What we know about car seats and how kids use them

We have known for a long time that car seats save children’s lives. But even with that knowledge, do parents and caregivers use them appropriately?

A new study by researchers at University of Michigan found that while most people use child restraints properly, many do not. The researchers analyzed data on more than 21,000 children observed in cars at gas stations, fast-food restaurants, recreation centers and child care centers from 2007 to 2009 using guidelines from the American Academy of Pediatrics.

They found 21  percent of children ages 4 and younger were not following the recommendations for sitting in car seats. Thirty-three percent of 4- and 5-year olds and 66 percent of 6- and 7-year-olds were not following the recommendations for using car seats or booster seats. And – the most precarious finding – 11 percent of children were not wearing seat belts or sitting in car seats at all. Children were especially likely to be completely unrestrained if they were driving with an adult who wasn’t wearing a seat belt or if there were four or more children in the car.

While the evidence on kids using car seats is not encouraging, there are some intervention programs proven to increase the use of child safety seats. One systematic review found strong evidence that child safety seat laws increase the use of safety seats. Programs that combine education with distribution of car seats, incentives for installing car seats correctly and stepped up enforcement of laws also increase the use of car seats.

The bottom line: Car seats help save kids lives. It’s important to use them as recommended by the American Academy of Pediatrics.

Evidence update: How are America’s children faring?

As a society, we put a tremendous value on the health, well-being and education of our children. But how do we know how they are doing?

Each year, the U.S. government publishes a report – America’s Children in Brief: Key National Indicators of Well-Being – that combines the data from 22 federal agencies to provide a reader-friendly, evidence-based account of the status of children in the U.S.

This year’s report unveils some interesting trends:

  • Preterm births declined for the fourth straight year. And fewer children died in the first year of life.
  • Average mathematics scores increased for 4th and 8th grade students,
  • The percentage of children living in poverty increased, and the percentage of children with at least one parent employed full time, year-round decreased,.
  • Fewer you were victims of violent crimes last year
  • Fewer young children lived in a home where someone smoked.

You can get the full story at http://www.childstats.gov.

To spray or not to spray?

Lyme disease – an infectious disease spread by ticks that thrive in wooded areas – is on the rise in the Northeast. The disease can be debilitating if undiagnosed, causing chronic fatigue, joint pain andneurological problems.

As a mom, it’s a really worry for me.  My kids are outside every day, often on trails or in wooded areas.  I check them daily for ticks, but one would be easy to miss.

This year, I’ve often debated with other parents the risk and benefits of using bug spray. On one hand, there is clear evidence that the insecticide DEET – or N,N-diethyl-meta-toluamide – effectively repels ticks.  But on the other hand, there are cases where it is clear that DEET has led to health problems including skin problems, hallucinations and seizures.

So I went hunting for some more sweeping analyses on what the evidence says about DEET. The Journal of Family Practice provided a good summary of several systematic reviews on the use of DEET in children. Both found the risk of adverse reactions was low – about 0.1 percent of children exposed experiences an adverse reaction – and that there was no clear dose-dependent relationship between exposure and extent of severity of the reaction.

The U.S. Centers for Disease Control maintains that DEET doesn’t present health concerns if it’s used according to the instructions, including not applying it to open wounds, under clothing, or near eyes or mouth.

As a mother, though, the narrative reports of small children undergoing hospitalization for seizures and neurological problems – even though it’s a very small number of cases over decades – stick in my mind.  So we use bug spray with DEET sparingly.  If I know the kids will be in the woods or fields where there are higher populations of ticks, I’ll give them a light spray – always with a bath that night to wash off all of the spray.  Even though the evidence shows DEET is safe, I still feel uneasy about this issue.

What about you? Are you comfortable using buy spray on a regular basis?

Studies on same-sex parenting: The details matter

Here on EBL, we’ve talked frequently about what makes for quality research. There’s new research out this month on gay parents that illustrates the importance of seeking out high quality research.

A new study by a University of Texas sociologist  surveyed nearly 3,000 Americans ages 18 to 39 to ask about their family structure growing up. Of the participants, 248 grew up in households where one parent  had a same-sex relationship at some point.  The study found that children of these parents were more likely than kids in other family structures to be on public assistance, unemployed or in therapy as adults, among other negative outcomes.

To collect information about same-sex parenting, the study asked: “Did either of your parents ever have a romantic relationship with someone of the same sex?” and then asked whether participants had lived with their parents at the time.

But the question does not collect enough information about these families. Are they parents involved in heterosexual marriages who had an affair, or divorced and then entered into a same-sex relationship?  We just know. The study didn’t ask any questions about whether participants were raised in stable homes with committed parents who were of the same sex.

The study has sparked a flurry of media attention, including the New York Times and Time magazine, among other

s, with plenty of criticism. And the criticism is merited, said Ritch Savin-Williams, Director of the Sex and Gender Lab at the Cornell’s College of Human Ecology.

“The research design of this study is sufficiently flawed (inappropriate comparison group) as to merit disbelief in the findings,” he said. “It is unclear if this major shortcoming was lack of scientific rigor or in some part influenced by the funding sources that have both religious and political agendas.”

There is a systematic review on same-sex parenting that provides more answers. The review looked at 33 studies that lesbian, gay and heterosexual parents. Their analysis found no difference in parenting ability or the children’s psychological and social success between same-sex and heterosexual parent partners.

Clearly, the issue of same-sex parenting is politically-charged for a lot of reasons. The point we’d like to make here on EBL is that it’s important to understand the details of research study, and draw your conclusions with all of the evidence.

Disney takes its cues from the evidence

In major news this week, the Walt Disney Co. banned the advertising of junk foods from its television, radio and Internet programming. Under the new guidelines, advertisers who want to promote food and beverages on Disney programming for children must meet guidelines on serving size, calories, and fat and sugar content.

While it’s inspiring that such a large company is interested in promoting health among kids, I was even more inspired that Disney created a policy based on real evidence. Because, in fact, there is a growing body of evidence that links media consumption – and specifically advertisements – with negative health outcomes for children.

This systematic review, for example, looked at 173 studies examining the relationship between media consumption and health outcomes among children. In 80 percent of the studies, more media exposure was associated with a negative health outcome, and childhood obesity had the strongest correlation. This analysis considered the quantity of media that children watched, but not the content.

Another meta-analysis found a significant association between the proportion of children overweight and the number commercials per hour on children’s television, especially ads that promoting junk foods. The study used data from surveys of advertising on children’s television and estimates of the prevalence of overweight among children, in the U.S., Australia and eight European countries. It concluded the quantity and content of advertising on children’s television programs has a specific effect on children.

It’s great to see a major company taking cues from the evidence in an effort to improve the health of children!

The evidence on check-ups for kids

With a one- and a three-year-old, I find myself at the pediatrician’s office fairly frequently – and not because my kids are sick. In the first two years of their lives, they visit the pediatrician every 3 months for well visits.

As a new mom, the visits provide a welcome opportunity to ask questions and make sure you’re not making any major mistakes. But the second time around, they can seem unnecessary. So I went out hunting for some evidence to determine whether well-visits are good for kids.

It turns out that they are essential.  A systematic review published in the Journal of the American Medical Association examined the found that primary medical care in the first three years of life promotes optimal development for children.

The review evaluated 47 studies published from 1979 to 1999 that looked at how activities in primary care settings such as counseling about children’s sleep habits, temperament and behavior encourage healthy development.

The review found behavioral counseling for parents with fussy infants and poor sleepers is effective in helping both parents and babies. It also found that soliciting parents’ concerns about their children’s development helped identify problems. And that structured and systematic approaches to asking about parents’ concerns are most effective.

The review did find some areas for improvement. Among them, efforts to identify developmental problems in young children need to be more methodical and identifying psychosocial risk factors can be improved by using questionnaires and parent-child assessments.

All in all, the evidence makes me feel better about our frequent trips to the pediatrician.

Energy drinks: Bad for kids, bad for your teeth

Brightly-colored, sugar-filled energy and sports drinks are everywhere – in vending machines, cafeterias and gas stations.

While they may seem like a healthy alternative – athletes drink them, after all – most lack nutritional value, and many contain caffeine. The evidence actually shows these drinks can be detrimental to kids and harmful to teeth.

First off, a systematic review commissioned by the American Academy of Pediatrics found that sports drinks – which don’t contain caffeine, but do have a lot of sugar – lead to obesity and tooth decay among children. And energy drinks – which do contain caffeine – can interfere with sleep, lead to anxiety and cause dehydration.

A more recent study published in the journal General Dentistry and covered by National Public Radio found both energy and sports drinks contain high levels of citric acid, which erodes tooth enamel, leaving teeth more prone to cavities and decay.

There’s certainly a place for sports drinks – specifically to replace electrolytes and energy stores in both children and adults who exercise vigorously for more than an hour at a time. But for the public at large, these drinks are essentially empty calories.

So help to discourage children from downing sports drinks unless they’re actually playing a sport.  And the next time you’re picking up a beverage to go with that sandwich or need to quench your thirst on a long drive, stick with water.  It’s the healthier choice.

A clearinghouse of education evidence

Parents across the nation send their children to public schools with the confidence that principals and teachers are providing an environment where children can learn, grow and thrive.

We hear so much about in the news about ways to improve our education system – especially in this presidential election year, when candidates are offering proposals and counter-proposals to fix our schools.

But is there any evidence as to what really works?  As a parent of young children, our schools are one important place where I want to see evidence-based guidelines put in place.

The best place I’ve found for evidence-based information on education is called the What Works Clearinghouse, an initiative by the U.S. Department of Education that conducts systematic reviews on education research to provide educators with the information they need to make evidence-based decisions.

The project is a true treasure trove of information, with research reviews on a myriad of topics including dropout prevention, school choice, early childhood education and student behavior, to name just a few.

On a recent cruise through the site, several topics piqued my interested including:

I’m certainly going to share this amazing resource with my son’s teachers, and use to gather information about the curriculums he’ll be learning in elementary school.  As a parent, it’s a relief to know there’s a place to look for reliable, evidence-based information on education.

Playground time pays off in the classroom

Sometimes when I drive past our local elementary school playground, I think back fondly to my time spent hanging upside down on the monkey bars and swinging as high as I could muster.

It has long been recognized that children need physical activity to break up the day.  But in recent years, it has become clear that school recess has even broader effects.  A new systematic review published this week in the Archives of Pediatrics & Adolescent Medicine shows a positive relationship between physical activity and academic performance – essentially demonstrating that recess helps kids learn.

The authors reviewed 14 studies over the past 20 years that collected data about physical activity or fitness and academic performance or cognition on children ages 6 to 18, and found that children who were more physically active performed better in school.

Researchers believe that exercise increases blood and oxygen flow to the brain. It also leads bodies to produce more of the neurotransmitters responsible for improving mood and boosts growth factors that help create new nerve cells.

But the available evidence has a fault. Of the studies included in the review, only two of them were classified as high-quality, primarily because of the measurements instruments used.

What’s needed, the researchers concluded are more studies that examine the dose-response relationship between physical activity and academic performance – essentially, how much exercise is optimal for helping kids in the classroom.

Moms working outside of the home: Good for kids?

How to balance work and raising children is a critical question that most mothers face today.

Many women (my own mother fell into this category) do not have the option to stay home to raise their children because their families need their incomes to get by. Other women (myself included) get an education, start a career, and then decide to have children – leaving them with some big choices about if and how much they should work outside of the home.

To be sure, the solution to this conundrum is different for every family. Our family has decided its best for me to work part-time from home – a choice that provides us with some extra spending money and me with some time to interact with adults on an intellectual level.

But no matter what our circumstances and choices, all mothers are concerned with one thing: what is best for their children.

There is an interesting column this week in the L.A. Times this week that addresses this very question, and delves into the evidence about working moms.

It turns out – according to a systematic review by researchers at the University of California-Irvine – that children whose mothers who return to work while they are infants and toddlers fare the same in school and behaviorally compared to children whose mothers stay home. The review looked at 69 studies over a period of 50 years that included data about children’s school performance and behavioral problems.

The only children who struggled more were those whose mothers returned to very intensive full-time employment early on – a finding that makes a case for longer maternity leaves, the researchers said.

Several factors help explain why maternal employment does not have adverse effects on child outcomes, says Sharon Sassler, associate professor of Policy Analysis and Management at Cornell.

For starters, the data shows that most women in the United States work, even after having a child (although many work part-time). Also, most children spend considerable amounts of time away from their families in school, Sassler explained, even as young as three and four years old.

But the biggest factor may be a cultural shift in parenting norms, she said.

“Even though more mothers are working, and more married families contain two working parents than in the past, various studies have revealed that children are spending more time with parents – fathers as well as mothers – than they did in the 1960s,” she said.

“The value of spending time with children has clearly increased, even if working mothers – and fathers – must decrease their own personal leisure time, devotion to house cleaning, or sleep to achieve that end.  And one of the more interesting research findings is that fathers – especially men with a college degree – have increased the amount of time spent with children, both when they are married and when they do not live with their children.  Not only does that offset any potential reduction resulting from working mothers time away from home, but it strengthens ties between all family members – husbands and wives or partners, as well as parents and children.”

In fact, Sassler herself is a working mother with a child in elementary school. On a personal note, she’s found that having two working parents has taught her son the value of cooperation. “He realizes that this is a team affair, and that sacrifices are sometimes required of all family members – but that we all benefit as well from the fruits of all of our labor,” she said.

To sum it up, navigating decisions about working outside of the home can certainly be a source of stress. But knowing the evidence shows that children thrive in both cases can help moms to make the decisions that are best for their families.

The evidence on child abuse

No one needs an academic study to understand that child abuse and neglect has horrible effects on children and families.  The toll on young people and their caregivers – emotionally, socially and developmentally – is tremendous. But the problem also takes a broader toll on our health care system and society as a whole.

A new study from the U.S. Centers for Disease Control quantifies the toll on society in financial terms. The study examined nearly 600,000 confirmed child maltreatment cases over the course of a year. Approximately 1,740 of the cases resulted in the death of a child. It found the financial costs associated with these cases to be $124 billion, which includes the costs of medical care, special education, the criminal justice system and lost productivity.

Researchers totaled the lifetime cost for each victim of child maltreatment who lived at $210,012 – a figure the matches the cost of other health conditions such as stroke, which has lifetime cost per person estimated at $159,846, or type 2 diabetes, which is estimated between $181,000 and $253,000.

Much of the data for the study came from a project at Cornell called the National Data Archive on Child Abuse and Neglect (NDACAN), housed in the Bronfenbrenner Center for Translational Research (BCTR). The project makes high-quality datasets available to researchers, including data from individual studies and  annual federal data collection efforts, such as state child abuse and neglect and foster care statistics.

“This study very likely underestimates the actual burden as we learn more about the impact of early childhood adversity on brain development and health and well-being  across the life span,” said John Eckenrode, director of NDACAN, professor of human development and director of the BCTR.

“Fortunately, there are now evidence-based programs that may prevent child maltreatment and the associated costs to society,” he said. Among them is the Nurse Family Partnership, a program founded at the College of Human Ecology that aims to improve the lives of disadvantaged mothers and their children.

The take home message: Child abuse and neglect is a big problem. The better we can understand its intricacies and impacts, the better we’ll be able to prevent it in the future.

Beware of pet turtles

They’re small, they’re cute and they seem harmless. But many pet turtles are illegal, and they can be a dangerous addition to your home. In fact, the U.S. Centers for Disease Control believes that pet turtles are the source of a salmonella outbreak among kids.

Since 1975, it’s been illegal to own a small turtle – with a shell less than 4 inches long – as a pet. (They are allow

ed for scientific and educational purposes only.)  That’s because they’re a recognized source of human Salmonella infections – a food poisoning that can be especially dangerous for small children.

Over the past year, there were 132 cases of Salmonella infections reported in 18 states, and the patients’ median age was 6 years old. Fifty-six of these patients who were interviewed by public health officials. Of them, 36 reported turtle exposure. In addition, five samples of turtle tank water from patient homes tested positive for the outbreak strain.

The take-home message: Small turtles are not suitable pets, and there is evidence that suggests they cause serious food poisoning among their owners, and especially children.

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