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The Informed Parent

What’s Up Doc?

by John H. Samson, M.D., F.A.A.P.
Published on Dec. 28, 2009
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Let’s wander through the medical literature again and see what looks interesting in keeping parents informed.

“MINIMIZING THE RISKS OF SUDDEN INFANT DEATH SYNDROME:
   TO SWADDLE OR NOT TO SWADDLE?”
Journal of Pediatrics, October 2009, page 475

The authors concluded that infants that are regularly swaddled are no increased incident for SIDS. They then noted that the infant not used to this practice may have less response to stimulus when sleeping while swaddled.

An editorial by Bradley T. Thach, M.D., on page 461 states:
   “In summary, the article by Richardson et al adds significant new information on arousal thresholds to tactile stimuli in swaddled infants. It should be noted, however, that currently there is insufficient evidence to indicate that infants swaddled while supine are at increased risk for SIDS. All in all, it would appear that the advantages of swaddling supine-sleeping infants outweigh the risks, if any.”

What is the answer? Dr. Thach’s closing comment, I think, answers the query.

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“MERCURY LEVELS IN PREMATURE AND LOW BIRTH WEIGHT NEWBORN INFANTS AFTER RECEIPT OF THIMEROSAL-CONTAINING VACCINES”
Journal of Pediatrics, October 2009, page 495

A good study attempting to answer the much debated topic of chimerical use in vaccines. This almost becomes a moot point since this product has been removed from many vaccines.

The author on page 498 states, “The low levels of mercury detected in this study suggest low risk for toxicity from this exposure.” As I mentioned, vaccines are available free of this product, and thus parental concerns can be alleviated.

We must remember, the whole subject of autism and vaccines has never been proven. In fact, it has been shown not to exist.

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Let’s keep control of the prescription medication your child uses!
“ADOLESCENT PRESCRIPTION ADHD MEDICATION ABUSE IS RISING ALONG WITH PRESCRIPTIONS FOR THESE MEDICATIONS”
Pediatrics, September 2009, page 875
This is certainly a truism. If more of a substance gets into the community, people will abuse it. As parents, we must keep a close watch on what our child does with the prescription medication he or she uses--particularly stimulants and, it seems from the data in this article, primarily amphetamines.

As much as we like to treat our adolescents as adults, they aren’t. But more importantly, adults themselves have a problem of not abusing themselves with medications.

This article by Jennifer Setlik, M.D. underscores the obligation parents have in preventing prescription medicine abuse.

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Ritalin use in a nationwide sampling of boys proves very interesting and causes thoughts beyond those addressed by the authors of this good study.
“AN 8-YEAR FOLLOW-UP STUDY OF PROFILES AND PREDICTORS OF METHYLPHENIDATE USE IN A NATIONWIDE SAMPLE OF BOYS.”
Journal of Pediatrics, November 2009, page 721

The authors show disruptive behavior and its co-occurrence with ADHD behavior and medication use tapers off after time.

Some parents lose interest in the compulsiveness necessary to keep their child on medication for ADHD. But those children that truly have primary ADHD, i.e. pre-frontal cortex dysfunction type, cannot successfully exist in a school of social environment without medication.

However, that underscores the fact that most children with ADHD behaviors are secondary to some other primary cause. Long-term medication was never needed. The primary causes of ADHD behavior are usually:
learning disabilities, dysfunctional family dynamics, physical impairments and other primary psychiatric conditions rather than the less common pre-frontal cortex dysfunction.

The incidence of ADHD behavior reflects the combined primary and secondary type. There is no question in my mind that far and away the most common cause of ADHD behaviors is the secondary type and it should never be prescribed stimulants. Instead the primary cause must be addressed and removed so the child may function normally.

It is a very small percentage of children that need medication for their behavior. It is clear to  me that children that have primary, i.e. brain dysfunction generated ADHD behaviors, remain on medication for prolonged time because they cannot succeed without it.

The author of the article is absolutely correct in saying the treatment of ADHD is complex. We must be sure of our diagnoses and it’s cause.




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