Category Archives: Newborn and Infant Health

Do teething babies need medicine on their gums? No

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Baby drinks from bottleConsumer Update from the US Food and Drug Administration

There are more theories about teething and “treating” a baby’s sore gums than there are teeth in a child’s mouth.

One thing doctors and other health care professionals agree on is that teething is a normal part of childhood that can be treated without prescription or over-the-counter (OTC) medications.

Too often well-meaning parents, grandparents and caregivers want to soothe a teething baby by rubbing numbing medications on the tot’s gums, using potentially harmful drugs instead of safer, non-toxic alternatives.

That’s why the Food and Drug Administration (FDA) is warning parents that prescription drugs such as viscous lidocaine are not safe for treating teething in infants or young children, and that they have hurt some children who used those products. Continue reading

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Moms, kids eat more (low mercury) fish – FDA says

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Medieval woodcut of fish in a netFDA Consumer Update

If you’re pregnant, you’ve no doubt been given a list of foods to avoid—undercooked meat, soft cheeses made from unpasteurized milk, and alcohol, to name a few.

The good news is that there is a food you should have more of while pregnant and while breastfeeding: fish and shellfish.

The latest science shows that eating fish low in mercury during pregnancy and in early childhood can help with growth and neurodevelopment. It can also be good for your health. Continue reading

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New study again finds higher rate of rare neurological birth defects in central Washington

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Washington MapA new study has again found a higher rate of a rare neurological birth defect, anencephaly, in Yakima, Benton and Franklin counties, Washington state health officials said Tuesday.

The study identified seven cases of the birth defect in these three counties in 2013, which translates into a rate of 8.7 per 10,000 births. That rate is similar to the rate seen in 2010-2012 and remains well above the national rate of 2.1 per 10,000 births, health officials said. Continue reading

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Q: Do I face a penalty if my kids’ CHIP coverage starts in April?

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Cute Baby Boy Isolated on WhiteBy Michelle Andrews

Q. I understand that I won’t have to pay a penalty for not having insurance because I signed up for coverage before the end of open enrollment.

But what about my kids? Their CHIP coverage didn’t start until April.  Continue reading

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How much to deliver a baby? Hospital charges vary 11-fold in California

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Cute Baby Boy Isolated on WhiteBy Roni Caryn Rabin
KHN

Hospital charges for labor and delivery vary so widely from one California medical center to another that some facilities charge women eight to 11 times more than others, according to a new study.

Comparing nearly 110,000 uncomplicated births and Caesarean sections, researchers found the lowest charge for a vaginal birth involving an average woman was $3,296, while the highest was $37,227.

For an uncomplicated Caesarean delivery, the lowest charge was about $8,312, while the highest was $70,908.  Continue reading

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Making palliative care more available to children

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Conversations matter palliative care

From the National Institute of Nursing Research

January 10, 2014 – New Palliative Care: Conversations Matter campaign helps ensure children with serious illnesses and their families get supportive care

A campaign just launched by the National Institute of Nursing Research (NINR) aims to increase the use of palliative care — comprehensive treatment of the discomfort, symptoms, and stress of serious illness — for children with serious illness.

Palliative care can reduce a child’s pain, help manage other distressing symptoms, and provide important emotional support to the child and family throughout the course of an illness. Continue reading

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tacuin women

Women’s Health – Week 18: Gestational Diabetes

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From the Office of Research on Women’s Health

Gestational diabetes (pregnancy)

Gestational diabetes is diabetes that occurs when a woman is pregnant. Changing hormone levels and weight gain are all part of a healthy pregnancy.

But both these changes can make it hard for your body to keep up with its need for a hormone called insulin. Your body may not get the energy it needs from the food you eat and, later in your pregnancy, you could develop gestational diabetes.

Gestational diabetes often goes away after the baby is born but having gestational diabetes can place you and your child at increased risk for developing diabetes later in life.

Taking care of yourself will help keep you and your baby healthy throughout your lives. Important action steps include:

  • Reaching and maintaining a healthy weight.
  • Being physically active for 30 minutes at least 5 days a week.
  • Following a healthy eating plan.

Your health care provider will decide when you need to be checked for diabetes depending on yourrisk factors. Risk factors include:

  • Age: 25 years of age or older.
  • Weight: Being overweight or obese.
  • Family history: Having a parent, brother, or sister with diabetes.
  • Baby’s birth weight: Delivering a baby weighing more than 9 pounds.
  • Health history: A previous diagnosis of gestational diabetes in an earlier pregnancy.
  • Blood glucose (blood sugar): Having pre-diabetes, a condition in which blood glucose levels are higher than normal.
  • Race/ethnicity: Being of African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander descent.
Risks of gestational diabetes
Having gestational diabetes may increase your risk of high blood pressure or your baby may grow very large. Both can make delivery difficult and dangerous for you both. It can also cause other problems for your baby including: 

  • Low blood glucose right after birth.
  • Breathing problems.
NIH and You
The NIH Office of Research of Women’s Health has partnered with the National Institute of Diabetes and Digestive and Kidney Disease’s National Diabetes Education Program on its Small Steps. Big Rewards – It’s Never Too Early…To Prevent Diabetes campaign to increase awareness about the future health risks for women with a history of gestational diabetes and their children. The campaign promotes screening for type 2 diabetes in women with a history of gestational diabetes, provides advice on future health risks, and promotes the importance of adopting and maintaining healthy behaviors.

for more information: www.niddk.nih.gov

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Twitter chat on pregnancy and childbirth with Group Health’s Dr. Jane Dimer, Tuesday, December 10

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hashtagJane Dimer, MD – an OB/GYN and chief of Women’s Services for Group Health – on Tuesday, Dec. 10 from 12-1 pm for an hour-long Twitter chat on pregnancy and childbirth. Dr. Dimer will be covering a variety of topics from getting pregnant to delivery, and answering your questions.

Topics will include:

  • Preparing your body for pregnancy
  • Nutrition
  • Is this normal?
  • Pregnancy myths
  • Making a birth plan
  • Delivery
  • Back to work/breastfeeding

When: Tuesday, Dec. 10 from 12-1 pm

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Lack of eye contact in early infancy may be sign of autism, study

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From the National Institutes of Health

Eye contact during early infancy may be a key to early identification of autism, according to a study funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health.

Published this week in the journal Nature, the study reveals the earliest sign of developing autism ever observed — a steady decline in attention to others’ eyes within the first two to six months of life.

“Autism isn’t usually diagnosed until after age 2, when delays in a child’s social behavior and language skills become apparent. This study shows that children exhibit clear signs of autism at a much younger age,” said Thomas R. Insel, M.D., director of NIMH. “The sooner we are able to identify early markers for autism, the more effective our treatment interventions can be.”

autism eye

Decline in eye fixation reveals signs of autism present already within the first 6 months of life. Data from a 6-month-old infant later diagnosed with autism are plotted in red.

Data from a typically developing 6-month-old are plotted in blue. The data show where the infants were looking while watching a video of a caregiver. Source: Warren Jones, Ph.D., Marcus Autism Center, Children’s Healthcare of Atlanta, and Emory University School of Medicine.

Typically developing children begin to focus on human faces within the first few hours of life, and they learn to pick up social cues by paying special attention to other people’s eyes.

Children with autism, however, do not exhibit this sort of interest in eye-looking. In fact, a lack of eye contact is one of the diagnostic features of the disorder.

To find out how this deficit in eye-looking emerges in children with autism, Warren Jones, Ph.D., and Ami Klin, Ph.D., of the Marcus Autism Center, Children’s Healthcare of Atlanta, and Emory University School of Medicine followed infants from birth to age 3.

The infants were divided into two groups, based on their risk for developing an autism spectrum disorder. Those in the high risk group had an older sibling already diagnosed with autism; those in the low risk group did not.

Jones and Klin used eye-tracking equipment to measure each child’s eye movements as they watched video scenes of a caregiver. The researchers calculated the percentage of time each child fixated on the caregiver’s eyes, mouth, and body, as well as the non-human spaces in the images. Children were tested at 10 different times between 2 and 24 months of age.

By age 3, some of the children — nearly all from the high risk group — had received a clinical diagnosis of an autism spectrum disorder. The researchers then reviewed the eye-tracking data to determine what factors differed between those children who received an autism diagnosis and those who did not.

“In infants later diagnosed with autism, we see a steady decline in how much they look at mom’s eyes,” said Jones. This drop in eye-looking began between two and six months and continued throughout the course of the study.

By 24 months, the children later diagnosed with autism focused on the caregiver’s eyes only about half as long as did their typically developing counterparts.

This decline in attention to others’ eyes was somewhat surprising to the researchers. In opposition to a long-standing theory in the field — that social behaviors are entirely absent in children with autism — these results suggest that social engagement skills are intact shortly after birth in children with autism. If clinicians can identify this sort of marker for autism in a young infant, interventions may be better able to keep the child’s social development on track.

“This insight, the preservation of some early eye-looking, is important,” explained Jones. “In the future, if we were able to use similar technologies to identify early signs of social disability, we could then consider interventions to build on that early eye-looking and help reduce some of the associated disabilities that often accompany autism.”

The next step for Jones and Klin is to translate this finding into a viable tool for use in the clinic. With support from the NIH Autism Centers of Excellence program, the research team has already started to extend this research by enrolling many more babies and their families into related long-term studies.

They also plan to examine additional markers for autism in infancy in order to give clinicians more tools for the early identification and treatment of autism.

Grant: R01MH083727

About the National Institute of Mental Health (NIMH): The mission of the NIMH is to transform the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and care. For more information, visit http://www.nimh.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health®

Reference

Jones W, Klin A. Attention to eyes is present but in decline in 2-6-month-old infants later diagnosed with autism. Nature, Nov. 6, 2013.

 

 

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Seattle Children’s sues to be included in more of the new health exchange plans

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Seattle Children’s is filing suit to be included in more healthcare plans on Washington’s Health Benefit Exchange.

Here is their press release:

Today, Seattle Children’s Hospital filed suit citing the failure of Washington state’s Office of the Insurance Commissioner (OIC) to ensure adequate network coverage in several Washington’s Health Benefit Exchange (Exchange) plans.

We believe strongly that the OIC and the majority of plans on the Exchange have failed to meet their mandate, as they do not currently cover care provided at Children’s.

Children’s is the only pediatric hospital in King County and the preeminent provider of many pediatric specialty services in the Northwest.

Some of these specialized services not available elsewhere in our area or region include acute cancer care, level IV neonatal intensive care and heart, liver and intestinal transplantation.

Without inclusion of Children’s, current and future patients and families who obtain insurance from several plans offered will not be able to access care at Children’s as an in-network provider.

This lack of suitable access to pediatric services means that families enrolled in these plans may not receive the most timely, appropriate care, and face larger out-of-pocket amounts.

“Every child should have access to essential healthcare and the intent of the new Exchange is to make it available to all families,” said Thomas Hansen, MD, CEO, Seattle Children’s. “However, we are very concerned about the limited networks being offered by some Exchange insurance plans. Omitting coverage for care at a facility like Children’s prevents families from accessing vital services they may desperately need.”

Children’s is committed to working with the OIC and Exchange insurers, and we hope a solution to this concerning situation can be found soon for Washington families.

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WIC services in Washington given 30-day reprieve during federal shutdown

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WIC WashingtonOLYMPIA - Despite the federal government shutdown, Washington’s Women, Infants, and Children food and nutrition program has funding to continue service through October. The United States Department of Agriculture (USDA) reallocated funding to cover the costs for the month.

The reprieve comes just in time for Washington’s WIC Nutrition Program, which had only enough remaining funds to operate the program statewide until Oct. 9.

WIC provides important nutrition assistance and health referrals along with breastfeeding support to pregnant and breastfeeding women and their children up to age five, whose family income is at or below 185 percent poverty level.

The state Department of Health contracts with local health organizations and tribes to provide WIC services in all 39 counties in Washington. The program also authorizes certain grocery stores to accept WIC vouchers for the purchase of approved healthy foods.

If the federal government shutdown continues through this month, USDA will not have funding to re-allocate for services in November, and Washington WIC may not have funding to continue operations.

The Department of Health had been working on contingency plans in the event that WIC services had to end in October when reallocation was announced. Agency officials now have more time to develop a strategy in the event the shutdown does not end by Nov.1.

“WIC helps low-income families feed their children. We hope a budget will be passed and this important program can continue beyond October 31,” said Janet Jackson Charles, director of Nutrition Services at the Washington State Department of Health.

  • For questions about local WIC services call the state WIC office, 1-800-841-1410.
  • The Washington WIC Nutrition Program website has information about local WIC clinics
  • Related services around the state can be found at ParentHelp123.org or by calling the Family Health Hotline at 1-800-322-2588.
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The $13 Test That Saved My Baby’s Life. Why Isn’t it Required For Every Newborn?

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by Michael Grabell
ProPublica

On July 10, my wife gave birth to a seemingly healthy baby boy with slate-blue eyes and peach-fuzz hair. The pregnancy was without complications. The delivery itself lasted all of 12 minutes. After a couple of days at Greenwich Hospital in Connecticut, we were packing up when a pediatric cardiologist came into the room.

We would not be going home, she told us. Our son had a narrowing of the aorta and would have to be transferred to the neonatal intensive care unit at NewYork-Presbyterian Hospital at Columbia, where he would need heart surgery.

It turned out that our son was among the first in Connecticut whose lives may have been saved by a new state law that requires all newborns to be screened for congenital heart defects.

It was just by chance that we were in Connecticut to begin with. We live in New York, where such tests will not be required until next year. But our doctors were affiliated with a hospital just over the border, where the law took effect Jan. 1.

As we later learned, congenital heart problems are the most common type of birth defect in the United States. The Centers for Disease Control and Prevention estimate that about one in 555 newborns have a critical congenital heart defect that usually requires surgery in the first year of life.

Many cases are caught in prenatal ultrasounds or routine newborn exams. But as many as 1,500 babies leave American hospitals each year with undetected critical congenital heart defects, the C.D.C. has estimated.

Typically, these babies turn blue and struggle to breathe within the first few weeks of life. They are taken to hospitals, often in poor condition, making it harder to operate on them.

By then, they may have suffered significant damage to the heart or brain. Researchers estimate that dozens of babies die each year because of undiagnosed heart problems.

The new screening is recommended by the United States Department of Health and Human Services, the American Heart Association and the American Academy of Pediatrics. Yet more than a dozen states — including populous ones like Massachusetts, Pennsylvania, Florida, Georgia, Wisconsin and Washington — do not yet require it.

The patchy adoption of the heart screening, known as the pulse oximetry test, highlights larger questions about public health and why good ideas in medicine take so long to spread and when we should legislate clinical practice.

Newborns are already screened for hearing loss and dozens of disorders using blood drawn from the heel. The heart test is even less invasive: light sensors attached to the hand and foot measure oxygen levels in the baby’s blood. This can cost as little as 52 cents per child.

Our son’s heart defect was a coarctation of the aorta, a narrowing of the body’s largest artery. This made it difficult for blood to reach the lower part of his body, which meant that the left side of his heart had to pump harder.

A: Coarctation (narrowing) of the aorta. 1:inferior caval vein, 2:right pulmonary veins, 3: right pulmonary artery, 4:superior caval vein, 5:left pulmonary artery, 6:left pulmonary veins, 7:right ventricle, 8:left ventricle, 9:main pulmonary artery, 10:Aorta.

A: Coarctation (narrowing) of the aorta. 1: inferior caval vein, 2: right pulmonary veins, 3: right pulmonary artery, 4: superior caval vein, 5: left pulmonary artery, 6:left pulmonary veins, 7: right ventricle, 8: left ventricle, 9: main pulmonary artery, 10: aorta. – Source: Wikipedia

In the hospital, though, he appeared completely healthy and normal because of an extra vessel that newborns have to help blood flow in utero. But that vessel closes shortly after birth, sometimes revealing hidden heart problems only after parents bring their babies home.

Depending on the heart defect, the onset of symptoms can be sudden.

This is what happened to Samantha Lyn Stone, who was born in Suffern, N.Y., in 2002. A photograph taken the day before she died shows a wide-eyed baby girl lying next to a stuffed giraffe. The next morning, her mother, Patti, told me, she was wiping Samantha’s face when she heard a gurgle from the baby’s chest.

Before her eyes, Samantha was turning blue. Blood began to spill from her mouth. Ms. Stone dialed 911, and minutes later, a doctor who heard the call over a radio was there performing CPR. Samantha went to one hospital and was flown to another.

But the damage was irreparable. Samantha had gone 45 minutes without oxygen: She lapsed into a coma and died six days later.

It wasn’t until several years later that Ms. Stone learned about the pulse oximetry test. “This could have saved my daughter,” she told me. “There is no parent that should ever have to go through what I went through.”

Pulse oximetry is not a costly, exotic procedure. Most hospitals already have oximeters and use them to monitor infants who suffer complications. You can buy one at Walmart for $29.88.

A recent study in New Jersey, the first state to implement the screening, estimated that the test cost $13.50 in equipment costs and nursing time. If hospitals use reusable sensors similar to those found on blood-pressure cuffs, the test could cost roughly fifty cents.

As medical technology advances, few screenings will be so cheap or simple. Recent years have seen controversy over prostate cancer and mammography screenings. Medical ethicists have to weigh the costs of each program and the agony caused by a false positive against the lives saved.

But with pulse oximetry, the false positive rate is less than 0.2 percent — lower than is seen for screenings newborns already get. The follow-up test is usually a noninvasive echocardiogram, or an ultrasound of the heart. A federal advisory committee came down in favor — three years ago.

“There’s really no question, scientifically, this is a good idea,” said Darshak Sanghavi, a pediatric cardiologist and a fellow at the Brookings Institution. “The issue is, how do we change culture?”

Opposition has taken two forms. One is from doctors who believe policy makers shouldn’t interfere with how medical professionals do their jobs. The other is from smaller hospitals, which worry about access to echocardiograms and the costs of unnecessary transfers.

These concerns can be addressed fairly easily. Nurses in New Jersey and elsewhere have been able to work the test into their normal routines. A rural hospital should already have a protocol to transfer a newborn in serious condition. If Alaska can do it, less remote states can, too.

But this is not simply a rural health care problem. Cardiologists and neonatologists I’ve spoken with said they knew of hospitals in New York City, Boston and metropolitan Atlanta that weren’t screening newborns for heart defects.

“It’s completely the luck of the draw of where you deliver,” said Annamarie Saarinen, who has pushed for the screening since her daughter narrowly avoided leaving the hospital with an undetected heart defect.

Fortunately, our son’s condition was also caught and corrected. The only lasting effects are a three-inch scar on his side and checkups with a cardiologist. He will live a normal life. He will be able to play sports and climb things he’s not supposed to.

Shouldn’t every baby have that chance?

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Nearly half of U.S. births now covered by Medicaid, study

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By Jay Hancock

About half the births in the United States are paid for by Medicaid — a figure higher than previous estimates – and the numbers could increase as the state-federal health insurance program expands under the Affordable Care Act, according to a study released Tuesday.

medicaid-pregancy-500

All pregnant women with incomes below 133 percent of the federal poverty level, just below $15,300 for an individual, are eligible for Medicaid, and many states provide coverage to women earning well above that amount.

While previous research has estimated about 40 percent of the nearly 4 million annual births in the United States were paid for by Medicaid, the latest study by researchers at George Washington University and the March of Dimes looked at individual state data and estimated that in 2010 48 percent of births were covered by Medicaid.

Researchers say they hope to use the figure as a baseline to determine the impact of the federal health law that expands Medicaid starting in January. Under the health law, about half the states are expanding Medicaid to cover everyone under 138 percent of the federal poverty level.

The percent of births paid for by Medicaid varied widely from a high of nearly 70 percent in Louisiana to below 30 percent in New Hampshire and Massachusetts, the study found (see chart for individual state data).

Cynthia Pellegrini, senior vice president of public policy at the March of Dimes and a co-author of the study, said while poor women can access Medicaid when they are pregnant, the health law will help improve birth outcomes because women will be able to get the coverage before becoming pregnant.

She said if women are healthier before they get pregnant, that will increase the chances of having a healthier baby. Women who gain Medicaid coverage when they are pregnant typically lose the coverage 60 days after giving birth. The health law could make some of them eligible to maintain coverage.

“We hope to see a gigantic improvement in birth outomes,” Pellegrini said.

The study was published in the September 2013 issue of the peer-reviewed journal Women’s Health Issues.

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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