the virus from passengers on previous flights.

I don’t understand why Delta, Read more »

Swimming May Not Be As Safe For Your Children As You Think

Lifeguard standing duty poolside.As summer continues in North America, and for anyone who goes near the water during any time of year, prevention of drowning is very important. The American Academy of Pediatrics (AAP) takes its responsibilities on this issue seriously, and in 2010 issued a policy statement on prevention of drowning. This is a remarkable and well-thought out document that addresses all of the important issues associated with risk for and prevention of drowning. The online version of the policy statement, along with updated information and services, is available on the web.

The document points out that, historically, drowning has been the second leading cause of unintentional death in individuals aged one to 19 years, causing more than 1,100 deaths per year in the United States alone.

The AAP defines drowning as “the process of experiencing respiratory impairment from submersion/immersion in liquid.” It does not imply any particular outcome. Persons may “drown” and survive. The categories of outcomes include:

  • death
  • no morbidity
  • morbidity (moderately disabled, severely disabled, vegetative state/coma, and brain death)

There is a discussion of entanglement in drains, particularly in females who are underwater with long hair near a suction outlet. Inflatable pools pose a particular hazard if they are not fenced.

The AAP has previously taken the stance that children are not developmentally ready for swimming lessons until after their fourth birthday. They based this opinion on factors including: Read more »

This post, Swimming May Not Be As Safe For Your Children As You Think, was originally published on by Paul Auerbach, M.D..

Ear Infections: To Treat Or Not To Treat?

Ear infections used to be a devastating problem. In 1932, acute otitis media (AOM) and its suppurative complications accounted for 27 percent of all pediatric admissions to Bellevue Hospital. Since the introduction of antibiotics, it has become a much less serious problem. For decades it was taken for granted that all children with AOM should be given antibiotics, not only to treat the disease itself but to prevent complications like mastoiditis and meningitis.

In the 1980s, that consensus began to change. We realized that as many as 80 percent of uncomplicated ear infections resolve without treatment in three days. Many infections are caused by viruses that don’t respond to antibiotics. Overuse of antibiotics leads to the emergence of resistant strains of bacteria. Antibiotics cause side effects. A new strategy of watchful waiting was developed.

Current Medical Guidelines

In 2004, the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP) collaborated to issue evidence-based guidelines based on a review of the published evidence. Something was lost in the transmission: The guidelines have been over-simplified and misrepresented, so it’s useful to look at what they actually said. There were six parts:

1. Criteria were specified for accurate diagnosis.

  • History of acute onset of signs and symptoms
  • Presence of middle ear effusion (ear drum bulging, lack of mobility, air-fluid level)
  • Signs and symptoms of middle ear inflammation: Either red ear drum or ear pain interfering with normal activity or sleep

They stressed that AOM must be distinguished from otitis media with effusion (OME). OME is more common, occurs with the common cold, can be a precursor or a consequence of AOM, and is not an indication for antibiotic treatment. Read more »

*This blog post was originally published at Science-Based Medicine*

Head Lice: FDA Approves New Treatment

Good news for parents, teachers, pediatricians, and others engaged in the ongoing battle against lice: The Food and Drug Administration (FDA) just approved a new treatment for head lice in children age four and older. Called Natroba, it’s a liquid that is rubbed into the hair and allowed to sit for 10 minutes before being rinsed off. Natroba is a useful addition to the anti-lice arsenal, since some head lice have become resistant to permethrin and pyrethrins, the active ingredients in over-the-counter anti-lice products such as Nix and Rid.

Head lice are tiny insects that go by the big name Pediculus humanus capitis. They thrive in the warm tangle of human hair, feeding off blood in the scalp and breeding with abandon. A female lays eggs called nits that she attaches to strands of hair. Nits hatch after about eight days, become adults in another week or so, feed for awhile, then begin to make more lice.

CDC photo of the stages of the life of a head louse, with a penny for size comparison.

What To Do

First off, here’s what not to do: Don’t shave your or your child’s head, or coat it with petroleum jelly or mayonnaise or anything else designed to “suffocate” the parasite. You’ll probably end up with greasy, smelly, lice-infested hair.

Current guidelines from the American Academy of Pediatrics call for the use of an over-the-counter product containing permethrin or pyrethrins as a first salvo against head lice. Shampoos and rinses made with these substances are generally effective. Most treatments for head lice need to be used twice, seven to 10 days apart, along with combing wet hair with a fine-toothed nit comb. Some lice are resistant to pyrethrin and permethrin. Stronger prescription drugs, such as malathion and lindane, also work but aren’t as safe for humans. That’s where Natroba comes in. Read more »

*This blog post was originally published at Harvard Health Blog*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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