The swine flu (now referred to as the Mexican flu or Novel H1N1 flu) has now spread to 41 states in the US with 642 confirmed cases (as of May 6) and 23 countries worldwide. The US Centers for Disease Prevention and Control (CDC) has provided recommendations for the general public but also to specific sectors for the population. Here are some info and recommendations for parents and parents-to-be:

• For moms who are breastfeeding
  According to the CDC, breast milk is one of the best defense against the flu for your baby. Do not stop breastfeeding even if you or your baby are ill. Continue to breastfeed even if you are being treated for the flu.
• For women who are pregnant
  The CDC does not know what the effect of this novel flu will be on pregnant women and their unborn babies. Pregnant women are thought to be very susceptible and are advised to take extra care. The CDC also cannot give much information about the effects of the antiviral agents on the pregnancy. Pregnant women who present with flu symptoms should contact their doctors immediately.
• For pregnant women who work in education, child care, and health care
  Pregnant women who work in schools, daycares, and hospital are especially vulnerable. Like all pregnant women, they should take extra precautionary measures in their workplace. Pregnant healthcare workers should consider temporary transfer to lower risk assignments.
• For parents with daycare- and school-aged children
  Parents should closely monitor their kids for early symptoms. They should also discuss the issue with their child care providers/teachers. Children who present with flu symptoms should stay at home and parents should inform the school/daycare immediately.
• For child care providers
  The CDC has also issued recommendations for child care providers, both center-based and home based. It has provided Child Care and Preschool Pandemic Influenza Planning Checklist for caregivers.
• For parents who want to talk to their children about the flu
  The CDC is encouraging parents to talk to their children openly about the flu. This is the best opportunity to focus on health and hygiene.

Click on the links for the full CDC recommendations!

I love e-cards. I love receiving them and sending them. Which is why I am so delighted to find free e-cards that serve a special purpose. Not only as birthday or holiday greetings. Not only for special occasions. These are e-cards that serve as health reminders as well.

I am referring to the health e-cards available on the site of the Centers for Disease Control and Prevention (CDC).

Some are really pretty cute but with some serious messages. One, for example says “Peep, chirp, quack! Why parents should think twice before giving baby birds to young children at Easter.” The card links to risks of Salmonella infection from baby chicks and ducklings. There’s one on safety and healthy tips for brides. And some on pregnancy health tips with really nice photos. There is almost an e-card for every type of health situation. What is also great is that the CDC continues to add new e-cards in accordance with the season as well as with health observances. Plus, they are available in Spanish as well. And like other e-cards, you can personalize them, are easy to make and send.

So if you want to send an e-card to a friend, a family member, a colleague, I suggest you check out the health e-cards at CDC. E-cards are a great way to spread cheer and laughter – and health messages.

It’s a baby boom! Government researchers just reported that in 2007, there were 4.3 million live births. That tops even the baby boom of the 1950s. After concerns on some fronts in recent years about the US population not reproducing itself, this is a sigh of relief. But the numbers are slightly misleading. According to the Centers for Disease Control, back in the 50s, there were fewer women having babies–but they had more of them (about four kids each). Today, women have 2.1 children a piece (I guess I’m just .1 away from normal. Any of you over your limit? You can have my share.) The highest numbers are in Utah. The lowest in Vermont. I wonder if that is adjusted for population? A quarter of the “women” giving birth are teenagers. And 40% of the births were to unwed parents.

Experts of every stripe are out in force today, ranging from the abortion advocates to family researchers, sociologists and economists. Each of them is weighing in on why things are the way they are. You may not even be surprised to learn that some of the issues here have been blamed on George Bush. (That’s kind of a long-standing game between my husband and I. What did someone blame on Bush today?) Economists say the trend in babymaking matches the economy. Since 2007 was a good year, there were lots of babies. Dr. Carol Hogue, a professor of maternal and child health at Emory University, thinks the birth rate will drop with the downturn in the economy. “The lowest birth rates recorded in the United States occurred during the Great Depression.”

Now the study didn’t say how many of the unwed births were unintended, nor how many of the unmarried women were in long-term relationships with the father. Still, 40% is not a good number. Why are teenagers getting pregnant? Some are saying it’s because they don’t have an abortion clinic nearby. Some say that George Bush tried to teach them abstinence-only but they didn’t get the message. For whatever reason, the teen birth rate had been going down for 15 years. Then suddenly, last year, it went back up.

I am no expert in such matters. But I have been a high school teacher for many years. I can tell you that teenagers are no longer branded by a negative social stigma when they get pregnant. So if it happens to one of them, they no longer have to face ‘outcast’ or ‘hussy’ status. Girls and boys freely discuss their sexuality in school. I also have noted that most of my students who were willing to speak up are very opposed to abortion on a personal level. They would much rather raise a baby than abort it. (This matches the fact that abortion rates have been dropping steadily. Which causes the other?) It also seems like a cultural trend to me when you consider that the numbers are not balanced among different races. The birth rate among black teenagers is twice as high as whites. Hispanic teenagers have three times as many babies as white girls. I live and teach in a community that is more than half hispanic. I don’t know all the ins and outs because I am not hispanic myself. But I do see a positive commitment to family among them. A baby is a good thing. Again, these are just my observations. Of course there are other experiences out there.

So why are older women having babies out of wedlock? Maybe for the same reasons. And, if you add in the fact that marriage is slightly on the decline, it makes sense. Again, if you look at the number breakdown, it is very much a trend within certain cultures. Almost 72% of all black babies were born to unwed mothers. A little more than half of hispanic babies were. Do you have any explanation for this other than cultural attitudes?

There were a few more interesting findings:
- One third of all births are by cesarean. (In Puerto Rico, it’s almost half of all births.) “Every pregnant woman in the U.S. should be alarmed by this rate,” said the president of the advocacy group, International Cesarean Awareness Network advocacy group. Pam Udy continued by saying that more than half of those could have been avoided. If you had a cesarean, why? Was it elective? Was it planned?
-On a positive note, there are fewer premature babies born now. Fewer infants are low-birth weight, too. Is this the result of younger mamas? Or better health care? None of the above?

What do you think of all these numbers?

The Advisory Committee on Immunization Practices met in Atlanta on Wednesday, Feb 25. The committee makes recommendations to the Centers for Disease Control and Prevention. Among the latest recommendations: the Hepatitis-A vaccine for people who come in contact with international adoptees.

Dr. Cindy Weinbaum, a medical epidemiologist with the CDC, said the recommendations cover adoptions from countries with a high or intermediate infection risk. “That includes most of the world. All that (it) excludes is North America, Western Europe, Australia, New Zealand and Japan,” she said. The disease is unfortunately common among children coming from the four top countries of origin for children being adopted by US families. Those are China, Russia, Guatemala and Ethiopia.

Formerly, only parents who were traveling to such countries were recommended for the vaccine. Now, the suggestion includes people such as grandparents and babysitters–anyone who will have close contact with an international adoptee withing 60 days of his or her arrival in the U.S. The average incubation for the disease is 28 days, but it can be longer, and young children often show only very mild symptoms, thereby increasing the risk to unsuspecting adults. And children adopted from other countries usually have not had a vaccination.

Even though these children only cause 3% (at the highest estimate) of Hep-A infections every year, federal officials state that the results can be tragic–especially since they are both foreseeable and preventable. The latest of these cases involved a 51-year old woman who became critically ill after exposure to her internationally adopted grandchildren. Weinbaum cited there were about 20 recent cases.

Hepatitis A is a highly contagious liver infection caused by a virus. It is typically spread through feces (in other words, be careful with the diapers!). Symptoms can include fever, jaundice, nausea and vomiting. It is usually more severe in adults, and can be fatal.

The vaccine is given in two doses. The first one should be administered as soon as an adoption is planned. The second would ideally be given two weeks before the child’s arrival. It is an expensive vaccine, by some standards ($140). But considering that international adoptions often cost between $20,000 and $40,000 (according to Dr. Weinbaum), it’s not a lot of money in the big scheme of things.

This recommendation follows the news last summer of many false-negative tuberculosis tests in international adoptees. For some reason, the children did not show positive results for three months. Similarly, young children with hepatitis-A don’t often show signs of jaundice, an indicator for the infection.

The latest CDC report says that the majority of children and adolescent accidental injuries in the US are due to vehicular accidents, drowning, and falls. From 2001 to 2006, approximately 55 million children were treated at emergency facilities for so-called “unintentional injuries”, leading to a yearly estimate of 9 million cases. Many accidents were non-fatal. However, a large number of accidents also resulted in deaths.

Other information given in the CDC report are:

• The highest death rates in children of all ages were among occupants of cars and other forms of motor vehicles;
• Drowning was the leading cause of death due to unintentional injury for children aged one to four years old;
• For older children aged 5 to 19 years old, fatal injuries were due to being an occupant in a motor vehicle crash;
• Poisoning and falls accounted for the highest rates of non-fatal injuries to young children aged one to four years old.

This indicates that the risks for different types of injuries are age-related and that parents and caregivers should therefore take precautionary measures according the minor’s age.

The full report, “CDC Childhood Injury Report: Patterns of Unintentional Injuries among 0-19 Year Olds in the United States, 2000-2006,” is available at www.cdc.gov/safechild/Child_Injury_Data.htm.

For preventive measures recommended by the CDC, check out www.cdc.gov/safechild.

Protecting your loved ones, especially the children – that’s what it’s all about.

The Centers for Disease Prevention and Control (CDC) has just released the CDC Childhood Injury Report: Patterns of Unintentional Injuries among 0-19 Year Olds in the United States, 2000-2006 earlier this month.

The report gives data on accidental children injuries associated with drowning, falls, fires or burns, transportation-related injuries, poisoning, and suffocation, among others. Here are some facts and figures to ponder upon:

• On average, 12,175 children 0 to 19 years of age died each year in the United States from an unintentional injury.
• Injuries due to transportation were the leading cause of death for children.
• An estimated 9.2 million children annually had an initial emergency department visit for an unintentional injury.
• Injuries due to falls were the leading cause of nonfatal injury.

For these reasons, the CDC launched the “Protect the Ones You Love: Child Injuries Are Preventable” initiative to increase awareness of parents and caregivers about the causes of child injuries. The initiative includes free resources such as information leaflets, e-cards, podcasts and special events. All materials are available free of charge.

A study published online in the July edition of the journal Pediatrics revealed that many internationally adopted children showed positive skin tests for tuberculosis (TB) three months after receiving negative results.

The U.S. Office of Immigration Statistics reports that 20,705 children were adopted from overseas in 2006, and most of them come from regions where TB is prevalent. Therefore, initial exams for such internationally adopted children regularly include TB skin tests. Around 21% of those children test positive for infection. However, the researchers later retested children with initial negative results and learned that another 20% had latent TB infections (not the active disease).

TB is a bacterial infection that typically attacks the lungs (but other organs are susceptible as well). Left untreated, it can be fatal. Tuberculosis in the lungs or throat is communicable through airborne particles, and infection spreads easily, but not all infected people become ill. This “latent” infection is not communicable, but the carrier can become ill at a later time. Luckily, it is easily treated when detected. The U.S. Center for Disease Control and Prevention has a pamphlet on the disease, it?s symptoms and other information on its website.

Because of the high incidence of false-negative results in the research study, the authors suggest an initial TB skin test when foreign adoptees are brought home, and a repeat test in three months for those with a negative result.

The US Centers for Disease and Prevention (CDC) conducted a survey on maternity practices in hospitals and birth centers nationwide in 2007. The survey looked at 7 areas providing support for women who choose to breastfeed their babies and rated them on a scale of 0 to 100.

The average scores presented below were based on the responses of 2,690 facilities (out of 3,143 who received the questionnaires) participated in the survey.

• labor and delivery – 60
• breastfeeding assistance onsite – 80
• mother-newborn contact – 70
• postpartum feeding – 77
• breastfeeding support after discharge – 40
• nurse/birth attendant breast-feeding training and education – 51
• structural and organizational quality – 66

It seems that even though most facilities scored high in initial breastfeeding assistance, support after discharge is lacking.

88% of the participating facilities taught the majority of mothers breastfeeding-related techniques. However, some facilities reported maternity practices that are deemed to be not supportive of breasfeeding, namely:

• 65% advised breastfeeding mothers to limit the duration of suckling.
• 45% gave pacifiers to more 50% of all healthy, full-term breastfed babies.
• 24% gave as a general practice supplements (and not breastmilk exclusively) to more than 50% of all healthy, full-term breastfed babies.
• 70% gave discharge packs containing infant formula samples to breastfeeding mothers.
• Only 20% provided postpartum home visits.

The scores varied a lot across states. Combining all scores, New Hampshire and Vermont have the highest score of 81 while many southern states had mean scores of as low as 48.

These findings are important since previous research studies have shown that support from birth facilities, their practices, and their policies play a very important role in initiating breastfeeding as well as its continuation after discharge.

More of the results of the survey can be found here.

I completely agree with the report’s concerns over this lack of support.

I had problems breastfeeding my premature twins. They had to be initially fed with glucose water and then special formula for preemies. The support of the maternity staff at my hospital plus the follow-up support of my midwife helped me to find a way to give them my milk. I pumped at the hospital, then at home after my discharge and brought my breastmilk to the neonatal station. The station always provided me with sterilized bottles to put my milk in. Later, when my twins could go home, my midwife helped me find a place to rent a double breast pump to facilitate pumping, all paid by my health insurance. I ended up providing milk for my twins this way for 4 months until I had to stop for health reasons.

Without support, I couldn’t have done it.

Sources:

HealthDay News, 12 June 2008

CDC’s Morbidity and Mortality Weekly Report, 13 June 2008

If you have noticed more people sniffling and sneezing around you than usual, or you?re starting to feel ill, there?s a reason for it: the flu has arrived. What?s worse, the flu shot you and your children may have received might not work as well as it has in past years. Officials at the U.S. Centers for Disease Control and Prevention said Friday that this year?s shot is a good match for only about 40% of this year’s flu viruses. In good years, the vaccine can fight 70-90% of the flu bugs that are spreading.

This week, widespread flu activity was reported in 44 states, up from 31 states last week. The number of children who have died from the flu is now 10 since the official start of flu season Sept. 30, 2007.

Health officials say that those numbers are not considered alarming. Early February is typically the time of year when flu cases tend to spike. Put into perspective, the 10 pediatric deaths are about the same number as were reported at this time in the last two flu seasons.

Flu symptoms include:

• fever
• headache
• extreme fatigue
• sore throat
• a dry cough
• a runny or stuffy nose
• muscle aches
• and stomach upset including nausea, vomiting, and diarrhea.

So what can you do to help prevent the spread of the flu? Health officials recommend frequent hand washing or the use of hand sanitizer when soap and water are not available, sneezing and coughing into your elbow, and try to avoid people who are sick. In addition, getting adequate rest and eating a balanced diet can help to prevent illness.

If you or your children do come down with the flu, stay home to avoid spreading germs. Get lots of rest, stay hydrated and increase your fluid intake. In addition, talk to your health care provider about whether you should take antiviral drugs.

Here is a link to the Center for Disease Control?s flu map, updated weekly.