Author: Children’s Hospital Boston staff

Maggie Hickey was a star athlete and scholar. But after hitting her head, she couldn’t exercise or study without coming down with crippling headaches or other mysterious symptoms.

Maggie’s story is featured in Dream’s online edition. Here’s an excerpt:

On a Friday afternoon last October, 15-year-old Maggie Hickey was getting ready to go to a high school football game when she started feeling queasy. The next thing she knew, she was lying on a couch with a whopping headache, a gash over her left eye and only the fuzziest idea about what had happened. “I felt so disoriented and started crying,” Maggie remembers.

It turned out that Maggie had fainted, smashing her forehead on a doorknob as she crashed to the floor. Eight stitches later, Maggie and her parents left the emergency room thinking that the mysterious incident was over. “It hurt a lot but I was mostly embarrassed,” she says. “I was more worried about what people were going to think of my stitches than anything else.” So, despite a dull headache that wasn’t quelled by Motrin, Maggie returned to school and varsity rowing practice that Monday. But the pressure in her head didn’t go away. Instead, the pain intensified—especially when she exercised, studied or, strangely enough, when she entered brightly-lit areas, like a room with fluorescent lights or the sunny outdoors. Each day ushered in more peculiar maladies: Just sitting still in class caused crippling headaches and Maggie became anxious, fatigued and forgetful. Soon, she couldn’t eat because of constant nausea, and couldn’t sleep because of the incessant pain. [click to continue reading story]

Recent news headlines have people asking if testing for a concussion can involve equipment as simple as a hockey puck. One teen seemed to think so.

NPR reports on how a Michigan high school student designed a simple hockey-puck-on-a-rod concussion test for his school’s science fair project.

NPR talks to Children’s Frances Jensen, MD about the neurological effects of repeat concussions.

Read more of our coverage on concussions in young athletes.

This Eagle Tribune article talks about how awareness of the risks of concussions is growing.

by Lyle J. Micheli, MD, director of Children’s Division of Sports Medicine

The Winter Olympics in Vancouver are now well underway; the question of athletic doping in sports inevitably will be addressed and revisited. It is important to realize that this is by no means a new issue although methods of detecting doping and the various methodologies for doping have now changed dramatically over the years.

In the simplest terms, doping is any extreme substance added to a regimen, an athlete’s diet or in the case of blood doping, to their physiological system in an attempt to enhance performance. Organized sports in general and the Olympics in particular take issue with these techniques because they are unethical and they represent cheating. In addition, medical doctors, such as myself, who have dealt with sports medicine for many years, are concerned about the health implications of doping, particularly in young athletes.

It is important to realize that this is not a new problem. Doping has probably been around as long as there have been athletic competitions. The world first became aware of doping during the cycling events in the late 19^th century in which competitive cyclists were taking substances ranging from caffeine to ether to cyanide. A number of drug related deaths resulted in outcry at that time and set the stage for doping detection.

The Olympic movement first began to systematically test for doping in the 1968 Olympics. It has now become an intrinsic part of any major sports competition. In addition to Olympic athletes, professional athletes ranging from football, baseball, tennis and rugby are now systematically tested in an attempt to rule out these methods which not only are cheating but they are so often unhealthy and unsafe.

As a physicians dealing with young athletes, one of our major concerns is that the young athletes, hearing of the elite athletes taking performance enhancing substances, might be tempted to emulate them. In particular, we are greatly concerned about the use of anabolic steroids in young athletes. These can be dangerous for a number of different reasons including their effect upon the cardiovascular system, the actual muscles and tendons themselves and on the liver.

In addition, in the growing child they may affect growth and actually tend to repress growth. Fortunately or unfortunately, testing in junior athletes is rare. For one thing, the cost would be prohibitive and no one knows for sure the extent of the problem. I believe the best way we can help prevent this behavior is to combine the efforts of sports physicians, athletic trainers, coaches and parents to diligently watch for signs of anabolic steroid use and to counsel against them at every level.

Other stories we’ve been reading:

New York’s soda tax could bring in $222 million. [Read Children’s obesity expert’s take on artificially sweetened beverages.] Chronic health conditions are increasing in children. If your child’s grandparents are babysitting regularly, it’s more likely your kid will be overweight. Bone-anchored hearing aids help kids with single-side deafness.

The best way to keep your kids vaccinations up-to-date is to keep a shot card. [Read about the updated immunization schedule.] Rapid flu tests are most accurate for young children. The new seasonal flu vaccine will contain an H1N1 strain.

Teens might exercise more if they think it’s fun. Video games aren’t the cause for your teen’s headaches. Tired teens are more prone to car crashes. A lack of morning light can cause irregular sleep for teens. {Read how late bedtimes affect teens mental health.]

Preemie twins may face lower risks of certain complications versus single preemie babies. Does an adult’s health differ when they’re an IVF baby? Bilingualism may begin in the womb. The average birth weight in the United States in on the decline.

Media expert Michael Rich, MD, MPH, director of the Center on Media and Child Health at Children’s Hospital Boston, answers your questions about media use. Last week, he discussed whether or not vampire fiction can contribute to a child’s anxiety.

Here’s this week’s question:

Q: I just recently found some sexual pictures in my son’s phone and I am totally shocked and scared. I do not know what to do and if I should tell his girlfriend’s parents or not. Is this a crime punishable to the parents of these “sexting” teens?
-Asked by Trish on Education.com’s JustAsk forum, after reading the article Is Your Child Sexting? What Parents Need to Know

A: Dear Trish,

When you think about it, sexting (sexual content + text messaging) is the perfect storm for teens: Start with the fact that they’re at the peak of sexual urges and curiosity, then combine it with their tremendous love of media and ease with technology. If that weren’t enough, you can add parents who are often uninterested in how media work, plus the fact that teens have not fully developed the area of the brain that lets them think through future consequences.

From a developmental perspective, exploring sexual expression is normal behavior for teens, regardless of whether adults approve of how, when, and where they choose to do so. However, the Digital Age has raised new concerns about these expressions. In the past, a printed photograph could be given to a love interest in relative privacy. Even if the photograph was passed around between friends, the print could eventually be destroyed. With today’s digital pictures and messaging, however, sexual photos and texts can spread to many more people much more rapidly, and since each person owns a copy of the file after they receive it, there is no good way to make sure that all copies are destroyed.

This has unexpected legal (and social) implications. Most of the laws about child pornography were established before the Internet became widely used, and certainly before sexting existed. In many states, your son, the girl in question, and anyone else connected to those images could be subject to prosecution under child porn charges, which could mean ending up as registered sex offenders—which sticks for a long time. Ironically, the laws that were created to protect children from being victimized by pornography are being used to convict children, who, in many ways, are doing what kids have always done.

Given all of these factors, do everything in your power to keep this out of the legal system and within the context of your family and the family of the girl in question. First, talk to your son. Avoid making this a moral question—this is not about whether he’s a good kid or not. You could say, for example, “We can deal with the issues of whether this was a good decision later, but right now, we need to talk about how to clean this up.” Then you should think about talking to the young woman and her parents, stressing that your concern is for her safety. Then, if necessary, consult an attorney about how the laws work where you live.

Ideally, prevention is the most effective approach. I encourage parents to really think through the implications of giving a child a cell phone, just as they would think through the implications of letting a child drive: he first needs to learn to use the tool safely. And that’s probably why you got him a phone in the first place—to keep him safe. To maintain that safety, start having clear, open discussions about what the phone will be used for as you move forward, who pays for it, and when and if you as a parent will have access to it. This is not to check up on him but rather to make the point that what’s on that phone is not, as he has now discovered, truly private.

See below for an MTV presentation on the consequences of sexting:

by Devika Rao, MD, Pulmonary Fellow

For a pediatric pulmonologist, the winter brings numerous questions from parents and other physicians regarding the management of recurring breathing problems in infants. Some of these infants have colds and some have chronic wheezing.

Some are hospitalized with bronchiolitis – an inflammation of the small airways of the lung. Bronchiolitis is typically caused by viruses, most commonly the respiratory syncytial virus (RSV) and infection rates peak from December to March. Symptoms range from just a cold with a runny nose, to wheezing or even severe difficulty breathing requiring hospitalization.  Some of the many known risk factors that predispose children to bronchiolitis include daycare attendance, tobacco smoke exposure and prematurity.

A recent study suggests that exposure to pool water in infancy may increase the risk of bronchiolitis. The results of this study showed that 36 percent of children who were exposed to pools before the age of two got bronchiolitis compared with 24 percent of children with bronchiolitis who did not swim during infancy.

The study’s results show that infants who swam for more than 20 hours had an increased risk for bronchiolitis compared to infants who either did not swim or who swam for a fewer number of hours.  The study suggests that exposure to chlorine byproducts in the pool water can cause inflammation of lung airways making infants more susceptible to infection.

I’m hesitant to apply the results of this study to all infants and children for several reasons.

• The information collected in this study was based on surveys asking parents to remember their children’s medical history from several years prior to when the questionnaire was distributed which can result in inaccurate information.
• A higher percentage of infants in the study who swam had a family history of asthma. This can predispose an infant to wheeze with viral illnesses, increasing the chances that a diagnosis of bronchiolitis may be made.
• It’s possible the increased amount of bronchiolitis is because of increased exposure to other sick children at pools rather than breathing in irritants – a variable the study did not consider.

Parents should be aware that while the relationship between pool exposure and respiratory health has not been well established, it is possible that the by-products of chlorination may be harmful to lung airways. When combined with organic contaminants such as urine or skin particles, chlorine can form potentially harmful byproducts known as chloramines, which cause the typical “chlorine” smell of pools and can lead to eye and skin irritation. Studies done in elite athlete swimmers have actually found higher levels of inflammation in their lungs, presumably due to the effect of chlorine byproducts.

However, rather than completely restrict water-based activities for infants, parents should be aware of the potentially irritating nature of chlorine, and more importantly, provide constant supervision of their children around pools.

Drownings are a leading cause of unintentional death in children. The American Academy of Pediatrics recommends delaying swimming lessons until after the age of four, when children are neurodevelopmentally fit to learn to swim.

Parents should also be aware that swimming is a wonderful form of exercise for asthmatic children, given the relatively humid environment that can prevent airway constriction seen with other forms of exercise. Parents can also ask whether the pools they allow their children to attend are within the recommended concentration of chlorine in the US of 1-3 mg/L.

Water-based recreation for infants and children can and should be a safe, enjoyable experience for both the child and parent.

by Peter C. Raffalli, MD, FAAP, pediatric neurologist & MARC pediatric associate.

Bullying is an ancient problem, right? Yes. Yes, it is. Bullying has been around for as long…well, as long as there have been kids, probably. So what’s new? Actually, a lot more than you might think.

While the problem of bullying is old, the severity of the problem is growing and the methods used by bullies, particularly with the advent of new technologies available to children and adolescents, have become more stealth and difficult for parents and educators to detect. However, the news is not all bad. There is simultaneously a call to arms from pediatric specialty groups (the American Academy of Pediatrics, the Massachusetts Aggression Reduction Center, the U.S. Health Resources and Services Administration) to increase vigilance to the problem and to advocate for victims of bullying.

The basic definition of bullying is kids who intentionally pick on other kids – not just once, but who do it more than once. Bullying can be from one peer or from a group of peers. The negative actions inflicted on the victim can include physical harm – hitting, kicking, pinching or psychological harm – teasing, insulting, belittling, shunning/excluding, playing repeated dirty tricks, spreading rumors.

It is high time that bullying is no longer dismissed as just a rite of passage in growing up. Bullying is a form of abuse victimization and many studies have shown the negative health impact of bullying, both short and long-term, on our kids. At the same time, the literature has also pointed to poor outcomes psychologically and socially for the bullies themselves.

It is important that we act quickly to identify effective screening tools and intervention protocols to help both bully and victim. The U.S. Health Resources and Services Administration (HRSA) has aptly pointed out that, since our goal is to help both the bully and the bullied, “our interventions need to be more therapeutic than punitive.”

Unfortunately, schools may differ in how they detect and deal with bullying which in turn leads to unpredictable success when enlisting the school’s help. Children sense this uncertainty and are very reluctant to report bullying to their parents.

In the case of electronic bullying, research from MARC has shown that 90% of children don’t report to anybody.  Very often the victim chooses to remain quiet in the hope that the bullying will stop. Unfortunately, the lack of action against the bully usually has quite the opposite effect – emboldening the bully. This is why more sensitive, proactive screening measures need to be in place. Schools cannot address bullying and cyberbullying in isolation. A strong network of cooperation between parent, school and pediatrician needs to be in place to screen for the problem and to intervene so that our children feel safe.

Studies have also drawn attention to the unfortunate fact that children with special needs are at higher risk for bullying than the general pediatric population. It is this aspect of bullying that has drawn me into the fray.

Recently I have begun to partner with Dr. Elizabeth Englander, a psychologist at Bridgewater State College and Director of MARC. She has studied the epidemiology of bullying behavior in children for many years, particularly in Massachusetts, and her team at MARC travels to schools to train school staff on bullying detection and intervention.

Together, Dr. Englander and I are combining our efforts at MARC and at Children’s by launching a project to study the risk factors for cyberbullying (a topic for which there is very little literature to date). We will be looking to determine whether cyberbullying shares risk factors in common with those known for other forms of bullying. Cyberbullying is growing fast and may already be the predominant form of bullying perhaps in part because it is done from a perceived distance and because it is even harder to detect without deliberate vigilance from parents and schools.

At the same time, Dr. Englander and I are developing a standardized interview questionnaire and short checklist that can be used efficiently by pediatricians to both screen for bullying in the office and also provide patients and families with basic guidance as to how to successfully help the child being bullied.

Here is some advice from Englander about what we should tell kids about bullying and cyberbullying.

The “old” advice about bullying – just ignore it, or stand up to a bully and they’ll leave you alone – isn’t very useful today.  Bullying often happens by the most popular kids in large groups, making it hard to ignore; and a child who hits another child (even if they are responding to being bullied) is likely to be disciplined themselves.

So what should we tell kids who are victims of bullying?
•    It’s not your fault, and you haven’t done anything wrong.  It’s never ok to attack another person.
•    Let’s separate – not mediate.  Mediation is the wrong approach to take with bullying situations, because bullies are not motivated to help change happen.
•    Talk to us!  Find a safe adult to talk to about what’s happening.
•    Think before requiring a bully to apologize.  An apology from a bully may be seen as a veiled threat.
•    Don’t retaliate.  Bullies want you to retaliate, so they can report you to adults.
•    If bullying happens online, report it.  Social networking sites have “report” links.
•    To help resolve this situation, we need details.  So walk me through a typical day and show me exactly, step by step, what happens.
•    Let’s spend a lot of time with our friends and our family.  Being with people who care about you can help how you feel.

What should we tell children who show signs of being a bully?
•    Even if you feel attacked or disrespected, it is never ok to attack another person.
•    Let’s look at different ways to interpret the social signals you receive from other children.
•    Sometimes kids do things that appear mean because they are trying to be funny.  It’s not funny and not ok.
•    Especially online, kids often believe that no one will ever see what they are doing.  Everything done online has a permanent record, and you can never control who sees you doing something on a social networking site.

by Marybeth Morris, Ed.M.

The advancement of medical science in diagnosing and treating certain pediatric cancers such as brain tumors or leukemia has led to increased survival rates for pediatric cancer patients. Due to neurocognitive deficits and physical sequelae, many child cancer survivors face significant challenges upon their return to school and throughout their academic career.

Schools often perceive that once a child’s treatment has ended, he or she will return to “baseline” and not necessarily require continued academic and emotional supports. Parents may also be uncertain about a few things.

• The continuing educational needs of their child
• How to ask for additional support
• What their specific rights are in ensuring an appropriate education for their child.

It’s important for parents and teachers to be aware of the subtle, and not so subtle, signs that a child may have an emerging deficit or weakness so that identification and intervention can begin as early as possible.

The most commonly reported deficits resulting from surgery, chemotherapy and/or radiation to the brain or spinal column include:

• Attention and executive function difficulties
• Poor memory
• Slowed processing speed
• Learning disabilities

Children are particularly vulnerable during times of transition, such as that from elementary to middle school or middle to high school. Potential signs of distress include but are not limited to:

• difficulty developing and maintaining peer relationships
• impulsivity and poor attention, organization and planning
• inability to independently complete assignments
• task avoidance
• slow pace completing homework and in-class assignments
• poor acquisition of reading and writing skills (connecting letters to sounds, letter sequencing and spelling)
• math difficulties (number sequences may be transposed, arithmetic signs confused, difficulties with word problems)
• difficulty remembering information and recalling facts including previously learned information

Most parents will, from time to time, see one or more of these warning signs in their children. If, however, a parent sees several of these characteristics over an extended period of time, formalized intervention may be necessary.

Public school systems are legally obligated to evaluate a student in the areas of suspected disability if the child’s parent requests an evaluation in writing. A typical core evaluation consists of an academic and psychological assessment. A psychological assessment always indicates cognitive testing, but may also include evaluation in the areas of social and emotional functioning and attention.  School personnel must complete all evaluation measures within 30 school days of parental consent and a special education team meeting to review results must be held within 45 school days.

Watch one Children’s patient’s return to school after chemotherapy.

Here’s a quick look at what Thrive was up to last week.

A new study suggests a change in the way we prescribe eyeglasses to children. Another study suggests more youth than ever are dealing with mental health issues. Judy Palfrey, MD, FAAP talks about the First Lady’s new anti-obesity initiative. A pill may just be the answer for individuals with fragile X syndrome. Find out all of the information you need to know about Massachusetts’s new tooth brushing law. A Children’s researcher discovers that people with anorexia have high levels of fat in their bone marrow. Massachusetts restaurants are leading the way in making dining out safer for those with food allergies. Our Mediatrician explores whether vampire fiction can contribute to anxiety. Children’s clinicians reflect on their time in Haiti.

Other stories we’ve been reading:

There’s more bad news for soda – a new study links it to pancreas cancer. [Read what Children’s obesity expert has to say about artificially sweetened beverages.] There are federal efforts to ban junk food from schools. [Read about junk food advertisements on kids’ websites.] The FDA wants nutrition information labels on the front of food packages. Junk food is getting the spot light in many movies.

Children born early in the year are more likely to be athletes. Obese children are more likely to die young. There’s a link between children with a super sweet tooth and alcoholism. Can you really tell if you’re child will be obese by age 2?

Depression during pregnancy could result in an antisocial teen. A pregnant woman can decrease her baby’s risk of schizophrenia later in life by increasing her iron intake. Obese moms put their newborns at risk for a number of health risks. Older women are more likely to give birth to a child who develops autism. Extremely premature babies show a higher risk for autism.

Obesity surgery may be the best solution for overweight teens. Early language problems may hinder adult literacy. There may be a genetic cause for your child’s obstructive sleep apnea. Childhood cancer survivors are at an increased of dying from a heart-related condition. Reading fiction may be the key to teen girls properly managing their weight.

Children’s deployed its own disaster response teams to Haiti immediately following the devastating earthquake. We’ve been fortunate enough to share their stories with you.

John Meara, MD, DMD of Plastic & Oral Surgery narrates this slide show featuring his time spent working in Haiti immediately following the earthquake. This was not Meara’s first time working with the people of Haiti.

Johanne Jocelyn, who is originally from Haiti and also a member of the disaster response team, recounts her experiences and shares her gratitude with her Children’s colleagues.

A team from The Boston Globe tells their stories while embedded with a disaster response medical team and features Children’s doc Meara.

Media expert Michael Rich, MD, MPH, director of the Center on Media and Child Health at Children’s Hospital Boston, answers your questions about media use. Last week, he discussed speech delays.

Here’s this week’s question:

by Sharyn Lincoln, M.S., C.G.C. & Jonathan Picker, MD, PhD

The ability to improve an intellectually disabled person’s IQ sounds like science fiction, and not so long ago it was – but that is changing.

The Boston Globe recently reported on one of the most exciting things happening in medicine, and one which may profoundly change the way society approaches children and adults with special needs.  Specifically, they reported on the use of a drug that looks like it is going to help individuals with fragile X syndrome think better.

Fragile X syndrome is a disorder that causes significant intellectual disability, as well as behavioral problems. As many as 1000 people in the greater Boston area are expected to have fragile X syndrome. Boys usually have more difficulties than girls, but the disorder can be devastating for both, as well as for their family and friends.

Right now, treatment is restricted to trying to control the effects of the disorder, and most individuals remain significantly impaired. Like many developmental disorders, better treatments have long been needed, but most researchers, until recently, had little hope for success.

That has all changed with the new so called ‘targeted’ drugs for fragile X syndrome.  These medications are the first to undergo large scale research trials with a specific goal of improving intellect. What makes these drugs so exciting is that they are “custom-made” to target the biochemical imbalance caused by the disorder.

Unlike traditional medicines that only treat symptoms, these drugs are specifically designed to restore the biochemical imbalance present in fragile X syndrome. As the brain chemistry normalizes, the symptoms, including intellectual disability, improve.

The advent of these medications is possible because of the research resulting from the Human Genome Project, which has allowed us to understand the molecular steps that cause various genetic conditions.  The development of targeted therapies has all happened at record speed as the scientists have worked hand in glove with the clinical researchers to move from theory to drug trials in the matter of just a few years.

And the best part is that fragile X syndrome is just one of many disorders that will benefit from this approach. While it is still early, we can at last begin to look towards the day when treating intellectual disability is as simple as taking a pill.

By Danielle M. Ledoux, MD, Department of Ophthalmology

Myopia or nearsightedness, a vision condition in which close objects are seen clearly, but objects farther away appear blurred, is extremely prevalent in our society and appears to be on the rise. A recent article estimated the prevalence of myopia in people aged 12 to 54 increased from 25 percent in the years in the early 1970s,  to 41.6 percent in the years 1999 to 2004.

Now, a new study suggests that treating myopia early with bifocal lenses—glasses that use two corrective powers in each lens–instead of single-vision lenses may slow progression of the eye condition in children.

Many factors are felt to contribute to myopia, most important being genetic factors.  Children who are myopic generally have parents who are myopic.However, environmental factors are possible contributors and attempts are being made to alter these to slow the progression of myopia.

One consideration is if computers or reading are causes of the increased incidence of myopia. As a possible explanation for this, we consider if prolonged focus (accommodation) changes the length of the eye.  This theory serves as the basis for a recent study published in Archives of Ophthalmology.

The study recruited Chinese-Canadian children from age 8 to 13 with mild to moderate myopia. The patients were selected if they had evidence of a mild increase in myopia during the year prior to enrollment.

The children were randomized to one of three treatment groups: single vision lenses (standard treatment), or to one of two types of bifocal lenses. Adding a bifocal to their myopic correction theoretically decreases the amount of focusing necessary to see clearly up close.

Their results showed a statistical benefit to the use of the bifocal lenses over single vision lenses in decreasing the progression of myopia during a two-year period.  We don’t know if this benefit would last if the patients were followed for a longer period of time.

The eyes treated with bifocals did show less eye growth than single vision lenses.  The theory of increased focusing resulting in increased myopia warrants more investigation.

The difference in myopic progression between bifocal versus single vision lenses was small. This may alter how much an eyeglass prescription changes yearly but it will not eliminate the need for glasses.

The authors admit the modest benefit seen in their study needs to be weighed against the increased cost of bifocal glasses, the appearance of the bifocal and the attitudes of the patient and their family to the use of bifocals.  They recommended caution in prescribing bifocals and I agree.  For these reasons, this study won’t change my current eyeglass prescribing patterns.

Here’s a quick look at what Thrive was up to last week.

Brian Skotko, MD, MPP, explores the term “Avatard.” A Children’s youth advisor calls for action to ban bullying. Children’s doctors recount time in Haiti to NPR’s All Things Condsidered and WGBH’s Greater Boston. Claire McCarthy, MD, warns parents about the choking game. Children’s doctors are closing in on the likely cause of SIDS. Brian Skotko, MD, MPP, discusses the “R” word the “R” word on ABC World News. The Mediatrician looks into whether TV watching could be related to speech delays.

Here’s a quick look at what Thrive was up to last week.

Brian Skotko, MD, MPP, explores the term “Avatard.” A Children’s youth advisor calls for action to ban bullying. Children’s doctors recount time in Haiti to NPR’s All Things Condsidered and WGBH’s Greater Boston. Claire McCarthy, MD, warns parents about the choking game. Children’s doctors are closing in on the likely cause of SIDS. Brian Skotko, MD, MPP, discusses the “R” word on ABC World News. After years of decline, teen pregnancy is on the rise. The Mediatrician looks into whether TV watching could be related to speech delays.

Other stories we’ve been reading:

Adolescents taking a certain anti-psychotic drugs are at an increased risk for diabetes. An industrial chemical is being sold as a dietary supplement for autism treatment. Diabetes drugs are helping dieting teens lose weight. [Read Minnie’s story about living with Type 2 diabetes.]

Loving foster homes improves children’s attention and impulsivity. Girls with ADHD are more likely to develop other mental health risks.

Obese boys are more likely to begin puberty later in life. A Girl Scouts’ survey found that the fashion industry pressures girls to be thin. [Read about unrealistic media images and how one teen feels about them.] Boys are treated with growth hormone therapy much more often than girls.

Babies of mothers who smoke during pregnancy are much more stressed out. [Read how dangerous secondhand smoke is to children.] Black and Hispanic infants are more likely to have HIV. Expectant mothers can receive pregnancy tips through texting.

Girls who bike to school are in better shape than those who walk or get a ride. The USDA is tightening requirements to assure school lunch safety. [Read about our nation’s fight for kids’ food.]  Overloaded backpacks set your child up for spine strain. [Read about National School Backpack Awareness Day.]

Media expert Michael Rich, MD, MPH, director of the Center on Media and Child Health at Children’s Hospital Boston, answers your questions about media use. Last week, he discussed toddlers and sign language.

Here’s this week’s question:

Q: I am a speech therapist, and a large percentage of the children with speech delays whom I treat are allowed to “graze” on TV all day. Are there any studies showing a relationship between TV watching and speech and communication delays in the preschool population?
–Serious about Speech in Atlanta, GA

A: Dear Serious,

We are not aware of many studies related specifically to speech delays, except for one study that suggests that “children with frequent television viewing…would have delayed development of meaningful word speech.” However, most of the media effects literature does not make a distinction between language delays and speech delays.

So if we look at the research that refers to language development but not specifically to speech, we can find more information that might also be related.  For example, babies seem to develop language far more effectively from people in real life than from people on screen. In one study, American children between ages of 6 and 12 months were exposed to native Chinese speakers in person and to the same native Chinese speakers on video. The infants who had real people interacting with them recognized and responded to specific phonemes, and those exposed to the video did not. What this seems to show is that human interaction appears to be critical in the complex process of language development.

But when the TV is on, parents tend not to talk as much to their children. And given that babies learn language from live people—particularly their parents!—having the TV on could be detrimental to that process. And although some research found no difference in word learning between babies who did and did not watch baby videos, it also found that the strongest predictor of number of words learned was the number of hours a baby was read to.

As a speech therapist, you likely already provide parents with specific guidelines on how to help their children. Though the media effects research specifically on speech is not an often-researched area, from these others studies I described, it seems like adding media recommendations could be helpful anyway.  Perhaps you could recommend that parents decrease or eliminate TV watching and increase interactions around books.  Or you could suggest that when their kids do watch TV, parents should watch with them and look to the TV program content for new topics to talk about with their kids.  By giving them activities that include speaking to, reading with, and interacting with the child, you can help families experience the difference between learning from a person and learning from a screen.

Enjoy your media and use them wisely,
The Mediatrician

By Brian Skotko, MD, MPP, Clinical Genetics Fellow

Some enthusiasts of the popular film by James Cameron are calling themselves “Avatards.” They are not the first to coin the term. The term has existed for a number of years, self-applied by fans of an animé series, Avatar: The Last Airbender. For many people with disabilities, the term bears chilling echoes of another word—the “R word”—that has come to haunt them in recent years.

While health care professionals are accustomed to the clinical terminology “mental retardation,” music artists and movie moguls have since popularized its pejorative playground usage. Ben Stiller mockingly used the “R word” in the 2008 movie, Tropic Thunder, and the Black Eyed Peas originally named one of their hit songs, “Let’s Get Retarded.” White House Chief of Staff Rahm Emanuel has come under fire recently for his use of the term “f—ing retarded” during a strategy session with White House staffers.

In response, thousands of individuals with disabilities have launched the “Spread the Word to End the Word” campaign, spearheaded by the Special Olympics. Celebrities like John C. McGinley, the popular Dr. Cox on Scrubs, says that “hearing the ‘R word’ makes people with intellectual disabilities—and those who love them—feel like less valued members of humanity.”

Even the government is taking notice. Last year, Massachusetts officially renamed its former “Department of Mental Retardation” as the “Department of Developmental Services.” A federal bill is currently working its way through Congress hoping to remove “mental retardation” and “mentally retarded” from federal laws, replacing the term with “intellectual disability” and “individual with an intellectual disability.”

So, while the enthusiasts of Avatar have chosen a peculiar name for themselves, our patients with disabilities have not. Their voices are now united asking all of us to think carefully about the next time we are tempted to use the “R word.” You can join the more than 50,000 people who have pledged support here.

Here’s a quick look at what Thrive was up to last week.

We continue our coverage of Children’s employees working in Haiti through daily updates from nurse anesthetist, Nelson Aquino. Judith Palfrey, MD, FAAP, president of the American Academy of Pediatrics writes about the most urgent children’s health stories that were neglected by the media last year. Claire McCarthy talks about the updated immunization schedule released by the American Academy of Pediatrics and the Center for Disease Control. Our Mediatrician answers one grandparent’s question about whether toddlers can learn sign language from DVDs.