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What is the painful condition called shingles? | CNN

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CNN
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Sen. Dianne Feinstein, the 89-year-old California Democrat, recently announced she is out of the hospital and recovering at home from shingles, a painful viral inflammation in the skin’s nerves that causes a blistering rash lasting for two to four weeks. Feinstein was diagnosed in February and hospitalized in San Francisco last week.

Shingles, also called herpes zoster, is caused by the varicella-zoster virus — which is the same virus responsible for chickenpox. Varicella zoster is also responsible for a rare condition called Ramsay Hunt syndrome that caused pop star Justin Bieber’s face to become partially paralyzed in June 2022.

“As you can see, this eye is not blinking. I can’t smile on this side of my face. This nostril will not move,” Bieber said at the time in answer to fans who wondered why he had canceled performances.

Painful skin is one of first signs of shingles, and for some people, the pain is intense. It can create a burning sensation, or the skin can tingle or be sensitive to touch, according to the Mayo Clinic. Shingles can occur at other places on the body, such as the face and scalp, but the most common presentation is on the torso on one side of the body.

A red rash will begin to develop at the site of the pain within a few days. The rash often begins as a small, painful patch, which then spreads like “a stripe of blisters that wraps around either the left or right side of the torso,” the Mayo Clinic said.

In rare cases, the rash may become more widespread and look similar to a chickenpox rash, typically in people with weakened immune systems, according to the US Centers of Disease Control and Prevention.

In addition to pain, some people may develop chills, fatigue, fever, headache, upset stomach and sensitivity to light. See a doctor if you are over 50, have a weakened immune system, the rash is widespread and painful, or the pain and rash occur near an eye.

“If left untreated, this infection may lead to permanent eye damage,” according to the Mayo Clinic.

The varicella-zoster virus is highly contagious when in the blister stage, spreading through direct contact with the fluid from blisters and via viral particles in the air.

However, you cannot get shingles from someone who has shingles. If you aren’t vaccinated for chickenpox or haven’t previously had it and are infected by that person, you will develop chickenpox, which then puts you at risk for shingles later in life, the CDC said.

If you have shingles, you can prevent the spread of the virus by covering the rash and not touching or scratching the raised vesicles that form the rash, the CDC stated. Wash your hands often.

“People with shingles cannot spread the virus before their rash blisters appear or after the rash crusts,” the CDC said.

If the rash is covered, the risk of transmission “is low,” the CDC said. “People with chickenpox are more likely to spread (the virus) than people with shingles.”

If you think you have shingles, call a doctor as soon as you can, the CDC recommended. If caught early, there are antiviral medications, including acyclovir, valacyclovir and famciclovir, that can shorten the length and severity of the illness.

“These medicines are most effective if you start taking them as soon as possible after the rash appears,” the CDC said.

Doctors may also suggest over-the-counter or prescription pain medication for the burning and pain, while calamine lotion, wet compresses and oatmeal baths may ease itching.

For older adults, the population most likely to develop shingles, the best treatment is prevention. The US Food and Drug Administration approved a two-dose vaccine called Shingrix in 2017 for people 50 and older.

“Shingrix is also recommended for adults 19 years and older who have weakened immune systems because of disease or therapy,” the CDC said.

Shingrix, which is not based on a live virus, is more than 90% effective in encouraging the aging immune system to recognize and be ready to fight the virus, according to its manufacturer, GlaxoSmithKline.

Anyone who has had a severe allergic reaction to a dose of Shingrix or is allergic to any of the components of the vaccine should avoid it, the CDC said.

“People who currently have shingles, and women who are pregnant or breastfeeding, should wait to get Shingrix,” the CDC said.

Another vaccine called Zostavax, which the FDA approved for people over 50 in 2006, is 51% effective in preventing shingles, according to the CDC. Zostavax is based on a live virus, the same approach used for the chickenpox vaccine recommended in childhood. It has not been sold in the United States since November 2020.

If you have never had chickenpox, you can’t get shingles. However, once you’ve had chickenpox, the virus remains inactive in the spine’s sensory neurons, possibly erupting years later as shingles.

Two doses of a chickenpox vaccine for children, teens and adults, introduced in 1995, is 100% effective at preventing a severe case of chickenpox, according to the CDC. Immunity lasts 10 to 20 years, the CDC noted.

In the small number of people who still get chickenpox after vaccination, the illness is typically milder, with few or no blisters.

The CDC recommends the vaccine be given to children in two doses, the first between 12 and 15 months and a second one between 4 and 6 years. Anyone 13 years old and older who has no evidence of immunity can get two doses four to eight weeks apart, the CDC said.

Some people should not get the vaccine, including pregnant women, people with certain blood disorders or those on prolonged immunosuppressive therapy, and those with a moderate or severe illness, among others.

About 1 in 10 people will develop a painful and possibly debilitating condition called postherpetic neuralgia, or long-term nerve pain. All other signs of the rash can be gone, but the area is extremely painful to touch. Less often, itching or numbness can occur.

The condition rarely affects people under 40, the CDC said. Older adults are most likely to have more severe pain that lasts longer than a younger person with shingles. For some, the nerve pain can be devastating.

“Five years later, I still take prescription medication for pain,” said a 63-year-old harpist who shared his story on the CDC website. “My shingles rash quickly developed into open, oozing sores that in only a few days required me to be hospitalized.

“I could not eat, sleep, or perform even the most minor tasks. It was totally debilitating. The pain still limits my activity levels to this day,” said the musician, who has been unable to continue playing the harp due to pain.

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Canadian siblings born four months early set record as the world’s most premature twins | CNN

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CNN
—

For expectant parents Shakina Rajendram and Kevin Nadarajah, the doctor’s words were both definitive and devastating: Their twins were not “viable.”

“Even in that moment, as I was hearing those words come out of the doctor’s mouth, I could still feel the babies very much alive within me. And so for me, I just wasn’t able to comprehend how babies who felt very much alive within me could not be viable,” Rajendram recalled.

Still, she knew that there was no way she would be able to carry to term. She had begun bleeding, and the doctor said she would give birth soon. The parents-to-be were told that they would be able to hold their babies but that they would not be resuscitated, as they were too premature.

Rajendram, 35, and Nadarajah, 37, had married and settled in Ajax, Ontario, about 35 miles east of Toronto, to start a family. They had conceived once before, but the pregnancy was ectopic – outside the uterus – and ended after a few months.

As crushing as the doctor’s news was, Nadarajah said, they both refused to believe their babies would not make it. And so they scoured the Internet, finding information that both alarmed and encouraged them. The babies were at just 21 weeks and five days gestation; to have a chance, they would need to stay in the womb a day and a half longer, and Rajendram would have to go to a specialized hospital that could treat “micropreemies.”

The earlier a baby is born, the higher the risk of death or serious disability, the US Centers for Disease Control and Prevention says. Babies born preterm, before 37 weeks gestation, can have breathing issues, digestive problems and brain bleeds. Development challenges and delays can also last a lifetime.

The problems can be especially severe for micropreemies, those born before 26 weeks gestation who weigh less than 26 ounces.

Research has found that infants born at 22 weeks who get active medical treatment have survival rates of 25% to 50%, according to a 2019 study.

Adrial was born weighing less than 15 ounces.

Rajendram and Nadarajah requested a transfer to Mount Sinai Hospital in Toronto, one of a limited number of medical centers in North America that provides resuscitation and active care at 22 weeks gestation.

Then, they say, they “prayed hard,” with Rajendram determined to keep the babies inside her just a few hours longer.

Just one hour after midnight on March 4, 2022, at 22 weeks gestation, Adiah Laelynn Nadarajah was born weighing under 12 ounces. Her brother, Adrial Luka Nadarajah, joined her 23 minutes later, weighing not quite 15 ounces.

According to Guinness World Records, the pair are both the most premature and lightest twins ever born. The previous record holders for premature twins were the Ewoldt twins, born in Iowa at the gestational age of 22 weeks, 1 day.

It is a record these parents say they want broken as soon as possible so more babies are given the opportunity to survive.

“They were perfect in every sense to us,” Rajendram said. “They were born smaller than the palm of our hands. People still don’t believe us when we tell them.”

The babies were born at just the right time to be eligible to receive proactive care, resuscitation, nutrition and vital organ support, according to Mount Sinai Hospital. Even an hour earlier, the care team may not have been able to intervene medically.

“We just didn’t really understand why that strict cut off at 22, but we know that the hospital had their reasons. They were in uncharted territory, and I know that they had to possibly create some parameters around what they could do,” Rajendram said.

“They’re definitely miracles,” Nadarajah said as he described seeing the twins in the neonatal intensive care unit for the first time and trying to come to terms with what they would go through in their fight to survive.

“I had challenging feelings, conflicting feelings, seeing how tiny they were on one hand, feeling the joy of seeing two babies on the second hand. I was thinking, ‘how much pain they are in?’ It was so conflicting. They were so tiny,” he said.

These risks and setbacks are common in the lives of micropreemies.

Dr. Prakesh Shah, the pediatrician-in-chief at Mount Sinai Hospital, said he was straightforward with the couple about the challenges ahead for their twins.

He warned of a struggle just to keep Adiah and Adrial breathing, let alone feed them.

The babies weighed little more than a can of soda, with their organs visible through translucent skin. The needle used to give them nutrition was less than 2 millimeters in diameter, about the size of a thin knitting needle.

“At some stage, many of us would have felt that, ‘is this the right thing to do for these babies?’ These babies were in significant pain, distress, and their skin was peeling off. Even removing surgical tape would mean that their skin would peel off,” Shah told CNN.

But what their parents saw gave them hope.

“We could see through their skin. We could see their hearts beating,” Rajendram said.

They had to weigh all the risks of going forward and agreeing to more and more medical intervention. There could be months or even years of painful, difficult treatment ahead, along with the long-term risks of things like muscle development problems, cerebral palsy, language delays, cognitive delays, blindness and deafness.

Rajendram and Nadarajah did not dare hope for another miracle, but they say they knew their babies were fighters, and they resolved to give them a chance at life.

“The strength that Kevin and I had as parents, we had to believe that our babies had that same strength, that they have that same resilience. And so yes, they would have to go through pain, and they’re going to continue going through difficult moments, even through their adult life, not only as premature babies. But we believed that they would have a stronger resolve, a resilience that would enable them to get through those painful moments in the NICU,” Rajendram said.

There were painful setbacks over nearly half a year of treatment in the hospital, especially in the first few weeks.

“There were several instances in the early days where we were asked about withdrawing care, that’s just a fact, and so those were the moments where we just rallied in prayer, and we saw a turnaround,” Nadarajah said.

Adiah spent 161 days in the hospital and went home on August 11, six days before her brother, Adrial, joined her there.

Adrial’s road has been a bit more difficult. He has been hospitalized three more times with various infections, sometimes spending weeks in the hospital.

Both siblings continue with specialist checkups and various types of therapy several times a month.

But the new parents are finally more at ease, celebrating their babies’ homecoming and learning all they can about their personalities.

The twins are now meeting many of the milestones of babies for their “corrected age,” where they would be if they were born at full-term.

“The one thing that really surprised me, when both of them were ready to go home, both of them went home without oxygen, no feeding tube, nothing, they just went home. They were feeding on their own and maintaining their oxygen,” Shah said.

Adiah is now very social and has long conversations with everyone she meets. Their parents describe Adrial as wise for his years, curious and intelligent, with a love of music.

“We feel it’s very important to highlight that contrary to what was expected of them, our babies are happy, healthy, active babies who are breathing and feeding on their own, rolling over, babbling all the time, growing well, playing, and enjoying life as babies,” Rajendram said.

These parents hope their story will inspire other families and health professionals to reassess the issue of viability before 22 weeks gestation, even when confronted with sobering survival rates and risks of long-term disability.

“Even five years ago, we would not have gone for it, if it was not for the better help we can now provide,” Shah said, adding that medical teams are using life-sustaining technology in a better way than in previous years. “It’s allowing us to sustain these babies, helping keep oxygen in their bodies, the role of carbon dioxide, without causing lung injury.”

Adiah and Adrial’s parents say they’re not expecting perfect children with perfect health but are striving to provide the best possible life for them.

“This journey has empowered us to advocate for the lives of other preterm infants like Adiah and Adrial, who would not be alive today if the boundaries of viability had not been challenged by their health care team,” Rajendram said.

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Up to 20,000 people who attended a religious gathering may have been exposed to measles. What should they do next? | CNN

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CNN
—

Up to 20,000 people who attended a religious gathering at a college in Wilmore, Kentucky, in February could have been exposed to a person later diagnosed with measles.

On Friday, the US Centers for Disease Control and Prevention issued an alert to clinicians and public health officials about the confirmed case of measles in an individual present at the gathering who had not been vaccinated against the disease.

“If you attended the Asbury University gathering on February 17 or 18 and you are unvaccinated or not fully vaccinated against measles, you should quarantine for 21 days after your last exposure and monitor yourself for symptoms of measles so that you do not spread measles to others,” according to the CDC advisory.

The CDC also recommended that people who are unvaccinated receive the measles, mumps, and rubella (MMR) vaccine.

Reading this news, people may have questions about measles, including its symptoms, infection outcomes and who is most at risk. They may also want to know what makes measles so contagious, what has been the cause of recent outbreaks and how effective the MMR vaccine is.

To help answer these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. Previously, she served as Baltimore’s health commissioner, where her duties included overseeing the city’s immunization and infectious disease investigations.

CNN: What is measles, and what are the symptoms?

Dr. Leana Wen: Measles is an extremely contagious illness that’s caused by the measles virus. Despite many public health advances, including the development of the MMR vaccine, it remains a major cause of death among children globally.

The measles virus is transmitted via droplets from the nose, mouth or throat of infected individuals. If someone is infected and coughs or sneezes, droplets can land on you and infect you. These droplets can land on surfaces, and if you touch the surface and then touch your nose or mouth, that could infect you, too.

Symptoms usually appear 10 to 12 days after infection. They include a high fever, runny nose, conjunctivitis (pink eye) and small, painless white spots on the inside of the mouth. A few days after these symptoms begin, many individuals develop a characteristic rash — flat red spots that generally start on the face and then spread downward over the neck, trunk, arms, legs and feet. The spots can become joined together as they spread and can be accompanied by a high fever.

A nurse gives a woman a measles, mumps and rubella virus vaccin at the Utah County Health Department on April 29, 2019 in Provo, Utah.

CNN: What are outcomes of measles infections? Who is most at risk?

Wen: Many individuals recover without incident. Others, however, can develop severe complications.

One in five unvaccinated people with measles are hospitalized, according to the CDC. As many as 1 out of every 20 children with measles will get pneumonia; about 1 in 1,000 who get measles can develop encephalitis, a swelling of the brain that can lead to seizures and leave the child with lasting disabilities. And nearly 1 to 3 out of every 1,000 children who are infected with measles will die.

Measles is not only a concern for children. It can also cause premature births in pregnant women who contract it. Immunocompromised people, such as cancer patients and those infected with HIV, are also at increased risk.

CNN: What makes measles so contagious?

Wen: Measles is one of the most contagious diseases in the world — up to 90% of the unvaccinated people who come into contact with a contagious individual will also become infected. The measles virus can remain in the air for up to two hours after an infected person leaves an area.

Another reason why measles spreads so easily is its long incubation period. In infected people, the time from exposure to fever is an average of about 10 days, and from exposure to rash onset is about 14 days — but could be up to 21 days. In addition, infected people are contagious from four days before rash starts through four days after. That’s a long period of time where they could unknowingly infect others.

CNN: What has been the cause of recent measles outbreaks?

Wen: It’s important to note that this incident in Kentucky is not yet considered an outbreak. Only one person has been diagnosed with measles. That person was possibly exposed to many others given the number of people in attendance at this gathering, but we don’t know yet if any of those people were infected.

But let’s look at a recent example of a confirmed outbreak in the US: In November 2022, health officials in central Ohio raised alarm over young children being diagnosed with measles. In all, 85 children got sick. None of the children died, but 36 needed to be hospitalized. All those infected were either unvaccinated or not yet fully vaccinated.

Health officials were able to contain the outbreak through contact tracing, vaccination and other public health measures in early February, and it was declared over. But there is concern it won’t be the last of its kind. A study from the CDC reported the rate of immunizations for required vaccines among kindergarten students nationwide dropped from 95% in the 2019-20 school year to 93% in the 2021-22 school year. Some communities have far lower rates than this national average, however, which can lead to outbreaks — not only of measles but also diseases like polio that can also have severe consequences.

CNN: How effective is the MMR vaccine?

Wen: The MMR vaccine is a two-dose vaccine. The recommendation is for children to receive the first dose at age 12-15 months and the second dose at age 4-6 years. One dose of the MMR vaccine 93% effective at preventing measles infection. Two doses are 97% effective.

CNN: What is the best way to protect against measles?

Wen: The MMR vaccine is an extremely safe and very effective vaccine and is recognized as a significant public health advance for preventing an otherwise extremely contagious disease from spreading and causing potentially very severe — even fatal — outcomes.

Consider that the vaccine was licensed in the US in 1963. In the four years before that, there were an average of more than 500,000 cases of measles every year and over 430 measles-associated deaths. By 1998, there were just 89 cases and no measles-associated deaths. That’s a huge public health triumph.

Young children should receive the vaccine according to the recommended schedule. Older kids and adults who never received it should also discuss getting it with their health care provider. And clinicians and public health officials in the US and around the world should redouble efforts to increase routine childhood immunizations so as to stop preventable diseases from making a comeback.

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A shortage of albuterol is about to get worse, especially in hospitals | CNN

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CNN
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An ongoing shortage of a medicine commonly used to treat people with breathing problems is expected to get worse after a major supplier to US hospitals shut down last week.

Liquid albuterol has been in short supply since last summer, according to the American Society of Health-System Pharmacists. It has been on the US Food and Drug Administration’s shortages list since October. The news of the plant shutdown worries some doctors who work with patients with breathing problems such as asthma.

“This is definitely concerning, especially as we are coming out of the respiratory season where we had a big demand with RSV, Covid-19 and flu, and are now heading into spring allergy season when a lot of kids and adults experience asthma symptoms,” said Dr. Juanita Mora, a national volunteer medical spokesperson for the American Lung Association and an allergist/immunologist based in Chicago. “This is a life-saving drug and being able to breathe is vital for everyone.”

The manufacturer that recently shut down, Akorn Operating Company LLC, had filed for Chapter 11 bankruptcy in May 2020.

It was the only company to make certain albuterol products used for continuous nebulizer treatment. It’s a staple in children’s hospitals, but had been out of stock since last fall. Without that particular form of the product, hospitals have had to scramble to find alternatives.

“Members are either forced to compound it themselves to make the product or go to an outside third party source who is compounding the product,” said Paula Gurz, senior director of pharmacy contracting with Premier Inc., a major group purchasing company for hospitals.

With the Akorn shutdown, Gurz said products from the one remaining major domestic source of liquid albuterol, Nephron Pharmacuticals, have been on back order. Nephron just started shipping albuterol last Friday, Gurz said, but to get back on track, “it’s going to be an uphill climb.”

Hospitals around the country said they’re watching the supply chain – and their current stock – closely. There’s concern they might have to delay discharging patients because they don’t have enough medicine, or that they may see more ER visits for people with breathing problems who don’t have access to medicine.

Dr. Eryn Piper, a clinical pharmacist at Children’s Hospital of New Orleans, said her hospital has been largely unaffected so far, but for months she has heard about retail pharmacies and other health systems that have had issues with albuterol shortages.

“The big problem we’ve been hearing about is inhalation solutions, not really the inhalers, it’s more like the solutions that go into the nebulizer machines for inhalation that the patients breath in,” said Piper.

Without the larger Akorn product, staff at Lurie Children’s Hospital in Chicago had to squeeze out the albuterol contents from smaller packages.

It’s “time-consuming and labor-intensive as it takes opening 40 containers to equal 20 mL (each patient on continuous albuterol requires 3-5 syringes per day),” said hospital spokesperson Julianne Bardele in an email.

When Nephron was unable to meet demand due to manufacturing issues, Bardele said Lurie had to make another temporary switch to a different concentration and use an alternative liquid bronchodilator, levalbuterol.

Most hospital pharmacies are aware of supply issues for many medicines, particularly pediatric medicines, said T.J. Grimm, the director of retail and ambulatory services at University Hospitals Cleveland Medical Center, and they try to keep a higher stock – especially of the less expensive medicines like albuterol.

“Just so we can cover situations like this,” Grimm said.

Grimm said his system has albuterol supply for a couple of months still, but he’s frustrated and concerned about the supply chain.

“When you have supply chains that are just-in-time, it can create some issues with when something goes off,” Grimm added. “There’s the short-term crisis we all have to get through and then there’s a longer term. We need to think about these things a little more strategically, especially with our kids.”

Jerrod Milton, the chief clinical officer at Children’s Hospital Colorado, said they’ve been paying close attention to the albuterol shortages for many months. The hospital has experienced shortages in the past, and has continued to implement protocols to conserve doses.

“Challenges are what we deal with when it comes to pediatric medicine. We consider most of the kids that we take care of as somewhat therapeutic orphans,” Milton said. “It’s just another one of the myriad of shortages that we have to deal with, I guess.”

Jessica Daley, the group vice president of strategic sourcing for Premier, said that she doesn’t anticipate that the albuterol shortage will be an ongoing problem for years, but when the market has only a handful of suppliers, “it makes for a very tight market, a very concerning market right now.”

Daley said there are things hospitals can do to help, such as protocol changes, making products on site and finding different suppliers.

The Children’s Hospital Association stepped in to help when it heard from members having difficulty finding enough supply. The association worked with STAQ Pharma, a facility that provides compounded pediatric medication, to start production on batches of albuterol for children’s hospitals in the sizes they needed.

“We’ve been creative and trying to work proactively. So when we think there’s going to be a problem, we’re trying to plan ahead,” said Terri Lyle Wilson, director of supply chain services for the Children’s Hospital Association.

STAQ should be at full production by May, so hospitals will have a steady, stable supply ahead of the next season in which respiratory viruses are in wide circulation, the association says.

Daley at Premier said that in an ideal world, there would be more suppliers of these products, particularly with generic drugs, so that when there is a problem with one, the market could handle it. When there is a concentration of manufacturing with a small number of suppliers, it is very hard to recover, she said.

“We really advocate for diversity and supply to prevent types these types of issues,” Daley said. “Meaning at least three globally, geographically diverse suppliers that are supplying the market with sufficient products.”

For patients, Piper at Children’s Hospital of New Orleans said they are encouraging patients with breathing problems to take precautions and avoid asthma triggers if possible. She said if a patient’s usual pharmacy runs out, it’s also good to check with a doctor to see if there is another medication that’s available.

Inhalers don’t seem to be impacted by the shortage so far, but Daley said if people panic about the lack of albuterol for hospitals, that could change.

“Albuterol is one of those things that if there’s a patient who needs it, you want to have it all the time. So there’s always that potential for the market to respond and react in a way that that will then create downstream shortages of other sizes or presentations of a product,” Daley said.

To avoid that problem, Milton at Children’s Hospital Colorado said it’s simple: “Talk to a provider and see if there are alternatives,” Milton said. “And please don’t hoard.”

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3 messages from Daniel Tiger that teens still need | CNN

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—

While I was playing with my toddler at the park in 2012, another mom told me about a new show that “you have to see”: “Daniel Tiger’s Neighborhood.” Soon, I was hearing the show’s coping strategy jingles everywhere. How many of us used the song, “When you have to go potty, stop and go right away” to toilet train our kids?

Much of the animated series’ appeal comes from its fidelity to Fred Rogers, who died 20 years ago this week. Rogers’ show “Mister Rogers’ Neighborhood,” which ran from 1968 to 2001 on PBS, was a transformative force in children’s media — largely because of the way it focused on children’s emotional development.

While they may no longer have use for Daniel Tiger’s “potty song,” older kids face other challenges. And though the first children who watched the show on PBS are now tweens and teens, the show’s lesson can still help them in the midst of our current mental health crisis.

I recently spoke to show creator Angela Santomero, who said she took Rogers’ beloved wisdom to heart as she “set out to create ‘Daniel Tiger’s Neighborhood’ for preschoolers — and for the teens that our first viewers have grown up to be.”

Here are three messages from Daniel Tiger and Rogers that not-so-little kids still need to hear.

Teens need the reminder that simply naming emotions is a powerful mental health strategy. According to research from neuroscientist Lisa Feldman Barrett, people who could “distinguish finely among their unpleasant feelings — those ’50 shades of feeling crappy’ — were 30 percent more flexible when regulating their emotions, less likely to drink excessively when stressed, and less likely to retaliate aggressively against someone who has hurt them.”

“Helping kids of any age to label and express their emotions is one of the key lessons from Fred Rogers,” Santomero said. That’s why so many “Daniel Tiger’s Neighborhood” episodes pair a single emotion with a strategy song – like anger (“When you feel so mad that you want to roar, take a deep breath and count to four.”) or sadness (“It’s OK to feel sad sometimes. Little by little you’ll feel better again.”).

Finding the right word to express how you are feeling inside isn’t always easy. I spent several years as a middle and high school teacher, and I remember chatting with a teen who said she was “so angry” with her best friend, but she didn’t know why.

Soon we began to talk about the college process, and she revealed that her friend had outscored her on the SAT. What she was really feeling, she realized, was jealousy, self-doubt and worry about the future. Once she could name that, her anger “evaporated.” When you can identify what you are feeling and why, it’s easier to figure out what to do next.

“If kids as young as preschoolers can start learning these strategies, our hope is that once they become teens they will have some tools to deal with hard situations that are mentally challenging,” Santomero said.

Remember all the newness and change your preschoolers faced — and how much they needed your comforting presence? Now think about tweens and teens: Their bodies are changing, their brains go through a second growth spurt, they face social and academic pressures, they are increasingly aware of societal problems, and they are doing the hard work of figuring out their identities and planning for the future.

If there’s one essential message from Rogers that I carry with me both as a parent and educator, it’s this: Don’t worry alone. As he said, “Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting and less scary.”

Adolescent psychologist Lisa Damour says that for teens, strong emotions are “a feature not a bug.” In her new book “The Emotional Lives of Teenagers: Raising Connected, Capable, and Compassionate Adolescents,” she writes, “It’s beyond our power to prevent or quickly banish our teens’ psychological pain, nor should that be our goal. We can and should, however, help our teenagers develop ways to regulate their emotions that offer relief and do no harm.” And this starts with listening.

One of my favorite aspects of Daniel Tiger is the way the adults in his life pause to really listen to his concerns. In the show’s very first episode, Daniel’s mom helps him work through his worries about going to the doctor with the song, “When we do something new, let’s talk about what we’ll do.”

Really listening to preschoolers or teens is a skill, said Santomero. It takes practice to “lean in, focus, ask relevant questions, and listen with your whole heart.” This kind of attentive listening “shows how empathetic you are to their situation, how much you care about them, and how important they are to you. And that goes a long way in supporting their mental health.”

One strategy from “Daniel Tiger’s Neighborhood” that can help parents of teens is “thoughtful pausing,” said Santomero, who is also a co-creator of “Blues Clues.”

Pausing during a conversation or vent session can give teens “time to get their thoughts together and reflect,” Santomero said. “It helps to make sure that it’s a two-way dialogue.” These pauses also open up space for teens to find their own solutions.

When I watched that first season of “Daniel Tiger’s Neighborhood” with my child, I found myself tearing up more than once because the familiar songs and messages brought back how Rogers made me feel as a young child: special.

We don’t need research to tell us how important unconditional love is for teens — but that data exists, regardless. In a 2014 study in the journal Child Development, researchers found that “parental warmth” amplifies every other effective parenting strategy, from setting boundaries to helping teens “tackle the academic and psychological challenges of secondary school.”

How did researchers measure parental warmth? With survey questions as simple as, “How often do you let your child know you really care about him/her?”

That warmth was a gift Rogers offered children every day when he signed off his show with, “You’ve made this day a special day, by just your being you. There’s no person in the whole world like you, and I like you just the way you are.” Teens need that message — even (maybe especially) when they are pulling away or pushing all our buttons.

One of Santomero’s “all-time favorite Mister Rogers’ moments” is a message he recorded for adults in 2002, shortly before he died. It’s a message that is just as applicable 20 years later as we support the next generation:

“I know how tough it is sometimes to look with hope and confidence on the months and years ahead,” he said. “But I would like to tell you what I often told you when you were much younger: I like you just the way you are. And, what’s more, I’m so grateful to you for helping the children in your life to know that you’ll do everything you can to keep them safe, and to help them express their feelings in ways that will bring healing in many different neighborhoods.”

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Why hard feelings are good for teens | CNN

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CNN
—

For many parents, the “Is it normal?” game begins early on. I’ve sent question after question to family and friends, and of course, all worried parents ask our No. 1 frenemy, Google.

Is it normal my fetus isn’t moving a lot in the morning? Is it normal my baby doesn’t nap? Is it normal that my 6-year-old can’t read? Is it normal that my 10-year-old has only lost four baby teeth?

For all the talk of helicopter parents and their snowflake children, most parents I know are more concerned with whether their child’s development would be considered normal by experts than whether they are raising a prodigy.

When the teen years arrive, the “Is it normal?” instinct can go into overdrive. Adolescence is marked by many changes, including ones that manifest physically and, their more challenging counterpart, ones that manifest emotionally. The moods and deep feelings are intense, and — for parents worried about teen mental health following the pandemic — cause for panic amid reports of heightened depression and anxiety among adolescents.

But difficult feelings are often not a cause for concern, according to psychologist Lisa Damour in her new book, “The Emotional Lives of Teenagers: Raising Connected, Capable, and Compassionate Adolescents.” Not only are sadness and worrying healthy and natural parts of being a teenager, but the ability to experience these feelings (without a parent panicking) and to learn how to cope with them is developmentally necessary.

CNN spoke to Damour about why we’ve become less tolerant of big feelings, how to handle them when they arise, and the ways parents can, and can’t, help.

This conversation has been edited and condensed for clarity.

CNN: You want to help parents distinguish between a teen in a mental health crisis, which is more common now, and a teen who is sad and moody but not in crisis. Why is this important?

Lisa Damour: We certainly have a teen mental health crisis, and part of what contributes to the crisis isn’t just that teenagers suffered in the pandemic but also that we don’t have a clinical workforce to provide as much care as they deserve.

But not all kids who are in psychological distress are having a mental health concern. Psychologists see those as two different things, and though it is uncomfortable for all involved, typical adolescent development comes with plenty of psychological distress. My aim in writing this book was to support parents in knowing the difference between distress that is natural to being a teenager and when a teenager may be facing a mental health concern.

CNN: How do you know the difference?

Damour: Psychologists fully expect to see distress in humans, and especially in teenage humans. When we become disturbed is by how that distress is managed. We want to see that teens can manage distress in a way that does no harm to themselves or others. This might include talking about feelings with people who care for them, finding healthy outlets for the distress and seeking habits that help them find relief.

What we don’t want to see is for them to find relief through something that comes with a price tag, things like using a substance or harming others.

The other time we become concerned is when one emotion is calling all the shots, like when they are so anxious that their anxiety is governing all their decisions, or so sad that depression is getting in the way of their typically forward development.

CNN: Why is it so hard for parents to see hard feelings, including sadness and anxiety, as part of a healthy adolescence?

Damour: There is a lot of commercial marketing around wellness that can give people the impression that they are only mentally healthy or their kids are mentally healthy if they are feeling good, calm or relaxed. This is not an accurate definition of mental health.

Since the pandemic, parents are more anxious than ever about teens suffering emotional distress.

Also, in the wake of the pandemic, what I am observing is that parents saw their kids go through an extremely hard time and are now surrounded by headlines about the ways in which teenagers especially suffered. It makes sense that parents are feeling more anxious than ever about their teenagers experiencing emotional distress.

In light of what we have all been through, and what our kids have been through, it can be very hard to get used to the idea that distress can be a sign of a teenager’s mental health. If a boy gets his heart broken and is very sad and he is in a lot of pain, it is proof that he is working just as he should. If a kid is unprepared for a test and it’s coming fast, and she feels anxious — that’s uncomfortable but appropriate.

One of the aims of this book is to prove that mental distress is not only inevitable — it is part of mental health and experiencing it is part of how kids grow and mature.

CNN: Many of us feel permanently short on time. How does that impact how we tend to our teens’ emotional distress?

Damour: As much as we can appreciate theoretically that teenagers are going to get upset and have bad days, that doesn’t mean that this is easy to deal with at night when the parent is tired, and the teenager is having a meltdown. In that moment, the very expectable and well-meaning response is for the parent to want to make the stress go away and jump into advice giving and problem-solving so that the teenager doesn’t feel that way anymore. But parents discover that this doesn’t work as well as they hope it will.

CNN: You point to deep listening as a better approach, which is often not as easy as it may sound. What is it?

Damour: The metaphor I find that helps us listen is to imagine that you are an editor and your teenager is your reporter. They are reading you an article, and when they come to the end of it, it is your job to produce the headline.

This exercise helps us tune in to what a teenager is saying and hear and distill what it is they are communicating. It also keeps us from doing what we so often do, which is have an idea and wait for the kids to pause so we can share it.

Parents may worry, but experiencing mental distress is part of how teens grow and mature.

If you come up with a good headline, teenagers often feel completely heard and get all the support they need. And even if you don’t, teenagers know us well and know when we are listening and giving them support without an agenda and trying to understand what they are really saying.

What helps with anyone experiencing difficulty, but especially teenagers, is to experience compassion. It is such a generous gesture to just hear someone out.

CNN: Does all emotional processing need to be verbal?

Damour: There are many other healthy ways kids regulate emotions besides talking. Listening to mood-matching music is a very adaptive way to regulate as the experience of listening to the music catalyzes the emotion out of them. Teenagers also discharge emotions physically — by going through a run, jumping on a trampoline or banging on drums. Sometimes they will discharge them through creative channels like drawing or making music.

As adults, we should not diminish the value of emotional expression that brings relief, even if it doesn’t come in the verbal form to which we are most accustomed.

CNN: Should parents ask to join in? To listen to the music with them or go on the run?

Damour: No, because what we ultimately want is for our teens to become autonomous in dealing with their hard feelings.

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A childbirth myth is spreading on TikTok. Doctors say the truth is different | CNN

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CNN
—

Ashley Martinez has four sons and is pregnant with the daughter she’s wanted for years.

Last month, she posted a video online imploring doctors to prioritize her life, not the life of her unborn baby, if complications arise when she is in labor and it comes down to that choice.

The San Antonio, Texas, resident is due in May and is one of a number of pregnant people who have recently posted “living will” videos on TikTok.

Martinez had an emergency C-section during her last pregnancy after her umbilical cord came out before her baby, a rare but dangerous condition known as an umbilical cord prolapse that can deprive a baby of vital blood flow and oxygen.

Martinez described her last delivery as terrifying. Eight months after the Supreme Court reversed Roe v. Wade, ending a constitutional right to abortion, she said she worries about what would happen if she faced similar challenges again.

Since the ruling in June, a number of US states have criminalized abortions, leading to some fears that doctors would prioritize the life of the unborn child during a medical emergency.

Martinez lost her mother to non-Hodgkin’s lymphoma at a young age, and the thought of her children going through a similar tragedy terrifies her.

“Having to go into another delivery where I’m going to have a C-section, it’s scary for me,” said the 29-year-old. “My fourth pregnancy was my only C-section. I’ve always thought about not being here for my kids just because of what I went through growing up without my mom.”

More than a dozen US states have banned or severely restricted access to abortions following the Supreme Court’s decision eight months ago. The abortion bans have led to legal chaos as advocates take the fight to courtrooms.

Even so, several ob/gyns told CNN that a hard choice between saving a mother and baby’s lives at childbirth, like the one outlined in the TikTok videos, is highly unlikely.

This trend on TikTok has sparked a flurry of dueling videos among pregnant women and other people. Some have posted videos telling doctors in such situations to prioritize their unborn babies first, and criticizing those who expressed a different view.

Martinez concedes that her mother, who died at 25, would likely have chosen to save her child first if she could.

“My mother, she didn’t have a choice, you know?” Martinez said. “The message that I want to send is just basically nobody is wrong or right in this situation. In both situations, it is a hard decision to pick your children over your unborn baby.”

In Texas, where Martinez lives, abortions are banned at all stages of pregnancy – unless there’s a life-threatening medical emergency.

Dr. Franziska Haydanek, an ob/gyn in Rochester, New York, who shares medical advice on TikTok, said she’s noticed many “living will” videos in recent months.

In most of the videos, a woman appears alongside a written message saying something like, “If there are complications during childbirth, save me before the baby.” Some people, including Martinez, reference their children in their decision and even show them in the video.

One was posted by Tuscany Gunter, 22, a woman whose baby is due in April. Abortion after 20 weeks of pregnancy is illegal in her home state of North Carolina, and Gunter told CNN she filmed her message in solidarity with others who said they would choose themselves first.

“I wanted to make it known where I stand and to stand up with other women who are getting bashed online for saying they would rather be saved first over their baby,” said Gunter, who lives in Fayetteville.

“As a mother to three young children, I cannot dump the emotional trauma of losing their mother on them as children and expect them to cope. While I would be crushed to lose a baby, I need to think of my other living children as well … And I know the baby that passed would be safe without ever having to experience any pain or sadness.”

Another woman, Leslie Tovar of Portland, Oregon, said that even though her state has no legal restrictions on abortion, she posted her video because she feared doctors would prioritize saving her unborn child to avoid legal ramifications in the post-Roe v. Wade era.

“I have two other kids at home who need mom. I can’t bear the thought of my two young boys ages 6 and 4 without their mom,” she said.

All three women said they’ve had these conversations with their partners, who agreed they should be saved first.

Of her husband, Tovar said, “His exact words were, ‘We could always have another baby later in life but there is never replacing the mother of my boys, I couldn’t do this without you.’”

It’s true that complications occasionally come up during a pregnancy that lead doctors to recommend delivery to save the mother’s life, medical experts said.

If this is done before a fetus is viable – under 24 weeks – the chances of the baby’s survival are low, said Dr. Elizabeth Langen, a maternal-fetal medicine physician at the University of Michigan Von Voigtlander Women’s Hospital.

Roe v. Wade’s reversal did make terminating such pregnancies more complicated, Langen and Haydanek say.

In cases involving a baby that’s not viable, it could mean that even when the baby is unlikely to survive and the mom’s health is at risk, the priority will be on saving the baby due to fear of legal ramifications, Langen said.

But both doctors say these scenarios don’t occur during the birth of a viable baby. In that instance, Roe v. Wade is “less involved,” Haydanek said.

“We do everything in our efforts to save both (mother and baby),” she said. “I can’t think of a time where the medical team has had to make a decision about who to save in a viable laboring patient. It’s just not a real scenario in modern medicine – just one we are seeing played out on TV.”

Hospitals have enough resources – obstetrics and neonatal intensive care unit teams, for example – to meet the needs of both the mother and the baby, Haydanek and Langen said.

“We’re usually doing our best to take care of both the mom and the baby. And there’s very rarely a circumstance where we will do something to harm the mom in order to have the benefit of the baby,” added Langen.

“If mom’s health is deteriorating, ultimately, she’s not going to be able to support baby’s wellbeing,” Langen said. “And so generally, what we encourage folks to do is really support mom’s health, because that’s in the best interest of both mother and baby.”

Abortion rights demonstrators hold signs outside the US Supreme Court in Washington after the court overturned Roe v. Wade in June 2022.

Both doctors said it’s important for patients to talk to their health care providers about their medical concerns and share their “living will” wishes with loved ones in case there are complications during labor that require partners to make medical decisions.

However, those decisions will not involve doctors asking your partner whose life should come first, they said.

“Before getting in a fight with your partner about who they choose to save, know that there isn’t a situation where we will ask them that,” said Haydanek, who has called the TikTok trend “horribly anxiety inducing.”

She said it’s come up so many times in recent months that she made her own TikTok video to reassure expectant parents.

“Please don’t feel like you have to make this choice,” she says in the video. “I know firsthand how much anxiety there can be in pregnancy … but it’s just not a situation that you’re gonna find yourself in.”

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Bullying doesn’t look like it used to. Experts share how to fix it | CNN

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Editor’s Note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the National Suicide Prevention Lifeline at 988 (or 800-273-8255) to connect with a trained counselor or visit the NSPL site.

CNN
—

Every generation has tales of bullying, but perhaps today’s adults are not as familiar with what it means now for a kid to be bullied.

Physical bullying — like confrontations involving hitting or shoving — actually showed very little association with a risk for mental distress, according to a new study.

“For adults doing this research, you kind of assume that bullying consists of being stuffed in a locker and beaten up on the playground,” said lead study author John Rovers, professor and John R. Ellis Distinguished Chair in Pharmacy Practice at Drake University in Des Moines, Iowa. “We found out that that really has remarkably little effect.”

Researchers took data from the 2018 Iowa Youth Survey of sixth, eighth and 11th graders to see whether there was an association between bullying and mental health and suicidal ideation, according to the study published Wednesday in the journal PLOS ONE.

The results showed different forms of bullying did have an impact on feelings of sadness or hopelessness or thoughts of suicide — but that they did not impact students equally.

Identity bullying, which includes bullying based on sexual orientation or gender identity as well as sexual jokes, was correlated with significant feelings of distress or suicide attempts, the study said.

Cyberbullying and social bullying — leaving someone out or turning peers against them — followed identity bullying on degree of impact.

The study is limited in that the sample did not include a high level of racial and religious diversity, but it does show “a theme very consistent with recent surveys as well as what I’m seeing in my clinical practice,” said child and adolescent psychiatrist Dr. Neha Chaudhary, chief medical officer at BeMe Health who is in the faculty at Massachusetts General Hospital and Harvard Medical School. Chaudhary was not involved in the research.

The teachers and school administrators surveyed were worried most about physical bullying, however, according to the study.

“This is a good learning for schools and families as they think about anti-bullying initiatives and how to talk to young people about the effects of bullying,” Chaudhary said.

It makes sense that identity would be a particularly painful form of bullying.

“Identity is so incredibly important for kids and teens as they develop, and not being able to be themselves without fear of judgement or bullying from others is not only isolating, it can significantly alter their confidence, peace of mind, and ability to see a future for themselves that’s free of pain,” Chaudhary said in an email. “People just want to be themselves, and be loved for who they are.”

The survey data reviewed by the study team revealed a troubling statistic when it came to the state of adolescent mental health.

“About 70,000 students responded to this survey. Five percent of them had attempted suicide in the last year,” Rovers said. “That’s 3,500 kids.”

And this week’s results of the US Centers for Disease Control and Prevention’s biannual Youth Risk Behavior Survey showed mental distress among teens is getting worse.

In rates that “increased dramatically” over the past decade, most high school girls (57%) felt persistently sad or hopeless in 2021, double the rate for teen boys (29%), according to the CDC. Nearly 1 in 3 teen girls seriously considered attempting suicide.

Most LGBTQ students (52%) have also recently experienced poor mental health, and more than 1 in 5 attempted suicide in the past year, the CDC survey showed.

Solutions that address adolescent mental health may come from families and schools working together — not in focusing on what the kids themselves can change, Rovers said.

“Blaming this on some 9-year-old kid is not right,” he added.

When it comes to bullying, there are three types of players: the bully, the victim and the child that is both being bullied and bullying others, Rovers said.

All three need support, said Dr. Hina Talib, adolescent medicine specialist at the Atria Institute in New York and associate professor of clinical pediatrics at the Albert Einstein College of Medicine in New York City.

“Bullying is such a pattern of behavior that causes harm to the victim of the bully, the children that might just be witnessing the bullying happening and even to the bully themselves,” said Talib, who was not involved in the research.

Rarely is a child exerting power over others just for its own sake, Talib added.

While caregivers may have the first reaction to punish their child when they hear they are bullying others, it is important to probe a little deeper into what is going on with them, she said.

“There are likely reasons there that are causing them to act out in this way,” Talib explained. “Underneath that, I think it’s important to see that their child is hurting also.”

She recommended coming to them with the mindset of “this is not acceptable behavior, and this is why, and I’m here to help you through it,” Talib said.

“The bully can and should be helped as well,” she added. “There’s almost always more to it.”

There are many ideas about what motivates bullying behavior, but one could be that kids are emulating how they see the adults in their lives resolve conflict, Rovers said. These adolescents might learn that violence is a way to protect themselves.

For children that are being bullied, they may not always be direct in telling the adults in their lives what is wrong, Talib said.

Instead of hearing about cruel words or isolating actions, families might first see stress, anxiety, depression, stomachaches and avoiding school, she said.

She recommended being attentive to your child and their individual behaviors and stepping in when you see a change. That could mean asking directly, having their pediatrician speak to them about it privately or even coming to them indirectly.

A helpful way in could be to ask about their friends’ experiences.

Say something like: “There was an interesting research report about bullying, and it made me think about bullying. It made me interested in if your friends were bullied or if you ever witnessed a bullying situation,” Talib said.

If you do find that your child is the victim of bullying, Talib said it’s a good idea to get in contact with the school and the other family to develop an action plan together.

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Almost half of children who go to ER with mental health crisis don’t get the follow-up care they need, study finds | CNN

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Editor’s Note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the 988 Suicide and Crisis Lifeline, or visit the hotline’s website.

CNN
—

Every night that Dr. Jennifer Hoffmann works as an attending physician in the pediatric ER, she says, at least one child comes in with a mental or behavioral health emergency. Over the span of her career, she’s seen the number of young people needing help grow enormously.

“The most common problems that I see are children with suicidal thoughts or children with severe behavior problems, where they may be a risk of harm to themselves or others,” said Hoffmann, who works at Ann & Robert H. Lurie Children’s Hospital of Chicago. “We’re also seeing younger children, especially since the pandemic started. Children as young as 8, 9 or 10 years old are coming to the emergency department with mental health concerns.

“It’s just mind-blowing.”

The surge of children turning up in emergency departments with mental health issues was a challenge even before 2020, but rates soared during the Covid-19 pandemic, studies show.

ER staffers may be able to stabilize a child in a mental health care crisis, but research has shown that timely follow-up with a provider is key to their success long-term. Unfortunately, there just doesn’t seem to be enough of it, according to a new study co-authored by Hoffmann. Without the proper follow-up, these children too often wound up back in the ER.

For their study, published Monday in the journal Pediatrics, Hoffmann and her co-authors looked at records for more than 28,000 children ages 6 to 17 who were enrolled in Medicaid and had at least one trip to the emergency department between January 2018 and June 2019. They found that less than a third of the children had the benefit of an outpatient mental health visit within seven days of being discharged from the ER. A little more than 55% had a follow-up within 30 days.

Research has shown that follow-up with a mental health care provider lowers a person’s suicide risk, raises the chances that they will take their prescription medicine and decreases the chances that they will make repeated trips to the ER.

The new study found that without a follow-up, more than a quarter of the children had to go back to the ER for additional mental health care within six months of their initial visit.

“The emergency department is a safety net. It’s always open, but there’s limited extent to the types of mental health services we can provide in that setting,” Hoffmann said. “This really speaks to inadequate access to services that these kids need.”

This dynamic can be “devastating” for parents and emergency department staff alike, she said.

“We know what a child needs, but we’re just not able to schedule follow-up due to shortages among the mental health profession. They’re widespread across the US,” she said.

A lack of professional help is a problem for many children. Before the Covid-19 pandemic, the US Centers for Disease Control and Prevention found that 1 in 5 children had a mental health disorder, but only about 20% got care from a mental health provider.

Children’s mental health has become such a concern in the US that the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association declared a national emergency in 2021.

Hoffmann’s study found that Black children fared worse than their peers. They were 10% less likely to have timely follow-up than White children – “which is very concerning, given that there are many disparities in access to care in our mental health system,” Hoffmann said.

The study can’t pinpoint why there is this racial disparity, but Hoffmann thinks there may be a few factors at play.

Black children are more likely to live in neighborhoods that have shortages of mental health professionals. There is also limited diversity among the mental health work force. Studies show that nearly 84% of psychologists are White, as are nearly 65% of counselors and more than 60% of social workers. And Black children more often rely on school-based mental health services, studies show.

Although the number of school counselors has been increasing over the years, few schools meet the National Association of School Psychologists’ recommended ratio of one school psychologist to 500 students. The national ratio for the 2021-22 school year was 1,127 to 1, the association found.

The new study found that the children who did not have mental health help before their ER visits had the most difficulty finding timely care afterward.

Dr. Toni Gross, chief of the Emergency Department at Children’s Hospital New Orleans, said she wasn’t entirely surprised by the study findings. Her hospital’s beds for with mental health concerns are “always busy,” she said.

“I’m well aware of the fact that we need more providers for these services. We deal with it every day,” said Gross, who was not involved in the new research.

The lack of providers who can do follow-up is a real source of concern. It’s not ideal to hand a phone number to a parent and hope they can arrange care, she said. It often takes weeks or even months to get a first appointment with a child and adolescent psychiatrist.

“It leaves a lot of us feeling like we wish we could do more,” Gross said. “When you always leave asking yourself at the end of the day, ‘did I really do what I set out to do, and that is to help people,’ it’s one of our biggest frustrations, and it may be one of the biggest reasons people in my group of physicians feel burnout.”

Like many children’s hospitals, hers has an active partnership with local school health programs that can provide some mental health care.

Hoffmann said that the amount of support varies by emergency department. Lurie has 24/7 coverage by mental health workers who can do an evaluation and provide recommendations for appropriate care, but not all areas do. For example, many rural emergency rooms don’t have pediatric mental health providers and may have few resources in the community, if any.

Several US counties have no practicing child and adolescent psychiatrists. Primary care physicians can help, but some patients would benefit from more specialized care, Hoffmann said.

President Joe Biden’s administration announced in August that plans to make it easier for millions of children to get access to mental health services by allowing schools to use Medicaid dollars to hire additional school counselors and social workers. He even mentioned the issue in his State of the Union address Tuesday.

But even more will need to be done. Hoffmann hopes her study will prompt policy-makers to invest more so children can access care no matter where they live. Investing in telehealth could also bridge the gap, she said, as would increasing Medicaid reimbursement rates for mental health services and more funding to pay for people to train to work with children as a mental health professional.

In a commentary published alongside the new study, the authors say their research shows that the US “is not meeting the behavioral health needs of our young people.”

“EDs are the last stop when all else has failed, and they, too, lack the resources to support, or even discharge, these patients,” the commentary says.

It points out that research has found this lack of access as far back as 2005.

“This new analysis adds to the overwhelming evidence that there is an urgent need for a dramatic change in our pediatric mental health care system,” the commentary says. “We believe it is time for a ‘child mental health moonshot,’ and call on the field and its funders to come together to launch the next wave of bold mental health research, for the benefit of these children and their families who so desperately need our support.”

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Common kinds of air pollution led to changes in teens’ blood pressure, study says | CNN

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Scientists know that air pollution can make it difficult to breathe and may ultimately cause serious health problems like cancer, but a new study shows that it might also have a negative impact on teens’ blood pressure.

Exposure to higher levels of nitrogen dioxide was associated with lower blood pressure in teens, according to the study, published Wednesday in the journal PLOS One. Exposure to particulate matter 2.5, also known as particle pollution, was associated with higher blood pressure.

The researchers say the impact is “considerable.”

Other studies have found a connection between blood pressure changes and pollution, but much of that work focuses on adults. Some research has also found negative associations with pollution exposure and younger children, but little has focused on teens.

Generally, low blood pressure can cause immediate problems like confusion, tiredness, blurred vision and dizziness. High blood pressure in adolescence can lead to a lifetime of health problems including a higher risk of stroke or heart attack. It’s a leading risk factor for premature death worldwide.

The study did not look at whether the teens had symptoms or health effects from the change in blood pressure.

The scientists saw this association between pollution and blood pressure in data from the Determinants of Adolescent Social Well-Being and Health study, which tracks the health of a large and ethnically diverse group of children in London over time.

The researchers took data from more than 3,200 teens and compared their records to their exposures to pollution based on annual pollution levels where they lived.

Nitrogen dioxide pollution is most commonly associated with traffic-related combustion byproducts. Nitrogen may help plants grow, but it can impair a person’s ability to breathe and may cause damage to the human respiratory tract. In this study, the nitrogen was thought to be coming predominantly from diesel traffic.

The particle pollution in the study is so tiny – 1/20th of a width of a human hair – that it can travel past the body’s usual defenses. Instead of being carried out when a person exhales, it can get stuck in the lungs or go into the bloodstream. The particles cause irritation and inflammation and may lead to a whole host of health problems.

Particle pollution can come from forest fires, wood stoves, power plants and coal fires. It can also come from traffic and construction sites.

In this study, the link between pollution exposure and changes in blood pressure was stronger in girls than in boys. The researchers can’t determine why there is a gender difference, but they found that 30% of the female participants got the least amount of exercise among the group and noted that that can have an effect on blood pressure.

“It is thus imperative that air pollution is improved in London to maximise the health benefits of physical exercise in young people,” the study says.

Although the study also can’t pinpoint why teens’ blood pressure changed with pollution exposure, others have found that exposure to air pollution may affect the central nervous system, causing inflammation and damage to the body’s cells. Additionally, exposure to particle pollution can disrupt a person’s circadian rhythms, which could affect blood pressure. Particle pollution exposure may also reduce the kidneys’ ability to excrete sodium during the day, leading to a higher nighttime blood pressure level, the study says.

When it came to nitrogen dioxide pollution, the researchers had previously done a crossover study that involved the blood pressure of 12 healthy teen participants who were exposed to nitrogen oxide from a domestic gas cooker with lit burners. Their blood pressure fell compared with participants exposed to only room air.

In the new study, the associations between pollution and blood pressure were consistent. Body size, socieoecomonic status and ethnicity didn’t change the results.

However, it looks only at teens in London, and only 8% of them were people of color. Those children were exposed to higher levels of pollution than White children, the study found.

Levels of pollution in London are also well above what World Health Organization guidelines suggest is safe for humans. However, the same could be said for most any area in the world. In 2019, 99% of the world’s population lived in places that did not meet WHO’s recommended air quality levels.

Earlier work has shown that pollution can damage a young person’s health and may put them at a higher risk for chronic diseases like heart problems later in life. Studies in adults found that exposure to air pollution can affect blood pressure even within hours of exposure.

Pollution caused 1 in 6 deaths worldwide in 2019 alone, another study found.

Some experts suggest that one way to reduce a teen’s risk of pollution-related health problems is to invest in portable air cleaners with HEPA filters that are highly effective at reducing indoor air pollution. However, the filters can’t remove all of the problem, and experts say communitywide solutions through public policy are what’s needed.

Dr. Panagis Galiatsatos, an assistant professor in pulmonary and critical care medicine at Johns Hopkins Medicine, said research like this is important to generate a hypothesis about what these pollutants are doing to people. Galiatsatos, a volunteer medical spokesperson with the American Lung Association, was not involved with the new study.

“A lot of these air pollutions tend to cluster in economically disadvantaged neighborhoods, so it’s one of the big reasons we want to always keep a close eye on this, as it disproportionately impacts certain populations more than others,” he said.

Blood pressure is an important marker to track for health because it is a surrogate to understand the more complex processes that might be happening in the body.

“My big takeaway is that these toxins clearly seem to have some physiological impact on the cardiovascular system, and any manipulation should be taken into the context of a concern,” Galiatsatos said.

Study co-author Dr. Seeromanie Harding, a professor of social epidemiology at King’s College London, said she hopes it will lead to more research on the topic.

“Given that more than 1 million under 18s live in [London] neighborhoods where air pollution is higher than the recommended health standards,” she said in a news release, “there is an urgent need for more of these studies to gain an in-depth understanding of the threats and opportunities to young people’s development.”

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