Because a woman’s birth canal is curved and only a little wider than a fetus’s head, a baby must proceed through the canal in a specific sequence of moves. A failure during the process, such as a head turned the wrong way at the wrong time, can result in difficult labor or dystocia.

Using the new software, called PREDIBIRTH, Dr. Olivier Ami and a team of researchers from the Department of Radiology at Antoine Béclères Hospital, Université Paris Sud, France, processed MR images of 24 pregnant women. The result was a three-dimensional (3-D) reconstruction of both the fetus and pelvis along with 72 possible trajectories of the baby’s head through the birth canal. The program scored each mothers likelihood of a normal birth based on these simulations.

“The mechanics of the human birth canal make for a very complicated delivery process compared to other mammals,” said Dr. Ami in a news release. “We now have computer-simulated childbirth to identify potential problems. The software simulates the properties of potential deliveries.”

For this study, the PREDIBIRTH scores were computed retrospectively and measured against delivery outcomes for the 24 women. Thirteen women had normal deliveries, which had been  scored as highly favorable by the simulator. Three women who had elective cesarean-section (C-section) were scored at high risk for dystocia.

Of the five women who had emergency C-sections, two involved heart rhythm abnormalities and had simulator scores of mildly favorable and favorable. Three involved obstructed labor, all of whom scored at high risk of dystocia. Three women delivered with vacuum extraction and had mildly favorable simulator scores.

Researchers say the results in predicting dystocia were highly accurate and are a notable improvement over pelvimetry, which measures the pelvis manually or by imaging to determine its adequacy for childbirth. While pelvimetry is commonly used, Dr. Ami said it’s not entirely reliable.

“A small pelvis may be able to deliver without problems, and a big pelvis might require mechanical help during childbirth,” he said. “This uncertainty raises the rate of C-sections.”

In the U.S., C-sections account for approximately one-third of all births. In France, the rate of mechanical problems is 30 percent, two-thirds of which are emergency procedures.

“An emergency C-section has six to seven times more morbidity and mortality than a planned C-section,” Dr. Ami said. “With this virtual childbirth software, the majority of C-sections could be planned rather than emergency, and difficult instrumental extractions might disappear in the near future.”

For more on  child safety issues, see the library of articles by Daytona Beach child injury attorney.

And that’s a big risk when you consider an estimated 40 million children between the ages of 5 and 14 could hit the trick-or-treat trails this Halloween, according to numbers form the U.S. Census Bureau. Other common Halloween injuries include eye injuries from sharp objects and burns from flammable costumes.

The nation’s emergency physicians want children and families to enjoy the holiday traditions safely and not experience any Halloween horrors that would include spending time in the emergency department. 

“

Children should be out having fun and spending time with family and friends,” said Dr. Sandra Schneider, with the American College of Emergency Physicians, in a news release. “They should not have to spend Halloween in the ER because of some injury that could have been easily prevented.”

Emergency physicians recommend that children “trick-or-treat” at organized Halloween festivities, such as local churches, shopping malls or schools. This way children are not walking in the dark and it allows constant adult supervision.

The ACEP suggests that adults follow these tips for a safe and fun Halloween:

• Make sure your child stays on the sidewalks as much as possible (off streets) and obeys all traffic signals.
• Discuss the importance of staying together in a group. Require at least one adult to serve as chaperone during trick-or-treat gatherings.
• Make sure your child knows the potential dangers from strangers. Make sure they know never to accept rides from strangers or visit unfamiliar homes or areas.
• Avoid costumes that could cause children to trip, such as baggy pants, long hems, high heels and oversized shoes.
• Avoid costumes that obstruct the child’s sight or vision.
• Avoid masks if possible. If your child must wear one, make sure it is well ventilated.
• Make sure costume fabric, wigs and beards area made of flame-resistant materials, such as nylon or polyester.
• Keep candlelit Jack-O-Lanterns away from children so they can’t get burned or set on fire.
• Make sure costumes are visible at night: avoid dark colors. Add reflective tape to costumes so your child is more visible to motor vehicles.
• Make sure you see all of the candy before your child eats it. Avoid candy that is not wrapped in its original wrapper, as well as all fruit
• Take a flashlight while trick-or-treating as visibility decreases long before it gets really dark.
• Check accessories such as swords, knives, wands and other pointed objects. Make sure they are made from flexible materials and have dulled edges.

For more on child safety issues, see the library of articles by Daytona Beach child injury attorney.

The rise in exposure to prescription products has been so striking that the Centers for Disease Control and Prevention has established the PROTECT Initiative, intended to prevent unintended medication overdoses in children. According to the CDC, more than 70,000 emergency visits each year result from unintentional overdoses among children under the age of 18.

Dr. Randall Bond, an emergency medicine physician at Cincinnati Children’s Hospital Medical Center, presented his study on children and pharmaceutical poisonings at a recent PROTECT Initiative meeting in Atlanta. The study was published in September in the Journal of Pediatrics.

“The problem of pediatric medication poisoning is getting worse, not better,” says Dr. Bond, who also is medical director of the Drug and Poison Information Center at Cincinnati Children’s, in a news release. “More children are exposed, more are seen in emergency departments, more are admitted to hospitals, and more are harmed each year.”

Bond found that exposure to prescription products accounted for most of the emergency visits (55 percent), admissions (76 percent) and significant harm (71 percent). Levels of ingestion of opioids, most often prescribed to treat pain; sedatives-hypnotics, frequently prescribed as sleep aids; and cardiovascular medications were particularly high.

“Prevention efforts at home have been insufficient,” Bond said. “We need to improve storage devices and child-resistant closures and perhaps require mechanical barriers, such as blister packs. Our efforts can’t ignore society’s problem with opioid and sedative abuse or misuse.”

Bond studied patient records from 2001 to 2008 in the National Poison Data system – an electronic database of all calls to members of the American Association of Poison Control Centers. Bond studied children 5 years old and younger exposed to a potentially toxic dose of a single pharmaceutical agent, either prescription or over-the-counter. A total of 453,559 children were included in the study.

The largest part of increasing admissions, injuries and death was due to children finding and ingesting medication on their own. Therapeutic errors at home were uncommon and increased only minimally.

The most likely explanation for these trends is a rise in the number of medications around small children, he says. A 1998-99 survey found that half of adults had taken at least one prescription medication in the preceding week and 7 percent had taken five or more. In 2006, the same surveyors found that 55 percent had taken at least one prescription medication in the preceding week and 11 percent had taken five or more.

There are 57 poison control centers in the United States. Together they provide free, 24-hour poison expertise and treatment advice by phone. All poison centers can be reached by calling the same telephone number 1-800-222-1222. Poison centers are staffed by pharmacists, physicians, nurses and poison information providers who are toxicology specialists.

For more on child medical safety issues, see the library of articles by Daytona Beach child injury attorney.

Children left alone in vehicles during hot weather are at risk of a serious injury or death from hyperthermia. According to NHTSA research, hyperthermia is the leading cause of non-crash vehicle deaths for children under the age of fourteen.

Reports by the San Francisco State University Department of Geosciences show 49 children under the age of 14 years died in 2010 due to hyperthermia, with 21 deaths so far in 2011. Several states have witnessed especially high incidences of fatalities for children aged 3 and under – including Florida, Texas, California, Nevada, and North Carolina.

“These twenty-one deaths were tragic and preventable – not one of those children should have lost their lives in this horrible way,” said U.S. Transportation Secretary Ray LaHood in a news release. “We need to do everything we can to remind people to be vigilant and never leave a child alone in or around a motor vehicle.”

Consider these facts from the NHTSA:

• Vehicles heat up quickly – even with a window rolled down two inches, if the outside temperature is in the low 80s, the temperature inside a vehicle can reach deadly levels in only 10 minutes.
• Children’s bodies overheat easily, and infants and children under four years of age are among those at greatest risk for heat-related illness.
• Children’s bodies absorb more heat on a hot day than an adult. Also, children are less able to lower their body heat by sweating. When a body cannot sweat enough, the body temperature rises rapidly. In fact, when left in a hot vehicle, a young child’s body temperature may increase three to five times as fast an adult. High body temperatures can cause permanent injury or even death.

NHTSA experts were joined by representatives from the automobile industry, car seat manufacturers, victims, researchers, consumer groups, and health and safety advocates to discuss strategies to reduce child fatalities and injuries in hot vehicles.

“We know hyperthermia is a serious threat that needs to be better addressed immediately,” said David Strickland, Administrator of NHTSA. “A coordinated, targeted approach to increase public awareness of this very serious safety danger should help prevent unnecessary tragedies and near-misses moving forward. We need to come together and give the best information to parents, caregivers, and our communities to protect children in vehicles.”

In the coming weeks and months, Strickland and his staff will host listening sessions and other activities in some of the states hardest hit by hyperthermia deaths. They will engage concerned parents, advocacy groups, automotive experts, and health and law enforcement professionals, to discuss the best ways to raise awareness and to propose strategies for preventing these tragic events.

The NHTSA offers these prevention tips:

• Never leave a child unattended in a vehicle.
• Do not let your children play in an unattended vehicle. Teach them that a vehicle is not a play area.
• Never leave infants or children in a parked vehicle, even if the windows are partially open.
• Make a habit of looking in the vehicle – front and back – before locking the door and walking away.
• If you are dropping your child off at childcare, and normally it’s your spouse or partner who drops them off, have your spouse or partner call you to make sure the drop went according to plan.
• Ask your childcare provider to call you if your child does not show up for childcare.
• Do things to remind yourself that a child is in the vehicle, such as:
• Writing yourself a note and putting the note where you will see it when you leave the vehicle;
• Placing your purse, briefcase or something else you need in the back seat so that you will have to check the back seat when you leave the vehicle; or
• Keeping an object in the car seat, such as a stuffed toy. When the child is buckled in, place the object where the driver will notice it when he or she is leaving the vehicle.
• Always lock vehicle doors and trunks and keep keys out of children’s reach. If a child is missing, check the vehicle first, including the trunk.
• If you see a child alone in a hot vehicle, call the police. If they are in distress due to heat, get them out as quickly as possible. Cool the child rapidly. Call 911 or your local emergency number immediately.

For more on child safety issues, see the library of articles by Daytona Beach child injury attorney.

The study, involving 257 students, highlights that a higher degree of pain was experienced with the use of gaming devices compared to mobile phones. Pain reported by children using Xbox and Gameboy was statistically higher than pain reported for the iPhone.

Importantly, the length of time spent on the devices heightened the pain suffered, as the data demonstrated that length of time was independently associated with the pain reported, with the odds of reporting pain increasing by two for every one hour of play.

“Our study has shown the negative impact that playing computer games and using mobile phones can have on the joints of young children, raising concerns about the health impact of modern technology later in life,” said Professor Yusuf Yazici, Rheumatology, NYU Hospital for Joint Diseases, New York. “We hope that further research in this area will shed light on what could be a serious health concern for today’s gaming children, in later life.”

The study also investigated pain attributed to mobile phone usage for the sending of text messages, the number of texts sent, the use of abbreviations, and the type of keyboard used, according to age and gender.

The results indicated that female students reported twice as much pain as male students respectively, measured using the 10cm Visual Analogue Scale (VAS, a pain measurement scale) and gender was the only independent variable associated with pain.

The study involved 257, nine to 15 year old students from two schools in St Louis. They were administered with a questionnaire to aid researchers in determining the possible association device type, age of children and hours played may have on wrist and finger pain.

A multivariable generalised linear model examined whether reported pain was associated with game device usage adjusting for age, gender, school and duration of game play per game device.

The study results were presented last week during the European League Against Rheumatism 2011 Annual Congress.

For more on medical issues, see the library of articles by Daytona Beach child injury attorney.

Only one of the 29 infants who received human milk developed the dangerous intestinal condition necrotizing enterocolitis (NEC) and recovered without surgery, compared with five out of the 24 babies on formula, four of whom required surgery. The findings, say the researchers at Johns Hopkins Chidren’s Center, justify a move toward a “human milk only” diet in extremely premature babies — those born weighing less than 1,500 grams, or 3.3 pounds.

“The stark differences in the risk of NEC, its complications and the need for surgery between babies who receive human donor milk and those who get formula signal the need for a change in feeding practices across neonatal intensive care units,” said lead investigator Dr. Elizabeth Cristofalo, a neonatologist at Hopkins Children’s, in a press release.

Moreover, babies who got human milk tolerated feeding better, allowing them to be taken off supplemental IV nutrition much sooner — after 27 days on average — than the group who received cow’s milk formula.

Those babies spent an average of 36 days on IV nutrition, largely because their intestinal tracts were not adapting to food as well, the researchers say. IV nutrition, used temporarily in all premature babies to supplement feeding, carries risks, the most serious of which is liver damage.

“Although we didn’t look specifically at liver function, we know from experience and from previous research that prolonged IV nutrition can harm a premature baby’s liver,” Cristofalo said. “Using human milk cuts that risk by allowing us to wean babies off IV nutrition sooner.”

Necrotizing enterocolitis is marked by tissue damage to the baby’s bowel. Because up to 40 percent of babies who develop NEC die, the condition is considered an emergency. Some cases of NEC can be treated with antibiotics and by temporarily withholding of food, but some babies require surgery to remove the dead portions of the intestines. The remaining intestine, however, can develop scarring that leads to poor absorption of nutrients, growth problems and the need for more surgery down the road.

The health advantages of mother’s milk have been well established, but some concerns about donor milk have lingered, including how it compares to mother’s milk and whether it is, indeed, superior to cow milk formula. The new findings should resolve any residual doubts about the risks and clarify the benefits of human donor milk, the investigators said.

The multi-center study is the first trial of its kind to compare the risk for NEC and NEC surgery between premature infants fed human donor milk and those fed preterm baby formula. An earlier study by the same team showed that babies who get their own mother’s milk fortified with the standard cow milk protein are more prone to NEC than babies given a combination of their mothers’ milk fortified with human donor milk.

Other hospitals participating in the study included Cohen Children’s Medical Center of New York, University of Texas, University of Florida-Gainesville, Innsbruck Medical University in Austria, Baylor College of Medicine and Children’s Hospital and Research Center, Oakland, Ca.

For more on child medical issues, see the library of articles by Daytona Beach child injury attorney.

A new, small study of parents in Colorado reveals another potential roadblock to child passenger safety: youngsters unbuckling themselves while the vehicle is moving.

Such incidents are alarming as restraining children inappropriately in a vehicle more than triples their risk for serious injury in a collision.

While previous studies have looked at potential obstacles to getting a child restrained safely, none has assessed how frequently youngsters unbuckle themselves, or the age at which children are able to do so.

In this study, researchers led by Dr. Lilia B. Reyes, clinical fellow in the Department of Pediatrics at Yale School of Medicine, surveyed parents with children younger than 6 years to find out the age at which children begin to unbuckle themselves from vehicle restraints and how frequently this occurs while the car is moving.

Parents at five urban and suburban pediatric offices also were asked to describe what they do if their child unbuckles.

Results from 378 parents showed that 51 percent reported that at least one of their children self-unbuckled. In addition, 75 percent of children who unbuckled themselves were 3 years of age or younger, and unbuckling was reported as early as 12 months of age. More boys unbuckled themselves than girls (59 percent vs. 42 percent, respectively).

Of the children who unbuckled themselves, 43 percent did so when the car was moving. The majority of parents reported that when this happens, they pull the car over, reprimand the child and re-buckle him or her.

“This pilot study elucidates another potential safety hazard in child motor vehicle restraint that needs to be addressed,” Dr. Reyes said. “Most importantly, it makes parents aware of the fact that their child may have the motor capability of self-unbuckling without having the full cognitive understanding of the consequences of this behavior.”

Future research should look at which restraint devices would be safer, Dr. Reyes concluded. “Keeping precious cargo safe is our duty.”

For more on child safety issues, see the library of articles by Daytona Beach child injury attorney.

Gastroenterologists from the Pediatric Inflammatory Bowel Disease Center at Johns Hopkins Children’s in Baltimore say that many of the hundreds of children they see were referred to them only after months of repeated visits to their primary-care physicians for symptoms mistakenly attributed to common GI ailments like viral gastritis.

“Inflammatory bowel disease is still considered an adult condition and is rarely on pediatricians’ radars,” says Dr. Maria Oliva-Hemker, chief of the Gastroenterology & Nutrition division at Hopkins Children’s and director of the comprehensive IBD center there, in a press release. “Fifty years ago, IBD was almost exclusively diagnosed in adults. These days, treating children with IBD is business as usual in our clinics.”

More than 100,000 children in the United States have IBD, according to the Crohn’s & Colitis Foundation of America. A 2003 study published in The Journal of Pediatrics reported a surprisingly high rate of IBD among children in Wisconsin — the highest in the world at that point — 7.5 cases per 100 000, with a CD rate of 4.56 and a UC rate of 2.14.

Scientists believe that IBD is triggered by an overactive immune system that mistakenly attacks the colon and small intestine. The reasons driving the rise of childhood IBD remain unclear, but genetic and environmental factors are clearly at play, experts say.

Because genetic makeup does not change drastically in populations over short periods of time, it is more likely that changing environmental factors are triggering new cases in genetically predisposed children, the researchers say.

The two main forms of IBD are Crohn’s disease (CD) and ulcerative colitis (UC). For unknown reasons, Crohn’s disease seems to be rising more rapidly in children than ulcerative colitis, Oliva-Hemker says.

Children with CD also tend to be diagnosed later than those with ulcerative colitis because the most common symptom is vague abdominal pain rather than the more suggestive bloody stools seen in ulcerative colitis, she notes.

Delays in treatment can make IBD worse and lead to severe anemia from gastrointestinal bleeding, poor food absorption, malnutrition and stunted growth. In advanced cases, IBD can cause serious damage to the colon and small intestine that requires surgery.
To prevent dangerous delays in diagnosis and treatment,  Oliva-Hemker says the following symptoms — especially if they keep coming back or never fully go away — should prompt a visit to a specialist:

• abdominal pain
• bloody stools
• diarrhea
• nausea and/or vomiting
• poor appetite and weight loss
• poor growth, especially in younger children
• pale skin, rapid heartbeat, fatigue and dizziness, all of which could indicate chronic anemia from GI bleeding
• a family history of IBD —  up to 30 percent of childhood cases have genetic roots

Oliva-Hemker advises pediatricians who suspect IBD to obtain routine blood tests to check for anemia and inflammation markers like elevated sedimentation rate and C-reactive protein. The diagnosis can usually be confirmed with an endoscopy and colonoscopy.

IBD is most commonly diagnosed in school-age children and teens, but gastroenterologists say that they have seen the disease in a growing number of children younger than 5 years of age.

For more on children’s medical issues, see the library of articles by Daytona Beach child injury attorney.

And almost two thirds of children who choke to death are three years of age or younger. Most of these deaths can be avoided. Understanding how to prevent choking, as well as what to do when choking occurs, can save a life.

CHOKING PREVENTION TIPS

The American College of Emergency Physicians (ACEP) offers these tips to help prevent incidences of choking:

“Supervise mealtimes for young children,” said Dr. David Vukich of ACEP. “Many choking cases occur when older brothers or sisters offer unsafe foods to a younger child. Some foods that can cause choking include hot dogs, nuts, chunks of meat, grapes, hard candy, peanuts, popcorn, chunks of peanut butter and uncooked vegetables.”

Avoid toys with small parts and keep other small household items out of reach of young children. Balloons are particularly dangerous.

TREATING CHOKING INFANTS

“If a child is choking, first find out if the child can breathe, cry or speak,” said Dr. Vukich. “A strong cough generally means little or no blockage, and the child may be able to dislodge the blockage by coughing. Only begin first aid if the child cannot breathe at all, or the child’s airway is so blocked that there’s only a weak cough and a loss of color.”

According to ACEP, the ways to properly treat choking victims, especially children under age four, are first aid that everyone should learn to help people breath easier.
For a conscious infant under 12 months of age, here are the first aid steps:

• Support the head and neck with one hand. Place the infant face down over your forearm, head lower than torso, supported on your thigh.

• Deliver up to five back blows, forcefully, between the infant s shoulder blades using the heel of your hand.
• While supporting the head, turn the infant face up, head lower than torso.
• Using 2 or 3 fingers deliver up to five thrusts in the sternal (breastbone) region. Depress the sternum 1/2 to 1 inch for each thrust. Avoid the tip of the sternum.
• Repeat both back blows and chest thrusts until the foreign body is expelled or the infant becomes unconscious.

For more on child safety, see the library of articles by Daytona Beach child injury attorney.

The number of pediatric emergency department visits that included a computerized tomography or CT examination increased from roughly 330,000 in 1995 to 1.65 million in 2008, with a compound annual growth rate of 14.3 percent. The leading complaints among those receiving CT included head injury, abdominal pain and headache. The rate of imaging for abdominal pain increased the most, owing to improvements in the technology.

“We need to think creatively about how to partner with each other, with ordering clinicians and with CT manufacturers to ensure that all children are scanned only when it is appropriate and with appropriate techniques,” said the study’s lead author, Dr. David B. Larson, director of quality improvement in the Department of Radiology at Cincinnati Children’s Hospital Medical Center in Ohio, in a press release.

Advancements in CT technology like helical scanning have made it a vital tool for rapid diagnostic evaluation of children in the emergency department. Decreased scan times are especially helpful in eliminating the need for sedation in many pediatric cases.

However, the relatively higher radiation doses associated with CT, compared to most other imaging exams, have raised concerns over an increase in risks associated with ionizing radiation.

A child’s organs are more sensitive to the effects of radiation than those of an adult, and they have a longer remaining life expectancy in which cancer may potentially form. In addition, the current prevalence of CT makes it more likely that children will receive a higher cumulative lifetime dose of medically related radiation than those who are currently adults.

To study CT utilization trends in children, Dr. Larson and colleagues analyzed National Hospital Ambulatory Medical Care Survey data from 1995 to 2008.

“We found that abdominal CT imaging went from almost never being used in 1995 to being used in 15 percent to 21 percent of visits in the last four years of the study,”  Dr. Larson said. “In 1995, abdominal CT took much longer, the resolution was not as good and the research hadn’t been done to support it. By 2008, helical scanning had helped make CT very useful for abdominal imaging. It’s widely available, it’s fast and there are a lot of great reasons to do it, but it does carry a higher radiation dose.”

Dr. Larson pointed out that abdominal CT’s effective dose of radiation is up to seven times that of a head CT, suggesting that the radiation dose to children in emergency departments increased at an even higher rate from 1995 to 2008 than the rate of increase in the percentage of visits in which CT was performed.

Non-pediatric focused emergency departments made up 89.4 percent of emergency department visits associated with CT in children and increased from 316,133 examinations to 1,438,413 over the study period. Dr. Larson noted that most of the radiologists who oversaw and interpreted these studies likely were not subspecialty-trained in pediatric radiology.

“The performance of CT in children requires special oversight, especially in regards to the selection of size-based CT scan parameters and sedation techniques,” he said. “It is important to consistently tailor CT technique to the body size of the pediatric patient.”

The results of this study were published online and in the June print edition of Radiology.

For more on children’s health issues, see the library of articles by Daytona Beach child injury attorney.