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Issue Date: January 4, 2004

From USA WEEKEND and Prevention
ADHD
Asthma
First Aid
Eczema, Acne
Childhood Obesity
Also this week:
Health Briefs: Back Pain and Bones
HealthSmart Discussing sex with kids
FitSmart: Helping kids exercise
Special Health Report

A special report from USA WEEKEND and Prevention
Good news about bad things that happen to your kids


All through 2004, USA WEEKEND will bring you today's most compelling health reporting, through partnerships with America's finest magazines. We'll deliver the best of the newsstand to your local newspaper. This week, we collaborate with Prevention, the No. 1 health publication, for this must-read report on kids' health. Next week, with Parenting: babies and health, plus a special pullout poster.

If you read only headlines, the news about children's health in America looks pretty grim:

  • The number of kids diagnosed with attention deficit hyperactivity disorder (ADHD) doubled in the 1990s alone, and the use of ADHD drugs among preschoolers tripled.
  • Each year 4 million American children have asthma attacks, making this lung condition a leading cause of emergency room visits and missed school days. Often, allergies trigger these frightening attacks.
  • Since 1980, the number of overweight children and teens has nearly tripled, prompting U.S. Surgeon General Richard H. Carmona to call childhood obesity a national health crisis.
  • In our mobile society, nearly 30% of young children still ride where they shouldn't -- in the front seat of the car. And 82% of kids aren't properly belted into safety seats, tripling their risk of serious injury in an accident.
  • Less than half of 10- to 14-year-olds in a recent survey said they wear a safety helmet every time they hop on a bicycle, even though most knew a bike accident could lead to a traumatic brain injury.

    But take a second look: Thanks to medical breakthroughs in every area of children's physical and emotional health, and to new efforts on the part of schools and communities, this truly may be the best of times for our kids' well-being.

    KIDS' HEALTH FAST FACTS
    • 82% of America's 70 million children are in good or excellent health.
    • Infant mortality is at an all-time low: 6.9 per 1,000 babies in 2000, compared with 15.1 in 1970.
    • Childhood immunizations are at an all-time high: Today 76% of kids get all basic immunizations by age 2; in 1995, just 53% did.

    For more kids' health good news, log on to http://www.prevention.com/links

    New drugs, tests, procedures and medical treatments are catching childhood illnesses sooner and treating them more effectively than ever before. When 8,700 pediatric experts gathered in New Orleans in November for the annual meeting of the American Academy of Pediatrics, the surgeon general praised the overall well-being of our children: Eighty-two percent of America's 70 million kids are in good or excellent health, he noted. Infant mortality is at an all-time low: 6.9 per 1,000 babies died in 2000, vs. 15.1 per 1,000 in 1970. And childhood immunizations are at an all-time high: By age 2, 76% of kids have gotten basic immunizations such as polio, measles, diphtheria, pertussis and hepatitis B, compared with just 53% in 1995.

    And kids are safer today in part because parents have more information and more control. So, although many parents don't know how to install child safety seats properly, it's easier these days to find hands-on help. Nearly every state transportation department offers car seat inspection stations. In addition, to help protect children on two wheels, many communities and health insurance plans now offer free or low-cost bicycle helmets.

    Go to top


    ADHD: Parent training may replace drugs
    Four out of five elementary school children with ADHD take medication such as Ritalin, and its use in preschoolers has tripled in the past decade. But groundbreaking research suggests parents can "vaccinate" kids against the behavioral problems associated with ADHD before elementary school.

    The new treatment isn't a drug. "The key is identifying preschoolers who may be at risk, then teaching their parents and teachers new skills, including firm -- yet calm -- discipline, social awareness and handling anger," says ADHD researcher George DuPaul, Ph.D., a psychologist at Lehigh University in Bethlehem, Pa., and director of an innovative new ADHD prevention program. "This helps the child reduce hyperactivity and gain better focus.

    "The prospect of medicating a little kid is one of the top reasons parents avoid seeking help early," DuPaul says. Many turn to unproven ADHD "diets" or supplements from health food stores -- or they do nothing, hoping their impulsive, hard-to-handle preschooler will just grow out of it.

    "The brains of ADHD kids are different. Behavioral cues can work just like medicine when a child's caregivers deliver them consistently and regularly," DuPaul says. "Changing a child's environment can change his brain function -- so well, in fact, that the need for medication can sometimes be eliminated altogether." (DuPaul acknowledges that some children do eventually need medication if they risk hurting themselves or others, but that behavior training still helps.)

    Who's at risk for ADHD? A preschooler or kindergartner who is so overactive, inattentive, distracted or impulsive that he endangers himself or can't complete daily activities such as eating, getting dressed and playing with friends. And don't overlook girls: Boys are three times more likely to get an ADHD diagnosis, but up to 75% of girls with ADHD are missed because they tend to be anxious, withdrawn and unfocused rather than hyperactive.

    DuPaul urges parents of at-risk kids to work with a school psychologist or family therapist on setting limits, rewarding good behavior and understanding the child's needs. "If children get this head start on learning to focus, making friends and doing better in school, their chance of succeeding without medication when they reach elementary school is much more promising," he says.

    Go to top


    Asthma: It's "absolutely controllable"
    Living with asthma is tricky. Just ask the parents of the 6 million U.S. kids with this life-threatening disease. Small wonder asthma can make a family feel out of control. A bewildering variety of triggers can set off an attack, including exposure to cold air, cigarette smoke or strong odors, as well as respiratory infections and allergies to pet dander, indoor mold, dust mites and even cockroaches. The result: wild rides to the emergency room, sick days from school, lots of worry for parents.

    And asthma doesn't go away when symptoms fade. Its components -- inflammation (airway swelling) and bronchoconstriction (tightening of the muscles surrounding the bronchioles, or airways) -- are always present. That's why a panel of top asthma experts has recommended that any child, even an infant, who has asthma and has had several wheezing episodes should be using inhaled corticosteroid medicine every day to protect the lungs.

    "Thanks to the increasing use of inhaled corticosteroid medication over the past 15 years, asthma is absolutely controllable -- if you're conscientious about controlling it," says asthma specialist Carlos Camargo, M.D., a Harvard University professor and spokesman for Asthma Action America, a new national education campaign committed to improving asthma care in the United States.

    Inhaled steroids help by suppressing airway swelling and protecting the lungs from irreversible damage due to unchecked inflammation. But many people with asthma forgo them, opting instead to reach repeatedly for rescue inhalers whenever asthma flares up. As many as 25% of parents aren't aware that their asthmatic child needs this lifesaving drug daily, whether the child feels sick or not. Others are afraid that steroids will stunt growth, a concern asthma experts say research has disproved. At lower doses, inhaled steroids do not affect growth. At higher doses, growth seems to slow slightly in the first year, but long-term studies suggest that kids on steroids catch up with their peers.

    Meanwhile, experts say upper respiratory allergies can be a prelude to later lung problems. "About 25% to 33% of those with upper respiratory allergies will develop asthma," says asthma expert Richard Weber, M.D., of the National Jewish Medical and Research Center in Denver.

    The good news is that treating allergies can help. Consider the usual routes: antihistamines, allergy shots and simply avoiding allergens.

    Go to top


    First aid: Treatments have been revolutionized
    Skinned-knee victims, listen up! New first-aid research suggests that keeping minor wounds sealed and moist works better than the old standby of exposing cuts and scrapes to the air.

    Moist wound care is a first-aid revolution, edging out the long-held belief that broken skin heals best when safely hidden under an old-fashioned scab. "A scab is like putting a big rock on a lawn," says Adam Singer, M.D., of the American College of Emergency Physicians. "Drying out wounds slows healing. It doesn't allow new cells underneath to grow well."

    Keeping wounds moist lets the skin's epidermal cells migrate faster to the injury site and rebuild torn tissue. The results: less infection, faster healing and less risk of a scar. Sealing kids' cuts and scrapes keeps them cleaner because there aren't any bandages to hold in dirt or fall off. Drugstore shelves have many varieties of liquid skin bandages and moisture-enhancing dressings that will do the trick.

    Here's how to use this 21st-century first aid: Clean the cut first with soap and water, but don't apply antibiotic ointment. Apply the liquid bandage, then let it be. It stays on for three to 10 days, then falls off naturally. If it falls off before the wound is healed, you can reapply. Never apply moist dressings over bites, punctures and other injuries that are highly susceptible to infection. See a doctor if the wound seems infected. Head to the ER if direct pressure doesn't stop the bleeding, or if the cut is jagged and can't be closed; it may need stitches.

    Innovative wound-healing products, still under development in labs, include bandages made with vinegar and chitosan, a naturally occurring shrimp shell protein that stops bleeding within minutes; a gelatin bandage that enhances the body's ability to repair and regenerate damaged tissue; and a dressing spun from fibrinogen, a blood-clotting protein 1,000 times thinner than a human hair, which one day could help minimize blood loss and promote natural healing.

    Go to top


    Eczema and acne: New treatments come in a cream -- and a light bulb
    Exciting breakthroughs are improving the way doctors (and parents) treat the biggest skin problems kids face -- from childhood eczema and teen acne to the "no big deal" sunburn that increases their risk for adult skin cancer.

    Up to one in five school-age kids has eczema, the itchy, scaly "super-rash" that can disturb sleep. Traditional eczema drugs (corticosteroids) ease symptoms, but at a price: thinning of the skin, formation of dilated blood vessels, stretch marks and infection. (Note: These corticosteroids are different from the inhaled ones for asthma.) Now, new steroid-free creams called topical immunomodulators (TIMs) work inside the skin to halt the immune reactions responsible for eczema's red, itchy, inflamed rashes.

    For teens with antibiotic-resistant acne (or those who prefer not to take antibiotics), an FDA-approved light treatment promises to stop acne due to Propionibacterium, the "bug" responsible for pimples, bumps, cysts and redness. ClearLight -- a lamp that shines high-intensity rays, available at dermatologists' offices --reduced breakouts by 60% in a State University of New York study. Volunteers had two 10- to 15-minute ClearLight treatments a week for four weeks, and skin continued to improve for three months after the last treatment. (Kids with severe acne may still need meds to control oil and prevent clogged pores.)

    About 80% of lifetime sun exposure, the trigger for potentially lethal skin cancer, happens before age 18. Being a tyrant about sun protection now (yes, even in winter) can keep your children healthy for decades to come.

    Go to top


    Childhood obesity: Lifestyle changes are essential
    An estimated 10% of preschoolers and 15% of kids 6 to 19 are overweight or obese. They are at high risk of developing bone and joint problems, asthma, high cholesterol, high blood pressure and Type 2 diabetes before they even graduate from high school.

    The solution appears to be in how we live and eat. "Almost all overweight children will benefit from the simple lifestyle changes that are easiest for them to build into their daily lives, like switching from high-calorie soda to diet soda or water, or biking instead of driving to school," says childhood obesity expert Thomas Robinson, M.D., associate professor of pediatrics at Stanford University and Lucile Packard Children's Hospital at Stanford. "Weight loss medication or surgery should be a last resort."

    With that in mind, the nation's two largest school systems, Los Angeles and New York City, now stock only healthy beverages in school vending machines, such as bottled water, low-fat milk and juices without added sweeteners. Dozens of districts have banned empty-calorie drinks, and at least 15 states have considered school junk-food limits -- a move that puts kids' health ahead of revenues from vending machines.

    Next on the agenda is squeezing longer physical education classes into the school day. It will take several years to see whether these steps help stem the tide of obesity. Meanwhile, experts are studying what helps busy families avoid weight-gain traps such as supersized fast food, high-calorie snacks, too much screen time (TV, computers, video games) and too little exercise.

    Parents can do their part by dining with their kids and encouraging their physical activity. Baylor College of Medicine researchers have found that kids who eat dinner with their families -- not in front of the TV -- consume less fat and more fruits and veggies.

    And in a new study of 180 families with preteen girls, researchers at the University at Albany found that 70% of the girls were active when both Mom and Dad encouraged them. Five key ways parents helped: They organized activities, drove daughters to team practices, cheered them on, got active with them on weekends and even coached their teams.


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