Download Drs. Herson and Ehrenkranz's letter of explanation on the new NICU Discharge Guidelines in the Word .doc format!
Download the new NICU Discharge Guidelines in the Word .doc format!
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POLICY STATEMENT MAY 1999
Trampolines at
Home, School, and
Recreational Centers
DANIELLE LARAQUE, M.D., FAAP
The May, 1999, issue of Pediatrics (Vol. 103 No. 5. pp1053-
1055) featured the policy statement on Trampolines
at home, school, and recreational centers. The latest
available data were reviewed in the statement and indicated
that an estimated 83,400 trampoline-related injuries were
treated in US hospital departments in 1996. This represents
an annual rate 140% higher than was reported in 1990.
Most injuries were sustained on home trampolines. In addition,
30% of the trampoline-related injuries treated in
emergency departments were fractures often requiring
hospitalization and surgery. These data allowed the AAP to
reaffirm its recommendations:
- trampolines should never be used
in the home, inside or outside
- during anticipatory guidance,
pediatricians should advise parents
never to purchase a home trampoline
or allow children to use home
trampolines
- trampolines should not be part of
routine physical education classes
in schools
- trampolines have no place in outdoor
playgrounds and should never be
regarded as play equipment
The limited use of trampolines in supervised training
programs (e.g. gymnastics, diving, and other competitive
sports) should follow design and behavioral recommendations.
Examples of these include proper maintenance of the
trampoline, the surface around the trampoline should have
impact-absorbing safety surface material, personnel trained
in trampoline safety and a competent spotter should be present
during use, only one person should use the trampoline
at a time and use by children under six should be prohibited.
Lead Poisoning Update
Childhood lead poisoning is the most common
preventable pediatric environmental health
problem in the United States.
Lead poisoning crosses all geographic, racial and
socioeconomic boundaries. According to the Center
for Disease Control and Prevention (CDC), since the
elimination of lead from gasoline, lead-based paint in
homes remains the major source of lead poisoning in the
United States.
Lead-based paint use on residential interiors
was not banned until 1978. Approximately
30% of Connecticut’s housing was built
before 1950, and 84% before 1980.
Children under six years of age are
most at risk because they absorb five
times more lead than adults with
equal exposure. Blood lead levels
greater than or equal to 10ug/dL have
been shown to have adverse health
effects. These effects include IQ deficits,
behavior disorders, and language and learning disabilities.
Blood lead screening is an important component in a
comprehensive approach to eradicate childhood lead
poisoning. In the state of Connecticut an advisory
committee has been formed, representative of health care
providers and local and state public health officials. After a
careful review of Connecticut’s data on screening and
prevalence and information on age of housing, the
committee supports continuation of the recommendation
for universal screening for all children between the ages of
one and six with a particular attention to children between
the ages of one and two years. Because so much of
Connecticut’s housing was built before 1950, there is not
sufficient prevalence data available to recommend targeted
screening at this time.
In the state of Connecticut there are two regional lead
treatment centers. One is in Hartford and the other is in
New Haven. The treatment centers are available for referrals
and consultation regarding childhood lead poisoning.
FOR MORE INFORMATION ABOUT LEAD POISONING,
call the Hartford Regional Lead Treatment Center at
860-714-4792, or the Yale New Haven Regional
Lead Treatment Center at 203-764-9106, or your
local health department.
Immunizations 1999
BY MARGARET K. IKEDA, M.D., FAAP
N E W S B R I E F S
Earlier this year, the CDC’s immunization schedule
was revised to include sequential IPV/OPV or all IPV,
oral rotavirus vaccine at 2, 4 and 6 months, and the
preferred use of acellular DTaP. The oral rotavirus vaccine
and other newer vaccines have been made available
in CT through the federally funded VFC program.
The state immunization budget is currently being considered
in the state legislature, and includes provisions
for varicella vaccines for infants and adolescents, and
hepatitis B vaccine for adolescents. The need for varicella
vaccine is supported by statistics which show that
varicella cost the state 11 million dollars in acute care,
12 deaths, and over 500 hospitalizations a year.
Statewide, vaccination of infants with varicella vaccine
is increasing as the percentage of VFC eligible infants
receiving the vaccine in 1998 approaches 90%. Funding
for hepatitis B vaccine for teens will make the vaccine
available to another high risk group.
School and day care immunization regulation changes
proposed by the state to become effective in 2000 are:
proof of varicella immunity by 7th grade or by daycare
and kindergarten entry for those born after 1996; a
required second dose of MMR before kindergarten
entry; and the first dose of hepatitis B vaccine before
7th grade with all 3 doses completed before 8th grade.
The CT chapter of the AAP spoke in favor of the state’s
immunization program at a public hearing on March 18,
1999. There were a number of speakers from an anti-vaccine
group. The Academy is interested in finding out
how widespread this movement is.
Pediatrician Immunization Survey
AAP members who have been contacted
by families reading information raising questions
about the safety and need for varicella, hepatitis B
and other vaccines, and who have had patients
refuse vaccinations should contact
Margaret Ikeda, M.D.
E-mail address: MKIkeda@pol.net
Fax: 203-456-6960
Phone: 203-458-7410
Immunization Coverage
If any pediatric practice would like a HEDIS report
on the children in your practice enrolled in the CT Immunization Registry and
Tracking System (CIRTS), please call the CIRTS office at 860-547-1426 x 7182.
The HEDIS report shows the immunization coverage rate for children born in
1996 who were enrolled in Medicaid Managed Care. With the expansion of CIRTS
to include all children in Connecticut, future HEDIS reports will be available
regardless of the type of insurance coverage.
UPDATE
Injury Prevention Committee
LEONARD BANCO, M.D., CHAIRPERSON
Injuries to children remain an
important health issue. Although
considerable progress has been made to
decrease unintentional injuries, they still
remain a major cause of morbidity and
mortality for children. In addition, the
impact of intentional injuries - peer
violence, child homicide, suicide, and
domestic violence is increasingly
being recognized.
Our chapter has been a leader in
injury prevention activities. The formation of the
Connecticut Childhood Injury Prevention Center in 1990
has institutionalized injury prevention research, education
and reduction activities across the state. Connecticut Safe
Kids has worked in communities across the state to
empower coalitions to implement injury prevention
activities locally. Additionally, the "Keep Kids Safe" license
plate, which our chapter conceived and established through
successful legislation, has already provided funds for over
40 local mini-grants for community-based injury
prevention activities, ranging from smoke detectors to bike
helmets, car seats to safety fairs, and fire prevention. The
list goes on and on...
Despite all of our chapter's injury prevention activities,
the Injury Prevention Committee has been dormant for the
past two years. We are now seeking to re-energize this
group. As chair, I would like to hear from anyone who has
an interest in considering new, interesting ways in which
injury prevention activities can be integrated into pediatric
practices and within local communities across Connecticut.
If you would like to serve on this group, enjoy 4 fun-filled
dinner meetings with fantastic, energizing conversation,
and make a difference in the lives of our patients in new
and exciting ways, please
consider becoming a member
of the committee. Please call
me at 860-545-9339 if you
are interested or would like
further information.
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