It's that time again. I don't know about you, but it's positively scary how fast each new year rolls around! Here, in no particular order, are my picks of the most interesting or important pediatric stories of 2007:
- Baby Einstein or Baby Birdbrain?
Turns out that studies show that Baby Einstein won't turn your infant into an adult genius. In fact, these DVDs may even have a negative effect if used as an electronic babysitter/teacher in lieu of human interactions. Come on, you didn't really believe you could plop an infant in front of a DVD and make him/her smarter.
Aside from the fact that Einstein himself never had the benefit of Baby Einstein, infants learn best in the context of a relationship which offers not only one-way stimulation (like a video), but interaction - complex responses based on what the baby does or does not do - and, most importantly, teaching that occurs in the context of a burgeoning emotional attachment with a beloved caregiver. What video can even come close to that?
- Immunizations rule.
The new Human Papilloma Virus (HPV) vaccine appears to be very safe and effective. For the inevitable future scary outbreak, a new bird flu vaccine has been developed. Intranasal flu vaccine appears to work well. And more vaccines are in the pipeline.
Repeat after Dr. P: Immunizations are one of the great human inventions of the 20th century. Don't be tragically misled by fear-mongers who try to convince you that immunizing your kids is somehow irresponsible, rather than one of the great gifts you as a parent can provide your children.
- New antibiotic-resistant bacteria emerge.
What goes around comes around. For years we have known that bacteria eventually develop resistance to antibiotics. And for years we have been prescribing (and many parents have been insisting on) unnecessary antibiotics (e.g., for viral respiratory infections.). The result: the usual bacterial suspects are becoming more antibiotic resistant.
Who will eventually emerge victorious in this do-or-die contest: the drug manufacturers' ability to stay ahead of the curve and invent new antibiotics or the bacteria's ability to become resistant to them? There's no cause yet for panic, but we need to learn our lesson: no more unnecessary antibiotics for viral infections "just to be safe".
- Cold meds a hot topic.
Although I believe their danger has been overblown and they are pretty safe, there have been case reports of nasty side effects, especially in pre-school kids given more than the recommended dose of cold medications.
More important than potential risks, in my view: cold medications are pretty much useless and therefore not worth any risk, however small. Cough medicines, for example, are totally ineffective (in fact, if they did work they could be harmful. We need to cough up the goop and not let it just hang out in the back of the throat.). Decongestants probably can help some to stem the flow of mucous and offer some relief but, especially in young kids, is that slight edge worth the potential side effects? Finally, antihistamines do nothing to alleviate cold symptoms, but occasionally do make some kids sleepy at night (which, I suppose, is nothing to sneeze at).
All in all, grandma was right: chicken soup, hot lemon tea and honey, a vaporizer, elevate the head of the bed, provide a healthy dose of TLC, and wait for tincture of time to cure the cold.
- New sources of stem cells.
This is a good news story of 2007. It doesn't take a lot of imagination to see the wonderful potential of stem cells to cure human disease. The very good news in 2007 has been that new sources (other than controversial frozen embryos) have emerged which are likely to be effective.
Aside from transforming plain old human skin into stem cells, the placenta and amniotic fluid seem to have an abundance of these cells. In 2008, watch for plans to harvest these tissues and cells to create "banks" of stem cells which can be later offered to genetically compatible recipients to cure their diseases. And watch for more parents to "bank" some of these amniotic/placental cells for the infant him/herself, should s/he contract some disease in later life. Ain't modern medicine grand?
- Sleepy heads.
More evidence is emerging about the importance of a good night's sleep for kids. Those who have apnea or significant snoring or don't sleep enough hours seem to have more daytime problems, such as poorer concentration, moodiness, behavioral problems, information processing issues, etc.
There is no perfect answer - some kids just aren't great sleepers and others perhaps don't even require as much sleep as the books say. But the (awful) term "good sleep hygiene" can be applied to every child: a consistent bedtime with a soothing bedtime ritual (e.g., a warm bath and a story), a bedroom free of distractions (like the TV), and the incentive allow the child to put himself to sleep on his own.
- Get the lead out.
As by now you are well aware, it turns out surveillance of the safety of children's toys has been spotty. It's not just toys from China that are of concern. My understanding is that many countries recycle old metals and paints - some of which contain lead - into their new toys and paints. As a result, it can be kind of random if a toy might have lead or not. And, I don't need to remind you - lead at any level does not belong in your child's body.
Watch for more lead testing in 2008 by the toy manufacturers, by US agencies, and by local toy stores. Insist on purchasing only those toys which have been approved as safe and lead-free.
- Better school grades for kids with ADHD who take their meds.
Most doctors (like me) and most parents dealing with ADHD know the incredible benefits that stimulant medications can provide a child. But while there are a ton of studies demonstrating the safety and effectiveness of these medications in the short run, there has been little evidence of long term benefits.
That's why it was reassuring to see the results of an analysis in 2007 showing that kids with ADHD taking stimulant medication had better grades in school, compared to kids with ADHD who don't take meds. And, need I remind you, success in school is the name of the game for the 21st century child.
- New asthma guidelines.
New guidelines for treating this most common of chronic diseases were published in 2007. The good news: they are sensible and should go a long way to decrease symptoms and hospitalizations due to asthma. The bad news: the majority of pediatricians do not follow them and hence deliver suboptimal asthma care.
Got a child with asthma? Be sure your pediatric provider is aware of and following these effective new guidelines.
- The numbers of uninsured children remains a national disgrace. In 2006, about 11 million children under the age of 19 were uninsured (with the vast majority in families in which one or more parents were employed). A few unidentified flying facts: Uninsured children are 13 times more likely to lack a usual source of health care, 3 times as likely not to have seen a doctor in the past year, 5 times more likely to have at least one delayed or unmet health care need.
And of course you know our no-child-left-behind champion used his veto to nix the expansion of SCHIP (the supplemental bare bones insurance offered to uninsured kids). He's worried that its financial eligibility criteria would be too liberal and thereby turn SCHIP into a middle class entitlement.
Sorry, I just don't get why universal health insurance for our children isn't a no-brainer national mandate. If Dr. P has said it once, he's said it a thousand times: Of all the stupid ways for our society to save money, not providing all kids with health insurance has to be among the stupidest.
Here's to a stellar 2008 for you and your family!
Enjoy your kids!
- Dr. P
译文:
P医生2007年儿科故事 TOP 10
又是这个时间。我不认识你，但是一年过得如此之快真是令人感到恐怖!以下是我挑选出的2007年最有趣/最重要的儿科故事。
婴儿天才还是婴儿蠢才?
研究证实，Baby Einstein（为3个月到3岁孩子交互式活动的一系列玩具和产品） 并不等于在孩子长大后变成一名天才。事实上，如果作为电子保姆/老师来替代人类交流，这些DVDS甚至会起到负面的影响。原来，你也不认为你所生的孩子，在DVD前就可以使他或她更聪明。
除了爱因斯坦从来不是儿童爱因斯坦的受益者这个事实，婴儿学习最好的背景不仅能提供单向的刺激（像视频），还有交流-这种复杂的反应是以孩子做了什么或不做什么-并且，最重要地是，在与照顾者之间的萌芽情感联系背景下的教育。什么视频能到达那样的效果？
免疫规则。
新式人类乳头状病毒（HPV）疫苗非常的安全，有效。为了未来不可避免惊慌的爆发，新式禽流感疫苗已得到发展。鼻腔流感疫苗的功能显著。更多的疫苗正在研制中。
跟着P医生：免疫是20世纪人类伟大的发明之一。.不要被那些恐慌的制造者误导，他们试图说服你们给孩子免疫在某种程度上是不可靠的，并不是父母所能给孩子的礼品。
新耐抗生素病毒的出现。
流传的事物复苏。几年里我们已经知道病毒最终发展成耐抗生素。并且我们拿到的处方（很多父母一直坚持）是不需要抗生素的。（比如，病毒性呼吸道感染。）。结果：一般病毒疑似者正变得越来越耐抗生素。
谁将在这场殊死的较量中最终取胜：药物制造商始终保持处以领先地位的能力，发明新的抗生素还是病毒的能力逐渐适应抗生素？没有恐慌的理由，但是我们需要学习课程：对于病毒感染“紧紧是为了安全”的话，那不需要不必要的抗生素。
冷药物成为热点话题。
虽然我相信他们的危险被过分夸大而且他们十分安全，也有恶劣负面作用的案例报告，尤其是给学龄前儿童注射了超过推荐剂量的冷药物。
以我的观点，比潜在的风险更重要：冷药物非常的没有用，因此不值任何风险，而且体积小。咳嗽药物，比如，完全不起作用（事实上，如果他们起作用，他们确实有害。我们需要这种糊状物质，不让他在咽喉里游荡。解充血药可能能帮助产生粘液流，并且感觉轻松一点，尤其是小孩，难道轻微的优势是潜在的副作用？最终，抗组胺根本不能减轻冷症状，但是偶尔地可以使孩子在晚上熟睡（我猜这点，与打喷嚏无关）。
总而言之， 奶奶是正确的：鸡汤， 热柠檬茶和蜂蜜，喷雾器，抬高床头，提供温暖的爱护和关怀，等待酒精的挥发来治疗感冒。
干细胞的新来源。
这是2007年故事中最好的新闻。不需要太多的想象就能看到干细胞治疗人类疾病的奇妙潜力。这则2007年的好消息可能是更有效的新来源（不是有争议性的冷冻胚胎）的出现。
除了改变普通人类皮肤成干细胞，胎盘和羊水似乎有大量的这种细胞。2008年，注意可以丰富这些组织和细胞的计划，建立干细胞“库”，稍后能提供给基因适合的接受者来治疗他们的疾病。注意更多的父母自己“存入”羊膜/胎盘细胞，为了孩子他/她以后染上的某些疾病。难道现代医学不伟大？
沉睡的脑袋。
越来越多的证据正在证明孩子夜晚良好睡眠的重要性。那些有窒息状况或者严重的鼻息声，或者是没有充足睡眠的人似乎遇到比较多的白天问题，比如，注意力不集中，情绪低落，行为问题，信息处理问题等等。
没有完美的回答-一些孩子不是很能睡，一些孩子甚至不需要书上说的睡眠量。但是术语（可怕的）“健康睡眠的卫生学”对每个孩子都适用：一贯的睡觉时间，安慰性的睡眠方式（比如，一个热水澡和一个故事），没有干扰的卧室（像电视）和刺激，这样可以让孩子自己入睡。
远离铅。
像你现在所知道的，对儿童玩具安全性的监察是参差不齐的。并不像中国的玩具那样受到关注。我的理解是很多的国家循环利用旧金属和旧颜料-其中的一些含有铅-用于新的玩具和颜料中。结果，如果一个玩具含铅或者不含铅，完全是一种随机现象。而且，我不需要提醒你-在某种程度上铅不应进入孩子的是身体。
注意2008年由美国的机构，当地玩具店，玩具商进行的更多的铅测试。坚决购买那些已通过安全，无铅认证的玩具。
那些患有注意力极度缺乏症并服药的孩子取得好成绩。
大多数医生（像我一样），大多数父母在处理极度缺乏症方面知道刺激性药物可以给孩子带来难以置信的好处。但是在不久的将来有大量的研究表明这些药物的安全性和有效性之前，已经有少数长远利益的证据了。
那就是为什么可以欣慰的看到2007年的分析结果，表明学校里患有注意力极度缺乏症服药的服刺激性药物的孩子要比那些患有注意力极度缺乏症不服用药的孩子的成绩更好。并且需要我提醒你的是，对于21世纪的孩子来说在学校取得好成绩是根本。
新的哮喘准侧。
治疗慢性常见慢性疾病的新准则在2007年出版。好消息是：他们是明智的，并且在消除由于哮喘引起的病症和住院治疗方面还有一段很长的路。坏消息：大多数的儿科医生不遵循这些规则，因此耽误的最佳治疗哮喘的时机。
孩子得了哮喘？确定儿科医生知道并遵循这些有效的新准则。
未保险的儿童数量是一个国家的不光彩。2006年，大约1100万19岁以下的孩子没有保险（在大多数单亲或者多亲家庭中）几个不确定的事实：未保险的孩子可能13次缺少健康治疗，在过去的几年里3次不能去看医生，5次可能至少有一次耽误或者不能满足健康治疗的需要。
当然你说知道我们所有孩子的保护者使用他的否决去拒绝了联邦治疗计划(SCHIP)的扩张（向为保险的孩子提供极少的保费）。他担心经济资格的标准太自由，因此把联邦治疗计划变成了中产阶级的权利。
对不起，我不明白为什么孩子普通的健康保险不是一个愚蠢的国家指令。如果P医生曾经说过，那就已说了几千次：我们社会所有愚蠢的节省资金的方法中，不能给所有孩子提供健康保险是其中最愚蠢的方法。
祝愿您和您的家庭有一个闪亮的2008!
爱护你的孩子！
P医生