Thiings To Consider Before Your Child Gets An X-ray

     There are times when a child needs an X-Ray but there are many more times when unnecessary X-rays are done. X-ray examinations cause exposure to radiation that accumulates over a child’s lifetime and causes an increased risk of cancer with every exposure. A child’s body is also more susceptible to the effects of radiation.

     Unnecessary X-ray studies are done for many reasons, but they are often done to confirm a diagnosis that can be made by physical examination alone. Often, the parents are the ones who insist on the study being done and the doctor complies because of the risk of a lawsuit. The child hits his head and may even have a mild concussion. The doctor can explain to the parents about the signs of an internal hemorrhage and instruct them on what to watch for but the parents often want a CAT scan “to be sure”. The doctor may not feel the CAT scan is necessary, but will get it to avoid “missing” a small hemorrhage. A CAT scan is now routinely done to diagnose appendicitis before any surgeon will agree to operate.  The frequent use of CAT scans in children is especially worrisome because CAT scans involve much higher doses of radiation than regular X-rays. Fluoroscopy also involves more radiation than standard X-rays and should only be done when absolutely necessary. Even with regular X-rays, doses of radiation designed for adults are often used when much lower doses would be sufficient for children.

     A doctor may get an X-ray of a fractured clavicle (collar bone) even though the history and physical exam clearly make the diagnosis and there is no treatment necessary. A doctor may make the diagnosis of pneumonia in a child who is not in any respiratory distress but feel an X-ray is necessary “to be sure”.  Again, with proper instruction on what symptoms to observe for, the X-ray doesn’t change either the diagnosis or the treatment.

     The FDA has recently asked manufacturers of imaging devices to create new machines designed specifically with children in mind. Radiology departments are developing protocols designed for children with smaller doses of radiation and limited areas of body exposure. Parents need to discuss the advantages and disadvantages of any X-ray with their doctor. They should always ask: “Is the result of the X-ray going to change the way we are going to treat the problem?”; “If we watch the child closely for any developing symptoms, can we hold off doing the X-ray as long as we agree to get it if the situation changes?” 

     An X-ray examination is simple and can be reassuring, but parents and physicians need to always consider the risk and ask if the study is necessary.

How To Tell When A Fever Is Dangerous

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     Each time there is a news report about a child who had a fever and rapidly progressed to death, all parents naturally become frightened. Some infectious diseases can move rapidly from mild to life-threatening. But there certain signs that parents can watch for to alert them when their child has a fever.

     Fever is the body's way of fighting infection. Fever itself is not dangerous and does not cause brain damage. The height of the fever does not tell you about the severity of the disease - even simple viral illness can cause a child to have high fevers. Viral illness can give an up-and-down fever for about three days. This fever is always higher at night. The child will feel poorly when the fever spikes, but the child should feel better when the fever goes down. The child who is acting progressively more ill – even after a fever-reducing agent is given and the fever goes down slightly – is a child parents should be concerned about. The child with a variable fever and mild symptoms of a viral illness such as sore throat or congestion is probably fine. The child with a more serious illness often has confusing symptoms that seem more severe than a typical cold or cough and the symptoms just keep getting worse. Fever in a child who has had a mild injury or cut but has pain out of proportion to the degree of injury should be investigated. So should fever with headache that is worse than any previous headache and continues to get worse even after taking pain-reliving medication.
     Any child whose symptoms continue to get worse needs to be examined right away, even if the child has been previously examined. Parents will frequently wait to have the child reexamined because the child was seen by a doctor and the parents were told the illness wasn’t serious. These parents will often say that they felt the child was sick but ignored their instincts because of that previous exam. A child who is getting worse or developing new symptoms needs to be reexamined even if he was seen earlier that same day.

     In a mild viral illness, daytime fever should resolve after three days even though the child may still have late-afternoon and night-time fevers for an additional night or two. If the daytime fever continues longer than three days, the child should be seen. Once the day-time temperature is gone, it does not return. If the day-time temperature ever goes away and then comes back again, the child needs to be examined.
     Finally, any child under one month of age who has a fever needs to be seen by their caregiver.

Taking Your Child's Temperature

     I’ve discussed fever in previous articles but there is a lot of ground to cover because fever is the most common reason that parents bring their children to the doctor. In this article, I’ll discuss the various ways used to determine a child’s temperature and when you should take a temperature.

     There is everything from forehead tape to rectal thermometers available for parents to take their child’s temperature. But all the methods usually start when the parent just feels the child and finds that the child feels warm. Studies of nurses and pediatricians have shown that it is impossible for anyone to accurately estimate the height of a child’s fever (101 verses 104) by feeling the forehead. However, feeling the forehead is an accurate way to tell whether a child has a fever or not.  If a parent feels a child and thinks “he’s warm” – the child probably has a fever.

     If your child feels warm, use any of the methods available to confirm that the child has a fever. As I have mentioned before, the actual temperature isn’t very important. Whether it is 101 or 104, doesn’t make much difference.  You will hear people say that the higher the temperature, the more serious the disease, but a child can have a temperature of 104 with a mild viral illness and he can have a temperature of 101 with meningitis, so you can’t rely on the height of the temperature to tell you how sick the child is. (see the article “How to tell when a fever is dangerous”) People will also say that the higher the temperature, the greater the risk of fever seizure or brain damage. This is also not true.  Fever (“febrile”) seizures occur at any temperature and trying to keep the fever down does not prevent fever seizures (see the “Fever Seizures” article). Fever, at any number, does not cause brain damage.

     The most accurate way to take the temperature is with a standard, old mercury thermometer but digital thermometers are also very accurate. The best place to take the temperature is in the rectum. Infants and toddlers get fever more often than older children, so, to take a rectal temperature in this age group, place the child’s legs between your legs facing sideways towards your leg. Bring your legs together to hold the child’s legs and bend the child’s chest and abdomen sideways over your leg.  Place your arm gently on the child’s back and the child’s butt will be up in the air and wiggle-free for as long as you want. Keep the mercury thermometer in the rectum for as couple of minutes. Keep the digital thermometer in the rectum for the time stated in the directions.

     Once you know that a child has a fever, you only need to follow the fever pattern. Forehead tapes, ear thermometers or about anything will allow you to do that. Remember, it is the fever pattern and how ill the child is acting that tells you how serious the illness is – not the number of the temperature.

Holding Kids Back In School

     There is a current fad fueled by a recent book that encourages parents to hold their children back from starting kindergarten if the child will be the “youngest in his class”. The reason given is that older children are more successful in both academics and athletics than their younger classmates. This is a fact: older children are able to comprehend more and they are bigger and more coordinated. Parents want to give their child an “edge” over the other kids by waiting an extra year to begin them in school.

     Decades ago, it was common practice to hold a child back a grade when his academic performance was deemed to be inferior to his classmates. The psychological problems created when a child saw his friends and classmates move ahead as he got left behind far outweighed any academic help the child received. Thankfully, this practice has been mostly abandoned.

     Almost every advantage gained by being the oldest child in your class can be matched by an equal-but-opposite disadvantage. Children are acutely aware of differences in themselves and other children. If a child is bigger than his classmates, he will be singled out – not necessarily in a good way. His athletic performance may be better, but athletic ability is a complex mixture of genetics, family culture and luck. The bigger child may end up just being bigger and suffering because of the difference. Parents who see their baseball-playing 6 year-old as a multimillion dollar-a-year future star are going to be disappointed. The older child may be more advanced academically but the boredom that results can lead to both acting out and dropping out. Being the last person in the class to drive may be a disadvantage, but being the first person in the class to drive certainly has its disadvantages, too.

     A child who has already started in a grade should never be held back.  If a pre-school child is born early in the year or after the school cut-off date, there is no problem. The best advice for parents whose child was born between June and September is to have as much information as possible about the local school and your child ‘s ability. Talk to the teacher who will be working with your child. What academic skills are necessary for success in that teacher’s class? What abilities do the most successful children entering that kindergarten have? Then ask yourself honestly if your child has those skills and abilities. If your child has those abilities, forget the younger/older, bigger/smaller debate and start the child on his way in school. Your love and support mean more to his success than the artificial “edge” of being older.

Diet Supplements and Performance-Enhancing Drugs

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     Young athletes frequently use both diet supplements and performance-enhancing drugs. Children are entering competitive sports at an earlier age, there is a greater emphasis on sports success and there is a social pressure on thinness in females and muscular development in males. In a study done in 2005, 8% of girls and 12% of boys reported using some type of product to improve appearance, gain muscle mass or improve strength. This article considers the effects and side effects of some of the more common supplements and performance-enhancing drugs.

            Creatine: Creatine is an organic acid that helps bring energy to all body cells, primarily muscle. It is used by athletes and bodybuilders. It has been proven to increase muscle mass and improve strength. Doses of 5 to 20 grams a day have not been found to cause side effects. The Mayo Clinic believes that creatine can cause asthma symptoms and recommends that people with allergy or asthma do not take it. It was felt that creatine can cause kidney and liver problems, but studies have not supported this.
            Carnitine: Carnitine is found in red meat and is often added to energy drinks with the thought that it will increase the metabolism of fats and increase energy levels. It has been suggested that carnitine increases the risk of heart disease.

            Steroids: Most of the steroids used by athletes are anabolic steroids that are synthetic derivatives of testosterone. They preserve muscle mass, prevent muscle breakdown and, when combined with strength training, increase muscle mass and strength. They also increase aggressiveness that causes athletes to push themselves harder. Adolescent acceptance of steroid use has decreased slightly with the focus of the media on professional athletes using them. Steroids have many adverse effects. They cause acne, tendon strains and ruptures, excess hair, breast shrinkage in girls and testicle shrinkage in boys, permanent breast enlargement in boys, baldness, increased blood pressure, depression, tumors and withdrawal symptoms. Because steroids have been proven to be so dangerous, newer drugs called steroid precursors have become more popular. These drugs are sold over the counter and have a huge market. They include androstenedione (“Andro”), androstenediol, norandrostenedione, norandrostenediol and DHEA.  These drugs are marketed saying that they increase testosterone but they don't work and, even though they have minimal desired effects, they still have many of the bad side effects of anabolic steroids.

            Protein: Health food stores have many forms of protein which can be added to the diet to increase muscle mass. These should be taken 2 hours before exercise or 1 hour after exercise. Like carbohydrates and fats, protein increases total caloric intake and increases weight. As long as the exercise that goes with the increased weight and muscle mass continues, the “muscle-building” effects continue. However, with age, that extra weight becomes more and more difficult to lose. We all are familiar with the guy who was a “big jock” in high school who, at age 30, is now just big – obese with a huge belly.

            Beta-alanine (“Beta”): This is an amino acid that causes weight gain and increased muscle mass. It also decreases fatigue and increases the total work that muscles can do.  If the dose taken is more than 20 mg per pound of body weight, nerve pain called paraesthesia can occur.

            Human Growth Hormone: This hormone is used to increase height in children who have growth hormone deficiency. When taken by normal people, it increases lean body mass and decreases fat. However, it can decrease exercise capability and cause joint pain and heart, liver and kidney disease.

            Erythropoietin (“EPO”): this hormone can increase the number of red blood cells in the blood stream and therefore give athletes more oxygen-carrying capacity which may improve prolonged athletic performance. However, the increased thickness of the blood can lead to dehydration, stroke and blood clots in the lung and brain.

            Stimulants: Drugs such as ephedrine and caffeine can decrease fatigue and both increase both mental and physical ability. Ephedra used to be a common additive in alternative medicines but was banned by the FDA in 2004 because it caused high blood pressure, altered heart rate, strokes and severe mental abnormalities. Caffeine is a common ingredient in many “power-boost” drinks sold everywhere (often as the ingredient Guarana). Because it helps to mask fatigue, it can help athletes continue in sports when the body needs to rest. It can cause abnormal heart rate and increased blood pressure. Some people who are very sensitive to caffeine report headaches, dizziness and nausea.

            Any drug that alters normal body mechanics or functioning must be used with caution. Even the vitamin and mineral supplements that are taken by most Americans can cause serious medical problems if taken in excess of the body’s requirements. Balanced diet, low saturated fat and low sugar intake with moderate exercise still appear to be the best means of creating and preserving health.