Join Dr. Shu Thursday, December 6, 2018 at 1 pmCentral Time!
Cold and flu season is upon us—so chances are you may find yourself dealing
with kids' sniffles, sneezes, coughs and more at some time during the next several months!
Join host Dr. Jennifer Shu, medical editor for HealthyChildren.org, for timely tips on how to soothe your family's cold and flu symptoms at home. In this 30-minute webinar, she will also discuss when to call your pediatrician and how to help prevent illness in the first place! A Q&A session will follow the presentation.
Parents should not spank their children, the American Academy of Pediatrics said on Monday in its most strongly worded policy statement warning against the harmful effects of corporal punishment in the home.
The group, which represents about 67,000 doctors, also recommended that pediatricians advise parents against the use of spanking, which it defined as “noninjurious, openhanded hitting with the intention of modifying child behavior,” and said to avoid using nonphysical punishment that is humiliating, scary or threatening.
“One of the most important relationships we all have is the relationship between ourselves and our parents, and it makes sense to eliminate or limit fear and violence in that loving relationship,” said Dr. Robert D. Sege, a pediatrician at Tufts Medical Center and the Floating Hospital for Children in Boston, and one of the authors of the statement.
The academy’s new policy, which will be published in the December issue of the journal Pediatrics, updates 20-year-old guidance on discipline that recommended parents be “encouraged” not to spank. The organization’s latest statement stems from a body of research that was unavailable two decades ago.
“Certainly you can get a child’s attention, but it’s not an effective strategy to teach right from wrong,” Dr. Sege said.
Recent studies have also shown that corporal punishment is associated with increased aggression and makes it more likely that children will be defiant in the future. Spanking alone is associated with outcomes similar to those of children who experience physical abuse, the new academy statement says.
There are potential ramifications to the brain as well: A 2009 study of 23 young adults who had repeated exposure to harsh corporal punishment found reduced gray matter volume in an area of the prefrontal cortex that is believed to play a crucial role in social cognition. Those exposed to harsh punishment also had a lower performance I.Q. than that of a control group.
Although the study was small in scope, it can help provide a biological basis for other observations about corporal punishment, Dr. Sege said.
So what is the best way to discipline children? That largely depends on the age and temperament of the child, experts say.
Effective discipline involves practicing empathy and “understanding how to treat your child in different stages in development to teach them how to cool down when things do get explosive,” said Dr. Vincent J. Palusci, a child abuse pediatrician at Hassenfeld Children’s Hospital at N.Y.U. Langone.
The academy’s parenting website, HealthyChildren.org, offers tips for disciplining younger and older children. Rewarding positive behavior, using timeouts and establishing a clear relationship between behavior and consequences can all be effective strategies.
“We can’t just take away spanking,” Dr. Palusci said. “We have to give parents something to replace it with.”
The number of parents who spank their children has been on the decline. A 2013 Harris Poll of 2,286 adults surveyed online found 67 percent of parents said they had spanked their children and 33 percent had not. In 1995, however, 80 percent of parents said they had spanked their children while 19 percent said they had not.
Attitudes about spanking are also changing. Although seven in 10 adults in the United States agreed a “good, hard spanking is sometimes necessary to discipline a child,” according to the 2014 General Social Survey, spanking has become less popular over time.
In 1970, Fitzhugh Dodson, a clinical psychologist and best-selling author of books on parenting, was quoted in The New York Times as saying that many discipline problems could be solved by using his “pow wow approach.”
“It’s my pow, followed by his wow,” he explained, demonstrating how he would swat a child’s bottom.
“I know some books say parents shouldn’t spank, but I think it’s a mistake,” he said. “A poor mother is left with nowhere to go. She’s mad at the kid, has had it up to the eyebrows with him, and longs to give him a big smack on the behind, but she’s been told she shouldn’t. She should, and it’s good for her, because it releases her tension. And the child definitely prefers it to long parental harangues.”
And in the 1945 edition of “Baby and Child Care,” Dr. Benjamin Spock said spanking “is less poisonous than lengthy disapproval, because it clears the air, for parents and child.” (In the ’80s, however, he changed his mind.)
Today, most doctors don’t support it.
A recent survey of 1,500 pediatricians in the United States found that 74 percent did not approve of spanking and 78 percent thought spanking never or seldom improved children’s behavior.
In 2000, the academy recommended that corporal punishment in schools be abolished in all states. And in 2016, the Centers for Disease Control and Prevention published a tool kit for preventing child abuse and neglect that highlighted a need for legislation to end corporal punishment.
But attempts to do so at the federal level have failed.
Parents are often disappointed or even a little bit upset when I tell them there’s no medicine to help their coughing, sneezing, drippy-nosed children feel better. There’s nothing that works, I say, and medicines can have bad side effects. We don’t recommend any of the cough and cold medications for children under 6.
But after all, parents are intimately aware of just how miserable a cough and a runny nose and congestion can make a small child feel, from cranky days to disruptive nights.
And often there is something both comforting and familiar about those over-the-counter medicines, which figure in many parents’ memories of their own sick days way back when. “They all took these medications themselves, there’s a comfort in knowing that,” said Dr. Ian Paul, a professor of pediatrics at Penn State College of Medicine.
In a new review in The BMJ, researchers considered evidence on whether a variety of over-the-counter cough and cold medicines are effective for treating runny nose, congestion and sneezing, as well as the question of whether they can do harm.
“Parents are always worried that something bad is happening and they have to do something,” said Dr. Mieke van Driel, who is a professor of general practice and head of the primary care clinical unit at the University of Queensland in Australia, and was the first author on the study. As a primary care physician herself, she said, she is well aware of the urgency that parents feel to find something that will relieve their children’s distress.
“Unfortunately, our research shows there’s very little evidence,” she said, and especially in children, “we were actually quite amazed by how little there was — hardly anything to be enthusiastic about.”
In addition to understanding that there is no evidence that these medications help, Dr. van Driel said, parents need to understand that there are clear risks in using them in young children. The Food and Drug Administration originally recommended against any over-the-counter cough and cold preparations in children under 2; the American Academy of Pediatrics has extended the recommendation to apply to all children up to 6. And after manufacturers voluntarily withdrew products marketed for infants, and changed labels to recommend against use in young children, researchers found a drop in children coming to emergency rooms for problems with these medicines, which in past studies ranged from hallucinations to cardiac arrhythmias to depressed level of consciousness.
When it comes to the sniffles or the cough associated with the common cold, “these symptoms are self-limited,” said Dr. Shonna Yin, an associate professor of pediatrics and population health at N.Y.U. School of Medicine. Parents can help comfort their children without giving medications, she said, offering plenty of fluids to keep children well hydrated, and honey for a cough in children over a year old (no honey for babies under a year because of the risk of botulism). Other measures may include ibuprofen or acetaminophen for fever and saline nose drops for congestion.
“Our 2007 study was the first to show that honey was more effective than dextromethorphan” — a common cough suppressant — “or no treatment,” said Dr. Paul. Since then, other studies have shown that honey does relieve cough, and the accompanying sleep disturbance. Organic agave nectar, on the other hand, had only a placebo effect, said Dr. Paul, who noted that over the past 10 years, he has consulted for many of the manufacturers of these medications, and carried out studies funded by them.
“The bottom line,” he said, “is that for all of the over-the-counter cough and cold medications, there is limited to no evidence of efficacy for any cold symptoms, particularly in those under 6 years.”
Studies have not shown that cough suppressants help children cough less, or that antihistamines and decongestants help them sleep better. Medicines which can help a child with a runny nose from seasonal allergies won’t help that same child when it’s a cold virus making the nose drip; the underlying mechanisms are different.
Even for older children and adolescents, Dr. Paul said, the evidence of efficacy is not strong for most of the ingredients in cough and cold medications, and there is always the danger of side effects, particularly when the medicines are taken in too-large doses, which can happen because there are so many different preparations, with so many different combinations of drugs.
Dr. Yin is working on a project funded by the F.D.A. to improve the labeling and dosing instructions on children’s cough and cold medications; so far, she said, the research has shown that parents in the study population are confused about the intended age ranges of the medicines, about the active ingredients, and about dosing. Many of these preparations contain several different drugs, including a cough suppressant, a decongestant, an antihistamine and a medicine for pain and fever.
“In my own practice, I reassure them, I check the child, I make sure I’ve covered the ears, the lungs, the throat,” Dr. van Driel said. “I reassure the parent, this is a cold, a cold is a self-limiting disease, we have capable immune systems that will take care of it, it will take about a week.” People need to feel confident in their bodies, she said, instead of relying on medicines. “I would tell them, there’s not a lot we know that helps. Don’t give him anything you might give your older child or take yourself,” said Dr. van Driel.
And of course, we always tell parents what to watch out for, symptoms that might suggest that something more than a cold is going on. Any respiratory difficulty in a child has to be taken seriously, so a baby who is breathing too fast or a child who is working harder than normal to breathe should be checked out. High fevers are concerning, as are any of the signs of influenza, such as shaking, chills and body aches; influenza in children can be treated with antiviral drugs — and prevented with flu shots.
Children with the “common cold,” on the other hand, should generally be able to eat and drink, should be alert and able to play — or at least, susceptible to distraction. “It’s unfortunate because the illnesses are so common, young children and babies suffer, parents miss work — but we’re no further along than we were 60 years ago,” Dr. Paul said. “We still don’t have good therapeutics for the common cold.” So read stories, bend the screen time rules, boil up the chicken soup.
“If you give people information and tell them what to expect,” Dr. van Driel said, “they generally accept that they don’t need medication.”
A child in Florida has become the first person to die of the flu this season, according to state health officials. State epidemiologists say the child had not been vaccinated and was otherwise healthy before getting sick with the flu.
The child, who tested positive for influenza B, died sometime during the week of Sept. 30, although privacy concerns prevent officials from saying exactly where, CBS affiliate WTSP reports.
Last flu season, 183 children in the U.S. died from flu or flu-related causes. That's the most since the CDC began keeping these records in 2004. Overall, an estimated 80,000 Americans died from flu last season.
CBS News medical contributor Dr. Tara Narula says this latest news should be a wake-up call to parents to get their children vaccinated.
"What this is a strong clear message to parents about the importance of vaccination," she told "CBS This Morning." "This vaccine is safe. It is the most effective tool we have. And we know of the pediatric deaths last year, 80 percent were in kids who were unvaccinated."