Health Features

Parenting: One Step at a Time

Each stage of a child’s life comes with new joys, discoveries and challenges. It’s only natural for parents to worry about them every step of the way, from baby vaccinations to teen drug use. Anyone who’s done it will tell you: parenting is one of the hardest jobs in the world. Fortunately, you’re not alone. We asked local experts to give us a little generic guidance. after all, you can never get too much good advice.

[vaccines]
Already this year, more than 160 people from 19 states were reported to have measles, a disease we thought had been eradicated. But due to certain loopholes, some parents avoid getting their children vaccinated. What does this mean for the rest of us—and for these vulnerable children?

rumor mill
More than a dozen scientific studies have proven that early childhood vaccines do not cause autism. The most recent study, published in the Journal of the American Medical Association (JAMA), found that toddlers who have an elevated risk of autism were no more likely to be diagnosed with the disorder if they were vaccinated against measles, mumps and rubella than if they weren’t. The study of nearly 100,000 toddlers who had an older sibling with autism leaves no doubt that there is no connection between the vaccine and autism, experts say.

Still, some parents have concerns. According to SLUCare pediatrician Dr. Ken Haller, it comes down to two emotions: love and fear. “Parents love their kids, and they don’t want anything bad to happen to them,” he says. “When it comes to vaccines, though, the fear should be if your child doesn’t get them. We vaccinate against diseases because they still make kids sick, and as we saw earlier this year with the Disney measles outbreak, your kid can catch these really bad diseases anywhere, even in the ‘happiest place on Earth.’

Dr. Gregory Finn, a pediatrician at Blue Fish Pediatrics, says parents have trouble sorting reliable sources of information from poor sources or internet myths. “When you read unreliable sources, it is easy to believe that some diseases no longer exist, that vaccines have hidden and dangerous side effects, or that you can protect your child from deadly disease with food or herbs. In reality, none of that is true,” he says.

truth or not?
« Multiple vaccines will overwhelm a baby’s immune system. “Vaccines cannot overwhelm a child’s immune system any more than breastfeeding can overwhelm their tummy,” Finn says. “Infant immune systems are exposed to thousands of proteins that the immune system must process during labor, during breastfeeding, and when exposed to siblings or pets. Infant immune systems are more than able to handle the small number of proteins in a vaccine.”

« Spacing out vaccines is a safe option. There are important reasons not to spread out vaccines. “First, the shots that we give at 2, 4, and 6 months do not have live viruses or bacteria in them,” Haller explains. “They have proteins that cannot cause disease but are distinctive enough for the baby’s immune system to know they come from organisms that are ‘not me.’ It provides a sort of ‘wanted poster’ for the immune system saying, basically, if you see anything like this, get rid of it!” But there is a danger in delaying them. “We give vaccines as early as 2 months because the younger a baby is, the harder these infections will hit them,” he says. Finally, Haller says studies of baby pain indicate that getting multiple shots is no worse than getting only one. “All we do by spreading them out is create even more painful experiences for our babies.”

« Do I have to vaccinate my school-age child? According to Haller, public schools and licensed day care centers require vaccines prior to enrollment. However, a child may be excused for a documented allergy to a vaccine component, and parents may claim an exemption based on a deeply-held religious belief. Missouri does not recognize the “personal belief
exemption” which allows parents to say, essentially, “I don’t want to.”

Need more convincing? Finn notes that an unvaccinated child can be a walking time bomb. “If an unvaccinated child spreads pertussis to a newborn, the newborn can die,” he says. “And some children cannot be vaccinated for medical reasons, such as cancer treatments. A child who has survived leukemia should not have to fear for their life when they go to school.”

to note
Haller says vaccines have been the victims of their own success. “They have been extremely effective at making once-common childhood illnesses so rare that young parents have no idea how bad they are.”
In 1962:
« One in a million kids in the U. S. got measles.
« Of those, about 100,000 got severe ear infections from the disease and many resulted in permanent hearing loss.
« About 50,000 got pneumonia, many of them ending up in the hospital.
« Another 1,000 got encephalitis, a severe infection of the brain and spinal cord that left many with mental retardation.
« As many as 500 kids died of complications of this childhood illness.

shutterstock_168842468[type 1 diabetes]
About 1 in 400 children and adolescents have Type 1 diabetes, and experts say the incidence is increasing at a rate of about 3 percent per year. So what is going on?

an autoimmune issue
Type 1 diabetes is an autoimmune disorder in which the body attacks the insulin-producing cells in the pancreas, causing high blood sugars, explains pediatric endocrinologist Dr. Jennifer Sprague of Washington University School of Medicine. There are genetic factors that make developing Type 1 diabetes more likely, however no single gene causes Type 1 diabetes.

Children are more commonly diagnosed between 4 and 6 years of age and at puberty, but Type 1 diabetes also can occur in infants and adults. “Before being diagnosed, parents may notice their child is drinking more, peeing more or eating more, but losing weight. They may start getting up at night to go to the bathroom or having nighttime wetting accidents. It takes months to develop diabetes,” Sprague says.

One in four people diagnosed present with a life-threatening condition called diabetic ketoacidosis (DKA), which happens when blood sugars get very high and the body begins to make acid. “DKA is more common in younger children and becomes less common in the teenage years. In the more severe cases with DKA, patients may have abdominal pain, vomiting, changes in breathing or shortness of breath, and changes in mental status,” Sprague warns.

after the diagnosis
When a child is diagnosed with diabetes, it impacts the whole family.“ Managing diabetes in young children is a challenge and requires attentive, vigilant adult caretakers to monitor symptoms, food intake and physical activity,” says Dr. Myrto Frangos, a pediatric endocrinologist at Mercy Children’s Hospital. “With time, the children learn to recognize symptoms of low and high blood glucose. They learn to check their own blood glucose level and give insulin shots at a young age. The whole family is involved in helping monitor for signs of low blood glucose.”

Sprague says the American Diabetes Association has a resource called ‘Safe at School’ to help guide parents in getting their child’s school prepared. “Their child’s diabetes team will give the school a written care plan with many of the details needed to care for a child with diabetes,” she says.

While a diabetes diagnosis may initially cause a lot of stress and worry, Sprague says it’s important for kids and families to realize that children with diabetes are still normal. “They still can go to birthday parties, play sports and do everything their classmates are doing, but it does take some extra work and planning to make sure those activities are safe and healthy,” she explains.

The long-term prognosis of a diabetic child who manages the disorder well is excellent, Frangos says. “Managing Type 1 diabetes entails monitoring blood glucose levels several times a day, counting the grams of carbohydrates consumed and dosing insulin accordingly, exercising regularly and adjusting insulin accordingly.” However, when diabetes is not well treated, the risk of complications like heart attacks, blindness and kidney failure increases.

The good news, according to Frangos, is that there continues to be research to find a cure and improvements in insulin delivery and blood glucose monitoring devices.

shutterstock_151740563[drugs and alcohol]
Adolescence arguably presents the most challenges for parents. It’s a time when kids are struggling to find their path, and they don’t want Mom and Dad in the way. They turn to friends and experimentation to assert their separation from childhood, and that often includes drugs and alcohol.

substance abuse at a glance
While at least 70 percent of Missouri teens have had at least one alcoholic drink, regular alcohol consumption has continued to decline from its peak in the 1970s. Currently, fewer than 40 percent of high school seniors report alcohol use in the past 30 days, according to Ned Presnall, executive director of the Clayton Behavioral Addiction Medicine Center. Cigarette use also has continued to decline, although experts are concerned about e-tobacco products on the rise.

However, heroin use has increased, and marijuana use has held steady over the past 20 years. “One concern with marijuana is that fewer teens perceive regular marijuana use as a major health risk,” Presnall says. “Decreased perception of risk is one factor that drives increased use. I expect marijuana use to increase among teens as the conversation around legalization continues.”

According to Julie Weber, director of Missouri Poison Center, abuse of common over-the-counter (OT C) and prescription medication also is prevalent among teens. These drugs include cough and cold medications containing dextromethorphan (commonly referred to as ‘Triple C’), diphenhydramine products (Benadryl), prescription pain medications (opioids), and prescription anxiolytics (benzodiazepines). Presnall says the increase in prescription pain medication abuse is particularly concerning because these drugs are often a ‘gateway’ to heroin use. “K2 (synthetic marijuana) is still around and unfortunately, it may be on the rise again in Missouri with a new twist on the chemical formulation,” Weber says.

the teenage brain
According to Presnall, the teenage brain is developing in two crucial ways. “First, the prefrontal cortex (the seat of judgment, decision-making and self-control) is still developing,” he explains. “Second, the teen is developing the capacity to regulate his or
her emotions. Regular drug and alcohol use impairs prefrontal cortex development and prevents teens from developing healthy methods of emotional regulation and coping.” These teens also are at risk for chronic mental health and substance use disorders later in life.

communicate, supervise, set limits
According to Weber, parents should be on the lookout for changes in behavior (moodiness, aggression, loudness), academic or behavioral problems in school, changes in groups of friends, decreased interest in activities and appearance, slurred speech, red eyes, flushed face, coordination problems, memory or concentration problems, alcohol on the breath, or the presence of drugs or alcohol among their things. Nodding off or falling asleep unexpectedly is a sign of opioid or heroin use.

Weber says communication is essential to preventing teen drug and alcohol use. “Our teens are educated and smart,” she says. “We need to give them credit for their knowledge and explain the risks. Often a personal experience will drive home the message. If a teen can see how drugs or alcohol has affected someone’s life, and the stress it puts on the family, I think their choice may change.” With regards to the newer drugs available to teens, including K2 products and bath salts, Weber says parents and teens need to understand the risks are high.

Presnall recommends a straightforward and non-reactive parenting style. “Do not give into the argument that alcohol or drug use is normal for teens,” he says. “Our best data supports the conclusion that only a minority of teens engage in regular drug and alcohol use. Prohibiting substance use, providing regular supervision, and setting limits in a non-reactive manner provide teenagers a safe environment in which to grow and develop. Teenagers will test limits, but that is no reason to remove the limits that promote their health and safety.”

Parents also need to dispose of all unused prescription medications in their household and closely monitor controlled medications. “Accidental poisoning has now surpassed motor vehicle accidents as the No. 1 cause of accidental death in the United States,” Presnall says.

If you have concerns, resources are available, including school counselors, teachers, ministers, church communities parent-teacher organizations, Partnership for Drug-Free Kids, and the Missouri Department of Mental Health.

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