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The day-care wars

Yet another salvo in the unending war between working mothers and opponents of day care was fired at a meeting of the Society for Research in Child Development in April. In the latest installment of an ongoing study of long-term results of child care, Jay Belsky, MD, scored one for the anti-day-care forces. According to Dr. Belsky and his colleagues, who are following more than 1,100 children in 10 cities in a variety of care settings, children who spend more than 30 hours a week in child care are "more demanding, more noncompliant, and more aggressive" than children who spend less time in the group care situation.

By the time they get to kindergarten, say their mothers and teachers, the 30-hour-plus children are the ones most likely to get into fights, bully other kids, and demand the lion's share of the teacher's attention. The correlation between long hours of care and behavioral difficulties held without regard to the socioeconomic status of families, the sensitivity of care mothers provided at home, or the type of care—although high-quality care offset the association to a slight extent.

The researchers did not offer an explanation for the correlation they found; the possibilities, according to researchers and outside commentators, include high stress levels in families where mothers work and a lack of training in emotional support among child-care providers. On a positive note, the study also found that time spent in day-care centers correlated with better language skills and better short-term memory.

In a different study, published in the May 9 issue of the Journal of the American Medical Association, researchers found positive benefits for poor children enrolled in a Chicago preschool program with a rigorous, uniform reading-readiness program. In this study, researchers at the University of Wisconsin have tracked 1,500 Chicago children since they were 5 years old, and continuing until age 20. Children who attended the Chicago preschool program, which requires parent participation and includes assistance in securing medical care and social services, were more likely to graduate from high school and less likely to be arrested than poor children who did not enroll.

Despite major differences in the way the two studies were conducted and in the outcomes being measured, both sides in the day-care dispute will readily find ammunition here for their cause. Bewildered working parents and their children will have to continue to take their chances.

The morning after

In February, the American Academy of Pediatrics joined a broad-based coalition of medical and women's groups to petition the Food and Drug Administration to support a switch to over-the-counter status for emergency contraceptive pills. The American College of Obstetricians and Gynecologists also issued a statement backing OTC status for a product that could reduce by half the number of unintended pregnancies in the United States each year.

For now, however, teens who need access to emergency contraception continue to require a doctor's prescription—and there's the rub. According to a survey published in the February issue of Pediatrics, few pediatricians even discuss emergency contraception with their adolescent patients. In a sample of 233 pediatricians surveyed in New York State, only 17% ever discussed emergency contraception, 75% were unable to identify any approved emergency pill regimen or inform patients of the necessary dosage and timing, and 68% said they were uncomfortable prescribing it. Apparently, adolescents aren't the only ones who need education in this area.

Curbing measles

The Drive to Curb Measles, a nationwide grassroots measles-awareness campaign, was launched May 10th in New York City. The program is sponsored by Merck Vaccine Division and supported by the National Partnership for Immunization (NPI), the National Association of Pediatric Nurse Associates and Practitioners (NAPNAP), the National Medical Association (NMA), Every Child by Two (ECBT), and the Partnership for Prevention (PfP).

Superhero "Vaccinator Woman" is now travelling across America in her "Measles Bug" (a white Volkswagen Beetle sporting red dots) to spread her message. Using skits and interactive presentations, she will remind parents and children that, to eliminate the disease, measles boosters are as important as the initial vaccination. Malls and other local meeting areas in major cities have been targeted for appearances. Schoolchildren in the city being visited will make up the cast. And a local pediatric nurse practitioner will be on hand to supply information and answer questions. First stops: Atlanta, Chicago, and San Francisco.

The hazards of summer

Summer vacation begins this month for the nation's schoolchildren, leaving them blessedly free to play ball, hang at the pool, or ride their bike. Despite rising gasoline prices, families will continue to drive to vacation spots across the nation. Kids will go to summer camp. Sounds idyllic.

But a new data analysis from the National Safe Kids Campaign puts a different twist on this time of year. Summertime (May through August), leaders of the campaign say, is the most dangerous time of the year—the season when nearly half of all injury-related childhood deaths occur. July is deadliest, accounting for 12% of childhood deaths.

Parents may be aware of the hazards summer poses, but few children are. In one poll, 70% of children said their parents worry too much about them being hurt in an accident, while only 38% knew that accidents were the No. 1 cause of death in their age group.

The AAP has a summer safety tipsheet that can help parents in your practice reduce summer's toll. Summer Safety Tips is available on the AAP Web site, www.aap.org , and includes advice on keeping children safe in the sun, at the pool, on their bikes, at the playground, at summer camp, and from biting insects and dogs.

A parting thought: If you believe that digging holes in the sand is a harmless beach activity for children, think again. According to Bradley A. Maron, a second-year medical student at Brown, there were seven recorded cases in the United States between 1997 and 2000 in which the digger disappeared into a hole that suddenly collapsed around him. Victims ranged in age from 8 to 21. Four died.

Eye On Washington

As the Bush administration moved past the 100-day mark, the Republican agenda remained on course. There were minor contretemps—House consideration of the budget had to be delayed until two pages of the document that went mysteriously missing could be found; the Senate parliamentarian had to be gotten rid of after making too many rulings that messed up the majority's timetable—but a budget deal that gives the administration most tax cuts that it wanted and makes up the shortfall by reducing expenditures for a variety of social programs won congressional approval by mid-May.

The budget resolution is a sort of grand plan for the future; specifics come later. One specific, known as "The Unborn Victims of Violence Act," has already been approved by the House. The bill would establish criminal penalties for harming a fetus during the commission of a crime against the mother. To many prochoice partisans, the bill is a thinly disguised attempt to secure legal recognition for the personhood of a fetus and thereby lend support to a future challenge of Roe v. Wade.

Another specific that may or may not get to the floor of either house is action on the MediKids Health Insurance Act of 2001. This proposal would enroll all newborns in one national health-care plan regardless of family income. MediKids would provide a comprehensive package of services, include a physician payment schedule comparable to Medicare, and cover children up to age 22 within five years. Funding would come from a combination of private insurance premiums, Medicaid, and the State Children's Insurance Program (SCHIP)—depending on families' choice and economic circumstances. MediKids is endorsed by the American Academy of Pediatrics, as is a companion proposal to allow states to cover children in SCHIP through 21 years of age and to offer 12-month continuous eligibility.

In other federal venues:

The National Institutes of Health has postponed the first meeting of a committee to review grant applications for research on human embryonic stem cells, at the behest of its parent agency, the Department of Health and Human Services.

The Environmental Protection Agency announced that it would put into effect a Clinton-era regulation requiring even small manufacturers to make public reports about their emission of lead into the air, water, and soil. The announcement came just as the results of a study by pediatrician Bruce Lanphear, MD, were reported, revealing an inverse relationship between children's IQ and lead levels lower than the currently accepted threshold of 10 µg/dL. For every 10 µg increase in lead, Lanphear and colleagues reported to the Pediatric Academic Societies meeting, children in the study showed an average 5.5% reduction in IQ.

The Bureau of the Census, analyzing data from last year's head count, found that the lives of children in metropolitan areas of the Midwest and Northeast are increasingly segregated by race. The 10 most segregated metropolitan areas are Detroit; Milwaukee; New York; Newark; Chicago; Cleveland; Miami; Cincinnati; Birmingham, Ala.; and St. Louis. The new census data also indicate that because of an influx of Hispanics and white flight to the suburbs, whites are in the minority in the largest cities.

The surgeon general unveiled a blueprint of goals and objectives to prevent suicide, the third leading cause of death among adolescents. The objectives include suicide-risk screening at the primary health-care level, increased insurance coverage for substance abuse and mental health, improved prevention education for health-care professionals, teachers, and key community gatekeepers, and a national violent death reporting system that includes suicide.

The Agency for Healthcare Research and Quality has developed an online resource—The Child Health Toolbox—to assist policy makers and children's advocates in assessing quality of care for children in such programs as Medicaid, SCHIP, and Title V maternal and child health programs. The toolbox can be found at www.ahrq.gov/chtoolbx .

The Federal Trade Commission released a report charging the music industry with continuing to produce explicitly violent material targeted at children and adolescents. According to the FTC, while the video and movie industries are making a positive effort to clean up their act, music recording companies lag behind. [To learn about the effects of violence in video games, see "How violent video games may violate children's health" in the May 2001 issue of Contemporary Pediatrics.]

CALENDAR

July 10-15 PREP: Infectious Disease, Chicago, Ill. For information on this and the following CME courses, go to the AAP Web site, www.aap.org .

July 23-25, Advances in Perinatal and Pediatric Nutrition, Stanford, Calif. For more information, call Symposia Medicus at 800-327-3161.

September 5-9, PREP: Adolescent Medicine, Chicago, Ill.

September 21-25, PREP the Course, Costa Mesa, Calif.

October 20-24, American Academy of Pediatrics National Conference and Exhibition, San Francisco.

November 1-4, Practical Pediatrics Continuing Education Course, Hamilton, Bermuda.

 

Updates. Contemporary Pediatrics 2001;6:10.