Bereft
“I got nothing.” These three words are the comic’s white flag of surrender, an admission that he cannot think up an adequate joke. Sometimes the sentence itself can be funny, such as when life serves up the very hyperbole that normally provides the standard for comparison: “Aww, your baby is sleeping like a...like a...I got nothing.” Regular readers of Needles (Mom) may notice that I usually open the column by poking fun at some recent news story, ideally involving popular culture. This week, however, there is only one news story, and as a pediatrician and a parent, I have nothing but the sadness, frustration, and anger so many of us share. I hope, however, that in helping families and children cope with the tragedy in Newtown and in advocating to prevent future events we all have something.
Milking It
I love the Goldilocks Principle, the rule that almost anything you can name comes in three quantities: not enough, too much, and just right. It applies to everything: Christmas carols, Champagne, Tom Cruise.... Now, finally, researchers have identified how much milk preschoolers should drink, and, at 16 ounces a day, it turns out to be exactly the same as my recommended daily allowance of Champagne!
It’s easy for parents, with the help of what you have to admit are some brilliant marketing campaigns (Got Ads?), to think of milk as an absolute good. Since we fortify milk with Vitamin D, a child needs only drink a quart a day to get the recommended 400 IU! But aside from the pesky issue of constipation, milk also seems to decrease iron absorption, so that kids who drink too much become anemic, like supermodels but smaller.
Canadian and US researchers plotted milk intake, 25-hydroxyvitamin D levels, and serum ferritin in 1,311 preschoolers, and found that the happy medium fell at right around two cups of milk a day, the place where vitamin D levels rose and iron stores had not yet fallen. But they had another finding, as mysterious as it is emotionally satisfying: preschoolers who drank their milk from bottles did not get the same vitamin D benefits as kids who used cups. There is no more explanation for this effect than there is for Lady Gaga’s choice of headgear, but who needs a reason? It’s awesome! Future research will determine whether, when given in a bottle, Champagne is still effective.
One Flu Over
In a world where there are not one but two apps for nose picking, one for shining your shoes, and four for making breakfast (two of which are devoted solely to toast) you’d think it should be pretty easy to design an app to tell people worried about influenza whether or not they need to go to the emergency department. And you’d be half right. According to a new study in the Archives of Pediatrics & Adolescent Medicine, a simple computerized questionnaire is great at telling worried parents to seek emergency care for their children’s flu-like symptoms. What it’s really, really bad at is telling them to stay home.
A group of researchers based in and around Washington, DC, developed a simple, user-friendly web-based decision-support tool with an epic name: SORT for Strategy for Off-site Rapid Triage. (Nobel prizes have been awarded for lesser acronyms.) The program utilized a series of questions based on flu guidelines from the Centers For Disease Control And Prevention. Based on the answers, the program would advise parents whether to seek emergency care for their children or to wait until daylight hours.
The program was well received by parents from widely varying cultural backgrounds; in clear, relatable language it told nearly all of them to take their kids to the emergency room. Investigators blamed the poor specificity on the inclusion of such criteria as a child being “fussy or cranky,” “much more tired than usual,” or “confused," terms which, let’s face it, describe all my kids and their dad on any Saturday morning until about 10:00 AM, later for me if I’ve had Champagne.
Sweet Child Of Mine
I confess: I love the idea that sweet-tasting solutions provide powerful pain relief for infants. Even if it didn’t turn out to work, I’d still use sucrose solution for painful procedures just because when the babies suck on it they look so cute! The latest effort to determine whether this intervention actually works was a Cochrane review led by Manal Kassab, PhD, who wisely performed a meta-analysis of 14 previous studies of crying babies, rather than listening to babies cry himself.
The review was complicated by widely varying methodologies and end points, but Kassab was able to determine that, when given at the time of vaccination, sweet-tasting solutions reduced infants’ overall crying time by an average of 13.5 seconds. How long the parents cried is not reported. Unfortunately, the evidence favoring the solutions was not strong enough to reach any definitive conclusions. On the up side, Kassab also could not identify any significant adverse reactions to the solutions, which is more than you can say for Champagne.
