Tag Archives: Child

The benefits of delayed cord clamping: New evidence

Hold on a minute (or three)!

Hold on a minute (or three)!

Something about the cord clamping debate has troubled me for quite some time now. Long after early cord clamping (ECC) was shown to be of no benefit to either mother or baby, and in fact may harm the baby through loss of iron during a critical period of brain development, some in the obstetrics community wanted to see more evidence before endorsing delayed cord clamping (DCC) for healthy term babies. The pro-DCC evidence was theoretical, they claimed; before they agreed to wait a couple of extra minutes to clamp the cord, they wanted hard proof that DCC actually helps babies.

The logic behind this foot-dragging—“We’re not abandoning a pointless practice without a darned good reason,” more or lessescapes me. After all, this isn’t like switching from one way of transplanting hearts to another. DCC doesn’t require new equipment or extensive training, and it’s not a budget-buster, either. You simply wait 2 or 3 minutes to clamp the cord, instead of doing it right at birth. It’s not brain surgery.

Well, there’s finally some solid evidence for the hard-to-convince, pro-ECC crowd. In a recently published randomized clinical trial, a Swedish research team led by Dr. Ola Andersson discovered that a group of healthy children who had been randomized to receive DCC (3 minutes after birth) had significantly better personal-social and fine-motor functioning at 4 years of age than did those who were randomized to receive ECC (< 10 seconds after birth). The effect was more marked in boys than in girls.

Andersson and colleagues checked the children’s iron stores at several points and found that, while DCC babies had more total body iron at 4 months of age, the ECC/DCC difference disappeared by 12 months of age. Looking at neurodevelopment, they found no differences between ECC and DCC babies at 12 months, but by 4 years the DCC children showed significant developmental advantages over the ECC group. It seems like an odd finding: how could a DCC-related “bump” in iron stores in early infancy cause developmental differences at 4 years but not at 12 months?

It likely comes down to an inadequate supply of iron at a critical time in neurodevelopment—those first few months, when many of the brain’s critical neural pathways are established. The resulting delays weren’t detectable with the kind of screening that can be done on a 12-month old, but by 4 years of age more extensive testing could pick it up.

The most important thing about this study is that it was a randomized clinical trial, a study design that can show that “a” is directly connected to “b”. The researchers in this case took two evenly matched groups of infants, randomly assigned them to different treatments (DCC or ECC), and then measured the relevant outcomes (iron stores + developmental differences). While there are some shortcomings to the study—the number of kids involved isn’t huge, for example—the findings fit with what’s currently known about the effects of iron deficiency in early childhood.

This study presents a solid argument in favor of DCC. And if that’s not enough to sway ECC advocates, what is?

More on iron metabolism (and why boys are affected more than girls) in upcoming posts…

Leave a comment

Filed under Cord clamping, Development, Iron deficiency

Bouncing for trouble

What goes up…

Anyone who speaks out against recreational trampoline use by kids quickly runs into one major obstacle: the darn things are a lot of fun. Bouncing high in the air, that stomach-flipping weightless sensation, the joy of conking heads with the other three kids boinging along with you…ah, childhood memories!

But for too many children those childhood memories include casts, crutches, and stitches–even hospital stays, surgery, and permanent neurologic damage. That’s why the American Academy of Pediatrics recently issued a statement strongly encouraging parents to keep their kids away from trampolines.

I know, I know… Just one more worry-wart, nanny-state, killjoy thing, you say. We all bounced on them, didn’t we? Why can’t the pediatricians just let kids be kids? They should all move to Canada…

Well, yes, I did occasionally play (injury-free) on a trampoline when I was a kid, and no one’s saying your children can’t. But before you set the kids a-boinging in the back yard, consider these facts:

  • How to break your ankle…

    More than 90,000 kids a year end up in doctors offices or ERs with trampoline injuries.

  • Of these, at least a third involve fractures or dislocations of the arms or legs, usually from falls.
  • More than 10,000 children suffer head and neck injuries, typically from falls or failed flips and somersaults.
  • About 4,000 kids a year end up with permanent neurologic damage.

And these:

  • Bad idea.

    Three-quarters of the injuries occur when more than one child is on the trampoline, especially when small children and larger children are on at the same time.

  • Children 6 years old or younger are 14 times more likely to be injured than larger kids in a shared-trampoline situation.

But what about all the safety equipment, like netting and padding and such? Doesn’t that protect them?

Not really.

The safety netting is often flimsy, poorly positioned, and kids often get hurt climbing on it. The pads over the frame and springs can deteriorate rapidly. And no one has shown that these make any difference at all–other than to give everyone a false sense of security.

And it is true of trampolines, like so many other modern products, that they don’t build ’em like they used to. The AAP report calls out the trampoline industry for making crummier units these days. Here’s one indication of worsening construction standards: the warranty on a new trampoline was 10 years in 1989. It’s five years today.

So, my advice: Ditch the trampoline. If parents absolutely can’t bear to part with it, adult supervision is critical. Set the unit up as close to the ground as possible, away from trees, fountains, family heirlooms, cliff edges, etc. Make a one-kid-at-a-time limit, and no flips or somersaults.

That’s a lot of supervision, and even then there are no guarantees…

* * *

Photo credits: Roxnstix, Sue Waters, and Pixabay.

Leave a comment

Filed under Safety

One family’s history

Gram Sloan in 1918. John Francis (left) died a month later in the Spanish flu epidemic.

Yesterday was my parent’s 65th wedding anniversary. I realized in talking with them over dinner that their family stories (and mine, too, of course) provide a pretty good snapshot of how children’s health has improved in the last century, at least on the infectious disease front.

Dad’s 93 now, born in 1919 during the waning days of the Woodrow Wilson administration. His mother (my Gram Sloan) experienced a lot of tragedy with her children. She gave birth to five babies, but only three survived to adulthood. My uncle John Francis died in the 1918 Spanish flu epidemic at the age of three, and Donald was 4 years old when he died of pneumonia in 1924. The striking thing about her experience is that it was basically the norm for families back then. In 1914, the year she married, about one in four children didn’t make it to their 5th birthdays. (I wrote an essay about John Francis for Notre Dame Magazine–link is here.)

Mom is 87 and, though she and her six siblings all survived to adulthood, her childhood was one long string of debilitating infections: whooping cough, diphtheria, scarlet fever, and polio (which left her with a weakened leg), to name a few. She even received the last rites of the Catholic Church once (for diphtheria), but defied her doctor’s dire predictions and pulled through.

Together Mom and Dad had seven babies. The first, my brother James, was born a few weeks early and died at two days of age from hyaline membrane disease (now called respiratory distress syndrome). The rest of us made it through childhood relatively unscathed–oh, we had measles, mumps, and chicken pox, like every other kid, but we were spared diphtheria, polio and the rest. (Mom dragged us to the pediatrician’s office, kicking and wailing no doubt, the day the polio vaccine arrived.)

And now my kids–they’re healthy and in their twenties. Both had chicken pox, the odd ear infection, and some wheezing, but basically had pretty healthy childhoods. The same is true for all of their cousins, a few of whom now have their own healthy children. If this were a century ago, I would probably be talking about a few of them in the past tense.

My career as a pediatrician is another indicator of how things have improved. I’ll just mention what I call the “spinal tap index.” When I started in the early 80s, I did about one spinal tap a week to diagnose or rule out meningitis. Then came the vaccines for Hib, pneumococcus, and meningococcus, and with them a huge decrease in cases of meningitis. It’s been more than a year since I did my last spinal tap.

Talk to your older relatives and friends–you’ll very likely find that they have similar stories. There is much to criticize in the current state of children’s health in the U.S., but on some fronts, particularly infectious diseases, the progress has been remarkable.

1 Comment

Filed under Infectious diseases