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By Charles H Geneslaw, MD
September 26, 2018
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OK, I may make some enemies in our community with what I am about to say, but here goes. There is a growing consensus among health professionals who care for children–including pediatricians like me, neurologists, radiologists, and others–that organized tackle football should be avoided in younger players. Children have larger heads and weaker neck muscles compared to adults, making collisions riskier. Moreover, younger, less experienced players more often utilize poorer tackling technique which also raises the risk threshold. While hard shell helmets do limit skull fractures, the evidence regarding concussion prevention is actually quite poor.

Of course, at these younger ages the brain is still developing. Researchers at Wake Forest Medical School recently followed children 8-13 yrs during football season with MRI scans. None of the boys had developed concussion symptoms during the study period, yet their scans showed subtle but clear disruptions of normal brain metabolism from pre to post season. Related studies done at Boston University Medical School looked at former NFL players and found that those who had started in the sport < 12 years old had a significantly higher incidence of “white matter” brain changes and more frequent difficulties with depression, cognitive impairment and behavioral problems in later life. There are additional studies reporting similar patterns in people playing other contact sports from an early age compared to those who did not.

So where does that leave us? Well, I am certainly NOT “anti-football”(well, maybe anti-NE Patriots, but anyway…). > 1 million boys play high school football. As I spend a good part of my time begging/yelling at my teen patients to get off their darn phones and to be more active, I strongly support this and all high school sports. Presently there are approximately 1.2 million US 9-12 year olds playing youth football (numbers have decreased in the last few years because of these concerns) and those kids sustain approximately 240-585 head hits each season. Note that youth football is a relatively recent phenomenon–when I was growing up in the 1960’s-70’s it hardly existed. Back then, tackle football was something we played on weekends in the park if we could collect enough guys to make 2 teams. There were no non-HS football “leagues”–tackle or otherwise– to speak of.

We need a new paradigm, and I believe this is where flag football comes in. The nonpartisan Aspen Institute recently issued a White Paper advocating for flag only < 14 years. Here in NJ, Assemblywoman Valerie Vainieri-Huttle (D-Bergen) has introduced a bill (A-3760) that would allow flag football but ban tackle statewide < 12 yrs. Given the above, the arguments against–that teaching younger boys proper tackling technique improves safety–are, at best, unconvincing. I believe this bill deserves serious consideration; personally (and professionally) I support it.

Don’t all yell at me at once– but send along questions and comments, and thanks for following.

September 11, 2018
Category: Uncategorized
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Our flu shots are in, so it’s time to get in and get vaccinated. I have discussed this before here, here and here.

The flu is not just a bad cold. Last year, 179 U.S. children died of influenza, which is the second most annual deaths ever (2009 was the worst). 80% of those deaths occurred in unimmunized children, and 49% of those deaths were in children who were previously healthy. The American Academy of Pediatrics recommends that everyone over age 6 months be immunized against the flu.

  • All healthcare and law enforcement personnel, and all who work with children should be immunized.
  • Pregnant women should be immunized. The immunity can pass across the placenta to the unborn baby and provide useful immunity in the first 6 months of life.
  • Children with egg allergy can safely receive flu shots. No special precautions are required.
  • Vaccination is safe for breastfeeding mothers and infants.
  • Children under age 3 should receive 2 doses of 0.25 cc vaccine at least 1 month apart in their first month immunized. In subsequent years, only one 0.25 cc dose is required less than 3 years.
  • Children 3-9 years should receive two doses of 0.5 cc at least 1 month apart the first year immunized. In subsequent years, they only need one 0.5 cc dose.
  • Above age 9, people required one dose 0.5 cc each year.
  • Injected, inactivated vaccine (“IIV4”) is the vaccine of choice. Note that since this is inactivated, there is no risk of infection from this shot.
  • Live, attenuated “quadrivalent” vaccine (“LA4”)–nasal spray–can be used in selected situations (greater than 2 years of age, no health problems). As this vaccine is less effective against H1N1, I have chosen to not stock this form.

As flu season is very unpredictable, AAP recommendations stress that the earlier the better to be immunized. If possible, by the end of October.

So give us a call.

Thanks for following.

By Charles H Geneslaw, MD
August 28, 2018
Category: Uncategorized
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With summer winding down and school revving up, let’s take a moment to review recent developments in adolescent health research.

First, the bad news(that we kind of already know): our kids don’t get enough sleep, and those practices extend far into their overall wellbeing. British researchers report a strong correlation between poor sleep and weight problems. You can see the study here.

I have written about the HPV vaccine before, and strongly recommend your child receive it. Recent studies in Australia and New Zealand show that the expected health benefits predicted from HPV immunization are beginning to occur there (vaccine rates are much higher in those countries), with lower rates of genital warts being reported. A recent US study did show that laws requiring HPV for school admission had no effect on adolescent sexual behavior. Teens were no more likely to be sexually active after receiving it. This research backs up previous work done at Kaiser Permanente that demonstrated similar results. Again, I strongly urge parents to get their teens and “preteens”(10-12 yrs) immunized, maximizing the opportunity to provide protection prior to any exposure to the virus later in life. As I keep stressing–its a CANCER shot, not a sex shot.

Let’s end on a positive note. Long term studies conducted at the University of Michigan strongly suggest that teens are abstaining from alcohol, psychoactive drugs, and tobacco at a much higher rate compared to decades past–as much as 5x less! That’s great news!! The researchers did state that, as more states legalize the use of marijuana, this trend may change. I will not advocate pro or con on this public policy issue as it plays out in NJ here. But it is food for thought.

Send along questions or comments, and thanks for following

By Charles H Geneslaw, MD
August 14, 2018
Category: Uncategorized
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I’m surprised at myself–I’ve been at this blog for 4 years now and have not mentioned trampolines. Time to fix that.

(Please note that here we are not discussing trampolines utilized as part of a specific organized athletic discipline program, like diving or gymnastics–assuming an approved practice facility with properly maintained equipment and trained coaches and spotters)

I’ve discussed the danger of recreational trampoline use throughout my career, and for good reason, I think. According to the American Academy of Orthopedic Surgeons(AAOS), there are >250,000 trampoline injuries annually, approximately 186,000 of those <14 years of age. The smaller the child the greater the risk–48% of injuries <5 years of age are fractures or dislocations. 75% occur when multiple people use the apparatus simultaneously.

Recently the AAP revisited the trampoline safety issue due to now rapidly proliferating “trampoline parks”–from 3 nationwide a decade ago to now >800 such facilities. The industry is virtually unregulated. Please note: proprietors insist that, given the inherent risk of trampolines, they make every effort to insure their patrons’ safety and I take them at their word. Nevertheless, we note that annual ER visits from injuries at tramp parks have increased from 581 in 2010 to almost 7000 in 2014. The AAOS recommends that no child < 6 years should use a trampoline. We pediatricians are even tougher:AAP now says no children should use them recreationally, period.

Considering a trampoline in your yard? Please remember the following:

  • Single user at a time
  • Keep at ground level if possible
  • No summersaults, flips, or other “trick” maneuvers–most common cause of serious neck injuries
  • Active adult supervision (mere “presence” is insufficient)
  • Adequate protective padding and a safety net. Remember : the safety net does not replace adult supervision and does not prevent on-apparatus injuries.
  • Frequent safety inspection. Replace damaged, worn parts. If unavailable, the tramp should be discarded
  • This is key: MAKE SURE that your homeowner’s insurance covers trampoline liability. Many do not. Also be aware that you are responsible for any child on your trampoline whether you gave permission for its use or not. That’s right: if a neighbor sneaks into your gated yard without your knowledge or consent and injures himself on your trampoline then YOU are still responsible, even if you were not home at the time. The trampoline is an “attractive nuisance” in your possession on your property and the injured party is a child, so YOU are financially responsible for the injury, not him or his parents. Also be aware that if you fail to notify your carrier of the presence of a trampoline on your property then they might possibly use that information to cancel your policy even over an unrelated liability matter due to your failure to disclose.

My question: how many trampoline owners out there are following the above safety regimen?

My recommendation? As almost always, I follow the AAP: best to forget the whole thing. Its a health and financial catastrophe waiting to happen. Do you really need this head/heartache? Just ride a bike or have a catch with your kid instead!

By Charles H Geneslaw, MD
June 19, 2018
Category: Uncategorized
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Every parent lives in fear of burn injury to their child. Here is a good, fairly comprehensive list of safety measures. How many do you practice?

  1. Do not let cooking appliance electric cords hang off of counter.
  2. Do not leave hot beverages or foods unattended or near the edge of table.
  3. Keep hot beverages away from children and do not have a child sit in your lap if you are drinking a hot beverage.
  4. Teach older children how to safely remove hot food from microwave and stove top.
  5. Minimize use of stove front burners.
  6. When carrying hot food in kitchen make sure young children are not in your path.
  7. Test bath and shower water temp with your hand for 30 seconds before using.
  8. Never leave young children unattended in bath or shower.
  9. Adjust water heater to no higher than 120 degrees.
  10. Avoid leaving unattended pots on stove.
  11. Keep children away form fireplace and wood stove doors.
  12. Install smoke detectors on all floors of your home and test monthly. Ideally, they should be hard wired with battery back up.
  13. Replace smoke detector batteries at least annually. Keep a schedule.
  14. Practice home fire drills and make sure children know how to exit the house in the event of a fire and where to meet outdoors.
  15. Keep fire extinguishers in kitchen, furnace room, and by fireplace.
  16. Teach children to exit the house low to floor if their is smoke in the room.
  17. Obtain a safety ladder if your home has a second floor.
  18. Teach children to not use elevators to escape a fire.
  19. Teach children to “stop, drop, and roll” if clothing catches fire.
  20. Avoid smoking indoors.
  21. Minimize storage of flammable liquids, keep them away from child play areas or from potential ignition sources.
  22. Minimize extension cord use.
  23. Keep matches and lighters out of the reach of children.
  24. Avoid use of fireworks.

Thanks to Robert L Sheridan MD from Shiners Children’s Hospital of Boston Massachusetts who’s article ” Burn Care in Children” is the source of the above list.