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MWMG Pediatrics

Health Care

By Kathy Sena


Choking is a leading cause of injury and death among children, especially children 3 years of age or younger. Food, toys and coins account for most of the choking-related events in young children, who put objects in their mouths as they explore new environments.

Because the size, shape and consistency of certain toys and food increase the possibility of being a choking hazard, and because many of the prevention strategies currently in place to prevent choking on toys have not yet been implemented to prevent choking on food, the American Academy of Pediatrics (AAP) now recommends:

° Warning labels on foods that pose a high choking risk.

° A recall of food products that pose a significant choking hazard.

° The establishment of a nationwide food-related choking-incident surveillance and reporting system.

° Food manufacturers should design new food and redesign existing food to minimize choking risk.

° CPR and choking first aid should be taught to parents, teachers and child-care providers.

° Pediatricians should continue to provide guidance to parents on safe and appropriate food and toy choices, as recommended by the AAP.


The rate of chronic health conditions among children in the U.S. increased from 12.8 percent in 1994 to 26.6 percent in 2006 for conditions such as obesity, asthma and behavior/learning problems, according to a study published recently in the Journal of the American Medical Association.

Jeanne Van Cleave, M.D. and her colleagues at Massachusetts General Hospital for Children, in Boston, used data from the National Longitudinal Survey of Youth-Child Cohort. Children were ages 2 through 8 years at the beginning of the study, and the children were followed for 6 years.

Items on the survey included reports by a parent of a child having a health condition that limited activities or schooling or required medicine, special equipment or specialized health services. To be included, the condition needed to exist for at least 12 months. Obesity was defined as a body mass index at or above the 95th percentile for age. Chronic conditions were grouped into four categories: obesity, asthma, other physical conditions and behavior/learning problems.

The researchers found that 16.6 percent of children had any chronic condition at the beginning of the study, and 20.8 percent reported a chronic condition by the end of the study period.

"Chronic conditions in childhood are common and dynamic, underscoring the benefits of continuous, comprehensive health services for all children to adjust treatment of chronic conditions, promote remission and prevent onset of new conditions," the authors conclude.


Parents of young children with asthma often recognize signs that their child is about to have an asthma attack but delay home treatment until the attack occurs, researchers at Washington University School of Medicine in St. Louis report.

Results of the study, published in the Annals of Allergy, Asthma and Immunology, show there are missed opportunities to intervene early and thus relieve a child's symptoms, possibly reduce the extent of the attack and prevent visits to the emergency room.

The study stems from comments received by asthma coaches employed by Washington University School of Medicine. The coaches are trained to help educate families dealing with asthma by offering information and social support.

While talking to parents of children with asthma, the coaches noticed that parents were often unsure of exactly how to use albuterol, a bronchodilator that relaxes muscles in the airways and increases airflow to the lungs, when they noticed signs that their child's asthma symptoms were worsening. The study followed up on those observations to determine if they are true among a larger group.

Asthma is one of the most common childhood diseases in the U.S. Every year, two of every three children with asthma have at least one attack (often referred to by doctors as an exacerbation). These exacerbations often result in missed school days, visits to the emergency room and hospitalizations. But the researchers say some of these exacerbations could be prevented with early home treatment with the inhaled medication albuterol.

For the study, the asthma coaches telephoned 101 parents of children ages 2 through 12 who had recent visits to the emergency department at St. Louis Children's Hospital with an asthma exacerbation or who had called the hospital's after-hours call center. The coaches surveyed the parents about how they detected that their child was about to have an asthma attack and what they did to prevent or treat it.

Parents reported noticing signs such as coughing, wheezing, shortness of breath, chest tightness or pain, cold or allergy symptoms or even behavioral signs such as becoming quiet or more temperamental.

"Every time the child had an exacerbation, many parents noticed the same medley of signs preceding it," says Jane Garbutt, M.D., associate professor of medicine and pediatrics. "But even though they noticed the signs consistently, they often didn't do anything about it. If parents had known to give albuterol earlier, they may have been able to manage things at home and avoid a trip to the emergency room," says Garbutt.

Garbutt notes that one of the reasons parents may not begin treatment is that they believe they are following their doctor's instructions. "The asthma plan from the doctor often says to start using albuterol when parents notice the child is wheezing or coughing or short of breath, but the doctor may have a different definition for those symptoms than the parent," Garbutt says.

Also, in some instances, parents knew they needed to give their child albuterol, but weren't sure how much or how often.

"Parents varied in terms of how often they used it, if they used it with a nebulizer, how often they repeated it and how they determined if it was working," Garbutt says. "A careful assessment of exactly which medicines are used and how they are administered and dosed could identify problems. We think that is something that can be addressed with education."

Garbutt and fellow researchers are conducting a follow-up study in which the asthma coaches are working with physicians to promote earlier use of albuterol as well as other effective self-management behaviors. In addition, the coaches are working with parents to help them identify the early signs of an asthma exacerbation by giving parents a symptom diary to help parents see symptom patterns.

If your child has asthma and you have questions about symptoms or treatments, talk with your healthcare provider.

— Kathy Sena is a freelance journalist specializing in health and parenting issues and is the mother of a 14-year-old son. Visit her blog, Parent Talk Today, on our site.

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Pouches' Community Corner

Pouches Visits the Past


If Pouches' experience at History Camp is any indication, your son or daughter will enjoy joining Washington Heritage Museums and the George Washington Foundation for History Camp in Fredericksburg. The week-long day camp will be held June 25-29, from 9:00 a.m. to noon each day.

Young historians discover American history with hands-on experiences as they walk in the footsteps where the history of Fredericksburg, and a budding America, was created. The camp complements the history taught in classrooms with activities such as soap making, code breaking, colonial crafts, penmanship and much more.