Child Health & Safety News Roundup: 01-12-2015 to 01-18-2015

twitter thumbWelcome to Pediatric Safety’s weekly “Child Health & Safety News Roundup”- a recap of the past week’s child health and safety news headlines from around the world. Each day we use Twitter and Facebook to communicate relevant and timely health and safety information to the parents, medical professionals and other caregivers who follow us. Occasionally we may miss something, but we think overall we’re doing a pretty good job of keeping you informed. But for our friends and colleagues not on Twitter or FB (or who are but may have missed something), we offer you a recap of the past week’s top 10 events & stories.

PedSafe Child Health & Safety Headline of the Week:
Teen Texting Cheat Sheet – top 20 troublesome teen texts for parents who want to protect their kids http://t.co/cSRkgAfh3p

Keeping Your Family Safe from Frostbite

Little Girl At Snow ParkThis year we had an extended break over the holidays in order to visit the Canadian grandparents and ski the Canadian Rockies in Alberta. It’s a very beautiful part of the world and I do love visiting there….but in the winter, it is COLD! Which is why I couldn’t help but laugh while we were packing for the trip – in our Midwest American winter – when my husband asked if I was packing the sunscreen. Seriously?! Whatever for? You see, however much sunlight might reflect off snow while skiing, creating a risk for sunburn – in the Canadian Rockies – EVERYTHING needs to be covered up, even your face.

Our 12-year old son learned this the hard way, when he began getting frostbite on his cheeks after extensive time out on the slopes on one of the colder days. We took care of it in fairly short order, but when I returned back to the U.S. and discovered it was actually COLDER in the Midwest than it had been in Canada, the idea of a frostbite post seemed like a good idea.

Windchill and Frostbite

When considering frostbite risk, a good place to start is with windchill, which is the term used for the rate of heat loss from the human body resulting from the combined effect of low temperature and wind. As winds increase, heat is carried away from the body at a faster rate, driving down both the skin temperature and, eventually, the internal body temperature.

It’s important to note that the only effect that windchill has on objects (or people) is that it shortens the time that it takes the object to cool to the actual air temperature (it cannot cool the object down below that temperature). Windchill matters because, for any given temperature, with increasing winds, it increases the risk of – and reduces the time for – frostbite of exposed skin to occur.

A Frostbite Primer

Girl with frostbite on cheek

A case of frostnip

At or below freezing (32 °F or 0 °C), blood vessels close to the skin start to constrict, and blood is shunted away from the extremities, like fingers, toes, ears and nose. The same response may also be a result of exposure to high winds. This constriction is helpful as it preserves core body temperature. However, in extreme cold – or when the body is exposed to cold for long periods – this protective strategy can reduce blood flow in some areas of the body to dangerously low levels. This lack of blood leads to the eventual freezing and death of skin tissue in the affected areas.

The level of severity of frostbite is characterized in degrees – similar to burns – with the least severe level known as first degree, or the quaint, “frostnip”. Below is an outline of the degrees of frostbite severity:

First degree (aka Frostnip)

  • Superficial cooling of the surface of the skin, without destruction of the skin cells.
  • At onset, there is itching and pain, then the skin develops white, red, and yellow patches and becomes numb.
  • Affected area usually does not become permanently damaged as only the skin’s top layers are affected – though long-term insensitivity to both heat and cold can sometimes happen after suffering from frostnip.

Second degree

  • If freezing continues, the skin may freeze and harden (destroying skin cells), but the deep tissues are not affected and remain soft and normal.
  • Injury usually blisters 1–2 days after becoming frozen. The blisters may become hard and blackened, but usually appear worse than they are.
  • Most of the injuries heal in one month, but the area may become permanently insensitive to both heat and cold.

Third and fourth degrees

  • If the area freezes further, deep frostbite occurs. The muscles, tendons, blood vessels, and nerves all freeze and can be destroyed.
  • The skin is hard, feels waxy, and use of the area is lost temporarily, and in severe cases, permanently. The deep frostbite results in areas of purplish blisters which turn black and which are generally blood-filled. Nerve damage in the area can result in a loss of feeling.
  • May result in fingers and toes being amputated if the area becomes infected with gangrene. If the frostbite goes untreated, they may fall off.

Frostbite Prevention

In order to avoid frostbite in the first place, it’s helpful to keep track of both the actual temperature – and the windchill or apparent temperature – and plan your time outdoors accordingly. For example, at an actual temperature of -10 °F, a light wind of 5 mph will make it feel like -22 °F and could cause frostbite after 30 minutes of exposure. But if the wind increases to 25 mph, it will feel like -37 °F and frostbite could occur in just 10 minutes – which might explain all the recent school delays and closures! The National Weather Service has a helpful windchill chart with estimated times for frostbite to occur.

When you and your family are outdoors in cold weather it’s also important to consider the following:

  • Dress in layers of loose, warm clothing – and check for gaps in the coverings (such as between gloves and sleeves)
  • Wear a hat or covering on your head – and make sure your ears are covered
  • Wear mittens rather than gloves – so your fingers can share warmth
  • Wear socks and sock liners that fit well, wick moisture and provide insulation
  • Consider using hand or foot warmers – we got a lot of benefit from these skiing in Canada
  • Try to keep moving outside to get blood flowing

Most of all, be aware of and check for signs of frostnip and frostbite, such as red or pale skin, and prickling feelings or numbness in the skin.

Frostbite Treatment

Frostnip – or mild frostbite – can be treated at home. It’s important to get out of the cold soon after the signs appear and change into dry clothing if needed. Warm the area gradually using warm (not hot!) water – about 100 to 150 degrees Fahrenheit (no hotter!) – or body heat such as a warm hand pressed on the cold skin. A couple of watch-outs:

  • Do NOT rub or massage the area – this can further damage the skin
  • Do NOT use direct heat from a heating pad, lamp, fire or radiator – as your skin will be numb and you will not be able to detect when it is burning

More serious frostbite needs medical attention immediately. Again, warm the area gradually, but do not start warming if the area may become exposed to cold again – this can make the situation worse. Remove any tight or wet clothing, and rest affected areas (e.g. do not walk on frostbitten feet). Also, leave any injured tissue intact for a physician to address – and follow the restrictions above for frostnip.

Thanks to my husband for the inspiration and much of the research for this post!

Deciding Whether Your Sick Child Should Attend School

Feel-good remedies for sick kidWhen your child is unwell, it can be hard deciding whether to keep them off school. A few simple guidelines can help.

Not every illness needs to keep your child from school. If you keep your child away from school, be sure to inform the school on the first day of their absence.

Use common sense when deciding whether or not your child is too ill to attend school. Ask yourself the following questions:

  • Is your child well enough to do the activities of the school day? If not, keep your child at home.
  • Does your child have a condition that could be passed on to other children or school staff? If so, keep your child at home.
  • Would you take a day off work if you had this condition? If so, keep your child at home.

Common Conditions

If your child is ill, it’s likely to be due to one of a few minor health conditions.

Whether you send your child to school will depend on how severe you think the illness is. This guidance can help you make that judgement.

Remember: if you’re concerned about your child’s health, consult a health professional.

  • Cough and cold. A child with a minor cough or cold may attend school. If the cold is accompanied by a raised temperature, shivers or drowsiness, the child should stay off school, visit the GP (pediatrician*) and return to school 24 hours after they start to feel better. If your child has a more severe and long-lasting cough, consult your GP. They can give guidance on whether the child should stay off school. Get more information in Common cold.
  • Raised temperature. If your child has a raised temperature, they shouldn’t attend school. They can return 24 hours after they start to feel better. Learn more in Feverish illness in children.
  • Rash. Rashes can be the first sign of many infectious illnesses, such as chickenpox and measles. Children with these conditions shouldn’t attend school. If your child has a rash, check with your GP (pediatrician*) or practice nurse before sending them to school.
  • Headache. A child with a minor headache doesn’t usually need to be kept off school. If the headache is more severe or is accompanied by other symptoms, such as raised temperature or drowsiness, then keep the child off school and consult your GP (pediatrician*).
  • Vomiting and diarrhoea (diarrhea*). Children with these conditions should be kept off school. They can return 48 hours after their symptoms disappear. Most cases of vomiting or diarrhoea get better without treatment, but if symptoms persist, consult your GP (pediatrician*). Learn more in Rotavirus gastroenteritis.
  • Sore throat. A sore throat alone doesn’t have to keep a child from school. If it’s accompanied by a raised temperature, the child should stay at home.

You can read more about medicines for children’s common health problems in Medicines for children.

You can get help identifying common childhood illnesses by using the Childhood illness slideshow.

Tell the School

It’s important to inform the school if your child is going to be absent. On the first day of your child’s illness, telephone the school to tell them that your child will be staying at home. The school may ask about the nature of the illness and how long you expect the absence to last.

If it becomes clear that your child will be away for longer than expected, phone the school as soon as possible to explain this.

Editor’s Note: * clarification provided for our U.S. audience

Child Health & Safety News Roundup: 01-05-2015 to 01-11-2015

twitter thumbWelcome to Pediatric Safety’s weekly “Child Health & Safety News Roundup”- a recap of the past week’s child health and safety news headlines from around the world. Each day we use Twitter and Facebook to communicate relevant and timely health and safety information to the parents, medical professionals and other caregivers who follow us. Occasionally we may miss something, but we think overall we’re doing a pretty good job of keeping you informed. But for our friends and colleagues not on Twitter or FB (or who are but may have missed something), we offer you a recap of the past week’s top 15 events & stories.

PedSafe Child Health & Safety Headline of the Week:
Can I leave my children home alone on snow days? – Great Q&A! http://t.co/Ir7zBLTKki

Treating Your Child’s Influenza – What You Should Know

Sick little boy doctor visitThe best treatment for Influenza is preventing its occurrence and first on the list is proper immunization for your child and the entire family. This should be redone every year as the strains of Flu can change from season to season, and last year’s Flu vaccine may not be protective this year. The vaccine is recommended for everyone over the age of six months – and if there is an infant in the home it becomes even more important for the entire family to be immunized. No vaccine is 100% effective in preventing an illness and Flu vaccine is no exception. So, even if you have received the vaccine (and especially if you have not), common sense dictates certain additional procedures you can do to limit exposure during the Flu season which can be anywhere from September to April. These include:

  • Frequent and thorough hand washing rubbing hands together with soap and doing this the length of time it would take to sing the “happy birthday” song twice.
  • The use of a cleansing agent which is readily available all over, can be used frequently when there is no access to soap and water but remember that hands should be washed at least once after using the cleansing agent five times.
  • Since the Flu bug gets into your system mostly by touch followed by transmission to your face (namely your eyes or mouth) it makes sense to touch your face as infrequently as possible.

There are medicines that can cure or shorten the Influenza illness and at times may even prevent Flu. There is also a rapid test that can be done in your Doctor’s office or the hospital to show the possible existence of Flu (… as with all testing it is not 100% infallible – so trust your instincts as a parent). Although the signs and symptoms of Flu are not much different than any other cold it is more acute in onset and is respiratory in nature (runny nose, cough, fever, headache, decreased appetite). It can also last longer than the usual 5-7 day cold. Vomiting and diarrhea or “stomach Flu” is not very common. Keep in mind these medications should be used within the first 48 hrs. of the disease or they’ll probably be ineffective. These medications can be used also in infants older than 1 month and have very few side effects.

Finally, the Flu virus has a particular ability to mutate over a relatively short period of time, and frequently does so after the release of the year’s vaccine. The strains of vaccine usually included in the production of vaccine for the year are “guessed “from the Australian experience during their winter months. Therefore there are years in which the vaccine is not totally protective. It happened last year and again this year. Most cases are still caused by the known strains of Flu so don’t forget to get everyone fully immunized.

The symptoms of the new variety of Flu are similar, if not worse, than the regular Flu.

So if you feel that you or your child has the Flu, talk to your Doctor’s office or bring your child in to be seen; the earlier the better.

Photo credit: Laura Smith; CC license

Smoking Bans May Help Cut Premature Births

smoking-bans-reduce-premature-births“Smoking ban ‘cuts premature births’,” BBC News has reported. Despite the BBC News headline, this research only showed an association between the smoking ban and a reduction in premature births. It didn’t show direct cause and effect.

The research that the BBC News story is based on recorded premature birth trends in Belgium around the time of a public smoking ban there. While not directly comparable to the bans in the UK countries, Belgium is a useful example to look at as they introduced public smoking bans in stages between 2006 and 2010.

The fact that there were three distinct steps means the beneficial impact of public smoking bans can be assessed more precisely.

The study found the number of preterm births dropped after each consecutive smoking ban, but can’t prove the smoking ban itself cut these rates. Other factors may also have been involved. For example, improvements in antenatal (prenatal*) care may have reduced the rate of premature birth.

The fairest summary of the findings is that they provide some circumstantial evidence that smoking bans may reduce premature birth rates. They do not provide conclusive evidence of a link.

What has the (UK*) smoking ban done for us?

As well as potentially having a positive effect on the rate of premature births, there are reports that the 2006 smoking ban in England and Wales has contributed to:

Where did the story come from?

The study was carried out by researchers from the University of Leuven and Hasselt University in Belgium, and was funded by the Flemish Scientific Fund and Hasselt University.

The study was published as an open-access article in the peer-reviewed British Medical Journal.

Despite the slightly simplistic headline, the BBC News story offers an appropriate interpretation of the results. The BBC explains that the study found an association but could not prove that the ban was the cause of the observed drop.

Before and after studies are a simple way to assess the impact of policies. However, the fact that other factors or trends may have occurred at the same time as the policy was implemented can sometimes bias results.

What kind of research was this?

This was an observational study (before and after study) looking into the association between a public smoking ban and the number of preterm births in Belgium.

Belgium’s smoking ban was introduced in three phases:

  • In public spaces and most workplaces in January 2006
  • In restaurants in January 2007
  • In bars serving food in January 2010

Smoking during pregnancy has been found to impair the baby’s growth and to be associated with preterm birth. Evidence relating to the effects of secondhand smoke exposure and risk of preterm birth is less consistent.

The researchers were interested to see if a smoking ban applied in phases across the region would be associated with the number of preterm births. Observational studies over several time points can be helpful in defining trends and links between two factors. If effects are large and interpreted alongside other studies they can build a case that one factor (in this case, public smoking bans) may be strongly linked to an outcome (preterm birth).

What did the research involve?

Researchers collected data on births in Flanders (a region in Belgium) from 2002 to 2011.

Births before 24 weeks’ gestation, after 44 weeks’ gestation and multiples births were not included in the analysis.

They researchers used these data to determine the annual risk of preterm birth in the years preceding the public smoking ban, during the three phases of the ban and immediately after the ban. They analysed the trend in this risk over time.

A second analysis was conducted to determine the percentage change in risk of preterm birth after the introduction of each phase of the smoking ban. Several potentially confounding factors were considered during this analysis, including:

  • Those related to the mother or pregnancy (infant sex, the mother’s age, number of previous children, living in an urban or rural area, socioeconomic status)
  • Those related to the environment (temperature and humidity, pollution)
  • Those related to other population-level health factors (such as flu epidemics)

What were the basic results?

Between 2002 and 2011, there were 606,877 births that were included in the study. Of these, 32,123 (7.2%) were classified as preterm births (occurring before 37 weeks’ gestation).

When examining the unadjusted percentage of births that were considered preterm, the researchers found that the rate in the four years prior to the smoking ban was relatively stable (although there was a slight reduction seen between 2004 and 2005).

After the first phase of the ban (2006 to 2007), the percentage of births classified as preterm dropped, and a further drop was seen in the year after the second phase ban (2007 to 2008).

A slight upturn was seen in early 2008, followed by another decline through 2009. After the third phase of the smoking ban was introduced in January 2010, an additional drop in the percentage of preterm births was seen.

When analysing the data while adjusting for the potential confounding factors, the researchers found that the risk of preterm delivery was reduced after each of the smoking ban introductions, with the drop being largest after the second and third phase of the bans.

After the second phase was introduced (banning smoking in restaurants), there was a 3.13% drop in the annual rate of spontaneous preterm delivery (95% confidence interval (CI) -4.37 to -1.87%). Following the third phase (no smoking in bars serving food) this drop in rate was -2.65% each year after January 2010 (95% CI -5.11% to -0.13%).

The researchers report that this is equivalent to a reduction in six preterm births per 1,000 deliveries over the five years following the second phase of the ban.

How did the researchers interpret the results?

The researchers concluded that there were “significant reductions in the rate of preterm births after the implementation of different types of smoking bans, whereas no such decrease was evident in the years or months before these bans” and that this has important public health implications, given the association between preterm birth and the baby’s health.

Conclusion

This study suggests that the rate of preterm births dropped in the years immediately after a public smoking ban was introduced in Belgium. This is not to say that the ban was the sole factor contributing to a change in the risk of preterm birth.

The study authors suggest that their research is best viewed and interpreted as: “an investigation into the possible impact of a ‘population intervention’ rather than an investigation of changes in individual behaviour”. They suggest that the trend in preterm births that they observed could possibly be due to the impact of unmeasured confounding variables, and not to the smoking ban.

They note that other outcomes were measured, including birth weight and size for gestational age. No trend over time was observed in these outcomes, despite the fact that they have been previously found to be associated with secondhand smoke exposure.

Given the limitations of a single time-trend study, it is not possible to state conclusively that population-wide smoking bans are associated with reduced risk of preterm birth.

The researchers also note that similar studies in different countries could be useful in determining whether this trend is consistently seen after smoking bans are introduced, and whether reverse trends are seen in countries in which such bans have been introduced but later relaxed. Of course, we would like to see the results for similar research in this country.

Despite these inherent limitations in interpreting the results of this study, it is still the case that smokers should avoid smoking near pregnant women and that pregnant women should avoid smoking and smoky environments.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Summary

“Smoking ban ‘cuts premature births’,” BBC News has reported. Despite the BBC News headline, this research only showed an association between the smoking ban and a reduction in premature births. It didn’t show direct cause and effect.

Links to Headlines

Links to Science

Editor’s Note: * Clarification provided for our U.S. audience