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Pet turtles– not a good thing

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					                              CHILD HEALTH LITERATURE                                                                      Winter
                                      REVIEW                                                                               2010

                                          Texas Department of
                                                                                                                            Health Service Region 1
                                          State Health Services



Pet turtles– not a good thing                                                                                                 Self-embedding
                                                                                                                                  disorder
“Between 74% and 90% of tur-          be handled like toys. Less com-        large multi-state outbreaks of salmonel-
tles are colonized with Salmo-        monly, Yersinia, Campylobacter,        losis from turtles continue to be re-
nella or shed Salmonella in their     Edwardsiella tarda, and Aeromo-        ported. Salmonella can survive out-of-        “Self-embedding disorder
feces. Although some pet stores       nas infections have been re-           doors, as well as on clothing and house-      involves insertion of for-
certify that their turtles are Sal-   ported. Six percent of cases of        hold surfaces. Hand washing alone may         eign objects into part of
monella-free, these claims are        salmonellosis in humans, and           not be enough to prevent infection after      the body, such as the
false and misleading. Salmo-          nearly all Salmonella infections in    handling a turtle, since re-infection of      neck, arms, hands, and
nella infections in children can      infants, are caused by a reptile       the hands may occur after touching            feet. Among nine girls in
be severe; they can result in         exposure in the home. About 3%         fomites such as clothing. Transmission        one study, 52 foreign bod-
hospitalization and, occasion-        of U.S. households own at least        is also possible when a sink or tub is        ies were removed. Foreign
ally, in death. Small turtles         one reptile (turtle, iguana or other   used for cleaning the turtle and then         objects included metal
pose a particular danger to           lizard, or snake). Despite a 1975      reused. Children younger than 5 and           needles, metal staples,
young children because these          ban by the FDA on the sale of          those immunocompromised should not            metal paperclips, glass,
turtles are not perceived as          small turtles (i.e., those with a      handle turtles. (Consultant                   wood, plastic, graphite,
health hazards and are likely to      shell length of less than 4 inches),   for Pediatrics, Mar. 2009)                    and stone.”
                                                                                                                           (Contemporary Pediatrics,
                                                                                                                           Vol. 26, No. 1)
Adolescent cancer survivors face challenges
“Survival rates for childhood cancer have      vulnerable to delayed or incorrect diag-     lation in the country. A cancer diagnosis during these
steadily increased in the U.S. over the        noses. In addition, AYAs are not all         years can also impede normal developmental tasks that
past 20 years. With current treatments,        treated in the same setting: adolescents     should have taken place during this time. These delays
nearly 78% of children diagnosed with          may be treated by a pediatric oncologist,    can cause teens who receive a cancer diagnosis to
cancer are expected to become long-            adult oncologist, community healthcare       engage in risky behaviors that may impair their health in
term survivors. By 2010, it is estimated       clinician, or in designated cancer cen-      the future. Survivors of childhood cancers may initiate
that 1 in every 250 young adults will be a     ters or children’s hospitals. These pa-      drug use and sexual experimentation long after their
survivor of cancer. However, rates of          tients are caught in between the worlds      peers have done so. Survivors of adolescent cancer
survival for the adolescent and young          of pediatric and adult oncology. Conse-      may be at particular risk for substance use and abuse-
adult (AYA) population have remained           quently, diagnosis, treatment protocol,      related problems due to physical and psychological late
relatively unchanged, while childhood          data collection, and supportive services     effects. The end of cancer treatment does not indicate
cancer survival has increased. The AYA         are not uniform. Where an adolescent is      the end of the effects of cancer. Survivors diagnosed as
population is defined as those diagnosed       treated may also influence their treat-      adolescents may experience a variety of physical and
between 15-39 years of age. One-third of       ment protocol and access to informa-         psychological late effects that can include poor peer
childhood cancer diagnoses occur be-           tion. After cancer, this population of now   relations, difficulty transitioning to adult care, significant
tween 15-21 years of age. Tumors that          young adults must suddenly face the          physical disability, issues with reduced growth, fertility,
occur in this age group differ from other      adult healthcare insurance system. Nu-       developmental delays, learning difficulties, social stigma,
age groups. 15- to 21-year-olds have           merous studies have pointed to the lack      depression, anxiety, posttraumatic stress disorder, and
been shown to have lower participation         of adequate insurance and health care        difficulty integrating their cancer experience into their
rates in clinical cancer trials. Five-year     financial support in this population. Pro-   current life.
survival rates for those 15-21 have in-        gress in treatment and follow-up of sur-     Additional physical effects can include damage to the
creased to 77%, with a 90% survival rate       vivors of AYA cancers is hindered by a       kidneys, lungs, heart, and other vital organs; increased
or better for some diagnoses. One of the       number of factors that are closely re-       risk of secondary malignancies; chronic obesity; speech
challenges for the age group is that can-      lated: significantly low participation in    and hearing difficulties; neurocognitive deficits; and mild
cer is often misdiagnosed. Low clinical        clinical trials; delayed diagnosis due to    to severe physical impairments.” (Family & Community
suspicion combined with low general            low provider suspicion of cancer; and        Health, January-March 2008)
public awareness makes this population         the highest uninsured rate of any popu-
Do you ‘fire’ patients whose parents refuse                                                          Cell phones and
vaccinations?                                                                                        pedestrian risk
Editor’s note: This is just how one individual     with their child’s health. This practice is
office handles this situation, and in no way       based on the fact that vaccine refusal is
reflects endorsement.                              often only the first step in a one-sided          “Adding to the list of anticipatory guidance
“This article reflects the practices of a pedia-   parent-physician relationship, where the          messages to kids, not crossing the street with
trician’s office in Pennsylvania. It talks about   physician’s experience, training, and ex-         a cell phone needs to be added to the list.
how the introduction of the importance of          pertise are disregarded. It is thought that       Crossing the street safely requires assess-
vaccinations begins with the prenatal visits,      by acquiescing to parent’s demands                ment of distances, speeds, and acceleration,
where their vaccine policy is handed out, and      against the better judgment of the pro-           and can be difficult for a preteen even without
continues at each well check so parents are        vider, it not only denies the provider any        the distraction of a cell phone. While a pre-
prepared for what to expect at each visit.         partnership in promoting the patient’s            teen having a phone helps the parent keep up
The importance of vaccinations, dispelling         health, but assumes tremendous liability          with their child, ownership of that phone must
misinformation, and allowing the parents to        when health fails. This holds true for vac-       come with safety considerations. A virtual
spread their child’s immunizations over more       cines, antibiotics and any advice dispensed       street was set up with monitors in a semicircle
visits is encouraged. But if the parents abso-     during the office visit. Such relationships are   in front of the child, showing a crosswalk, mov-
lutely refuse all vaccinations, they are asked     unproductive and unsatisfying for parents,        ing traffic, traffic noise and ambient sounds.
to find another health care provider who           patients, and physicians.”                        The view changed as the child stepped off the
shares their beliefs. This is done after urging    (PediatricSuperSite.com, Feb. 2009)               curb into the crosswalk. Each child crossed
them to consider the risks they are taking                                                           the virtual street 12 times. Half the children
                                                                                                     received a cell phone call during the first
                                                                                                     crossing, and half received a call during the
                                                                                                     seventh crossing. Each phone call lasted for 6
The connection between childhood sleep duration and the                                              crossings, which resulted in half the children
adult body mass index (BMI)                                                                          being on the phone during the first half of their
                                                                                                     experience and half being on the phone during
New Zealand conducted a study of 1,000 individu-        and older, the BMIs for short sleepers       the second half of the experience. Hits and
als up to the age of 32. According to this lengthy      were consistently higher than those for      near misses were recorded. Kids on the phone
study, childhood sleep duration and adult body          moderate and long sleepers. No consis-       were less likely to look both ways before
index are inversely related. Sleep information was      tent differences in BMIs were seen be-       crossing. They were more likely to be hit or
obtained from the parents when the children were        tween the moderate and long sleepers.        have a close call when they were on the
age 5, 7, 9, and 11, and from the study partici-        Proposed mechanisms for this associa-        phone at the beginning of the experience
pants themselves when they reached the age of           tion include sleep effects on appetite-      compared with when they were not distracted
32. Analysis showed that shorter childhood sleep        altering hormones and the association of     or when they received the phone call later in
times were significantly associated with higher         sleep with decreased fatigue, increased      the experiment. The take home is to have the
adult BMI values. Short sleepers were defined as        physical activity, and less awake time       child end calls before attempting to cross the
children who spent a mean of up to 11 hours in          with access to food. Amazingly, 96% of       street.” (Consultant for Pediatricians, April
bed between ages 5 and 11. Moderate sleepers            the kids and 70% of the parents were         2009)
were in bed between 11 and 11.5 hours, and long         located at the end of the 32-year study.
sleepers for more than 11.5 hours. At 7 years           (Contemporary Pediatrics, Vol. 26, No. 1)       46% of overall vegetable con-
                                                                                                        sumption is French fries
No Vicks® VapoRub® for little ones                                                                      “More facts on the same study are: Mexi-
                                                                                                        can-American children tend to eat more
“The labeling for Vicks® indicates it is not for use in children younger than age 2, and not
                                                                                                        fruit than non-Hispanic white children and
for use in the nostrils. After reports of severe respiratory distress in young children, testing
                                                                                                        older youth; dark green vegetables are a
confirmed Vicks in vitro exposure to VapoRub increased mucous secretions by 59% and
                                                                                                        favorite among non-Hispanic black chil-
decreased mucus clearance by 39% from baseline. Testing was conducted on ferrets be-
                                                                                                        dren and adolescents; while Mexican-
cause their airway anatomy and cellular composition are similar to humans. One particular
                                                                                                        American and non-Hispanic white chil-
situation that was a catalyst for the study involved an 18-month-old who developed severe
                                                                                                        dren and adolescents prefer deep yellow
respiratory distress after having had Vicks placed under her nose.“ (Clinician’s Review,
                                                                                                        vegetables.” (Contemporary Pediatrics,
February 2009, Vol. 19. No. 2)                                                                          Vol.26, No. 4)
  Page 2                                                                                                                                        Winter

				
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