Advanced Pediatrics: 2016

2016-06-23

AP to Comply with CDC: No FluMist this Year

The CDC Issues a Dramatic Reversal Today

FluMist No Longer Recommended

Advanced Pediatrics to Respect the New Findings: No Nasal Spray for Flu Protection this Fall, only the Shot

It seems every year, the immunization effort to prevent infections from the influenza virus, which causes 1/3 of all wintertime colds and flus, has a twist.

One year, it was a national shortage of all flu immunizations. Last year, it was a severe shortage of the nasal form of the immunization, FluMist.

Today, the surprise are recently shared findings from the CDC that the FluMist, long a better performer than the shot, no longer works as well.

Today, the CDC announced that the FluMist product has slipped. It now fails to protect as many as 20% of children who might get it as well as the shot. The CDC committee charged with monitoring immunization policy came out with a formal recommendation that we no longer use it:

http://www.cdc.gov/media/releases/2016/s0622-laiv-flu.html

This is truly breaking news. The data on how well FluMist performed compared to the flu shot were made available to the CDC a few weeks ago, and the CDC presented their conclusions on them just today.

This is also remarkable news for two reasons:

1. Until today, the reported literature on how the FluMist works showed it worked better than the flu shot.

2. Almost all live vaccines work better than dead ones. FluMist is a live vaccine, the flu shot is a dead form of the influenza immunization.

It appears this new development reflects problems in the manufacture of FluMist, which were foreshadowed last year by the failure of the company to even deliver the product.

Although a surprise, it is truly surprising, and unprecedented in our experience, to see a product we have vetted and trusted turn into one we can no longer trust, we cannot use it this year.

Although a disappointment, we much prefer the pain free approach of a nasal spray to a shot, we cannot use it this year.

We hope that next year the company that makes FluMist gets it right, but the CDC finds it has not, so we cannot use it this year.

Bottom Lines

1. A surprise set of findings from last year's flu epidemics finds that FluMist, long the superior choice, no longer works as well as the flu shot in preventing infections from the influenza virus.

2. The CDC's committee on immunization practice voted yesterday to recommend not using FluMist this upcoming flu season.

3. THEREFORE, EFFECTIVE IMMEDIATELY ADVANCED PEDIATRICS WILL NOT OFFER THE NASAL SPRAY FORM OF FLU IMMUNIZATION THIS FALL. ONLY THE SHOT FORM OF FLU IMMUNIZATION WILL BE MADE AVAILABLE.

4. The shot form works well, and it turns out hurts less than many fear. It is what we used almost entirely last year, and will work well again this year.

5. If and when the manufacturer of FluMist develops a product the CDC works better than the flu shot, Advanced Pediatrics will consider using it once more, but not this year.

Stay tuned for announcements for when FluFest 2016, our fun provision of easy access to influenza immunization, featuring Mitchell's Ice Cream, will be later this year.

To Your Health,

Dr. Arthur Lavin

2016-06-20

Celebrating a Hero in our Community

Celebrating a Community:

An Appreciation of the NBA Championship in Cleveland

A friend once surprised me with this question many years ago: what's the difference between sports and theater? Answer: In sports you never know how the drama will end.

Last night, Cleveland, and all those connected to it, were treated to a deep and profound drama. We got to see a true hero reach....

...and make it.

LeBron James is a true hero.

Families in the practice who live in or near Akron have recently shared stories with me that astound.

This child of Akron has purchased blocks in what we call "the inner city," but are actually structurally set areas of many generations of despair. LeBron has purchased some of these blocks and transformed their housing and business infrastructures into middle class neighborhoods, and they work.

The people of the place have jobs and earn enough to live good lives. A barber who could not afford the new rent was given free rent by LeBron so he could finish his career continuing to care for the people he has groomed for many years.

Here is a man of rare talent, who oriented use of his gift to the benefit of others. How may elite athletes volunteer to leave a championship game and endless wealth, to come home to a team that has sunk to irrelevance, with no hopes of even playoff play? This is LeBron, he came home to inspire Akron and Cleveland, his homes.

I have observed that, if lucky, most of us get to be really good at a small number of things, maybe 1, maybe 2 or 3, but rarely many more skills. Think of them as our gifts, and if we are really lucky, we get to pursue and develop them. When that happens, life becomes a story in part of how a person takes their gift and overcomes struggles to help as many people as possible. That is one of the great narratives we have available to us as people.

It is in that sense that I right this appreciation of the Cavaliers winning the championship last night. I was lucky enough to be with my wife at a small restaurant across the street from the Q last night. We heard of people flying in from Hawaii to Massachusetts to be there for the moment, and sat with people from Cleveland, Baltimore, and Cincinnati. The downtown, the center of our greater Cleveland community, was as full of people as we have ever seen. We all held our breaths as these two teams, each who had scored 610 points over the first 6 games of the Finals, traded leads in the tightest game of the Finals.

As the last minute came, a strange elevation took place in the room. People had trouble following the details, all we knew was something we would never experience again was happening, and we drew together, so happy. That joy and amazement filled downtown in that instant. Prospect Street became a carpet of people screaming for joy, dancing, happy. A fire engine parked in 9th Street with all its lights on, with the crowd standing and cheering on it. We drove home to see urban Cleveland, Cleveland Heights, and Shaker Heights filled with scenes of celebration.

And all as the result of a good man pursuing his gift, against monumental odds, reaching. LeBron James, son of our NorthEast Ohio community, directly applied all his efforts to deliver a championship to his community, with the express intent to inspire us to be better. To come together, and to care for each other as he has.

So here is my thank you to this truly great man, I am deeply grateful. And I am so pleased we could come together last night.

As a small token of our gratitude, Advanced Pediatrics will be closed for part of the day this Wednesday, to join with you all to be at the parade acknowledging the power of a gift that cares. Dr. Hertzer and I will remain available throughout the day for calls of course, and the office will remain able to help.

To your health,
Dr. Arthur Lavin

2016-06-16

Folic Acid- A Third Benefit for your Child

Folic Acid- A Third Benefit for your Child:

Lowering the Risk of Obesity

Vitamins have promised extraordinary benefits for many years, including hopes of curing colds, ending cancer, slowing aging, boosting energy. The very name vitamin suggests magical powers.

But the record is quite disappointing. All vitamins offer nutritional benefits that are met by eating very tiny amounts of them, but with one exception, taking extra turns out to offer no benefits whatsoever. Famous vitamins whose claims have come and gone include Vitamin C, Vitamin E, B complexes, etc. Claims of powerful benefits for Vitamin D are still under scrutiny, but no positive proof of great benefit has been found yet.

One vitamin stands alone as having proof that taking more than is found in a regular diet could offer a benefit, and that is folic acid (aka, folate, Vitamin B9, Vitamin Bc).

Folic acid, and only folic acid, has been shown to change a real outcome in a population.

If pregnant women take 400 mcg of folic acid during pregnancy, they nearly eliminate spina bifida, a congential defect in spinal cord development. We know it works because when pregnant women did this, the number of children with spina bifida (aka myelomeningocele) actually dropped dramatically.

In the last few years, two new benefits of folic acid appear to be real as well.

The first reported was that if women take 400 mcg of folic acid a day prior to conception and throughout pregnancy, the risk of their child developing autism drops 5-fold. This is an association in a published study. We have not seen actual drops in the rate of autism in response to taking folic acid in this manner. But the finding does make it plausible that we could see a drop with this use of folic acid.

Now comes a report that studied the impact of blood levels of folic acid in pregnant women on the chance that their babies would grow up to be obese. The researchers looked at mother-child pairs in China, Chicago, Boston, and several other cities. They studied over 1500 such pairs, and followed the babies born to an average age of 6.

They then asked, what is the difference of risk of becoming obese by age 6 if the mother had a high or low folic acid blood level. It turns out comparing kids of moms whose folic acid blood level was in the top three-quarters v. those in the lowest quarter, there was 45% more obesity in kids whose Mom's folic acid levels were in the lowest quarter.

For obese Moms, those who had the lowest folic acid blood levels had children with triple the risk of obesity of those Moms not in the lowest level.

This study is at this website:

http://archpedi.jamanetwork.com/article.aspx?articleid=2528517

And the NY Times story on it is here:

http://well.blogs.nytimes.com/2016/06/15/folic-acid-during-pregnancy-may-lower-risk-of-childhood-obesity/?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=rank&module=package&version=highlights&contentPlacement=7&pgtype=sectionfront&_r=0

BOTTOM LINES

1. Vitamins have been shown to offer no benefit when taken in amounts that exceed what you eat, with one exception, folic acid.

2. One proven benefit of taking folic acid early in pregnancy is the near elimination of the chance of your child having spina bifida, an astounding benefit.

3. An association not yet proven as solid is a dramatic drop in your child developing autism if the mother takes 400 mcg daily from before conception through pregnancy, a five-fold drop.

4. Now comes an early observation that raises the possibility of a third benefit, actually changing the chance that your child will become obese. This benefit is not seen with the 400 mcg dose, but only if the actual blood level of folic acid in the Mom goes up. So this benefit requires a blood test.

5. The elimination of spina bifida is a proven benefit of folic acid. The reduction in risk for autism and obesity are highly enticing possibilities, not yet fully proven.

6. How interesting that the chemical profile of a Mom in pregnancy could define if her child will become obese. It makes us rethink obesity.

To your health,
Dr. Arthur Lavin

2016-06-03

Lazy- A Troublesome Concept

Lazy- A Troublesome Concept

Many kids in school struggle to succeed. The national average is 1 in 6 children, millions of school children!

There are a web of complex reasons why we find ourselves facing so many of our children not enjoying school and having such a hard time getting the work done.

But one reason that we hear as much as any other reason should be put aside: laziness.

When we meet with families, one of the most common thoughts about why their child is not performing well in school is that the problem is the child's attitude gets in the way. The child either does not care, or seems to be dismissive of the work. It actually makes perfect sense for any parent to think that the child's attitude is a major piece of the puzzle. And if that's the case, why not conclude that they are being lazy?

So why would we urge everyone to no longer think of laziness as relevant to the problem of children doing poorly in school? The problem is that there is a major difference between laziness and other reasons for not doing work, and for nearly every child struggling in school, laziness is not the problem.

To be clear, the word lazy means that the child is not doing work because they do not want to do any work, or anything. When the word lazy explains a situation, we are concluding that the problem is the person has a fundamental defect in their relationship to work, and it's a simple one- they don't work because they object to working itself.

There may be lazy children and youth, but we haven't seen any. With no exceptions that I can recall, everyone seems to want to do something. It may not be what we want them to do, but nearly everyone likes doing something.

In nearly every instance, what looks like laziness is far more likely to be someone choosing to do something else for a very good reason. Those reasons can vary quite a bit, but nearly all are compelling, once understood.

The key reasons children who are failing school avoid doing school work:
1. There is a cognitive dysfunction that makes the work very, very difficult to do.
2. There is an emotional problem blocking the path towards doing the work.
3. They would rather do something else.
4. A physical illness prevents access to the work.
5. Conflicts with the teacher or parents make doing the work very difficult to do.

A look at the real reasons children who are failing school avoid doing their school work.

Cognitive dysfunctions

A great many children who struggle in school have one, or several, problems with how their mind works that make learning new facts, writing new essays, reading new books, doing math or science, paying attention or focusing actually very, very difficult. One can be quite brilliant, and have one of these problems, and end up essentially being unable to some of the work schools assign.

Consider how hard it is for any of us to do something our minds cannot do without tremendous stress. This is a very unpleasant experience, and like anyone, we avoid the unpleasantness and do something else.

Emotional problems

Anxiety, depression, and/or mania affect large numbers of people, including children. When any of these conditions is active they can have a devastating effect on anyone's ability to get work done.

Rather do something else

This is a unifying theme as nearly every child will have grades or days when they would rather do something else, and is the sense all children who struggle in school have when the other issues are present.

Physical illness

Of all the reasons kids refuse to do their work, this is the one not confused with laziness. If someone's eyes are injured, no one thinks the child is lazy if they avoid reading. The same goes for nearly all physical illnesses, especially acute illnesses.

Conflicts

It would surprise many to find out how many times a problem in school reflects conflicts with teachers, and parents, and friends.

Why none of these reasons are explained by the concept of lazy.

For each of the five examples of reasons children who struggle in school do not do their work, laziness simply fails to explain anything.

If your mind cannot think through the problem at hand, your emotions keep you from attending, you are too physically ill, have serious conflicts related to the work, or would rather do something else you end up doing something else.

It is almost never the case that laziness explains any behavior, notice how in each case noted, the child ends up doing something else, not nothing.

Finally, assuming the reason school work is not done is laziness causes two very major problems:
1. Since it is not true, it misses the ability to do anything about the situation.
2. It is not an explanation, but really down deep, just an insult.

BOTTOM LINES
1. Many, many children struggle to do their school work, about 1 in 6 risk failure.
2. In nearly every instance, a reason explains their difficulty.
3. That reason is almost never laziness.
4. Thinking it is laziness seems reasonable, after all they are not doing their work.
5. But calling your child lazy, in addition to being wrong, usually just makes matters worse, as it is more of an insult than explanation.

We recommend highly that if your child struggles in school, that the real reason(s) be found, only then can situations change and the situation get better.

To your health,
Dr. Arthur Lavin

2016-05-26

The Power of Touch- Progress on a Great Sense

The Power of Touch-

Progress on a Great Sense

In May of 2106, The New Yorker published a deeply fascinating review of recent advances in understanding a sense that all people have, but few of us stop to consider: touch.

http://www.newyorker.com/magazine/2016/05/16/what-the-science-of-touch-says-about-us

The article is loaded with many fun facts, but I will highlight three of them:

1. The organization of touch

2. Progress in reproducing touch

3. The essential nature of touch

The Organization of Touch

All senses in the body, including taste, vision, and hearing, are organized by the detection of a signal being translated into a nerve impulse that the brain then converts into a perception.

A word on each of these steps should be helpful, and hopefully, interesting. Think about vision. Vision happens when light in the world is converted by our eye into an electrical nerve impulse that our brain transforms into a visual picture of the world. This requires a special sensor that converts the light into a nerve impulse, and that would be the light-sensing cells of the retina. When light hits these cells, they create an electrical charge that shoots down a series of nerves to the brain. Once the pattern of electrical impulses from the eye hit the brain, the brain turns those patterns into all the extraordinary things we see.

Two more thoughts on this process: the sensor for each sense is very specific for that sense. The retina can only turn light into nerve impulses, it cannot do that with sound. That is why the eye can only see, it cannot hear. And, all nerve impulses are the same, a nerve can only be quiet or shooting an electrical signal, it is either on or off. The nerve impulses from the tongue are the same as from the eye. But there are literally billions of these nerves and it's their pattern that carries the information from the sensor and allows the brain to perceive. Think of the lights on a movie marquee, each light bulb can only be on or off, and all the light bulbs are often the same. But the pattern of their going on and off gives the sense that the lights are moving around the marquee. Pattern causes information.

For touch, the sensor is a special nerve ending that makes a nerve fire if it is squeezed. It turns out that if the sensor is squeezed, a nerve signal is created, which goes to the brain and creates our perception of touch. Touch also includes the ability to sense a vibration, or temperature, but this discussion will focus on the simple notion of touch itself. The variations of pressure allow us to sense all that we do about the world via touch. Our fingers, and much of our skin, are able to distinguish very minute differences in texture, for example, a soft satin, or a satin that is a tiny bit stiffer. Or more easily, the feel of wood v. glass, or a pencil point v. a pen point on paper v. cardboard.

Three observations now can be shared about the way touch is organized in our nerves and minds:

1. The brain detects incoming signals about touch in a frequency of 1 impulse per second.

The information that the brain manages comes in the form of waves of electricity, in particular differences in waves. So for touch, the essential wave is a pulse of electricity that beats once a second. Variations in this pulse actually carry the information of touch to the brain. Interestingly this rate of electrical pulsing is essentially the same as the rate of a heartbeat.

2. There are several separate systems of touch, itch has its very own set of nerves. It turns out that some nerves that deliver the touch signals to the brain cover many areas of function, including pain and sensual pleasure. But itch has a separate system of nerves exclusively devoted to delivering that message to the brain where the sense of feeling itchy actually comes alive.

3. The general system of touch nerves can deliver different experiences of touch. As noted above, pain and sensual pleasure touches are experienced through the same set of nerves. But the setting of the activation of the touch signals varies.

Progress in Reproducing Touch

As the essay notes, there has been astounding progress in reproducing touch. Perhaps the most amazing steps forward have involved the development of a pen like device that can dial up almost any touch texture.

You can set the device to create the sensation of wood, and your hand holding the "touch pen" will soon experience the sensation of touching the type of wood you selected. Or plastic, or silk, or paper, whatever the texture, the pen will recreate the sensation of touching it. It is designed to help people with injuries re-experience various touch sensations, but it remains extraordinary that scientists can recreate the wide variations of our experience of touch.

The Essential Nature of Touch
Perhaps one of the most interesting insights from this essay is how essential touch is.

Many people will over time suffer loss of vision or hearing, or even be born without these senses, but there are no reports of a person losing their sense of touch. It is the least of the senses discussed, but may turn out to be fundamental to being alive and human.

There are even specialists in neuroscience who think touch is the best way to understand our consciousness, that is, our awareness of the world depends greatly on what we touch.

BOTTOM LINES

The article in The New Yorker from May, 2016 offers a rare inside look at the sense of touch.

http://www.newyorker.com/magazine/2016/05/16/what-the-science-of-touch-says-about-us

Reading it will give you amazing insights into how senses are delivered and experienced by our brains, new insights on how touch functions are organized into systems, and the great and essential role touch plays in our lives.

To your health,
Dr. Arthur Lavin

2016-05-25

Advanced Pediatrics, Who's the Boss Parenting Academy Note that Sleep Training Comes of Age

Advanced Pediatrics, Who's the Boss Parenting Academy Note:

Sleep Training Comes of Age

The #1 reason parents hire parenting consultants in NYC and LA is to find an approach that lets everyone in the family get a full night's sleep.

This is why Susan Glaser and Dr. Lavin teamed up in 1994, about 22 years ago (!), to develop approaches to teaching one's infant and child to sleep through the night based on their already extensive experience in helping so many families succeed in this quest.

That collaboration led to the publication of their philosophy of parenting and specific how-to's to help families achieve all night sleep in: Who's the Boss: Moving from Conflict to Collaboration (2006). Based on the success of this book, Wiley Publishers invited Ms. Glaser and Dr. Lavin to be the offical For Dummies authors for their reference book on sleep for young children: Baby and Toddler Sleep Solutions for Dummies.

And, more recently, their parenting advice has been made available on-line via the Who's the Boss Parenting Academy at www.whosthebossparentingacademy.com. There, the philosophy and specific guidance first developed in 1994 and published in 2006 are available to anyone.

So it is with great pleasure that we read in the NY Times of May 23, 2016 that studies have demonstrated that our approach to helping families achieve a full night of sleep are very safe, and only support the bond of child and parent. A recent study was reported to find that this approach, now widely adopted under the name "sleep training," has no negative impact over time on the relationship of the baby and the parents. Check iBt out: http://well.blogs.nytimes.com/2016/05/24/sleep-training-shouldnt-make-parents-feel-guilty/?_r=0

We have known for nearly 25 years that if parents gently ask their 4 month-old, or older infant or child, to take care of their own sleep, they will always do a terrific job, much better than any parent or doctor could. And we have known for a long time that when parents do turn the job of getting to sleep and getting back to sleep over to their child, it really works, and has for over 10,000 families we have worked with over the years.

So it is very nice to see our approach found to be, as we have seen all along, very supportive of parent-child relationships.

BOTTOM LINE

Sleep training, now the dominant approach to managing the sleep of your infant or young child, reflects the approach and technique first put forward by Ms. Glaser and Dr. Lavin in print in 2006, and now more recently available as an on-line course.

Recent data supports this approach as effective and very safe for the relationship of the child with the parent.

To your health,

Dr. Arthur Lavin

2016-05-20

Home Birth- The American Experience of Giving Birth at Home

Home Birth-

The American Experience of Giving Birth at Home

All people are born, but how mothers give birth and where varies quite a bit from culture to culture and across time.

Current American preferences heavily favor giving birth in the hospital, about 99% of all births in the US occur in a hospital. Those that occur out of the hospital include births planned to deliver in the hospital but didn't make it in time, and deliveries that were planned to occur in the home of the mother.

In 2012, about 0.9% of all deliveries took place in the US, by plan, at home.

In the Netherlands, also in 2012, about 16% of all deliveries took place, by plan, at home.

And even in the US, the rate varies. The state with the highest rate of home births is Oregon, where in 2012 and 2013, about 4% of women gave birth at home.

American Infrastructure for Home Birth

One reason home birth is less frequent in the US than the Netherlands is a vast difference in how babies are delivered at home in the Netherlands. There, the person delivering the baby is a fully certified, highly trained professional, whose actions in delivering at a home are openly and highly coordinated with local medical centers. The delivering professional is part of the community health professional structures.

This means that the professional delivering a baby at a Dutch home has highly developed and open contingency plans for the first sign of trouble. The same approach takes place in Canada. These plans strictly deny the option of a home birth to mothers who have complicated pregnancies (e.g., twins, breech presentation). In Canada, about 25% of mothers attempting to deliver at home are easily transferred to a obstetric division in a hospital if any danger seems to be developing to mother or baby. That number is 45% for first time mothers.

The delivering medical professional in Canada and the Netherlands has hospital privileges, and so can continue to care for mother if she delivers in the hospital.

The US is dramatically different. Home births are frowned upon in the US. Very few, if any, licensed obstetricians will support midwives delivering at home. Very few certified nurse midwives who have hospital privileges, will deliver at home. Home deliveries in the US take place nearly in secret, certainly without coordination with hospital systems. The delivering professional is typically a certified professional midwife (CPM), which used to be called a lay midwife. CPM's are only given legal permission to deliver in 28 states. Many achieve CPM certification via correspondence courses and receive training by other CPM's. In 2012, requirements were updated to require a high school diploma. In contrast, the certified nurse midwife (CNM) is an advanced degree nurse who can legally deliver babies in all 50 states, has to achieve graduate school level schooling, with rigorous clinical training, and often must practice in collaboration with an obstetrician.

The real difference in the US comes down to this: in Canada and Netherlands the midwife who delivers at home is fully integrated in the official medical system, can also deliver their patient in the hospital, and has a seamless connection to it. In the US the midwife who delivers at home does so essentially separate from the medical system, unable to deliver the mother in the hospital, with no well-established two-way systems (hospital and midwife working together) in place to rapidly respond to a problem.

Many of these issues are clearly presented in this NY Times article:

http://www.nytimes.com/2016/05/01/opinion/sunday/why-is-american-home-birth-so-dangerous.html?_r=1

Safety of Home Birth in the US

In the last issue of 2105, the world's leading medical journal, The New England Journal of Medicine, published as study of all births in the state of Oregon in 2012 and 2013, and asked, how did mothers and babies do if they planned to deliver at home v. planned to deliver in the hospital.

They compared groups' plans, because if you just look at those who actually delivered at home, you artificially exclude those who were going to deliver at home, but had to go to the hospital due to problems.

Now, it is important to note that there is a rate of death in the newborn period no matter where you deliver, in the very best of worlds, some tragic death still takes place.

With that in mind, here are the numbers:

From 1970 through to today, despite the increased use of induction and C-section, the chance of a baby not living much past delivery has remained steady at 1 in a thousand (1:1000) births.

In 2012 and 2013, in Oregon, if you planned to deliver in a hospital, the chance of the baby not living to a week of age was 1.8:1000 (as time goes on, this number goes up, as we know, after 120 years it goes to 1000:1000).

In 2012 and 2013, in Oregon, if you planned to deliver at home or at a birthing center out of a hospital, the chance of the baby not living to a week of age was 3.9:1000.

Births following the plan to deliver out of hospital births also carried higher risks of the baby suffering certain troubles, including need for a ventilator, blood transfusion, seizures.

At the same time, women planning to deliver out of the hospital experienced far fewer C-sections, induced labors, and episiotomies.

In this same issue of the Journal, a commentary by Dr. Michael Greene, Chief of Obstetrics, Massachusetts General Hospital, who I have known a long time, gives the above information is a very balanced and measured approach. His last line is: "Ultimately, women's choices for place of delivery will be determined by the extent of their tolerance for risk and which risks they want to avoid."

He is referring to the risk of the baby coming to some harm versus the risk of the mother experiencing obstetric procedures.

BOTTOM LINES

1. Home birth in the US would benefit tremendously from full integration with the medical system. This would allow fully trained midwives to participate with full backing of obstetricians, and the development of full communications with hospitals to make transfer to the medical setting far easier and more integrated. In countries where this is the reality, no difference in newborn survival at home v. hospital is seen.

2. Until that happens, giving birth at home does more than double the chance of a baby not living to a week of age.

3. It is also true that planning to give birth at home sharply reduces the chance the mother will have a C-section, induced labor, or episiotomy.

4. Wherever one delivers, the baby needs a shot of Vitamin K soon after birth. About 1:1000 babies who do not receive this very helpful aide will actually experience serious bleeding in their brain. The Vitamin K shot provides the needed substance to help the baby make normal clotting factors.

Very importantly, we at Advanced Pediatrics are very happy to work with all parents, whatever their plans, to discuss what is an important, and often complex, decision.

To your health,

Dr. Arthur Lavin

Your Chance to Offer a Good Word

Dear Families,

As many of you know, Advanced Pediatrics is updating our look and feel.

Most of you have seen our renovated office. Now we are working on our new website.

We thought it would be nice to feature some of your stories, and so we are now asking for you to send in testimonials to info@advancedped.com

We are seeking stories and testimonials from families covering three broad ranges of experiences.

These would include testimonials regarding day-to-day success stories such as getting prompt service, seeing who you want to see, having issues addressed. And we would also great appreciate testimonials families might have about help we have offered that has made a difference in your child and/or family's life.

Once again we ask with tremendous gratitude to all of you for the trust you have put in us to be your infant, child, adolescent, and family's pediatricians.

With my best,

Dr. Arthur Lavin

Antibiotics- What Goes Wrong if not Used Properly

Antibiotics:

What Goes Wrong if not Used Properly

Antibiotics are the most popular prescriptions but the most poorly understood.

They do tremendous good, but when used inappropriately, they cause much more harm than people know.

And, by people we mean families and doctors.

In fact, so many doctors prescribe so many antibiotics inappropriately that the CDC a few years ago began looking into restricting the ability of doctors to prescribe them.

Most of us appreciate the tremendous power of antibiotics to help, but what is the story of how they can hurt?

What is an antibiotic?

An antibiotic is a medication that can kill bacteria without killing our own human cells.

The key word in that sentence is the word bacteria.

Antibiotics kill bacteria, not other germs such as viruses, fungi, and parasites.

What is the difference between bacteria and other germs?

There are four types of germs that cause infections: Bacteria, fungi, parasites, and viruses

Bacteria

Bacteria are single-celled organisms that live by eating nutrients in their environment, and in the case of bacteria that cause infections in us, by eating our cells. When bacteria infect, their eating usually creates pus. Bacterial infections not only feature pus, but higher fevers, and often more serious and feared infections, such as bacterial pneumonia, bacterial meningitis, and various abscesses.

The most common and minor bacterial infections are the very familiar and usually harmless strep throat and ear infection. Bacteria also cause urinary tract infections which also tend to be harmless.

Bacteria are killed by antibiotics, and can cure these infections.

Fungi

Fungi are also single-celled organisms but can grow in complex branching forms that join many fungal cells together. Healthy people do not get internal fungal infections normally. For most healthy people the only fungal infections are surface infections and include ringworm, yeast infections, and oral yeast infections in infants (thrush). These infections involve the fungi only eating dead cells that line the outer levels of the skin and mouth. They create scaly rashes, fuzzy white plaques in babies' mouths, red rashes in the diaper area, but not pus.

Fungi are not killed by antibiotics, and antibiotics cannot cure these infections.

But there are other medications, related to antibiotics, called anti-fungals that can cure these infections.

Parasites

Parasites are single-celled organisms that are more complex cells. Like fungi, in healthy people, most parasitic infections take place on the outside of the body. Keep in mind the inside hollow tube of our gut is outside our body. Think about what happens if you swallow a penny, you pass it through your gut and poop it out, and so it never enters your body. The most common parasites that cause infections are lice, pinworms, and giardia. Each of these never really enter our body, our bloodstream.

Parasites are not killed by antibiotics, and antibiotics cannot cure these infections.

But there are other medications, related to antibiotics, called anti-parasitics that can cure these infections.

Viruses

Viruses are a totally different type of germ than any of the above three. All the germs listed above are made our of different types of cells that live on their own, and live by eating material and/or cells around them. Like all animals and plants they eat, reproduce, and eat and reproduce.

But viruses are so, so different. A virus is a bit of genetic material inside a coating of protein. That's it. Viruses never eat. And without a cell to infect, they cannot reproduce, ever.

The way viruses work is very simple, and is described as a two step process:

1. Their protein coat contains codes that allow the virus to enter their target cell.

2. Once they have cracked the code to get in, the genetic material in the virus takes over the DNA in the target cell, forcing it to make all new viruses, and tons of them.

Together, these two steps lead one virus to create millions more, usually popping the cell and leading to millions more cells getting infected and destroyed.

That's the incredible biology of viruses. But there are some other very important points to be made about them:

1. In infants, children, adolescents, and young adults, viruses cause the overwhelming majority of infections.

Think about the main viral infections we experience: colds, flus, stomach flus, viral fevers and rashes. About 70-90% of all fevers in childhood are due to viruses.

2. These most common viral infections are miserable, but harmless. Everyone gets viral infections, no exceptions. And in a healthy population of young people, such as we have in the US, viral infections come and go without causing any permanent harm. Consider the most common viral infection- the common cold. If it does not lead to any complications, such as bacterial pneumonia, and remains a cold, essentially everyone recovers without any harm long term at all.

3. All viral infections often cause aches, pains, fever, and lots of inflammation and mucus, but not pus. Again think about viral colds, they cause aches, pains, fever, and lots of mucus, but no pus. The runny nose always starts with clear mucus and ends with yellow and white mucus, but there is no pus.

And, in regard to antibiotics, they are useless against viruses, they simply do not kill them, or even slow them down. They do nothing to viruses or the infections they cause.

Of all the germs listed above, we have the fewest medications for viruses. A tiny number of viruses have some medications that can kill them, such as the antiviral medication acyclovir to kill the herpes virus. There are no such medications whatsoever that have any impact on the viruses that cause the common cold and stomach flus. There are some medications that kill the influenza virus, but they have limited impact and can cause seizures in children.

But when it comes to the antibiotics, they have no impact on viruses at all.

What's the big deal about using an antibiotic in a viral infection?

The big deal is that right now, about 23,000 Americans die every year from the use of antibiotics used for viral infections. This is comparable to the number of Americans who die every year from guns and cars (about 30,000 each).

Many people wonder, it's one thing to use an antibiotic for a viral infection knowing it won't work. But how could using an antibiotic that doesn't work lead to harm, particularly someone dying?

The way that happens is explained in one word: resistance.

This brings us back to bacteria. Every time we use an antibiotic, remember that's a medicine whose only purpose is to kill bacteria, the clever bacteria get another chance to find a way to neutralize the antibiotic.

Consider what was once the most common antibiotic ever used: penicillin. After many years of use, all but one bacteria have figured out how to not be killed by penicillin. The only exception is the strep germ of strep throat fame, it has never failed to be killed by penicillin, but so many bacteria in our mouths neutralize penicillin, that the strep germ can at times be protected.

So each use of antibiotics gives bacteria a chance to evolve a way to neutralize them. The other part of the story of resistance comes in another key word: volume.

If doctors and families only used antibiotics to kill viruses a total of once a year, bacteria could learn to neutralize them, but it would be extremely unlikely. But consider of millions of people take antibiotics every day when they only have a viral infection, now unlikely turns to certain. And that is precisely what happens.

So many millions of people have colds and so many of them get antibiotics, that bacteria have millions and millions of chances to learn resistance, chances they should never have.

The result is that we are experiencing a dramatic epidemic of bacteria learning to laugh at all our antibiotics, creating germs that can infect us that cannot be killed or cured, opening the door to a huge rise in dangerous infections that cannot be treated. This is how use of antibiotics for colds is right now killing 23,000 of us a year.

The example of viral pink eye

Few completely harmless infections cause more fear and anxiety than viral pink eye. Pink eye is condition in which our eyes get red, make extra tear or mucus, and become uncomfortable. There are three main causes of pink eye:

1. Viral pink eye- this is exceedingly common during cold season. Viral pink eye is in fact, the manifestation of a cold in the eye. Just like colds in the nose cause the lining of the nose to get swollen and sore, and make loads of mucus, colds in the eye cause the lining of the nose to turn red (hence "pink eye") and make lots of tears and mucus. In the morning the mucus can accumulate from overnight and cause the eyes to be swollen shut and matted with dried mucus, but there is no pus. There is no drug that can help or treat viral pink eye. Antibiotic eye drops have no impact on viral pink eye.

2. Allergic pink eye- this is exceedingly common during allergy seasons. Allergic pink eye is like hay fever in the nose. In both cases there is itch and mucus. Red, itchy eyes, with some mucus during allergy seasons associated with nasal hay fever troubles is most likely allergic pink eye. This form is treatable with antihistamine, by oral route or eyedrop.

3. Bacterial pink eye- this is the least common form of pink eye, and the only one with pus. Bacterial pink eye causes lots of pus, not just mucus, to form, usually overflowing the eye. It is the only form of pink eye that antibiotic eye drops do anything at all.

Now, here it gets very interesting and worrisome. It has been determined that if we use topical antibiotics for children with a cold in the eye, we will be giving millions of people antibiotics that have no benefit, and it has been shown that very dangerous bacteria, like MRSA, start to appear.

MRSA is a form of a dangerous bacteria, Staph, that can no longer be killed easily with common, or most, antibiotics. Now imagine, if doctors and families agree to the use of antibiotics for simple viral pink eye, the nation becomes exposed to potentially deadly bacteria.

BOTTOM LINES

1. Antibiotics are medicines that kill bacteria.

2. Antibiotics do not kill any viruses, cure no illnesses caused by viruses, help no one with a viral infection in any way.

3.. The vast majority of infections in infancy and childhood are caused by viruses, including pink eye.

4. Not only is the use of antibiotics in viral infections useless, but it causes about 23,000 Americans to die every year for no reason aside from our misguided habits.

Putting it all together, this is why we at Advanced Pediatrics will always let you know when it is clear that your child's infection is a virus, and will explain why use of antibiotics is not only not helpful, but could end up hurting someone we all care about. We also appreciate that when any child is ill, the need for a solution is urgent and pressing, but we know that families ultimately want to avoid treatments that do no good and cause real harm. Perhaps one day we will have a medicine that kills and cures the common viruses, safely and effectively.

To your health,

Dr. Arthur Lavin

News, Some Change, An Appreciation

News, Some Change, An Appreciation

Dear Families,

As many know, we have approached the practice of pediatrics with the relationship to families as the central core of what we do. Over the years, this has meant many families have formed very close working relationships with our providers. And you should know we also enjoy working together as well.

So it is with some real sadness that we are informing our Advanced Pediatrics family that Kelley Muldoon Rieger is going to be retiring from Advanced Pediatrics to spend more time with her family.

At the same time, we are happy for Kelley that she can have this special time together while her children are still young. Kelley has let us know that her last day in the office will be May 20 of this year.

That is the news.

The change of course will be that Kelley will no longer be in the office caring for your children. Dr. Hertzer and I will be available for all such care starting once Kelley leaves. We will continue to offer the same level of service, including availability for same day appointments.

The only other change that you might experience will be during times of scheduling health supervision visits (check-ups) around the time that camps, sports, or school start. That has always been a time when appointment requests tend to bunch together causing us to only able to offer appointments some days after the requested time. But there are several solutions to this potential challenge:

1. The best idea is to schedule your child's annual health supervision visit (check-up) around their birthday, this avoids trying to book this sort of appointment on the day before school when so many others find themselves having to do who did not use this strategy.

2. Talk to our office to enroll in our online services program called Healow. Get a username and password, and go online to request appointments well in advanced.

That is the change.

As Kelley prepares to leave, we want to offer much deserved appreciation. Ms. Muldoon Rieger came to Advanced Pediatrics before we opened, as our account representative for our first electronic medical record software, in 2002. She and her husband had recently moved to Cleveland, and the various interests aligned, as we were looking to hire a nurse practitioner and Kelley was interested in practicing pediatrics. And so Kelley joined Advanced Pediatrics at its very inception and has been here since.

Kelley has brought a refreshing, upbeat, sharp, caring stance to her practice of medicine. This has been in strong evidence every day over the last 13 years. Her clinical acumen has been exceptional, many families have been the beneficiary of her expertise and clear eye. In practice, we are called upon to evaluate large numbers of situations and not miss the one of these many that indicates a serious problem. Over the years, many families have come to experience Kelley's outstanding ability to do just that, to know something is different, that something needs further evaluation. And in essentially every such circumstance, Kelley has been right and found a problem that was important to address. Many children and families have benefited from her abilities.

Just as important as her medical expertise has been her total commitment to care. To make sure families were comfortable, that they understood, that their issues were listened to and addressed.

I have always valued the sound of laughter coming from Kelley and the families she is seeing in her rooms.

Putting it all together, I want to thank Kelley for her care of all of you over the years. There are few doctors or nurses I know who have done, or could have done a better job. We will miss Kelley working here, and wish only the best going forward, and say so with a tremendous amount of gratitude.

And, as I know Kelley would agree, Dr. Hertzer and I remain here, able to carry on just these same qualities so that Advanced Pediatrics will continue the same level and quality of care you have come to expect from us.

To your health,

Dr. Arthur Lavin

2016-05-15

On Emerging Words and Sentences- the Power of Language

On Emerging Words and Sentences-

The Power of Language

This is the next in a series of musings inspired by visits with our wonderful granddaughter, Evie, who lives in Hong Kong.

The occasion this is an amazing event in our family's life, the wedding of our daughter, Hannah in May of 2016. This great celebration brought the whole family together, including our son, and his family, which means Evie. I will note that the wedding was an extraordinary moment. Of all family events, weddings are one of my favorites, it is a moment of incredible creation through our own actions. After all, no one chooses their parents, and few choose their children, but every couple chooses each other, and creates a new relationship, and often, family, from that choice. We are very lucky that our new son-in-law is a terrific person who cares for Hannah so well, and who we care for very much as well.

During the week after the wedding, Evie's parents took a break, and we took Evie home with us for most of a week. It was a powerful and wonderful experience spending 4 days with our 21 month old granddaughter, we really got to know her ways, her daily rhythms, who she is. It was nothing but pure delight!

She turns out to be a very witty and positive young girl, who is consumed with songs and stories. She also uses the word yes much more than I would expect.

In these posts on Evie, I like to share whatever few insights I gain observing her at various ages. The main experience that moved me this time, again at age 21 months, was the power of emerging language. Last time we were with her, her ability to understand what people say was emerging. This time, her ability to tell us in complex sentences what she is thinking is emerging.

I suppose the first thing to share is the power of song in learning to say something. Music is a totally different production of the mind from words, and seems to be a much older part of our minds. There is evidence that some human-like species, the hominin species like Homo habilis or erectus, made bone flutes that even today can make in-tune music, a million years before we Homo sapiens were evolved, long before the first word was spoken. We also know at the the end of life, songs we know are remembered long after many facts fade.

So it is very intriguing to watch Evie start her life of talking with songs. She loves songs, especially songs with gestures and strong emotion, such as "The Wheels of the Bus," "The Itsy Bitsy Spider," "Little Boy Blue," "Open-Shut Them." To name just a few. We have watched her pick up the idea of the song, and even most of the lyrics, after 2-3 rounds of singing them. Once she knows the words, she loves singing them together with us, over, and over, and over.

The tune is quickly recognized and picked up, then when one adds words, you have easy access to telling a whole story. Singing songs, like reading familiar books, opens a path to telling a story.

But telling a story turns out to go well beyond telling that story. Telling a story allows one to create one's own story. And this is the next thing we got to see with our time with Evie. Evie spends most of every moment when awake in the frame of a story. She creates a narrative that explains to herself and others, what she is doing and what she is thinking.

Her stories organize her ability to tell people her thoughts, but they also organize what her own thoughts are.

Of course, this is a fact for all of us. Give it a try, try to have a thought unconnected to any story or narrative. It is likely next to impossible to have a thought that is not part of a context, a story.

At our age, our words come pouring out, like in this post, a mile a minute, and our words achieve so many ends, but when spoken language first emerges, at any age, but typically between ages 1 and 3, we see the power of a story in full view.

And that is just where Evie is at, she is moving from understanding what we are saying, to crafting words to tell us what she is thinking, and linking them into sentences that do indeed tell us what we are thinking.

How powerful, how delightful, and what a privilege all grandparents and parents have, to watch their children and grandchildren's language emerge, and at every step to see just how powerful language is, it's not just what we say and think, it reveals how we think.

We love our time with Evie, and it is a great pleasure to share some of these moments with all of you.

To your health,
Dr. Arthur Lavin

2016-04-26

Get Ready to say Goodbye to Rice Cereal

Rice Cereal is Fading as a First Choice

In 2013, we reported that arsenic was emerging as a potent toxin capable of a surprising range of harm, including chronic lung disease, heart disease, and some cancers. (see below)

It has been known for some time that rice is a plant that concentrates arsenic. If grown in soil with arsenic in it, the plant sucks up those molecules and concentrates them in the part we eat, the grains of rice.

Now comes the AAP News, he official newsmagazine of the American Academy of Pediatrics to report that the FDA is proposing limits on the levels of arsenic in infant rice cereals.

The key findings from the FDA on rice cereal and arsenic are at http://www.fda.gov/food/foodborneillnesscontaminants/metals/ucm319870.htm

The FDA would like to limit rice cereal sold to infants contain less than 100 parts per billion of arsenic in the cereal. The current standard in drinking water is that it must be less than 10 parts per billion. The FDA found that infant rice cereals contain, on average, more than double the arsenic that other toddler foods contain.

Members of experts on arsenic in baby food sources at the AAP are now starting to promote use of other purees as first foods, and as infant foods. They recommend other grains, fruits, and vegetables, in addition to rice cereal.

This signal is new and suggests, along with the recent moves from the FDA, that the US is taking a new look at the long practice of using rice cereal as the first solid. Rice milk is now currently not recommended.

BOTTOM LINE

1. Arsenic is a very dangerous chemical element causing a surprising range of long-term damage and disease.

2. Rice has long been known to concentrate arsenic, but now the FDA is finding elevations of arsenic in infant rice cereals.

3. As initial steps in response, the FDA is setting a standard so that all infant rice cereals only have arsenic below the standard.

4. The American Academy of Pediatrics is taking initial steps to move all parents away from dependence on infant rice cereal as the first solid, encouraging people to instead use other grains, fruit, and vegetable purees.

Our recommendation is to right now reconsider the use of rice cereal in infancy. As the AAP has noted, other purees work just as well. And if the FDA is raising alarms, why use rice cereal?

Rice cereal has been the American infant's first food for many, many decades, it will be sad to see it go, but the rise of arsenic in our rice demands us to be smart.

To your health,
Dr. Arthur Lavin

Arsenic: What it Does, Why to Worry, and What to Do

Recent reports have brought to all our minds the concern that arsenic may be causing us harm in our food supply, particularly from rice and apple juice.

This note will take a look at arsenic. What is arsenic? What sort of harm can it cause? Should we be worried, and if so, what exactly is worrisome and what is not? And given any real worry, what can be done?

What is Arsenic?

Most of us know arsenic as a poison, perhaps out of familiarity with the 1939 play by Thomas Kesselring, Arsenic and Old Lace. And, indeed, this grey metal can be made into a powder that is quite poisonous to nearly every form of life, including insects and humans. But what is arsenic? Arsenic is an element that forms metal-like crystals, and is useful in making copper and lead more better in items we use, and is an important element in the materials that make electronic components.

How does Arsenic cause Harm?
Arsenic hurts nearly any living cell by blocking its ability to make energy. Only a handful of unusual bacteria can live in the presence of arsenic, all other life is killed by the ability of arsenic to block the production of ATP, the currency of energy for all life. Another famous poison, cyanide also blocks ATP production, but this poison creates a total and complete cessation of energy production, and hence sudden death. Arsenic leads to varying levels of blocked energy production and so its typical method of harm has more to do with various organs and systems not working well, and eventually failing. Death from arsenic is the result of various organs failing to work.

What is the Sort of Harm Most Often Seen Caused by Arsenic?
More typically, at the lower levels of the more common exposures, arsenic weakens organ functions, leading to a variety of complex problems and scenarios. There is some indication that over time, continued exposure to even low levels of excessive arsenic can shorten life, but the most typical problems are more chronic in nature rather than deadly.

On September 20, 2013, the New York Times published an important article on findings on what arsenic is actually doing to us now. http://well.blogs.nytimes.com/2013/09/20/the-arsenic-in-our-drinking-water/?ref=health

The current evidence suggests that ongoing, low level exposure to excessive arsenic can cause people to increase their chance of having heart disease and strokes, diabetes, and cancers of the skin, bladder, and lung. Curiously, the recent studies have found that arsenic can cause people to experience far more colds, even during infancy!

Some studies found that people exposed to levels of 19 parts per billion (ppb) in their drinking water began to show signs of chronic lung dysfunction, and at 120 ppb, their lung function was as abnormal as a chronic smoker. In one country whose drinking water had levels of arsenic as high as 1,000 ppb, 24% of all deaths from all chronic illnesses could be blamed on the impact of arsenic.

Who Should be Worried?

Drinking Water
In the United States, arsenic is found in varying concentrations in the drinking water, depending on two key items:
1. Does the family use a water system supply, or a private well?
2. If they use a well, do the rocks in their region have a lot of arsenic in them or not?

The areas of the United States that have the highest levels of naturally occurring arsenic in the ground water are:
1. The Southwest. Areas of Nevada have well water with levels as high as 500 ppb.
2. The Upper Midwest.
3. A band of New England- from the coast of Maine to an area midway in Massachusetts.

Water supplied by a municipal water system is mandated by Federal law to keep the level of arsenic below 10 ppb. This means you are very unlikely to be exposed to arsenic in your tap water if the water is from a municipal source. Private well users must measure their arsenic level to be sure it is not over 10 ppb, particularly in the US Southwest, Upper Midwest, and the swath of New England noted above.

Food
Arsenic exposure can cause harm via the ability to concentrate in certain foods. Rice, for example, is a plant that sucks arsenic out of the soil quite well, and so if it is planted in soil with arsenic contamination, that arsenic will end up in the rice grains and potentially cause harm to those eating rice.

Other foods that concentrate arsenic include leafy vegetables, seafood, and apple and grape juice.

Juice
In July, 2013, the FDA set a standard of 10 ppb, the same as drinking water, for apple juice, ensuring that apple juice that meets the FDA standard is as free of arsenic as safe, metropolitan, drinking water.

Rice
The problem with American-grown rice is that much of it is grown in fields that used to grow cotton- for a very long time. Cotton was doused with arsenic very heavily- after all no one ate it. But over the last few hundred years that meant the soil of these fields got good and soaked with arsenic. As noted, rice sucks arsenic out of soil really well, and so rice from the American South can contain too much arsenic.

Bottom Line
Arsenic is a very dangerous and very insidious poison. If you get too much you don't just keel over, you get chronic illnesses. It is worth taking efforts to avoid exposure. Here are the top 3 things to do to avoid eating too much arsenic:

1. Make your water tap water. If you must use a well, find out the arsenic concentration and don't drink it if it is over 10 parts per billion (ppb)
2. Commercial apple juice is now regulated to have arsenic levels below 10 ppb, it should be safe.
3. Rice is a real problem. American rice from California is probably the safest bet. Rice from the American South likely cannot be trusted to have low enough arsenic levels to be safe, and rice from the rest of the world, who knows. So try to stick to California rice.

Our best,
Dr. Arthur Lavin

2016-04-22

Homework v. Play- We have a Winner

Homework v. Play- We have a Winner

There has long been a tremendous fascination and draw to homework across many American households. It could reflect ongoing anxieties about how our children will do once they have to find a job, competing with the superachievers across the globe. How will our children win the struggle for good jobs unless they have mastered countless hours of homework? In fact, isn't the case that the more work we pile on, the better and more advanced our child's mind will be? Without hours of homework a night, doesn't the child's brain wither and weaken, or at the very least, fail to reach is full potential?

Surely the agonies of hours of homework are more virtuous than empty hours of play. Surely.

This is a question that has been inside educational theory for decades, probably since homework was first foisted on our unsuspecting kids. And I suppose it makes some sense on the surface of things.

But, fortunately for children everywhere, someone has actually tested this question, had looked at how kids turn out as adults with and without homework, and the answer across such studies is clear.

Homework offers no benefits, play is the best way to grow a mind.

Isn't that incredible? Kids who do no homework, learn just as much and do just as well as adults, as kids who do homework hours every night. Incredible.

This conclusion has been dramatically demonstrated in the the country that is listed by most measures as the nation with the best schools in the world. The students that graduate from the public schools in this country outperform all other nations. The country is Finland. And their schools do three notable things:

1. They assign NO homework from K-12, the only exception being some work now and then in high school.

2. They do NO standardized tests.

3. There are NO private schools in Finland, all students go to public schools.

And, again, their graduates have better academic skills than any graduates in the world!

You might wonder, when will these lessons ever be put into practice here at home?

The answer is now. I have just learned that the Shaker Heights Public School system is embarking on a sharp decrease of homework in their K-4 elementary schools. Given all we know, I applaud this move, and am so happy for these students. There are a number of other schools that already have done this and more that are considering it.

In fact, enough private and public schools are moving in this direction that it appears the victory of play over homework for American children may be approaching.

This is good news not only because homework offers little educational benefit, but because there is no activity of the brain more helpful to brain function than play. This is true in infancy, childhood, adolescence, and adulthood. Dr. Alice Kolb at the Weatherhead School of Business at Case has devoted her long career to the role of play in advanced cognitive functioning in business, and has found abundant evident that the playful mind outperforms the mind blocked from play.

BOTTOM LINES

1. Nothing tops play as an activity to promote the development and function of the mind, at any age.

2. Homework, often thought to be a useful discipline to improve learning, is not.

3. The best school system in the world, the schools of Finland, assign essentially no homework from Kindergarten through senior year in high school.

4. Many schools in the US are moving away from giving homework, we are pleased to report the Shaker Heights Public School system is doing that for next year.

So play with your kids, and let your kids play. Nothing will be better for their minds.

To your health,
Dr. Arthur Lavin

2016-04-15

The American Academy of Pediatrics Opens its Doors to Families

The American Academy of Pediatrics Opens

Its Doors to Families

A new venture from the American Academy of Pediatrics (AAP), the FamilY Partnerships Network www.aap.org/fpn has been launched.

Nearly all pediatricians in the United States belong to the Academy, which has 65,000 members. Medical students and pediatric dentists and nurse practitioners are members of the Academy as well.

Most of the world turns to the AAP for its expertise and guidance across a very wide range of issues that determine how children receive medical care.

So it is especially good news that two legends of advocacy for children, Ms. Betsy Anderson, and Ms. Julie Beckett, who helped found and direct Family Voices, have teamed up with the AAP to create a new program, the FamilY Partnerships Network or FPN.

FPN, you may have noticed, has a capital Y at the end of family to emphasize that the organization addresses needs of youth and young adults as well as young children.

The FPN is an advisory group to the Academy's Board of Directors, and will represent the perspective of parents to the Academy as it pursues its wide range of activities on behalf of infants, children, and adolescents.

The activities of the FPN will include:

Develop and promote education to doctors about family concerns
Review and contribute to policy and publications of the AAP
Advocate for the needs of children and families with the AAP
Develop AAP resources to help explain a range of issues to families

The actual topics of interest to the FPN will range as widely as the parents who constitute it.

An exciting aspect to the FPN is that membership in the Network is open for consideration by any parent of a child. And it's easy for parents to inquire.

Simply fill out this inquiry survey and someone from the FPN will be in touch to answer questions and see if you are interested in participating: https://www.surveymonkey.com/r/FPNApp

I have to say that having participated at the national level at the AAP for many years, it is an amazing experience. The level of expertise and caring is truly inspiring, and the work really does help a nation of children. If you have a particular interest when it comes to how the nation's doctors care for our children, what issues need attention, and how they should be attended to, the FamilY Partnerships Network could be an incredible opportunity for you.

Please do let me know if you are interested, just send an email to info@advancedped.org

To your health,

Dr. Arthur Lavin

Participation in a Major New Paper- from the AAP, on Poverty

Participation in a Major New Paper-

from the AAP, on Poverty

The American Academy of Pediatrics (AAP) has published a major new policy statement on the topic of poverty in this month's (April, 2016) issue of Pediatrics. And I am very honored to be listed as one of the authors as the member of an AAP Committee that participated in the drafting of the document.

http://pediatrics.aappublications.org/content/early/2016/03/07/peds.2016-0339

As many of you know the AAP is one of the world's leading pediatric professional societies. It has a very wonderful history of helping children. The AAP, in fact, was founded in protest against AMA actions that tried to block the government from providing free milk to poor children, in the 1920's. When the AMA lobbied Congress to block this bill from passing, the pediatricians walked out of the AMA in protest and created the AAP.

Since that time, the AAP has been one of the only doctors' societies whose main purpose has not been the doctors, but rather the children we serve.

This major paper is firmly in that tradition. Every few years, the AAP identifies the top three priorities facing children in America. When the Academy identified poverty as a top priority, that was a major event. Our Academy found that one of the top three priorities defining the health of children was not a disease, was not an infection, but a creation of our own national community.

I applauded that decision, as I agree with our Academy that poverty creates worlds of suffering and dire impacts that are at the root of many of the major catastrophes children face today, including
mental health conditions, lethal and disabling injuries from gunfire and other violence, malnutrition, and higher rates of more traditional diseases such as asthma.

It is a real honor that for several years I have served on one of the national committees of the AAP, the committee charged with setting policy for the Academy on matters pertaining to the psychological and social health of children and their families. One of the jobs of this committee is to draft and/or review policy statements adopted by the Academy and published in Pediatrics, widely regarded as the leading journal for pediatric papers in the world.

I would encourage you to read this paper, Poverty and Child Health in the United States.

http://pediatrics.aappublications.org/content/early/2016/03/07/peds.2016-0339
I consider it an historic publication, as it calls our national community to witness that poverty is a problem we have created, that we can dramatically reduce, and that not doing so has very real, durable, and identifiable health consequences for our children.

As our committee publishes other policy statements of the Academy, I will be keeping you informed.

To your health,
Dr. Arthur Lavin

2016-06-23

AP to Comply with CDC: No FluMist this Year

2016-06-20

Celebrating a Hero in our Community

2016-06-16

Folic Acid- A Third Benefit for your Child

2016-06-03

Lazy- A Troublesome Concept

2016-05-26

The Power of Touch- Progress on a Great Sense

2016-05-25

Advanced Pediatrics, Who's the Boss Parenting Academy Note that Sleep Training Comes of Age

2016-05-20

Home Birth- The American Experience of Giving Birth at Home

Your Chance to Offer a Good Word

Antibiotics- What Goes Wrong if not Used Properly

News, Some Change, An Appreciation

2016-05-15

On Emerging Words and Sentences- the Power of Language

2016-04-26

Get Ready to say Goodbye to Rice Cereal

2016-04-22

Homework v. Play- We have a Winner

2016-04-15

The American Academy of Pediatrics Opens its Doors to Families

Participation in a Major New Paper- from the AAP, on Poverty

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