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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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CNN
—

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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I’m a parent with an active social media brand: Here’s what you need to check on your child’s social media right now | CNN

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Editor’s Note: Sign up for CNN’s Stress, But Less newsletter. Our six-part mindfulness guide will inform and inspire you to reduce stress while learning how to harness it.

CNN
—

If you follow me on Twitter or Instagram, you’ll know I wear a lot of hats: romance author, parent of funny tweenagers, part-time teacher, amateur homesteader, grumbling celiac and the wife of a seriously outdoorsy guy.

Because I’m an author with a major publisher in today’s competitive market, I’ve been tasked with stepping up my social media brand: participation, creation and all. The more transparent and likable I am online, the better my books sell. Therefore, to social media I go.

It’s rare to find someone with no social media presence these days, but there’s a marked difference between posting a few pictures for family and friends and actively creating social media content as part of your daily life.

With a whopping 95% of teens polled having access to smartphones (and 98% of teens over 15), according to an August Pew Research Center survey on teens, social media and technology, it doesn’t look like social media platforms are going away anytime soon.

Not only are they key social tools, but they also allow teens to feel more a part of things in their communities. Many teens like being online, according to a November Pew Research Center survey on teen life on social media. Eighty percent of the teens surveyed felt more connected to what is happening in their friends’ lives, while 71% felt social media allows them to showcase their creativity.

So, while posting online is work for me, it’s a way of life for the tweens and teens I see creating and publishing content online. As a parent of two middle schoolers, I know how important social media is to them, and I also know what’s out there. I see the good, the bad and the viral, and I’ve have put together some guidelines, based on what I’ve seen, for my fellow parents to watch for.

Here are eight questions to ask yourself as you check out your children’s social media accounts.

If you don’t, it’s time to start. It’s like when I had to look up the term “situationship,” I saw that ignorance is not bliss in this case. Or really any case when it comes to your children. Both of my children have smartphones, but even if your children don’t have smartphones, if they have any sort of device — phone, tablet, school laptop — it’s likely they have some sort of social media account out there. Every app our children wish to add to their smart devices comes through my husband’s and my phone notifications for approval. Before I approve any apps, I’ll read the reviews, run an internet search and text my mom friends for their experience.

Most tweens and teens use social media for socializing with local friends.

If I’m still uncertain about an app, I’ll hold off on approving it until I can sit down with my children and ask them why they want it. Sometimes just waiting and forcing a short discussion is enough to convince them they no longer want it. In our household, I avoid any apps that run social surveys, allow anonymous feedback or require the individual to use location services.

If you don’t have your family phone plan all hooked together with parental controls, I’d advise setting that up ASAP. Because different devices and apps have different ways to monitor and set up parental controls, it’s impossible to link all the options here. However, a quick search will give you exactly the coverage you are comfortable with, including apps that track your child’s text messages and changing the settings on your child’s phone to lock down at a certain time every night.

The top social media platforms teens use today are YouTube (95% of teens polled), TikTok (67%), Instagram (62%) and Snapchat (59%), according to the Pew Research Center survey on teens and social media tech. Other social media platforms teens use less frequently are Twitter, Reddit, WhatsApp and Facebook. Most notably, Facebook is seeing a significant downturn in teen users. This list isn’t exhaustive, however. I would check out your children’s devices for group chat apps (such as Slack or Discord) and also scroll through their sport or activity apps where group chat capabilities exist.

I’ve seen preteens and teens using their real names, birthdate, home address, pets’ names, locker numbers or their school baseball team. Any of that information could be used to identify your child and location in real life or using a quick Google search. All of that is an absolute “no” in our house.

I also tell my kids not to answer the fun surveys and quizzes that invite children to share their unique information and repost it for others to see. These can be useful tools for predators and people trying to steal your children’s identity.

What I do: I made the choice a long ago to withhold the names of my children and partner. It’s not an exact science, and I know some clever digging could find them. For my husband, it’s for the sake of his privacy and also the protection of his professionalism. Just because he’s married to a romance author doesn’t mean he should have to answer for my online antics, whatever they may be. For my children, I want to avoid anything embarrassing that could be traced back to them during their college application season.

Even if your children keep their social media profiles private (more on that later), their biographical information, screen name and avatar or profile picture are public information.

Do an internet search of your child’s name to see what’s out there and scroll through images to make sure there isn’t anything you wouldn’t want to be made public. In our household, I’ve asked my children to use generic items or illustrated avatars in their social media bios.

What I do: Parents who do have active social media accounts may want to do a search of their own names. When my first book was published in 2019, I did a search of my name and images and found many photos of my children that came directly from my social media pages. I hadn’t posted pictures of them, but I did use a family photo as my profile photo and those are public record. Once I deleted them, the photos disappeared.

Another “no” in our household is posting videos or photos of our home or bedrooms. Something that feels innocent and innocuous to your middle schooler may not feel that way to an adult seeking out inappropriate content.

I learned this from one of my children’s Pinterest accounts. My kid loves to create themed videos using her own photos and stock pictures, and she’s gained over 500 followers in a short period of time. She has completely followed our rules and I know, because I check and follow her myself — but it hasn’t stopped the influx of adult men following her content.

What we do: Over the holidays, I sat with her and went through each follower one by one and blocked anyone we decided was there for the wrong reasons. In the end, we blocked close to 30 adult men on her account. (I also know that some predators cleverly disguise themselves as children or teens, and we may not catch them all, but this is still a worthy exercise.)

We also talk to our children about how to protect themselves. They wouldn’t want those strangers standing in their bedroom; therefore, they don’t want to post videos of their bedroom or bathroom or classroom for strangers to view.

This is a tricky one for lots of reasons. For content creators to build their following, they need to remain public on social media. If your child is an entrepreneur or artist hoping to grab attention, locking down their account will prevent that from happening.

That said, a way around this is to have two accounts. First, a private one, locked down and only used for family and close friends, and second, a public one that lacks identifiers but showcases whatever branding the child is hoping to grow. I’ve come across some well-managed public accounts for children who have giant followings and noticed they are usually run by parents, who state that right in the profile. I like this. If your children want public profiles because they are hoping to catch the attention of a talent scout, having the accounts monitored by a responsible adult who has their best interest in mind is a healthy compromise.

This is the exception, however. Most tweens and teens today use their social media for socializing with local friends. The benefit of keeping their account as private (or as private as can be) is threefold. It allows them to screen who follows their content, thus preventing our Pinterest fiasco. It prevents strangers from accessing their content and making it viral without their permission. And it protects them from unsolicited contact with strangers.

Not all social media platforms have the option to make your account “private.” For example, YouTube has parental controls that can be adjusted at any time. TikTok and Instagram can be made private (which means users must approve followers) by making the change in the account settings. Once the account is private, a little padlock will show next to the username.

Snapchat allows users to approve followers on a case-by-case basis as well as turn off features that disclose a user’s location. Notably, Snapchat also informs users when another user takes a screenshot of their story, which is a feature other social media platforms don’t have yet.

Most group chat apps don’t have the ability to go private so much as they ask users to approve of follower requests. Take time to discuss with your children who they allow to follow them and what personal information they allow those followers to know. It’s also a great time to teach them the art of “blocking” those individuals who are unsafe or unkind.

My suggestion is to log in, scroll around and even ask your children to teach you about the platforms they use. Then, when they roll their eyes at you, go ahead and tell them about your first Hotmail email address and the way you picked the perfect emo playlist on your Myspace page … and when they’re bent over laughing, sneak a peek at their follower list. Trust me, it’ll be worth it.

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Proposed changes to school lunches aim to reduce sugar and sodium, but flavored milk stays | CNN

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CNN
—

If new US Department of Agriculture school food guidelines stand as proposed, chocolate milk is in, but for the first time ever, at least some added sugars will be out – and sodium levels will be reduced gradually.

Agriculture Secretary Tom Vilsack publicly announced the changes on Friday.

“The purpose of this is to improve the health and welfare of our children. And I think everybody who comes to this issue shares that goal and hopefully, collectively, we can make sure it happens,” Vilsack told CNN in an interview Thursday ahead of the announcement.

The federally assisted school meal program provides nutritionally balanced meals at school at low or no-cost.

More than 15.3 million kids every day get breakfast at school in the US and 29.6 million get a school lunch, Vilsack said. The numbers were higher earlier in the pandemic, when meals were offered free to all children regardless of their family’s income, but in June, Congress did not extend the Covid-19 pandemic waivers that had expanded the program.

While school meals are paid for by local and federal funding, the standards for what goes on a kids’ cafeteria tray are set by the USDA. The agency’s job is to make sure any meal served at school is nutritious and falls in line with the US Dietary Guidelines.

Flavored milk with “reasonable limits on added sugars” would be allowed under the proposal. Vilsack said school meal administrators tell the USDA that kids just won’t drink much no-fat skim milk or unflavored milk. “That’s not what they get at home,” Vilsack said. “We want to encourage kids to drink milk because there are there’s tremendous nutritional value in milk.”

However, the proposed standards would limit added sugar in certain high-sugar products like prepackaged muffins, yogurt, and cereal. Eventually, the guidelines would then limit added sugars across the weekly menu.

The standards would reduce sodium limits, but that would happen gradually over several school years.

“The [US Food and Drug Administration] provided some insight and direction by suggesting that it is easier for people to accept and adopt to reduced sodium if you do it over a period of time in small increments,” Vilsack said.

A gradual reduction would also give industry time to reformulate their products, said Dr. Lauren Au, an assistant professor at UC Davis’ Department of Nutrition who studies the effectiveness of school nutrition programs.

The guidelines would also place a bigger emphasis on whole grains, but still leave options open for an occasional non-whole grain product.

“Maybe a biscuit can be instituted for a little variety, or grits can be provided where that may make sense from a geographic standpoint. You are sensitive to cultural demands and needs,” Vilsack said.

The proposed rule would also strengthen the Buy American requirements encouraging schools to use more locally grown food.

The USDA will invest $100 million in the Healthy Meals Incentives initiative which offers farm-to-school grants and grants to buy equipment. In the 1980s, schools around the country tore out kitchens and bought prepackaged processed food. To make more nutritious meals, schools have had to rebuild or update kitchens.

“A lot of schools have outdated ovens, freezers, fridges, and that puts limitations on how they can prepare food, so grants that have helped with equipment have been really successful,” Au said.

The money would also reward schools that do a good job providing nutritious meals. Grants would also be aimed at small and rural districts and training.

Vilsack said the USDA created these proposed standards after the USDA received thousands of comments and held 50 listening sessions with parents, school food administrators, the food industry, public health and nutrition experts.

“Establishing these standards are difficult because you have to follow the science you have to follow the dietary guidelines, but you also have to understand that they need to be implemented in the real world which is which is which is tough,” Vilsack said in an interview with CNN.

Real world circumstances are tough already with the higher cost of food, staff shortages and supply chain problems.

Au hasn’t seen all of the proposed policies, but she said what she has seen look good.

“It’s a step forward in terms of promoting healthy nutrition in schools,” Au said. The reduction of added sugar, she added is a big deal.

“Reducing added sugars for this age range is so important,” AU said.

Megan Lott, deputy director for the Robert Wood Johnson Foundation program Healthy Eating Research, said that the policies seem to be heading in the right direction.

“There are a couple of things we would probably like to see strengthened, but it also seems like there are plans to do that over time,” Lott said.

The sugar standard is a good start, she said, but she’d prefer the proposal instead say that no more than 10% of calories should come from added sugars across the meal plan.

“But we recognize that schools might need a little bit of time for implementation,” Lott said.

Lott had also hoped they would take flavored milk off the menu. Research shows that schools that have gotten rid of flavored milk show a drop in milk consumption for a year or two, but milk sales eventually rebound.

School food has become a proverbial hot potato.

After decades of bipartisan support for school meals, the program has been politicized in about the last 10 years Lott says, meaning there is bound to be some pushback.

Friday’s proposed changes would be the first large scale reform of school meal standards since President Barack Obama signed the 2010 Healthy, Hunger-Free Kids Act into law.

The law that went into effect in 2012, championed by first lady Michelle Obama, really did improve US kids’ diet, studies show. The law raised the minimum standards and required schools to serve more whole grains, fruit, vegetables, and fat-free and/or low-fat milk more frequently and serve fewer starchy vegetables and foods high in trans fat and sodium.

Meals that were eaten by students – not just served to students and then tossed into garbage cans – were much healthier and had better overall nutritional quality, the study showed. Students who didn’t participate in the national program did not see an improvement in their diets.

Despite the program’s success, in 2018, the Trump administration announced a proposal to roll back many of the policies in the name of “flexibility,” including ones that involved sodium and whole grains. Trump’s policy would essentially create a loophole letting schools sell more burgers, pizza and french fries and reduce the fruit and vegetables sold. A federal court struck down the rule in April 2020.

During the pandemic, some of the polices were relaxed, like for whole grains, because it was difficult to find products, Lott said.

Studies show kids who eat meals at school ate more fruits, vegetables, whole grains and dairy, compared with those who ate at school less frequently.

Better nutrition can help prevent obesity. About 20% of the US population ages 2 to 19 live with obesity, which can cause kids to have high blood pressure, breathing problems and type 2 diabetes, and lead to lifelong health problems, according to the US Centers for Disease Control and Prevention.

Hungry kids have a hard time paying attention in class. Students who ate healthy meals at school scored better on end-of-year academic tests, studies have shown.

The new standards are just a proposal. The USDA will ask for additional feedback.

Vilsack is hopeful the standards will incentivize more schools to offer more healthy options.

“In terms of future of this program,” Vilsack said, “we want to see more and more school districts push themselves not only to meet the standards, but in some cases to exceed them.”

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Children’s mental health tops list of parent worries, survey finds | CNN

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CNN
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Forty percent of US parents are “extremely” or “very” worried that their children will struggle with anxiety or depression at some point, a new survey finds.

The Pew Research Center report said mental health was the greatest concern among parents, followed by bullying, which worries 35% of parents. These concerns trumped fears of kidnapping, dangers of drugs and alcohol, teen pregnancy and getting into trouble with the police.

Concerns varied by race, ethnicity and income level, with roughly 4 in 10 Latino and low-income parents and 3 in 10 Black parents saying they are extremely or very worried that their children could be shot, compared with about 1 in 10 high-income or White parents.

Nearly two-thirds of the respondents said that being a parent has been at least somewhat harder than they expected, about 41% say that being a parent is tiring, and 29% say it is stressful all or most of the time.

The report captured the perceptions of a nationally representative sample of 3,757 US parents whose children were younger than 18 in 2022.

Experts say mental health issues among children and adolescents have skyrocketed in recent years.

“I would say over the last 10 years, since I’ve been practicing as a general pediatrician, I have seen a shift both in the amount of patients and of all ages dealing with anxiety and depression. And their parents being concerned about this is a key issue,” said Dr. Katherine Williamson, a pediatrician and spokesperson for the American Academy of Pediatrics. “Even before the pandemic, we were seeing skyrocketing numbers of kids and adolescents dealing with mental health issues, and that has increased exponentially since the pandemic.”

Suicide became the second leading cause of death among children 10 to 14 during the Covid-19 pandemic, according to the US Centers for Disease Control and Prevention. Mental health-related emergency room visits among adolescents 5 to 11 and 12 to 17 also jumped 24% and 31%, respectively.

Many parents feel helpless when their children have mental health issues because they don’t feel equipped to offer support in this area.

“They are unable to relieve [mental health issues] and address that as they could if they were struggling with their grades or other things that seem more traditional to for kids to struggle with,” said Allen Sabey, a family therapist at the Family Institute at Northwestern University.

Parents trying to “work out and look at and connect with their own feelings will give them important information about what feels off or OK for their kid,” he said.

When it comes to anxiety and depression in children, pediatricians say, parents can watch for signs like decreased interest or pleasure in things they previously enjoyed, poor self-esteem and changes in mood, appetite or sleep.

Experts also say parents should consider the amount and content of social media their child consumes, as research has found that it can have negative effects on their mental health.

But, they say, having more parents recognize the importance of mental health in children is a step in the right direction.

“I have always felt there’s been so much resistance to seeking care for mental health among the population that I serve. And I am actually happy that since the Covid pandemic, at least people now are recognizing this as a very key and important health need,” said Dr. Maggi Smeal, a pediatrician at Stanford Medicine Children’s Health.

Smeal hopes that “all people that are interacting with children can be aware of these issues and feel empowered to identify and advocate for these children, to tell them to go to their primary care provider and have an assessment just like you do if your kid has a cough or a fever or ear infection.”

The number of parents concerned about gun violence reflects the fact that guns are the leading cause of death among children in the US, research has showed. From 2019 to 2020, the rate of firearm-related deaths increased 29.5% – more than twice the increase as in the general population.

“Gun violence is a real risk to our kids today. And that is both being killed by somebody else as well as suicide in the face of the mental health issues that we’re seeing today,” Williamson said.

The survey found that Black, Hispanic and lower-income parents were most likely to be concerned about gun violence, a finding that’s consistent with the communities most affected. Research has shown that from 2018 to 2021, the rate of firearm-related deaths doubled among Black youth and increased 50% among Hispanic youth. Another study found that children living in low-income areas are at higher risk of firearm-related death.

Direct and indirect exposure to gun violence can contribute to mental health problems.

“Even if they hear gunshots in their community, they hear adults talking, there’s all different ways that children are traumatized and victimized by gun violence. And what we see is all the symptoms of anxiety in even the youngest of children. We see children with somatic complaints – stomachaches, headaches. They have post-traumatic stress disorder,” Smeal said.

Most of the parents in the survey said parenting is harder than they expected, and that they feel judgment from various sources.

“The findings of this of this report were, as a pediatrician and a parent, just exactly what you would expect. Parenting is the hardest thing you’ll ever do, and there are very high levels of stress and fatigue, especially in the parents of young children,” Smeal said.

One of the best things parents can do is lean on fellow parents, experts say.

“The main challenge for parents is our siloed independent nature sometimes, and so we want to find people who we trust and kind of work towards being more vulnerable and open with,” Sabey said. “To where it’s like not just you and your kid, but it’s a kind of a group of people caring and working together.”

Pediatricians emphasize that no parent is perfect and that the most important thing you can do is to just be there for your child.

“We know that the best chance for a child to be successful and happy is for them to have at least one person in their life who believes in them and advocates for them. So I think it’s important for parents to know that there’s no such thing as a perfect parent, because we are all human, and humans are imperfect by nature, but that is OK,” Williamson said.

A parent’s job is to “really make sure that they know how important they are and they have a voice in this world,” she said. “Every child will have their own unique struggles, whether it is academically, emotionally, physically. Our job is to help them with the areas [where] they struggle, but even more, help them recognize their strengths.”

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Does having a teen feel like living with a chimpanzee? You may not be far off, study shows | CNN

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CNN
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Chimpanzee teens may not be so different from the ones living in our homes, a new study says.

Except that your teen might be more impulsive.

Researchers worked with 40 chimpanzees born in the wild while they were at a sanctuary in the Republic of Congo, playing games that tested the adolescent animals’ orientation toward risk-taking and impulsivity, according to the study published January 23 in the Journal of Experimental Psychology: General by the American Psychological Association.

“Human adolescents are grappling with changing bodies and brains, and tend to be more impulsive, risk-seeking, and less able to regulate emotions than adults,” said lead study author Dr. Alexandra Rosati, associate professor of psychology and anthropology at the University of Michigan, via email. “Chimpanzees face many of the same kinds of challenges as humans as they grow up.”

The study described chimpanzees’ adolescence as a period from about ages 8 to 15 in a 50-year life span. Like young humans, they experience rapid hormone changes, new social bonds, increased aggression and a competition for social status.

Teen chimpanzees are overlooked in studies compared with infants and adults, said Dr. Aaron Sandel, an assistant professor of anthropology at the University of Texas at Austin, who was not involved in the current study.

“For a while there was a pretty big gap in the literature on (chimpanzee) adolescents,” Sandel said, noting that researchers often don’t focus on this period. Scientists may avoid studying teen chimps because their own human experiences with teenage years are complicated, he said.

The new study found that adolescent chimpanzees were more likely to take risks in their games than their adult counterparts, but they just as likely would wait for a greater delayed reward.

But human teens are known to be more likely to take a smaller, more immediate reward, the study noted.

The chimpanzees underwent two tests with food rewards. These animals tended to dislike cucumbers while liking peanuts somewhat and loving bananas.

The first test involved a bit of a gamble. Both adult and teen chimpanzees were asked to choose between two containers: one that always had peanuts and another that had either the dreaded cucumber or treasured banana, the study said.

The adolescent chimps were more likely to take a risk and go for the cucumber or banana container than the adults, the study said. Both groups showed similar negative reactions – such as moaning, whimpering, screaming and banging on the table – when they ended up with a cucumber.

The second test resembled a well-known one that has been given to human children. Chimpanzees had the option of having one banana slice immediately or waiting for a minute and then getting three slices.

Both adults and adolescents waited for the three slices at a similar rate, but the teens were more likely to throw a fit while they waited a minute, the study said.

In a similar test, human teens were more likely to take the smaller treat right away, according to the study.

“Prior work indicates that chimpanzees are quite patient compared to other animals, and this study shows that their ability to delay gratification is already mature at a fairly young age, unlike in humans,” Rosati said.

Sandel noted that it is important to be careful about comparing the experience of humans with other animals. While primates are our closest relatives, we are different species, he pointed out.

So how might a parent handle a teen who engages in risky behavior and hates to wait for a reward?

The first step is to understand what is going on in their developing brains, said Dr. Hina Talib, an adolescent medicine specialist and associate professor of pediatrics at the Albert Einstein College of Medicine in New York City.

“I think teenagers get a bad rap,” she said. “We often think of them as risky little devils. It does come from some element of truth.”

The human teenage years are a time of explosive growth and development, she added.

Their brains are wired to seek out new experiences and information, which often means taking risks, Talib said.

At this time, they can try new things, build their ideas of who they are and try on different identities, said Tina Bryson, a Pasadena, California, therapist and author of “The Power of Showing Up: How Parental Presence Shapes Who Our Kids Become and How Their Brains Get Wired.”

They learn from the information they gain, which can help them manage their behavior better – eventually, Talib said.

Families can encourage them to try new things, she said, while providing ground rules and support that will help keep them safe.

“We want you to go anywhere and do everything … Here is where we might step in or where we have house rules about something,’” Talib recommended that parents say. Your conversations should be “coming from a perspective of we are here as the floor, as the safety net as you go and have these amazing trapeze experiences.”

And while their brains are growing a lot, not every area is able to be fully and optimally utilized at the same time.

Late middle and early high schoolers might be relying on the parts of the brain that rule emotion and reactivity, she added, while their decision-making and reasoning parts are busy growing.

That doesn’t mean that teens are not capable of good decision-making and long-term planning, she added – you just have to help set them up for success.

“When things are calm, they are able to problem solve just as well as adults,” Talib said. Help them stay calm when they are in trouble and need to solve a problem and save the difficult conversations for when they are no longer stressed out, she added.

Instead of worrying about how to get rid of their impulsivity, Bryson recommended finding ways to help strengthen empathetic, thoughtful, and reasoned decision-making.

Encourage them to pause before acting and walk through the thinking process with them, she said. You can also talk through how you think through your own decisions, Bryson said.

And while their brains may be undergoing changes, be sure to call out the things they are doing well, Talib said.

“The more you do that, the more you help them see themselves in a positive light, the more that gets hardwired in them,” she said, “and they are better able to face the world around them.”

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Weight loss surgery extends lives, study finds | CNN

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CNN
—

Weight loss surgery reduces the risk of premature death, especially from such obesity-related conditions as cancer, diabetes and heart disease, according to a new 40-year study of nearly 22,000 people who had bariatric surgery in Utah.

Compared with those of similar weight, people who underwent one of four types of weight loss surgery were 16% less likely to die from any cause, the study found. The drop in deaths from diseases triggered by obesity, such as heart disease, cancer and diabetes, was even more dramatic.

“Deaths from cardiovascular disease decreased by 29%, while deaths from various cancers decreased by 43%, which is pretty impressive,” said lead author Ted Adams, an adjunct associate professor in nutrition and integrative physiology at the University of Utah’s School of Medicine.

“There was also a huge percentage drop — a 72% decline — in deaths related to diabetes in people who had surgery compared to those who did not,” he said. One significant downside: The study also found younger people who had the surgery were at higher risk for suicide.

The study, published Wednesday in the journal Obesity, reinforces similar findings from earlier research, including a 10-year study in Sweden that found significant reductions in premature deaths, said Dr. Eduardo Grunvald, a professor of medicine and medical director of the weight management program at the University of California San Diego Health.

The Swedish study also found a significant number of people were in remission from diabetes at both two years and 10 years after surgery.

“This new research from Utah is more evidence that people who undergo these procedures have positive, beneficial long-term outcomes,” said Grunvald, who coauthored the American Gastroenterological Association’s new guidelines on obesity treatment.

The association strongly recommends patients with obesity use recently approved weight loss medications or surgery paired with lifestyle changes.

“And the key for patients is to know that changing your diet becomes more natural, more easy to do after you have bariatric surgery or take the new weight loss medications,” said Grunvald, who was not involved in the Utah study.

“While we don’t yet fully understand why, these interventions actually change the chemistry in your brain, making it much easier to change your diet afterwards.”

Despite the benefits though, only 2% of patients who are eligible for bariatric surgery ever get it, often due to the stigma about obesity, said Dr. Caroline Apovian, a professor of medicine at Harvard Medical School and codirector of the Center for Weight Management and Wellness at Brigham and Women’s Hospital in Boston. Apovian was the lead author for the Endocrine Society’s clinical practice guidelines for the pharmacological management of obesity.

Insurance carriers typically cover the cost of surgery for people over 18 with a body mass index of 40 or higher, or a BMI of 35 if the patient also has a related condition such as diabetes or high blood pressure, she said.

“I see patients with a BMI of 50, and invariably I will say, ‘You’re a candidate for everything — medication, diet, exercise and surgery.’ And many tell me, ‘Don’t talk to me about surgery. I don’t want it.’ They don’t want a surgical solution to what society has told them is a failure of willpower,” she said.

“We don’t torture people who have heart disease: ‘Oh, it’s because you ate all that fast food.’ We don’t torture people with diabetes: ‘Oh, it’s because you ate all that cake.’ We tell them they have a disease, and we treat it. Obesity is a disease, too, yet we torture people with obesity by telling them it’s their fault.”

Most of the people who choose bariatric surgery — around 80% — are women, Adams said. One of the strengths of the new study, he said, was the inclusion of men who had undergone the procedure.

“For all-causes of death, the mortality was reduced by 14% for females and by 21% for males,” Adams said. In addition, deaths from related causes, such as heart attack, cancer and diabetes, was 24% lower for females and 22% lower for males who underwent surgery compared with those who did not, he said.

Four types of surgery performed between 1982 and 2018 were examined in the study: gastric bypass, gastric banding, gastric sleeve and duodenal switch.

Gastric bypass, developed in the late 1960s, creates a small pouch near the top of the stomach. A part of the small intestine is brought up and attached to that point, bypassing most of the stomach and the duodenum, the first part of the small intestine.

In gastric banding, an elastic band that can be tightened or loosened is placed around the top portion of the stomach, thus restricting the volume of food entering the stomach cavity. Because gastric banding is not as successful in creating long-term weight loss, the procedure “is not as popular today,” Adams said.

“The gastric sleeve is a procedure where essentially about two-thirds of the stomach is removed laparoscopically,” he said. “It takes less time to perform, and food still passes through the much-smaller stomach. It’s become a very popular option.”

The duodenal switch is typically reserved for patients who have a high BMI, Adams added. It’s a complicated procedure that combines a sleeve gastrectomy with an intestinal bypass, and is effective for type 2 diabetes, according to the Cleveland Clinic.

One alarming finding of the new study was a 2.4% increase in deaths by suicide, primarily among people who had bariatric surgery between the ages of 18 and 34.

“That’s because they are told that life is going to be great after surgery or medication,” said Joann Hendelman, clinical director of the National Alliance for Eating Disorders, a nonprofit advocacy group.

“All you have to do is lose weight, and people are going to want to hang out with you, people will want to be your friend, and your anxiety and depression are going to be gone,” she said. “But that’s not reality.”

In addition, there are postoperative risks and side effects associated with bariatric surgery, such as nausea, vomiting, alcoholism, a potential failure to lose weight or even weight gain, said Susan Vibbert, an advocate at Project HEAL, which provides help for people struggling with eating disorders.

“How are we defining health in these scenarios? And is there another intervention — a weight neutral intervention?” Vibbert asked.

Past research has also shown an association between suicide risk and bariatric surgery, Grunvald said, but studies on the topic are not always able to determine a patient’s mental history.

“Did the person opt for surgery because they had some unrealistic expectations or underlying psychological disorders that were not resolved after the surgery? Or is this a direct effect somehow of bariatric surgery? We can’t answer that for sure,” he said.

Intensive presurgery counseling is typically required for all who undergo the procedure, but it may not be enough, Apovian said. She lost her first bariatric surgery patient to suicide.

“She was older, in her 40s. She had surgery and lost 150 pounds. And then she put herself in front of a bus and died because she had underlying bipolar disorder she had been self-medicating with food,” Apovian said. “We as a society use a lot of food to hide trauma. What we need in this country is more psychological counseling for everybody, not just for people who undergo bariatric surgery.”

Managing weight is a unique process for each person, a mixture of genetics, culture, environment, social stigma and personal health, experts say. There is no one solution for all.

“First, we as a society must consider obesity as a disease, as a biological problem, not as a moral failing,” Grunvald said. “That’s my first piece of advice.

“And if you believe your life is going to benefit from treatment, then consider evidence-based treatment, which studies show are surgery or medications, if you haven’t been able to successfully do it with lifestyle changes alone.”

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FDA vaccine advisers vote to harmonize Covid-19 vaccines in the United States | CNN

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CNN
—

A panel of independent experts that advises the US Food and Drug Administration on its vaccine decisions voted unanimously Thursday to update all Covid-19 vaccines so they contain the same ingredients as the two-strain shots that are now used as booster doses.

The vote means young children and others who haven’t been vaccinated may soon be eligible to receive two-strain vaccines that more closely match the circulating viruses as their primary series.

The FDA must sign off on the committee’s recommendation, which it is likely to do, before it goes into effect.

Currently, the US offers two types of Covid-19 vaccines. The first shots people get – also called the primary series – contain a single set of instructions that teach the immune system to fight off the original version of the virus, which emerged in 2019.

This index strain is no longer circulating. It was overrun months ago by an ever-evolving parade of new variants.

Last year, in consultation with its advisers, the FDA decided that it was time to update the vaccines. These two-strain, or bivalent, shots contain two sets of instructions; one set reminds the immune system about the original version of the coronavirus, and the second set teaches the immune system to recognize and fight off Omicron’s BA.4 and BA.5 subvariants, which emerged in the US last year.

People who have had their primary series – nearly 70% of all Americans – were advised to get the new two-strain booster late last year in an effort to upgrade their protection against the latest variants.

The advisory committee heard testimony and data suggesting that the complexity of having two types of Covid-19 vaccines and schedules for different age groups may be one of the reasons for low vaccine uptake in the US.

Currently, only about two-thirds of Americans have had the full primary series of shots. Only 15% of the population has gotten an updated bivalent booster.

Data presented to the committee shows that Covid-19 hospitalizations have been rising for children under the age of 2 over the past year, as Omicron and its many subvariants have circulated. Only 5% of this age group, which is eligible for Covid-19 vaccination at 6 months of age, has been fully vaccinated. Ninety percent of children under the age of 4 are still unvaccinated.

“The most concerning data point that I saw this whole day was that extremely low vaccination coverage in 6 months to 2 years of age and also 2 years to 4 years of age,” said Dr. Amanda Cohn, director of the US Centers for Disease Control and Prevention’s Division of Birth Defects and Infant Disorders. “We have to do much, much better.”

Cohn says that having a single vaccine against Covid-19 in the US for both primary and booster doses would go a long way toward making the process less complicated and would help get more children vaccinated.

Others feel that convenience is important but also stressed that data supported the switch.

“This isn’t only a convenience thing, to increase the number of people who are vaccinated, which I agree with my colleagues is extremely important for all the evidence that was related, but I also think moving towards the strains that are circulating is very important, so I would also say the science supports this move,” said Dr. Hayley Gans, a pediatric infectious disease specialist at Stanford University.

Many others on the committee were similarly satisfied after seeing new data on the vaccine effectiveness of the bivalent boosters, which are cutting the risk of getting sick, being hospitalized or dying from a Covid-19 infection.

“I’m totally convinced that the bivalent vaccine is beneficial as a primary series and as a booster series. Furthermore, the updated vaccine safety data are really encouraging so far,” said Dr. David Kim, director of the the US Department of Health and Human Services’ National Vaccine Program, in public discussion after the vote.

Thursday’s vote is part of a larger plan by the FDA to simplify and improve the way Covid-19 vaccines are given in the US.

The agency has proposed a plan to convene its vaccine advisers – called the Vaccines and Related Biological Products Advisory Committee, or VRBPAC – each year in May or June to assess whether the instructions in the Covid-19 vaccines should be changed to more closely match circulating strains of the virus.

The time frame was chosen to give manufacturers about three months to redesign their shots and get new doses to pharmacies in time for fall.

“The object, of course – before anyone says anything – is not to chase variants. None of us think that’s realistic,” said Jerry Weir, director of the Division of Viral Products in the FDA’s Office of Vaccines Research and Review.

“But I think our experience so far, with the bivalent vaccines that we have, does indicate that we can continue to make improvements to the vaccine, and that would be the goal of these meetings,” Weir said.

In discussions after the vote, committee members were supportive of this plan but pointed out many of the things we still don’t understand about Covid-19 and vaccination that are likely to complicate the task of updating the vaccines.

For example, we now seem to have Covid-19 surges in the summer as well as the winter, noted Dr. Michael Nelson, an allergist and immunologist at the University of Virginia. Are the surges related? And if so, is fall the best time to being a vaccination campaign?

The CDC’s Dr. Jefferson Jones said that with only three years of experience with the virus, it’s really too early to understand its seasonality.

Other important questions related to the durability of the mRNA vaccines and whether other platforms might offer longer protection.

“We can’t keep doing what we’re doing,” said Dr. Bruce Gellin, chief of global public health strategy at the Rockefeller Foundation. “It’s been articulated in every one of these meetings despite how good these vaccines are. We need better vaccines.”

The committee also encouraged both government and industry scientists to provide a fuller picture of how vaccination and infection affect immunity.

One of the main ways researchers measure the effectiveness of the vaccines is by looking at how much they increase front-line defenders called neutralizing antibodies.

Neutralizing antibodies are like firefighters that rush to the scene of an infection to contain it and put it out. They’re great in a crisis, but they tend to diminish in numbers over time if they’re not needed. Other components of the immune system like B-cells and T-cells hang on to the memory of a virus and stand ready to respond if the body encounters it again.

Scientists don’t understand much about how well Covid-19 vaccination boosts these responses and how long that protection lasts.

Another puzzle will be how to pick the strains that are in the vaccines.

The process of selecting strains for influenza vaccines is a global effort that relies on surveillance data from other countries. This works because influenza strains tend to become dominant and sweep around the world. But Covid-19 strains haven’t worked in quite the same way. Some that have driven large waves in other countries have barely made it into the US variant mix.

“Going forward, it is still challenging. Variants don’t sweep across the world quite as uniform, like they seem to with influenza,” the FDA’s Weir said. “But our primary responsibility is what’s best for the US market, and that’s where our focus will be.”

Eventually, the FDA hopes that Americans would be able to get an updated Covid-19 shot once a year, the same way they do for the flu. People who are unlikely to have an adequate response to a single dose of the vaccine – such as the elderly or those with a weakened immune system – may need more doses, as would people who are getting Covid-19 vaccines for the first time.

At Thursday’s meeting, the advisory committee also heard more about a safety signal flagged by a government surveillance system called the Vaccine Safety Datalink.

The CDC and the FDA reported January 13 that this system, which relies on health records from a network of large hospital systems in the US, had detected a potential safety issue with Pfizer’s bivalent boosters.

In this database, people 65 and older who got a Pfizer bivalent booster were slightly more likely to have a stroke caused by a blood clot within three weeks of their vaccination than people who had gotten a bivalent booster but were 22 to 42 days after their shot.

After a thorough review of other vaccine safety data in the US and in other countries that use Pfizer bivalent boosters, the agencies concluded that the stroke risk was probably a statistical fluke and said no changes to vaccination schedules were recommended.

At Thursday’s meeting, Dr. Nicola Klein, a senior research scientist with Kaiser Permanente of Northern California, explained how they found the signal.

The researchers compared people who’d gotten a vaccine within the past three weeks against people who were 22 to 42 days away from their shots because this helps eliminate bias in the data.

When they looked to see how many people had strokes around the time of their vaccination, they found an imbalance in the data.

Of 550,000 people over 65 who’d received a Pfizer bivalent booster, 130 had a stroke caused by a blood clot within three weeks of vaccination, compared with 92 people in the group farther out from their shots.

The researchers spotted the signal the week of November 27, and it continued for about seven weeks. The signal has diminished over time, falling from an almost two-fold risk in November to a 47% risk in early January, Klein said. In the past few days, it hasn’t been showing up at all.

Klein said they didn’t see the signal in any of the other age groups or with the group that got Moderna boosters. They also didn’t see a difference when they compared Pfizer-boosted seniors with those who were eligible for a bivalent booster but hadn’t gotten one.

Further analyses have suggested that the signal might be happening not because people who are within three weeks of a Pfizer booster are having more strokes, but because people who are within 22 to 42 days of their Pfizer boosters are actually having fewer strokes.

Overall, Klein said, they were seeing fewer strokes than expected in this population over that period of time, suggesting a statistical fluke.

Another interesting thing that popped out of this data, however, was a possible association between strokes and high-dose flu vaccination. Seniors who got both shots on the same day and were within three weeks of those shots had twice the rate of stroke compared with those who were 22 to 42 days away from their shots.

What’s more, Klein said, the researchers didn’t see the same association between stroke and time since vaccination in people who didn’t get their flu vaccine on the same day.

The total number of strokes in the population of people who got flu shots and Covid-19 boosters on the same day is small, however, which makes the association a shaky one.

“I don’t think that the evidence are sufficient to conclude that there’s an association there,” said Dr. Tom Shimabukuro, director of the CDC’s Immunization Safety Office.

Nonetheless, Richard Forshee, deputy director of the FDA’s Office of Biostatistics and Pharmacovigilance, said the FDA is planning to look at these safety questions further using data collected by Medicare.

The FDA confirmed that the agency is taking a closer look.

“The purpose of the study is 1) to evaluate the preliminary ischemic stroke signal reported by CDC using an independent data set and more robust epidemiological methods; and 2) to evaluate whether there is an elevated risk of ischemic stroke with the COVID-19 bivalent vaccine if it is given on the same day as a high-dose or adjuvanted seasonal influenza vaccine,” a spokesperson said in a statement.

The FDA did not give a time frame for when these studies might have results.

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FDA proposes new levels for lead in baby food, but critics say more action is needed | CNN

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CNN
—

The allowable levels of lead in certain baby and toddler foods should be set at 20 parts per billion or less, according to new draft guidance issued Tuesday by the US Food and Drug Administration.

“For babies and young children who eat the foods covered in today’s draft guidance, the FDA estimates that these action levels could result in as much as a 24-27% reduction in exposure to lead from these foods,” said FDA Commissioner Dr. Robert Califf in a statement.

The

Baby foods covered by the new proposal – which is seeking public comment – include processed baby foods sold in boxes, jars, pouches and tubs for babies and young children younger than 2 years old, the agency said.

While any action on the part of the FDA is welcome, the suggested levels of lead are not low enough to move the needle, said Jane Houlihan, the national director of science and health for Healthy Babies Bright Futures, a coalition of advocates committed to reducing babies’ exposures to neurotoxic chemicals.

“Nearly all baby foods on the market already comply with what they have proposed,” said Houlihan, who authored a 2019 report that found dangerous levels of lead and other heavy metals in 95% of manufactured baby food.

That report triggered a 2021 congressional investigation, which found leading baby food manufacturers knowingly sold products with high levels of toxic metals.

“The FDA hasn’t done enough with these proposed lead limits to protect babies and young children from lead’s harmful effects. There is no known safe level of lead exposure, and children are particularly vulnerable,” Houlihan said.

The director of food policy for Consumers Reports, Brian Ronholm, also expressed concerns. In 2018, Consumer Reports analyzed 50 baby foods and found “concerning” levels of lead and other heavy metals. In fact, “15 of them would pose a risk to a child who ate one serving or less per day,” according to Consumer Reports.

“The FDA should be encouraging industry to work harder to reduce hazardous lead and other heavy metals in baby food given how vulnerable young children are to toxic exposure,” Ronholm said in a statement.

Exposure to toxic heavy metals can be harmful to the developing brain of infants and children. “It’s been linked with problems with learning, cognition, and behavior,” according to the American Academy of Pediatrics.

Lead, arsenic, cadmium and mercury are in the World Health Organization’s top 10 chemicals of concern for infants and children.

As natural elements, they are in the soil in which crops are grown and thus can’t be avoided. Some crop fields and regions, however, contain more toxic levels than others, partly due to the overuse of metal-containing pesticides and ongoing industrial pollution.

The new FDA guidance suggests manufactured baby food custards, fruits, food mixtures — including grain and meat-based blends — puddings, vegetables, yogurts, and single-ingredient meats and vegetables contain no more than 10 parts per billion of lead.

The exception to that limit is for single-ingredient root vegetables, such as carrots and sweet potatoes, which should contain no more than 20 parts per billion, according to the new guidance.

Dry cereals marketed to babies and toddlers should also not contain more than 20 parts per billion of lead, the new FDA guidance said.

However, the FDA didn’t propose any lead limit for cereal puffs and teething biscuits, Houlihan said, even though the products account for “7 of the 10 highest lead levels we’ve found in over 1,000 baby food tests we have assessed.”

The limit set for root vegetables will be helpful, Houlihan added. Because they grow underground, root vegetables can easily absorb heavy metals. For example, sweet potatoes often exceed the 20 parts per billion limit the FDA has proposed, she said.

Prior to this announcement, the FDA had only set limits for heavy metals in one baby food — infant rice cereal, Houlihan said. In 2021, the agency set a limit of 100 parts per billion for arsenic, which has been linked to adverse pregnancy outcomes and neurodevelopmental toxicity.

There is much more that can be done, according to Scott Faber, senior vice president of government affairs for the Environmental Working Group, a nonprofit environmental health organization.

“We can change where we farm and how we farm to reduce toxic metals absorbed by plants,” Faber said. “We also urge baby food manufacturers to conduct continuous testing of heavy metals in all their products and make all testing results publicly available.”

Companies can require suppliers and growers to test the soil and the foods they produce, and choose to purchase from those with the lowest levels of heavy metals, Houlihan added.

“Growers can use soil additives, different growing methods and crop varieties known to reduce lead in their products,” she said.

What can parents do to lessen their child’s exposure to toxic metals? Unfortunately, buying organic or making baby food at home isn’t going to solve the problem, as the produce purchased at the grocery store can also contain high levels of contaminants, experts say.

A 2022 report by Healthy Babies, Bright Futures found lead in 80% of homemade purees or store-bought family foods. Arsenic was found in 72% of family food either purchased or prepared at home.

The best way to lessen your child’s exposure to heavy metals, experts say, is to vary the foods eaten on a daily basis and choose mostly from foods which are likely to have the least contamination. Healthy Babies, Bright Futures created a chart of less to most contaminated foods based on their testing.

Fresh bananas, with heavy metal levels of 1.8 parts per billion, were the least contaminated of foods tested for the report. After bananas, the least contaminated foods were grits, manufactured baby food meats, butternut squash, lamb, apples, pork, eggs, oranges and watermelon, in that order.

Other foods with lower levels of contamination included green beans, peas, cucumbers and soft or pureed home-cooked meats, the report found.

The most heavily contaminated foods eaten by babies were all rice-based, the report said. Rice cakes, rice puffs, crisped rice cereals and brown rice with no cooking water removed were heavily contaminated with inorganic arsenic, the more toxic form of arsenic.

After rice-based foods, the analysis found the highest levels of heavy metals in raisins, non-rice teething crackers, granola bars with raisins and oat-ring cereals. But those were not the only foods of concern: Dried fruit, grape juice, arrowroot teething crackers and sunflower seed butter all contained high amounts of at least one toxic metal, according to the report.

While buying organic cannot reduce the levels of heavy metals in infant food, it can help avoid other toxins such as herbicides and pesticides, Dr. Leonardo Trasande, director of environmental pediatrics at NYU Langone Health told CNN previously.

“There are other benefits to eating organic food, including a reduction in synthetic pesticides that are known to be as bad for babies, if not even more problematic,” Trasande said.

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Pediatricians are giving out free gun locks to approach the gun violence epidemic as a public health crisis | CNN

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CNN
—

In a triage waiting room of St. Louis Children’s Hospital in Missouri, a clear basket filled with gun locks sits near the walkway, just noticeable enough to those passing by.

The hospital staff calls it the “No Questions Asked” basket, to encourage gun safety without having to confront gun owners about what can be a sensitive and divisive topic. It holds an assortment of cable gun locks free of charge, available to those who need them, alongside pamphlets explaining how to properly and safely store firearms.

The initiative, aimed at reducing the stigma of addressing gun safety, is part of a growing effort by medical professionals who are treating the country’s gun violence epidemic as a public health crisis.

“It takes standing at the bedside of one child who has been shot to realize that we all have to do more and as the leading cause of death for children in this country, pediatricians need to be front and center of the solution, of all the solutions,” said Dr. Annie Andrews, a professor of pediatrics at the Medical University of South Carolina and an expert on gun violence prevention.

Over the course of two years, thousands of gun locks have been taken from the basket, according to Dr. Lindsay Clukies, a pediatric emergency medicine physician at the hospital.

In the coming weeks, baskets filled with free gun locks will be available at more than 17 locations operated by BJC HealthCare, an organization serving metro St. Louis, mid-Missouri and Southern Illinois, Clukies said. It’s a low-cost and effective way to easily distribute firearm safety devices.

“We’ve had employees as well as patients take our locks, also their families and even a grandmother who took one for her grandson. It’s for anyone who needs them,” Clukies told CNN. In recent years, a rising number of pediatricians across the country have been engaging with the topic of gun safety in medical settings by focusing on safety and prevention, already a natural aspect of their work.

During patient visits, it’s increasingly common for pediatricians to ask the patient’s parents if there are guns at home, and if so, how they are stored. Some hospitals then offer free gun locks, often sourced from donations or police departments and paired with safe storage education.

Some pediatricians, who bear witness to the effects of gun violence on children in their workplace every day, told CNN they see it as their obligation as medical professionals to be part of the solution to the epidemic.

In 2022, 1,672 children and teenagers under 17 were killed by gun violence and 4,476 were injured, according to the Gun Violence Archive, a nonprofit organization tracking injuries and deaths by gunfire since 2014.

“We have just as an important voice in this conversation as anyone else because we’re the ones who have invested our entire careers to protecting children and ensuring that children can grow up to be the safest healthiest version of themselves,” said Andrews.

“It is only natural that we see these things that we understand that they’re preventable, and we want to get involved in finding the solutions,” she added.

So far in 2023, high-profile incidents of children accessing firearms have heeded calls for stronger, more consistent laws nationwide, requiring adults to safely secure their guns out of the reach of children and others unauthorized to use them. They have also highlighted a lack of public education on the responsibility of gun owners to store their guns unloaded, locked and away from ammunition, CNN previously reported.

In early January, a 6-year-old boy was taken into police custody after he took a gun purchased by his mother from his home, brought it to school and shot his teacher at Richneck Elementary School in Newport News, Virginia, police said. Just over a week later, a man was arrested in Beech Grove, Indiana, after video was shown on live TV of a toddler, reportedly the man’s son, waving and pulling the trigger of a handgun, CNN previously reported.

Hundreds of children in the US every year gain access to firearms and unintentionally shoot themselves or someone else, according to research by Everytown for Gun Safety, a leading non-profit organization focusing on gun violence prevention. In 2022, there were 301 unintentional shootings by children, resulting in 133 deaths and 180 injuries nationally, Everytown data showed.

Firearm injuries are now the leading cause of death among people younger than 24 in the United States, according to the Centers for Disease Control and Prevention. The American Academy of Pediatrics released an updated policy statement in October 2022, stating firearms are now the leading cause of death in children under the age of 24 in the US.

The Academy’s statement urged a “multipronged approach with layers of protection focused on harm reduction, which has been successful in decreasing motor vehicle-related injuries, is essential to decrease firearm injuries and deaths in children and youth.”

The Academy has free educational modules for pediatricians to guide them on how to have what can be challenging or uncomfortable conversations about firearms with families, according to Dr. Lois Kaye Lee, a pediatrician and the chair of the Academy’s Council on Injury, Violence and Poison Prevention.

“This shouldn’t be considered as something extra; it should be considered as part of the work that we do every day around injury prevention, be it around firearms, child passenger safety and suicide prevention,” Lee said.

Dr. Georges Benjamin, executive director of the American Public Health Association, told CNN the public health approach to addressing gun violence removes the politics from the issue and “puts it into a scientific evidence-based framework.”

“Physicians have a unique opportunity to engage their patients, the parents of kids or the parents themselves as individuals to make their homes safer,” Benjamin said. “We already do this for toxins under our kitchen cabinets, razor blades and outlets in the wall.”

In the emergency department at St. Louis Children’s Hospital, all patients are screened for access to firearms and offered free gun locks, as well as safe storage education, Clukies said. Gun locks can also be mailed to families, free of cost, through the hospital’s website.

“Every patient that comes into our emergency department, whether it’s for a fever or a cold or a broken arm, is asked about access to firearms,” said Clukies, adding 5,000 locks have been given out since the initiatives were started in 2021.

In a collaborative effort between trauma nurses, physicians, social workers, violence intervention experts and family partners, the hospital created a “nonjudgmental” script for doctors to follow as they ask patients about access to firearms, Clukies said.

During the screening process, pediatricians will ask parents or caretakers questions such as: Do you have access to a firearm where your child lives or plays? How is it stored? Is it stored unloaded or loaded?

“When I first started doing this, I would say, ‘Are there any guns in the home? Yes, or no?’ But I have found and learned from other experts that if you just say, ‘If there are any guns in the home, do you mind telling me how they’re secured?’ it takes away the judgment,” said Andrews, a pediatrician whose hospital, the Medical University of South Carolina, also offers free gun locks to patients.

An assortment of cable gun locks offered free of charge by the Medical University of South Carolina.

Families are asked about firearms in the “social history” phase of a patient visit, during which pediatricians will ask who lives in the home, what grade the child is in, what activities they engage in and where the child goes to school, according to Andrews. When parents indicate their firearms are not safely stored, like on the top of a shelf or in a nightstand drawer, Andrews said those are important opportunities for intervention and education about storage devices such as keypad lockboxes, fingerprint biometric safes and other types of lock systems.

It’s also important for pediatricians to understand the parents’ or caretakers’ motivation for owning a firearm to “inform the conversation about where they’re willing to meet you as far as storage goes,” she added.

Andrews and Clukies said they were pleasantly surprised by the willingness of families to discuss firearm safety, most of whom recognize it is an effort to protect their children.

“I expected more pushback than we received, which is attributed to us really focusing on how we properly word these questions,” Clukies said. “I think it’s because we turn it into a neutral conversation, and we focus on safety and prevention.”

Andrews added it is uncommon for medical schools or residencies to discuss gun violence prevention, which she says is due to the “politics around the issue.”

“Thankfully, that has evolved, and more and more pediatricians are realizing that we have to be an integral part of the solution to this problem,” Andrews said.

At the St. Louis Children’s Hospital, pediatricians followed up with patients who received a free gun lock in a research study roughly two months after they launched the initiative in the fall of 2021 to see if their storage practices changed.

The study found two-thirds of families reported using the gun lock provided to them by the hospital and there was a “statistically significant decrease” in those who didn’t store their firearms safely, as well as an increase in those who stored their firearms unloaded, according to Clukies.

But there is still much more work to be done in the medical community to fight the gun violence epidemic and scientific research on the issue is “woefully underfunded,” Andrews contended.

According to the American Public Health Association’s Benjamin, a multidisciplinary approach by policymakers, law enforcement and the medical community is essential to fostering a safer environment for children.

“Injury prevention is a core part of every physician’s job,” Benjamin said. “It’s clearly in our lane.”

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