Category Archives: Child & Youth Health

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Health reform law leaves autism coverage decisions to the states

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By Christine Vestal
Stateline Staff Writer

Autism advocates celebrated what they thought was a major victory when President Barack Obama signed the Affordable Care Act in 2010:  They expected the law to require all insurance companies to cover pricey, potentially lifelong treatments for those with the incurable condition.

But instead of creating a national standard for autism coverage, the administration bowed to political pressure from states and insurers and left it to states to define, within certain parameters, the “essential benefits” that insurance companies must provide.

Coverage requirements for autism treatments, such as behavioral counseling and speech and occupational therapy, already vary from state to state.  Far from smoothing out those differences, critics say the ACA will add a new layer of complexity.

The U.S. Department of Health and Human Services (HHS) says it will consider setting a national standard in 2016. Until then, states will decide what autism treatments insurance companies must cover.

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What is autism, how is it treated and at what cost?

Autism is a mental disorder affecting more than 2 million Americans and tens of millions of people worldwide. According to the U.S. Centers for Disease Control, one in every 88 children in the U.S has the condition, and the number is rising. Paying for treatment can be financially catastrophic to families.

Symptoms of autism first appear from birth to early childhood, and include mild to severe social, communication and behavioral challenges as well as repetitive behaviors. Treatments include counseling, speech and physical therapy and medications.

Advocates say applied behavior analysis (ABA), in which a therapist reinforces positive behaviors in the patient, is essential to helping children with autism reach their full potential.

ABA, developed in the 1960s, has become the most widely used autism treatment. But it requires hours of intensive, one-on-one therapy, and costs as much as $60,000 a year.

Depending on the severity of symptoms, a trained therapist using ABA may spend as many as 40 hours a week with a child. A new study by researchers at the University of Pennsylvania and the London School of Economics estimates the cost of treating a person with autism during his or her lifetime is $2.3 million. Autism costs Americans an estimated $126 billion annually, a number that has more than tripled since 2006.

Who opposes broad coverage of autism treatments?

ABA is endorsed by the American Medical Association, the American Academy of Pediatrics, and the U.S. Surgeon General. But insurance companies often object to paying for it because they say it is unproven and is largely educational, not medical.

Consumer advocates led by the Council for Affordable Health Insurance also argue that covering ABA is so costly it causes insurance premiums to rise, making basic health coverage unaffordable for millions of Americans.

What have states done to help ensure coverage of autism therapies?

Starting with Indiana in 2001, a total of 34 states and the District of Columbia have enacted autism insurance mandates, requiring carriers within their borders to provide coverage of ABA and other autism treatments in some or all of their policies.

States require insurers to cover nearly 2,300 categories of illness, treatments, and screenings.  Every state with an autism mandate requires insurers to cover ABA for state employees.

Beyond that, state laws vary widely. Some apply only to individual health policies, while others include small group and large corporate policies.

(No state mandates apply to the self-funded policies large employers typically offer, which is the type of coverage one-quarter of insured Americans have.)

Last year, the federal government began requiring coverage of ABA for the nation’s 8 million federal employees, retirees and their dependents.  Insurance coverage for members of the military also includes ABA treatments, with some restrictions.

Will existing state insurance mandates apply to policies sold on the state insurance exchanges?

Maybe.

The ACA says state insurance mandates in place before Dec. 31, 2011 may apply to policies offered on the exchanges.  If a state requires commercial carriers to cover ABA, that same requirement may be applied to policies sold on its exchange.

However, when the administration directed states to define “essential benefits,” every state either chose a “benchmark plan” (defined as the small business plan in the state with the most beneficiaries) or let the federal government choose a similar plan for them.

If a state’s benchmark plan includes a requirement to cover ABA and other autism treatments, then all the plans on its exchange must do the same.

But in 11 of the 34 states with autism mandates, the benchmark plan does not include autism coverage, according to an analysis by advocates Autism Speaks.

In those states, as well as the 16 states without autism mandates, state officials have the option of adding autism coverage as a required “supplemental” plan.

In Ohio, where the legislature is currently considering an autism bill, Gov. John Kasich, a Republican, mandated autism coverage by executive order in December 2012.

Alaska’s insurance chief, Bret Kolb, wrote to state lawmakers last month confirming that Alaska’s newly-minted autism mandate would apply to policies sold on the federally-run exchange.

How do state mental health parity laws affect autism patients?

According to the National Conference of State Legislatures, every state but Wyoming now has a mental health parity law on the books, requiring that when insurers cover mental illness and/or substance abuse they do so on an equal financial basis with physical illnesses.

A federal law – the Mental Health Parity and Addiction Act of 2008 – also requires equal treatment, but the Obama administration has yet tocomplete the federal rules that would enable states to enforce it.

Parity laws only require carriers to pay as much for mental health treatments as they pay for medical treatments, with the same co-pays, deductibles and coverage limitations.

The laws do not require carriers to cover specific treatments, such as ABA treatments. Still, state parity laws, combined with mandates, will maximize coverage for any given child.

What is “habilitation” and how does it affect autism coverage?

The federal government lists 10 categories of health care services states must include in their essential benefits. Two relate to autism: mental health services and habilitation, which is defined as therapies for children with developmental disabilities.

In accepting state benchmark plans last year, HHS told states they must spell out what services are covered under habilitation.

The way states define habilitation and how that plays out after 2014, when insurance companies begin processing claims, remains to be seen.

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Fair season is here: win the blue ribbon for health and safety

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From the Washington State Department of Health

Hanging out with the goats, poultry, and cows can be the highlight of any trip to the local fair. Yet fair animals can also spread certain diseases.

“Going to see the animals at the fair is a treasured tradition for many families,” said Ron Wohrle, public health veterinarian for the Department of Health. “But even healthy animals can spread E. coli and Salmonella bacteria to people, which can make them sick. By following some basic safety tips you can enjoy the animals at the fair and stay healthy.”

Many kinds of animals can carry dangerous bacteria and viruses. The germs can be in their saliva, on their coats, and on surfaces contaminated by their waste. People can pick up those germs when they touch the animals or their surroundings. Most get sick by putting their hands or a contaminated object in their mouth or nose.

An estimated half-million people in the U.S. get sick every year because of a visit to animals at a fair, petting zoo, or other exhibit. Washington rules require signs warning people of the health risks, along with hand washing or sanitization stations near animal exhibits. Pregnant women, older adults, kids under five, and anyone who has an underlying illness should be especially careful to follow posted precautions.

Washing hands with running water and soap is the best way to avoid getting sick. It’s especially important after touching animals or their surroundings and before eating or drinking.

Children under five should be watched at all times while they visit animals to make sure they don’t put their hands or objects, like a pacifier, in their mouth while interacting with animals.

Stroller wheels can also pick up germs from animal areas and have been tied to illnesses in the past.

Call your health care provider immediately if someone in your family becomes sick after coming in contact with animals.

The Department of Health investigates cases and outbreaks of animal-related illnesses and works to make sure that places where animals are displayed follow state regulations. Information on staying healthy around animals is available online.

Photo courtesy of Christine Landis

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Tips for a less stressful shot visit – CDC

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child wincing while be given a shot injection

Making the choice to vaccinate your child is vital for their health and well-being. Even so, getting shots can still be stressful for you and your little one. Fortunately, there are simple ways you can support your child before, during, and after shots.

Before Getting Shots

Come prepared! Take these steps before your child gets a shot to help make the immunization visit less stressful on you both.

Help children see vaccines as a good thing. Never threaten your child with shots, by saying “If you misbehave I will have the nurse give you a shot.” Instead, remind children that vaccines can keep them healthy.


Ways to soothe your baby:

  • Swaddling
  • Skin-to-skin contact
  • Offering a sweet beverage, like juice (when the child is older than 6 months)
  • Breastfeeding

Your health care professional may cool or numb the injection site to reduce the pain associated with your child’s shots.

  • Read any vaccine materials you received from your child’s health care professional and write down any questions you may have.
  • Find your child’s personal immunization record and bring it to your appointment. An up-to-date record tells your doctor exactly what shots your child has already received.
  • Pack a favorite toy or book, and a blanket that your child uses regularly to comfort your child.

For older children

  • Be honest with your child. Explain that shots can pinch or sting, but that it won’t hurt for long.
  • Engage other family members, especially older siblings, to support your child.
  • Avoid telling scary stories or making threats about shots.

At the Doctor’s Office

If you have questions about immunizations, ask your child’s doctor or nurse. Before you leave the appointment, ask your child’s doctor for advice on using non-aspirin pain reliever and other steps you can take at home to comfort your child.

Try these ideas for making the shots easier on your child.

  • Distract and comfort your child by cuddling, singing, or talking softly.
  • Smile and make eye contact with your child. Let your child know that everything is ok.
  • Comfort your child with a favorite toy or book. A blanket that smells familiar will help your child feel more comfortable.
  • Hold your child firmly on your lap, whenever possible.

For older children

Remember to schedule your next visit! Staying current with your child’s immunizations provides the best protection against disease.

  • Take deep breaths with your child to help “blow out” the pain.
  • Point out interesting things in the room to help create distractions.
  • Tell or read stories.
  • Support your child if he or she cries. Never scold a child for not “being brave.”

Once your child has received all of the shots, be especially supportive. Hold, cuddle, and, for infants, breastfeed or offer a bottle. A soothing voice, combined with praise and hugs will help reassure your child that everything is ok.

Take a moment to read the Vaccine Information Sheet your health care professional gives you during your visit. This sheet has helpful information and describes possible side effects your child may experience.

After the Shots

Sometimes children experience mild reactions from vaccines, such as pain at the injection site, a rash or a fever. These reactions are normal and will soon go away. The following tips will help you identify and minimize mild side effects.

  • Review any information your doctor gives you about the shots, especially the Vaccine Information Statements or other sheets that outline which side effects might be expected.
  • Use a cool, wet cloth to reduce redness, soreness, and swelling in the place where the shot was given.
  • Reduce any fever with a cool sponge bath. If your doctor approves, give non-aspirin pain reliever.
  • Give your child lots of liquid. It’s normal for some children to eat less during the 24 hours after getting vaccines.
  • Pay extra attention to your child for a few days. If you see something that concerns you, call your doctor.
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Teens missing recommended vaccines, Seattle study finds

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HPV

HPV

By Sharyn Alden, HBNS Contributing Writer
Research Source: Journal of Adolescent Health

‘Health care providers are missing opportunities to improve teens’ vaccination coverage, reports a new study in the Journal of Adolescent Health.

Recommendations for routine vaccination of meningococcal (MCV), tetanus, diphtheria, and acellular pertussis (Tdap) and human papillomavirus (HPV) in adolescents are fairly new and many parents may be unaware of the need for adolescent vaccines.

“Our study found that when adolescents who are vaccine-eligible come to their health care provider for preventive visits, there are missed opportunities for vaccination. Adolescents who come in for non-preventive visits have even greater missed opportunities,” said lead author Rachel A. Katzenellenbogen, M.D., assistant professor of pediatrics at the University of Washington and Seattle Children’s Hospital.

“Our data found that adolescents who have an appointment come into their health care provider’s office and leave without receiving all three recommended vaccines—Tdap, HPV and MCV,” Katzenellenbogen said.

Adolescents need fewer preventive care visits than infants and are a relatively new population to be targeted for vaccination when compared to infants and children, she explained.

Katzenellenbogen and her colleagues analyzed vaccination rates for 1,628 adolescents aged 11- 18 with 9,180 visits to health care providers between 2006 and 2011.

All of the teens in the study were seen at a pediatric clinic in Seattle. During that time frame, 82 percent missed being vaccinated against MCV, 85 percent missed Tdap and 82 percent missed the first dose of HPV1.

“If parents know to expect that their adolescent should receive three vaccines when they turn 11 or 12, they may be more likely to schedule a preventive visit or bring up vaccination with their child’s health care provider during any office visit,” commented Kristen A. Feemster, M.D., assistant professor in the division of infectious diseases at the University of Pennsylvania School of Medicine.

Feemster said she was not surprised that missed opportunities occur because there are many challenges to implanting adolescent vaccine recommendations. “It is more challenging, for example, to establish eligibility for adolescent vaccines—many registries do not yet reliably capture adolescent vaccination.  Providers may have questions or concerns about the recommended schedule, plus adolescents may seek care in alternative locations where it is particularly difficult to establish eligibility.”

The researchers suggest that improved vaccine tracking and screening systems, such as provider prompts through electronic health records or manual flags by nurses or medical assistants, would enable providers to more easily identify those teenagers eligible for vaccines at all visit types.

Health Behavior News Service is part of the Center for Advancing Health

The Health Behavior News Service disseminates news stories on the latest findings from peer-reviewed research journals. HBNS covers both new studies and systematic reviews of studies on (1) the effects of behavior on health, (2) health disparities data and (3) patient engagement research. The goal of HBNS stories is to present the facts for readers to understand and use for themselves to make informed choices about health and health care.

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Rise in King County teen suicides prompts call to action

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Alert IconFrom Public Health – Seattle & King County

A committee of experts convened to review child deaths in King County is calling for action to prevent suicides among teenagers, after a high number of youth suicides in 2012.

Last year, eleven children died by suicide, according to the King County Medical Examiner’s office. That compares to four suicides in an average year among children younger than 18 years of age.

Of those eleven suicides, five were by firearm, five by hanging, and one by jumping.

In recent years, the highest number of youth suicides in any one year had been seven, based on a review of data from 1999 to the present. While the numbers do not represent a statistical trend, the suicides are worrisome.

Know the warning signs of suicide:

  • Talking about wanting to die or making a plan
  • Talking about feeling hopeless or having no purpose
  • Talking about feeling trapped or in unbearable pain
  • Talking about being a burden to others
  • Increasing use of alcohol or drugs
  • Depression such as moodiness or withdrawal
  • Displaying extreme mood swings

 

What to do, if you or someone you know exhibits warning signs of suicide:

  • Call the National Suicide Prevention Lifeline (800) 273-8255 (TALK)
  • Do not leave the person alone
  • Remove any firearms, alcohol, drugs, or sharp objects that could be used in a suicide attempt
  • Take the person to an emergency room or seek help from a medical or mental health professional

“As a community, it’s our duty to protect children from all forms of violence, including violence that is self-inflicted,” said King County Executive Dow Constantine.

“Suicide is a tragic and preventable public health problem,” said Dr. David Fleming, Director and Health Officer for Public Health – Seattle & King County. “It calls for a comprehensive approach, so that we make sure all young people get the treatment they need, and we limit access to dangers such as guns and drugs.”

The King County Child Death Review (CDR) Committee, comprised of 37 people representing numerous agencies and communities, recently reviewed in-depth the circumstances of six suicide deaths from 2012, as well as data from prior years, to make recommendations for action and future prevention.

Recommendations from the CDR Committee include:

  • Increasing public awareness about the warning signs of suicide and risk factors for suicidal behavior and available crisis response resources.
  • Educating families and communities about the importance and methods for safe firearm storage.
  • Advocating for other methods that restrict access to lethal means, such as secure medicine return programs and safe firearm storage legislation.
  • Encouraging strong implementation of House Bill 1336, which took effect July 28, 2013. It requires suicide risk and referral training for school providers and teachers, and it also requires school districts and the Office of the Superintendent of Public Instruction to develop plans to recognize and respond to troubled youth.
  • Assuring medical and mental health care providers are trained to screen children for suicide and mental health risk factors and able to connect youth to resources or treatment.

The CDR committee includes members from health care, government agencies, law enforcement, fire departments, schools, community groups and others. The committee reviews the circumstances of preventable child deaths in King County, including suicides, and uses the information to take action to prevent future deaths.

 

“Suicide is everyone’s business. When young people and their families, teachers, health care providers, and other connected adults have the tools and skills to identify and respond to suicide risk, we can work together to save young people’s lives,” said Victoria Wagner, Executive Director of the Youth Suicide Prevention Program, a statewide non-profit organization based in King County.

According to the 2012 Healthy Youth survey data, an estimated 11,600 King County high school students (14% of students) indicated that in the prior 12 months they had made a plan of how to attempt suicide.

“Youth suicide is often an impulsive action with permanent consequences,” said Dr. Karen Milman, Prevention Division Director, Public Health – Seattle & King County.  “We can help save lives by making it harder for King County youth to access lethal means, including firearms.”

You can find more information here:

 

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What to say when mom or dad has cancer

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The Goodman family has dealt with mom Julie’s cancer diagnosis since 2009. Clockwise from top left are John, Julie, Jack and Lena (Photo by Carrie Feibel/KUHF).

HOUSTON — At any one time, an estimated 2.9 million children have a parent who has, or has had, cancer.

Dozens of studies show that many of these children experience worry and stress, but that good communication can ease their fears and isolation, even up to the point of a parent’s death.

Still, figuring out what to tell the kids – and when – is not an easy decision, and many parents who have cancer get little to no advice from their doctors about how to handle it.

Two hospitals in Houston are tackling the issue with support groups for parents and children. The Lyndon B. Johnson Hospitaland MD Anderson Cancer Centerwork with The Children’s Treehouse Foundation to offer emotional and practical support for families dealing with the disease.

Martha Aschenbrenner, a hospice counselor at MD Anderson, says that a very natural response to a cancer diagnosis is to try to protect children by hiding the facts or keeping them vague. But she urges parents to tell their children what’s happening in age-appropriate ways. Whether Mom or Dad is going to die is usually one of the first things a pre-teen will ask, she says.

“The wrong way to answer the question is ‘No, no, I’m not going to die.’ Because you can’t promise that,” Aschenbrenner says. “A better way that also invites more conversation is: ‘That is not my plan. And I’m going to a hospital where they’re going to give me very strong medicine, and I hope and my plan is I’m going to get better. And I’m going to tell you what happens, so you don’t have to worry that I’m keeping secrets from you. I’m going to keep you informed.’”

The Susan J. Komen Houston Affiliate funds a support group at LBJ, which is part of the publicly-funded Harris Health System, with a two-year grant of $237,500. That means women with breast cancer and their children can benefit from the six weeks of group sessions free of charge. The grant even covers parking charges for participants.

During a recent meeting of the group called Tender Drops of Love, Lindsey Leal, a child-life specialist at LBJ Hospital, explains to kids that parents with cancer sometimes feel sad, but it’s not the kids’ job to cheer them up.

“The thing is sometimes [your parents are] going to feel bad about themselves, and they’re going to feel sad and they’re going to feel angry. And sometimes you’re going to feel sad and you’re going to feel angry. And, is that okay?” Leal asks the group of kids aged six to 12. One boy answers, “No, that’s not helping.”

But Leal counters:  “It is okay. No, it’s not healthy to punch a wall. It’s not healthy to act on your anger. It is healthy to talk about your anger.”

Laura Molina, 9, shows the mask she created expressing the feeling of "sadness." Molina's mother is being treated for inflammatory breast cancer at the Lyndon B. Johnson hospital in Houston, Texas (Photo by Carrie Feibel/KUHF).

Laura Molina, 9, shows the mask she created expressing the feeling of “sadness.” Molina’s mother is being treated for inflammatory breast cancer at the Lyndon B. Johnson hospital in Houston, Texas (Photo by Carrie Feibel/KUHF).

As cancer progresses or retreats, parents need to keep the discussion going, therapists say.

Julie Goodman was diagnosed with colorectal cancer in 2009 at the age of 43. Her daughter Lena was in fourth grade and son Jack was in seventh. After the colorectal cancer spread to her lungs, she had more surgeries and chemo.

But now she’s had six months of clean scans.

“And whenever I come home from that, we just go ‘Yay, mom had clean scans!’ And they’re like ‘Yay, OK, what’s for dinner?’ You know, moving on,” Goodman says. “They may be desensitized a little bit to it now. Mom goes to the doctor, mom comes home, she’s fine.”

Goodman says she still struggles with how much to tell her kids. On the one hand, she wants her children to remember she’s not out of danger, not yet.

But she also loves the fact that they’re not worried anymore, that they don’t think about it every day. Instead, they have what every parent wants: that the everyday concerns be what’s for dinner, and walking the dogs, and homework, and time for bed.

This story is part of a collaboration that includes KUHFNPR and Kaiser Health News.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Don’t get stung!

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From the Washington State Department of Health

Wasp

Several tips to lower the risk of bee, wasp and hornet stings

To many, pesky bee stings typically only cause temporary throbbing. That doesn’t mean you’ll never have a bad reaction.

Public health officials warn that having one type of reaction after a sting doesn’t mean a person will always have the same reaction next time.

While it’s crucial for people who’ve had an allergic response to avoid the insect of concern, a previously non-reactive person can develop sensitivity at any time.

Insect stings can cause different symptoms, ranging from brief pain to a severe allergic reaction. First-aid kits should contain an antihistamine to help prepare for an unexpected serious reaction to a bite or sting.

There are several steps one can take to lower the risk of bee, hornet, wasp and other insect stings:

• Avoid insect encounters: slowly move away; don’t wave your arms or swat at them.

• Cover exposed skin and wear shoes.

• Don’t use products with strong perfumes such as soaps, shampoos, and deodorants; they can attract insects.

• Avoid wearing bright colors or flower-patterned clothing.

• Watch out for insects around flowers, outdoor areas where food is served, and garbage and compost areas. Remove fallen fruit in your garden, and keep a well-fitting lid on your garbage can.

• Never disturb insect nests. Arrange to have a nest removed by a professional pest control service if it’s in or near your home.

• Keep food and drinks covered when outside. Meats and sugary drinks attract wasps and bees. Both can get into open bottles or cans that you’re drinking from.

Insect stings typically don’t require a visit to a doctor. However, call 911 if you’re having any symptoms that suggest a severe allergic reaction (anaphylaxis).

Signs of anaphylaxis include skin reactions in parts of the body other than the sting area. Hives, itching, and flushed or pale skin are almost always present.

People may also have difficulty breathing; swelling of the throat and tongue; a weak and rapid pulse; nausea, vomiting, or diarrhea; dizziness or fainting; or a loss of consciousness.

Any of these symptoms should be treated as a medical emergency.

If you have a prescribed epinephrine injector (EpiPen, Twinject), use it immediately as directed by your health care provider. And get medical care immediately if you’ve been swarmed by bees and have been stung multiple times.

This is especially important for children, older adults, and people who have breathing or heart problems.

Remember, most insects are usually not aggressive and play a very beneficial role in nature. By taking a few precautions most stings can be avoided.

The Department of Health website has more information about avoiding insect stings and the role of insects in our lives. The Mayo Clinic website also has information on symptoms and treatment of insect stings.

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Birth defects study in south central Wa finds no common causes, Department of Health

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From the Washington State Department of Health

Birth defects study in south central WA is inconclusive — no common causes

Magnifying GlassOLYMPIA – A state-led study into several cases of a rare birth defect in Yakima, Benton, and Franklin counties has revealed no common exposures, conditions, or causes.

State and local public health investigators found no significant differences between women who had healthy pregnancies and those affected by anencephaly, a rare neural tube defect.

Anencephaly is a fatal birth defect that results from incomplete formation of the brain during the first month of pregnancy. An unusually high number of anencephaly cases in Washington prompted the study, which was led by the state Department of Health in cooperation with local health officials and the Centers for Disease Control and Prevention.

Typically, one or two anencephaly cases would be expected in about 10,000 annual births. The investigation found about eight cases per 10,000 births in the three-county area of Yakima, Benton, and Franklin.

Anencephaly and a related spinal cord disorder known as spina bifida are often caused by a lack of the B-vitamin folic acid in the mother’s diet.

Other factors include certain medications, diabetes, pre-pregnancy obesity, or previously having a child with a neural tube defect.

The study examined medical records from January 2010 through January 2013 and looked at possible risk factors including family history, pre-pregnancy weight, health risk behaviors such as supplemental folic acid and medication use, and whether the woman’s residence received drinking water from a public or private source.

No significant differences were found when comparing cases of anencephaly with healthy births in the three county area. Although the number of affected pregnancies was large for this area, larger numbers are often needed to identify causes. Medical record reviews might not have captured all information, preventing a cause from being identified.

The higher than expected number of anencephaly births in the region could be coincidental. Still, state health officials will keep monitoring births in the region through 2013 to see if the elevated number of affected pregnancies continues and if more can be learned about causes.

State and local health officials say women of childbearing age should follow the U.S. Preventive Services Task Force recommendation of taking 400-1000 micrograms of folic acid daily, either from foods fortified with folic acid or a supplement.

They also advise seeing a health care professional when planning a pregnancy or as soon as pregnancy is recognized, and making sure to provide a list of all medications and nutritional supplements that are being used.

Women who are pregnant or planning pregnancy should be sure that drinking water from private wells is tested at least annually for nitrate and bacteria. If levels exceed standards, an alternate source of drinking water should be used.

More information on anencephaly is available on the Centers for Disease Control and Prevention Birth Defects website. Information on testing private well water is on the state Department of Health Drinking Water website.

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Snohomish parents get a B+ for kids’ back-to-school shots

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child wincing while be given a shot injectionFrom Snohomish Health District 

More 5 and 6 year olds in Snohomish County had all the vaccines they needed to enter school last year, according to recent data released by the state Department of Health.

For the 2012-2013 school year, 86.3 percent of local kindergarteners were up to date on their shots, better than past years and higher than the state average of 85.6 percent

Vaccines are required for school children because they prevent disease in a community setting. The rate of vaccination has continued to climb since an all-time low in 2008-2009.

School districts report vaccination rates to the state. The highest immunization rates for all grades (K-12) in Snohomish County last school year were in Lakewood (94.8%) and Everett (94.7%) school districts.

A small percentage of families seek exemption from the vaccination requirement, an average of 5.3 percent in Snohomish County schools compared to 4.5 percent statewide for children entering kindergarten.

In 2011 the process for parents or guardians to exempt their child from school or child care immunization requirements was changed.

Parents need to see a medical provider to get a signature on the Certificate of Exemption form for their child’s school. 

More information about the form and the law is available online at www.doh.wa.gov/cfh/Immunize.

Although exemptions are allowed for medical, religious, or personal reasons, the best disease protection is to make sure children have all their recommended immunizations.

Children may be sent home from school, preschool, or child care during outbreaks of diseases if they have not been immunized.

Summer is a good time to make sure your children are up to date on required shots. The cost of childhood vaccines is subsidized by federal and state government so that every parent can choose to have their child protected without regard to cost.

Required childhood vaccines are available for the school year 2013-2014.

 Two doses of chickenpox (varicella) vaccine or doctor-verified history of disease is required for age kindergarten through grade 5. Students in grade 6 are required to have one dose of varicella or parental history of disease.

 The whooping cough (pertussis) vaccine, Tdap, is required for students in grades 6-12 who are 11 years and older.

Recommended vaccines also are available.

 Varicella vaccine for children in grades 7-12 who have never had chickenpox.

 Meningococcavaccine for adolescents age 11-12. A second (booster) dose at age 16-18 if first dose was given at ages 11-15.

 A three-shot series of human papillomavirus (HPV) for both adolescent boys and girls age 11 and older.

 Children 12 months and older should receive hepatitis A vaccine, a two-shot series.

 Flu vaccine for all people age 6 months and older.

Snohomish Health District promotes routine vaccination of children and adults.

Snohomish Health District’s Immunization Clinic will serve you if your family does not have a health care provider. A visit to a Health District clinic includes a check of your child’s record in the Washington Immunization Information System, the state’s immunization registry.

Parents should beat the rush by making appointments now with their child’s health care provider. At the Health District, parents can make an appointment during normal clinic hours at either the Lynnwood or Everett office.

A parent or legal guardian must accompany a child to the clinic, and must bring a complete record of the child’s immunizations. 

You need to fill out a Snohomish Health District authorization form to have another person bring your child to the clinic. Ask the clinic staff to mail or fax a form to you.

Health District clinics request payment on the day of service in cash, check, debit, or credit card. Medical coupons are accepted, but private insurance is not.

The cost can include an office visit fee, plus an administration fee per vaccine. Reduced fees are available by filling out a request based on household size and income.

Teens also occasionally require travel vaccines for out-of-country mission work or community service. The Health District offers those immunizations and health advice for traveling in foreign countries.

Please call if you have questions, concerns or to schedule an appointment: SHD Immunization Clinic 425.339.5220.

Back-to-school shots hours:

SHD Everett Immunization Clinic, 3020 Rucker Ave, Suite 108, Everett, WA 98201

425.339.5220

By appointment: 8 a.m.-noon and 1-4 p.m. Monday-Wednesday-Friday

SHD Lynnwood Immunization Clinic, 6101 200th Ave SW, Lynnwood, WA 98036

425.775.3522

By appointment: 8 a.m.-noon and 1-4 p.m. Tuesday and Thursday

NOTE: Both clinics will be closed on weekends and on Labor Day, Sept. 2.

 

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Number of children in US drops

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kids children playgroundFrom the National Institutes of Health

The number of children living in the United States declined slightly, as did the percentage of the U.S. population who are children, according to the federal government’s annual statistical report on the well-being of the nation’s children and youth.

The percentage of children living in the United States who are Asian, non-Hispanic increased, as did the percentage of children who are of two or more races, and the percentage of children who are Hispanic.

The percentages of children who are white, non-Hispanic, and black, non-Hispanic declined.

By 2050, about half of the American population ages under 17 is projected to be composed of children who are Hispanic, Asian, or of two or more races, the report stated.

The report projected that, among children under age 17, 36 percent will be Hispanic (up from 24 percent in 2012); 6 percent will be Asian (up from 5 percent in 2012); and 7 percent will be of two or more races (up from 4 percent in 2012).”

These and other findings are described in America’s Children: Key National Indicators of Well-Being, 2013. The report was compiled by the Federal Interagency Forum on Child and Family Statistics, which includes participants from 22 federal agencies as well as partners in several private research organizations.

The forum fosters coordination, collaboration, and integration of federal efforts to collect and report data on children and families.

The report, the 16th in an ongoing series, presents key indicators of children’s wellbeing in seven domains: family and social environment, economic circumstances, health care, physical environment and safety, behavior, education, and health.

Among the findings in this year’s report:

  • A drop for the fifth straight year in the percentage of infants born preterm, from 12.8 percent in 2006 to 11.7 in 2011.
  • A drop in the percentage of children ages 4–11 with any detectable blood cotinine level, a measure for recent exposure to secondhand smoke, from 53 percent in the years 2007 and 2008 to 42 percent in 2009 and 2010).
  • A drop in births to adolescents, from 17 per 1,000 girls ages 15 to 17 in 2009 to 15 per 1,000 in 2011 (preliminary data).
  • A drop in the percentage of births to unmarried women ages 15 to 44, from 40.8 percent in 2010 to 40.7 percent in 2011.
  • A rise in the percentage of male and female 12th graders who reported binge drinking — consuming five or more alcoholic beverages in a row in the past two weeks — from 22 percent in 2011 to 24 percent in 2012.
  • A drop in the percentage of children from birth to 17 years of age living with two married parents, from 65 percent in 2010 to 64 percent in 2011.
  • A drop in the percentage of children from birth to 17 years with no usual source of health care, from 5 percent in 2010 to 4 percent in 2011.
  • A rise in the percentage of households with children from birth to 17 years that reported housing that costs more than 30 percent of household income, crowding, and/or physically inadequate housing, from 45 percent in 2009 to 46 percent in 2011.
  • A rise in the percentage of children from birth to 17 years of age living with at least one parent employed year round full time, from 71 percent in 2010 to 73 percent in 2011.
  • A drop in the percentage of children ages 5–17 with untreated dental caries (cavities or tooth decay) over the past decade, from 23 percent in 1999 – 2004 to 14 percent in 2009 – 2010.
  • A rise in the percentage of children ages 5–17 with a dental visit in the past year from 85 percent in 2010 to 87 percent in 2011.

The percentage of youth ages 12–17 who had a major depressive episode was unchanged in the previous year (8.2 percent in 2010 and 2011).However, this figure was lower than the 2004 high of 9 percent.

The report notes that adolescent depression can affect school and work performance, impair peer and family relationships, and exacerbate other health conditions, such as asthma and obesity.

The Healthy Eating Index score, a measure of overall dietary quality did not differ significantly from recent years. For children ages 2-17, total scores ranged between 47 and 50 percent in 2003-2004, 2005-2006, and 2007-2008, . The report noted that the diet quality of children and adolescents fell considerably short of recommendations.

“Poor eating patterns can lead to childhood obesity and contribute to chronic diseases starting in childhood, such as type 2 diabetes, and those that emerge throughout the life cycle, such as cardiovascular disease,” the report stated.

The report added that the diet quality of children and adolescents would be improved by an increase in vegetables, especially dark greens and beans, replacing refined grains with whole grains, substituting seafood for some meat and poultry, and decreasing the intake of sodium, solid fats, and added sugars.

This year’s report includes a special feature on the kindergarten year, described as a pivotal marker for children’s development..Three and a half million children entered kindergarten for the first time in the fall of 2010.

On average, girls received higher scores than boys on kindergarten entry assessments in reading and approaches to learning. There were no differences between girls and boys in mathematics and science.

The special feature was based on data from the Early Childhood Longitudinal Study, Kindergarten Class of 2010 — 2011 (ECLS-K:2011), conducted by the National Center for Education Statistics.

The report noted that the ECLS-K:2011 will follow the children’s progress through the fifth grade, providing information on how the children’s development may be shaped by such factors as child care, home educational environment, teachers’ instructional practices, and class size.

About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s website at http://www.nichd.nih.gov.

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Protect babies from whooping cough – CDC infographic

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Protect Babies from Whooping Cough (Text Version)

If you’re pregnant get a Tdap shot!

Whooping cough is deadly for babies

[Picture of a nurse holding a baby beside a hospital]
Whooping cough (pertussis) is a respiratory infection that can cause severe coughing or trouble breathing.
About half of infants who get whooping cough are hospitalized!
[picture of arrow saying “1 out of 2” pointing to hospital]
Whooping cough cases across the U.S. have been on the rise since the 1980s.

Pregnant women need to get a Tdap shot

[Picture of a pregnant woman talking to a mother holding a baby]
Pregnant woman: I got my whooping cough vaccine and will encourage everyone caring for my baby to get a shot, too!
Mom: This vaccine helps protect you from whooping cough and passes some protection to your baby.

Create a circle of protection around your baby

4 out of 5 babies who get whooping cough catch it from someone at home*
[Picture of a baby surrounded by his parents, brother and sister, grandparents, and childcare providers]
Everyone needs whooping cough vaccine:

  • Parents
  • Brothers & sisters
  • Childcare providers
  • Grandparents

* When source was identified

Make sure your baby gets all 5 doses of whooping cough vaccine on time

Your baby needs whooping cough vaccine at:

  • 2 months
  • 4 months
  • 6 months
  • 15 thru 18 months
  • 4 thru 6 years

You can get whooping cough vaccines at a doctor’s office, local health department, or pharmacy

[Picture of a nurse and a doctor]
Like it? Tell a friend! It’s important! Pinit! Tweet it! Share it on Facebook!
[Picture of parents with a newborn baby and young daughter]
www.cdc.gov/whoopingcough

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention

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Hot weather: How to stay cool and safe

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Blue sky and white clouds (Panorama)

Hot weather tips from Public Health – Seattle & King County

When outside temperatures are very high, the danger for heat-related illnesses rises. People’s bodies are not able to cool themselves quickly enough, and they overheat.

In severe instances, people can suffer heat stroke, which can cause death or permanent disability if emergency treatment is not provided.

Older adults, young children, and people with mental illness and chronic diseases are at highest risk for heat-related illness. But even young and healthy individuals can suffer in heat if they participate in strenuous physical activities during hot weather.

You can protect yourself and loved ones against very hot temperatures by following these recommendations:

Stay cool

  • Spend more time in air conditioned places. If you don’t have air conditioning, consider visiting a mall, movie theater or other cool public places.
  • Cover windows that receive morning or afternoon sun.
  • Dress in lightweight clothing.
  • Take a cool shower or bath, or place cool washcloths on your skin.
  • Check up on your elderly neighbors and relatives to take these precautions too.

Drink liquids:

  • Drink plenty of water. Avoid drinks with caffeine, alcohol and large amounts of sugar because they can actually de-hydrate your body.
  • Have a beverage with you at all times, and sip or drink frequently. Don’t wait until you’re thirsty to drink.

If you go outside:

  • Limit the time you’re in direct sunlight.
  • Do not leave infants, children, people with mobility challenges and pets in a parked car, even with the window rolled down.
  • Avoid or reduce doing activities that are tiring, or take a lot of energy.
  • Do outdoor activities in the cooler morning and evening hours.
  • Avoid sunburn. Use a sunscreen lotion with a high SPF (sun protection factor) rating.

Water safety:

Some people turn to local rivers to cool off, but drowning is a real concern. Please use caution and wear a personal flotation device (PFD) on the water. Find deals on affordable lifejackets. And if you want to swim, choose a safer location – visit a local pool or lifeguarded beach instead.

Certain medications may increase sensitivity to the heat. If you are concerned about the heat and the medications you are taking, check with your doctor. Do not take salt tablets unless your doctor tells you to.

Hot Weather fact sheets in other languages by the Washington State Dept. of Health:

Recognizing heat exhaustion and heat stroke

When people’s bodies can’t cool themselves quickly enough it can cause heat exhaustion. Symptoms of heat exhaustion include muscle cramps, weakness, dizziness, headache, nausea and vomiting.

If you see someone with signs of overheating, move the person to a cooler location, have them rest for a few minutes and then slowly drink a cool beverage. Get medical attention for them immediately if they do not feel better.

Heat exhaustion can lead to heat stroke, which can cause death or permanent disability unless treated immediately. Symptoms of heat stroke include:

  • An extremely high body temperature (above 103°F)
  • Red, hot, and dry skin
  • Rapid, strong pulse
  • Nausea, confusion and unconsciousness

For more information, visit these websites:

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Photo by Sanja Gjenero

Salmonella in eggs: An unwelcome summer visitor

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Photo by Sanja Gjenero

Photo by Sanja Gjenero

CDC Features

Eggs and summer go together: deviled eggs, homemade ice cream, and potato salad.

But, just a few hours outside of the refrigerator and your eggs can create lasting memories that you’d rather forget.

This summer, make sure that eggs carrying Salmonella don’t come to your next outing.

Summer is the perfect season for Salmonella, a germ that commonly causes foodborne illness–sometimes called food poisoning.

Warm weather and unrefrigerated eggs or food made from raw or undercooked eggs create ideal conditions for Salmonella to grow.

Many germs grow to high numbers in just a few hours at room temperature.

Although anyone can get Salmonella food poisoning, older adults, infants, and people with weakened immune systems are at increased risk for serious illness.

A person infected with Salmonella usually has a fever, abdominal cramps, and diarrhea beginning 12 to 72 hours after consuming a contaminated food or beverage.

The illness usually lasts 4 to 7 days, and most people recover without antibiotic treatment. But, in rare cases, people become seriously ill.

In the United States, Salmonella infection causes more hospitalizations and deaths than any other germ found in food, resulting in $365 million in direct medical costs annually.

Wondering if you haveSalmonella food poisoning?

salmonella on cultured human cells

Salmonella / CDC

See your doctor or healthcare provider if you have:

  • Diarrhea along with a temperature over 101.5°F
  • Diarrhea for more than 3 days that is not improving
  • Bloody stools
  • Prolonged vomiting that prevents you from keeping liquids down
  • Signs of dehydration, such as
    • Making very little urine
    • Dry mouth and throat, and
    • Dizziness when standing up

Salmonella can be sneaky

You can get Salmonella from perfectly normal-looking eggs. Salmonella can live on both the outside and inside of eggs that appear to be normal. Chicken feces on the outside of egg shells used to be a common cause of Salmonella contamination. To counter that, regulators in the 1970s put strict procedures into place for cleaning and inspecting eggs. Now, Salmonella is sometimes found on the inside of eggs; it gets there as the egg is forming.

Good news for egg lovers

Professionals from public health, government, and the food industry are continually working to reduce the risks of Salmonella in eggs. Here are just a few contributions made thus far:

Be proactive. Reduce your risk.

Did You Know?

Eating raw or undercooked eggs can be especially dangerous for young children, pregnant women, older adults, and those with weakened immune systems.

Salmonella can contaminate more than poultry and eggs. It sneaks its way into many foods—ground beef, pork, tomatoes, sprouts—even peanut butter. Here are six tips to make eggs and other foods safer to eat.

  1. Like other perishable foods, keep eggs refrigerated at or below 40° F (4° C) at all times. Buy eggs only from stores or other suppliers that keep them refrigerated.
  2. Discard cracked or dirty eggs.
  3. Do not keep eggs or other foods warm or at room temperature for more than two hours.
  4. Refrigerate unused or leftover foods promptly.
  5. Avoid restaurant dishes made with raw or lightly cooked unpasteurized eggs. Although restaurants should use pasteurized eggs in any recipe containing raw or lightly cooked eggs –such as Hollandaise sauce or Caesar salad dressing—ask to be sure.
  6. Consider buying and using shell eggs and egg products that are pasteurized. These are available for purchase from certain stores and suppliers.

 Photo of eggs courtesy of Sanja Gjenero

More Information

For more information about Salmonella, foodborne illness, and food safety, call 1-800-CDC-INFO, e-mail cdcinfo@cdc.gov, or visit these web sites:

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Doctor offers 8 tips to keep kids safe while biking

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Bike ThumbBy Kathryn Bluher
From Seattle Children’s On the Pulse blog

The long, sunny days of summer are the perfect time to get the bikes out of the garage, but parents should hit the brakes and talk to children about bike safety first.

Bike accidents are the second-leading cause of serious injury in school-age children.

According to the Centers for Disease Control, in 2010, 800 bicyclists were killed in the U.S. and an estimated 515,000 sustained bicycle-related injuries that required emergency department care.Roughly half of these cyclists were children and adolescents under the age of 20.

Tony Woodward, MD, MBA, medical director of emergency medicine at Seattle Children’s Hospital, says most biking injuries occur because a child either isn’t wearing a helmet or is putting themself in a potentially dangerous situation. “Children may see themselves as invincible when they are on a bike, which is not the truth,” says Woodward.

Biking is a great summer time activity for children and families, incorporating both physical fitness and family time, but proper safety measures are important to keeping kids injury-free. Accidents can and will happen while biking, even on the quietest roads and safest sidewalks, but these tips can help reduce the risk of serious injuries.

Top tips for keeping kids safe while biking

Wear a helmet every time. Children should wear a helmet every time they ride a bike. “Most of the serious and life-threatening injuries we see are head injuries,” says Woodward, but that risk can be reduced by wearing a properly fitted helmet. By simply wearing a helmet that fits correctly, children can reduce their risk of serious injury up to 85 percent. It doesn’t matter if a child is biking across town or across the driveway, children should wear a helmet every time they ride their bike, says Woodward. “Children shouldn’t be allowed on their bike unless their helmet is on their head first.”

Make sure you have the right helmet and the right fit. Not all helmets are made for biking. For instance, football helmets or hard hats are not acceptable for biking. Bike helmets are made specifically for head-first falls and should be properly fitted on a child. Helmets should meet safety standards and should have a CPSC (U.S. Consumer Product Safety Commission) or Snell sticker inside. Proper fitting is also important. “Helmets only work if they are the right size,” says Woodward. If you can move the helmet from side to side, the helmet should be adjusted. Helmets should fit solidly on a child’s head and feel level. Due to the type of built-in protection, helmets are also only good for one crash. Remember, after a crash consider it trash!

Wear proper clothing. Kids should wear bright clothes while biking to be more visible to other bikers, pedestrians and cars. Reflectors or lights on the front and back of a bike and helmet are also a great way to increase visibility and ensure safety. Avoid wearing loose-fitting clothing that could catch in the bike’s chain and mechanics, and wear proper shoes. “Wearing closed toed shoes while biking can reduce the risk of losing a toe and long sleeves can help guard against road rash if a child falls off their bike,” says Woodward. Flip-flops or shoes with heels are also hazardous.

Ride a bike that is right for you. Bikes come in all shapes, colors and styles. Choose a bike that fits your child’s skill level and style, but most importantly, find a bike that is the right size. Don’t purchase a bike that a child will grow into. A properly sized bike is a safer bike. Your child should be able to sit on the seat with their feet flat on the ground and the handlebars should be no higher than their shoulders.

Perform a safety check before every ride. Before every ride check to make sure a bike’s seat, handlebars and wheels are all adjusted correctly and in good shape. Nothing should be loose or falling apart. Check the chain of the bike and the brakes, and make sure the tires have enough air.

Be aware of surroundings while biking. Set clear guidelines with your child about where it is safe to ride their bike – on the street or on the sidewalk – and how far is too far away from home. Woodward recommends kids younger than 10 not ride without an adult in the street. Bike paths are a great option for children, free from motor vehicles. However, bike paths are not free from potential hazards, like sticks, rocks, protruding objects and other potential obstacles such as dogs, people and faster bikers. Also, bike paths are meant to be shared. Teach children to be respectful of walkers and other bikers and to always pay attention to their surroundings.

Proper supervision is key. Supervision is key, but it isn’t just when kids are on their bike, says Woodward. Supervision starts by preparing kids for their bike, with proper equipment and modeled behavior.

Follow road rules. Most pediatricians recommend not allowing children under 10 to bike on the roads, but if a child is deemed old enough and mature enough to ride on roads, make sure they understand the rules of the road:

  • Ride with traffic, never against traffic
  • Always stop and check for traffic in both directions when exiting a driveway
  • Stop at all stop signs and obey traffic lights
  • When riding on the road, act as a car
  • Use bike lanes and bike routes
  • Avoid riding too close to parked cars to avoid car doors opening suddenly
  • Use proper hand signals, when safe to do so

Accidents can happen anywhere – on the sidewalk, in the driveway, even on a quiet bike path – that’s why being prepared, supervised and aware of surroundings are so important. Biking is fun, but safety comes first!

Resources:

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Tips to keep kids and teens safe this Fourth of July

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From Seattle Children’s On The Pulse blog

Photo by Johnny BergThe Fourth of July is a time for fun and celebration; however, families should follow precautions to ensure a safe and enjoyable occasion.

Not only do parents need to worry about firework safety, but families should also keep in mind alcohol and sun safety, too.

Tony Woodward, MD, MBA, medical director of emergency medicine at Seattle Children’s, says that inadequate preparations for what might happen is the standard issue on Fourth of July.

To keep your kids out of the emergency department this year, Woodward recommends some basic safety tips.

Photo: Courtesy of JohnNyberg

Stay safe around fireworks

First and foremost: The main event on July Fourth is fireworks. Even though they are fun and exciting, they can be dangerous ifprecautions aren’t taken around kids.

The best way to avoid injury is to leave the pyrotechnics to the professionals and attend public fireworks displays. But if you plan to use fireworks at home, Woodward has some suggestions to keep your kids safe.

Children should never be allowed to use fireworks, including the popular sparklers. Woodward says the majority of firework-related injuries to children under the age of 5 are caused by sparklers.

“We often see kids with preventable burns and injuries from sparklers,” he says. Sparklers burn at a very high temperature (up to 2,000 degrees Fahrenheit).

Another important tip is to only light fireworks on level ground. “At least 50 percent of kids that we see are not the people who are setting off the fireworks, but the bystanders,” Woodward says.

Anticipate the consequences and provide adequate supervision to minimize any chance of injury. Never re-light or touch a firework that has not exploded.

If a child is injured by fireworks, Woodward says, “Remove them from the area and stop the burning. If it is serious, you are unsure or it involves face, eyes or hands, the child should be seen by a medical professional.”

Avoid heat illness

Don’t forget that July can have particularly hot weather, says Woodward. During a long day in the sun, he recommends that parents be on the lookout for symptoms of heat cramps, heat exhaustion, and heat stroke. Kids can become very ill if proper safety measures are not taken.

Woodward recommends that parents make sure kids drink plenty of fluids and wear lightweight, loose clothing. Stay indoors during the hottest part of the day, usually the afternoon.

If your child is experiencing heat cramps, be aware that they can be painful, says Woodward. Stop activity, take a break, and encourage your child to drink small amounts of water. In serious cases, heat cramps can lead to heat exhaustion, with symptoms such as pale skin, headache, dizziness, exhaustion, and nausea.

The third and most dangerous stage of heat illness is heat stroke. Parents should be alert to symptoms such as vomiting, decreased alertness or loss of consciousness, extremely high body temperature, rapid or weak pulse, and shallow breathing. Heat stroke can be life threatening, so be prepared to call 9-1-1 if symptoms worsen.

Talk to your teen about drunk driving dangers

According to the National Highway Traffic Safety Administration, Fourth of July is the deadliest holiday of the year – even deadlier than New Year’s Day. Many teens find themselves in dangerous driving situations during July Fourth celebrations, especially when alcohol is involved.

Research has shown that nearly 80 percent of high school kids have tried alcohol. In a recent Teenology 101 blog postYolanda Evans, MD, MPH, with Seattle Children’s adolescent medicine division, offers tips for parents of teens to help keep them safe during summer celebrations.

Evans recommends parents keep an open line of communication with their teens, as well as the parents of their teens’ friends. She also encourages a “free phone call” policy, so teens know they can call any time of night if they need a ride home. Visit Teenology 101 for more tips on talking to teens about alcohol and drugs.

Photo: Courtesy of JohnNyberg

More safety tips from On the Pulse:

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