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Helping Your Child Succeed at School

A new school year is once again upon us! And for those with children who may need a little extra help in their classes, this may be a stressful time. Children with disabilities or impairments may be eligible for modifications or accommodations at school to help them learn and succeed.

Knowing if your child has a disability impacting their learning can be challenging. Usually a student will begin to have poor, down trending grades.  He/she may have difficulty remembering to do homework or may struggle to complete it.  If this is not brought up by your child’s teacher, you may need to speak up. An evaluation may need to be performed by the school in order to test for certain learning disabilities or other issues. Additionally, you should speak with your child’s pediatrician for developmental, vision, and hearing screens.

Some students qualify for special education services under the federal law, Individuals with Disabilities Education Act. If eligible, an individualized education plan (IEP) is developed to lay out goals for the school year and describe any services or supports the student may need.  Any child age 3 or older with a suspected disability can request a free full individual evaluation from the local public school district.  Several categories of eligibility exist, including specific learning disability, hearing/visual impairment, and “other health impairment.”

Other students may qualify for accommodations under Section 504 of the Rehabilitation Act of 1973. These can include supports such as reminders to stay on task, preferential seating in the classroom, shortened assignments, and other items.  You can ask your child’s teacher or school counselor for a “504 meeting.”

It is vital to know that your child will only receive services if it has been shown that your child’s learning has been affected by these issues and problems with functioning at school exist. If this is the case, a meeting for either special education or 504 accommodations will involve a plethora of staff (classroom teachers, diagnostician or school psychologist, special education teacher, campus administrator, and others).  The group, along with you the parent, decides what the child needs. You, as a parent, will have the option to review the proposals and agree or disagree. Do this to make sure your child is getting all the services he/she may need. Make sure to discuss any changes you would like to be made.

The 504 plan or IEP should be reviewed annually. If you are not seeing appropriate changes to your child’s performance or learning goals – speak up.  Ask your child’s pediatrician for any suggestions or recommendations for your child.   You are the best advocate for your child!

To learn more, visit:

https://sites.ed.gov/idea/

https://www2.ed.gov/about/offices/list/ocr/504faq.html

Kristina Ciaglia, MD

 

 

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MISINFORMATION- THE CONVERSATION WE NEED TO BE HAVING

love baby boys family

Photo by Pixabay on Pexels.com

“Misinformation is not like a plumbing problem you fix. It is a social condition, like crime, that you must constantly monitor and adjust to.” -Tom Rosenstiel

As a society, we are blessed to live in an age of abundant and easily accessible information. However, it can be difficult to distinguish between what is true and what is false. As pediatric providers, we have become aware of this- especially when it comes to parents who are concerned about vaccine safety. These concerns must be acknowledged and addressed. Along with providing medical advice and resources for reliable information, we should also be educating parents on how misinformation is presented. (more…)

The Need to Keep Families Together

According to the US Census Bureau, only 68% of children live in households with two parents, a figure that has been steadily decreasing over the past few decades1. The separation of parents and the lack of two-parent households occurs for a multitude of different reasons, and there are some cases in which it is better for the health and development of a child to live with a single parent. However, multiple independent studies have shown that generally, children have more health problems with only one parent in the household. One study2 that included 17,000+ preschool-age children showed that one parent homes had:

  • Increased risk regarding parent-reported poor health status [boys: odds ratio (OR) 1.39 (95% confidence interval (CI): 1.06-1.82), girls: 1.73 (1.28-2.33)]
  • Psychological problems [boys: 1.90 (1.38-2.61), girls: 1.58 (1.03-2.42)]
  • Overweight [boys: OR 1.23 (1.01-1.50)}
  • Asthma [only girls: OR 1.90 (1.15-3.15)]

 

Many of the above trends also hold true for refugee children displaced to countries without their parents. This is unsurprising, given the data above showing that removing one parent from the household already shows decreases in child health. The removal of both parents, in addition to the violence/trauma surrounding the move to a new home, would naturally be expected to prove problematic on the health and well-being of these children. A review3 of roughly 50 studies and 5,000+ children living in the USA and other high-income countries found that many of these children (especially those of adolescent age, those with mental health disorders or those experiencing trauma around the parent’s removal) experienced higher than average rates of PTSD, anxiety, depression and general health problems with inconsistent improvement over time.

 

While the factors surrounding the decline in two-parent households are very complex, the current refugee situation within the United States offers a clearer path of way to make an immediate difference. As many well know by now, 2,000+ children4 have been removed from their homes and many of their parents deported to Mexico or other countries including Honduras, Guatemala and El Salvador. Many of these children are toddlers or have mental/medical disorders (such as down syndrome, or those requiring complex medical care) that will add further difficulty and traumatization to the removal from their households.

 

Regardless of personal views on immigration legality and procedure, there is a substantial amount of data that supports the notion that children have better outcomes when they are with their families. This begs the question, what is the best way to help keep these children from being separated?

 

One of the easiest ways to get involved is to follow legislation that is currently in progress to help keep these families together. Following this legislation, keeping an eye out for events at a local level and contacting state representatives can all assist with this cause beyond what any one individual can do alone. There is a lot of legislature currently in progress surrounding this issue:

 

Across the board, children have better outcomes when their parents are around and able to provide both the financial and emotional support that children need to thrive and survive. While it is difficult to affect family divorce/separation rates, what we currently can do is advocate for the children being pulled away from their families in light of recent deportations. This can be done via legislation that is currently on the floor aiming to prevent dissolution and protect these children and these families. Immigration beliefs aside, these children deserve better than what they’re currently receiving, and it’s important to prioritize keeping these families together.

 

Taylor Valadie, MD

 

References:

1) US Census Bureau (November 2017) Families and Households https://www.census.gov/topics/families/families-and-households.html

2) Scharte M1, Bolte G; GME Study Group (2013) Increased health risks of children with single mothers: the impact of socio-economic and environmental factors. Eur J Public Health. 2013 Jun;23(3):469-75

https://www.ncbi.nlm.nih.gov/pubmed/22683774

3) Fazel, Mina. Reed, Ruth V. Panter-Brick, Catherine. Stein, Alan. (2011) Mental health of displaced and refugee children resettled in high-income countries: risk and protective factors. Lancet 2012; 379: 266–82 http://www.evidenceaid.org/wp-content/uploads/2016/03/1-s2.0-S0140673611600512-main.pdf

4) de Córdoba, Jose. Perez, Santiago (June 19 2018) Mexico Criticizes U.S. Over Policy Removing Immigrant Children From Parents. https://www.wsj.com/articles/mexico-rebukes-u-s-over-policy-removing-immigrant-children-from-parents-1529432369

Discussing Depression and Suicide in the Media

Avicii (Tim Bergling), Chester Bennington, Kate Spade, Mark Salling, Robin Williams, Anthony Bourdain: All names in media for the unfortunate fame of recent suicides. Similarly, TV shows such as “13 Reasons Why” (released to Netflix in 2017) and pop songs like “1-800-273-8255” by Logic (featuring Alessia Cara and Khalid), shed light on the persistent and ever growing issue of adolescent depression and suicide. There has been heated national debate regarding the effect media has on perpetuating suicidal thoughts versus raising awareness. Whether by parental choice or not, the discussion of mental health and self-harm has made its presence known to the public eye of children with these big names of Hollywood and pop culture. Just as it is important to address gun violence covered by media, pediatricians and parents must take strong roles in approaching the sensitive subject of depression. Suicide is itself a very private matter, however more recently it has become publicized, glorified, and often shamed. In light of these portrayals, it is crucial to remember it for what it is: a mental health illness.

According the CDC 2018 Vital signs, suicide rates across ages continue to rise with a significant jump by 30% from 1996 to present, in half the US states [1]. Suicide remains the 3rd leading cause of death in children 10-14 years of age, and (since 2016) the 2nd leading cause of death in adolescents 15-24 years of age. Looking state specifically, Texas falls in the range of 19-30% increase in suicide rates. Fortunately, amongst adolescents, attempt rates and health injury caused by suicide attempts, remains relatively stable between 2013-2015, according to Youth Risk Behavior Survey [2]. The disappointing reality exists that even under the watchful eye of healthcare providers, 77% of those who complete suicide have been seen by a primary care provider, and 40% have been seen by an emergency care provider in the year leading up to their suicide [3].

What can be done? And how do we intervene? Initial screenings are not only welcomed by adolescent patients [4] but also effective in providing a backbone for further follow up [5]. Systematic tracking of endorsed suicidality, with formulas/surveys such as the PHQ-9, help to quantify mental health and to make screening easier for the providers.

For parents and pediatricians alike, anticipatory guidance during adolescent well child exams or sports physicals can serve as a time to review key topics such as:

  • Warning signs of depression:
    • social withdrawal, loss of interest in prior hobbies, hopeless talk, extreme or labile emotions/mood swings, verbal outcries on social media
  • Open communication:
    • encouraging parent-teen relationships, providing attention and empathy before patient outcries (http://www.bethe1to.com/), avoiding shame, expressing concern about the patient
  • Access to guns/medications/drugs at home:
    • removing adult (or child) medications that can be abused, removing and locking away guns (4-10x higher likelihood of suicide in households with gun access) [6]
  • Cyberbullying:
    • Limiting social media use, monitoring internet searches on suicide (more than 5 hours of internet use daily associated with higher rates of suicide) [7]
  • When to escalate and who to reach out to with concerns:

By initiating a conversation early on with parents and adolescents alike, pediatric providers may alter the perspective on mental health. Pop culture media is not required to uphold the ethics of beneficence or non-maleficence. Ultimately, it is the responsibility of the pediatrician and the community at large to invest in the future of its young adults. We can do this by advocating for improved funding (in light of budget cuts to mental health services), and perpetuating positive and open dialogue early on regarding mental health and depression.

~Alisha Wang, MD

 

References:

[1] Suicide Rising Across the US: https://www.cdc.gov/vitalsigns/suicide/

[2] Trends in the Prevalence of Suicide-related Behavior: https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trends/2015_us_suicide_trend_yrbs.pdf

[3] Parkland Leads Way Nationally with Innovative Suicide Screening Program: https://www.parklandhospital.com/phhs/news-and-updates/parkland-leads-way-nationally-with-innovative-suic-769.aspx

[4] To Ask or Not to Ask? Opinions of Pediatric Medical Inpatients about Suicide Risk Screening in the Hospital. Journal of Pediatrics. Mar 2016. https://www.jpeds.com/article/S0022-3476(15)01464-X/pdf

[5] Suicide Screening in Primary Care: Use of an Electronic Screener to Assess Suicidality and Improve Provider Follow-Up for Adolescents. Journal of Adolescent Health. Feb 2018. https://www.jahonline.org/article/S1054-139X(17)30466-4/fulltext

[6] With Suicide Now Teens’ Second-Leading Cause of Death, Pediatricians Urged to Ask About Its Risks. AAP. Jun 2016. https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/With-suicide-Now-Teens%E2%80%99-Second-Leading-Cause-of-Death-Pediatricians-Urged-to-Ask-About-its-Risks.aspx

[7] Suicide and Suicide Attempts in Adolescents. AAP. Jun 2016. http://pediatrics.aappublications.org/content/early/2016/06/24/peds.2016-1420

Parental Responsibility to Regulate Screen Time for Children

In 2016, the American Academy of Pediatrics (AAP) revised screen time guidelines for children. The previous guidelines advised no screen time for kids less than 2, and no more than 2 hours in front of the TV for kids over the age of 2. With the advent of smart phones and tablets making screen time and Internet access nearly ubiquitous, many pediatricians and other professionals felt the AAP was long overdue in revising screen time guidelines to be more appropriate for current and future generations of children. Newly revised 2016 guidelines were broken down into four basic age groups with added flexibility to customize screen time to fit the needs of the individual child, as follows:

  • For infants less than 18 months of age:
    • Parents should avoid use of screen media other than video chatting.
  • For infants 18 to 24 months of age:
    • If desired, parent should choose high-qualityprogramming, and watch with children to help them understand what they’re seeing.
  • For toddlers 2 to 5 years of age:
    • Parents should limit screen use to 1 hour per day of high-quality
    • Parents should co-view media with children to help them understand what they are seeing and apply it to the world around them.
  • For children 6 years of age and older:
    • Place consistent limitson the time spent using media, and the types of media, and make sure media does not take the place of adequate sleep, physical activity and other behaviors essential to health.

These new guidelines recognize that visual media can be an important tool for development and educationwhen properly utilized. The problem is that many parents do not properly adhere to these guidelines. Contrary to what some may believe, these guidelines do not relax the parameters for screen time. Rather, these guidelines call for increasedparental investmentin actively regulating their child’s media consumption. Examples of inappropriate screen time, at times even commonly witnessed directly by pediatricians in clinic, include some the following:

  • Parents using video streaming on mobile devices as a means of distracting their infants or children.
  • Parents not adequately supervising screen time.
  • Parents failing to set consistent limits on media use.
  • Parents or children choosing to view poor quality programming with little educational benefit.

Adverse effects of unregulated screen time are well understood to include the following: obesity, sleep problems, problematic internet use (e.g. gaming disorders), negative effects on school performance, risky behaviors (e.g. substance abuse, inappropriate sexual behaviors), sexting, piracy, predators and cyber bullying.

Given the common adverse effects of unregulated media use, it is important to recognize that the above guidelines do not indicate AAP’s endorsement of screen time as a primary learning activity. The AAP recommends that parents prioritize creative, unplugged playtimefor infants and toddlers. The amount of daily screen time for older children depends on the child and family, but children should prioritize productive time over entertainment time.

The AAP provides an important but underutilized tool online that helps families build their own custom Family Media Plan (see link below). Pediatricians who wish to emphasize the importance of regulated screen time should consider providing this resource to families in their clinics. The plan provides a customizable template that includes setting important boundaries in the development of healthy screen time behavior.

Lastly, a quote from Bill Watterson, arguably one of the most creative minds of the late 1980s-early 1990s who is known for his authorship of Calvin & Hobbes, helps reinforce the importance of alternatives to screen time:

“We’re not really taught how to recreate constructively. We need to do more than find diversions; we need to restore and expand ourselves. Our idea of relaxing is all too often to plop down in front of the television set [or internet] and let its pandering idiocy liquefy our brains. Shutting off the thought process is not rejuvenating; the mind is like a car battery—it recharges by running.”

Alex J. Foy, MD

 

Sources and Resources:

Build Your Own Family Media Plan

https://www.healthychildren.org/English/media/Pages/default.aspx#home

10 Tips for Becoming a More Active Family

https://www.choosemyplate.gov/ten-tips-be-an-active-family

Children and Adolescents and Digital Media

http://pediatrics.aappublications.org/content/early/2016/10/19/peds.2016-2593

Constantly Connected: Adverse Effects of Media on Children & Teens

https://www.healthychildren.org/English/family-life/Media/Pages/Adverse-Effects-of-Television-Commercials.aspx

Obesity and Food Insecurity: A Dichotomy in the Current State of Nutrition in America

Nutrition plays a vital role in growth, behavioral and cognitive development, reproductive health, and long-term health maintenance.  Pediatric is arguably the most vulnerable population to the affect of food availability. In the early stages of childhood, appropriate nourishment can facilitate growth, cognitive and motor development. In school age children, it can facilitate or hinder academic success, and set up a foundation for a lifetime of healthy lifestyle or predispose a child to multiple chronic morbidities such as fatty liver disease, diabetes, and hypertension. In their teenage years, poor nutrition can lead to infertility, either through anovulation from malnourishment or PCOS from obesity.

 

Children are entirely dependent on their caretakers for appropriate nutrition in the most crucial stages of their lives. In America, 16 million children currently live in food-insecure households, and more than one third of children and adolescents are overweight or obese. While obesity touches all colors, genders, and social-economic backgrounds in America, African Americans, Hispanics, and children from households with lower education level are especially affected.

 

Obesity is usually thought of as a disease of excess, however, there’s a positive correlation between poverty and obesity. According to a study of over 28,000 low-income children in the Massachusetts WIC program, children in food-insecure households have 22 percent greater odds of childhood obesity compared to their food-secure counterparts.  Though initially counterintuitive, several factors explain this relationship: lack of access to healthy food, greater exposure to obesity-promoting products, cycle of starvation and overeating, few opportunities for physical activities, high level of stress, depression, and anxiety, and limited access to healthcare.

 

Currently, several nutritional assistance programs such as WIC, Food Bank, and SNAP target low-income, food insecure populations. However, while these programs might address the issue of food insecurity and cycle of overeating and starvation, the types of food provided might contribute to obesity. For example, WIC provides 128 oz of fruit juice monthly to children ages 1-4, which is the maximum amount recommended by the AAP, food banks provide soda, juice, chips and other sugary snacks, and SNAP allows soft drinks, candy, cookies, ice cream, and cake to be purchased using monthly SNAP allowance. While the AAP’s policy statement in June 2017 does allow up to 3 oz of juice a day for 1-3 years old toddlers, it states that “fruit juice …has no essential role in healthy, balanced diets of children” and calls for pediatricians’ support to “reduce the consumption of fruit juice…by toddlers and young children already exposed to juice, including through…WIC.”

 

While we concentrate our efforts in providing assistance to food-insecure families, it is important to be mindful of the other phenomenon that tends to coexist with poverty and food insecurity: obesity.  When families are provided with juice, soda, and other non-nutritious food as part of their food package, it can be confusing and difficult to choose to consume only nutritious food. It is crucial for healthcare providers and nutritionists to counsel patients on healthy food choices, especially in families with limited access to resources and education.

 

Several resources can help families learn more about healthy food choices:

https://www.nutrition.gov/

https://www.choosemyplate.gov/

https://www.girlshealth.gov/nutrition/index.html

 

 

Phinga Do, MD

 

 

References:

https://ihcw.aap.org/Documents/COPC_Module1_RoleofHCProvider_FINAL.pdf

http://frac.org/wp-content/uploads/frac_brief_understanding_the_connections.pdf

http://pediatrics.aappublications.org/content/139/6/e20170967

https://fns-prod.azureedge.net/sites/default/files/wic/SNAPSHOT-of-WIC-Child-Women-Food-Pkgs.pdf

https://www.fns.usda.gov/snap/eligible-food-items

https://www.aap.org/en-us/advocacy-and-policy/federal-advocacy/Pages/ChildNutrition.aspx

 

 

Heat Stroke in High School Football Players: A Lack of Regulation Placing Children at Risk

At the start of every school year, thousands of high school athletes come in excited to hit the field.  Unfortunately, heat related death in high school sports, especially high school football, remains a real risk due to lack of regulations and safeguards in place.  However, these injuries and deaths are entirely preventable by proper practices.  Pediatricians have a duty and an opportunity to protect these athletes from environments and circumstances that put them at increased risk for heat stroke and death.

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SNAP: The Supplemental Nutrition Assistance Program and Its Future

When we come home every evening to join our friends and families for dinner, many of us seldom worry about whether we will have food on the table. For millions of Americans, however, hunger is a very real difficulty as they struggle to feed both themselves and their children. As part of the effort to combat hunger in the United States, physicians should support the continued funding of SNAP, a program implemented by the federal government to answer the challenge of food insecurity.

Since the 1960s, the Supplemental Nutrition Assistance Program, or SNAP, has provided eligible, low-income individuals and families with benefits for food at eligible retail stores. Formerly known as food stamps, this federal program assisted nearly 45 million individuals in 2017, especially households with children, elderly, and disabled persons. Eligibility for SNAP is limited to people with gross incomes up to 130% of the federal poverty line. Families are provided with monthly electronic debit cards to purchase groceries at authorized retailers.

In 2015, SNAP helped 4.6 million Americans rise above the poverty line, including 2 million children. The program also reduced the prevalence of food insecurity by as much as 30%. It also supports the economy; for every $1 billion added to SNAP funding, approximately 18,000 new jobs are created.

Research by the USDA Economic Research Service has found strong correlations suggesting that food insecurity increases the risk of adverse health outcomes and leads to higher healthcare costs. In 2017, food-insecure households spent 45% more on medical care compared to food-secure households. These people had a higher prevalence of heart disease and diabetes, and were more likely to be non-adherent to their medications. Conversely, SNAP participants were healthier and incurred about $1,400 less in medical costs over a year than other low-income individuals. Additionally, children with access to SNAP have improved long-term health, with lower risks of obesity, heart disease, and diabetes.

While SNAP fights to ensure that no American goes hungry, it also encourages work through specific requirements for able-bodied adults without dependents, or ABAWDs. Through the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, non-disabled individuals between the ages of 18 and 49 can only get SNAP for 3 months in 36 months unless they work 80 hours per month, participate in a qualifying educational or training activity, or do unpaid work through special State-approved programs. While the USDA’s Food and Nutrition Service determines its broad policy, states and counties manage its daily activities and administration. Many states request federal permission to waive these time limits due to local economic difficulties. These waivers have been crucial in assisting individuals who live in areas of particular hardship.

Currently SNAP is facing significant changes to its funding and structure. President Trump’s 2019 budget proposes cutting SNAP funding by over $213 billion over the next 10 years and restructuring how benefits are delivered. At least 4 million people would lose eligibility, and many others will have reduced benefits.

The biggest change is that the government will stop its partnership with over 260,000 retail stores around the country and instead provide government-purchased food boxes of nonperishable goods. This would mean that families would have less choice in their food, especially with fresh fruits and vegetables. Also, the states would be left to determine how these food boxes would be distributed and bear its costs.

Furthermore, a portion of these SNAP benefits would be withheld from households, and would ultimately affect 34 million people, or almost 90% of SNAP participants, in 2019. The proposal would also limit waivers for ABAWDs and increase the maximum age, which would severely impact those in high-unemployment areas, the elderly, and the disabled. Additionally, SNAP nutrition education funding would be eliminated, which would severely hinder the program’s goals for improved nutrition.

Proponents of these changes suggest that this will be an effective method of cutting government spending, while providing standardized meals for families. Concerns exist that SNAP creates “food stamp dependency” and increases the risk of childless and disability-free adults relying solely on SNAP benefits instead of working. Some studies by organizations such as the Foundation for Government Accountability report that many ABAWDs who left these programs after certain states renewed these time limits found work within 12 months and experienced a significant increase in their income. However, many studies have found that most people continue to work while remaining on SNAP, and that these waiver restrictions mostly affect people who live in areas without any available work.

While managing government spending is a perpetual aim for every Congress and President, the proposed changes to SNAP have the potential to negatively affect millions of American families, especially children. There would likely be an increase in health-related problems for individuals of all ages who relied on these benefits, which would lead to an increase in healthcare costs. It would also undermine previous efforts at promoting healthy nutrition habits and education. Improving savings in the national budget is a worthy goal, but not at the expense of pushing millions of people closer to hunger.

As physicians, we should make every possible effort to protect families and children from hunger. Please contact your local and federal representatives and encourage them to continue SNAP funding without restructuring the program or withholding SNAP benefits from those in need of assistance.

Vishnu Prathap, MD

References:

Archambault, Josh. “Restoring Work Requirements: An Important Fix To America’s Food Stamp Crisis.” Forbes, Forbes Magazine, 11 Aug. 2015, www.forbes.com/sites/theapothecary/2015/08/11/restoring-work-requirements-an-important-fix-to-americas-food-stamp-crisis/#61d40681a20a.

Belluz, Julia. “45 Million Americans Rely on Food Stamps. Trump Wants to Gut the Program.” Vox, Vox, 23 May 2017, www.vox.com/policy-and-politics/2017/5/23/15675892/food-stamps-snap-evidence-health-poverty-hunger.

Carlson, S, and B Keith-Jennings. “SNAP Is Linked with Improved Nutritional Outcomes and Lower Health Care Costs.” Center on Budget and Policy Priorities, 17 Jan. 2018, www.cbpp.org/research/food-assistance/snap-is-linked-with-improved-nutritional-outcomes-and-lower-health-care.

Ingram, J, and N Horton. “How Kansas’ Welfare Reform Is Lifting Americans Out of Poverty Work.” The Foundation for Government Accountability, 16 Feb. 2016, https://thefga.org/research/report-the-power-of-work-how-kansas-welfare-reform-is-lifting-americans-out-of-poverty.

Office of Research and Analysis. “Food and Nutrition Service.”Food and Nutrition Service, United States Department of Agriculture, Apr. 2012. https://fns-prod.azureedge.net/sites/default/files/BuildingHealthyAmerica.pdf.

Rector, Robert, and Vijay Menon. “SNAP Reform Act Offers Sound Basis for Welfare Policy.” The Heritage Foundation, 9 Jan. 2018, www.heritage.org/hunger-and-food-programs/report/snap-reform-act-offers-sound-basis-welfare-policy.

Rosenbaum, D, et al. “President’s Budget Would Cut Food Assistance for Millions and Radically Restructure SNAP.” Center on Budget and Policy Priorities, 15 Feb. 2018, www.cbpp.org/research/food-assistance/presidents-budget-would-cut-food-assistance-for-millions-and-radically.

“Supplemental Nutrition Assistance Program (SNAP): Able Bodied Adults Without Dependents.” Food and Nutrition Service, United States Department of Agriculture, 26 Feb. 2018,www.fns.usda.gov/snap/able-bodied-adults-without-dependents-abawds.

“Understanding SNAP, the Supplemental Nutrition Assistance Program, Formerly Food Stamps.” Feeding America, 2018, www.feedingamerica.org/take-action/advocate/federal-hunger-relief-programs/supplemental-nutrition-assistance-program.html?referrer=http%3A%2F%2Fwww.feedingamerica.org%2Ftake-action%2Fadvocate%2Ffarm-bill.html.

Cyberbullying: A Pediatrician’s Role in the Digital Age

Due to the recent explosion of hand-held technology over the past 2 decades, a new form of bullying has emerged called “Cyberbullying”. This type of bullying utilizes electronic means of communication such as text messaging, email, websites, or social media (Facebook, Twitter, etc.) to victimize and cause a power imbalance between peers. Pediatricians should identify signs of cyberbullying and provide appropriate anticipatory guidance and resources to both parents and patients.

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Firearm Safety Considerations in the Pediatric Population

Recent tragedies in Las Vegas, Nevada, and Parkland, Florida have returned the topic of firearm safety to the forefront of societal and political discourse. Children and adolescents are particularly affected by firearm violence. The latest population data is sobering – nearly 12 firearm deaths per day in the United States in children ages 0-21 years old. The American Academy of Pediatrics (AAP) continues to call for legislative action to reduce the incidence of firearm-related violence. Initiatives championed by the AAP include: (1) banning assault-style weaponry, (2) banning Internet sale of firearms, and (3) requiring background checks prior to purchase of a firearm, to name a few.

How can pediatricians work to promote safety in their patient population? Efforts on both a political front through advocacy and on a personal scale via anticipatory guidance during well child examinations can create societal and individual change to improve the health and safety of all children.

Problem

  • Nearly 1 in 5 deaths in American youth under-20 is firearm-related.
  • Merely the presence of firearms in the home increases the risk of suicide among adolescents. The risk is even worse if the gun is kept loaded.
  • A study of personal firearm storage revealed:
    • 21.7% of subjects kept their firearms loaded when stored at home
    • 31.5% of subjects stored their firearms in unlocked locations
    • 8.3% of subjects kept their firearms loaded AND stored in unlocked locations
  • More than 75% of guns used in suicide attempts and unintentional injures of children ages 0-19 were stored in the residence of the victim, a relative, or a friend.
  • Children as young as 3-years old can produce enough squeezing pressure to pull a trigger on a loaded gun

Solutions

  • The most effective measure to prevent firearm violence is the absence of firearms in the home.
  • Stricter regulations regarding access and purchasing of firearms
  • Better storage of weapons including trigger locks and locked storage boxes
  • Mechanistic alterations to make firing a weapon more difficult for children, such as increasing trigger pressures

Actions

  • Advocacy
    • Send correspondence to your local state legislator to share your views on firearm safety and the need for stricter control of access and storage
      • The AAP has resources to find the contact information for your state legislators and a draft email here.
    • Engage with local schools and media to offer your experience and expertise.
      • The AAP has developed talking points regarding firearm violence in the pediatric population that can be found here.
    • The AAP recommends pediatricians address firearm safety as part of routine anticipatory guidance for families with children of all ages.
  • Anticipatory Guidance
    • Always asked about firearms in the home. Where are they stored? Are they locked? Who has access?
    • Inform families that the safest homes are those without guns.
    • For homes with firearms, encourage families to take practice safe storage – store guns and ammunition separately and in locked containers.
    • Encourage removal of firearms in homes with adolescents, especially if there is a history of mood disorders, substance abuse and/or a history of suicide attempts.
    • Encourage parents to ask if there is a gun in the house before sending children to play at a friends’ home.

Firearm violence is a huge issue that will constantly provoke heated debate and passionate rhetoric from all sides. As pediatricians, we can take simple steps to inform parents and help protect the most vulnerable population of our society.

D. Alan Potts, MD

 

References: