By: James Parles, MD, Three Village Behavioral Medicine (Three Village, New York)
A recently published article raised concern about starting stimulant medicines in the treatment of ADHD. Children who were stable on stimulant medications did not have similar problems and there is no reason for anyone currently on ADHD medications to stop them.
In the study, the authors analyzed insurance claims and found that a tiny number of patients (0.1-.0.2%) 12 to 25 years old developed symptoms of psychosis, such as hallucinations, soon after beginning stimulant treatment. Here are important take-home points for patients and families:
• Only patients who are new to stimulants were included in the study. There was no concern raised about patients who are already on stimulants for some time.
• The authors used insurance claims without access to other clinical information about the patients. This type of study is a useful starting point to help direct researchers who study actual patients. It is not designed to tell doctors and patients what treatments are safe or effective.
• Any treatment for any illness involves some risk. If the risks from the untreated illness are greater than the risks of treatment, then it makes sense to take the medication. The long term risks of untreated ADHD include higher rates of depression, smoking, substance abuse, unintended pregnancy, school failure, conduct problems, unemployment and law enforcement interaction. Stimulant medication is proven to safely and significantly decrease those risks.
If you have concerns about this topic, or about anything related to the treatment of your child’s ADHD, please discuss them with your prescribing doctor. Together you will be able to make fully informed treatment decisions which integrate knowledge gained from medical science with what you and your doctor know from experience with your child.
By: Kerry Fierstein, MD, Pediatric Health Associates (Plainview, New York)
Mealtime should be fun – for you and your child! You can de-stress mealtimes by remembering some simple concepts.
#1 – Don’t really care if your child eats or not. Normal, healthy, neurologically-intact children will not starve themselves. The more invested you are, the more power you have given to your child and the more likely he is to use mealtime to manipulate.
#2 -Your job is to provide the food. Your child’s job is to determine which choice and how much. Make sure whatever you offer has some nutritional value. She doesn’t drive or shop. Don’t give her food you don’t want her to have. Don’t play waitress. If you make Mac & cheese whenever she doesn’t like what you give her, soon she will only be eating Mac & cheese.
#3 -Give them control – Make a buffet and let your child fill the plate. Create dips out of applesauce, tomato sauce, avocado, mayo, yogurt or ketchup. Put Parmesan cheese in a child-sized shaker.
#4 – Involve them. Use the IKEA principle. We are all more invested in things we make. Cooks are invested in their meals – so let your little helper prepare dinner with you.
#5 – Appeal to their sense of fun! Make plates colorful. Arrange foods in a happy face. Have pizza for breakfast or pancakes for dinner. Have a picnic in the den for lunch.
#6 – Have realistic expectations. From one year to puberty kids are just not growing that quickly. A toddler should eat 1/4 of what an adult should. That means one chicken nugget, 1/4 of a grilled cheese sandwich or 1/2 an egg.
One good meal a day is fine. So if your toddler eats two good meals today, he may not eat tomorrow at all!
#7 – Don’t sabotage mealtimes. Goldfish will fill up her little belly with no nutritional value, and no wonder she doesn’t eat dinner. Milk is not a substitute for eating. Don’t let him drink all day. Max out milk at 16 oz per day. Max out juice at 4 oz per day. Offer water liberally.
#8 – Give your child the gift of recognizing and responding to their hunger signals. Don’t you wish you only ate when you were hungry?
#9 – Go easy on yourself. Your value as a parent is not judged by how well your child eats at any given meal.
By: Eric Levene, MD, Chester Pediatrics (White Plains, New York)
It has been a scary week for our country. First, days of hearing about bombs being sent to many of our leaders as well as people who broadcast the news. Then on Saturday, we hear about the senseless shootings at a house of worship in Pittsburgh.
Our thoughts go out to the families that lost loved ones in such a senseless way. We are humbled by our first responders, running into the gunfire to save the innocent. Our prayers go out to those who were injured and wish all a speedy recovery.
Our country was founded on the principle of political and religious freedom. It is simply unconscionable for people to be targeted during worship, and unthinkable that it would happen in the United States in this day and age. This violence occurs at a time when there is an increase in religious harassment on college campuses and online. But how do we this explain to our kids, how do we reassure them that their house of worship they will be safe? What’s next?
First thing is to reassure our children they are safe. Listen to their fears, validate what they are feeling, and let them ask questions. Keep your explanations age appropriate. Early elementary school need simple concrete answers. Take them to schools and houses of worships to show them they are safe. Ask principals, ministers, rabbis priest and imams to talk with them about the safety of the buildings. Schools are already doing drills to prepare students. Ask your house of worship if they are prepared as well. Suggest or run a program for students to make them comfortable.
Older elementary and middle school students need to ask more detailed questions. They are just developing opinions and are able to understand more. Ask them open-ended questions. Remind them they are safe and encourage them to talk with their school and religious leaders. Let them hear how the community is working to keep them safe.
Older middle school and high school students will have varying opinions and are developing political and religious views that might be different than their parents. Encourage the students to talk, if not to you but to people they respect. Listen and ask what can you do for them. They might have different views than you, validate them and discuss with them how to be civil with those that hold different views.
Observe your kids. Look for changes in behavior, appetite and sleeping patterns. Limit your younger children’s television viewing and try to limit their online news. Watch your conversations with your spouse and friends in person and the phone. Maintain your normal routines. The more normal life appears for your kids the better. Do enjoyable things as a family.
Martin Luther King said, “Darkness cannot drive out darkness; only light can do that. And hate cannot drive out hate; only love can do that.
Button Battery Injuries in Children: A Growing Risk
More than 3,000 button batteries are ingested each year in the United States. It may be as frequent as every three hours that there is a child in the ER somewhere in this country for a battery-related emergency issue.
Small, shiny and appealing to children, button batteries can result in a major injury and even death if ingested.
What Are Button Batteries?
Button batteries are the small round batteries found in small electronics, such as:
- Remote controls
- Games and toys
- Hearing aids
- Bathroom scales
- Key fobs
- Electronic jewelry
- Holiday ornaments
As more homes use these small electronics, the risk of these batteries getting into the hands of curious and crawling infants and young children increases.
What Should Parents Do?
Parents and caregivers should not assume that every battery-powered product that enters their home is safe for use by children. In many products, for example, the battery is easily accessible or can fall out when the product is dropped. Make sure that the battery compartments of all electronic items are taped shut and loose batteries are always stored out of children’s reach.
A button battery stops powering a device way before it runs out of a charge. So, what we think of as a “dead” battery still has the charge to harm a child should it get caught in their ear, nose, and throat or swallowing passage. The higher the voltage of the battery (3V vs. 1.5V), the faster the injury.
When a child ingests a button battery, their symptoms could be virtually absent or similar to those of a common infection. This makes it challenging for health care professionals who are evaluating the child.
- When a button battery is placed in the nasal cavity or the ear canal, drainage or pain may be noted, which is not unique to button batteries. Non-specific symptoms combined with an unwitnessed placement can lead to a delay in diagnosis and even greater injury. Batteries that are lodged in the nasal cavity can cause nasal mucosal injury, periorbital cellulitis, scar tissue formation and nasal septal perforation. Injuries in the ear canal include hearing loss, tympanic membrane perforation, and facial nerve paralysis.
- When lodged in the body, the electric current in a button battery rapidly increases the pH of the tissue adjacent to the battery, causing significant tissue injury even within two hours. Esophageal button battery injuries can include esophageal perforation, mediastinitis, vocal cord paralysis, tracheoesophageal fistula, esophageal stricture, or death caused by a significant hemorrhage of an aortoesophageal fistula.
Figure 1 (left): Endoscopic view of button battery injury to nasal septum in right nasal cavity of a child.
Figure 2 (right): Rigid esophagoscopy showing button battery injury extending into the muscular layer of esophagus in a child.
If You Suspect Your Child Has Ingested a Button Battery
If a parent or caregiver is suspects their child ingested a button battery, the child needs to be taken immediately to an emergency room.
Healthcare professionals in the primary care, urgent care, and emergency room setting need to consider that any metallic foreign body in the nose, ear canal, or esophagus is a button battery until proven otherwise.
The diagnosis can be confirmed on a two view x-ray, which from a distance can sometimes be mistaken for the more commonly ingested foreign body, a coin. See Figures 3 and 4 below. Note: The button battery has the double ring, or halo sign, as opposed to a single ring of the coin.
Figure 3 (left): Double ring, or halo sign, of a button battery in the esophagus of a child.
Figure 4 (right): Homogenous appearance of a coin in the esophagus of a child.
The treatment for a button battery stuck within the body is urgent removal in order minimize local tissue damage. Both immediate assessment of the area of battery contact and follow-up surveillance for long-term, delayed complications should be performed to identify acute or delayed injuries.
Awareness is Key to Prevention
Parents and caregivers need to be aware of the risk posed by button batteries in their home. Keep loose and spare batteries locked away and store any product that uses button batteries out of reach. A child’s curiosity can be dangerous. Take the necessary precautions to prevent these situations and be sure you are prepared.
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