MELANOMA RATES DROPPING AMONG CHILDREN AND TEENS

Melanoma, characterized by mole-like cancerous growths, is on the rise in the U.S. The most serious form of skin cancer, it’s particularly rising among women and seniors. But what about kids?

While melanoma is significantly less common among children, five to six kids in every million develop melanoma in their youth. It takes just a few blistering sunburns to double the chance a child will develop skin cancer in her lifetime.

But while studies in years past suggested the rate of melanoma in children was also rising, the newest research says the opposite. Last summer, researchers at Case Western Reserve University in Cleveland and its affiliated medical center reported in the Journal of Pediatrics that the rate of melanoma diagnoses in children and adolescents is actually declining.

Researchers analyzed data from the Surveillance, Epidemiology, and End Results registry of the National Cancer Institute on more than 1,100 people under 20 years old who were diagnosed with melanoma between 2000 and 2010. Melanoma rates dropped by nearly 12 percent from 2004 to 2010, with the largest decline among teens and boys.

The researchers can’t pinpoint one particular cause of this trend, but growing awareness about sun safety may be responsible. Research indicates that teenagers are taking more steps, such as applying sunscreen, to protect themselves from damaging sun exposure. The authors also suggest that parents are becoming more proactive in safeguarding their young children.

They speculate that a negative trend may contribute to the decline as well: children, particularly boys, are spending more time playing video games and watching TV. That’s nothing to celebrate, as playing indoors may mean less harmful sun exposure, but also less exercise and other physical activity.

Whatever the cause, we hope the rates of pediatric melanoma keep dropping. The National Cancer Institute estimates more than 75,000 cases of adult melanoma in the U.S. this year. A lower risk of pediatric melanoma could mean fewer diagnoses when these children reach adulthood.

We encourage parents to continue to take healthy steps to protect their children from harmful sun exposure. Here are some helpful tips for the whole family:

Cover up

Wear protective clothing such as hats, visors, dark sunglasses, long sleeves and pants to block harmful UV rays.

Stay in the shade

While outdoors, seek shelter under overhangs, canopies, trees and awnings. Stroller hoods and umbrellas offer extra protection for little ones. Keep infants under six months out of direct sun.

Wear sunscreen

Look for sunscreen lotions – not spray or sticks – with zinc or titanium as the active ingredients (avoid oxybenzone or retinyl A). Apply liberally and reapply frequently, especially when swimming, sweating or playing in water.

Watch the clock

Harmful UV rays peak midday, so schedule errands and playtime during morning or late afternoon.

Be safe on the go

Pack diaper bags, purses and backpacks with sun safety essentials such as hats and sunscreen. Keep extra at your school, office or in the car.

What's Wrong with Pacifiers?

I received a question from a reader recently:

"Should a natural mama ever consider using a pacifier?"

I know there are experts who disagree with me, but the short answer is Yes. Every baby is different and some simply have very strong comfort sucking needs. Most of the time, those needs are met by breastfeeding, but there are plenty of breast-fed babies who still need to suck their thumbs. And while a thumb is definitely a more “natural” choice than a pacifier, there is one clear way in which a pacifier trumps a thumb. But I’m getting ahead of myself.

Pacifier manufacturers were given a blank check recently when the American Academy of Pediatrics released a recommendation that babies be given pacifiers at naptime and bedtime through the first year of life because studies show that pacifiers decrease the risk of SIDS.

The recommendation specifies that pacifiers should not be introduced until after one month of age in breastfeeding infants, when, presumably, nursing is well established and the pacifier won’t cause nipple confusion. The artificial nipples of both bottles and pacifiers are easier for a baby to latch onto than breast nipples, which may undermine an infant’s ability to correctly latch onto the breast. In addition to giving mom sore nipples, babies can get so frustrated and upset they refuse to nurse.

Are pacifiers necessary to protect against SIDS?

However, many breastfeeding experts are challenging the AAP recommendation. Their argument? SIDS is thought to result from an infant falling into too deep a sleep before his body has gained the ability to regulate its own arousal. Sucking on a pacifier while sleeping keeps the baby from sleeping as deeply, thus guarding against SIDS. However, Mother Nature has already designed the perfect way to help babies regulate their arousal systems during the early months of life: waking frequently at night to nurse, and sleeping near Mama. In fact, co-sleeping and breastfeeding have both been shown to have a protective effect against SIDS, because the baby’s physiology is kept at a higher level of arousal. His sleep cycles even parallel his mother’s. SIDS was probably unknown before separate bedrooms and cribs were invented, and as both co-sleeping and breastfeeding have increased since 1992, SIDS has decreased.

Given that pacifiers do not offer any particular benefit against SIDS for babies who are already breastfeeding, most breastfeeding experts continue to advise against pacifiers, even after nursing is well established. Why? Frequent nursing is the best way to create a good milk supply, which remains a necessity long after the first month. Babies drink 1/3 of their daily food intake during their night feedings, so using a pacifier to calm a crying baby at night can lead to poor weight gain as well as plugged ducts, mastitis, and a decrease in milk supply. In other words, pacifiers can easily sabotage nursing.

Bonding experts also worry that a baby’s cry is meant to initiate connection, and pacifiers could take the place of love. From a bonding perspective, nursing is not just about feeding a baby, it's about emotional nurturance, or just plain comfort. When a baby cries, she needs to be held and comforted.

In answer to the worry that the baby is just "using the breast as a pacifier," most natural mamas would retort “Isn’t that how nature designed humans? Which would you rather your baby see as her source of comfort: You, or a piece of plastic?”
So if a pacifier is a risk factor for breastfeeding and can even undermine mother-child bonding, why do I say that a natural mama might consider a pacifier?
Simply because I think being dogmatic and judgmental is a disservice to mothers. We know that every baby is different. Some babies need much more comfort sucking than others. Even some breastfed-on-demand babies suck their thumbs or fingers. In fact, some infants suck their thumb or fingers in utero and come out ready to find their thumbs again.

You might argue that a thumb is more natural than a pacifier, and I would have to agree. I would also point out that in the middle of the night, a baby can always find his thumb, when he almost certainly will not be able to locate his pacifier by himself. Toddlers who suck their thumbs are famously the best sleepers. However, neither thumb nor pacifier should be used past the age of five, when the arrival of the permanent teeth nears. And that’s where the pacifier trumps the thumb.

The pacifier habit is far easier to break than the thumb habit, simply because it doesn’t stay on your child’s hand, beckoning. Pacifiers get thrown away, the child mourns, has a tough week, and goes on with her life. But the siren song of the thumb is always there, leading to feelings of shame and anxiety as the poor child tries hard to please her parents, peers and the dentist by giving up her comfort habit.

Of course, there are many kids who give up their thumbs easily. I personally remember doing so, and I would absolutely choose a thumb over a pacifier for my own children. (I breastfed each child well into toddlerhood, and early on with each I rooted for them to find their thumbs, but they never did.)

What is the pacifier made of?

If you’re considering offering your baby a pacifier, there’s one other critical element we haven’t discussed. What is the pacifier made of? Many pacifiers have BPAs in them, although I predict their rapid extinction given all the recent publicity. But other pacifiers aren’t necessarily safe, either. Latex pacifiers leak low levels of nitrosamines, a known carcinogen. Some pacifiers are still made with diisononyl phthalate (DINP) or phthalate esters, which can be released during sterilization. Silicone pacifiers were considered safe for a long time, but are now highly suspect. The only safe pacifier on the market seems to be Natursutten’s rubber pacifier, which has no synthetics or additives, but the instructions say they have to be replaced every five to seven weeks to stay safe, which is costly and inconvenient. And while the Natursutten is currently claimed to be safe, there’s always the problem that what's considered safe today might not be considered safe tomorrow. After all, most of us hadn't heard of BPAs a few years ago.

Author,

Dr. Laura Markham.

Must-Read Guide to Babies and Ear Infections

"Doctor, I think my baby has an ear infection!" I hear this every day in my practice, and because ear infections are such a common cause of sleepless nights and missed work (not to mention just downright painful!), I spend a lot of time explaining what can be done to prevent them. Now, if you came to see me in my office (and you're always welcome to), here's how I would answer your questions.

Why are ear infections so common in babies?

Let's venture inside the middle ear to see how germs and tiny ears make such frequent contact. A canal called the eustachian tube connects the middle ear to the back of the throat and helps to equalize pressure. But the throat, along with the nose, serves as a moist breeding ground for bacteria. Because a baby's eustachian tube is short, wide and horizontal, throat and nose secretions—and any germs they may be harboring—travel more easily through it. Any fluid trapped in a cavity (such as the middle ear) acts as a medium for germs to grow, hence the frequent ear infections we see in many young children.

Why is it important to treat ear infections properly?

Your child's hearing depends on the proper vibrating of the eardrum and the structures of the middle. Repeated infections can damage the eardrum, while repeated fluid accumulation dampens the vibrations, both of which interfere with hearing. That's why it's imperative to take ear infections seriously, especially when your baby is learning to talk. Periodic hearing loss can lead to speech delays or even language problems that can affect her school performance later.

How can I spot an ear infection?

The following signs are babies' way of saying, "There's some painful stuff going on in my ear. Please take me to the doctor!" Early treatment makes for a better outcome, so if your baby has had several ear infections, learn to read his unique "sore-ear language." One sign you likely won't see is a fever. High temps don't often accompany an ear infection unless there's a more severe respiratory infection.

The nose knows In babies, middle-ear infections usually follow a cold, so what's coming out of the nose often reflects what's going on in the ear. A common scenario is that baby is mildly stuffy and has clear, watery nasal drainage, but isn't that sick—until a few days later when crankiness kicks in and the discharge becomes more yellow or green and snotty.

It's been a hard day's night

If baby is waking more frequently at night and seems to be in pain, especially with a worsening cold, that's also a red flag. As the infected fluid places pressure on the eardrum, he may not want to lie flat when napping or sleeping. To alleviate the pressure, position him so that the sore ear faces up.

The eyes have it

The rule in our practice is that when a parent tells us their baby has a cold and eye drainage, we see them that day. In the early months, eye drainage may simply signal a clogged tear duct, but when accompanied by a cold, especially in an older infant, it usually means an underlying sinus and/or ear infection.

If I suspect an ear infection, should I always take my baby to the doctor?

Usually. Ear infections are hard to treat blind—sort of like drawing a map when you're not sure where you're going. Your doctor needs to examine both the eardrum and the whole respiratory tract to make what is called the right "drug and bug" match.

Most mild to moderate ear infections will completely heal without the use of antibiotics, which is why the American Academy of Pediatrics recommends the "watch and wait" approach. "Watch" means to observe your child for signs that she is becoming sicker. "Wait" means the doctor may not immediately prescribe antibiotics for her, even if there is fluid behind the middle ear, unless she fails to improve on her own within two or three days.

He's tugging at his ears a lot, so why does the doctor say he's fine?

Ear-tugging doesn't necessarily signal an ear infection. It can be referred pain from teething or that baby is simply discovering his ears and likes pulling on them. However, if a baby has a cold, especially with nasal or eye drainage, and is pulling at his ears, the problem is likely not teething. Tugging, rubbing or banging on the ears can also be a sign that your child has some ear pain from persistent or chronic middle-ear fluid, a condition known as otitis media with effusion. In my practice I find that a mother's intuition is useful in alerting me that her baby is feeling worse. If you feel there's something more to your baby's symptoms, talk to your pediatrician.

How can I prevent ear infections altogether?

Now that you know how germs make their way into those little ears, here are some guidelines to keep that germy fluid from collecting behind your baby's eardrums:

• Breastfeed: Mother's milk provides increased natural immunity.
• Bottle-feed upright:  Feed baby in an upright position (at least 30 degrees) and keep her upright at least 30 minutes afterward.
• Keep allergens at bay:  Irritants can cause fluid to build in the nasal passages and middle ear. Keep stuffed and real animals and other fuzzy things away while baby sleeps. And absolutely no smoking around baby!
• Pass on pacifiers:  Studies show a correlation between the frequency of pacifier use and ear infections. Limit pacifier use to when baby is falling asleep at night, especially once she is 6 months or older.
• Boost immunity:  Fruits, veggies and seafood have been shown to improve babies' developing immune systems.
• She'll outgrow it:  The good news is that as your child grows, the eustachian tube becomes longer and narrower, and slants more acutely, making it more difficult for germs and fluid to collect in the middle ear. At the same time, her immune system matures, minimizing those pesky ear infections.

Author,

By William Sears, M.d.

Causes of Absent Red Reflex in Newborns

The term 'red reflex' refers to the reddish-orange glow or the reflection of light that is observed from the eye's retina during direct ophthalmoscopy. This Buzzle write-up provides information on the causes of the absence of red reflex in newborns.

Meaning of absent red reflex in newborns

Did You Know?

The American Academy of Pediatrics (AAP) recommends that red reflex test must be conducted for every newborn before discharge from the nursery, and an infant with an abnormal or absent reflex must be referred to an ophthalmologist for an examination at the earliest.

One of the main vision-related tests―the red reflex test―is a screening test that must be conducted for the early detection of vision problems in newborns. This test involves the use of an ophthalmoscope, which is a lighted instrument that is used by ophthalmologists to examine the inside of the eye, including the retina and the optic nerve.

The test is conducted in a dimly-lit room, and the ophthalmoscope is held at a distance of 12 to 18 inches. During this test, light that is transmitted from an ophthalmoscope passes through the tear film, cornea, aqueous humor, crystalline lens, and vitreous humor (transparent parts of the human eye). As this light reflects off the fundus (back of the eye) and is transmitted back through a tiny opening in the ophthalmoscope, the ophthalmologist can see a magnified image of the structures at the back of the eye, which include the optic disc, retina, retinal blood vessels, macula, and choroid.

In case of healthy eyes where there is no obstruction in the optical pathway, red reflex is present, which means that a reddish-orange reflection of light from the retina would be observed. Absence of red reflex is indicative of certain serious eye conditions, which is why, this test is conducted in newborns to rule out vision-related problems.

Ophthalmoscopic Examination for Red Reflex

Red reflex is considered to be an effective test for the detection of abnormalities or opacities in the back of the eye or the visual axis. For accurate results, a direct ophthalmoscope that has a large-sized aperture should be used, as that would allow the doctor to focus on the face clearly and check and compare the reflection in both eyes simultaneously.

Ophthalmoscopic examination
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Ophthalmoscope

Normal Red Reflex

The test will be considered normal under the following circumstances:

➠ The red or orange glow must be observed in both the eyes.

➠ The reflection should be symmetrical in terms of color, intensity, and clarity.

Red reflex

The pediatrician should make a referral to an ophthalmologist in the following cases:

➠ Opacities or white spots (leukocoria) are observed within the area of red reflex in one or both eyes

➠ Dark spots are present in the region of red reflex

➠ Red reflex is blunted on one side

➠ Red reflex is absent

➠ White reflex is present (retinal reflection)

The test must be conducted properly, as the pupils in infants can sometimes be small. Moreover, the infant might not keep the eyes open. In such cases, pupils might have to be dilated, provided the infant is older than 2 weeks. While observing the change in the color, the change in the level of pigmentation of the fundus in children from different ethnic groups should be considered. In case the reflection is abnormal or absent, and there is family history of retinoblastoma or cataract, the child should be taken to an ophthalmologist at the earliest.

Absent/Abnormal Red Reflex in Newborns

If the reddish-orange reflection of the light is not observed in one or both eyes, it implies that the red reflex is absent. This indicates the presence of an obstruction or abnormalities in the structures located at the back of the eye. In some cases, lack of symmetry in the red reflex might be indicative of unequal or high refractive errors. The contributing factors for an absent red reflex might include:

Cataract

Cataract is an eye condition that is characterized by the clouding of the natural lens of the eye. It can affect one or both eyes. The natural lens is a clear part of the eye, which helps focus light or an image on the retina. Under normal circumstances, light passes through the transparent lens to the retina. 

 

Once it reaches the retina, light is changed into nerve signals that are sent to the brain.

Human eye

Cataract

The lens must be clear for the retina to receive a sharp image. If the lens is cloudy from a cataract, the image would be blurred. This condition can also be present at birth. However, the cataract in newborns might be so small that it might not affect the vision. Thus, checking red reflex is extremely important to rule out cataract.

Retinal Abnormalities

Retinoblastoma refers to a rare type of eye cancer that might affect children before the age of 5 years. The cancer affects the retina, which is the specialized light-sensitive membrane at the back of the eye. Leukocoria, which refers to the whiteness in the pupil, is one of the most early signs of retinoblastoma. This can be detected through the red reflex test, or even observed in photographs that have been taken with a flash. It is believed that retinal detachment (detachment of retina from the underlying tissue layer) could be responsible for the absence of red reflex.

Damaged optic nerve and retinal detachment

Retinal detachment could occur in individuals affected by Coat's disease, where dilated and abnormally twisted blood vessels in the eye hamper the normal flow of blood. Leakage of fluid from the blood vessels might give rise to a buildup of fatty material into the retina. Retinal detachment can occur when there is a large buildup of fatty material. In children affected by Coat's disease, a yellowish glow is observed during direct ophthalmoscopy.

Refractive Errors

For us to be able to see properly, light rays are bent (refracted) while they pass through the cornea and the lens. Thereafter, the light is focused on the retina, which is a light-sensitive membrane covering the back wall of the eyeball that is continuous with the optic nerve. The retina converts the images into electric signals, and sends them to the brain through the optic nerve. The brain then interprets these messages into the images we see. Refractive errors occur when one has a problem in focusing due to the irregular shape of the cornea or the length of the eyeball. High refractive errors could sometimes cause an asymmetrical red reflex. Sometimes, both eyes might have a red reflex; however, there might be difference in the level of brightness. This could be indicative of anisometropic amblyopia that occurs due to different refractions.

Strabismus

Strabismus, which is commonly referred to as crossed eyes, is an eye condition that is characterized by abnormal alignment of one or both eyes. This condition could occur in the event of problems related to eye muscles, control center in the brain that is involved with movements of the eyes, or the nerves that transmit information to the muscles. The cause of congenital strabismus, which means strabismus that occurs at or shortly after birth, is not known. It is believed that family history could put one at a risk. Conditions such as retinoblastoma, retinopathy of prematurity, cerebral palsy, etc., could be associated with strabismus in children.

On a concluding note, both cataract and retinoblastoma are the most common causes of absent red reflex in newborns. However, the differential diagnosis also includes the presence of foreign body in the tear film, aqueous, vitreous, or corneal opacities, or iris abnormalities that affect the pupil. This test must be conducted during the first 2 months by a pediatrician. An examination by an ophthalmologist is essential for infants who are in the high-risk groups. Once the underlying cause has been determined, the treatment options can be ascertained.

Disclaimer: The information provided in this article is solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.

 

Author,

 

Smita Pandit