2010-08-25

Tips for Meeting with School Officials about possible IEP's

Tips for Meeting with School Officials about Individualized
Education Plans

I was recently invited to speak at a national convention devoted to the care of children with a very rare metabolic disorder, but at the convention, a neuropsychologist from Denver, Colorado, Dr. Kendra Bjoraker, offered a series of tips to help parents in meetings with school officials.

These tips each were so insightful, so helpful, I wanted to make them available to you all.  Each really help put  you, the parent, in a better position to get the best educational plan for your child possible.

Keep in mind, these tips were designed for meetings with officials who have the power and authority to decide what help your family and your child will receive from their school.  As such these tips could be helpful for any such meeting, school or otherwise:


Your overall goal is to get the organization to help you and your child

  • Be sure to sit next to the most senior decision-maker at the meeting.
  • Dress formally, make sure you look like you take their time seriously
  • Bring food, fruit or cookies, it is harder to say no to someone who feeds you.
  • Print the Rules and Regulations of the State of Ohio on the subject you are discussing, for example, IEP services, and place them in a binder with the title Rules and Regulations of the State of Ohio on the spine of the binder.  Place the binder with the spine facing towards meeting participants.
  • If an administrator states that the law forbids or does not allow them to help you in the way you request, ask them to point to the statute, in your binder.
  • Take notes.
  • Before you leave, insist on getting copy of the administrator's notes.  Often promises made at the meeting don't make it into the final report.
  • Tape record the meeting and leave it on as everyone is saying their goodbyes.  Often promise are made as a friendly parting gesture.
  • Be sure to go after the problem, not the people.  The challenge is to get help, not to go after individuals.  If you are getting angry at someone, the focus is off center.


*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

2010-08-19

Time to Rethink the use of Acetaminophen (aka Tylenol)

Time to Rethink the use of Acetaminophen (aka Tylenol)

On August 16, 2010, The New York Times published a brief account of a research study looking at the association of asthma and use of acetaminophen (the medication in Tylenol, known in Europe as paracetamol).

The New York Times logoImage via Wikipedia
http://www.nytimes.com/2010/08/17/health/research/17risk.html?_r=1&ref=health&pagewanted=print
This study, looked at hundreds of thousands of children across 50 countries and found that if kids took Tylenol, the chance of them having asthma, hay fever, or itchy eyes increased.
There have been some indicators that acetaminophen could increase the chance of developing allergic problems like asthma, runny nose, and itchy eyes, but now the evidence is strong enough for we at Advanced Pediatrics to issue the following recommendation, particularly since ibuprofen works just as well:
Advanced Pediatrics recommends that pregnant women, infants, children, and adolescents no longer use acetaminophen (Tylenol).

Why?  Sufficient evidence now exists to be concerned that use of acetaminophen during pregnancy, infancy, childhood, and/or adolescence can increase the chance of developing asthma, hay fever, and/or allergic itchy eyes.

What about fever, pain, inflammation?  It turns out ibuprofen (Advil, Motrin) works as well or better than acetaminophen, so stopping the use of acetaminophen still allows you to give something for fever, pain, and/or inflammations.

What about high fevers and alternating meds?  It also turns out that if you use ibuprofen to control fever, adding an alternating dosage of acetaminophen does not lower the fever any further.  So stopping the use of acetaminophen will not cause the fever to go higher.

See below for abstracts on the NYT quoted study, and a recent survey of the biologic plausability of acetaminophen really causing asthma to develop.

Dr. Arthur Lavin
AJRCCM
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Published ahead of print on August 13, 2010
Am. J. Respir. Crit. Care Med. 2010, doi:10.1164/rccm.201005-0757OC
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Submitted on May 12, 2010
Accepted on August 13, 2010

Acetaminophen Use and Risk of Asthma, Rhinoconjunctivitis and Eczema in Adolescents: ISAAC Phase Three

Richard W Beasley1*Tadd O Clayton2Julian Crane3Christopher K.W. Lai4Stephen R Montefort5Erika von Mutius6Alistair W Stewart2and the ISAAC Phase Three Study Group1 Medical Research Institute of New Zealand, Wellington, New Zealand, 2Faculty of Medical & Health Sciences, The University of Auckland, Auckland, New Zealand, 3 Otago University Wellington, Wellington, New Zealand, 4Chinese University of Hong Kong, Hong Kong, China, 5 University of Malta, Malta, Malta, 6 Dr von Haunersches University Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
* To whom correspondence should be addressed. E-mail: richard.beasley@mrinz.ac.nz.

Rationale: There is epidemiological evidence that the use of acetaminophen may increase the risk of developing asthma. Objective: To investigate the risk of asthma and other allergic disorders associated with the current use of acetaminophen in 13 to 14 year old children in different populations worldwide. Methods: As part of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three, 13 to 14 year old children completed written and video questionnaires, obtaining data on current symptoms of asthma, rhinoconjunctivitis and eczema, and a written environmental questionnaire obtaining data on putative risk factors including acetaminophen use in the past 12 months. Measurements: The primary outcome measure was the odds ratio (OR) of current asthma symptoms associated withacetaminophen use calculated by logistic regression. Main results: A total of 322,959 adolescent children from 113 centres in 50 countries participated. In the multivariate analyses the recent use of acetaminophen was associated with an exposure-dependent increased risk of current asthma symptoms [OR 1.43 (95% CI 1.33 to 1.53) and 2.51 (95% CI 2.33 to 2.70) for medium and high versus no use respectively]. Acetaminophen use was also associated with an exposure-dependent increased risk of current symptoms of rhinoconjunctivitis and eczema. Conclusions: Acetaminophenuse may represent an important risk factor for the development and/or maintenance of asthma, rhinoconjunctivitis and eczema in adolescent children.

Clin Exp Allergy. 2010 Jan;40(1):32-41.

The role of paracetamol in the pathogenesis of asthma.

Medical Research Institute of New Zealand, Wellington, New Zealand.

Abstract

Paracetamol use represents a putative risk factor for the development of asthma. There is convincing epidemiological evidence that the risk of asthma may be increased with exposure to paracetamol in the intrauterine environment, infancy, later childhood and adult life. A dose-dependent association has also been observed in these different age groups in different populations world-wide. An association has also been shown between paracetamol use in both rhinoconjunctivitis and eczema. There is biological plausibility with paracetamol use leading to decreased glutathione levels resulting in increased oxidant-induced inflammation and potentially enhanced T-helper type 2 responses. At the population level, patterns of paracetamol use might explain, to some extent, the world-wide variation in the prevalence of asthma and related disorders, particularly the high rates in English-speaking countries, which have high per capita prescription and over-the-counter use of paracetamol. A temporal association also exists between the international trends of increasing paracetamol use and increasing prevalence of asthma over recent decades. Further research is urgently required, in particular randomized-controlled trials (RCTs) into the long-term effects of frequent paracetamol use in childhood, to determine the magnitude and characteristics of any such risk. Importantly, RCTs will also enable evidence-based guidelines for the recommended use of paracetamol to be developed.

*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.
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2010-08-02

Concerns about the New Meningitis Vaccine- Menactra- Now Resolved

Logo of the United States Department of Health...Image via Wikipedia
Concerns about the New Meningitis Vaccine- Menactra- 
Now Resolved

Several years ago, improvements to the meningococcal meningitis vaccine led to the licensure of Menactra.
Menactra offers the advantage of a longer duration of coverage.

However, soon after it was licensed, a group of 6 people who got the vaccine developed a syndrome of temporary paralysis called Guillan-Barre Syndrome.  The FDA launched a study to see if the vaccine was at fault.  We have held off recommending this vaccine until this issue was settled.  Note that our stance was never that the Menactra vaccine was dangerous, we just wanted to ensure its safety before recommending it.

Two important studies have now been published and establish that the Menactra vaccine does not cause Guillan-Barre syndrome and we now recommend its use to prevent meningococcal meningitis, the type of meningitis seen in college.

One of the studies looked at the experience of 1.4 million children who got the Menactra shot, in Boston.  There were no cases of Guillan-Barre syndrome associated with the shot.

The other study was from the CDC showing no increased risk of developing Guillan Barre syndrome after being immunized with Menactra.

Bottom Line:
Advanced Pediatrics, on the basis of recent evidence that Menactra has no connection to Guillan-Barre syndrome, is now recommending the routine use of Menactra in all children, starting at age 11-12.

Dr. Arthur Lavin






*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.
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2010-07-27

The Evolution of Mother-Child Interactions- Interesting News

The Evolution of Mother-Child Interactions-
How Our Three Smallest Bones Led to
Human Brains and Love for Mom

One of the world's leading experts on how humanity came to be, Dr. Melvin Konner,
has recently published a work that has been 25 years in the making: The Evolution of Childhood: Relationships, Emotion, Mind (Belknap Harvard University Press, 2010,  943 pages)

I had the pleasure of knowing Dr. Konner during my time in Boston, and have been studying his book this summer.

From time to time, I would like to post some of his most fascinating findings in this monumental, and historic exploration of how humans came to be.

Today's observation has to do with the emergence of mammals from reptiles and how the mother-child bond helped define our history.

Mammals first appeared on our planet about 225 million years ago, clearly descended from reptiles.

Most people think that to be a mammal you have to nurse your young and/or give birth to a live child, not an egg.  Now nearly all mammals do both these things, including humans.  But platypuses are mammals and lay eggs, and have no fully developed breasts.

It turns out that the one difference between reptiles and mammals has to do with might appear to be a very minor anatomic detail.

Reptiles have three little bones in their jaw joint.  Mammals do not.

Feel your jaw, the jawbone connects directly to your skull.  Go ahead, open and close your mouth with your finger on your jaw joint.  You can feel the jaw connect directly to your skull.  Reptiles have three tiny bones in this joint that act as a major hinge, allowing the reptile to open their mouth far more widely than we can.  It explains how a snake can swallow a mongoose- their hinged jaw opens that widely.  Ours never will.

So where are the three tiny bones of the reptile jaw in mammals, including us?  They have moved inwards, just a few millimeters, and taken their place as the three tiny bones of hearing- the hammer, anvil, and stirrup.

We are not sure what got those bones to move, but the fossil record clearly proves that their movement led to the development of the ear of the mammal, which opened up hearing a much wider range of sounds.  With the movement of these, our smallest three bones, the ear of a mammal was born, able to hear high pitches that even today no reptile can hear.  

Now you might ask, how does the development of a better ear lead to closer infant-mother connections and the human brain?  It turns out, rather directly.

With the advantage of better hearing, the newborn of a mammal can cry out for help in as loud a voice as it wants, the predator reptile cannot hear the baby, but the baby's Mom can.  Now, for the first time, a baby can cry out with the predator at the door, without fear of the predator hearing it, and confident the mother will respond.

This new reality ushered in the era of the mammal, and the central fact of mammal life- its babies are deeply connected to their Mamas.  

But since hearing became the foundation and starting point for this connection, this move also opened the door to another powerful, and ultimately decisive, advantage for the mammals- the growth of the thinking brain.  After all, with the development of better hearing and communication comes the development of language.  And many hold that one of the main drivers for the development of the human brain has been language.

So, from the chance movement of the three smallest bones from the jaw to the ear comes a new type of animal, the mammal, the creation of a new type of hearing that leads to a quantum leap in the depth of attachment between newborn and mother, the creation of language, and the direction towards a human brain.

Extraordinary how the random events of evolution can lead to the most extraordinary outcomes!

Dr. Arthur Lavin 





*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

2010-07-07

A Natural Product for Babies Retail Store in Beachwood.

Dear Families,

I wanted to let you know about an interesting place to get BPA and phthalate free plastic baby products. It's called Teeks Natural Garden, and it's in the Beachwood Place mall:

The owners recently sent along this description of their offerings, which I am pleased to send along to you:

Teeks Natural Garden really started out to be able to offer alternatives to the many chemical driven products  that has the potential to harm our babies and children. From phthalates,  BPA,pvc, styrene  and conventionally grown cotton. 

Pesticide and chemically treated clothing, diapers and bedding block the natural balance of the skin by trapping heat and preventing it from breathing. 

We now know through research that parents must wash foods and try to purchase as much organic pesticide  free foods.   Does it not make sense that chemically treated clothing wrapped around our babies, absorbing into their skin not have the same results.

Our store is filled with organic clothing, diapers, bedding and even our stuffed animals.  Our products are all environmentally safe. We are the local distributor of
Bum Genius Cloth Diapers,
The Wean Machine, a  portable food smasher allowing your child to eat the same foods as the parents while out.
The Tummy Tub,  a baby bathtub with advantages such as a special design which allows the baby to relax in the familiar fetal position. Soft baby material. Stress free bathing for your baby. It is exceptionally beneficial for babies who tend to be unsettled or suffer from wind/colic. It is fully recyclable and saves energy.
Sophie the Giraffe.  The most requested natural teether on the market.
Oh Plah  teething bracelets
Rockin Green, cloth diaper and laundry detergent. Tree hugger approved and phosphate free. Wonderful for cloth diapers and all babies clothing.
Under the NIle organic clothing
Baby LuLu organic clothing
Sage Creek organic clothing
Parade organic clothing
Fierce Hugs organic onesies.
Our clothes fit babies from birth to 24 months and we carry preemie clothing as well.

Hope you find this source of safe baby products of interest,

Dr. Arthur Lavin


*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

2010-06-26

Needless Death in California

The Ultimate Price of a Flawed Argument:
Five Infants Die in California for Lack of a Simple Shot

Now and then, an intervention will spark the suspicion of the community, and independent of any facts or evidence, will be considered potentially dangerous.   Even after decades of good observation and research demonstrating the intervention is safe, it will often be shunned or avoided simply out of suspicion.

Two prominent examples of the power of rumor and suspicion are the fluoridation of water and immunizations.  When doctors and dentists first noted that kids growing up in the Rockies had almost no cavities, and that adding fluoride to water could offer this protection to all children, the public reacted with a very emotional fear, initially articulated as a vague sense that adding fluoride to water was a terrorist-like move of secret Communist influence in the US government.  We may laugh at the irrationality of this reaction, but strong anti-fluoride sentiment still is very strong in our country, it just uses other arguments to stay alive.

The other example of the tragic power of irrational fear in blocking good help getting to children is the avoidance of immunizations.  Clearly, giving a child a shot is a traumatic event.  Jabbing someone with a needle is simply not a nice thing to do to anyone, it hurts, and it looks scary.  But few interventions have as solid a record of saving  lives as the key immunizations of childhood.  Because of immunizations, parents no longer really have to worry about infections posing a deadly risk to their infant and child.  Infant meningitis is nearly eliminated, polio is eliminated from the Western hemisphere, almost no one gets tetanus or diphtheria anymore.  And pertussis was in sharp decline.  Almost every child used to get measles, and 1 in 1000 of children with measles ended up with permanent, severe brain damage from the infection, but now almost no one gets measles, and so crippling the brain damage from measles is now nearly eliminated.

And yet, despite the blazing triumph of immunizations in stopping germs from hurting our children, the power of suspicion has worked its way, and a rapidly increasing number of children in the United States are not getting immunized.  I understand the suspicion.  Drug companies have simply squandered our trust with harmful, devious marketing practices that leave all of us unsure of what to believe from them.  And immunizations have been proliferating, with so many developed against relatively harmless illnesses, one has to wonder if the next immunization is being developed to save lives or make money.

But sadly, these suspicions have led many families to block their baby's access to basic immunizations that could save a life.

This trend is right now being tragically demonstrated in California.  Enough families have opted out of giving their babies pertussis immunization that right now a deadly epidemic of whooping cough rages in California.  As of June 23, 2010, nearly 1000 children have had documented cases of whooping cough, and now 5 babies are dead who did not need to die.  All the deaths were in infants under 3 months of age.  

Controversies are the very stuff of American entertainment.  Politics, scandals, medical controversies fill our airwaves, cables, and Internet pages.  It's sort of fun to question the party line, and actually an urgent priority  to protect one's family from suspicious vendors.  But this game of American dialogue and controversy becomes less entertaining when lives of infants hang in the balance.  The draw of the immunization controversy has lured good minds into the fray, with the Sears family of physicians and Dr. Oz offering "alternative" immunization schedules.  A rather disappointing spectacle has emerged in which the shock of a famous celebrity outweighs decades of good, solid scientific study on a subject.

But now, given the recent expose of the group that invented the suspicion that MMR causes autism (see post on this earlier this month), and now the death of five young infants in California, it is time to call the suspicion of basic immunizations for what it is:  groundless and dangerous.

Pertussis is a bacterial infection of the airway- nose, eyes, throat, and lungs.  In older children and adults, it can be harmless.  But the younger you are, the greater the chance it can kill you, even with modern ICU's and IV antibiotics available, as the tragedy of the 5 dead young infants in modern California sadly demonstrates.

This is precisely the reason we recommend protecting your newborn from deadly infections, as soon as the immunization can work.  In the case of pertussis, that age is 6-8 weeks old.

Bottom Line
Basic immunizations, like those that protect against tetanus, diphtheria, pertussis, and meningitis, offer protection to infants by as young as 6 weeks of age.   We urge families to protect their children from these potentially deadly diseases by no later than 2 months of age.

The ongoing epidemic in California dramatizes a very simple point:  these immunizations are incredibly safe and incredibly important.  Getting these shots causes no lasting harm, but not getting them can be deadly.

Again, I fully respect, and share, a deep distrust of the marketing of American pharmaceuticals.  We will continue, at Advanced Pediatrics, to do everything in our power to weigh every immunization's potential risks and benefits.  To that end we will continue to prohibit any solicitation or gifts from any pharmaceutical company, stay up-to-date on research related to immunizations, and provide as measured a judgement on each immunization as possible.

With all that in mind, let us find a way as a community to reject both the pressures of social movements and the marketing of corporations, and continue efforts to always re-focus our attention on the best interests of our children.  It is time to step away from the cynical movements spawned by the likes of Dr. Wakefield in England, and return to a calm, cool consideration of the facts: namely, the key basic immunizations (DTap, Hib, PCV) are very safe and withholding them presents a clear and present danger. 

Dr. Arthur Lavin





*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.
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2010-06-21

Report on Lead in Juice and Baby Foods- Cause for Concern?

Report on Lead in Juice and Baby Foods- Cause for Concern?

I recently received a question regarding a report about lead in baby and children's foods.
Here was my response to the parent:

Dear Parent,

Thanks for your inquiry regarding the disturbing article on lead being in children's juices and baby foods, http://www.valleycentral.com/news/story.aspx?id=470720

The article refers to an organization that measured the level of lead in various juices and purees fed to infants and children.  They found levels that exceeded the level set as safe.

The study raises the most important question in toxicology:  what levels of exposure to a dangerous chemical are safe?  And its corollary, if that level of exposure is exceeded, when and how does damage occur?  That is, if the line is crossed even a tiny bit, does harm occur; or, do harmful events start happening only at double, triple, or 10 times the "safe level," and does the level at which bad things happen vary from child to child.

The article you sent gives no indication if the lead levels seen in sold foods actually hurt anyone, or achieved levels of exposure that can lead to actual harm.

My conclusions, therefore, are:
1.  It is very upsetting to see lead leak into what one would think would be a lead-free product.
2.  I urgently want to know how high the level of lead got, and whether these levels are indeed actually seen to cause real harm.
3.  And, if so, work hard to eliminate the lead from these foods.

Dr. Lavin*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.