Tag Archives: Children’s Health

Massachusetts study: School nurses provide economic benefit

2 Jun

The National Association of School Nurses provides the following information about school nurses:

How many school nurses are there in the United States?
According to the Health Resources and Services Administration (HRSA), there are 73,697 registered nurses working as school nurses (HRSA, 2010).

Click to access rnsurveyinitial2008.pdf

How are school nurses funded?
Local school district budget, state budget, EPSDT, Title I, Medicaid (accessed by only 42% of schools), and community sponsors. http://www.nasn.org/AboutNASN/FrequentlyAskedQuestions

The Robert Wood Johnson Foundation reported in School Nurse Shortage May Imperil Some Children, RWJF Scholars Warn:

Demand for school nurses is growing.
Medical advances are allowing more premature babies and others with severe health conditions to survive into adulthood, but these children often require complex, continuous care at home and at school. There is a rising incidence of diseases with life-threatening implications such as diabetes, seizures, asthma, bleeding disorders, and severe allergies, according to a 2010 report on the future of nursing by the Institute of Medicine (IOM). And there is an increase in mental health disorders, such as substance abuse problems, eating disorders, anxiety, depression, and aggression. “What we saw 20 years ago in acute care hospitals is what we’re seeing now in the schools,” Newell said.
Growing poverty rates are also taking a toll, Newell added. She sees students with rotting teeth who can’t afford dental care; students who share asthma inhalers and insulin strips with relatives because their families cannot afford enough supplies for each individual member; and students who go to school sick because their parents can’t afford to take unpaid time away from work to care for them.
Under these circumstances, an inadequate supply of school nurses can be deadly. In September, Laporshia Massey, 12, died after suffering a severe asthma attack at a Philadelphia school on a day when no nurse was present. Massey’s father has said that an on-site school nurse could have saved his daughter’s life. “We’re worried that more tragedies like this will occur” if students don’t have access to a school nurse, Maughan said.
A Vital Role
School nurses serve nearly 50 million students nationwide in nearly 100,000 public schools, according to the IOM report. They are a subset of the nation’s public health nursing workforce; learn more about this workforce in a 2013 RWJF report…. http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2013/12/School-Nurse-Shortage-May-Imperil-Some-Children.html

See, Are school nurses disappearing? http://www.cnn.com/2011/HEALTH/04/04/school.nurse.shortage.parenting/

Denisa Superville and Evie Blad reported in the Education Week article, Philadelphia Tragedy Highlights Role of School Nurses:

The value of full-time, registered school nurses is not limited to the medical assistance they provide; there is also an economic benefit to society, according to a study published last month in the Journal of the American Medical Association.
Researchers studied 78 Massachusetts districts that participated in the state’s Essential School Health Services Program during the 2009-10 school year to demonstrate the benefits of having a full-time registered nurse on staff. The program cost $79 million, but researchers estimated that it saved $20 million in medical-care costs; $28.1 million in parents’ productivity loss; and $129.1 million in teachers’ productivity loss, generating a net benefit of $98 million.
Despite their medical and economic value, nurses are often among the first to go when districts face budget constraints because not every state requires a nurse to be in every school building, according to experts in the field. The U.S. Department of Health and Human Services recommends a ratio of one full-time, registered school nurse to every 750 students. The National Association of School Nurses suggests a lower ratio for schools with high numbers of students with special health needs, chronic illnesses, or developmental disabilities.
But in a 2013 survey of nearly 7,000 school nurses by the National Association of School Nurses, only 48 percent of respondents said they worked in environments that met or exceeded the federal recommendation—an improvement over 2011, when 43 percent met or exceeded that standard.
In the 2013 survey, 21.7 percent of the responding nurses reported that they covered several buildings and thus trained unlicensed co-workers to perform daily routines. And 16.2 percent of respondents said school nurse jobs in their areas had been threatened by cuts. Nearly 6 percent of nurses surveyed said other nurses in their district had been cut… http://www.edweek.org/ew/articles/2014/06/04/33philly_ep.h33.html?tkn=NYVF%2Fx9i5XFMOi7aMUx8sW20naBH5P%2FvtW78&intc=es

Citation:

Cost-Benefit Study of School Nursing Services
ONLINE FIRST
Li Yan Wang, MBA, MA1; Mary Vernon-Smiley, MD, MPH1; Mary Ann Gapinski, MSN, RN, NCSN2; Marie Desisto, RN, MSN3; Erin Maughan, PhD, MS, RN, APHN-BC4; Anne Sheetz, MPH, RN, NEA-BC2
[+] Author Affiliations
JAMA Pediatr. Published online May 19, 2014. doi:10.1001/jamapediatrics.2013.5441
ABSTRACT
ABSTRACT | METHODS | RESULTS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES
Importance In recent years, across the United States, many school districts have cut on-site delivery of health services by eliminating or reducing services provided by qualified school nurses. Providing cost-benefit information will help policy makers and decision makers better understand the value of school nursing services.
Objective To conduct a case study of the Massachusetts Essential School Health Services (ESHS) program to demonstrate the cost-benefit of school health services delivered by full-time registered nurses.
Design, Setting, and Participants Standard cost-benefit analysis methods were used to estimate the costs and benefits of the ESHS program compared with a scenario involving no school nursing service. Data from the ESHS program report and other published studies were used. A total of 477 163 students in 933 Massachusetts ESHS schools in 78 school districts received school health services during the 2009-2010 school year.
Interventions School health services provided by full-time registered nurses.
Main Outcomes and Measures Costs of nurse staffing and medical supplies incurred by 78 ESHS districts during the 2009-2010 school year were measured as program costs. Program benefits were measured as savings in medical procedure costs, teachers’ productivity loss costs associated with addressing student health issues, and parents’ productivity loss costs associated with student early dismissal and medication administration. Net benefits and benefit-cost ratio were calculated. All costs and benefits were in 2009 US dollars.
Results During the 2009-2010 school year, at a cost of $79.0 million, the ESHS program prevented an estimated $20.0 million in medical care costs, $28.1 million in parents’ productivity loss, and $129.1 million in teachers’ productivity loss. As a result, the program generated a net benefit of $98.2 million to society. For every dollar invested in the program, society would gain $2.20. Eighty-nine percent of simulation trials resulted in a net benefit.
Conclusions and Relevance The results of this study demonstrated that school nursing services provided in the Massachusetts ESHS schools were a cost-beneficial investment of public money, warranting careful consideration by policy makers and decision makers when resource allocation decisions are made about school nursing positions.

According to Truth About Nursing.org school nurses are a first defense against disease and injury. See, Why School Nurses Are Good for Children and Schools https://www.aft.org/pdfs/healthcare/value_schoolnurses.pdf

In Why do we need school nurses? Truth About Nursing summarizes the importance of school nurses:

School nurses save lives, increase student attendance and decrease early dismissals. Here’s what school nurses do. They:
• are the first line of defense against epidemics and disease outbreaks, monitoring the health of the overall population and connecting with public health officials;

• are the first responders to critical incidents on school property;

• provide direct health services for students;

• identify threats to health in the school community (peanut butter, dogs, traffic, broken equipment and facilities, bullies, lack of clean water or hand soap) and work to elimate those problems as a cause of ill health;

• provide leadership for the provision of health services, health policies and programs;

• provide a critical safety net for the most fragile students;

• provide screening and referral for health conditions such as vision, hearing;

• promote a healthy school environment;

• enable children with chronic health conditions to attend school;

• promote student health and learning;

• serve as a liaison between school personnel, family, community, and health care providers.
Important information from the National Association of School Nurses: http://www.nasn.org/
“The Role of the School Nurse” http://www.nasn.org/Portals/0/positions/2011psrole.pdf
Student-to-School Nurse Ratio Improvement Bills http://www.nasn.org/PolicyAdvocacy/StudenttoSchoolNurseRatioImprovementAct

Also see:
“Unlocking the Potential of School Nursing: Keeping Children Healthy, In School, and Ready to Learn,” by the Robert Wood Johnson Foundation. http://www.rwjf.org/en/research-publications/find-rwjf-research/2009/01/charting-nursings-future-archives/unlocking-the-potential-of-school-nursing.html http://www.truthaboutnursing.org/action/school_nurses.html#ixzz33YEv89BA

The study indicates that in the long run school nurses save money and increase the quality of life for children, their parents, and their communities. There is a nursing shortage and financially challenged school districts are in no position to compete for the scarce supply of nurses.

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States getting tough about requiring childhood vaccinations

19 May

Michaeleen Doucleff reported in the NPR story, How Vaccine Fears Fueled The Resurgence Of Preventable Diseases:

For most of us, measles and whooping cough are diseases of the past. You get a few shots as a kid and then hardly think about them again.
But that’s not the case in all parts of the world — not even parts of the U.S.
As an interactive maphttp://www.cfr.org/interactives/GH_Vaccine_Map/index.html#mapfrom the Council on Foreign Relations illustrates, several diseases that are easily prevented with vaccines have made a comeback in the past few years. Their resurgence coincides with changes in perceptions about vaccine safety….
http://www.npr.org/blogs/health/2014/01/25/265750719/how-vaccine-fears-fueled-the-resurgence-of-preventable-diseases?utm_medium=Email&utm_campaign=20140202&utm_source=mostemailed

There are many myths regarding vaccination of children.

Evie Blad reported in the Education Week article, States Tightening Loopholes in School Vaccine Laws:

As outbreaks of preventable diseases have spread around the country in recent years, some states have been re-evaluating how and why they allow parents to opt their children out of vaccines required for school attendance.
Requiring vaccines before school admission has been a key component of a decades-long campaign that had nearly rid the United States of some of its most severe illnesses, from the measles to whooping cough, public-health experts say. But they also warn that broad “personal belief” exemptions that don’t relate to a child’s medical condition or a family’s religious beliefs have made it too easy to bypass vaccines, poking a sizable hole in the public-health safety net.
While some parents act out of a sense of personal conviction, others do so simply because they don’t have time to schedule an appointment, said Stephanie L. Wasserman, the executive director of the Colorado Children’s Immunization Coalition, an Aurora, Colo.-based group that seeks to increase vaccine coverage in the state.
“We want to close that convenience loophole,” she said. “When you choose not to immunize, there are consequences not only to your child and your family; there are consequences to your community as well.”
Since 2011, Washington, Oregon, California, and Vermont have revised their personal exemption processes.
In Colorado—a state with one of the highest opt-out rates in the country and the most recent one to examine its vaccine-exemption policies—a bill passed this month would draw schools into the public health fight….
Laws at a Glance
While all states have school vaccination laws on the books, states vary on how much leeway parents have to opt their children out of required vaccinations.
50 states require specified vaccines for students, but allow exemptions for medical reasons.
48 states grant exemptions for people who have religious beliefs against immunizations. (Mississippi and West Virginia do not allow this exemption.)
19 states allow exemptions for those who object to immunizations for personal or moral beliefs.
SOURCE: National Conference of State Legislatures
http://www.edweek.org/ew/articles/2014/05/14/31vaccines.h33.html

Dina Fine Maron wrote in the Daily Beast article, 6 Top Vaccine Myths:

To sort through the onslaught of information and misinformation about childhood immunizations, we asked Austin, Texas-based pediatrician Ari Brown, coauthor of “Baby 411: Clear Answers and Smart Advice for your Baby’s First Year,” to debunk some of the most common vaccination myths.

Myth 1: It’s not necessary to vaccinate kids against diseases that have been largely eradicated in the United States.
Reality: Although some diseases like polio and diphtheria aren’t often seen in America (in large part because of the success of the vaccination efforts), they can be quite common in other parts of the world. The Centers for Disease Control and Prevention warns that travelers can unknowingly bring these diseases into the United States, and if we were not protected by vaccinations, these diseases could quickly spread throughout the population….

Myth 2: Mercury is still in kids’ vaccines.
Reality: At the center of this issue is a preservative called thimerosal (a compound containing mercury) that once was a common component in many vaccines because it allowed manufacturers to make drugs more cheaply and in multidose formulations. But public concern, new innovations and FDA recommendations led to its removal from almost all children’s vaccines manufactured after 2001. (More thimerosal background can be found at the FDA’s Web site) Since flu vaccines are not just for children, manufacturers still put thimerosal in some flu-shot formulations. You can ask your pediatrician for the thimerosal-free version, says Brown.
If your child does not have asthma and is at least 2 years old, Brown recommends the FluMist nasal-spray vaccination over the flu shot. “It seems to have better immune protection and it could help your child avoid another shot,” she says. (Caveat: the spray does contain a live version of the virus, which can result in a slight increase in flulike symptoms).

Myth 3: Childhood vaccines cause autism.
Reality: There is no scientific evidence that this link exists. Groups of experts, including the American Academy of Pediatrics and the Institute of Medicine (IOM), agree that vaccines are not responsible for the growing number of children now recognized to have autism…..

Myth 4: Getting too many vaccines can overwhelm the immune system and cause adverse reactions or even serious illness.
Reality: Children’s immune systems are capable of combating far more antigens (weak or killed viruses) than they encounter via immunizations. In fact, the jury is still out on if there’s an actual limit on how many the body can handle—though one study puts the number around a theoretical 10,000 vaccines in one day.(Visit the American Academy of Pediatrics’ site or the Network for Immunization Information for more information)
Currently, “There is even less of a burden on the immune system [via vaccines] today than 40 years ago,” says Edgar Marcuse, a professor of pediatrics at the University of Washington who works on immunization policy and vaccines…..

Myth 5: It’s better to let my kid get chickenpox “naturally.”
Reality: Before the chickenpox vaccine was licensed in 1995, parents sometimes brought their child to a party or playground hoping that their child might brush up against a pox-laden kid to get their dose of chickenpox over since cases were usually less severe for children than adults. But pediatricians say severe complications are possible with chickenpox—including bacterial infections that could result in a child’s hospitalization or death….

Myth 6: The flu shot causes the flu.
Reality: The flu shot does not contain a live virus, so your child can’t get the flu from this shot. But, after the shot, it’s not uncommon to feel a bit achy while the immune system mounts its response. Remember that for two weeks following the shot, your child can still get the flu, so be sure to help your child avoid that feverish kid next door.http://www.thedailybeast.com/newsweek/2009/02/22/six-top-vaccine-myths.html

A question in the current climate is what can be done to make parents responsible for putting other children at risk.

Jed Lipinksi wrote in the Slate article, Endangering the Herd: The case for suing:

As you’d expect, the growing anti-vaccination movement responded in fury. After Caplan wrote a related post for the Harvard Law Blog, angry comments poured in. “This article is industry propaganda at its worst,” one commenter declared. Another wrote: “Caplan would have familiar company in fascist Germany.” The blog eventually shut down the comments for violations of the site’s policies against “abusive and defamatory language” and the sharing of personal information.
Here’s why the anti-vaxxers are wrong and Caplan and his co-authors are right to raise the idea of suing or criminally charging them: Parents who choose not to vaccinate their kids for reasons of personal belief pose a serious danger to the public.
Measles vaccines are about 95 percent effective when given to children. That leaves a 5 percent chance that kids who are vaccinated will contract measles. This means that no matter what, the disease still poses a public health risk, but we rely on others to get vaccinated to hugely reduce the likelihood of outbreaks. That’s the process known as herd immunity.
Unvaccinated children threaten the herd. Take the San Diego measles outbreak of 2008. After unknowingly contracting the disease on a trip to Switzerland, an unvaccinated 7-year-old boy infected 11 other unvaccinated kids, according to the Centers for Disease Control and Prevention. The majority of the cases occurred in kids whose parents had requested personal belief exemptions (or PBEs) through the state of California, one of 17 states to allow them. But three of the infected were either too young or medically unable to be vaccinated. And overall, 48 children too young to be vaccinated were quarantined, at an average cost to the family of $775 per child. The CDC noted that all 11 cases were “linked epidemiologically” to the 7-year-old boy and that the outbreak response cost the public sector $10,376 per case.
Today, several states blame a rise in preventable diseases on the declining child vaccination rates. In Michigan, less than 72 percent of children have received their state-mandated measles, mumps, and rubella (MMR) vaccines. In New York, as Caplan noted in his blog post, pockets of Brooklyn’s Hasidic Jewish community are experiencing a mini measles epidemic. Thirty cases have been confirmed so far. According to Dr. Yu Shia Lin of Maimonides Medical Center, some members of the community avoid the measles vaccine because they think it causes autism. The most visible proponent of this idea, former Playboy Playmate Jenny McCarthy, will receive a giant new platform for her viewpoints when she joins the daytime gossipfest The View on Sept. 9.
The belief that the MMR vaccine causes autism goes back to a 1998 study published in the Lancet by a British gastroenterologist named Andrew Wakefield. In 2010, after years of criticism, the journal finally retracted Wakefield’s study, announcing that it was “utterly clear, without any ambiguity at all, that the statements in the paper were utterly false.” Britain’s General Medical Council later revoked Wakefield’s medical license, noting that he’d failed to disclose his role as a paid consultant to lawyers representing parents who thought vaccines had harmed their kids. The CDC makes clear there is no connection between vaccines and autism.
Yet this dangerous idea persists. Often, it persists among people who are simply doing what they think is best for their kids. Which is why it’s necessary to take extra measures to ensure nonvaccinators understand the risk they pose to other people’s children….
There are legal obstacles to penalizing parents who don’t vaccinate their kids. Courts are generally less likely to impose liability on someone who fails to act than they are on someone who acts recklessly. Also, proving cause and effect will sometimes be difficult. Then again, to win damages, a plaintiff would only have to prove that it’s “more likely than not” that a nonvaccinated child infected another person.parents who don’t vaccinate their kids—or criminally charging them….http://www.slate.com/articles/news_and_politics/jurisprudence/2013

It is just a matter of time before there will be lawsuits regarding whether a parent owed a duty to the public to vaccinate their child.

Here is information from the 6 Top Vaccine Myths regarding vaccination schedules:
For Health Care Professionals
Birth-18 Years and Catch-up
• View combined schedules (birth-18 years and catch-up)
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6201a2.htm
• Print combined schedules (including intro, summary of changes, references…) [355 KB, 7 pages]

Click to access mmwr-0-18yrs-catchup-schedule.pdf

• Print combined schedules in color (chart in landscape format) [202 KB, 5 pages] also in black & white [348 KB, 5 pages]

Click to access mmwr-0-18yrs-catchup-schedule.pdf

• Print full MMWR supplement (birth-18 years, catch-up, adult, adult medical and other indications, adult contraindications and precautions) [1MB, 21 pages]

Click to access mm62e0128.pdf

• Order free copies from CDC
http://wwwn.cdc.gov/pubs/ncird.aspx#schedules
For Everyone
Easy-to-read Schedules for All Ages
Easy-to-read formats to print, tools to download, and ways to prepare for your office visit.
• Infants and Children (birth through 6 years old)Find easy-to-read formats to print, create an instant schedule for your child, determine missed or skipped vaccines, and prepare for your office visit…
http://www.cdc.gov/vaccines/schedules/easy-to-read/child.html
• Preteens & Teens (7 through 18 years old)Print this friendly schedule, take a quick quiz, fill out the screening form before your child’s doctor visit, or download a tool to determine vaccines needed…
http://www.cdc.gov/vaccines/schedules/easy-to-read/preteen-teen.html
• Adults (19 years and older)Print the easy-to-read adult schedule, take the quiz, or download a tool to
• determine vaccines needed…
http://www.cdc.gov/vaccines/schedules/easy-to-read/adult.html
http://www.cdc.gov/vaccines/schedules/

Here is information from the American Academy of Pediatrics regarding vaccination.
http://www2.aap.org/immunization/ Parents must consult their doctors about vaccinations.

Related:

3rd World America: Tropical diseases in poor neighborhoods

3rd World America: Tropical diseases in poor neighborhoods

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

School personnel must be aware of epilepsy among children with physical disabilities

17 Mar

The Epilepsy Foundation has a great synopsis of the issues for schools regarding children with epilepsy. In Educators, the Epilepsy Foundation says:

About 300,000 American children and adolescents have seizure disorders, also known as epilepsy. Today, thanks to regular treatment with medicines that prevent seizures, many children with epilepsy have these episodes infrequently or not at all and are able to participate fully in school activities. However, children who are still having seizures may run into problems at school, problems like isolation from other students, low self-esteem and a lower level of achievement. Fortunately, many of these problems can be overcome or prevented through appropriate management by an informed school staff, particularly the classroom teacher and the school nurse.
Scholastic Achievement
Most children with epilepsy develop and learn similarly to children without epilepsy; however, as a group their risk for problems with learning is increased threefold. Approximately 9 percent of children with epilepsy have IQ’s below 70, a percentage that is three times greater than in the general population.
Children who achieve seizure control relatively quickly with few side effects and no cognitive impairments generally have the best chance for average or above average educational achievement. However, it is worth noting that children with epilepsy with average I.Q. may not achieve up to their potential, and attention problems have been identified across the spectrum. Loss of school time because of previously undiagnosed seizures or medical tests may also affect performance, even among children who are otherwise doing well.
Students with epilepsy are at increased risk for academic underachievement, particularly in the basic skills of reading, language, and arithmetic. Many of them are found to be significantly behind their peers in academic achievement levels, ranging from 16 percent below grade in reading to 50 percent in general knowledge. In addition, children with epilepsy have been found more likely to have impairment of self-concept and behavior than are children with asthma. Children with severe epilepsy are also likely to experience social rejection from peers.
Social Issues: Teachers & School Nurses Promote Understanding
Teacher attitude is an important factor in a child’s social adjustment at school; programs for the school community form an important part of most Epilepsy Foundation programs in local areas. Such programs generally focus on teacher awareness of seizure symptoms, seizure management and full integration of the child within the community. School nurses also play an important role in the management of the child with epilepsy at school, especially in dispensing of antiepileptic medication during the school day, and in educating the rest of the school community about epilepsy.
Education Rights
Gaining access to needed educational services is often difficult for parents of children with epilepsy. The Individuals with Disabilities Education Act (IDEA) is a federal law which states that every child with a disability is entitled to a free, appropriate education in the least restrictive setting. Children with epilepsy may be entitled to special education and related services under the Act if having epilepsy affects their educational performance. Every state has laws providing for some kind of educational services for children with disabilities.
Students of all ages may face obstacles to participation in educational programs, sports or housing programs. The Americans with Disabilities Act (ADA) forbids discrimination against qualified students with disabilities by educational institutions, including colleges and universities. If a school or college receives federal funds, the anti-discrimination regulations of Section 504 of the Rehabilitation Act of 1973 may also apply. http://www.epilepsyfoundation.org/livingwithepilepsy/educators/

Many children with physical disabilities also have epilepsy.

Special Education News posted Facts About Epilepsy Teachers Should Know:

A lot of teachers do not know but some children with physical disabilities will also suffer from problems like epilepsy.
Post by SEN Team | march 14th, 2013
There is a high chance of this occurring and because of that, special education teachers need to know the basic facts of what epilepsy is and how to deal with seizure first aid inside the classroom.
The Chance of Epilepsy Occurring
The occurrence of epilepsy in children is high. In a survey with over 200 children, there is a 0.5% chance of epilepsy from happening. Using this data, the special education services are making changes in the curriculum and teacher training in order for them to be able to handle epilepsy alongside another disability that the child is experiencing.

Teachers would have to understand how children are affected by these conditions. They need to learn what the long-term applications are in order for them to be able to adjust the well-being and daily functioning of the child.
General Facts and Myths about Epilepsy:
Truths:
1. Epilepsy can be diagnosed when seizures happen repeatedly without another trigger event.
2. Individuals who take correct treatment and medication can get rid of epilepsy.
3. There are over 40 various types of epileptic seizures with different range and ways of attacking a person.
4. Not every child with disability will have what they call tonic clonic seizure or grand mal.

False Statements:
1. A person can swallow their tongue when being attacked with seizure.
2. Epilepsy can be transferred from one person to another
3. People who have epilepsy have intellectual problems
What causes epilepsy?
Epilepsy occurs when there is a problem in the transmission and receiving of electrical activity in the brain. When an interruption occurs it can happen in different places in the brain and it will affect behavior, consciousness level as well as sensation and movement.

Children suffering from epilepsy will have a different brain activity, sometimes it will run at a much faster rate than what is normal causing the epileptic seizure to occur. Some types of seizure are easier to detect when compared with others.

Types of Epilepsy and Seizures
Other types of seizure are not easily detectable. Some seizures are described as simple or partial and will have no direct effect on the conscious level of the individual while the other will be described as more complex.

A person suffering will have an altered state of consciousness and it would be best for teachers to know the standard emergency procedures needed to help solve the problem while it is occurring in class.
http://www.specialednews.com/news/facts-about-epilepsy-teachers-should-know.htm

The Epilepsy Foundation also has great resources which explain to parents their children’s rights for an education.

In Elementary and Secondary Education Law, the Epilepsy Foundation advises:

IDEA and Your Right to a “Free, Appropriate Education”
IDEA, formerly known as the Education for All Handicapped Children Act (P.L. 92-142), guarantees children with disabilities a “free, appropriate public education in the least restrictive setting.” This means that local school districts must develop and pay for an educational program that is tailored to the individual needs of the child with a disability. In some situations, the local school district may even be legally required to pay tuition at a private school or the cost of an outside provider if it is unable to provide the needed services in its own schools.
To qualify for protection under IDEA, a child must have a disability that adversely affects his or her ability to learn, and thus needs special education and related services. “Special education” includes instruction that is specifically designed to meet the child’s unique needs that result from a disability. It can involve adapting the content, methodology or delivery of the instruction. Disabilities covered under IDEA may include health impairments such as epilepsy, as well as traumatic brain injuries, learning disabilities, mental retardation and autism. (A child with epilepsy or another disability who does not qualify for services under IDEA may, however, qualify for services under Section 504 of the Rehabilitation Act, as discussed below.)
By law, public schools are required to educate children with disabilities in the “least restrictive environment” possible. This means schools cannot place a child with epilepsy in a special education classroom, away from students who do not have a disability, simply because the child with the disability requires special services. Instead, the school must allow these children to be mainstreamed and provide the related service in some other way, such as having the child visit the nurse at a designated time each day to receive medication.
For a child with epilepsy, commonly requested related services include: health services (such as administration of medication in the event of a prolonged seizure), specialized recreation services (for a child with uncontrolled seizures), counseling (to compensate for the social adjustment aspects of epilepsy) and other non-instructional services. Specialized instruction may also be necessary to compensate for accompanying learning disabilities or other cognitive impairments resulting from frequent losses of consciousness or other impairment of attention or learning ability. In some situations, it may be appropriate for the child to receive this instruction once a week for an hour at a time, for example, whereas in other situations, the severity of a child’s disability requires he or she receive specialized instruction full time. Under IDEA, the school is required to provide effective educational services in the least restrictive environment, including any related services that may be necessary to educate the child…. http://www.epilepsyfoundation.org/livingwithepilepsy/educators/educationlaws/elementary-and-secondary-education-law.cfm

All children have a right to a good basic education.

Resources:

What Is Epilepsy
http://www.epilepsyfoundation.org/aboutepilepsy/whatisepilepsy/index.cfm?gclid=CKrPqJSmmr0CFc9AMgodchQA5w

Epilepsy and Your Child’s School http://www.webmd.com/epilepsy/guide/children-school

Epilepsy http://kidshealth.org/parent/medical/brain/epilepsy.html

Related:

Father’s age may be linked to Autism and Schizophrenia https://drwilda.com/2012/08/26/fathers-age-may-be-linked-to-autism-and-schizophrenia/

Where information leads to Hope. © Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©
http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©
http://drwildareviews.wordpress.com/

Dr. Wilda ©
https://drwilda.com/

Preventable diseases are on the rise because of fears of vaccines

8 Feb

Michaeleen Doucleff reported in the NPR story, How Vaccine Fears Fueled The Resurgence Of Preventable Diseases:

For most of us, measles and whooping cough are diseases of the past. You get a few shots as a kid and then hardly think about them again.
But that’s not the case in all parts of the world — not even parts of the U.S.
As an interactive map http://www.cfr.org/interactives/GH_Vaccine_Map/index.html#map from the Council on Foreign Relations illustrates, several diseases that are easily prevented with vaccines have made a comeback in the past few years. Their resurgence coincides with changes in perceptions about vaccine safety.
Since 2008 folks at the think tank CFR have been plotting all the cases of measles, mumps, rubella, polio and whooping cough around the world. Each circle on the map represents a local outbreak of a particular disease, while the size of the circle indicates the number of people infected in the outbreak.
As you flip through the various maps over the years, two trends clearly emerge: Measles has surged back in Europe, while whooping cough is has become a problem here in the U.S.
Childhood immunization rates plummeted in parts of Europe and the U.K. after a 1998 study falsely claimed that the vaccine for measles, mumps and rubella was linked to autism.
That study has since been found to be fraudulent. But fears about vaccine safety have stuck around in Europe and here in the U.S.
Viruses and bacteria have taken full advantage of the immunization gaps.
In 2011, France reported a massive measles outbreak with nearly 15,000 cases. Only the Democratic Republic of Congo, India, Indonesia, Nigeria and Somalia suffered larger measles outbreaks that year.
In 2012, the U.K. reported more than 2,000 measles cases, the largest number since 1994.
Here in the U.S., the prevalence of whooping cough shot up in 2012 to nearly 50,000 cases. Last year cases declined to about 24,000 — which is still more than tenfold the number reported back in the early ’80s when the bacteria infected less than 2,000 people.
So what about countries in Africa? Why are there so many big, colorful circles dotting the continent? For many parents there, the problem is getting access to vaccines, not fears of it.
http://www.npr.org/blogs/health/2014/01/25/265750719/how-vaccine-fears-fueled-the-resurgence-of-preventable-diseases?utm_medium=Email&utm_campaign=20140202&utm_source=mostemailed

There are many myths regarding vaccination of children.

Dina Fine Maron wrote in the Daily Beast article, 6 Top Vaccine Myths:

To sort through the onslaught of information and misinformation about childhood immunizations, we asked Austin, Texas-based pediatrician Ari Brown, coauthor of “Baby 411: Clear Answers and Smart Advice for your Baby’s First Year,” to debunk some of the most common vaccination myths.
Myth 1: It’s not necessary to vaccinate kids against diseases that have been largely eradicated in the United States.
Reality: Although some diseases like polio and diphtheria aren’t often seen in America (in large part because of the success of the vaccination efforts), they can be quite common in other parts of the world. The Centers for Disease Control and Prevention warns that travelers can unknowingly bring these diseases into the United States, and if we were not protected by vaccinations, these diseases could quickly spread throughout the population. At the same time, the relatively few cases currently in the U.S. could very quickly become tens or hundreds of thousands of cases without the protection we get from vaccines. Brown warns that these diseases haven’t disappeared, “they are merely smoldering under the surface.”
Most parents do follow government recommendations: U.S. national immunization rates are high, ranging from 85 percent to 93 percent, depending on the vaccine, according to the CDC. But according to a 2006 study in the Journal of the American Medical Association, the 20 states that allow personal-belief opt outs in addition to religious exemptions saw exemptions grow by 61 percent, to 2.54 percent between 1991 and 2004.
Brown is concerned that parents who opt out or stagger the vaccine schedule can end up having to deal with confusing follow-up care, which could produce an increase in disease outbreaks like last summer’s measles epidemic. A 2008 study in the American Journal of Epidemiology reported that when there are more exemptions, children are at an increased risk of contracting and transmitting vaccine-preventable diseases.
For more on the pros and cons of staggering or skipping vaccinations, visit MSN’s guide or read this U.S. News and World Report piece. For information on vaccine safety, check out the CDC’s information page. To search for your state’s vaccine requirements, see the National Network for Immunization Information.
Myth 2: Mercury is still in kids’ vaccines.
Reality: At the center of this issue is a preservative called thimerosal (a compound containing mercury) that once was a common component in many vaccines because it allowed manufacturers to make drugs more cheaply and in multidose formulations. But public concern, new innovations and FDA recommendations led to its removal from almost all children’s vaccines manufactured after 2001. (More thimerosal background can be found at the FDA’s Web site) Since flu vaccines are not just for children, manufacturers still put thimerosal in some flu-shot formulations. You can ask your pediatrician for the thimerosal-free version, says Brown.
If your child does not have asthma and is at least 2 years old, Brown recommends the FluMist nasal-spray vaccination over the flu shot. “It seems to have better immune protection and it could help your child avoid another shot,” she says. (Caveat: the spray does contain a live version of the virus, which can result in a slight increase in flulike symptoms).
Myth 3: Childhood vaccines cause autism.
Reality: There is no scientific evidence that this link exists. Groups of experts, including the American Academy of Pediatrics and the Institute of Medicine (IOM), agree that vaccines are not responsible for the growing number of children now recognized to have autism.
Earlier this month, the law supported scientists’ conclusions in this arena with three rulings from a section of the U.S. Court of Federal Claims, which stated that vaccines were not the likely cause of autism in three unrelated children. The U.S. Department of Health and Human Services said in an online statement following the ruling, “The medical and scientific communities have carefully and thoroughly reviewed the evidence concerning the vaccine-autism theory and have found no association between vaccines and autism.” Noting the volume of scientific evidence disproving this link, an executive member of one of the nation’s foremost autism advocacy groups, Autism Speaks, recently stepped down from her position because she disagrees with the group’s continued position that there is a connection between the vaccines and autism.
Get Newsweek on your Tablet
Myth 4: Getting too many vaccines can overwhelm the immune system and cause adverse reactions or even serious illness.
Reality: Children’s immune systems are capable of combating far more antigens (weak or killed viruses) than they encounter via immunizations. In fact, the jury is still out on if there’s an actual limit on how many the body can handle—though one study puts the number around a theoretical 10,000 vaccines in one day.(Visit the American Academy of Pediatrics’ site or the Network for Immunization Information for more information)
Currently, “There is even less of a burden on the immune system [via vaccines] today than 40 years ago,” says Edgar Marcuse, a professor of pediatrics at the University of Washington who works on immunization policy and vaccines. He points to the whooping-cough vaccine as an example where there are far fewer antigens in the shot than the earlier version administered decades ago. Brown says she supports following the recommended schedule for vaccinations, which outlines getting as many as five shots in one day at a couple check-ups. (The CDC’s recommended vaccination schedule can be found here.) “I have kids, and I wouldn’t recommend doing anything for my patients that I wouldn’t do for my own kids,” she says.
The CDC reports that most vaccine adverse events are minor and temporary, such as a sore arm or mild fever and “so few deaths can plausibly be attributed to vaccines that it is hard to assess the risk statistically.” Of all deaths reported to the Health and Human Services’ Vaccine Adverse Events Reporting site between 1990 and 1992, only one is believed to be even possibly associated with a vaccine. The Vaccine Safety Datalink Project, an initiative of the CDC and eight health-care organizations, looks for patterns in these reports and determines if a vaccine is causing a side effect or if symptoms are largely coincidental.
If you have concerns about following the recommended vaccination, schedule don’t wait until a check-up. Set up a consultation appointment with your pediatrician, or even outline a strategy for care with your doctor during your pregnancy.
Myth 5: It’s better to let my kid get chickenpox “naturally.”
Reality: Before the chickenpox vaccine was licensed in 1995, parents sometimes brought their child to a party or playground hoping that their child might brush up against a pox-laden kid to get their dose of chickenpox over since cases were usually less severe for children than adults. But pediatricians say severe complications are possible with chickenpox—including bacterial infections that could result in a child’s hospitalization or death. (More information on the chickenpox vaccine is available at the CDC’s Web site.)
Now that there’s a vaccine for chickenpox, more than 45 states require the shots (unless your child already had the chicken pox or can prove natural immunity). Two shots usually guarantees your child a way out of being bedecked in calamine lotion for two feverish weeks, but some individuals do still come down with a milder form of the pox. Most pediatricians recommend getting the shot.
Myth 6: The flu shot causes the flu.
Reality: The flu shot does not contain a live virus, so your child can’t get the flu from this shot. But, after the shot, it’s not uncommon to feel a bit achy while the immune system mounts its response. Remember that for two weeks following the shot, your child can still get the flu, so be sure to help your child avoid that feverish kid next door. http://www.thedailybeast.com/newsweek/2009/02/22/six-top-vaccine-myths.html

A question in the current climate is what can be done to make parents responsible for putting other children at risk.

Jed Lipinksi wrote in the Slate article, Endangering the Herd: The case for suing:

As you’d expect, the growing anti-vaccination movement responded in fury. After Caplan wrote a related post for the Harvard Law Blog, angry comments poured in. “This article is industry propaganda at its worst,” one commenter declared. Another wrote: “Caplan would have familiar company in fascist Germany.” The blog eventually shut down the comments for violations of the site’s policies against “abusive and defamatory language” and the sharing of personal information.
Here’s why the anti-vaxxers are wrong and Caplan and his co-authors are right to raise the idea of suing or criminally charging them: Parents who choose not to vaccinate their kids for reasons of personal belief pose a serious danger to the public.
Measles vaccines are about 95 percent effective when given to children. That leaves a 5 percent chance that kids who are vaccinated will contract measles. This means that no matter what, the disease still poses a public health risk, but we rely on others to get vaccinated to hugely reduce the likelihood of outbreaks. That’s the process known as herd immunity.
Unvaccinated children threaten the herd. Take the San Diego measles outbreak of 2008. After unknowingly contracting the disease on a trip to Switzerland, an unvaccinated 7-year-old boy infected 11 other unvaccinated kids, according to the Centers for Disease Control and Prevention. The majority of the cases occurred in kids whose parents had requested personal belief exemptions (or PBEs) through the state of California, one of 17 states to allow them. But three of the infected were either too young or medically unable to be vaccinated. And overall, 48 children too young to be vaccinated were quarantined, at an average cost to the family of $775 per child. The CDC noted that all 11 cases were “linked epidemiologically” to the 7-year-old boy and that the outbreak response cost the public sector $10,376 per case.
Today, several states blame a rise in preventable diseases on the declining child vaccination rates. In Michigan, less than 72 percent of children have received their state-mandated measles, mumps, and rubella (MMR) vaccines. In New York, as Caplan noted in his blog post, pockets of Brooklyn’s Hasidic Jewish community are experiencing a mini measles epidemic. Thirty cases have been confirmed so far. According to Dr. Yu Shia Lin of Maimonides Medical Center, some members of the community avoid the measles vaccine because they think it causes autism. The most visible proponent of this idea, former Playboy Playmate Jenny McCarthy, will receive a giant new platform for her viewpoints when she joins the daytime gossipfest The View on Sept. 9.
The belief that the MMR vaccine causes autism goes back to a 1998 study published in the Lancet by a British gastroenterologist named Andrew Wakefield. In 2010, after years of criticism, the journal finally retracted Wakefield’s study, announcing that it was “utterly clear, without any ambiguity at all, that the statements in the paper were utterly false.” Britain’s General Medical Council later revoked Wakefield’s medical license, noting that he’d failed to disclose his role as a paid consultant to lawyers representing parents who thought vaccines had harmed their kids. The CDC makes clear there is no connection between vaccines and autism.
Yet this dangerous idea persists. Often, it persists among people who are simply doing what they think is best for their kids. Which is why it’s necessary to take extra measures to ensure nonvaccinators understand the risk they pose to other people’s children….
There are legal obstacles to penalizing parents who don’t vaccinate their kids. Courts are generally less likely to impose liability on someone who fails to act than they are on someone who acts recklessly. Also, proving cause and effect will sometimes be difficult. Then again, to win damages, a plaintiff would only have to prove that it’s “more likely than not” that a nonvaccinated child infected another person.parents who don’t vaccinate their kids—or criminally charging them…. http://www.slate.com/articles/news_and_politics/jurisprudence/2013/08/anti_vaxxers_why_parents_who_don_t_vaccinate_their_kids_should_be_sued_or.html

Related:

3rd World America: Tropical diseases in poor neighborhoods https://drwilda.com/2012/08/20/3rd-world-america-tropical-diseases-in-poor-neighborhoods/

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University of Montreal study: Aggressive behavior in toddlers may have genetic link

22 Jan

Moi wrote in Study: Consumption of soft drinks may be linked to aggression in children
The Center for Sport Policy and Conduct (Sport Center) at Indiana University, Bloomington has excellent capsule definitions of violence, aggression, and deviance According to the Sport Center violence is defined as:

Violence can be seen as a form of physical assault based on an intent to injure another person or destroy the property of others. To continue this definition, “violence in sport violates the norms and rules of the contest, threatens lives and property, and usually cannot be anticipated by the persons affected” (Smith, 1983, p. 6). http://www.indiana.edu/~cspc/violence.htm

Aggression is defined as:

Aggression can be generally defined as all behavior intended to destroy another person’s property or to injure another person, physically or psychologically. It has been reported that action has to violate norms and rules shared by society in order to be defined as aggressive. Several experiments (Tedeschi, Gaes, & Rivera, 1977) found that a protagonist who intends to cause injury is only judged by witnesses to be aggressive when his behavior is also judged to be antinormative; in other words, when they are opposing the social rules that apply to that particular situation. Judgment is the same when the action or “intent to injure” constitutes a response to a previous provocation. If, however, the action exceeds the preceding deed, the revenge is viewed as excessive and judged as inappropriate and aggressive.

Deviance is defined as “Deviant behavior is usually that which departs from the norm; anything that goes against the accepted societal standards could be classified as such.”

Leo J. Bastiaens, MD and Ida K. Bastiaens wrote an excellent article about youth aggression in the Psychiatric Times. One part of the article looked at the economic impact.

Before taking into account the costs of juvenile justice programs and institutions, youth violence alone costs the United States more than $158 billion each year….
US cities lose nearly $50 billion a year because of crime and violence….Reallocation of resources, new social spending initiatives, programs with a higher quality of care, and a better public health perspective would change the lives of our youths and cut the social cost of juvenile crime in the United States. http://www.psychiatrictimes.com/display/article/10168/51911?verify=0

What is Aggressive Behavior?

Dr. Dianne S. O’Connor lists the following causes of aggressive behavior in children

• Genetic and/or temperamental influences.
• Insecure or disorganized attachment patterns.
• Ongoing and unrelieved stress.
• Lack of appropriate problem solving and coping strategies.
• Limited experience with role models (e.g. peers, family members, TV. & computer games) who value and provide examples of non-aggressive behaviors.
• Ineffective parenting style: for example, authoritarian, controlling, harsh or coercive parenting style; permissive, overindulgent parenting style; rejecting parenting style; psychological problems in the parent such as depression or alcoholism.
• Poor fit between parent and child: Ineffective parenting could be an effect rather than a cause of the child’s behavior. Children’s problem behaviors may affect parents’ moods and parenting behaviors.
• Family stress, disruption and conflict. http://www.solutionsforchildproblems.com/aggressive-behavior-children.html

There are certain family and social risk factors which should alert educators and social workers that an early intervention may be needed.

Physorg.Com reported about an University of North Carolina at Chapel Hill study which cites early neglect as a predictor of aggressive behavior in children.

Early child neglect may be as important as child abuse for predicting aggressive behavior, researchers say. Neglect accounts for nearly two-thirds of all child maltreatment cases reported in the United States each year, according to the Administration for Children and Families. http://phys.org/news126764603.html
According to Joan Arehart-Treichel’s article in Psychiatric News, aggression comes in four types. She writes about a study project conducted by He was Henri Parens, M.D., a professor of psychiatry at Jefferson Medical College and a training and supervising analyst at the Psychoanalytic Center of Philadelphia. “Parens and his colleagues not only met with 10 socioeconomically disadvantaged mothers and their 16 infants twice a week over seven years, but have been following up with the mothers and their offspring ever since.” According to Arehart –Treichel, the four types of aggression are
One was a nondestructive aggression, the kind the 5-month-oldgirl had demonstrated. It is children’s attempt to master themselves and their environment. “This is a magnificent kind of aggression,”Parens said. It represents the kind that drives youngsters toexcel academically, win at sports, climb mountains, and do fantastic things with their lives. It is inborn and essential for survivaland adaptation. It is the kind of aggression that parents should cultivate.
A second kind of aggression is the urge to obtain food. It toois inborn and essential for survival and adaptation.
A third kind of aggression is displeasure-related aggression(say, a temper tantrum or a rage reaction), and a fourth kindof aggression is pleasure-related aggression (for example, teasingand taunting). Neither is inborn; both are hostile aggression,and both are activated by emotional pain. In other words, hurtinga person’s feelings can generate hostile aggression. That istrue for all people. In contrast, people whose feelings arenot hurt will probably not engage in hostile aggression.

According to Parens’ observations a good deal of the aggression behavior observed in the children in the study was related to how their parents treated them.

Aggressive Behavior in Boys

PBS has a good description of aggression in boys and what characteristics are normal and not necessarily cause for concern.

Why do boys become aggressive? Sometimes boys are aggressive because they are frustrated or because they want to win. Sometimes they are just angry and can’t find another way to express that feeling. And some may behave aggressively, but they’re not aggressive all the time.
An active boy is not necessarily an aggressive one. “We often see young boys playing out aggressive themes. It’s only a problem when it gets out of control,” comments Thompson.
Competition, power and success are the true stuff of boys’ play. Many young boys see things in competitive terms and play games like “I can make my marble roll faster than yours,” “my tower is taller than yours” and “I can run faster than you.” But these games of power and dominance are not necessarily aggressive unless they are intended to hurt.
Fantasy play is not aggressive. A common boy fantasy about killing bad guys and saving the world is just as normal as a common girl fantasy about tucking in animals and putting them to bed. “Most boys will pick up a pretzel and pretend to shoot with it,” comments teacher Jane Katch. “If a boy is playing a game about super heroes, you might see it as violent. But the way he sees it, he’s making the world safe from the bad guys. This is normal and doesn’t indicate that anything is wrong unless he repeatedly hurts or tries to dominate the friends he plays with. And sometimes an act that feels aggressive to one child was actually intended to be a playful action by the child who did it. When this happens in my class, we talk about it, so one child can understand that another child’s experience may be different than his own. This is the way empathy develops.”
Only a small percentage of boys’ behavior is truly aggressive. While “all boys have normal aggressive impulses which they learn to control, only a small percentage are overly aggressive and have chronic difficulty controlling those impulses,” says Michael Thompson, Ph.D. These are the boys who truly confuse fantasy with reality, and frequently hit, punch, and bully other kids. They have a lack of impulse control and cannot stop themselves from acting out. “They cannot contain their anger and have little control over their physical behavior and this is when intervention by parent or teacher is needed,” says Thompson. http://www.pbs.org/parents/raisingboys/aggression02.html

The key point is a lot of behavior, which is normal activity for most boys is not unacceptable aggression and should not trigger the use of medication for behavior which is within the normal range.

A University of Chicago examined boys who exhibited abnormal aggression and found that there might be a physical cause.

Unusually aggressive youth may actually enjoy inflicting pain on others, research using brain scans at the University of Chicago shows.
Scans of the aggressive youth’s brains showed that an area that is associated with rewards was highlighted when the youth watched a video clip of someone inflicting pain on another person. Youth without the unusually aggressive behavior did not have that response, the study showed.
The results are reported in the paper “Atypical Empathetic Responses in Adolescents with Aggressive Conduct Disorder: A functional MRI Investigation” in the current issue of the journal Biological Psychology. Benjamin Lahey, the Irving B. Harris Professor of Epidemiology and Psychiatry at the University, co-authored the paper, along with University students Kalina Michalska and Yuko Akitsuki. The National Science Foundation supported the work.
In the study, researchers compared eight 16- to 18-year-old boys with aggressive conduct disorder to a control group of adolescent boys with no unusual signs of aggression. The boys with the conduct disorder had exhibited disruptive behavior such as starting a fight, using a weapon and stealing after confronting a victim.

Clearly, the youth in this study were not the typical boy and required intervention.

Generally, boys are thought to be more physically aggressive and girls are thought to be more socially or indirectly aggressive. Carolyn Willbert reports on a study at WebMD, which finds boys use indirect methods of aggression as well.

Girls often get a bad rap for gossiping, forming cliques, and other aggressive social behavior, as characterized in the popular movie Mean Girls. Boys, meanwhile, are known for physically aggressive behavior, such as hitting.

One study, however, says these attitudes may be at least partly unfounded. While boys are indeed more physically aggressive, girls and boys are equally guilty of aggressive social behavior, according to the report published in Child Development.

Researchers did an analysis of 148 studies that included nearly 74,000 children and teenagers. The studies were mostly done in schools and looked both at direct aggression, which is physical or verbal, and indirect aggression, which includes covert behaviors designed to damage another person’s social relations with others, without direct confrontation.
“These conclusions challenge the popular misconception that indirect aggression is a female form of aggression,” says Noel A. Card, PhD, assistant professor of family studies and human development at the University of Arizona and the study’s lead author, in a news release.
Based on the analysis, researchers concluded that often the same kids who are directly aggressive are also indirectly aggressive. Although boys tend to exhibit more direct aggression than girls, there is little difference between girls and boys for indirect aggression. This continues over different ages and ethnicities….
Kids who are indirectly aggressive often have depression and lower self-esteem. However, they tend to have high pro-social behavior, necessary to get support of others such as convincing peers to gossip and exclude others http://news.uchicago.edu/images/pdf/081107.Decety_BiologicalPsy2008.pdf

Behavior is unacceptable when it is “intended to destroy another person’s property or to injure another person, physically or psychologically.” Purposeful harm to another person is never acceptable.
Aggressive Behavior in Girls

Dr. Nicki Crick, of the University of Minnesota has studied aggression in girls. Her work in the field of relationalship aggression is summarized:

Most studies about aggressive behavior in children have focused on boys and on physical expressions of aggression. “It gave the appearance that girls really were sugar and spice and everything nice,” says Nicki Crick, professor of child development. “But I didn’t believe that was really the case.”
For more than six years, Crick has been conducting longitudinal studies of relational aggression, witnessed mainly in girls. Rather than physically harming others, relationally aggressive children will threaten such retaliations as: “Do this or I won’t be your friend.” Or: “If you don’t help me, I’ll tell Amy you said she was ugly….”
What the research shows
Some of Crick’s early research findings show relational aggression is related to factors such as particular types of family relationships and relationships with friends and other peers. She is especially interested in children whose aggression is gender-atypical—that is, girls who are physically aggressive and boys who are relationally aggressive.
“These kids seem to be the most at-risk for more serious social problems later in life,” she says. “The most apparent reason is that not only does their aggressive behavior make them less popular, but the fact that they’re perceived by their peers as acting inappropriately for their gender further isolates them.”

Study: Consumption of soft drinks may be linked to aggression in children

Science Daily reported about a University of Montreal study which examined genetic influences on aggressive behavior.

In Toddlers’ Aggression Strongly Associated With Genetic Factors Science Daily reported:

The development of physical aggression in toddlers is strongly associated with genetic factors and to a lesser degree with the environment, according to a new study led by Eric Lacourse of the University of Montreal and its affiliated CHU Sainte-Justine Hospital. Lacourse’s worked with the parents of identical and non-identical twins to evaluate and compare their behavior, environment and genetics.
“The gene-environment analyses revealed that early genetic factors were pervasive in accounting for developmental trends, explaining most of the stability and change in physical aggression, ” Lacourse said. “However, it should be emphasized that these genetic associations do not imply that the early trajectories of physical aggression are set and unchangeable. Genetic factors can always interact with other factors from the environment in the causal chain explaining any behavior….”
http://www.sciencedaily.com/releases/2014/01/140120192437.htm#.Ut37JzikSXQ.email

Citation:

Journal Reference:
1. Eric Lacourse, PhD, Michel Boivin, PhD, Mara Brendgen, PhD, Amélie Petitclerc, PhD, Alain Girard, MSc, Frank Vitaro, PhD, Stéphane Paquin, PhD candidate, Isabelle Ouellet-Morin, PhD, Ginette Dionne, PhD and Richard E. Tremblay, PhD. A longitudinal twin study of physical aggression during early childhood: Evidence for a developmentally dynamic genome. Psychological Medicine, January 2014
Behavior Modification

The American Academy of Pediatricians has the following suggestions for dealing with aggressive behavior for most children

The best way to prevent aggressive behavior is to give your child a stable, secure home life with firm, loving discipline and full-time supervision during the toddler and preschool years. …
Self control
Your youngster has little natural self-control. He needs you to teach him not to kick, hit, or bite when he is angry, but instead to express his feelings through words. It’s important for him to learn the difference between real and imagined insults and between appropriately standing up for his rights and attacking out of anger.
Supervision
The best way to teach these lessons is to supervise your child carefully when he’s involved in disputes with his playmates. …
Your example
To avoid or minimize “high-risk” situations, teach your child ways to deal with his anger without resorting to aggressive behavior. Teach him to say “no” in a firm tone of voice, to turn his back, or to find compromises instead of fighting with his body. …
Discipline
If you must discipline him, do not feel guilty about it and certainly don’t apologize. If he senses your mixed feelings, he may convince himself that he was in the right all along and you are the “bad” one…
When to call the pediatrician
If your child seems to be unusually aggressive for longer than a few weeks, and you cannot cope with his behavior on your own, consult your pediatrician. Other warning signs include:
• Physical injury to himself or others (teeth marks, bruises, head injuries)
• Attacks on you or other adults
• Being sent home or barred from play by neighbors or school
• Your own fear for the safety of those around him….
The pediatrician or other mental health specialist will interview both you and your child and may observe your youngster in different situations (home, preschool, with adults and other children). A behavior management program will be outlined. Not all methods work on all children, so there will be a certain amount of trial and reassessment

Here is the press release from the University of Montreal:

Jan 20 at 8:55 PM
1/20/14

in French.
MONTREAL, January 21, 2014 – The development of physical aggression in toddlers is strongly associated genetic factors and to a lesser degree with the environment, according to a new study led by Eric Lacourse of the University of Montreal and its affiliated CHU Sainte-Justine Hospital. Lacourse’s worked with the parents of identical and non-identical twins to evaluate and compare their behaviour, environment and genetics.
“The gene-environment analyses revealed that early genetic factors were pervasive in accounting for developmental trends, explaining most of the stability and change in physical aggression, ” Lacourse said. “However, it should be emphasized that these genetic associations do not imply that the early trajectories of physical aggression are set and unchangeable. Genetic factors can always interact with other factors from the environment in the causal chain explaining any behaviour.”
Over the past 25 years, research on early development of physical aggression has been highly influenced by social learning theories that suggest the onset and development of physical aggression is mainly determined by accumulated exposure to aggressive role models in the social environment and the media. However, the results of studies on early childhood physical aggression indicate that physical aggression starts during infancy and peaks between the ages of 2 and 4. Although for most children the use of physical aggression initiated by the University of Montreal team peaks during early childhood, these studies also show that there are substantial differences in both frequency at onset and rate of change of physical aggression due to the interplay of genetic and environmental factors over time. Genetically informed studies of disruptive behavior and different forms of aggression across the lifespan generally conclude that genetic factors account for approximately 50% of the variance in the population.
Lacourse and his colleagues posited and tested three general patterns regarding the developmental roles of genetic and environmental factors in physical aggression. First, the most consensual and general point of view is that both sources of influence are ubiquitous and involved in the stability of physical aggression. Second, a “genetic set point” model suggests a single set of genetic factors could account for the level of physical aggression across time. A third pattern labeled ‘genetic maturation’ postulates new sources of genetic and environmental influences with age. “According to the genetic maturation hypothesis, new environmental contributions to physical aggression could be of short duration in contrast to genetic factors,” Lacourse explained.
About the twins cohort
This twin study was initiated by Michel Boivin of Laval University and Richard Tremblay, who is also affiliated with the University of Montreal and University College Dublin. All parents of twins born between April 1995 and December 1998 in the Greater Montreal area (Canada) were invited to participate, which resulted in the participation of 667 monozygotic and dizygotic twin pairs. Monozygotic means the twins originated from the same embryo they are genetically identical. Dizogytic means they developed in separate embryos, meaning they are not identical.
Mothers were ask to rate their twins physical aggression, by reporting behaviour such as hitting, biting, kicking and fighting, at the ages of 20, 32 and 50 months. “The results of the gene-environment analyses provided some support for the genetic set-point hypotheses, but mostly for the genetic maturation hypotheses,” Lacourse said. “Genetic factors always explained a substantial part of individual differences in physical aggression. More generally, the limited role of shared environmental factors in physical aggression clashes with the results of studies of singletons in which many family or parent level factors were found to predict developmental trajectories of physical aggression during preschool.” Our results suggest that the effect of those factors may not be as direct as was previously though.
Long-term studies of physical aggression clearly show that most children, adolescent and adults eventually learn to use alternatives to physical aggression. “Because early childhood propensities may evoke negative responses from parents and peers, and consequently create contexts where the use of physical aggression is maintained and reinforced, early physical aggression needs to be dealt with care,” Lacourse said. “These cycles of aggression between children and siblings or parents, as well as between children and their peers, could support the development of chronic physical aggression.” We are presently exploring the impact of these gene and social environment interactions.

Contact: Julie Gazaille
j.cordeau-gazaille@umontreal.ca
514-343-6796
University of Montreal
Source:Eurekalert

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Journal of American Medical Association study: Consumption of nuts by pregnant woman may reduce nut allergies in their children

24 Dec

Moi wrote about allergies in Food allergies can be deadly for some children:
If one is not allergic to substances, then you probably don’t pay much attention to food allergies. The parents and children in one Florida classroom are paying a lot of attention to the subject of food allergies because of the severe allergic reaction one child has to peanuts. In the article, Peanut Allergy Stirs Controversy At Florida Schools Reuters reports:

Some public school parents in Edgewater, Florida, want a first-grade girl with life-threatening peanut allergies removed from the classroom and home-schooled, rather than deal with special rules to protect her health, a school official said.
“That was one of the suggestions that kept coming forward from parents, to have her home-schooled. But we’re required by federal law to provide accommodations. That’s just not even an option for us,” said Nancy Wait, spokeswoman for the Volusia County School District.
Wait said the 6-year-old’s peanut allergy is so severe it is considered a disability under the Americans with Disabilities Act.
To protect the girl, students in her class at Edgewater Elementary School are required to wash their hands before entering the classroom in the morning and after lunch, and rinse out their mouths, Wait said, and a peanut-sniffing dog checked out the school during last week’s spring break….
Chris Burr, a father of two older students at the school whose wife has protested at the campus, said a lot of small accommodations have added up to frustration for many parents.
“If I had a daughter who had a problem, I would not ask everyone else to change…. http://www.reuters.com/article/2011/03/22/us-peanut-allergy-idUSTRE72L7AQ20110322

More children seem to have peanut allergies. Researchers are trying to discover the reason for the allergies, but also asking the question of whether the number of nut allergies in children can be reduced.

Michael Pearson of CNN reported in the story, Study: Eating nuts during pregnancy may reduce baby’s allergy risk:

The children of women who regularly ate peanuts or tree nuts during pregnancy appear to be at lower risk for nut allergies than other kids, according to a new study published Monday.
The study, published in the Journal of the American Medical Association, is the first to demonstrate that a mother who eats nuts during pregnancy may help build up a baby’s tolerance to them after birth, its lead author, Dr. Michael Young, told CNN.
The effect seemed to be strongest in women who ate the most peanuts or tree nuts — five or more servings per week, according to the study, which controlled for factors such as family history of nut allergies and other dietary practices.
Peanut and tree nut allergies tend to overlap, according to the researchers.
What food allergies are costing families — and the economy
Earlier studies indicated that nut consumption during pregnancy either didn’t have any effect or actually raised the risk of allergies in children.
However, the authors of the latest study say those studies were based on less reliable data and conflict with more recent research suggesting that early exposure to nuts can reduce the risk of developing allergies to them.
There is currently no formally recognized medical guidance for nut consumption during pregnancy or infancy. http://www.cnn.com/2013/12/23/health/nut-allergy-study/

Citation:

Original Investigation | December 23, 2013 JOURNAL CLUB
Prospective Study of Peripregnancy Consumption of Peanuts or Tree Nuts by Mothers and the Risk of Peanut or Tree Nut Allergy in Their Offspring FREE ONLINE FIRST
A. Lindsay Frazier, MD, ScM1,2; Carlos A. Camargo Jr, MD, DrPH2,3,4; Susan Malspeis, MS2; Walter C. Willett, MD, DrPH4,5,6; Michael C. Young, MD7
[+] Author Affiliations
JAMA Pediatr. Published online December 23, 2013. doi:10.1001/jamapediatrics.2013.4139
Article
Tables
References
Comments
ABSTRACT
ABSTRACT | METHODS | RESULTS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES
Importance The etiology of the increasing childhood prevalence of peanut or tree nut (P/TN) allergy is unknown.
Objective To examine the association between peripregnancy consumption of P/TN by mothers and the risk of P/TN allergy in their offspring.
Design, Setting, and Participants Prospective cohort study. The 10 907 participants in the Growing Up Today Study 2, born between January 1, 1990, and December 31, 1994, are the offspring of women who previously reported their diet during, or shortly before or after, their pregnancy with this child as part of the ongoing Nurses’ Health Study II. In 2006, the offspring reported physician-diagnosed food allergy. Mothers were asked to confirm the diagnosis and to provide available medical records and allergy test results. Two board-certified pediatricians, including a board-certified allergist/immunologist, independently reviewed each potential case and assigned a confirmation code (eg, likely food allergy) to each case. Unadjusted and multivariable logistic regression analyses were used to evaluate associations between peripregnancy consumption of P/TN by mothers and incident P/TN allergy in their offspring.
Exposure Peripregnancy consumption of P/TN.
Main Outcomes and Measures Physician-diagnosed P/TN allergy in offspring.
Results Among 8205 children, we identified 308 cases of food allergy (any food), including 140 cases of P/TN allergy. The incidence of P/TN allergy in the offspring was significantly lower among children of the 8059 nonallergic mothers who consumed more P/TN in their peripregnancy diet (≥5 times vs <1 time per month: odds ratio = 0.31; 95% CI, 0.13-0.75; Ptrend = .004). By contrast, a nonsignificant positive association was observed between maternal peripregnancy P/TN consumption and risk of P/TN allergy in the offspring of 146 P/TN-allergic mothers (Ptrend = .12). The interaction between maternal peripregnancy P/TN consumption and maternal P/TN allergy status was statistically significant (Pinteraction = .004).
Conclusions and Relevance Among mothers without P/TN allergy, higher peripregnancy consumption of P/TN was associated with lower risk of P/TN allergy in their offspring. Our study supports the hypothesis that early allergen exposure increases tolerance and lowers risk of childhood food allergy.
Peanut allergy affects 1% to 2% of the population in most Western countries,1- 3 and in the United States, the prevalence of childhood peanut allergy has more than tripled, from 0.4% in 1997 to 1.4% in 2010.4 Typically, the onset of peanut allergy is in early childhood; 70% of reactions occur during the first known exposure.5 These IgE-mediated hypersensitivity reactions require prior allergen exposure and sensitization, implying that prior exposure to peanut had already occurred in utero or through unknown exposures in the diet or environment, such as through skin or respiratory routes.6 Because of frequent overlap between peanut allergy and tree nut allergy and their similar natural history, with 80% to 90% persistence of the food allergy into adulthood,7 these 2 allergies are often considered together as peanut or tree nut (P/TN) allergy.
For many years, pediatric guidelines have recommended the avoidance of P/TN for at least the first 3 years of life, with some experts also recommending that P/TN be avoided during pregnancy.8 These recommendations were rescinded recently when literature reviews showed little support for them.9,10 For decades, many investigators have posited that modifications of the maternal diet during pregnancy might prevent food allergies.11- 14 However, some studies on maternal avoidance of peanut during pregnancy actually demonstrated an increase in peanut sensitization in the child,15- 17 while other studies found no association.5,14,18,19 In related research, early exposure to allergenic foods in infant diets may decrease sensitization and increase oral tolerance to those foods.20- 24
Given the lack of clarity in the current literature, an important quandary exists: should the pregnant mother include or exclude P/TN in her diet? The goal of our investigation was to clarify the association between peripregnancy consumption of P/TN by mothers and the subsequent development of P/TN allergy in their offspring…. http://archpedi.jamanetwork.com/article.aspx?articleid=1793699

Resources:

Micheal Borella’s Chicago-Kent Law Review article, Food Allergies In Public Schools: Toward A Model Code

Click to access Borella.pdf

USDA’s Accommodating Children With Special Dietary Needs http://www.k12.wa.us/ChildNutrition/pubdocs/SpecialDietaryNeeds.PDF

Child and Teen Checkup Fact Sheet http://www.health.state.mn.us/divs/fh/mch/ctc/factsheets.html
Video: What to Expect From A Child’s Physical Exam
http://on.aol.com/video/what-to-expect-from-a-childs-physical-exam-325661948

Related:
New federal guidelines for schools regarding student allergies

New federal guidelines for schools regarding student allergies

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Violence against teachers is becoming a bigger issue

29 Nov

Education is a partnership between the student, the teacher(s) and parent(s). All parties in the partnership must share the load. The student has to arrive at school ready to learn. The parent has to set boundaries, encourage, and provide support. Teachers must be knowledgeable in their subject area and proficient in transmitting that knowledge to students. All must participate and fulfill their role in the education process. Increasingly, those in the teaching profession are victims of violence in the classroom.

Carolyn Thompson of AP reported in the article, Teacher Killings Bring Shocking School Violence Numbers To Light:

About 4 percent of public school teachers reported they had been attacked physically during the 2007-08 school year, according to the U.S. Department of Education, citing a 2012 school safety report. Seven percent were threatened with injury by a student.
A 2011 survey found that 80 percent of teachers reported being intimidated, harassed, assaulted or otherwise victimized at least once during the previous year.
Of the 3,000 teachers surveyed, 44 percent reported physical offenses including thrown objects, student attacks and weapons shown, according to the American Psychological Association Task Force on Violence Directed Against Teachers, which conducted the national web-based survey.
The task force recommended creating a national registry to track the nature and frequency of incidents, saying this would help develop plans for prevention and intervention. It also suggested that all educators be required to master classroom management before they are licensed to teach…
http://www.huffingtonpost.com/2013/11/18/teacher-killings-bring-shocking-school-violence-rates_n_4295203.html?utm_hp_ref=@education123

The National Education Association (NEA) is also following the school violence issue.

Tim Walker wrote in the NEA Today article, Violence Against Teachers – An Overlooked Crisis?

According to a recent article published by the American Psychological Association (APA), 80 percent of teachers surveyed were victimized at school at least once in the current school year or prior year. Teacher victimization is a “national crisis,” says Dr. Dorothy Espelage of the University of Illinois at Urbana-Champaign, who served as chair of the APA task force on Classroom Violence Directed at Teachers. And yet, the issue is generally ignored or at least underreported by the media and given inadequate attention by scholars – a deficiency that has widespread implications for school safety, the teaching profession and student learning.
The APA article was based on a survey – one of the few national studies – conducted in 2011 that solicited anonymous responses from almost 3,000 K-12 teachers in 48 states (NEA assisted APA by distributing the survey to its members).
NEA Today recently spoke with Dr. Espelage about the tasks force’s findings and recommendations and how addressing teacher victimization must be a component of any comprehensive school safety plan.
What kinds of attacks are teachers facing?
About half of the teachers who reported being victimized experienced harassment. Others reported property offenses, including theft and damage to property. And about one-quarter of these teachers experienced physical attacks. Harassment includes anything from obscene gestures, verbal threats and intimidation and obscene remarks. With physical offenses, teachers widely reported objects being thrown at them and being physically attacked. The most severe and uncommon cases are physical attacks that result in a visit to the doctor.
In your work with the task force, what did you find out that might surprise people?
A big surprise was the general scarcity of research out there about the victimization of teachers in the workplace. When the APA asked me as head the task force to conduct a survey, I assumed a lot of research was out there, but itwasn’t. It’s 2013 and there have been only 14 studies conducted internationally. It’s a very underreported problem.
So if you have an area that isn’t being studied thoroughly, it will never come to the attention of the public. And that won’t translate into better pre-service training, professional development for teachers, more support from administrators and other measures that can be taken to address the issue.
Any comprehensive examination of school violence must include violence directed at teachers. Focusing solely on student victimization to the exclusion of teacher victimization results in an inadequate representation of safety issues, which makes it more difficult to formulate effective solutions.
What people also should know is that we’re not just talking about students attacking or harassing teachers. Students are not always the perpetuators. We heard about incidents of adult-on-adult incidents – including parents and colleagues. What we found is that a physical attack was more likely to come from a parent as opposed to a student.
You also found that a teacher who is victimized by a member of one group, say a student, is more likely to be victimized by another group.
Yes, but it’s hard to determine why that is. It could be a number of factors. A student who harasses or threatens might come from a family who is inclined to victimize the teacher in some way as well. It could be something about the teacher. Maybe he or she is not adequately supported by the administration and puts them at risk for other episodes.
What are the costs to the school or community?
The big issue is teacher attrition. It’s hard to know exactly but we suspect that it is one component of many that explains why teachers are leaving the profession. Other costs include lost wages, lost instructional time, potenial negative publicity for the school, and a negative impact on student learning. Teacher cannot perform their job effectively if they feel threatened.
The task force makes a number of recommendations, including the creation of a national registry that can be used to track these incidents. You also urge that teacher preparation programs be strengthened so that teachers enter the classroom better prepared to confront and defuse potential violence. How much of an impact can this make when so many other outside factors contribute to the problem?
Many pre-service teachers aren’t necessarily equipped with the skills to manage their classrooms. So it starts with pre-service education. This is a priority in special ed, where teachers are really taught how to deescalate conflict. So one of the top recommendations we make in the report is urging teacher preparation programs to provide the next generation of teachers with a better skill-set that can at least help manage conflicts before they escalate.
Clearly teachers aren’t victimized just because they haven’t received adequate pre-service training or professional development.I also take a sociological perspective to studying the issue. What are the demographics of the school? What’s the administration like? What resources are available at the school? What neighborhood is the school situated in? And obviously we have to look at parental involvement.
And what’s the school climate like? We know about the connection between positive school climate and lack of aggressive or violent behavior. The research is very clear on that connection. Really strong leadership by the administration is needed to create a positive learning climate. How well does the administration connect with the teachers, how well do they know the student? The entire ecology of the school and the community has to be taken into account.
As for additional resources and teacher support, the trend in many states isn’t headed in the right direction. Class sizes are betting bigger – that certainly doesn’t help – and teachers are receiving less support, not more. So major shifts have to occur in our priorities for education funding. This is why we need to study this issue more, raise greater awareness, and help move the conversation forward.
Read the APA article, “Understanding and Preventing Violence Directed Against Teachers.”

Click to access amp-68-2-75.pdf

See also:
When Educators Are Assaulted-What NEA Affiliates Are Doing to Protect Members from Violent and Disruptive Students
http://www.nea.org/home/42238.htm
Bullying of Teachers Pervasive in Many Schools
http://neatoday.org/2012/05/16/bullying-of-teachers-pervasive-in-many-schools/
Related posts:
1. Preventing School Violence: Are We Making the Grade?
2. Educators Say Mental Health Awareness Key to Preventing Gun Violence
3. NEA Poll: Educators Support Stronger Laws to Prevent Gun Violence
4. How Teachers Can Help Cope With a Crisis
5. Four Things You Need to Know About the Pension “Crisis”
http://neatoday.org/2013/02/19/violence-against-teachers-an-overlooked-crisis/

Dr Joan Simeo Munson has some good suggestions about how to deal with aggressive behavior in young children http://www.empoweringparents.com/author_display.php?auth=Dr.-Joan-Simeo-Munson
According to Leo J. Bastiaens, MD and Ida K. Bastiaens in their article about youth aggression in the Psychiatric Times, http://www.psychiatrictimes.com/articles/youth-aggression-economic-impact-causes-prevention-and-treatment?verify=0 one of the treatment options is medication. For some children medication works and helps them to control their aggressive tendencies. Probably, more children are medicated than need to be, but the decision to use medication is highly individual and should be made in conjunction with health care providers. A second or even a third opinion may be necessary. NYU’s Child Study Center has an excellent Guide to Psychiatric Medicine for Children and Adolescents http://www.aboutourkids.org/articles/guide_psychiatric_medications_children_adolescents Mary E. Muscari, PhD, CPNP, APRN-BC,CFNS Professor, Director of Forensic Health/Nursing, University of Scranton, Scranton, Pennsylvania; Pediatric Nurse Practitioner, Psychological Clinical Specialist, Forensic Clinical Specialist, Lake Ariel, Pennsylvania writes at Medscape.Com about pharmacotherapy for adolescents

Before prescribing medication therapy for aggression, the clinician should ensure that the patient has a medical evaluation to rule out contraindications to treatment and to determine whether the patient’s aggressive symptoms might improve with appropriate medical care. Psychiatric evaluation is also necessary to determine whether psychosis, depression, anxiety, substance abuse, or other problems are present. Treatment of these conditions may also result in reduced symptoms of aggression. Nonpharmacologic measures should be instituted; however, when pharmacologic treatment is warranted, institute treatment with an antiaggression medication that best fits the patient’s symptom cluster. http://www.medscape.com/viewarticle/545247

Medication should not be a first resort, but is an acceptable option after a thorough evaluation of all treatment options has been made.

Aggressive behavior can be costly for the child and society if the child’s behavior is not modified. At least one study has found preventative intervention is effective:

E. Michael Foster, Ph.D., University of North Carolina at Chapel Hill, and Damon Jones, Ph.D., Pennsylvania State University, in conjunction with the Conduct Problems Prevention Research Group, examined the cost effectiveness of the NIMH-funded Fast Track program, a 10-year intervention designed to reduce aggression among at-risk children….
Previous results showed that among children moderately at risk for conduct disorder, there were no significant differences in outcomes between the intervention group and the control group. However, among the high-risk group, fewer than half as many cases of conduct disorder were diagnosed in the intervention group as in the control group. These results were extended in the current paper to consider also the cost effectiveness of providing the early intervention. By weighing the costs of the intervention relative to the costs of crime and delinquency found among the study participants, the researchers concluded that this early prevention program was cost-effective in reducing conduct disorder and delinquency, but only for those who were very high-risk as young children. http://www.4therapy.com/news/also-news/targeted-preventive-interventions-most-aggressive-children-2747

As with many problems, the key is early diagnosis and intervention with appropriate treatment. Purposeful harm to another person is never acceptable.

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New federal guidelines for schools regarding student allergies

4 Nov

Moi wrote about allergies in Food allergies can be deadly for some children:
If one is not allergic to substances, then you probably don’t pay much attention to food allergies. The parents and children in one Florida classroom are paying a lot of attention to the subject of food allergies because of the severe allergic reaction one child has to peanuts. In the article, Peanut Allergy Stirs Controversy At Florida Schools Reuters reports:

Some public school parents in Edgewater, Florida, want a first-grade girl with life-threatening peanut allergies removed from the classroom and home-schooled, rather than deal with special rules to protect her health, a school official said.
“That was one of the suggestions that kept coming forward from parents, to have her home-schooled. But we’re required by federal law to provide accommodations. That’s just not even an option for us,” said Nancy Wait, spokeswoman for the Volusia County School District.
Wait said the 6-year-old’s peanut allergy is so severe it is considered a disability under the Americans with Disabilities Act.
To protect the girl, students in her class at Edgewater Elementary School are required to wash their hands before entering the classroom in the morning and after lunch, and rinse out their mouths, Wait said, and a peanut-sniffing dog checked out the school during last week’s spring break….
Chris Burr, a father of two older students at the school whose wife has protested at the campus, said a lot of small accommodations have added up to frustration for many parents.
“If I had a daughter who had a problem, I would not ask everyone else to change…. http://www.reuters.com/article/2011/03/22/us-peanut-allergy-idUSTRE72L7AQ20110322

More children seem to have peanut allergies.
See, More school battles about peanut allergies https://drwilda.com/tag/allergy/

Mike Stobbe of AP reported in the article, Feds post food allergy guidelines for schools:

ATLANTA (AP) — The federal government is issuing its first guidelines to schools on how to protect children with food allergies.
The voluntary guidelines call on schools to take such steps as restricting nuts, shellfish or other foods that can cause allergic reactions, and make sure emergency allergy medicine — like EpiPens — are available.
About 15 states — and numerous individual schools or school districts — already have policies of their own. “The need is here” for a more comprehensive, standardized way for schools to deal with this issue, said Dr. Wayne Giles, who oversaw development of the advice for the Centers for Disease Control and Prevention.
Food allergies are a growing concern. A recent CDC survey estimated that about 1 in 20 U.S. children have food allergies — a 50 percent increase from the late 1990s. Experts aren’t sure why cases are rising.
Many food allergies are mild and something children grow out of. But severe cases may cause anaphylactic shock or even death from eating, say, a peanut.
The guidelines released Wednesday were required by a 2011 federal law.
http://www.huffingtonpost.com/2013/10/30/school-allergy-guidelines_n_4177867.html?utm_hp_ref=email_share

Here is information from the Centers for Disease Control about the guidelines:

Food Allergies in Schools
Food allergies are a growing food safety and public health concern that affect an estimated 4%–6% of children in the United States.1, 2 Allergic reactions can be life threatening and have far-reaching effects on children and their families, as well as on the schools or early care and education (ECE) programs they attend. Staff who work in schools and ECE programs should develop plans for preventing an allergic reaction and responding to a food allergy emergency.
Voluntary Guidelines for Managing Food Allergies In Schools and Early Care and Education Programs [PDF – 10MB]
Food Allergy Guidelines FAQs [PDF – 163KB]
What is a Food Allergy?
A food allergy occurs when the body has a specific and reproducible immune response to certain foods.3 The body’s immune response can be severe and life threatening, such as anaphylaxis. Although the immune system normally protects people from germs, in people with food allergies, the immune system mistakenly responds to food as if it were harmful.
Eight foods or food groups account for 90% of serious allergic reactions in the United States: milk, eggs, fish, crustacean shellfish, wheat, soy, peanuts, and tree nuts.3
Symptoms of Food Allergy in Children
Symptoms Communicated by Children with Food Allergies4
• It feels like something is poking my tongue.
• My tongue (or mouth) is tingling (or burning).
• My tongue (or mouth) itches.
• My tongue feels like there is hair on it.
• My mouth feels funny.
• There’s a frog in my throat; there’s something stuck in my throat.
• My tongue feels full (or heavy).
• My lips feel tight.
• It feels like there are bugs in there (to describe itchy ears).
• It (my throat) feels thick.
• It feels like a bump is on the back of my tongue (throat).
The symptoms and severity of allergic reactions to food can be different between individuals, and can also be different for one person over time. Anaphylaxis is a sudden and severe allergic reaction that may cause death.5 Not all allergic reactions will develop into anaphylaxis.
Food Allergies in Schools
• Children with food allergies are two to four times more likely to have asthma or other allergic conditions than those without food allergies.1
• The prevalence of food allergies among children increased 18% during 1997–2007, and allergic reactions to foods have become the most common cause of anaphylaxis in community health settings.1,6
• In 2006, about 88% of schools had one or more students with a food allergy.7

Treatment and Prevention of Food Allergies in Children
There is no cure for food allergies. Strict avoidance of the food allergen is the only way to prevent a reaction. However, since it is not always easy or possible to avoid certain foods, staff in schools and ECE programs should develop plans to deal with allergic reactions, including anaphylaxis. Early and quick recognition and treatment of allergic reactions that may lead to anaphylaxis can prevent serious health problems or death.
Voluntary Guidelines for Managing Food Allergies In Schools and Early Care and Education Programs
In consultation with the U.S. Department of Education and a number of other federal agencies, CDC developed the Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Centers [PDF – 10MB] in fulfillment of the 2011 FDA Food Safety Modernization Act to improve food safety in the United States. Download Food Allergy Guidelines FAQs [PDF – 163KB].
The Voluntary Guidelines for Managing Food Allergies provide practical information and planning steps for parents, district administrators, school administrators and staff, and ECE program administrators and staff to develop or strengthen plans for food allergy management and prevention. The Voluntary Guidelines for Managing Food Allergies include recommendations for each of the five priority areas that should be addressed in each school’s or ECE program’s Food Allergy Management Prevention Plan:
1. Ensure the daily management of food allergies in individual children.
2. Prepare for food allergy emergencies.
3. Provide professional development on food allergies for staff members.
4. Educate children and family members about food allergies.
5. Create and maintain a healthy and safe educational environment.
References
1. Branum AM, Lukacs SL. Food allergy among U.S. children: trends in prevalence and hospitalizations. NCHS Data Brief. 2008;10:1-8.
2. Liu AH, Jaramillo R, Sicherer SH, et al. National prevalence and risk factors for food allergy and relationship to asthma: results from the National Health and Nutrition Examination Survey 2005-2006. J Allergy Clin Immunol. 2010;126(4):798-806.e13.
3. Boyce JA, Assa’ad A, Burks AW, et al; NIAID-Sponsored Expert Panel. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(suppl 6):S1-S58.
4. The Food Allergy & Anaphylaxis Network. Food Allergy News. 2003;13(2).
5. Sampson HA, Munoz-Furlong A, Campbell RL, et al. Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network Symposium. Ann Emerg Med. 2006;47(4):373-380.
6. Decker WW, Campbell RL, Manivannan V, et al. The etiology and incidence of anaphylaxis in Rochester, Minnesota: a report from the Rochester Epidemiology Project. J Allergy Clin Immunol. 2008;122(6):1161-1165.
7. O’Toole TP, Anderson S, Miller C, Guthrie J. Nutrition services and foods and beverages available at school: results from the School Health Policies and Programs Study 2006. J Sch Health. 2007;77:500-521.
Voluntary Guidelines for Managing Food Allergies In Schools and Early Care and Education Programs [PDF – 10MB]
Food Allergy Guidelines FAQs [PDF – 163KB]
http://www.cdc.gov/healthyyouth/foodallergies/

It requires a great deal of tact and give and take on the part of parents and the school to produce a workable situation for students, the child with the allergy, and parents.
A physical examination is important for children to make sure that there are no health problems. The University of Arizona Department of Pediatrics has an excellent article which describes Pediatric History and Physical Examination http://www.peds.arizona.edu/medstudents/Physicalexamination.asp The article goes on to describe how the physical examination is conducted and what observations and tests are part of the examination. The Cincinnati Children’s Hospital describes the Process of the Physical Examination http://www.cincinnatichildrens.org/health/p/exam/
If children have allergies, parents must work with their schools to prepare a allergy health plan.

Resources:

Micheal Borella’s Chicago-Kent Law Review article, Food Allergies In Public Schools: Toward A Model Code http://www.cklawreview.com/wp-content/uploads/vol85no2/Borella.pdf

USDA’s Accommodating Children With Special Dietary Needs http://www.k12.wa.us/ChildNutrition/pubdocs/SpecialDietaryNeeds.PDF

Child and Teen Checkup Fact Sheet http://www.health.state.mn.us/divs/fh/mch/ctc/factsheets.html

Video: What to Expect From A Child’s Physical Exam http://on.aol.com/video/what-to-expect-from-a-childs-physical-exam-325661948

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Dr. Wilda says this about that ©

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Dr. Wilda Reviews health book: ‘The A to Z of Children’s Health’

31 Oct

Moi received a complimentary copy of the A to Z of Children’s Health. Here are the details from Amazon:

•Paperback: 448 pages

•Authors: Dr. Jeremy Friedman, Dr. Natasha Saunders, and Dr. Norman Saunders

•Publisher: Robert Rose (September 19, 2013)

•Language: English

•ISBN-10: 0778804607

•ISBN-13: 978-0778804604

•Product Dimensions: 10.4 x 7.7 x 0.9 inches

•Shipping Weight: 2.7 pounds (View shipping rates and policies)

•Average Customer Review: Be the first to review this item

•Amazon Best Sellers Rank: #278,119 in Books (See Top 100 in Books)

Here is what the authors say about the book:

The A to Z of Children’s Health

September 30, 2013

There has been an enormous increase in the amount of information at our fingertips since the growth of the Internet and, more recently, social media. The majority of parents in North America now have access to medical and parenting advice at the click of a mouse or with the touch of a fingertip. So why publish a book of medical advice for parents on how to deal with all of their children’s symptoms from A to Z and everything in between?

In some ways, the need is greater now than a generation or two ago, when Dr. Spock was one of our only options. The reason is that much of what you read on the web and information shared through social media is sincere in its intent but generally strongly held personal opinion and conviction. Convincing yes, but not always in context, accurate, or even true. Certainly, in most cases, not based on the latest scientific evidence or consensus among children’s health?care providers.

Our book meets this need for evidence-based information and advice published in an accessible format. We will guide you through your questions about your child’s health, advise you when you should be seeking help, and give you practical tips and strategies that will help you to avoid having to spend countless hours in your provider’s waiting room or, even worse, in an emergency care center.

This book is written by a dozen of the top pediatricians at the Hospital for Sick Children (a.k.a. SickKids), recognized internationally as one of the best children’s hospitals in the world. SickKids is not only renowned for the outstanding clinical care provided to its young patients and their families, but this hospital is a leader in educating patients, families, and the next generation of pediatric health-care providers, as well as a powerhouse of research, providing the evidence behind the latest and best treatments and care for children worldwide.

— Jeremy Friedman and Natasha Saunders

http://www.robertrose.ca/article/z-children%E2%80%99s-health

Here is background about the authors:

By: Jeremy Friedman, MB.ChB, FRCPC, FAAP

By: Natasha Saunders, MD, MSc, FRCPC

By: Norman Saunders, MD, FRCP (C)

An indispensable reference that is sure to become the go-to health & wellness guide for parents.

This comprehensive and contemporary guide is written by the pediatric experts at the world-renowned Hospital for Sick Children (SickKids). It goes without saying that no one understands kids better than these experts.

The guide covers over 235 childhood conditions and illnesses in children ages newborn to ten in a friendly yet authoritative manner.
All the illnesses and conditions are arranged alphabetically, making it easy, quick and accessible for parents — for those situations when time really is of the essence!

Parents will find expert advice on how to cope with everything from common accidents and emergencies like fever and abdominal pain to conditions such as spina bifida, infective endocarditis and shingles. Photos and diagrams are featured throughout so parents can accurately pinpoint what potential condition and/or illness their child may be experiencing.

This book addresses virtually every question a parent might have, and knowing that this kind of help is available, on any topic that may arise, provides the reassurance every parent needs and wants.

Dr. Jeremy Friedman, MB.ChB, FRCPC, FAAP is the associate Pediatrician-in-Chief at The Hospital for Sick Children and a Professor of Pediatrics at the University of Toronto. He is also the father of two young children.

Dr. Natasha Saunders, MD, MSc, FRCPC, is the mother of a busy toddler, and a staff pediatrician at the hospital for sick Children and Rouge Valley health system in Toronto. She’s completing an Academic General Pediatrics Fellowship at the Hospital for Sick Children.

Dr. Norman Saunders, MD, FRCPC, was a renowned and hugely respected general pediatrician with over 3 decades of experience. He was also a staff paediatrician at the Hospital for Sick Children and an Associate Professor of Paediatrics at the University of Toronto

http://www.robertrose.ca/book/z-childrens-health

The concise review is parents and caregivers should buy this book because it is an essential part of a caregivers tool kit. If you are attending a baby shower or welcoming new parents home from the hospital, you might consider making the book a gift. Moi began her process of review by going to the Mayo Clinic site to find out the issues that folks seek information about.

The Mayo Clinic lists issues in Children’s Health Questions and Answers:

Children’s Health Questions and Answers

Review all Children’s Health questions and answers:
•ADHD diet: Do food additives cause hyperactivity?
•ADHD: Does caffeine help?
•Albuterol side effects: What’s normal?
•Angelman’s syndrome
•Autism treatment: Can chelation therapy help?
•Autism treatment: Can special diets help?
•Autistic spectrum disorders
•Baby sign language: A good idea?
•Baby teeth: When do children start losing them?
•Baby walkers: Are they safe?
•Bipolar disorder in children: Is it possible?
•Calcium-fortified juice: A good source of calcium for kids?
•Child growth: Can you predict adult height?
•Childhood schizophrenia: How early can it be diagnosed?
•Coxsackievirus in children: How serious is it?
•Crohn’s disease in children: Are growth delays permanent?
•Croup treatment: Does high humidity relieve symptoms?
•’Cutting’ weight: A safe practice for youth wrestlers?
•Depression treatment for children: What works?
•Dystonia treatment: Can it impair bone growth?
•Flu shots for kids: Does my child need a flu shot?
•Fruit juice: Good or bad for kids?
•Gray hair in child
•Ketotic hypoglycemia in children: What causes it?
•Kids and caffeine: An unhealthy combination?
•Kohler’s disease: Does it cause permanent bone damage?
•Multivitamins: Do young children need them?
•Older fathers and autism risk: Is there a connection?
•Osteoporosis: Can kids get it too?
•Peanut allergy: Can a child outgrow it?
•Recurring strep throat: When is tonsillectomy useful?
•Septo-optic dysplasia
•Sleep apnea in young children
•Stuttering in children: Is it normal?
•Sugar: Does it cause ADHD?
•Tummy time: How much does your baby need?
•Urinary tract infections in children: Are bubble baths a culprit?
•Using an oral thermometer: How do I clean it?
•Warm-mist vs. cool-mist humidifier: Which is better for a cold?
•Weight-loss surgery: Safe for kids?
•http://www.riversideonline.com/health_reference/Childrens-Health/q-and-a.cfm

See, Kids.gov http://kids.usa.gov/health-and-safety/health/index.shtml
Next, moi started looking through the A to Z of Children’s Health.

The book is well organized alphabetically by topic. The charts are phenomenal. See, the chart for chronic abdominal pain at pp. 26-27. There are really useful info boxes throughout the book. Info heading include topics like:

Diagnosis

What Causes ____

How Treated

Goals of Treatment

Medications

Questions to Ask the Doctor

Red Flags

Doc Talk

The book is well written and published on good quality paper. There are pictures of a diverse population. Information is highlighted so that those seeking information will easily find a topic.

Dr. Wilda HIGHLY RECOMMENDS the A to Z of Children’s Health.

Other Reviews:

Book review: ‘The A to Z of Children’s Health’

http://long-island.newsday.com/kids/long-island-parent-talk-1.3679226/book-review-the-a-to-z-of-children-s-health-1.6238900

The A to Z of Children’s Health

http://lifetakesover.wordpress.com/2013/10/22/the-a-to-z-of-childrens-health/

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Blogs by Dr. Wilda:

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Concussions: American Academy of Pediatrics issued recommendations for “return to learn” checklists

27 Oct

Moi wrote in Don’t ignore concussions:
Kids Health has some great information about concussions at their site:

What Is a Concussion and What Causes It?
The brain is made of soft tissue and is cushioned by spinal fluid. It is encased in the hard, protective skull. When a person gets a head injury, the brain can move around inside the skull and even bang against it. This can lead to bruising of the brain, tearing of blood vessels, and injury to the nerves. When this happens, a person can get a concussion — a temporary loss of normal brain function.
Most people with concussions recover just fine with appropriate treatment. But it’s important to take proper steps if you suspect a concussion because it can be serious.
Concussions and other brain injuries are fairly common. About every 21 seconds, someone in the United States has a serious brain injury. One of the most common reasons people get concussions is through a sports injury. High-contact sports such as football, boxing, and hockey pose a higher risk of head injury, even with the use of protective headgear.
People can also get concussions from falls, car accidents, bike and blading mishaps, and physical violence, such as fighting. Guys are more likely to get concussions than girls. However, in certain sports, like soccer, girls have a higher potential for concussion.http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_

Don’t ignore concussions


See, Update: Don’t ignore concussions https://drwilda.com/2012/05/20/update-dont-ignore-concussions/

Jan Hoffman reported in the New York Times article, Concussions and the Classroom:

Because of heightened awareness about the hazards of sports-related concussions, many states have implemented standards determining when an injured student may resume playing contact sports. But only a few states have begun to address how and when a student should resume classwork.
On Sunday the American Academy of Pediatrics issued recommendations for “return to learn” checklists to alert doctors, school administrators and parents to potential cognitive and academic challenges to students who have suffered concussions.
“They’re student athletes, and we have to worry about the student part first,” said Dr. Mark E. Halstead, the lead author of “Returning to Learning Following a Concussion,” a clinical report in this week’s Pediatrics.
For adolescents prone to risk-taking behaviors, concussions are not just the nasty by-products of sports. Dr. Halstead, an assistant professor in pediatric sports medicine at Washington University, recently treated a 15-year-old girl whose concussion came not from a soccer match, but because “she was running backwards in a school hallway and cracked heads with someone.”
The academy emphasized that research about recovery protocols and cognitive function is scant: There is no established rest-until-recovered timeline. The new recommendations are based on expert opinions and guidelines developed by the Rocky Mountain Youth Sports Medicine Institute in Denver.
Doctors generally recommend that a student with a concussion rest initially, to give the brain time to heal. That may mean no texting, video games, computer use, reading or television. But there’s a big question mark about the timing and duration of “cognitive rest.” Experts have not identified at what point mental exertion impedes healing, when it actually helps, and when too much rest prolongs recovery. Although many doctors are concerned that a hasty return to a full school day could be harmful, this theory has not yet been confirmed by research.
The student’s pediatrician, parents and teachers should communicate about the incident, the recommendations said, and be watchful for when academic tasks aggravate symptoms such as headaches, dizziness, sensitivity to light and difficulty concentrating. The academy acknowledged that case management must be highly individualized: “Each concussion is unique and may encompass a different constellation and severity of symptoms.”
Most students have a full recovery within three weeks, the article said. But if the recovery seems protracted, specialists should be consulted.
Many school officials do not realize they can make simple accommodations to ease the student’s transition back to the classroom, the academy said.
To alleviate a student’s headaches, for example, schedule rests in the school nurse’s office; for dizziness, allow extra time to get to class through crowded hallways; for light sensitivity, permit sunglasses to be worn indoors. Students accustomed to 45-minute classes might only be able to sit through 30 minutes at the outset, or attend school for a half-day.
“Parents need to follow up with schools and make sure plans are being followed,” Dr. Halstead said…. http://well.blogs.nytimes.com/2013/10/27/concussions-and-the-classroom/?ref=education&_r=0

Citation:

From the American Academy of Pediatrics
Clinical Report
Returning to Learning Following a Concussion
1. Mark E. Halstead, MD, FAAP,
2. Karen McAvoy, PsyD,
3. Cynthia D. Devore, MD, FAAP,
4. Rebecca Carl, MD, FAAP,
5. Michael Lee, MD, FAAP,
6. Kelsey Logan, MD, FAAP,
7. Council on Sports Medicine and Fitness, and Council on School Health
Abstract
Following a concussion, it is common for children and adolescents to experience difficulties in the school setting. Cognitive difficulties, such as learning new tasks or remembering previously learned material, may pose challenges in the classroom. The school environment may also increase symptoms with exposure to bright lights and screens or noisy cafeterias and hallways. Unfortunately, because most children and adolescents look physically normal after a concussion, school officials often fail to recognize the need for academic or environmental adjustments. Appropriate guidance and recommendations from the pediatrician may ease the transition back to the school environment and facilitate the recovery of the child or adolescent. This report serves to provide a better understanding of possible factors that may contribute to difficulties in a school environment after a concussion and serves as a framework for the medical home, the educational home, and the family home to guide the student to a successful and safe return to learning.

Here is the press release:

After a Concussion Students May Need Gradual Transition Back to Academics
10/27/2013
American Academy of Pediatrics offers new guidance on “returning to learning” after concussion
ORLANDO, Fla. — A concussion should not only take a student athlete off the playing field – it may also require a break from the classroom, according to a new clinical report from the American Academy of Pediatrics (AAP).
In the clinical report, “Returning to Learning Following a Concussion,” released Sunday, Oct. 27 at the AAP National Conference & Exhibition in Orlando, the AAP offers guidance to pediatricians caring for children and adolescents after suffering a concussion.
“Students appear physically normal after a concussion, so it may be difficult for teachers and administrators to understand the extent of the child’s injuries and recognize the potential need for academic adjustments,” said Mark Halstead, MD, FAAP, a lead author of the clinical report. “But we know that children who’ve had a concussion may have trouble learning new material and remembering what they’ve learned, and returning to academics may worsen concussion symptoms.”
Dr. Halstead will deliver a plenary address on concussion injuries at 10:30 a.m. ET Oct. 27 at the Orange County Convention Center. A news briefing on the new clinical report will immediately follow. Reporters interested in covering either event should check in at the press room, W203B.
Research has shown that a school-aged student usually recovers from a concussion within three weeks. If symptoms are severe, some students may need to stay home from school after a concussion. If symptoms or mild or tolerable, the parent may consider returning him or her to school, perhaps with some adjustments. Students with severe or prolonged symptoms lasting more than 3 weeks may require more formalized academic accommodations.
The AAP recommends a collaborative team approach to help a student recovering from a concussion. This team should consist of the child or adolescent’s pediatrician, family members and individuals at the child’s school responsible for both the student’s academic schedule and physical activity. Detailed guidance on returning to sports and physical activities is contained in the 2010 AAP clinical report, “Sport-Related Concussion in Children and Adolescents.”
A symptom checklist can help evaluate what symptoms the student is experiencing, and how severe they are.
“Every concussion is unique and symptoms will vary from student to student, so managing a student’s return to the classroom will require an individualized approach,” said Dr. Halstead. “The goal is to minimize disruptions to the student’s life and return the student to school as soon as possible, and as symptoms improve, to increase the student’s social, mental and physical activities.”
Because relatively little research has been conducted on how concussion affects students’ learning, the AAP based its report primarily on expert opinion and adapted it from a concussion management program developed at the Rocky Mountain Hospital for Children, Center for Concussion in Denver, Colo. The AAP calls for further research on the effects and role of cognitive rest after concussion to improve understanding of the best ways to help a student recovering from a concussion.
Information for parents about returning to learning after a concussion also will be available on HealthyChildren.org (starting Oct. 27).
###
The American Academy of Pediatrics is an organization of 60,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit http://www.aap.org.

Parents must be alert to what is happening with the children when they participate in athletic events and activities.

Resources:

Concussions
http://kidshealth.org/teen/safety/first_aid/concussions.html#a_What_Is_a_Concussion_and_What_Causes_It_

Concussion
http://www.emedicinehealth.com/concussion/article_em.htm

Concussion – Overview
http://www.webmd.com/brain/tc/traumatic-brain-injury-concussion-overview

Related :

Study: Effects of a concussion linger for months

Study: Effects of a concussion linger for months

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