California
Chapter 1
August 1997 News Update
By Tom Long Chapter President
The transition is made. Becoming President of your Chapter was a little intimidating and humbling to say the least. Lucy Crain set me off in the right direction with jobs to do and a routine to follow. Our Academy office is well organized and very supportive and all of you have been very receptive and gracious when I have called upon you. Thanks for your help. Willingness to be involved is a unique quality of pediatricians.
Pediatrics is unique. Do you remember why you became a pediatrician? There were certainly many choices. Most of the disciplines of medical school were challenging and we were all exposed to more than one special teacher who was in one way or another inspirational. I will bet that that teacher was not necessarily a pediatrician. And it is unlikely that economics was the primary determinant. But then in those days few of us had any sense of the business of medicine. And even if we did, that sense was a far cry from the managed care challenge of today.
When I look back to my medical school days, I remember the Hospital for Sick Children in Toronto. It was a large dedicated pediatric facility in the heart of downtown Toronto, a stone’s throw from Queen’s Park and the Ontario Parliament buildings. The city seemed to value its presence. There was always a building campaign and there was an annual appeal that was widely supported. When I arrived to begin a summer laboratory job, the residents and house officers were serious in their pursuit, proud of their association and eager to establish their place in the world of medicine. My turn came and I too was proud to be recognized as a resident of the Hospital for Sick Children. Pediatrics was always in the news. Advances in health care, medical care for special-needs kids, and recognition that came from local and international centers sparked pride and greater endeavors. I have heard some of my staff lounge associates refer to those days as the “golden age” of medicine. What is happening today?
The Pediatrician was at one time the physician who was the specialist in childcare. Today it is possible to practice pediatrics without nursery privileges, without taking after-hours calls and at a time when someone often challenges our decisions that were made with only a handbook of clinical practice guidelines. We have led the way in outpatient and home care. Children belong at home. We fight for public health issues. We are cost-conscious. Pediatrics is also economically more predictable than other medical disciplines. This might make pediatric management less individual and more a matter for group or self-help care. Healthy children are the norm, and congenital problems, malignancy and specialized pediatric problems are relatively uncommon in any practitioner’s experience. We struggle more today to balance our occupational, personal, and family lives. We have pediatric specialists who will assume our diagnostic dilemmas. Why do I see and hear of pediatricians who have given up the skills and the privileges that they have worked so hard to obtain?
Now when I talk with today’s medical students I sense their eagerness, I hear their queries, and I admire their sense of challenge. They are confident of their abilities and eager to make their contribution. That’s reminiscent of the same energy and enthusiasm we knew as students. But what will be their inheritance? What will be the role of tomorrow’s pediatrician?
Our Managed Care Initiative, designed to promote the pediatrician as the best primary care provider for children, recognizes this problem. The Academy too has a Pediatric Work Force Committee and there is an Education Task Force. I think the Academy sees our changing role. It’s easy to say that we are the best advocates for children. But that is consequence of our primary interest, health care, and the needs of children. We must continue to stand up for the health care standards for children and for tomorrow’s pediatrician.
Pediatric care is not always convenient. No one other than a Board Certified pediatrician should care for a hospitalized child. Will we take our pediatric concerns into the work place or into the schools? We need to apply our skills more widely perhaps as supervisors of well childcare, or as consultants to preschool and day care programs. We can advocate for children’s health issues. Another role might be in teaching parenting skills or consulting on behalf of children for the courts or other social services. The health of our children may depend on it. In today’s health market the one-on-one care that we are accustomed to providing is valuable in itself but highly inefficient. Change is inevitable.
Our Chapter has many committees and task forces that will enable you to join forces with colleagues who share your interest and passion and will provide a forum for you to make a difference. Give me a call. We are the authors of our own destiny. Let’s not forget the visions we had as we stood on the threshold of our pediatric careers.
Minutes Summarized from Chapter 1 Board of Directors Meeting
May 25, 1997
Hyatt Regency, Monterey, California
Past President, Lucy Crain, MD thanked Drs. Peter Michael Miller and Joe Herbert for their years of service on the Board. Dr. Herbert received a Certificate of Appreciation.
Dr. Crain announced National, District and Chapter election results as follows:
National President Elect; Joel Alpert, District IX Chair, Lucy Crain; Chapter 1 Vice President, Paul Jewett; Secretary, Carol Miller; Treasurer, Susan Cummins; Nominating Committee, Alan Burckin; Alternate Members at Large, George Balella (Area #11), Martin Cohen (Area #3), Michael Harris (Area #8), Michael Rankin (Area #9), and Kevin Tracy (Area #2). The by-laws amendments were accepted.
National committee nominations and election will be reported in July.
Dr. Crain announced that Dr. Long will appoint the committee chairs for 1997-99 and that she had sent letters to all existing chairs thanking them for their service to the Chapter. Dr. Crain also provided Dr. Long with recommendations and critiques of the various committees. In particular, Dr. Crain suggested that rural pediatrics and international child health committees be retired due to lack of activity in past two years.
President’s Report:
Dr. Long shared a poem on children’s rights entitled “All About Me” and stressed the need to advocate rights for children.
Dr. Long proposed a Chapter 1 retreat to focus Chapter activities for the next two years. This would be a one-day retreat to define charges for our committees and determine long range strategic planning. An outside facilitator will be contacted to assist the Board with this retreat.
Future Board meeting dates were selected as follows: Wednesday, September 3, 1997; Wednesday, March 4, 1998; Wednesday, December 3 the location for Board meeting will be determined in the immediate future and will possibly be held in Sacramento in September in conjunction with our second annual legislative day.
Drs. Long and Jewett will represent our Chapter at the Annual Chapter Forum. Other Board members interested in attending this meeting were asked to contact Dr. Long.
Committee Reports:
Mark Simonian described the metamorphosis of the Chapter 1 web site. He is investigating Internet providers to carry the web page, since Cybergate is no longer a viable option. Dr. Simonian requested input on what other items might be appropriate to list on the web site. The following suggestions were made:
The Executive Committee will review and approve all materials prior to their being listed on the Chapter 1 web site. The suggestion was made to ask various committees to submit book reviews of interest to be listed on the site. These shall not include any books in which they have any commercial interest. Dr. Kasuga volunteered to contact the Monterey speakers to request pearls from their talks to post on the web site.
Dr. Crain reported on the various resolutions being submitted to the Annual Chapter Forum and she asked for volunteers to act as a nominee for the district representative to the Chapter Forum.
Dr. Long announced that Myles Abbott and Mary Jane Pionk have been appointed to Cochair the Medical Education committee. Dr. Long proposed that the Chapter recognize one or two individuals who are advocates for children during the luncheon presentation at the Annual Winter Meeting. These individuals need not be physicians or legislators. Willie Brown, Ellen Taucher, and Liz Figueroa were suggested as possible honorees. Board members are requested to submit additional names to Dr. Long for consideration.
Tobacco &
Youth
Task Force Update:
Dr. Long reported that the Task Force has requested committee status, focusing on tobacco. Seth Ammerman and Eileen Yamada were suggested as Cochairs for this committee. Dr. Long reminded the Board that the task force is focusing on the November Great American Smokeout and the October Child Health Month activities in coordination with National AAP.
Dr. Long requested that all Members at Large complete the enclosed tobacco survey and return it to the office as soon as possible. He also requested that Board members submit the names of 5 pediatricians in their area who might be willing to participate with the AAP in these events in October and November. It was also suggested that residents might be recruited to make presentations in schools on tobacco use and cessation. Dr. Long reported that each county has a tobacco control office, which can provide resources and information on this topic. Dr. Long also reported that the legalization of marijuana for medical use is a problem that the Committee on Substance Abuse has identified as an issue with which pediatricians need to be very knowledgeable.
Dr. Long requested that Members at Large make personal contact (via phone or in person) with all new fellows elected to the Academy. Beverly will provide lists of these physicians so that the Members at Large can welcome them into the Academy and suggest that they become Chapter members (if they are not already members of Chapter 1).
Treasurer’s report:
Dr. Cummins described the third quarter income and expense report submitted to the Board. A lengthy discussion was held regarding the difficulties of reporting income and expense in the same fiscal year in which they are incurred. Dr. Miller suggested that perhaps a financial report, which reflects actual fiscal year expenditures, might also be presented on a yearly basis. Dr. Cummins will meet with Beverly to develop a slightly different financial report form.
Dr. Cummins also reported that dues are now $100 per member, with $20 going to District IX for their dues assessment and $80 going to the Chapter.
The issue of the 1997 cruise seminar was discussed. Dr. Cummins will contact Dr. Stephen Fernbach to discuss implementing a better reporting system for income and expenses for this cruise and any future cruises offered by Chapter 1.
Maurice Gillespie discussed his areas of concern with the Medi-Cal Managed Care program and how it is affecting pediatric care in the Fresno area.
Rik Kasuga reported on the 0 to 3 Initiative in San Mateo County, which he feels is working successfully and having positive effects on the families it serves. Dr. Kasuga also reported that pediatricians in his area no longer attend deliveries and that hospitals have their own in-house physicians covering these services.
Mary Beth Hughes described the Child Immunization Project in the San Jose area, which she feels is continuing to function well. The immunization registry is now in use in all county pediatric offices and will hopefully be implemented in private pediatric offices in the future. Dr. Hughes reported that the Medi-Cal Managed Care program in her community is working satisfactorily.
Ralph Myers discussed the upcoming Comprehensive School Health program, which he and Dr. Julian Davis will be attending in June. The primary focus for the entire meeting is a “train the trainer” approach whereby attendees will return to their communities to teach others about the program. Dr. Myers also described his county’s success with the Touch Point Pilot Project. This trains health care providers to understand child development, family issues, etc. Dr. Myers will provide a summary of this project for the Chapter 1 newsletter.
Joe Herbert eloquently shared his concerns about the Academy and its mission. Dr. Herbert suggested that a redefinition of the Academy’s Mission Statement might be in order at this time. He also reasserted his previous concerns about primary care pediatricians and their apparent abdication of their duties to other health care specialists. Dr. Herbert suggested that the Chapter might examine the ethical and moral issues of pediatrics in today’s world.
Bruce Gach reported on his Early Childhood Adoption and Dependent Care Committee activities. He also reported that the health childcare program is still not fully functioning.
Yasuko Fukuda reported on the Medi-Cal Managed Care issues facing San Francisco. Dr. Fukuda reported that this system remains chaotic and that there were physician concerns about the financial health of the San Francisco health plan. Dr. Fukuda also reported on the Immunization Coalition, stating that its goals are to bring together private and public sectors regarding immunization education.
Paul Jewett reported his concerns about the future of pediatrics and the need to distinguish pediatricians from other primary care physicians providing services.
Legislative News:
I need some up to date legislation or proposals. The CMA has some CMA conference delegate proposals but these have no current impact on the legislature. Any ideas?
By J.D. Northway
President and CEO
Valley Children’s Health System
A little over a year from now, the children of Central California will receive a wonderful gift: a new state-of-the-art pediatric hospital. Like nothing of its kind in the region, the new Valley Children’s Hospital will continue to serve more than one million children from the Central Coast to Bishop and from Merced to Bakersfield.
By the time the doors open in 1998, this new hospital will have been ten years in the making. But as the blueprints become operating rooms and patient rooms and playrooms, I’m asked one question with greater frequency: “Why would you build a new hospital in light of all the issues with managed care?”
Although my response seems rhetorical, it truly summarizes my feelings as they relate to caring for children: “Why wouldn’t we?”
From a practical perspective, the reason we’re building a new hospital is that our current facility was built in 1949 and simply does not meet our present needs and will not allow us to grow and change to meet our future needs.
From a real-time perspective, the
reason is much bigger, much more important.
These days, it’s not easy being a child. There are about 14 million uninsured children in the United States. The infant mortality rate is too high. Immunization rates are too low. And 25% of our nation’s children live in poverty. So the way I see it, as we build new facilities we are building bridges with educational and social services to help ensure that each child is given every opportunity to become a productive adult.
I worry about the healthcare system that is not making plans to replace their facilities as they age because I believe that we as healthcare providers have a responsibility to children. We have to ensure that they are raised in a safe community; that they have access to good educational resources and social services; that their parents have appropriate income and can provide decent, safe and secure housing. Most importantly, we must make a promise to them that they will have access to good health care. We must focus on the whole child.
We all know that illness is not going away. And although there will be new and different ways to provide service, a strong and viable integrated delivery system with capable and caring doctors and nurses and a facility in which to properly provide care is vital to meet the challenges which sit clearly on our horizon.
What we’re doing here is Fresno is not just building a better hospital; we’re building a better community for our children. And that’s a gift that will last a lifetime.
Fresno Valley Children’s Hospital Telephone Triage Center
By Mark M Simonian
Medical Director, Telephone Advice Service
Telephone Triage Centers are springing up around the country. This is partly due to a well-documented article that appeared in Pediatrics several years ago describing the success of the Denver Children’s triage program. Fresno pediatricians did not want to miss an opportunity to relieve one of the greatest stresses in their practice – after hours telephone calls. They wanted to learn more, and to see if it could be applied here.
The traditional method to staff such a service is to hire and train experienced pediatric nurses. They sit by telephones and hand write onto paper logs whatever information they remember. Later some of this information is presented to the primary pediatrician.
After many hours of research, on-site visits, and consultation with community pediatricians and administrators, a unique proposal was presented to the medical staff to develop telephone triage in Fresno. Three issues needed to be addressed: manpower, documentation of the telephone triage call, and standards to be used for the staff.
We already have an established manpower base that could allow a transition to a full pediatric telephone service. Fresno’s Valley Children’s Hospital hosts the region’s Poison Control Center. These specially trained and certified pharmacists and nurses handle more than questions about drug dosing, medication side effects, and pharmacokinetics. They give a great deal of advice and referral for common medical problems for all ages. Why not use this already tested resource for the telephone triage program?
What was particularly unique about this Poison Control Center is that all the information is documented into a sophisticated database created locally by a Fresno pharmacist-programmer, Terry Carlson. It has been a model program for the nation and its design is currently being used for much of California. With some additions, it can serve as the backbone for documentation of an advice service too.
The staffing and documentation aspects were only part of the solution. Protocols were an essential component and needed to be available. Standard responses and routines must be consistent and retrievable by the staff. Although one pediatric protocol system was available, it did not provide flexibility, it was not customized to our community needs, and there was a worry of copyright conflicts. At the onset, I believed that computerized access of protocols would provide fast access to a knowledge database. So, I started designing pediatric protocols based on the most common problems described by S. Poole and B. Schmidt in their Denver study group. These protocols were developed into a format that any Windows© user could access in the form of a Windows Help file. This information later was translated into the current Poison Control database and is used to assist staff and document responses to the callers.
This system with trained personnel and a custom database linked to the current Poison Control database did lend itself to a “prototype” program that covered telephone calls directed to the V.C.H. Emergency Department. After a one-year trial no problems appeared. Patient satisfaction was high, and no complaints or missed referrals were documented.
The system has worked well thus far. It demonstrates a unique approach to telephone triage and to document the parental concerns and the support staff answers. It is another means to staffing and documentation that we think will prove a model for other programs considering telephone triage advice services.
During the 1987 California school year, an eleven-year-old child, Peter (not his real name) ingested a small amount of cake containing peanut oil. Within minutes he developed wheezing and started vomiting. His mother arrived at school, picked up Peter, and within 15 minutes was in his physician’s office. There he received subcutaneous epinephrine and intramuscular Benadryl. Despite this treatment, Peter’s respiratory distress increased. He was then given oxygen and metaproteranol. When the ambulance arrived with sirens on, he became agitated, cyanotic, and then unresponsive. Intubation was attempted along with other resuscitation during the transport and later in the emergency room. The effects of anaphylactic shock were complicated by neurologic damage. Peter was pronounced brain dead in the hospital Intensive Care Unit four days after tasting a food containing a small amount of peanut oil. This is an example of how anaphylaxis can lead to a catastrophe for the individual and the community.
School staffs are a resource who, when properly trained, will be able to initiate prompt, accurate assessments, and effective treatment for anaphylaxis. Since 1995, the Napa Valley School District Health Committee, composed of members of the NVUSD staff and members of the Napa County Medical Society has sought to place a protocol for recognition and initial treatment of a severe allergic reaction at the school site. A consensus of goals and a cooperative action of allied community organizations would be necessary.
Initially the Position Statement of the American Academy of Allergy and Immunology (#26) served as a launching pad in the recruitment of that support. Paragraph 5 states, “It would be optimal for epinephrine to be available in all schools for nurses or trained individuals to administer to students or staff presumed to be having an anaphylactic reaction.” This declaration and the availability of a premeasured parenterally administered epinephrine dose supported the action (sponsored by the California Chapter 1 representatives) of the 1996 AAP Forum. The Forum passed Resolution 37 recommending that appropriately trained school staff be empowered, “to administer to any student a premeasured epinephrine dose for a serious, potentially life threatening allergic reaction when a registered nurse is not available.” The publication “ School Health Alert (Volume 8, Number 5, January 1993) had argued for the universal availability of epinephrine for anaphylaxis treatment of students known and unknown to be a risk. In 1988 Dr. George Flores, Public Health Officer of Sonoma County in California, approved and implemented a protocol that provides for epinephrine treatment of any county schoolchild experiencing a severe allergic reaction.
This information when presented to the 1997 Assembly of the California Medical Association House of Delegates prompted the passage of Resolution 110-97 which will promulgate the institution of a policy regarding appropriate use of an epinephrine dose for possible student anaphylaxis. It also directs the CMA to work cooperatively with the California Conference of Local Health Officers to develop an approved protocol for implementation in the jurisdiction of the health officer. The CMA Panel on Allergy has reviewed and forwarded a recommended protocol to the CMA Council on Scientific Affairs for its endorsement.
Circuitous as a thread’s path, each action required weaves a tapestry of support for that trained school staff member who must have the skills and the confidence that the treatment decision is necessary, and endorsed by the community. What began as a local response to a tragic event has recruited an alliance of professionals, each contributing to a needed change.
Chapter Members in the News
Dr. Richard Umansky, director of the Child Development Center at Children’s Hospital Oakland, for his contribution to April’s Pediatrics, “The Clinic Phenotype of Succinic semialdehyde Dehydrogenase Deficiency (4-Hydroxybutyric Aciduria): Case Reports of 23 New Patients.”
Dr. Mark Lobato for “Tinea Capitis in California Children: A Population-based Study of a Growing Epidemic” in April’s Pediatrics.
Please submit news items to the editors or Executive Director Beverly Busher.
From the Public Relations Chair
By Mika Hiramatsu, M.D.
Now available for chapter members is the Annie E. Casey Foundation’s annual Kids Count Data Book. The project is a national and state-by-state effort to track the status of children in the United States. An AAP member can refer to the Data Book for statistics on how his or her state is faring in 10 different areas, including infant mortality, juvenile arrest rate and the percent of children living in poverty. The information is useful for congressional correspondence, testimony, media interviews, newsletter articles, speeches, educational materials and other projects. For more assistance, you can contact Marjorie Tharp, AAP public affairs manager at (800) 336-5475. I have a copy to loan if anyone is interested: contact Beverly Busher or me.
You may obtain your own copy of the book by calling (410) 223-2890, or writing the Annie E. Casey Foundation, Attn: Kids Count Data Book, 701 St. Paul Street, Baltimore, MD 21202. The Kids Count Data Online is available on the Internet at www.aecf.org.
Facts on Children and Health Insurance
[Ed. note: The following information is for member use for legislative testimony, communication with legislators, media interviews, and other AAP activities involving health insurance status of children.]
Sources:
1. US Department of Commerce, Bureau of the Census, April 1, 1990 to July 1, 1995
2. AAP Analysis of Current Population Survey, 1996
3. AAP Analysis of Current Population Surveys, 1991, 1994, and 1996
4. AAP Analysis of data from the Health Care Financing Administration, Bureau of Data Management and Strategy. “Medicaid Statistical File, FY 1995.” Based on data from the HCFA-2082. See also AAP Medicaid State Reports, FY 1995
5. AAP Analysis of National Governors’ Association data, “MCH Update: State Medicaid Coverage of Pregnant Women and Children, September 1996” Medicaid managed care enrollment figures are based on monthly enrollment.
For questions, please contact:
Beth K. Yudkowsky, MPH, Director
Division of Health Policy Research
(847) 981-7946
Samuel S. Flint, Ph.D.
Associate Executive Director
(847) 981-7102
American Academy of Pediatrics
14 Northwest Point Blvd
Elk Grove Village, IL 60007
Don’t forget, October is Child Health Month. This year’s theme is Tobacco Abuse Prevention. Here are a few words from the National Office for your patients, letters to the editor, neighbors and friends:
“Prevention here can start before a baby is even born. Smoking during pregnancy can cause irregular breathing during fetal life, reduced birth weight and growth during the first year of the child’s life, and cancer, respiratory disorders and heart disease in later years.”
Forty-three percent of children aged 2 months to 11 years live in a home with at least one smoker. That means those children are likely exposed to Environmental Tobacco Smoke (ETS), which is linked to up to 2,000,000 ear infections in children each year. ETS may cause asthma, and it causes children who already have asthma to have more severe symptoms. Studies show that up to a million asthmatic children have their conditions worsened by ETS.
Some parents may not realize that their own behavior and substance abuse can determine the entire course of their child’s life. In fact, children often model behavior they see at home. Every day approximately 3,000 children in the U.S. begin to use tobacco. We all know the health hazards associated with smoking.
The key to helping our children resist cigarettes, alcohol and drugs is the same key to raising a happy, healthy and self-confident child. Make sure your child feels he or she is important in your life. Show an interest in his or her schoolwork and hobbies. Spend time together.
Be honest with your child in all aspects of your relationship with her. Parents who lie or break promises give their child reasons to distrust them. The child will lose the desire to please his parents, including in areas like substance abuse.
Clearly articulate your own attitudes about substance abuse. Straightforward communication is crucial, and can begin to take place between you and your child while that child is still very young. Talk to your child’s pediatrician about further ways to protect your child from the varied dangers of substance abuse.”
I have information on:
Also available for members are speaker’s kits on Environmental Tobacco Smoke (available in August) and Substance Abuse (available in September) for $30 each from the national office, as well as T-shirts for a Tobacco Merchandise Exchange Event, and Child Health Fair Kits ($30 each). Contact our Chapter’s very own Cathy McDonald at 800-433-9016 x7943 to place your order.
American
Cancer Society, Inc.
1710 Webster Street
Oakland, CA 94612
510-893-7900
American Lung Association of California
424 Pendleton Way
Oakland, CA 94621-2189
510-638-5864 (LUNG)
Next Generation
California
Tobacco Control Coalition
39 Los Gatos Circle
Sacramento, CA 95831
916-424-1505
Center for
Substance Abuse Prevention
Department of Alcohol and Drug Programs
1700 K Street, 1st Floor
Sacramento, CA 95814-4022
800-879-2772
From the Pediatrics Electronic Pages
Parents Still Unnecessarily Request Antibiotics
Despite a growing concern over “antibiotic resistance,” parents still request that pediatricians unnecessarily prescribe antibiotics for their children. A new study, from Boston Medical Center, also says parents give their children antibiotics without seeking physician advice. In a survey of 400 parents and 61 pediatricians, 18 percent of parents give their children antibiotics without consulting a physician. Nine out of 10 thought antibiotics were needed for ear infections, 8 out of 10 thought antibiotics were needed for throat infections, and 6 out of 10 thought antibiotics were needed for cough and fever. “Growing bacterial resistance to antibiotics represents a global threat to the health of the world’s population,” the authors state. “If parents can better understand the role of antibiotics in the treatment of disease, they may exert less pressure on physicians to dispense antibiotics inappropriately.” (June, 1997)
Children Need More Than Sunscreen at the Beach
Parents might think sunscreen alone provides enough protection for their children, but they’re wrong, according to the first large-scale study of U.S. children and sun protection. Researchers from Dartmouth Medical School, Hanover, NH, studied 871 children and found only 20 percent wore shirts and 3 percent wore hats, items experts highly recommend to prevent skin cancer. “It is helpful to remind families to protect the regions most frequently omitted from protection . . . girls’ legs and boys’ and girls’ faces,” the researchers state. They recommend a program developed in Australia that encourages people to “slip” on a shirt, “slop” on sunscreen and “slap” on a hat. (June 1997).
[Ed. note: The national AAP offers brochures on sun safety for children for your patients.]
Public Schools Must Prepare For Students With HIV
Children with HIV are living longer and staying healthier, which means more HIV-infected children attending schools in years to come. More than 1600 HIV-infected children were born in 1993, and these children have a life expectancy of more than 9 years. In early 1994 there were more than 12,000 HIV-infected children living in the U.S., with nearly 40 percent of them of school age. A new study from hospitals and clinics across Massachusetts, the Massachusetts Department of Health and the Centers for Disease Control and Prevention reviewed data on 92 school-aged HIV-infected children. Of the 92, only 3 were too ill to attend school, 5 were home-schooled, and the other 84 attended school outside the home. Half of those in public school missed less than 2 weeks of school per year. More than two-thirds of the children between the ages of 5 and 10 and not been told that they had HIV, and in more than half of the cases, the school had not be informed of the child’s infection. The authors conclude that the health care professionals involved with the child can assist the family in making their decision whether to reveal their child’s condition, can serve as an advocate for the child in the educational system and can offer guidance to school personnel on the medical issues that may arise for the HIV-infected child. (July, 1997)
New Resources for Parents
Fit for a King Nutrition Video: Targeting children ages 7 to 121, this new video kit teaches healthy lifestyle habits based on good nutrition and exercise. It is a collaboration of the AAP and the American Dietetic Association, with support from the National Cattlemen’s Beef Association and the Sugar Association. This entertaining, child-friendly video uses a storyteller, king, scientist and a traveling sales kid to stress the importance of a balanced diet, as well as how important it is to “keep moving to stay in shape.” The kit includes a 10-minute video, leader’s guide and activity sheets for children, for $19.95, plus $4.95 S/H. Call 800-433-9016.
Packy and Marlon Diabetes Videogame: Packy and Marlon go to summer camp, and players have to help them monitor their blood sugar, eat a balanced diet and take their insulin. The game also deals with common social situations children with diabetes may encounter. Available for $69.96 through Raya Systems at 800-276-4376.
Inhalant Abuse Brochure: From the AAP, the brochure helps parents educate their children about the dangers of inhalants and describes the signs and symptoms of inhalant abuse. Send a SASE (business-size) to AAP, Dept. C-Inhalant Abuse, PO Box 927, Elk Grove Village, IL 60009-0927.
Study Finds Link between Risk Behaviors and Teen Suicide Attempts
Certain behaviors that can seem like typical teenage “acting out” may actually indicate that a teen has attempted suicide, according to a new study from Harvard Medical School, Boston. The study, which reviewed data from over 3000 high school students in the 1993 Massachusetts Youth Risk Behavior Survey, linked behaviors such as not wearing a seat belt, smoking cigarettes or using smokeless tobacco, abusing drugs or alcohol, getting into physical fights and carrying a gun, and having unprotected sex after substance use with suicide attempts. Suicide rates have increased among 15 to 24 year olds from 4.5 per 100,000 in 1950 to 13.2 per 100,000 in 1990. (Pediatrics, June 1997)
Many Child Care Centers Don’t Practice Sleep Position Guidelines
A new study has found that staff members at many child care centers are unaware of the association between infant sleep position and SIDS, and few centers have policies regarding sleep position. Based on 131 child care centers caring for infants less than 6 months old in Washington, D.C., and Montgomery and Prince Georges Counties in Maryland, the study found that 49 percent of the centers placed infants to sleep on their stomachs at least some of the time, and 20 percent positioned infants exclusively on their stomachs. The authors, from Children’s National Medical Center, Washington, D.C., discovered that 22 percent of child care centers said they placed an infant on its stomach for fear of choking (despite the AAP recommendation change of 1992 to place infants on their side or back to reduce SIDS). (Pediatrics, July 1997)
My Mother Caused My Illness
“My earliest memory of child abuse was when I was 2 years old; the year was 1961. My parents reported that I had fallen down a flight of stairs and twisted my right ankle,” said the victim. “What the physicians didn’t know was the injury to my ankle was no accident; the cause — repeated blows with a hammer by my mother.” One child’s eight-year ordeal with Munchausen by Proxy Syndrome is chronicled by authors from St. John Hospital, Detroit, and Children’s Hospital of Michigan at Detroit Medical Center/Wayne State University, Detroit. The study is the first detailed published account of what it was like to grow up in a family where the mother systematically induced serious illness or injury in a child. (Pediatrics, July 1997)
“Immunize for Healthy Lives ®” This August
Nearly one million American children under age 2 go unprotected against life-threatening, yet preventable, childhood disease every year because they are not fully immunized, according to the Centers for Disease Control and Prevention. To help improve immunization rates, McDonald’s restaurants are for a fourth year teaming up with local health officials on “Immunize for Health Lives,” an immunization education program. Throughout August, participating McDonald’s will distribute immunization education materials in the form of a tray liner and leaflet which features the AAP-recommended vaccination schedule. Last year, more than 6800 McDonald’s participated, reaching over 65 million people, which helped increase immunization rates in many communities, anywhere from 2 to 21 percent.
Acetaminophen, what’s that?
I agree completely with Dr. Gary Chin (May 1997 News Update) who objects to the use of Tylenol Cold Medicine ® as an unnecessary combination of medicines. He goes on to say, “As a practicing pediatrician for almost 20 years, I have been impressed with Tylenol’s sound marketing efforts….” Personally, I am impressed with the way McNeil Labs has made Tylenol a household word.
I am the Telephone Advice doctor at the Palo Alto Medical Clinic. When I advise a parent to use acetaminophen for their child’s fever (mostly I advise against any fever medications) the mom usually says, “acetaminophen, what’s that?” – “Oh, you mean Tylenol.” To which I say, “Tylenol is a brand name; I do not own any shares of stock in McNeil Pharmaceuticals.” It is a shame that acetaminophen is such a big and unfamiliar word. Madison Avenue wins again!
Joseph H. Davis, MD
40 Anderson Way, Menlo Park 94025
Fax: (415) 853-6051
Job Opportunitiy
Bruce Gach, MD and his practice group are interested in adding a pediatrician. Interested parties are encourage to call Bruce at 415/668-0888 or Fax 415/572-5391.
Internet Website Hard to Find?
Did you look for our Chapter webpage and couldn’t find it? Well there is a good reason because of some mischief caused by our Internet Provider, Cybergate.
The good news it that we are back on-line and looking better than ever with new design layout, content, and features.
Our address has changed too. We offer multiple addresses (mirror sites) so that you have more than one chance to reach us (URL):”
(This last address in bold will be our main address and easier to remember and find. It should be available this August.)
Once you arrive you will be able to search our website like the powerful search engines found on Yahoo, Excite, Alta Vista, or Lycos. If you are interested in any information that you feel should be part of our website, please contact me through our Chapter office. Have fun.
Meetings and Announcements:
Pediatric Anesthesia for the Wild Kingdom
September 10, 1997
Speaker: Frederick G. Mihm, MD
Professor of Anesthesiology at Stanford University Medical Center
What: Dr. Mihm has served as an anesthesia consultant at the San Francisco Zoo. Anesthetic challenges in exotic animal species pose some unique problems and risks to both animal and personnel. Dr. Mihm will relate a few of his memorable experiences. This is an opportunity for pediatric residents to see the Academy and its activities. Costs are $30.00 per person Contact: Beverly Busher, at (415) 459-4775.
Eleventh Annual California Conference on Childhood Injury Control
Date: October 6-8, 1997
Location: Marriott Mission Valley in San Diego, California
Goal: The conference is designed to update physicians, public health professionals, and injury prevention advocates on current issues and future directions in injury epidemiology, public policy, and injury prevention strategies.
Contact: California Center for Childhood Injury Prevention of the Graduate School of Public Health, San Diego State University, 6505 Alvarado Road, Suite 208, San Diego, CA 92120, (619) 594-3691
There remain a number of serious tobacco-related issues that pediatricians in California can help impact positively. By writing the governor and your local state congressperson and senator, you can make a difference on these issues. Although we list a number of issues it is best to focus on only one issue in a given letter. Choose the one that interests you most, or if you are interested in a few or all of these, it is more effective to write sequential letters, about once a month covering the specific issue in each letter. It is also most effective to hand write your letter, and enclose a business card.
Here is a sample letter to Governor Wilson:
Dear Governor Wilson,
I am writing you about tobacco use in California. I ask that you keep in mind that tobacco has been found to he as addictive as heroin. Yet tobacco is being deceitful glamorized by the tobacco industry to attract youth to replace adults who quit or die. Unusual efforts are in order to protect our children from this drug.
I am particularly concerned about the following tobacco-related issue, and I believe it is important to ...
I. Make sure that the California Health Department maintains an uninterrupted hard-hitting media campaign. This campaign should be aimed at both youth and adults; should rotate messages every 30-40 days; and should focus on the following messages:
Thank you for the new hard-hitting campaign that has recently been established. Please keep it up - I’ll continue to watch your efforts in this area.
2. Have a major increase in excise taxes. These kinds of tax increases have been found to be a powerful deterrent to both adult and youth purchase of tobacco. California is only 18th in excise taxes with its tax of 37 cents, compared to 82.5 cents in other states.
3. Convene a task force to study all California tax breaks for the tobacco industry and move to eradicate every single one of them.
4. Introduce and support legislation requiring merchants to be licensed to sell tobacco products. Vendors would lose their licenses for selling tobacco products to minors. Current Stake Act compliance checks reveal that about 35% of vendors are still selling cigarettes to minors. Urge law enforcement to focus fines on adults who sell or supply tobacco to youth, rather than on addicted youth who possess cigarettes Any intervention with teens possessing cigarettes should be directed at programs that help teens evaluate their use of this drug and motivate them to quit, rather than being punitive.
5. Actively implement AB 13, including a media campaign to explain the law to all Californians and inform them of the next phase effective in January 1998, requiring smoke free bars.
6. Aggressively pursue legislation that would prohibit outdoor advertising of tobacco. It is clear that advertising is aimed at youth (84% of youth smoke the 3 most heavily advertised brands of Cigarette, versus 37% of adults), and has contributed to the recent increase in smoking nationally. We need to shield children from ad campaigns that impose adult messages and encourage use of a product that is illegal for children.
7. Develop smoke free zones around the entrances to health facilities and facilities serving children, including child care centers, schools, and recreation centers. Please keep in mind that our children’s health is not a partisan matter. Tobacco is a leading cause of preventable death. We all need to act swiftly and aggressively to protect our youth.
Thank you very much for your willingness to give appropriate consideration to this extremely serious problem.
If you are particularly knowledgeable or able to help more on a particular issue, add “Please contact me for further information or assistance in addressing this serious matter.”
Sincerely,
(Sign your name here)
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This page create 12/30/97 Last Updated 08/10/04
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